Treatment of syphilis in:
- primary, secondary, early latent stage (<12 months)
- late latent stage (>12 months), or unknown, cardiosyphillis
- neurosyphillis
- congenital syphillis
- benzathine penicillin G IM in single dose
- benzathine penicillin G IM weekly in 3 doses
- aqeuous penicillin G IV 10-14 days
- aqeuous penicillin G IV 10 days
What is Jarisch-Herxheimer reaction?
acute febrile reaction within 24 hours of spirochetes treatment – chills, headaches, myalgia.
innate immunologic reaction to lysis of spirochetes
3 thyroid effects of amoidarone, and treatments related to conditions
- decreased peripheral T4-T3 conversion, clinically euthyroid, no treatment needed. normal to slightly elevated TSH.
- inhibits thyroid hormone synthesis–> hypothyroidism. Give levothyroxine. Increased TSH
- amiodarone induced thyrotoxicosis (AIT)– depending on type 1 vs 2, antithyroid drugs vs steroids. Low TSH.
Treatment of painful vertebral metastasis in metastatic prostate cancer
- 1 week of antiandrogen (flutamide) followed by LH releasing hormone agonist (leuprolide) to reduce initial symptom flare
Treatment of tinea capitis, diagnosis test?
oral griseofulvin and terbinafine
KOH prep
Pt with HIV presents with fever, blurry vision, headaches, and signs of meningitis. What bug is it? Treatment?
Cryptococcus neoformans (yeast)
- amphotericin B and flucytosine. If improvement occurs, then consolidation and maintenance with fluconazole.
- if meds don’t improve, then repeat lumbar puncture to decrease intracranial pressure
- ** don’t start HAART until 4-10 weeks later for paradoxical worsening of infection
Cryptococcus neoformans meningitis findings in CSF
- elevated opening pressure
- elevated protein, low glucose
- positive india ink presentation/cryptococcal antigen test
What screening tests are needed in patients with Turner’s syndrome?
- Echo
- renal ultrasound
- TSH levels
- visual and hearing test
lead poisoning test, management based on levels of lead- mild, moderate, severe
- mild (5-44mcg): no meds, repeat level in 1 month
- moderate (45-69): DMSA
- severe (>70): DMSA+EDTA
Definition of pre-eclampsia
- new onset hypertension >140/90 after 20 weeks gestation AND
- proteinuria OR
- signs of organ damage
Severe features of pre-eclampsia
- creatinine >1.1 or doubling
- thrombocytopenia <100,000
- > 160/110
- elevated transaminases
- pulmonary edema
- new onset visual/ cerebral symptoms
Management of pre-eclampsia
- IV mag for seizure ppx
- delivery for term patients
- if bp >160/110, then give IV labetalol, hydralazine or nifedipine PO
HPV indications
- female 9-26
- male 9-21 (upto 26 in MSM)
- immunocompromised individuals 9-26
- NOT indicated in pregnant women
Clinical manifestations of Henoch Schonlein purpura (IgA mediated leukocytoclastic vasculitis)
- palpable purpura, esp in legs and buttocks
- arthritis/ arthralgia
- abdominal pain/intussusceptions
- renal disease similar to IgA nephropathy
Lab findings and treatment of HSP
- normal to increased creatinine
- normal platelet count and coag studies
- hematuria +/- RBC casts +/- proteinuria
- supportive (hydration & NSAIDs) treatment, hospitalization and systemic glucocorticoids for severe sx
How long should varicella zoster virus patients be isolated?
isolate till lesions are crusted
Clinical features of lateral medullary syndrome (wallenburg syndrome)
- vestibulocerebellar: horizontal and vertical nystagmus, vertigo
- sensory: loss of pain and temperature in ipsilateral face and contralateral body
- ipsilateral bulbar muscle weakness
- ipsilateral horner’s syndrome, hiccups
Best test to diagnose infantile hypertrophic pyloric stenosis, and what med usage is linked with this disease
ultrasound
erythromycin
Contraindications of MMR
- anaphylaxis to neomycin, gelatin
- severe immunodeficiency
- pregnancy
- ** presence of fever after vaccine is ok
Diagnosing acute mesenteric ischemia
- metabolic acidosis
- marked leukocytosis
- hemoconcentration (high hematocrit)
- CT angiogram
harsh holosystolic murmur in 4th intercostal space, palpable thrill. Which cardiac defect causes this?
VSD
Which electrolyte imbalance can lead to rhabdomyolysis?
hypophosphatemia
Gold standard for diagnosing nephrolithiasis
- non contrast helical CT scan
- in pregnant patients, u/s is good alternative
When is lung cancer screening recommended? Which test?
- pt age 55-80
- more than 30 years smoking history AND is current smoker or quit smoking in last 15 years
- CT scan of lung
