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PANCE REVIEW 1
Terms in this set (721)
Typical ABG of Restrictive Pulmonary Disease (e.g. Sarcoidosis)
Respiratory Alkalosis, hypoxemia (low O2), and hypocapnia (low CO2)
Due to: increased stiffness of lung, hyperventilation, and reduced O2 diffusion with no outflow obstruction
Results of Pulmonary Function tests of Restrictive Pulmonary Disease (e.g. Sarcoidosis)
Reduced TLC, deceased Carbon monoxide diffusing capacity, FEV1/FVC normal
Results of Pulmonary Function tests of Obstructive Pulmonary disease (e.g. bronchitis, asthma)
Reduced TLC, Decreased FEV1/FVC
Types of Restrictive Lung diseases
Sarcoidosis, Idiopathic Pulmonary Fibrosis, Asbestosis, Siliciosis, Coal Miners Lung,
Causes of vitamin B12 deficiency?
Pernicious Anemia, Strict Vegan diet, Crohns disease
Macrocytic anemia - Either Folate or B12, what symptoms differ?
B12 - neurologic symptoms --> not seen in Folate
Peripheral Blood Smear findings In B12 Deficiency and Folate?
Macrocytosis and Hypersegmented Neutrophils
What serum level will be increased in someone with B12 deficiency?
MC vasculitis in children - typically follows an URI
S/S hematuria, palpaple purpura, arthritis, and abdominal pain
Red Blood Cell Casts
Side effects of niacin
Cutaneous flush, hyperglycemia, increase in Uric acid, hypotension
What differentiates idiopathic pulmonary fibrosis from chronic bronchitis?
Normal FEV1/FVC ratio in IPF, decreased in chronic bronchitis
What drug is contraindicated in acute heart failure?
Beta blockers-have negative inotropic effect, but they are indicated in chronic systolic heart failure
What are the medications of choice in those with chronic systolic heart failure?
Beta blockers, ace-i, loop diuretics
Left ventricular dilation does what to preload?
Effects of IV nitroglycerin
Lowers bp (decreases afterload), causes venodilation (reducing preload)
What drugs should not be given to a patient in systolic heart failure?
Nifedipine, verapamil, diltiazem
Causes of QT prolongation
Red blood cell casts
Pathognomonic for glomerulonephritis
Chronic Bronchitis-predominant patient presentation
percussion is resonant
auscultation - wheezes and coarse ronchi that change after cough
Emphysema-predominant patient presentation
tachypnea, accessory muscle use, diminished breath sounds, typically no ronchi
Pigmented granular "muddy" casts
Acute tubular necrosis
What nationality is at greater risk for prostate cancer
chronic atrophic gastritis with achlorhydria and failure to secrete intrinsic factor
Achlorhydria (no hydrochloric acid) in stomach
Seen in pernicious anemia - which causes secondary increase in gastrin levels (gastrin stimulates the release of HCL in stomach)
How to differentiate between Zollinger-Ellison syndrome AND Pernicious anemia if high gastrin levels are found -
Measurement of gastric PH - ph in ZE < PA
Cosyntropin stimulation test
Eosinophils are found in the nasal secretions of what disorders?
Allergic rhinitis AND nasal polyposis (eosinophils are typically seen in tissues affected by an allergic process)
Asthmatic Patient with nasal polyps should not take what?
NSAIDs or aspirin
What type of sprays are most effective agents against allergic rhinitis?
inhaled corticosteroid sprays
nasal mucosa is inflamed from overzealous use of sympathomimetic decongestants - counsel patients to not use decongestants more than 3 to 4 days in a row
Treatment of rhinitis medicamentosa?
avoidance of decongestants, intranasal corticosteroids, or anticholinergic agent - can try a short tapering dose of oral glucocorticoid
Bicuspid Aortic Valve is related to what other cardiac anomaly
coarctation of aorta
What congenital abnormalities are associated with aortic dissection?
Coarctation of aorta, bicuspid aortic valve (especially in pregnant women)
Endocarditis prophylaxis for dental, Upper respiratory, or oral prodcedures?
penicillin, penicillin allergic (clarithromycin, azithromycin, or cephlexin)
Endocarditis prophylaxis for gastro or GU procedures
ampicillin, amoxicillin, or vancomycin
What is the difference between Alk Phos and Gamma-glutamyl transpeptidase (GGTP)?
GGTP is only found in the liver, Alk phos is found in liver and bone - If GGTP is elevated think liver/billiary system
When controlling ventricular rate in atrial fibrillation, and patient suffers from COPD or claudication what are the drugs of choice?
Verapamil and Diltiazem (nondihydropyridine CCBs)
Elevated Alk Phos
Consider checking urinary hydroxyproline
Serum Ca+, Phos, GGTP normal
Those with atrial fibrillation and poor ventricular response (with rates greater than 100) may develop what?
What is the most common cause of maternal death globally?
How do post-partum hemorrhages present?
Persistent boggy, enlarged uterus with significant vaginal bleeding (>500cc vaginal birth, >1000cc C-section)
What is the most common cause of post-partum hemorrhage?
What is first line treatment of post-partum hemorrhage?
Uterine massage and uterotonic agents (oxytocin, carboprost, methylergonovine)
MOI Postaglandin analog, causing uterine contraction
Adverse effects: can cause bronchospasm - avoid in asthmatics
What are contraindications to methylergonovine?
Coronary artery disease and HTN (drug causes vasospasm)
Used in post-partum hemorrhage
What are some causes of low-output heart failure
dilated cardiomyopathy, chronic hypertension, valvular heart disease
What are some common causes of high-output heart failure?
Hyperthyrodism, Beriberi, Paget's disease, AV fistula, Severe anemia, and pregnancy
What is the MOST COMMON cause of low-output (decreases EF) heart failure?
ischemic heart disease
Acute onset of eye pain and vision loss?
Acute angle closure glaucoma
Physical exam findings of Acute angle closure glaucoma
Cornea hazy or steamy - dilated pupil not reactive to light
Treatment of Acute angle closure glaucoma?
Timolol (topical bb), apriclonidine (topical alpha agonist), pilocarpine (topical miotic)
OR IV acetazolamide or mannitol
most common cause of pneumo, rusty colored sputum, rigors, gram + paired lancets
alcohols, currant jelly sputum, bulging fissures
Staph Aureus pneumonia
IVDA, postinfluenza, elderly
Gram ++ cocci in clusters
H. influenzae pneumonia
COPD, gram - pleomorphic rods
cystic fibrosis, nursinging home resident, cyanosis
Health Care associated Pneumonia
Outpaitent, healthy pneumonias
macrolide of doxycyclikne
Outpatient, with comorbidity pneumonia
Respiratory tract fluroquinolone
Respiratory tract fluroquiolone
anti-pneumococcal Beta-lactam (ceftriaxone or cefotaxima) + azithromycin or respiratory tract fluroquinolone
Confusion Assessment Methoid
cognitive ability and intelligence test in children
What is the most common type of colorectal cancer?
marker for colorectal cancers
Most common type of prostate cancer
EEG - generalized 3Hz spike and wave pattern
Absense seizure (tx: ethosuximide)
Fundal Height @ 12 weeks
Fundal height @ 20 weeks
Fundal height @ 36 weeks
IUP visualized when beta HCG > 1500
IUP visualized when beta HCG > 4000
What is the first line medical treatment for Crohn's disease?
Mesalamine (ileitis) or sulfasalazine (ileocolitis/colitis)
ASCA position, p-ANCA negative
Painless rectal bleeding in a boy younger than 5 years?
How is diagnosis made for meckels diverticulum?
(99m technetium pertechnetate - meckels scan)
Most common congenital malformation of the GI tract
Chleating agent that binds iron
Acute Kidney Injury/Failure
-increase in creatinine >0.3 mg/dL over a 48 hour span
-a >50% increase in baseline creatinine
a decreased urinary output <0.5 ml/kg/hr for more than 6 hours
Who are at higher risk for contrast-induced acute kidney injury following IV contrast?
underlying chronic renal disease, CHF, and DM
What medication can be used to to reduce contrast-induced AKI along with IV hydration?
N-acetylcysteine, vasodilators, ascorbic acid, and theophylline and aminophylline
chelator used in arsenic, mercury and lead poisoning
agent used in the treatment of Wilson's disease
What is the MOST COMMON cause of neonatal respiratory distress
Respiratory distress syndrome
caused by surfactant deficiency, usually in premature infants younger than 32 weeks
CXR in respiratory distress syndrome
Bilateral, diffuse, "ground glass" appearance
congenital abnormality of the laryngeal cartilage - causes a congenital stridor, 4 to 6 weeks of age
Meconium aspiration syndrome
requires presence of meconium stained amniotic fluid or neonatal distress
CXR meconium aspiration?
air trapping, atelectasis
What is the treatment of choice of respiratory distress syndrome?
typically results from untreated or inadequately treated otitis media
Typical presentation acute mastoiditis?
post auricular erythema and tenderness, discharge from external auditory canal.
Diagnosis and treatment of acute mastoiditis
Tx: IV antibiotics
How does treatment of Acute mastoiditis differ from chronic?
Acute: requires IV abx and often an admission
Chronic: oral abx and ENT f/u
What is the treatment for cases of mastoiditis that are refractory to parenteral ABX?
surgical irrigation and debridement with possible mastoidectomy
Complications of acute mastoiditis
meningitis, encephalitis, sinus thrombosis, brain abscess, facial nerve palsy, and sepsis
ideal intrapartum glycemic target for patient with gestational diabetes?
fasting glucose < 95
Risk factors for Gestational Diabetes?
history of gestational diabetes, pregnancy weight >110% ideal BW, maternal age > 25, delivery of baby > 9 lbs, PCOS, current glucocorticoid use, hispanic americans, african americans, or Native american
When is screening for gestational diabetes?
24 to 28 weeks
1-hr 50g glucose challenge for Gestational diabetes?
>130 after an hour.....then complete 3-hour 100g tolerance test.
Diagnosis of gestational diabetes is made if 100g glucose challenge meets what criteria?
>180 @ 1 hr
>155 @ 2 hrs
>140 @ 3 hrs
What Hemoglobin A1C value is diagnostic of gestational diabetes?
What is the MOST COMMON cause of acute pancreatitis WORLDWIDE?
What are the components of Ranson's Criteria on admission?
Age, WBC, glucose, LDH, AST
ecchymosis of left flank
What enzyme is best to evaluate acute pancreatitis Lipase or Amylase
MOI of ibuprofen
Reversibly inhibits cyclooxygenase- 1 and 3 enzymes resulting in decreased formation of prostaglandin precursors
The risk of what is a black box warning for acetaminophen?
What is the most effective intervention to treat an acute ibuprofen overdose?
What is the leading cause of death in acute MI?
decreased CO and tissue hypoxia in the presence of sufficient intravascular volume
Present with hypotension, tachycardia, AMS, cool cyanotic extremities, faint peripheral pulses and oliguria
Systolic minus diastolic
normally 40 mg
Parvovirus-induced transient aplastic crisis is most likely to occur in patients with which disorder?
Sickle Cell anemia, thalassemia, or spherocytosis
prolonged PR interval, wide QRS complex, and peaked T waves
Treatment of hyperkalemia
Calcium gluconate, insulin, albuterol, kayexalate, bicarbonate
What kind of anal fissure is concerning for an underlying systemic illness?
(consider Crohns, HIV, leukemia, TB, or syphilis)
Anal Fissures MOST COMMONLY develop at what position?
What are some common causes of hypomagnesemia?
Malnutrition and alcoholism
Increased QT interval, dysrhythmias
Oculomotor dysfunction (nystagmus), cerebellar dysfunction, AMS
Wernicke Encephalopathy is a result of what?
If you're giving someone thiamine and insulin - which should be administered first?
Thiamine before glucose (can worsen Wernicke Syndrome)
Often seen in patients with Wernickes
Disorder of anterograde and retrograde amnesia
Dementia, Ataxia, urinary incontinence
Normal pressure hydrocephalus
Paresthesias, decreased proprioception, weakness, AMS
Yersiniosis (yersinia enterocolitica)
Can mimic appendicitis - ilececitis
What two gastrointestinal pathogens can mimic appendicitis
Yersinia enterocolitica AND campylobacter jejuni
ST-elevation MI evolution, first change seen on EKG?
Hyperacute T Wave
What occurs after Hyperacute T-waves, but before there is ST-elevation on EKG during an STEMI?
J point elevation
What vessel is responsible for the majority of inferior myocardial infarctions?
What is the MOST COMMON cause of tricuspid regurgitation?
Elevated right heart pressure
Blowing holosystolic murmur best heard at the left sternal border
Pansystolic murmur becomes louder during inspiration
Helps distinguish from mitral regurgitation
what is the most common cause of right heart failure?
left heart failure
What stage of Pertussis is the "whoop"?
Paroxysmal Stage (7 to 28 days)
Three stages of Pertussis?
Catarrhal (7 to 10 days)
Paroxysmal (7 to 28 days)
Convalesent (Several Months)
Catarrhal Stage of Whooping cough?
mild fever, cough, coryza, conunctivitis
Paroxysmal Stage of Whooping cough?
Spasmodic fits of coughing followed by inspiratory stridor "whoop"
Convalescent Stage of Whooping Cough
Decreasing frequency and severity of paroxysms
Treatment of Pertussis?
Macrolides (Azithromycin or erythromycin)
Infants, a staccato-like cough
barking cough that sounds like a sea
Prevention of pertussis?
DTap in Children < 7
Tdap in children > 7 and adults
High pitched, blowing and decrescendo murmur best heard at the left sternal border
pansystoic murmur best heard at the apex
Diastolic rumble heard over the left sternal border at the level of the 4th intercostal space - with ventricular thrill
variant of aortic regurgitation
best heard with bell at apex
low-pitched and rumbling
Most common cause of Acute Aortic regurgitation?
Most common cause of chronic aortic regurgitation?
Rheumatic heart disease
How does pulse pressures differ with acute and chronic aortic regurgitation?
de Musset sign
head bobbing with systole
Prominent nail pulsations
"singsong" murmur over femoral artery
Objective of treatment in aortic regurgitation
decrease after load
Hypertension and Diabetes?
Ace Inhibitors First line
HTN? ACEi first line agents in individuals with what?
DM, heart failure, CKD, and history of MI!
alpha blocker - not recommended for initial therapy
HTN and BPH
Most common adverse effect of the ACEi
BP Goals in those < 60 or diabetic?
BP goals for someone > 60
HTN in african americans?
thiazide or CCB
Postpartum depression treatment?
SSRI (sertraline) most commonly used
Most common food borne disease?
2nd most common food borne disease?
hx of eating poultry, meat, or eggs
-fever, bloody diarrhea, abd cramps
-common cause of osteomyelitis in children with sickle cell disease
in patients with an inferior STEMI the use of what is relatively contraindicated?
hypokalemia is often associated with what other electrolyte disoder?
Which bone fracture is most commonly involved in acute compartment syndrome?
Tibia (long bone fractures)
6 p's of compartment syndrome
Pain out of proportion to exam
Delta pressures > than what determines treatment of a fasciotomy in compartment syndrome?
Triptans (for migranes) are contraindicated in?
HTN or CV disease
Acute mitral regurgitation symptoms?
dyspnea, pulmonary edema, cardiogenic edema
Chronic Mitral regurgitation symptoms?
asymptomatic until CHF onset, S3
Acute Mitral Regurgitation treatment
nitroprussside, dobutamine, balloon pump, emergency surgery
Chronic Mitral Regurtitation treatment
Anticoagulation, CHF rx, valve replacement
Primary biliary cirrhosis
Treatment for acute symptoms of MS?
IV high dose corticosteroids
After MS diagnosis is made begin...
interferon beta or glatiramer
Spinal electric shock sensation with neck flexion
How is MS diagnosis made?
T2- weighted MRI
Bilateral internuclear ophthalmoplegia (eyes can't look at nose) is pathognomonic for what?
What medication is preferred outpatient treatment of HTN in pregnancy?
Heart Failure Staging/Classification: American Heart Association/American College of Cardiology staging
Stage A: high risk without symptoms/disease
Stage B: structural disease without sx
Stage C: structural disease + sx
Stage D: refractory heart failure
Heart Failure Staging/Classification:New York Heart Association classification
II: sx with ordinary activity
III: asymptomatic only at rest
IV: sx at rest
G6PD or alpha thalassemia (but it is microcytic)
What is the most common enzymatic deficiency in the humans?
G6PD can be triggered by?
infection, medications (anti-malarials, sulfonamides, nitrofurantoin), Fava beans
ALWAYS Doxycycline even in children, unlike lyme - can use amoxicillin
Sausage shaped mass in abdomen? Currant jelly? Target sign on US?
Most common cause of intestinal obstruction in infants 6 month - 36 months
Treatment of Intussusception?
Method of choice to diagnosis Pertussis?
B. Pertussis-specific polymerase chain reaction (PCR) by nasopharyngeal specimen
Gold standard for diagnosing pertussis?
Bacterial culture, should be used as a confirmatory test
What electrolytes are depleted in re-feeding syndrome?
Phosphate and magnesium
What cardiac abnormality is almost universally seen in patients with anorexia nervosa?
Treatment of enterocele
Treatment of a rectocele
Gram negative rods
Psuedomonas, E. coli, H. flu
Gram positive cocci in pairs
Small, obligate, intracellular bacterium
Gram positive cocci in clusters
Intracellular aerobic bacterium gram negative rods
Respiratory distress IgE and eosinophilia, large branching hyphae
Mold with NONbranching hyphae
Gram negative oxidase-positive comma (s-shaped) rods/bacillus
Acid fast rods
gram positive non-spore forming rods
dermatitis characterized by pruritic vesicles with "tapioca appearance" , often on palms or soles
Tx of dishydrotic ezcema
pruritic sharply demarcated, coin-shaped lesions most commonly seen on dorsum of hands and feet, extensor surfaces
Not used first line for treatment of depression due to side effects and potential toxicity in overdose cases
Peripheral buffy coat smear = morulae in the white blood cells + Splenomegaly
Widened Mediastinum on CXR
Aortic Dissection, Pulmonary Anthrax
Rib notching/3 sign
Coarctation of aorta
Variation of pulses between left and right?
Aortic dissection or Takayasu arteritis
Bitemporal heteronymous hemianopsia
Contralateral homonymous hemianopsia
Lesion @ optic tract or occipital lobe
Lesion @ Meyers Loop
Obstructive Lung disease are associated with...
increased lung volumes due to air trapping, everything else is decreased in empysema
Isoniazid: Side effects
Hepatitis (esp > 35yo) and peripheral neuropathy (administer with b6), and avoid tyramine containing foods
Rifampin: Side effects
thrombocytopnia, orange colored secretions, hepatitis, fevers, GI upset and hypersensitivity rxn
Pyrazinamide: Side effects
hepatitis, hyperuricemia, GI upset, arthritis, photosensitive rash
Ethambutol: Side effects
optic neuritis, peripheral neuropathy and GI upset
Streptomycin: Side effects
nephrotoxicity and ototoxicity
amyloidosis (MC cause of restrictive cardiomyopathy)
Diastolic collapse of ventricles
hypotension, JVD, muffled heart sounds
Becks triad (cardiac tamponade)
Myasthenia Gravis is associated with what other abnormality?
75% have thymoma gland abnormality (thymoma or hyperplasia)
Small Cell lung cancer frequently presents with what what other syndromes?
Paraneoplastic syndromes (e.g. Lambert-Eaton Myasthenic Syndrome)
Malignancy induced production of auto antibodies preventing PRE-synaptic release of acetylcholine, presents similarly to Myasthenia Gravis
Lambert-Eaton Myasthenic Syndrome
How does Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome differ in physical exam?
Both present with weakness, but Lambert-Eaton Myasthenic Syndrome IMPROVES with repeated use and have abnormal deep tendon reflexes
eczema, asthma, aspirin
bulls-eye appearance, associated with Lyme disease
painful, erythematous, inflammatory nodules on anterior shin
Erythema Nodosum (can be associated with sarcoidosis, estrogen exposure, TB or fungal infections)
Purple, polygonal, planar, pruritic and papular (with fine scales)
lichen planus (5Ps)
Beefy red rash with scalloped borders, seen in most, dark skin areas (axilla, groin, pendulous breasts)
Candida Esophagitis: Treatment
Budding yeast with hypae on KOH smear
Caspofungin (when to use)
in severe, life threatening infections or resistant candida infections (fungemia)
1st line topical treatment for candida infections
Metformin: Adverse Effects
macrocytic anemia, LACTIC ACIDOSIS, renal impairment, GI compaints metallic taste - Increaed risk for renal impairment when used with contrast dye
What if patient is on metformin and need MRI with contrast?
discontinue metformin use for 48 hours before AND after contrast is given
Meglitinide: Side Effects
Acarbose: Side Effects
hepatitis, GI symptoms
Canagliflozin: Side Effects
thrist, Abdominal pain and UTI
glyburide: Side Effects
hypoglycemia, GI upset, disulfram reactions, weight gain and cardiac dysrhythmias
Edema, proteinuria, and hyperlipidemia?
80% of children with nephrotic syndrome is due to?
minimal change Tx? prednisone
dry skin, dry mouth, pupillary dilation, and decreased breath sounds
anticholinergic effects (consider Tricyclic antidepressant overdose)
dry mouth, conjunctival erythema, narrow complex tachycardia and hypotension
pupil constriction, respiratory depression. bradycardia, hypotension, coma, N/V
hypocalcemia and hypomagnesemia
Chvostek sign and Trousseau sign
Anti double stranded DNA antibodies
young woman presenting with fever, joint pain and a rash worsened with sun exposure
Anti centromere antibodies
How do you differentiate between dermatomyositis and SLE?
SLE spares nasal labial folds - dermatomyositis does not spare the folds
Anti-smooth muscles antibodies
Anti endomysial AgA antibodies
vesicular rash most commonly seen on the extensor surfaces, neck, trunk, and scalp
Best to lower HDLs?
Best to lower LDL's
HMG-CoA reductase inhibitor (statin)
Rodent Vector, SW united states, can lead to cardiopulmonary affects and renal failure
SARS (severe acute respiratory syndrome)
Associated with small pox
Major depressive disorder and hypomania (no social impairment)
Major depressive disorder and hypermania (social impairment)
clumping of the red blood cells
autoimmune hemolytic anemia
causes increase in ESR
multiple myeloma, inflammatory d/o, connective tissue d/o, and malignancies
dullness to percussion, bronchial breath sounds, egophony
hyperresonnance to percussion on affected side with tracheal deviation
Resonance to percussion, vesicular breath sounds, normal fremitus
normal chest exam
dullness to percussion, decreased breath sounds, and decreased fremitus on affected side
hyperresonance on percussion, decreased breath sounds, decreased femitus on affected side
pneumothorax or hyperinflation (Eg emphysema)
painless vaginal bleeding, non-tender uterus
Maternal hypertension, severe abdominal pain, painful uterine contractions/bleeding, rigid uterus
tender, rigid uterus and abdominal pain - fevers, maternal tachycardia, leukocytosis, and confirmation of premature rupture of membranes
painless vaginal bleeding and fetal distress
anti-mitochodrial antibodies, jaundice, pruritus, and fatigue
primary biliary cirrhosis
anti-smooth muscle antibodies, elevated AST/ALT 5x normal
positive perinuclear anti-neutrophil cytoplasmic antibodies
P-ANCA, hx of IBD (UC), intra and extra hepatic biliary involvement
Primary Sclerosing cholangitis
Initial study of choice for suspected AAA
What is the definitive or gold standard for AAA?
fevers, chills, myalgias - red maculopapular rash that starts on the wrists and ankles, spreading to palms and soles
RMSF (rickettsia rickettsii)
erythema migrans, arthritis, neurologic and cardiac symptoms
Lyme disease (Borrelia Burgdorferi)
wood and dog ticks (dermacentor species)
Ixodes tick (deer tick)
Elevated cortisol level, no suppression on dexamethasone screening, but suppression on high dose dexamethasone
Cushing's disease (pituitary ACTH hypersecretion)
Elevated cortisol level, no suppression with screening or high dose dexamethasone, high ACTH production?
ectopic ACTH production (small cell lung cancer)
Adrenal Insufficiency: Treatment?
fludrocortisone replacement therapy
Elevated cortisol level, no suppression with screening or high dose dexamethasone, low ACTH production
corticosteroid use or adrenal tumor
Types of hemoglobin
Hemoglobin A (adult): 2 alpha, 2 beta chains
Hemoglobin F (fetal): 2 alpha 2 gamma chains
Hemoglobin A2: 2 alpha 2 delta chains
lack beta chains - decreases hemoglobin A sythensis - other kids are made in response F>A2
High % of homozygous Hemoglobin S, increased Hemoglobin F, and no Hemoglobin A
Sickle Cell Anermia
Multiple Sclerosis: Drug of Choice Acute Exacerbations?
IV high-dose corticosteroids
What drugs slow down and reduce frequency of relapse-remitting type of MS
IV glatiramer and beta-interferon
CXR findings: tapering of enlarged bronchi and bronchial wall thickening, "tram-track" apperance
Bronchiectasis (enlargement of the larger airways)
CXR findings: diffuse reticular opacities giving a "honeycombing" appearance
Idiopathic pulmonary fibrosis
What occurs if hyponatremia is corrected too rapidly?
central pontine myelinolysis
What occurs if hypernatremia is corrected too rapidly?
unsalvageable pregnancy, <20 weeks gestation, no products of conception expelled, cervical dilation >3 cm
unsalvageable pregnancy, no products of conception expelled, cervix is closed
unsalvageable pregnancy, some products of conception expelled, cervix is dilated, boggy uterus
pregnancy may be viable, with 1st trimester bleeding, closed cervix, and no products of conception expelled
headache, scalp tenderness, jaw claudication, fevers, and visual loss
Giant cell arteritis (temporal arteritis)
Giant cell arteritis (temporal arteritis): Treatment
high dose corticosteroids
Migraine: Abortive treatment
Ergo and Triptans
Migraine: Prophylactic treatment
Polymyalgia rheumatica: Treatment
Low dose corticosteroids
Synovitis and bursitis of proximal joints of shoulders and hip, and associated with temporal arteritis
What EKG finding is equivalent to ST elevations in myocardial injury?
left bundle branch block (v5, v6)
Deep S wave in lead I, isolated Q wave in lead III, inverted T wave in lead III - S1Q3T3
PPD positive finding in healthcare worker/prisoner at risk for exposure?
> 10mm induration
PPD positive finding in HIV infection
>/= 5mm induration
PPD positive finding in someone with no risk factors
MC cause of epididymitis?
Chlamydia, but often gonorrhea (so treat both - ceftriaxone and azithromycin
Levofloxacin management of choice for...
gram negative uropathogens
E.coli and H. flu
What exam findings differentiates Epididymitis and Testicular torsion
Positive Prehns sign and positive cremasteric reflex
primarily gram positive oraganisms and anaerobes
Chagas disease: Acute phase
Chagoma (unilateral periorbital edema)
Complications of Chagas Disease
toxic mega colon and esophagitis
MC cause of congestive heart failure in Latin america
Round worm infection, Transmitted by wild boar, bear, or pork, undercooked meat
Virus transmitted by mosquitos, biphasic fevers, rash, joint pain
Transmitted by flying squirrels and human body louse
Rash starts on trunk --> Ext. spares soles, palms, face
African sleeping sickness
Presents: painless chancre, region lymphadenopathy, daytime solemnness
small, raised, translucent, pearly white papule with central ulceration and rolled borders
basal cell carcinoma
MC skin cancer in US
Use of acetic acid for diagnosis?
What should be avoided in symptomatic Meniere's disease?
Caffeine (increases endolymphatic pressure)
MC cause of meningitis in those under the age of 18
Drug of choice for Neisseria meningitis?
IV Penicillin G
Neisseria meningitis: gram positive or negative?
Gram negative diplococci
Acute Choleycystitis (Right shoulder pain from phrenic nerve irritation)
Left shoulder pain (e.g. splenic bleeding)
periumbilical ecchymosis (MC: pancreatic hemorrhage)
Palpable, NON-tender gallbladder (associated with pancreatic cancer)
mass in the RUQ or epigastrium with absence of bowel in RLQ (associated with intussception)
MC cause of acute native valve infective endocarditis?
Staph Aureus (MRSA seen often in IV drug users)
Tx: Infective bacterial endocarditis?
Vancomycin (covers gram positive and MRSA)
TOC for routine empiric management of ACUTE native valve infective endocarditis?
IV nafcillin and gentamicin
TOC for routine SUBACUTE native valve infective endocarditis?
IV penicillin and gentamicin
What two increased lab values are indicative of cholestasis?
Increased ALT and GGT
Progressive jaundice, pruritis, RUQ pain, hepatomegaly
Primary sclerosing cholangitis
salivation, lacrimation, urination, digestion, defecation, and constriction of pupils
DOC: Adult with Idiopathic Thrombocytopenic Purpura
DOC: Children with Idiopathic Thrombocytopenia Purpura
IV Immunoglobulin (usually follows a viral infection) or observation
When is treatment indicated for severe thrombocytopenia?
Platelet count <10,000 mcL
Tx with fresh frozen plasma?
indicated with management in patients with coagulation factor
neonatal intestinal obstruction - failure of meconium passage >48 hrs in full term infant
projectile, non-bilious vomiting and an olive-shaped mass
persistant portion of the embryonic Vitteline duct (yolk sack)
Vomiting, abdominal pain, and passage of blood per rectum - currant jelly stools
MC area for volvulus?
Sigmoid and cecum
Triple therapy for H.Pylori eradication
PPI + amoxicillin 500mg + clarithromycin 5000 mg
Triple therapy for H.pylori eradication with penicillin allergy?
PPI + metronidazole 500mg + clarithromycin 5000 mg
Misoprostol (prostagladin analog)
can prevent ulcer recurrence in patients with aspirin or NSAID induced ulcers
Exaggerated T-cell response with formation of NONCASEATING granulomas
erythema nodosum, uveitis, pulmonary involvement, CXR with bilateral hilar lymphadenopathy
Production of CASEATING granulomas with central caseous necrosis in tissue
Small vessel vasculitis associated with granulomatous inflammation and necrosis
MC indication for hysterectomy?
Fever, eosinophilia, arthralgias and a maculopapular rash - White blood cell casts
Acute interstitial neprhitis
White blood cell casts in urine
Acute Interstitial nephritis (commonly caused by drugs)
epithelial cells casts or muddy brown casts in urine
acute tubular necrosis
red blood cell casts and dysmorphic red blood cell casts in urine
TOC Herpes simplex keratitis
dendritic lesions or lesion on tip of nose
Herpes simplex keratitis
What drug is helpful for the fatigue symptoms of MS?
patient older than 40 with hematuria and negative urine
Must r/o malignancy of urinary tract
First event of DVT prophylaxis?
heparin with warfarin for 6 to 12 months
Recurrent DVT or risk factor for DVT prophylaxis?
heparin with warfarin for >12 months
Common side effect of Lithium?
hypothyroidism and hyperparathyroidism
1st generation antipsyschotics (e.g. haldol) are associated with an increased incidence of what?
neuroleptic malginant hyperthermia
Clozapine side effects
Agranulocytosis, myocarditis, DM, seizures, NEMS, mild increases in prolactin levels, hyperglycemia, weight gain, hyperlipidemia
Negative Nikolsky's Sign
Positive Nikolsky's Sign
Toxic epidermal necrolysis, SJS, pemphigus vulgaris, Scalded skin syndrome
well demarcated borders, marked erythema and warmth, MC on face
bilateral upper and lower extremity weakness (UE>LE) with sensory and temperature loss in a "shawl like distribution
central cord syndrome (position, light touch and proprioception typically spared)
contralateral hemiparesis greater in the LE than the UE, urinary incontinence and personality changes
Anterior Cerebral artery infarct syndrome
Complete paralysis as well as sensory, temperature, and pain loss especially in LE.
Anterior cord syndrome
loss of proprioception and vibratory sense only
posterior cord syndrome
ipsilateral proprioception, vibratory, light touch and motor deficits with contralateral pain and temperature deficits
Brown SeQuard Syndrome
child with abdominal pain and constipation, varying neurologic symptoms, anemia, and metabolic acidosis
increased serum iron, decreased TIBC, increased Ferritin
Radiograph findings: Lead Poisoning
linear lead hyper densities at the metaphyseal plate
MC organism associated with cat bites
DOC: cat bite wounds
cause of cat scratch disease
Brucellosis - goats, sheep, cattle, and hogs (ingestion of unpasteurized milk and cheese)
India Ink detects?
candidal fungal infections
Cold agglutinin Test detects?
autoimmune hemolytic anemia, secondary disorders that cause it --> mycoplasma pneumonia and infectious mononucleosis
DOC: Pheochromocytoma induced HTN
Phenoxybenzamine (use prior to surgery to prevent hypertensive crisis prior to resection)
macular, erythematous, non-pruritic, annular rash with rounded , sharp demarcated edges
erythema marginatum (part of Jones criteria for rheumatic fever)
Differentiation between Erythema multiforme and erythema migraines?
Erythema multiforme are pruritic and have central clearing
AV nicking (venous compression at the artery-venous junction) on fundoscopic exam
Stage II hypertensive retinopathy
yellow spots with sharp margins that are circinate: Hard exudate pattern
fluffy gray-white spots on retina (soft exudates)
Stage III HTN retinopathy
primary amenorrhea, short stature, webbed neck, prominent ears, a broad chest with hypo plastic widely spaced nipples
XXY, gynecomastia, testicular atrophy
low set ears, flat facial features, up slanting palpebral fissures and single transverse palmar crease
alteration FMR1 gene, autism, MVP, tall stature, lax joints, a long narrow face, prominent forehead and chin, large ears, macroorchism
Fragile X syndrome
Mainstay treatment PCOS
combination oral contraception
elevated FSH: LH ratio, insulin resistance, increased androgen levels, amenorrhea, hirustism, and obesity
MC cause of transudate effusion?
leg pain and cyanosis worse with dependency
peripheral venous disease
Lamotrigine Side Effects
SJS, rash, headache diplopia
valproic acid side effects
pancreatitis, hepatotoxicity, GI disturbances, thrombocytopenia
phenobarbital side effects
permanent neurologic deficits if injected near peripheral nerves, depression, osteoporosis, and increased irritability
purple heliotrope rash around the eyelids and raised violaceous eruptions on knuckles (grotton papules)
DOC: Nephrogenic DI
Indomethacin and HCTZ
DOC: neurogenic DI
antibodies against ADAMTS13 leading to large von willebrand multimers causing platelet activation
pathophysiology of thrombotic thrombocytic purpura
pathogenic activation of the coagulation system causing micro thrombi and subsequent thrombocytopenia
Disseminated Intravascular Coagulation
Aplastic crisis in sickle patient can be precipitated by what infection?
area of bones that give the appearance of a fracture - due to vitamin D deficiency
Osteomalacia is due to what in adults?
Vitamin D deficiency, chronic renal disease (renal osteodystrophy)
"Salt and pepper" appearance of skull
Punched out lesions on skull
Cotton wool appearance on skull
Pathologic fractures and radiologic evidence of kyphosis?
Kaposi Sarcoma are caused by what infection?
Human herpes virus 8
nodulopapular, violaceous lesions on skin, gums, and other areas in immunosuppressed
diarrhea, constipation, and abdominal pain relieved by defection
abdominal pain that is worse with eating, intestinal angina, weight loss, Hx of HTN, CAD, Hyperlipidemia
Chronic mesenteric ischemia
used in acute angle glaucoma or to treat Sjrogens disease
What drugs can cause "red man syndrome" with rapid IV administration?
repetitive involuntary movements, mostly involving extremities and face (lip smacking, teeth grinding, pill rolling)
tardive dyskinesia (long-term dopamine blocking agents, e.g. haloperidol)
Intermittent spasms, trismus, protrusions of tongue, facial grimacing, difficulty speaking, hours to days after the initiation of dopamine-blocking anti-psychotics
acute dystonic reaction
L:S ratio < 2:1 in newborn
Indicates fetal lung immaturity (Tx: terbutualine or mg sulfate to delay delivery and corticosteroid for lung development)
Mild WBC (high % of PMN), negatively birefringent, needle shaped, crystals
Classic radiologic "rat bite" erosions on X-ray s
Mild WBC (high % PMN), positively birefringent rhomboid shaped crystals
WBC >59000 (high % PMN), cloudy fluid
dysphagia, esophageal webs, and atrophic glossitis in a patient with iron deficiency anemia
decreased serum iron, decreased ferritin, increased TIBC
iron deficiency anemia
Decerased serum iron, increased ferritin, decreased TIBC
anemia of chronic disease
Increased serum Iron, increased ferritin, decreased TIBC
Superior vena cava syndrome is most commonly caused by what?
Non-hodgkins Lymphoma, small cell lung cancer
dyspnea without anginal symptoms (but risk factors for MI)
hyperkeratotic lesions on palms and soles - Reactive arthritis
Infective Endocarditis (janeway, osler nodes, roth spots)
gray/white membranes on posterior pharynx
Diptheria (enlarged cervical lymphandenopathy)
gray/white membranes on posterior pharynx, bull neck, myocarditis
diptheria antitoxin + penicillin
Abdominal pain/flank pain, palpable flank mass, MVP, berry aneurysms
Polycystic Kidney Disease
primary manifestation of HSV1 in children
fever, anorexia, gingivitis and yellow grey vesicles on oral mucosa and tongue and lips
primary manifestation of HSV1 in adults
Vincent's angina/Trench Mouth
necrotizing ulcerative gingivitis - gum bleeding and pain, interdental papilla with ulcerative necrosis
linear plaques in esophagus
large superficial ulcers in esophagus
Columnar cells in esophagus
small deep ulcers in esophagus
corrugated rings in esophagus
mid-distal radial shaft fracture with dislocation of the DRUJ
Proximal ulnar shaft fracture with anterior radial head dislocation
isolated mid-shaft ulnar fracture
estrogen antagonist in breast and endometrium
MC thyroid malignancy
Papillary thyroid carcinoma
Adverse Effects of Haloperidol
dopamine blockade leads to increased prolactin levels --> galactorrhea, decreased libido, and amenorrhea
When would you use urine electrophoresis?
Multiple Myeloma - looks for bence-jones proteins
Organophosphate Poisoning Tx
Atropine and Pralidoxime
Diastolic dysfunction with marked dilation of both atria
global systolic dysfunction
dilated cardiomyopathy, systolic heart failure
thickened septal wall > 15mm
apical ballooning of the left ventricle
diastolic collapse of ventricles
Side effect of Efaviranz
Vivd dreams and neurologic disturbances - Treatment for HIV
Side Effect of Zidovudine
bone marrow suppression, myopathy, hepatomegaly, and pancreatitis
Side Effect of Indinavir (and other protease inhibitors)
N/V/D, lipodystrophy and renal stones
Crampy abdominal pain, N/V and constipation
small bowel obstruction
step ladder appearance on ABD xray
Small bowel obstruction
Early finding in small bowel obstructions
high-pitched, hyperactive bowel sounds
Post-partum/breast feeding, unilateral breast pain with localized tenderness, warmth and swelling
mastitis Tx (warm compress, breast pump, doxycycline)
BILATERAL breast enlargement often 2 to 3 days post-partum
Congestive mastitis - Tx: ice packs, tight fitting bra, and avoidance of breast stimulation
dysphagia, muffled "hot potato" voice, difficulty with oral secretions
swelling and erythema to the upper neck and chin, examination shows pus on the floor of mouth
boggy, nontender prostate
Most common organism in chronic prostatitis
Most common cause of hyper-coagulability?
Factor V Leiden mutation
(Protein C, Protein S, and Antithrombin III are less common)
Most common inherited cause of bleeding
von willebrand disease
What are the most common causes of myocarditis?
Enteroviruses (Echovirus and Coxsackie viruses)
Associated with trypanosoma cruzi - swelling at site of bite from Assassin bug
Associated with trypanosoma cruzi - ipsilateral periorbital swelling
HYPOTENSION WITH BRADYCARDIA, decreased pulmonary capillary wedge pressure
What is the hallmark of neurogenic shock?
hypotension with bradycardia
Hypotension with tachycardia, decreased pulmonary capillary wedge pressure
cool, clammy skin, decreased Cardiac output with increased pulmonary capillary wedge pressure?
cardiogenic or obstructive shock
daily symptoms with use of SABA, and night-time awakenings > 1 time a week. FEV 60 to 80% (abnormal)
Moderate Persistent Asthma
symptoms >2 days a week, use of SABA > 2 days a week, and night-time awakenings 3 to 4 times a month. FEV 80% (normal)
Mild Persistant Asthma
Symptoms throughout day, use of SABA several times a day, and nightly awakenings. FEV 60%
Severe persistant Asthma
symptoms less than or equal to twice daily and twice weekly. Normal FEV.
Hyperkalemia and Beta Blockers
Beta blockers can cause potassium to shift out of cells so it can worsen hyperkalemia (but beta-2 agonists can do opposite)
IV calcium gluconate
used in management of hyperkalemia when EKG changes or severe hyperkalemia
malignancy of a single clone of plasma cells that can lead to an increase in monoclonal antibody production
Basophilc Stippling of Red Blood Cells
lead poisoning, sideroblastic anemia, heavy metal poisoning, thalessemia
G6PD and Thalassemia
hyperchromic, sphere-shaped red blood cells
hereditary spherocytosis and autoimmune hemolytic anemia
small, dense basophilic inclusions in the red blood cells
Howell-Jolly Bodies - splenectomized patients and severe hemolytic anemia
Management of severe pain crisis in sickle cell disease, polycythemia vera, CM and some solid tumors
chelating agent used in iron overload states (e.g. hereditary hemochromatosis and thalassemia)
Gold Standard Pulmonary Embolism
local burning at site followed by blanching with a red halo around the ischemic center --> hemorrhagic bullae --> eschar formation
Brown recluse spider bite
red maculopapular rash first on wrists and the ankles --> spreads centrally over 2 to 3 days
rocky mountain spotted fever
SE of beta-blockers
fatigue, depression, impotence, masks symptoms of hypolycemia, hypotension, bradycardia, 2nd/3rd degree heart block, bronchospasms
bloody diarrhea in LLQ, smoking is protective, stovepipe sign on barium enema, inflammation of the mucosa and submucosa only
early infancy, projective, non-bilious vomiting, olive-shaped mass
vomiting, abdominal pain, passage of currant jelly stools
profund lethargy, loss of musclar tone, ingestion of spores in honey
Management of an ACUTE esophageal bleed (due to varices)
endoscopic ligation of the bleeding vessel
What is the prophylactic treatment of choice to prevent esophageal rebleed?
If an active bleed continues despite endoscopic or pharmacological treatment?
insertion of a triangular intrahepatic portosystemic shunt
altered sensorium associated with tactile, visual or auditory hallucinations with tremor (3 to 4 days)
delirium tremens (alcohol withdrawl)
autonomic dysfunction (tachycardia, blood pressure fluctuations, hyperthermia, hyperreflexia, myclonus, dilated pupils, agitation and a hyper active GI tract
Side Effects of Clozapine
MC agranulocytosis, myocarditis
Side Effects of Lithium
Increased thirts, DI, seizures, arrhythmias, hypercalcemia, hyperparathyroidism, hypothyroidism
Side Effects Aripiprazole
increased suicidal rate in children
Diabetes Insipidus: Decreased or Increased Urine osmolarity
Decreased urine osmolarity
Diabetes Insipidus: Hyponatremia or hypernatremia?
DECREASED urine osmolarity and INCREASED serum osmolarity with NO peripheral edema
Triad of hemolytic anemia, venous thrombosis of large vesselds, and pancytopenia?
paroxysmal nocturnal hemoglobinuria (associated with dark colored urine that is worse at night)
Ice Rink Sign on fluorescein staining
Contact Wearer with eye infection
cover for pseudomonas (ciprofloxacin)
Intrarticular distal radial fracture associated with dislocation of carpal bones
Distal radius fracture with ventral angular (apex dorsal), Fall on the hand with hyperflexion
Comminuted fracture of the base of the first metacarpal bones
1st line management for Eclampsia/Preeclampsia
After stabilizing patient with Eclampsia with magnesium sulfate, whats the next step?
Oxytocin and the prompt delivery of fetus
painless vaginal bleeding, uterine size/date discrepancies, an elevated bHCG for gestational age, "snowstorm" or "cluster of grapes" on US
Gestational trophoblastic disease (hydatifrom molar preganancy)
Gestational trophoblastic disease (hydatifrom molar preganancy) - Treatment
prompt removal of uterine contents with suction curettage
treatment of hyperosmolar hyperglycemia syndrome (HHS)
1st: Normal Saline
3rd: Once glucose levels get to 250 mg/dl, start 5% dextrose and 0.45% saline to prevent hypoglycemia
Side effects of Methimazole
Used to treat hypothyroidism -
Myelosuppression (agranulocytosis) and hepatotoxicity
Long term Treatment of Myasthenia Gravis
Pyridostigmine and neostigmine (acetylcholinesterase inhibitor)
used to diagnose myasthenia davis
Side Effects of Doxorubicin
dilated cardiomyopathy, bone marrow suppression, GI side effects and alopecia
Indications for Doxorubicin
AML, ALL and other solid tumors
When is carotid endarterectomy recommended?
when internal or common carotid stenosis is greater than 70%
Lactic acidosis, macrocytic anemia (decreased b12 uptake), Contrast induced kidney injury, diarrhea
Classic Side effects of metformin
Isolated left sided heart failure is characterized by what?
Increased pulmonary venous pressure due to fluid backing up into the lungs -->Pulmonary symptoms dominate
Periods of deep breathing alternating with periods of apnea
Irregular respirations - shallow breaths of equal depth with irregular periods of apnea
Deep rapid continuous respirations
Kussmaul's respiration --> result of metabolic acidosis
Lyme disease treatment
Neurologic and Cardiac disease as result of Lyme disease Treatment
Most common clinical manifestation of Q fever?
culture negative endocarditis
Q Fever (High-risk occupations include farming, veterinary medicine, and animal research
seen in Crohns, UC, RA (inflammatory dz); inflammatory nodule or pustule that becomes necrotic ulcer with purple undermined borders and purulent base
solitary, glistening, friable red nodule often seen after trauma
erythematous rash with circumoral pallor, "slapped cheek" appearance
erythema infectiosum (Fifths disease)
dusty violent or red purpuric lesions with vesicles or bullae in the center, target appearance - absence of mucosal involvement
Erythema multiforme Minor
dusty violent or red purpuric lesions with vesicles or bullae in the center, target appearance - involvement of >/ mucous membranes including oral, genital and ocular mucosa
Erythema multiforme Major
Begins with sore throat, myalgias and fevers- progresses to ulcerative lesions and blisters associated with epidermal detachment and skin (+)nikolsky's sign <10% of body
Steven Johnson Syndrome
Begins with sore throat, myalgias and fevers- progresses to ulcerative lesions and blisters associated with epidermal detachment and skin (+)nikolsky's sign >30% of body
Toxic epidermal necrolysis
Cervical Motion Tenderness (Hallmark of PID)
Toxic Shock Syndrome treatment
IV clindamycin + Oxacillin
tall stature, MVP, hyperextensible joints, long and narrow face, prominent chin and forehead, large ears, developmental issues, MACROorchidism
Fragile X Syndrome
47, XXY. gynecomastia, testicular atrophy, obese later in life, and difficulty with language comprehension
45, X. leads to gonadal dysgenesis and primary amenorrhea, short stature, webbed neck, prominent ears, and broad chest with hypoplastic, widely spaced nipples
Disorder of collagen, MVP, smooth and doughy skin, easy bruising, positive Metenier's sign - may develop arterial aneurysms
Auer Rods - linear intracellular inclusions
Smudge Cells- fragile, well differentiated WBC that smudge during presentation
Leukemia in a child
Monoclonal protein spike and Bence Jones proteins
Philadelphia Chromosome and strikingly elevated WBC counts
Hx or atherosclerosis, sudden unilateral vison loss, pale retina, cherry red macula
Central retinal artery occlusion
Cherry red macula
Central retinal artery occlusion
transient loss of vision in one eye - usually seen in those with atherosclerotic dz. Can last a few minutes to a few seconds
flashing lights with PROGRESSIVE visual loss (curtain or shade coming down on the visual fields), schaffer's sign
clumping of the pigment cells in the anterior vitreous chamber
Postive Schaffer's sign
Sudden onset of visual loss - extensive retinal hemorrhages "blood and thunder" appearance
Central retinal vein occlusion
Blood and thunder appearance
Central retinal vein occlusion
functional decline, hallucinations of bizarre delusions > 6 MONTHS with 1 month of acute symptoms
Shares symptoms of schizophrenia but < 6 months of symptoms
odd, eccentric behavior and patterns suggestive of schizoprenia with no psychosis or delusions
Schizotypical personality disorder
asterixis (flapping tremor) and fetor hepaticus (foul smelling breath from stool bacteria)
increased amylase and lipase
increased alk phos and GGT
decreased thiamine levels
thiamine deficiency (seen in alcoholics)
parasthesias, peripheral neuropathy, and reflex impairment
Triad of global confusion, ataxia, and ophthalmoplegia
parasthesias, gait abnormalities, memory loss (hyper-segmented neutrophils)
Vitamin B12 deficiency
Why use Buproprion over other SSRIs
less sexual dysfunction and GI effects
Neisseria (meningitis or gonorrhea)
gram negative diplococci
E. Coli or H. flu
gram negative rods
gram positive rods (tx: ampicillin)
gram positive cocci in pairs or chains
Factor IX (intrinsic pathway) - increase in PTT
G6PD causes of oxidative stress
infections, fava beans, meds (sulfa drugs, antimalarials, methylene blue, isoniazid, nitrofurantoin, aspirin, and dapsone)
episodic hemolytic anemia
Sphere-shaped RBCs and Coombs positive
Autoimmune hemolytic anemia
Sphere-shaped RBC's and Coombs negative
Diplopia, dry mouth, dysphagia, dysarthria, dysphonia, deceased muscle strength, dilated but fixed pupils
flu-like symptoms, cervical lymphandenopathy, pseudomembranes on posterior pharynx
Painful, diffuse, erythematous rash that may develop fluid-filled blisters and (+) Nikolskys sign. Desquamation of the palms and soles is common
Staphylococcal scalded skin syndrome
vesicular lesions on a reddened base with an erythematous haloes in the oral cavity followed by vesicular rash involving palms and soles
Hand Foot and Mouth syndrome
Microscopic polyangitis, UC, and pyoderma gangrenosum
Clindamycin classically is associated with what?
First line therapy of C-diff
pseudomembrane appearance of colon
Tx of IV Vancomycin
Gram positive organisms such as MRSA
2nd line therapy for c-diff
PO vancomycin (1st line if severe - toxic megacolon or severe disease)
hepatic vein thrombosis or hepatic vein occlusion
Acute onset of ascites, hepatomegaly, and RUQ pain, jaundice
Budd-Chiari syndrome is associated with what other diseases?
paraoxysmal nocturnal hemoglobinuria, hypercoagulable states, Oral contraceptive use, malignancies and pregnancy
Extremely high Alk Phos, fatigue, pruritis, jaundice, RUQ and hepatomegaly
Primary biliary cirrhosis
Kayser-Fleischer rings (corneal copper deposits)
loss of collagen in blood vessels, leading to hyperkeratosis, perifollicular hemorrhages and purpura
Vitamin C deficiency (scurvy)
Anything that makes the LV smaller (e.g. valsalva, standing), or increase contractility (exercise, positive inotropes like digoxin) increases insensity of what Murmur?
RBBB seen in V1 and V2, ST elevations in V1 through V3
Brugada Syndrome Treatment
cardioverter defibrillator to prevent sudden cardiac death
osborne J wave (elevated J point due to abnormal repolarization
broken heart syndrome
left ventricular apical ballooning
holosystolic murmur, best heard at the apex - accentuated when lying on left side and radiates to axilla
Mitral valve prolapse
What is the most common cause of mitral regurgitation?
Mitral valve prolapse
most common cause of mitral stenosis?
rheumatic heart disease
antibodies against the presynaptic calicum-gated channels that release acetylcholine - IMPROVES with muscles use. (unlike myasthenia gravis) common paraneoplastic syndrome of SCLC
dopamine depletion in the substantia nigra
antibodies against the post-synaptic acetylcholine receptor
destruction and necrosis of both upper and lower motor neurons with progressive motor degeneration and preserved sensory
amyotrophic lateral sclerosis (ALS)
prion-mediated degeneration of the brain
rapidly progessing dementia, marked gait abnormalities and myclonus
Acute COPD exacerbation treatment
anticholinergic + SABA (ipratropium + albuterol)
Tx of urge incontinence
oxybutynin (any anticholinergic) - reduces bladder contraction and reduce bladder overactivity
kidney stones >10mm, struvite stones, and staghorn calculi
treatment in myasthenia crisis?
plasmapheresis or IVIM
Intial management of Heparin induce thrombocytopenia
direct thrombin inhbitor (argatroban)
hyperthermia, headache, flushing, N/V, sweating, tachycardia, tremors, pupillary dilation and peripheral vasconstriction
pupillary constriction, respiratory depression, bradycardia, hypotension, coma, N/V
lethargy, prolonged reaction time, muscular incoordination and facial flushing
hyper or hypothyroid with thyroid pain and tenderness
rock-hard, painful fixed nodular thyroid
reidel's thyroiditis, anaplastic thyroid carcinoma
MOA: increased insulin sensitivity at peripheral receptor sites
SE: cardiotoxicity, CHF, hepatotoxicity, fractures
MOA: decreases absorption of carbs in GI tract
SE: hepatitis, diarrhea, abd pain, and flatulence
Staph Aureus, Group A beta hemolytic strep, honey-colored crusts
vesicles form large bullae and rupture leaving "varnish-like" crusts
erythematous, pruritic rash with development of papules, vesicles arranged commonly in LINEAR or STREAK-LIKE configurations
erythematous plaques and fine, white scales common in scalp, face, eyebrown, beard, nasolabial folds, chest and intertriginous regions of the groin
tx for tinea versicolor
selenium sulfide, ketoconazole, corticosteroids, sodium sulfacetamide
What is helpful in treating the tremor and rigidity in Parkinson's disease?
dry mouth, nausea, constipation, urinary retention, confusion and agitation
Side effects of anticholinergics (especially in the elderly)
Amantadine, levodopa, and selective MOA-i
help with manifestations of parkinson's disease
acute infective endocarditis
Staph Aureus, more common in IV drug users
Subacute infective endocarditis
strep viridans - More common etiology
What can improve pulmonary hypertension?
O2 most hours of the day
How often should lipid panels be preformed if no risk factors?
q 5 years
Past URI, female, non-blanchable purpura, decreased platelet count
ITP (1st: dexamethasone, 2nd: IVIG)
pancytopenia with circulating blasts
Acute lymphoblastic leukemia
Auer Rods, myeloid enzymes such as peroxidase
Acute myeloid leukemia
lymphadenopathy, hepatosplenomegaly, and isoloated lymphocytosis
Chronic lymphocytic leukemia
Side effects of Hydroxychloroquine
Dose dependent - retinal toxicity
Pancolitis - increased risk of malignancy
Complication of Ulcerative colitis
Patchy areas of hair loss with fine scale and no inflammation
20 to 50% of hair loss with large numbers of hairs with white bulbs after gentle tugging
several 1 to 4 cm oval patches of hair loss with smooth skin and short stubs of new hair
triangular frontal-temporal recession of hair
reduce glucose by delaying glucose absorption
glipizide (other sulfonylureas)
increased insulin secretion
lowers glucose by decreasing hepatic glucose production and increasing glucose utilization
decreases insulin resistance and increases glucose utilization
Rabies vaccine schedule
day seen, 3, 7, 14, 28 days
Tx of varicose veins
What things are associated with a poorer prognosis of schizophrenia
Insidious onset, slow rate of progression, low socio-economic status
What is associated with a better prognosis of schizophrenia?
onset of illness at age 20 or later
Left anterior descending artery supplies..
anterior free wall of the left ventricle and anterior 2/3 of the interventricular septum
Right Coronary artery supplies...
posterior portion of the heart and AV node
Left circumflex artery supplies...
posterolateral surface of the heart
Left marginal artery supplies...
left lateral wall of the heart
hypertension emergency treatment?
Hepatitis B immunization schedule
series of 3 shots (birth, 1 and 6 months later)
DTap immunization schedule
Start at 2 mos (2 mos and 4 mos)
Hepatitis A schedule
children 12-23 months old, followed by a second dose 6-18 months later
Drug of choice for arthralgias and fever in rheumatic fever?
Treatment of restless leg syndrome?
Nonergotamine dopamine agoists (pramipexole) or ropinrole
Atenolol most commonly interatcts with what drug?
catecholamine depleting drugs
Hydrochlorothazide most commonly interacts with what drug?
Lorazepam most commonly interacts with what drugs?
Proton pump inhibitors may decrease the excretion of what drug?
pancytopenia with decreased reticulocytes? purpura and petechia
Macrolides and some fluoroquinolones
May prolong QT interval (avoid in those with long QT syndrome)
bluish or purplish discoloration of vagina and cervix
Softening of the cervix, occurs by the second month of pregancy?
widening of the softened area of the isthmuson bimanual examination, occurs by the 6 to 8th week of pregancy?
Uterine body and cervix and can be easily flexed against one another
contraindication to exercise stress test
aortic stenosis due to increase chance of syncopal episode
Vasoactive substance that is injected to penis that cause a rigid erection if vascular system intact - if it doesnt elicit an erection, 2nd line arteriography
When to use tetanus immune globulin?
entire immunization is unknown or if the individual received less than the full initial series at childhood
When to use tetanus toxoid?
If you do not known when their most recent immunization status, if they had less than the three recommended doses or if it has been 5 years since last dose
chronic otitis media (recurrent infections)
Aphthous ulcers, linear or stellate ulcers, strictures, and segmental involvement with areas of normal-appearing mucosa adjacent to inflamed mucosa
5-ASA (mesalamine) and Sulfasalazine
renal calculus with increasing BUN (indicates obstruction)
Prednisone and Bells Palsy?
only beneficial if started within the first 5 days of symptoms
Stable patient, ectopic pregancy, empty uterus with B-Hcg >2000
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