2 Flashcards
analgesic nephropathy
florid nephrotic range proteinuria
multiple myeloma protein usually not on u/a-UPEP
Subclinical hypothyroidism
Treat if
complications
Elevated TSH, normal free T4, get anti-TPO
TSH >10, symptomatic, pregnant, infertile, goiter, positive antibody
miscarriage, preeclampsia, preterm birth, pregnancy complications
severe bradycardia 2/2 RCA MI
IV atropine
Refeeding CHF
hypophosphatemia-oral phosphate (no diuretics)
also watch mg, k, thiamine
Sickle cell
aplastic crisis
hyperhemolytic crisis
dactylitis, hemolytic anemia. HgbS on electrophoresis
transient cessation of erythropoiesis due to parvovirus, low rec count, transfuse
increased rec count
Disseminated VZV
IV acyclovir (ganciclovir for local), airborne and contact precautions
Helminth infection
eosinophilia, chronic diarrhea, high risk of reinfection, treat entire family
Pseudotumor cerebri vs migraines
If fat and fertile, do eye exam
migraines can be associated with aura-vision changes, nausea, tingling
friable cervical lesion
rule out cancer
Hot flashes treatment
escitalopram/venlafaxine
Neonates with bilirubin >20
breastfeeding jaundice
exchange transfusion
supplement with formula
Hawthorne effect
change in behavior due to observation
GBS babies
observe for 2 days
if no abx >4 hours before delivery AND preterm or PROM, obtain CBC and culture
post op SIADH hyponatremia
mild-fluid restrict, salt tabs
only symptomatic, severe with seizures-hypertonic saline
Suppurative otitis media
copious drainage, feeling better after tympanic membrane ruptures
Diaper dermatitis
No powder-aspiration risk
tx: zinc oxide, petrolatum
* candida dermatitis-nystatin, miconazole
synthroid drug interactions
calcium and iron should be taken 3-4 hours later
45 XO
Turner syndrome: get TTE (cardiac defects), renal ultrasound, TSH, hearing and vision tests
Testicular cancer workup
ultrasound, CT scan, CXR, serum markers, orchiectomy
Indolent pna with interstitial infiltrates in immunocompromised patient
tx
steroids if
pcp
bactrim
o2gradient >35 or pao2 <70 (inflammation from pcp lysis)
if sputum culture is negative->bronchoalveolar lavage
Digoxin toxicity
induced by
N/V, anorexia, fatigue, confusion, cardiac abnormalities, visual disturbances
verapamil, amio, quinidine
burning sensation, mucoid discharge that crusts eyes shut,
infectivity
w/ itching
viral
over after discharge resolves bacterial-after 24 hr of topical therapy
allergic
TSH in history of thyroid cancer
Use levo to suppress TSH to low normal range
CAP treatment
Mac/doxy (healthy), mac+beta lactam/fluoroquinolone (comorbidities)
Inpt: fluoroquinolone OR beta lactam+mac
ICU: beta lactam+ mac OR beta lactam+ fluoroquinolone
TP FP PPV (TP/ TP+FP)
FN TN NPV (TN/TN+FN)
Sens Spec
(TP/TP+FN) (TN/TN +FP)
Spec, sens table
tuberous sclerosis testing
cause of death
Imaging, EEG, skin exam (ash-leaf, hypopigmented), benign tumors
epilepsy (neurologic impairment), aspiration pna, obstructive hydrocephalus
Lead time bias vs length time bias
Screening catches earlier vs patients who are screened have slowly progressive form of disease
Asthma exacerbation do not need imaging
prednisone and albuterol
myxedema coma
pretibial myxedema
hypothyroidism
synthroid increases risk of MI in CAD, start slowly
iodine loading is for hyperthyroidism
Grave’s-hyperthyroidism
Essential tremor vs Parkinson’s
essential tx
movement, no bradykinesia, no rigidity vs resting tremor
propranolol if necessary
Acute hep c
antibody may be negative, get viral load
clozapine risk
agranulocytosis
EBV mono treatment
complication
Supportive care and NSAID
aplastic anemia, airway obstruction-steroids
otitis externa
mild-topical acetic acid
moderate-topical abx
severe with edema-placement of a wick
uterine atony
postpartum hemorrhage-> massage uterus+ oxytocin/misoprostol/methylergonovine/carboprost
tetanus ppx for bite wounds
dirty: booster if last dose >5 years ago, vaccine and ig if unimmunized/not fully immunized
clean: vaccine if last dose >10 years ago, vaccine if unimmunized
lupus nephritis
monitoring
GET BIOPSY!
anti-dsdna and complement (will be low) levels
Postconcussive syndrome
headache, confusion, amnesia, difficulty concentrating, vertigo, mood disorder
Pseudomonas pneumonia (HAP or structural lung disease)
gentamicin/zosyn/Levaquin (2 of 3 required)
if respiratory failure-vanc to cover for MRSA
Elevated PSA with urinary symptoms
observe. only workup for prostate cancer if persistent
multifocal atrial tachy
irregular, 3 different P morphologies-treat underlying cause
pulm disease in elderly, sepsis, electrolytes
bronchiectasis
recurrent infections
oculoglandular syndrome
conjunctivitis and ipsilateral preauricular and cervical adenopathy due to cat scratch disease, complicated by lymph node suppuration, azithromycin
TTP treatment (plex)
repleting ADAMST13-a metalloproteinase
Cyclosporine gout
decreased excretion of uric acid
* do not use colchicine with azathioprine in post-transplant patients. *
Tourette
chronic tic
provisional tic
Tourette treatment
several motor with at least one vocal tic
motor OR vocal >1 year
<1 year
habit reversal therapy, antipsychotic (Risperdal, abilify in children)
Status epilepticus
Benzo, if refractory-fosphenytoin/valproic acid
still refractory-continuous midazolam, phentobarb, propofol
Pregnant UTI
fosfomycin, cephalexin, amoxicillin-clavulanate
CABG for
3 vessel disease
multivessel disease involving LAD
DM and multivessel disease
pernicious anemia associated atrophic gastritis
glandular atrophy in gastric body and fundus, inflammation, intestinal metaplasia
Rosacea treatment
complications
topical brimonide/flagyl
ocular-chalazion (nodule on eyelid)
Low risk surgery preop (breast, ambulatory, endoscopy, cataracts)
If no active disease-no further workup
otherwise, RCRI, if >=4 METS-no workup, if less-workup
Intususception diagnosis
Intestinal malrotation and volvulus dx
target sign on u/s-tx: air or water contrast enema (complications-perf)
bilous emesis-upper GI series
Wallenberg syndrome
lateral medulla
occlusion of PICA or vertebral artery, loss of pain and temp over opposite sides of body, bulbar muscle weakness, vertigo, nystagmus, ipsilat limb ataxia, horner’s syndrome
tamoxifen
risks
nonmetastic estrogen receptor positive breast cancer
prevention in hyperplasia with history of lobular carcinoma in situ
endometrial cancer, uterine sarcoma in postmenopausal women
only evaluate if symptomatic
Medicare A
B
C
D
inpatient
outpatient
private insurance plans
prescription drugs
Pregnant thyroid
mildly hyperthyroid is fine
Opioid toxicity
pinpoint pupils, resp depression, AMS
Raynaud treatment
amlodipine, nifedipine
DM and exercise
If short-decrease preprandial
If > 60 mins-consider decreasing basal also
Allergic bronchopulm aspergillosis
CXR
treatment
Asthma/cystic fibrosis, recurrent infections with brown sputum, eosinophilia, test skin
upper lobe opacities, mucous plugging, bronchial wall thickening
oral prednisone, omalizumab, itraconazole/voriconazole
Mucormycosis tx
liposomal amphotericin B
Achilles tendon rupture
Thompson test-no plantar flexion when calf muscle is squeezed-MRI
Duchenne muscular dystrophy
treatment
LE weakness in 2-3 yo boy, gowers sign, calf pseudohypertrophy, dilated cardiomyopathy, scoliosis
*measure CK
*testing-dystrophin deletion
steroids
Acute bronchitis in COPD
give antibiotics
verification bias
when a test is only used on positive/negative screening
Tick paralysis
sensation intact with ascending paralysis, hyporeflexia, remove tick
hepatavalent antitoxin for botulism
Pregnant acne
topical abx, azelaic acid
retinoids/-tene
Steroids can make you go crazy.
Reduce
To rule out a disease
Sensitivity
Iron def anemia
microcytic hypochromic RBCs
If legal guardian exists and can’t be reached
proceed in emergency
Antipsychotics in elderly
increased mortality
Warts that turn white with acetic acid
treatment
HPV
trichloroacetic acid, interferon, surgical excision
Mammogram starting at age
Genetic testing
40
2 first degree relatives, 3 2nd degree relatives, relative with ovarian and breast cancer OR bilateral breast cancer, male relative with breast cancer
Ashkenazi-just one relative
Erythrocytosis and hematuria in smoker
RCC-get CT scan-thickened septa/walls-no biopsy needed, refer for nephrectomy
bupropion CI in
seizures
varenicline is safe-maybe cardiac effects
HypoMg, HypoK EKG
Prolonged QTc
Licorice side effects
inhibits conversion of cortisol to cortisone. cortisol binds to mineralocorticoid receptors-hypertension, hypokalemia, metabolic alkalosis
Asymptomatic LV systolic dysfunction
ACEI, BB
Bicuspid valve screening
management
echo every 1-2 years
valvuloplasty or surgery (if aorta is involved)
cranial nerve III palsy (ptosis, anisocoria)
posterior communicating artery aneurysm-subarachnoid hemorrhage (headache, nausea, nuchal rigidity
pleuritic chest pain, loud P2, pleural friction rub, hypoxemia, small effusion
acute PE
only a normal v/q scan rules out pe in high pretest probability
Functional hypothalamic amenorrhea
treatment
exercise-induced, all hormones decreased
increased calories, estrogen, calcium/vitamin d
exogenous growth hormone-hypertension, fluid retention
amputated body parts
wrap in sterile gauze, moisten with saline, place in sealed, sterile plastic bag on ice mixed with saline
Pregnancy synthroid
increase by 25-50%
Paget’s disease
treatment
bone pain, weightbearing bones, neuro symptoms, hypercalcemia, hypercalciuria, CHF
xray-cortex thickening, bone scan-increased uptake
bisphosphonates
calcitriol is for the treatment of hypoparathyroidism
pathologic scoliosis
back pain, neuro symptoms, rapidly progressing curvature, vertebral anomalies on x ray
DVT/PE treatment
If cancer-lovenox
If not-orals
Cervical insufficiency
short cervix
> =2 painless miscarriages in 2nd trimester-cerclage
incidental finding-serial measurement and vaginal progesterone
SGLT2 inhibitor (-gliflozin) side effect metformin
euglycemic DKA
lactic acidosis
actinic keratoses
come and go, cryodestruction, biopsy if >1cm, tender, indurated, ulcerated, growing rapidly
large volume foul-smelling stools, flatulence, weight loss, microcytic anemia, elevated stool osmotic gap
collagenous colitis
celiac disease
small bowel biopsy-villous atrophy, intraepithelial lymphocytic infiltrate, crypt hyperplasia
nocturnal diarrhea, fecal urgency, decreased osmotic gap (secretory), thick subepithelial collagen band
NSAIDs kidney
AIN
hyperthyroidism
complication
behavioral changes, weight loss, tachy, hyperreflexia, lid lag (sclera above irises), sweaty skin
arrhythmia, cardiomyopathy, osteoporosis
Orthostatic hypotension caused by
diuretics, alpha blockers or nitrates
pulmonary contusion vs PE
fat embolism
opacification on CXR-supportive care
confusion, petechial rash
narcolepsy testing
treatment
treatment of associated cataplexy
sleep study
stimulants-modafinil, methylphenidate
SNRIs, SSRIs, TCAs, sodium oxybate
absence seizures-valproic acid
likelihood ratio
independent of prevalence, applies to individual patient
