12 Flashcards by Elizabeth DeGroot

antibiotics for anaerobic coverage

metronidazole with amoxicillin, amoxicillin-clavulanate (augmentin), clindamycin

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rapid cessation of steroid use may result in ?

central adrenal insufficiency

low ACTH, low cortisol, normal aldosterone (RAAS controlled)

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how to interpret hazard ratio

hazard ratio less than 1 indicates an event is more likely to occur in the control group
greater than 1 more likely to occur in the treatment group

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thyrotoxicosis with decreased RAIU

painless (silent) thyroiditis
subacute (de Quervain) thyroiditis
amiodarone induced tyroiditis
excessive synthroid
struma ovarii
iodine-induced
thyroid cancer mets

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painless (silent) thyroiditis vs de Quervain thyroiditis

painless: variant of Hashimoto (TPO Abs) but has hyperthyroid phase, may be tx with propranolol
de Quervain: painful, tender goiter, preceded by URI, tx with NSAIDs, prednisone

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inflammatory arthritis, splenomegaly, neutropenia

Felty syndrome, common in RA pts

^risk vasculitis, skin ulcers

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skin lesions in Hep C+ pt

porphyria cutanea tarda
other conditions assoc. with PCT: HIV, ^^etOH consumption, estrogen use, smoking
PCT tx: phlebotomy or hydroxychloroquine

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features of mixed cryoglobulinemia

palpable purpura, arthralgias, GN

due to imm-complex deposition in small BVs, leading to endothelia injury and end-organ damage

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heart manifestations of acromegaly

cardiomegaly, HTN, HF, mitral/aortic regurg

myocardial hypertrophy, diastolic dysfunciton, LF dilation, global hypokinesis

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Pancoast tumor presentation

(superior pulmonary sulcus tumor)
shoulder pain*
Horner syndrome
C8-T2 neuro involvement (weakness/atrophy of intrinsic hand muscles, pain/paresth. of digits 4, 5, medial arm
supraclavicular LN enlargement, weight loss

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also give ? with TMP-SMX in HIV+ pts with PCP if PaO2 less than 70 or A-a gradient more than 35

corticosteroids

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incidentally discovered cystic hepatic lesion with eggshell calcification, think ?

hydatid cyst (Echinococcus granulosus)
dogs are definitive hosts
tx: sx resection with albendazole, risk of anaphylactic shock with aspiration
in contrast, simple hepatic cysts do not have calcification

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the probability of being free of a disease if the test is negative equals ?

the negative predictive value (NPV)
true negatives / all negatives
the NPV varies with pre test probability
if PTP is high, then NPV is LOW, if PTP is low, NPV is high

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what organisms involved in a SINGLE brain abscess from direct extension from OM, sinusitis or dental infection

Viridans strep or S. aureus
s/s: Ha, fever, neuro deficits, seizure
single ring-enhancing lesion with central necrosis on imaging

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brain imaging:
Rhizopus
toxo
primary CNS neoplasm
Nocardia
HSV encephalitis

Rhizopus: highly destructive necrosis
Toxo: MULTIPLE ring-enhancing lesions
primary CNS neoplasm: SINGLE ring-enhancing lesion
Nocardia: brain abscess with ring-enhancing lesion
HSV encephalitis: hypodense lesions in temporal lobe (no ring enhancement)

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situational syncope during micturition, defecation, cough is due to ?

alteration in autonomic response leading to cardioinhibitory, vasodepressor, or mixed response

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medications that can trigger acute angle-closure glaucoma

decongestants, antiemetics, anticholinergic drugs

sympathetics ^pressure, B-blockers HELP

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gold standard for acute angle-closure glaucoma diagnosis

gonioscopy

next is tonometry which measures IOP

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lead vs arsenic poisoning

both may have stocking glove neuropathy
arsenic also has skin changes (hypo/hyperpigmentation), hyperkeratosis), pancytopenia, hepatitis (^AST, ALT)
lead typically has GI complaints

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where do you get arsenic poisoning

how to treat

mining, pesticides, metalwork, working with antique pressure-treated wood preserved with arsenic
tx: chelation with demercaprol, DMSA

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how to antihistamines (i.e. chlorpheniramine (H1)) alleviate cough symptoms?

exhibit anti-inflammatory effects by blocking histamine release from mast cells and limiting the secretory response to inflammatory cytokines

skin infection with severe headache, bilateral periorbital edema, CN III, IV, V, VI deficits think ?

cavernous sinus thrombosis

may result from uncontrolled skin infection as the facial/opthalmic venous system is valveless

why does BP rise in hyperthyroidism?

increase in heart rate and contractility

SVR typically decreases but BP still rises

pt with pneumonia, hepatitis, gastroenteritis following solid organ transplant and no ppx, think ?

CMV
PCP would cause pneumonia but not other issues
ppx with TMP-SMX and valganciclovir

most common skin malignancy in pts on chronic immunosuppressive therapy

squamous cell carcinoma | BCC most common overall

CYP450 inhibitors (^warfarin's effect)

acetaminophen, NSAIDs, abx/antifungals (metro), amiodarone cimetidine (H2), cranberry juice Ginkgo, vitamin E Omeprazole, Thyroid hormone, SSRIs

H1 vs H2 receptor blockers

H1: 1st generation: diphenhydramine (Benadryl) 2nd generation: loratadine (Claritin) and fexofenadine (Allegra) -less sedation H2: found in stomach: famotidine (Pepcid) and ranitidine (Zantac)

CYP450 Inducers (decrease warfarin's effect)

``` CRAP GPS induce me to madness! Carbamazepine Rifampicin Alcohol (chronic) Phenytoin ``` Griseofulvin, Ginseng Phenobarbital, Pregnancy prevention (OCPs) Sulphonylureas, St. John's Wort

CYP450 inhibitors (^warfarin's effect) part II

Sodium Valproate Isoniazid Cimetidine (an H2 receptor blocker) Ketoconazole & fluconazole Fluoxetine Alcohol - acute consumption & cigarettes Cardiac failure and liver failure Erythromycin & clarithromycin (macrolide antibiotics) Sulphonamides (antibiotics) . Ciprofloxacin Omeprazole (a proton-pump inhibitor) Metronidazole (antibiotic effective against anaerobes)

SOB and bibasilar crackles in pt with aortic dissection, think ?

aortic valve insufficiency pericardial tamponade may occur with dissection but presents with hypotension, pulses paradoxes, ^JVP, cardiogenic shock with clear lung fields

erysipelas caused by what organism?

S. pyogenes "Pyo Pelas"

haptoglobin levels in hemolytic anemia

decreased haptoglobin binds free Hgb, so more Hbg in serum exceeds binding ability of haptoglobin, so decreasing level of haptoglobin

AMS, motor deficits, ataxia, with multiple non enhancing brain lesions with no mass effect (edema) on imaging in HIV+ pt with CD4 less than 200

Progressive multifocal leukoencephalopathy (JC virus reactivation)

contralateral pure sensory loss +/- transient hemiparesis, athetosis, ballistic movements, think ?

lacunar stroke of posterolateral thalamus (branches of PCA) +/- thalamic pain syndrome later (allodynia) disruptions of neighboring basal ganglia structures and corticospinal fibers in posterior limb of internal capsule

major cause of delayed morbidity/mortality in SAH | how to prevent?

vasospasm, prevent with nimodipine

if nonopioid analgesics are not effective for cancer-related pain, move on to ?

short-acting opioids | if requires frequent dosing or bedtime dose does not last through the night, add a long-acting opioid

risk with fentanyl patches

respiratory depression, use only in opioid-tolerant pts

stones less than ? typically pass spontaneously

5mm

lithium toxicity, think ?

tremor, hyperreflexia, ataxia, seizures

horizontal nystagmus, cerebellar ataxia, confusion, think OD with ?

phenytoin

slurred speech, unsteady gait, drowsiness | BUT lack of severe respiratory depression and lack of pupillary constriction, think OD on ?

benzos

neutropenic is PMNs less than

1500

best treatment for chemo-induced n/v

serotonin (5HT) antagonists | zofran (ondansetron)

most common adverse reaction occurring within 1-6 hours of blood transfusion

febrile nonhemolytic transfusion reaction small amounts of residual plasma +/- leukocyte debris may remain in red cell concentrate which release cytokines in storage may cause fever, chills, malaise, without hemolysis

worrisome finding in acute asthma exacerbation

normal or elevated PaCO2 (should be low due to hyperventilation) implies impending respiratory failure

how often to get mammograms

every 2 years from 50-74

when to do lipid panel

men starting at 35, women at 45 | every 5 years

when to do pap smears

age 21-65 every 3 years

thyroid storm may be triggered by

surgery, trauma, childbirth, infection, iodine load (CT scan)

cardiac manifestations of sarcoidosis

infiltration of noncaseating granulomas leases to surrounding inflammation and can result in conduction defects (complete AV block*) restrictive or dilated cardiomyopathy, valvular dysfunction, HF sudden cardiac death from complete AV block or ventricular arrhythmia

concentric vs eccentric cardiac hypertrophy

concentric: chronic pressure overload (aortic stenosis or HTN) eccentric: chronic volume overload (valve regurgitation)