14 JAN 2017 1634 IM Flashcards
what is the treatment for bacillay angiomatosis caused by bartonella infection?
doxycycline or erythrocmycin
history of a recent URT infection followed by sudden onset of cardiac failure in an otherwise healthy patient is suggestive of _______________ most likely secondary to __________________
- dilated cardiomyopathy
- acute viral myocarditis
viral myocarditis is most commonly seen following infection by what type of virus?
coxsackie B (also parvo B19, HHV 6, adenovirus, enterovirus)
what symptoms distinguish atypical pneumonia (e.g. Legionella) from CAP?
FIGAR
fever - high grade fever over 102.2
intersitial infiltrates - CXR shows interstitial infiltrates
GI - symptoms
ataxia - neuro symptoms (confusion, ataxia)
rales
what antibiotics are used to treat Legionella?
(ie need to cover gram negative)
- macrolides or fluoroquinolones
- fluoroquinolones are favored when illness is severe enough to warrant admission
what is the preferred first line drug for fibromyalgia? what are alternate options?
- amitriptyline (TCAs)
- SS/NRIs (duloxetine, milnacipran), pregabalin
what antibiotic is used for fight bites (hand laceration from teeth)?
(eikenella = gram negative)
augmentin (amoxicillin/clavulanate) (covers majority of virulent oral bacteria - gram pos and gram neg)
what are the side effects of hydralazine?
- salt and fluid retention
- peripheral edema
- palpitations
- orthostatic hypotension
- drug induced lupus
what is a hazard ratio?
ratio of an event rate occurring in the treatment group compared to an event rate occurring in the non-treatment group
what does a hazard ratio less than 1 mean? higher than 1?
- treatment group had a significantly lower event rate
- treatment group had a much higher event rate
what is oscillopsia?
sensation of objects moving around in the visual field when looking in any direction
what is the cause of Meniere disease? what is the classic triad of symptoms?
- excess endolymphatic pressure in the inner ear
- episodic dizziness, low frequency hearing loss, tinnitus
pulsus parvus et tardus is seen with what murmur?
aortic stenosis
aortic stenosis is associated with what type of pulse abnormality?
pulsus parvus et tardus
what is the equation for anion gap?
AG = Na - (HCO3 + Cl)
what are the indications for treating emergent hyperkalemia? what is the treatment and why?
- rapidly rising serum potassium
- potassium level 6.5mEq/L or higher
- ECG changes (tall peaked T waves)
- treatment: IV calcium (gluconate) to stabilize cardiac myocyte membranes and make them resistant to the effect of hyperkalemia
what is the best initial test for SCC detected in a cervical lymph node?
panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)
what therapy is used for SVT in patients who are hemodynamically stable? why?
- adenosine or vagal maneuvers
- temporarily slow conduction via the AV node and can aid in diagnosis by unmasking ‘hidden P’ waves in patients with atrial flutter or atrial tachycardia
- can cause transient AV nodal block and terminate AV node-dependent arrhythmias
when is amiodarone or lidocaine used?
- hemodynamically stable patiends with wide QRS complex tachycardia
- amiodarone is also used to treat atrial fib
what therapy should be initiated in a patient following coronary artery stenting in order to prevent future events as well as stent thrombosis?
- dual antiplatelet therapy (DAPT): aspirin and p2y12 receptor blockers (clopidogrel, prasugrel, ticagrelor)
- beta blockers
- ACEIs or ARBs
- HMG-CoA reductase inhibitors
- aldosterone antagonists (if LV EF under 0.40)
when are factor Xa (apixaban) used?
- anticoagulatino in nonvalvular atrial fib
- management of DVT and PE
what do beta AGONISTS do to potassium? why?
- potassium shift into intracellular space by stimulating NaK ATPase and NaK2Cl cotransporter
- adrenergic agents also stimulate release of insulin, which further promotes intracellular potassium shift, causing HYPOKALEMIA
where is the stroke?
- unilateral motor impairment
- no sensory or cortical deficits
- no visual field abnormalities
posterior limb on internal capsule (lacunar)
where is the stroke?
- contralateral somatosensory and motor deficit (face, arm, leg)
- conjugate eye deviation toward side of infarct
- homonymous hemianopsia
- aphasia (dominant hemisphere)
- hemineglect (nondominant hemisphere)
middle cerebral artery
where is the stroke?
- contralateral somatosensory and motor deficit, predominantly in lower extremity
- abulia (lack of will or initiative)
- dyspraxia (emotional disturbances, urinary incontinence)
anterior cerebral artery occlusion
where is the stroke?
- alternate syndromes with contralateral hemiplegia and ipsilateral cranial nerve involvement
- possible ataxia
vertebrobasilar system lesion (supplying the brain)
a water hammer pulse is seen with what type of murmur?
AR
- asian woman under 40
- fever, arthralgias, weight loss (early)
- claudication, distal ulcers (arterio-occlusive manifestations) in upper extremities
- BP discrepencies
- pulse deficits
- bruits
- elevated ESR, CRP
- possible mediastinal widening
takayasu arteritis
