1 Flashcards
café au lait spots with smooth borders café au lait spots with irregular borders
neurofibromatosis I - freckling, check eyes Mccune-albright: fibrous dysplasia + precocious puberty neurofibromatosis II- no cafe au lait, check ears
Overlapping confidence intervals
there may not be statistically significant difference
NSTEMI treatment
Aspirin, Plavix, atorvastatin, heparin drip, metoprolol
Hereditary hemochromatosis
arthropathy (2nd and 3rd MCP joints, calcium pyrophosphate- positively birefringent rhomboids, not improved with phlebotomy) +hepatomegaly+diabetes
Toxic megacolon treatment
NGT decompression, antibiotics, steroids if IBD, not c. diff
TP FP FN TN
PPV = TP/ (TP+FP) NPV= TN/ (TN+FN) Sensitivity= TP / (TP+FN) Specificity= TN/ (TN+FP)
Ptosis and miosis with unilateral headache
Carotid artery dissection
Perforated ulcer Renal colic vs peritonitis
IV PPI, abx, fluids Writhe in pain vs motionless
C. diff treatment
Severe: WBC >15k, cr 1.5x baseline, albumin <3-vanc Severe+ileus: vanc+ IV flagyl Mild/moderate: PO flagyl
Continue antidepressants for 1-3 years in
chronic, severe, recurrent depression
Restless legs syndrome lab treatment
ferritin, supplement if <75 pramipexole/ropirinole/gabapentin
Oropharngeal dysphagia
difficulty initiating, drooling, aspiration, coughing do nasopharyngeal laryngoscopy
Tight glycemic control effect
decreases microvascular complications-nephropathy, retinopathy
Abdominal pain nonproportional to exam
mesenteric ischemia
C. diff treatment prevention of diarrhea
14 days of flagyl, 14 days of flagyl, then vanc minimize antibiotics, PPIs *prevention of MRSA-chlorhexidine bathing
Most common cause of hereditary thrombophilia
Factor V leiden
Onychomycosis diagnosis treatment
KOH prep terbinafine (hepatotoxicity), itraconazole
Varices treatment
Band ligation with surveillance and rebanding prn, Propanolol, nodalol (nonselective beta blockers)
NAAT
chlamydia and gonorrhea, first prenatal visit, repeat in 3rd trimester. complications: PPROM, preterm labor, postpartum endometritis
Spinal TB Health care workers post exposure
Pott disease If PPD initially negative, retest in 8-10 weeks
Chest pain and neuro symptoms in cocaine ingestion
Aortic dissection-CTA, MRA, TEE
Plantar warts
HPV, salicylic acid and tape/liquid nitrogen/topical imiquimod, scrape
Anti epileptics in pregnancy
Change 6 months before conception. High dose folic acid, AFP testing and u/s
SLE treatment
Prednisone, hydroxychloroquine Cyclophosphamide (if vasculitis, CNS, nephritis)
Absent cremasteric reflex
Testicular torsion *Epididymitis-increased blood flow on Doppler, pain relief with scrotal elevation*
FFP
When INR>2, vitamin k deficiency
Dengue fever Typhoid fever
Break bone fever, retroorbital pain, thrombocytopenia, petechiae—->shock rising fever, chills, abdominal pain, rose spots (salmon coloured macules)—->intestinal perf *leptospirosis-conjunctival suffusion—>jaundice and renal failure
Saw palmetto for treatment of Garlic St. John’s wort Glucosamine, chondroitin
BPH–(side effect: bleeding) HLD–bleeding Depression–GI distress, photosensitivity, fatigue OA *ephedra can cause MIs
Intention to treat analysis preserves
randomization despite dropout and crossover *Type II error-failure to reject a false hypothesis, dependent on power of study
Drug induced pancreatitis
thiazide, loop diuretics, immunosuppressive drugs, analgesics, AEDs, HIV
Internal validity External validity
Are you measuring what you think you are? Applicability
SSRI side effects usually
go away, continue
EHEC, ESCS Tests
E. coli, Shigella, Campylocater, Salmonella- bloody diarrhea. Do not treat e. coli with abx-HUS. fecal leukocytes, stool culture, shiga toxin
Oliguria ff hypotension Drug-induced AIN Pre-renal
ATN-FeNa>2%, does not respond to fluids 3-5 days after abx, eosinophils BUN/creatinine ratio >20
New onset afib Calculating HR on ECG
BB/CCB (verapamil, dilt) QRSs x6
Relative risk
Exposed/ Unexposed
refractory diverticulitis
abscess-get CT *f/u colonoscopy, elective partial colectomy*
Cocaine related chest pain
Benzos, nitroglycerin. Phentolamine. No beta blockers
Newborn weight
Lose 10% in first few days, surpass birth weight at 2 weeks
Temporal headaches + weight loss
Temporal arteritis
Primary biliary cholangitis Treatment Wilson’s
Elevated alk phos, fatigue, pruritus, xanthelasma, AMA antibodies, osteoporosis ursodeoxycholic acid neuropsychiatric, low serum ceruloplasmin
Diabetic neuropathy management
TCAs, duloxetine, pregabalin
Recurrent pneumonia in the same spot, responsive to abx
Endobronchial obstruction
SLE antibodies Sjogren’s CREST (scleroderma)
Anti-dsDNA, Anti-Smith most specific Anti-Ro/SSA Anti-centromere
Congenital rubella
Hearing loss, cataracts, PDA, maculopapular rash (head to feet) supportive care
GBS prophylaxis (penicillin) if status unknown
ROM >18 hours/ febrile/ preterm
Folate deficiency drugs
Methotrexate, phenytoin, trimethoprim -block conversion of folic acid to folinic acid Give folinic acid (leucovorin)
Compression fracture management
surgery
Steroid ulcer ppx
Misoprostol can be used
Hypercalcemia 2/2 granulomatous disorder (sarcoid, TB) Drug induced hypercalcemia
Production of extrarenal Vitamin D Thiazides, lithium tx: bisphosphonates
MODY
hyperglycemia without ketones, family history
Testing multiple endpoints
increases type 1 error
Vibrio treatment
marine environments in liver, diabetic, chronic medical conditions, rapidly progresses to hemorrhagic bullae cellulitis IV ceftriaxone and doxy
Psychogenic vs metabolic(true) coma
Presence of caloric response (cold water in ear)
Cirrhosis+varices abc prophylaxis
Fluoroquinolone for 7-10 days
Cardiovascular disease risk equivalents
DM, CKD, atherosclerosis
Hyperthyroidism in pregnancy Treatment
Measure total T4, not free T4 Subclinical hyperthyroidism is normal if symptomatic (clinical)-PTU in first trimester, then methimazole
Splenic vein thrombosis 2/2 results in treatment
Pancreatitis/ pancreatic cancer gastric varices, left sided portal htn, splenomegaly splenectomy
Sjogren syndrome
Sicca (dry eyes), dry mouth (white patches-oral candida)
TPN refeeding syndrome
Monitor phosphorus
Posterior urethral valve
Bilateral hydronephrosis + dilated, thickened, palpable bladder+ oligohydramnios——> Potter sequence (pulmonary hypoplasia, flattened facies) Dx: voiding cystourethrogram Tx: foley then ablation
Gout diagnosis Treatment
arthrocentesis- negatively birefringent, needle-shaped, monosodium urate NSAIDs (not if CHF, PUD, anticoagulation, AKI/CKD), colchicine *no allopurinol in acute gout*
DMARDs for RA
erosions mtx, hydroxychloroquine, sulfasalazine, leflunomide, azathioprine
Net clinical benefit
Benefit -harm *CI which includes 1 is not statistically significant*
Acute hep B treatment % progression to chronic hep B
Close outpatient follow up if not in functional liver failure, clearance w/in 6 months children-90%, adults-<5%
CBT-exposure response therapy for CBT-dialectic behavior therapy for
OCD borderline
AVN treatment Diagnosis
Stage 1-2 (no femoral collapse)-core decompression Stage 4-THA MRI
Rheumatoid arthritis
clinical diagnosis, RF/anti-CCP (more specific) help NSAIDs, not steroids *lupus-more migratory, shorter morning stiffness*
Chronic Hep B diagnosis post exposure treatment
Hep B surface antigen IG + vaccine
Extrapyramidal symptoms causes treatment
Dystonia (muscle stiffness), akathisia, parkinsonism metoclopramide Benadryl/benztropine
Diabetic ulcer osteo
bone biopsy and culture if bone probe is negative, get MRI
Acute otitis media orgs AOM+Purulent conjunctivitis AOM+nonpurulent conjunctivitis Treatment
Strep pneumo/Nontypeable H. influenzae/ M. catarrh H. influenzae Adenovirus amoxicillin, amoxicillin-clavulanate if recurs
Acute painless vision loss
central retinal artery occlusion: pale with cherry red spot, cnt make distinctions like fingers, tx: ocular massage, acetazolamide, call ophtho central retinal vein occlusion: retinal hemorrhage and edema vitreous hemorrhage: dark streaks, elevated head *angle closure glaucoma-painful*
Discrete, circular, smooth hair loss Progressive frontal, temporal hair loss Moth-eaten, scarring hair loss
Alopecia areata-regrows but can also relapse, thought to be autoimmune-give intralesional/topical steroids Androgenetic alopecia Syphilis
upper esophageal lesion lower esophageal lesion
alcohol, smoking-squamous cell GERD/Barrett’s-adenocarcinoma
Ethylene glycol toxicity
Fomepizole-inhibits ADH *do not give with ethanol
foley candida
do not treat
FFP
When INR>2, vitamin k deficiency
ADHD diagnosis treatment
impairment in 2 settings behavioral therapy, if >6-can consider meds (obtain cardiac history and exam, weight and vital signs before) *can immediately switch to another without tapering*
Reactive arthritis
Post GI/GU infection, circinate balanitis, salmonella, chlamydia, synovial fluid-WBCs, culture negative Retest for chlamydia *Syphilis/LNV-lymphadenopathy*
Anti-D immune globulin administration
at 28 weeks in Rh D negative with negative anti-D antibody screen, repeat after delivery if baby is +
Seborrheic keratosis herald patch café au lait macules
stuck on pityriasis rosea neurofibromatosis
ADLs Homebound
nonskilled care, PT/OT/meds-skilled care use of assist devices/cnt leave without someone/medical condition
NSAIDs
ibuprofen, naproxen, indomethacin
Adverse events in medical patients
drugs, infections
Multiple linear regression Correlation 1 way analysis of variance, 2 sample t test multiple logistic regression
1 quantitative, 1 qualitative, other variables 2 quantitatives only >2 group means, 2 group means
Abdominal pain nonproportional to exam
mesenteric ischemia
Cauda equine/cord compression 2/2 trauma/malignancy Spinal epidural abscess treatment
steroids surgical decompression and drainage
Aspiration pneumonia Aspiration pneumonitis
clinda resp distress hours after aspiration event-no abx-supportive care
Ankylosing spondylitis diagnosis Monitoring Extraarticular manifestations
Back pain/stiffness >3 mos+ limited ROM of spine+ limited chest expansion, x ray x rays, ESR uveitis (acute pain, photophobia, blurry vision), AR, apical pulm fibrosis, IgA nephropathy, restrictive lung disease Exercise is good, most do well, same life expectancy, no disability
Graves treatment eyes meds side effects
methimazole preferred (PTU causes hepatotoxicity)-total t3 and free t4 4-6 weeks, then 2-3 months-normalize thyroid state before definitive tx give prednisone agranulocytosis
Lung cancer screening
55 years old, annual low dose CT *AAA-65 yo*
vertebrobasilar insufficiency cataplexy
labyrinth and brainstem-vertigo, dizziness, dysarthria, diplopia, numbness sudden, temporary loss of muscle
Reactive arthritis
post GI/GU infection
Traveler’s diarrhea
most commonly E.coli *rotavirus/norovirus-vomiting *giardia-fatty stools/ salmonella-fevers/campylobacter-pseudoappendicitis, bloody *sporidia-chronic in immunosuppressed/ cyclospora-prolonged, relapsing
Cough variant asthma
Coughing upon exercise, at night, forced expiration
Only give lasix
if volume overloaded
Inability to extend knee or raise leg
patellar tendon rupture-surgery
Glutamic acid decarboxylase antibody
pancreatic autoantibody
Febrile seizures increase risk of
recurrence and epilepsy
