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0
Q

Infectious endocarditis treatment

A

Native: vanco+gentamicin+ceftriaxone

Prosthetic: vanco+gentamicin+rifampin

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1
Q

Koplik spots
Conjunctivitis
Coryza
Conjunctivitis

A

Measles

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2
Q

Bacterial endocarditis

A

Native valve: mitral, streptococcus
Prosthetic valve: S. Epidermidis
GI malignant: S. Bovis

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3
Q

Erythema multiforme MCC

A

HSV

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4
Q

Adrenal insufficiency

A 
Hyponatremia
Hyperkalemia 
Fatigue
Abd cramps, dizzy, weak
Hyper pigmentation
Metabolic acidosis
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5
Q

Status epilepticus

A

BENZOS>PHENYTOIN>PHENOBARB

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6
Q

Systolic murmurs

A

Aortic stenosis
Pulmonic stenosis
M/T regurgitate
VSD

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7
Q

Diastolic murmurs

A

ARMS
Aortic Regurgitation MCC!!
M/T Stenosis
Also…pulmonic regurgitation

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8
Q

Only true continuous murmur that occurs both systole and diastole

A

PDA

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9
Q

Erythema multiforme medications

A 
Sulfonamides 
PCN
Barbiturates 
Phenytoin 
NSAIDS
Oral hypoglycemic meds
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10
Q

Ejection click

Systolic

A

Aortic stenosis

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11
Q

Opening snap

A

Mitral stenosis

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12
Q

Mid systolic click

A

Mitral valve prolapse

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13
Q 
Tremor
Insomnia
N/V
Hallucinations 
Agitated 
Anxiety 
Seizure
A

Alcohol withdrawal
Treat with:
BENZOS
Or Barbiturates

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14
Q 
Philadelphia chromosome
50-55
Increased WBCs and leuk
Anemia
Splenomegaly
Fatigue
Weight loss
A

Chronic Myelogenous Leukemia

Treat with HSCT and Imatinib

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15
Q

Rose thorn infection
Red ulcers that skip
Lymphocutaneous spread

A

Sporotrichosis

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16
Q

Chronic stable angina management

A

Statin
Anti hypertension meds-BB Preferred
Antiplatelet -ASA
Nitrates

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17
Q

What electrolyte abnormality can cause ileus?

A

Hypokalemia

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18
Q

Treatment for intracranial abscesses

A

Ceftriaxone+ metro

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19
Q 
Sore throat 
Fever
Muffled voice
Leans forward 
Thumbprint sign on X-ray
A

Epiglottitis

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20
Q

Synovial fluid analysis:

Inflammation

A 
Opaque
Yellow
WBC 3,000-50,000
PMNs: 50%
Low glucose
High LDH
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21
Q

Synovial fluid

INFECTION!

A 
Opaque
Yellow
WBC > 50,000
PMNs >75%
Very low glucose 
High LDH
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22
Q

What type of crystals are present in gout?

A

Uric acid
Needle shaped
Negative birefringence

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23
Q

What type of crystals are present in pseudogout?

A

Calcium pyrophosphate
Prism shaped
POSITIVE birefringence

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24
Q

What labs, signs, symptoms in RA?

A 
Positive RF and CCP 
Symmetrical joints PIP/MCPs
Ulnar deviation 
Boutonnière def.
Swan neck deformities
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25
Q 
Medication used in RA
folate antagonist
Side effects:
Interstitial pneumonitis
Gastritis 
Stomatitis
A

Methotrexate

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26
Q

Third line medications for RA

A

Etanercept- Embrel
Infliximabe- Remicade

Side effects leukopenia and reactivate TB!!!

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27
Q

What labs are positive in SLE?

A 
ANA
ANTI NATIVE DNA -60%
Some:
Anti-sm 
Anti-ssa/ssb 
Anticardiolipin 
Anti phospholipid 
False positive VDRL
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28
Q

Medications used to treat SLE

A

Hydroxychloroquine-plaquenil

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29
Q

What drugs can induce positive ANA?

A

Procainamide

Hydralazine

Isoniazid

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30
Q

Labs positive in Sjogrens?

A

ANA
RF
ANTI SSA/B

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31
Q

What does CREST syndrome stand for?

A 
Calcinosis
Raynauds 
Esophageal dysmotility 
Sclerodactyly 
Telangectasias
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32
Q

What is the triad of Reiters syndrome?

A

Urethritis
Conjunctivitis/ Uveitis
Arthritis- knee/ankle, asymmetric

Positive HLA B 27
Follows infection G.I. or chlamydia

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33
Q

What are the characteristics of temporal arteritis?

A

Over 60 years old
Female more than make
Jaw claudication, fever, scalp tenderness, headache
In one half of patients, PMR exists

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34
Q

What are labs done in temporal arteritis?

A

ESR is usually over 100
Do temporal artery biopsy.
Treat with prednisone 60 to 120 mg daily

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35
Q

What are the symptoms of Wegener’s granulomatosis?

A 
Necrotizing vasculitis
 Triad of:
Upper respiratory symptoms
Lower respiratory symptoms
Focal segmental glomerular nephritis
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36
Q

What are the symptoms of polymyalgia rheumatica?

A

Over 50 years old, pain and stiffness of shoulder and pelvic girdle,
Fever malaise and weight loss
Associated with giant cell or temporal arteritis
Have high ESR

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37
Q

What rash and symptoms is associated with polymyositis and dermatomyositis?

A 
Heliotrope rash on EYELIDS
Gottrons papules on HANDS
Proximal muscle weakness
Elevated CK/ANA/myoglobin 
Increased Risk of colorectal cancer
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38
Q

How many sites of muscular pain are indicated in fibromyalgia

A

11 of 18 sites

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39
Q

What are symptoms of polyarteritis nodosa?

A 
Vasculitis of small to medium vessels, younger males,
Proximal myalgia and weakness
Arthralgias
Palpable nodules
Fever, weight loss, night sweats,
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40
Q

What pathogens commonly cause otitis externa?

A

Pseudomonas
Enterobacter
Proteus
Staph aureus

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41
Q

What is the fun saying for Hypercalcemia?

A

Stones, bones, abdominal groans, psychic moans and fatigued overtones

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42
Q

What deficiency is commonly present in alcoholics?

A

Folic acid deficiency

Patients typically present with megaloblastic anemia. Give them 1 mg of folic every day

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43
Q

What murmur is associated with hypertrophic cardiomyopathy ?

A

Harsh left sternal border systolic crescendo decrescendo murmur that worsens with Valsalva maneuver

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44
Q

What is treatment for PID?

A

OP:
CEFTRIAXONE+DOXY+METRO

IP:
CEFOXITIN OR CEFOTETAN + DOXY
or CLINDA + GENT

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45
Q

Definition of menopause

A

12 months amenorrhea

FSH OVER 40

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46
Q

PCOS FINDINGS

A

Normal estradiol
LH/FSH 3:1
Free testosterone over 50
Insulin resistance

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47
Q

What Meds can cause galactorrhea?

A

Psychotropics
Cimetidine
TCAs
OCPs and DEPO

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48
Q

What leads check for axis?

A

I AND AVF

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49
Q

Lead I positive

Lead AVF negative

A

Left axis deviation

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50
Q

Lead I negative

Lead AVF positive

A

Right axis deviation

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51
Q

What is normal Tono pen pressure

A

10 - 21.5 mm Hg

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52
Q 
Sudden onset painless vision less
Atrial fib
Carotid disease 
Temporal arteritis 
CHERRY SPOT ON MACULA
A

Central retinal artery occlusion

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53
Q 
Blurry vision upon weakening
Worsens over hours
Diabetics
Diffuse hemorrhage 
Cotton wool spots
A

Central retinal vein occlusion

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54
Q

What are physical findings in acute angle closure glaucoma?

A 
Sudden eye pain
Blurriness
Fixed dilated pupil
Cloudy cornea 
IOP over 49
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55
Q

When do you usually hear an S3 gallop and where is it heard best?

A

CHF and volume overload

Heard best in left lateral decubitus

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56
Q

When and where do you hear an S4 gallop?

A

Pressure overload

Heard best in left lateral decubitus

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57
Q

What murmur is heard in a young child/adult, has fixed split, at LL sternal border?

A

ASD

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58
Q

What murmur is loud and associated with a thrill?

A

Grade 4 out of 6

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59
Q

What murmurs increase with the Valsalva or abrupt standing?

A

Hypertrophic cardiomyopathy and mitral valve prolapse

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60
Q

What are three causes of aortic disease in adults?

A
  1. Calcific disease
  2. Bicuspid valve
  3. Rheumatic disease- less developed countries
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61
Q

What factors are associated with aortic stenosis?

A

Diabetes, metabolic syndrome genetics hyperlipidemia, smoking and end-stage renal disease

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62
Q

What classic physical findings are present in aortic stenosis?

A

SAD- syncope, angina, dyspnea

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63
Q

What physical findings are present in aortic stenosis?

A

Congestive heart failure or in late findings
Pulsus parvus and tardus- small, weak slow rising pulse
Systolic ejection murmur

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64
Q

What are physical findings in aortic regurgitation?

A

WATER HAMMER aka Corrigan pulse = wide pulse pressure
Exaggerated by raising arm
Diastolic murmur LLSB

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65
Q

What is MCC of mitral stenosis?

A

Rheumatic fever

66
Q

What is treatment for mitral stenosis?

A

Diuretics
Beta blockers
Digoxin

67
Q

What are findings in central retinal vein occlusion?

A

Painless vision loss
Hemorrhages
Disk edema

Blood and thunder!

68
Q

What are components of CHADS2 score?

A 
CHF 
HTN
OVER 75
DM
TIA/CVA (2)
All others are 1
69
Q

What are anticoagulant guides for CHADS2 score?

A 
0= no anticoagulants 
1= ASA or Warfarin 
2= Warfarin
70
Q

What infection is associated with rheumatic fever?

A

Group A strep

71
Q

What are manifestations of rheumatic fever?

A 
Arthritis 
Carditis
Chorea 
Erythema marginatum
Subq nodules
72
Q

What lab and EKG findings in acute or rheumatic fever?

A

Increased ESR and CRP
Prolonged PR interval
Positive ASO tiger

73
Q

Causes of dilated cardiomyopathy

A 
Idiopathic 
ETOH
Tachycardia 
Autoimmune
Viral
HIV
Chemotherapy
74
Q

What are symptoms of dilated cardiomyopathy?

A 
GLOBULAR HEART
AND Congestive heart failure!!!!
Ejection fraction less than 40%!!!
Arrhythmias
Systemic emboli
Crackles in lungs
S3
75
Q

Causes of restrictive cardiomyopathy

A 
Genetics is the number one cause
Remember that your families restrict you!
Also:
Sarcoidosis 
scleroderma 
hemochromatosis
76
Q

Causes of acute pericarditis

A

Most commonly idiopathic Coxsackievirus and tuberculosis!
post MI
lupus and rheumatoid arthritis

77
Q

What are classic signs of acute pericarditis?

A

Chest pain - improved by leaning forward!
Friction rub
EKG changes of ST elevation and PR depression

78
Q

What is treatment for acute pericarditis?

A

NSAIDs
Colchicine
Aspirin for post MI

79
Q

What are signs and symptoms of constrictive pericarditis?

A

Most often follows cardiac surgery! Right-sided heart failure
EKG shows low voltage
CXR shows pericardial calcification echocardiogram with pericardial thickening
cardiac catheterization Diagnostic!!!

80
Q

What is treatment for constrictive pericarditis?

A

Diuretics and salt restriction definitive therapy with pericardectomy

81
Q

What are the two types of pericardial effusion and what are the causes of each?

A

Transudative and exudative
T- CHF
E-Infection, malignancy, autoimmune or myocardial infarction

82
Q

What are signs and symptoms of pericardial effusion ?

A

Right heart failure
pericardial rub
water bottle heart on chest x-ray diagnostic test of choice is echo

83
Q

What is becks triad in cardiac tamponade?

A

Hypotension
JVD
Muffled heart sounds

84
Q

What are 5 cyanosis congenital heart diseases!
5 TS
Remember R to L

A 
Truncus arteriosus 
TGA
Tetralogy of Fallot
Tricuspid atresia 
Total analomous pulmonary venous return
85
Q

What are characteristics of tetralogy of Fallot?

A
  1. Overriding aorta
  2. Right ventricular outflow obstruction
  3. Right ventricular hypertrophy
  4. Ventricular septal defect
86
Q

What are symptoms in child with tetralogy of Fallot?

A

Cyanosis crying with feeding

chest x-ray reveals boot shaped heart treatment is surgery

87
Q

What is characteristic of long QT syndrome and how is it treated?

A

QT interval of greater than 440 to 460 ms which is often treated by using beta blockers.
It can progress to torsades de pointed or sudden cardiac death

88
Q

What drugs can prolong the QT interval?

A 
Procainamide and quinidine
Propafenone and flecanide
Antidepressants
Droperidol
Erythromycin
Methadone
89
Q

What is the classic triad of AAA?

A

Abdominal or back pain, hypotension and a pulsatile abdominal mass

90
Q

What are three MCC of SVT?

A
  1. AV re-entrant
  2. WPW
  3. Dig toxicity
91
Q

What is difference between Multifocal atrial tachycardia and wandering atrial pacemaker?

A

Rate less than 100 in WAP

Rate over 100 in MAT

92
Q

What are 4 acyanotic congenital heart diseases?

A

ASD
VSD
PDA
CoA

93
Q

Increased CO2 = Increased acid = decreased pH

A

Respiratory acidosis

94
Q

Decreased CO2 = decreased acid equals increased pH

A

Respiratory alkalosis

95
Q

HCO3 acts as a base

HCO3 increase = increase base = increased pH

A

Metabolic alkalosis

96
Q

HCO3 decreased = decreased base and also decreased pH

A

Metabolic acidosis

97
Q

Causes of respiratory acidosis

…any process that decreases ability to exchange CO2 for oxygen

A

COPD
Asthma
Congestive heart failure
Pneumonia

98
Q

Causes of respiratory alkalosis

Any process which increases respiratory rate

A

Anxiety
Fever
Overventilation

99
Q

Causes of metabolic acidosis

Any process that decreases bicarbonate

A

Diabetic ketoacidosis

Renal failure

100
Q

Causes of metabolic alkalosis or any process that decreases acid or increases by carbonate

A

Prolonged vomiting or nasogastric suction

101
Q

Describe how to analyze ABGs

A

First analyze the pH
…if pH is low it is acidosis
…then look at carbon dioxide
…if CO2 is elevated it is respiratory acidosis
…if CO2 is normal or low it is metabolic acidosis

102
Q

Stage two or moderate COPD features

A

FEV1 between 50 and 80% and chronic cough sputum production

103
Q

Stage III or severe COPD features

A

FEV 1 between 30 and 50% with progressive airway limitation and exacerbations

104
Q

What are characteristics of stage four or very severe COPD

A

FEV1 less than 30% or…

FEV1 less than 50% plus chronic respiratory failure

105
Q

When should I inhaled corticosteroids be used in the treatment of COPD?

A

In stage 3 and 4 COPD with greater than three exacerbations per year

106
Q

What are some characteristics manifestations of cystic fibrosis?

A

Sinusitis and nasal polyps in infancy with multiple respiratory infections

107
Q

What test is screening test for cystic fibrosis?

A

Sweat test also known as quantitative pilocarpine iontophoresis which shows increased sodium and chloride levels

108
Q

What are characteristics of Horner’s Syndrome and what tumor can it represent?

A

Miosis
Ptosis
Anhidrosis

…Pancoast tumor

109
Q

Which two types of lung cancers related to brain mets?

A

Adenocarcinoma

Small cell

110
Q

Which bacteria that causes pneumonia is common in COPD pts?

A

Haemophilus influenza

111
Q

What are characteristics of patients with legionella pneumonia?

A

High fever

hyponatremia and diarrhea with very ill appearance

112
Q

What is inpatient treatment for community acquired pneumonia ?

A

Provide coverage of strep pneumonia and Legionella with ceftriaxone plus Z

113
Q

What is Potts disease and how does it manifest?

A

Skeletal tuberculosis with thoracic and lumbar vertebral fractures

114
Q

What TB readings are considered positive?

A

> 5mm: immunosuppressed pts
10mm: recent immigrants, children, other risk factors
15mm: normal no risk factors

115
Q

What is treatment of active TB?

A 
INH
RIF
PZA
EMB X 8 wks 
Then INH AND RIF X 16 wks
116
Q

What are non pulmonary manifestations of sarcoidosis?

A 
Erythema nodosum
Cardiac conduction issues 
Uveitis 
Parotitis 
Hypercalcemia
117
Q

What is easy difference to identify pleura fluid transudate vs exudate?

A

Transudate protein < 3

Exudate protein > 3

118
Q

What is gold standard test for PE?

A

Pulmonary angiography

119
Q

Which antibiotic can cause permanent hearing loss?

A

Gentamicin and vancomycin which are part of the aminoglycosides group

120
Q

Which anabiotic’s are associated with nephrotoxicity?

A

Amphotericin
Gentamicin
Nafcillin

121
Q

Which antibiotic is associated with red man syndrome?

A

Vancomycin

122
Q

Which antibiotic can cause hyperkalemia , especially in older pts taking an ace inhibitors?

A

Bactrim

123
Q

Which antibiotic has highest incidence of c. Diff?

A

Clindamycin then augmentin and keflex

124
Q

Possible effect on cbc by heparin

A

Thrombocytopenia

125
Q

What drug can cause blue skin discoloration and thyroid abnormalities with toxicity?

A

Amiodarone

126
Q

What drug can cause yellow and green vision disturbance and PVCs?

A

DIGOXIN

127
Q

Name three alpha blockers

A

Prazosin
Terazosin
Doxazosin

128
Q

What medications can cause gingival hyperplasia?

A

Phenytoin > nifedipine > amlodipine

129
Q

What condition warrants caution when using inhaled anticholinergics?

A

Glaucoma

130
Q

What are possible neuropsych side effects of montelukast?

A 
Insomnia
Agitated 
Anxiety
Depressing 
Suicide
131
Q

What are possible side effects of theophylline?

A 
GI se
HA
anxiety 
Seizures 
Arrhythmia
132
Q

What gout medication should not be used in pts with history if Uric acid renal stones?

A

Probenecid

133
Q

What serological tests should be done before using infliximab or etanercept in RA?

A

HBV
HCV
TB

134
Q

Which H2 blocker has anti androgen effects…ED and gynecomastia?

A

Cimetidine

135
Q

What is black box warning associated with metoclopramide?

Used in diabetic gastroparesis?

A

Acute dystopia

136
Q

Name significant interactions of promethazine?

A

Levodopa

Otc prolongation

137
Q

Side effects of PTU and methimazole

A

Vasculitis
Agranulocytosis
Hepatic failure

138
Q

Common side effects Phenytoin

A

Gingival hypertrophy
Teratogenic
Nystagmus
Stevens Johnson

139
Q

Which BP medicine interacts with Prozac and Paxil cyp2d6

A

Metoprolol

140
Q

Name 3 MAOIs and their interactions

A

Isocarboxazid
Tranylcypromine
Phenelzine

Interacts w sympatomimetics a do high tyranime foods

141
Q

What drug is used to reverse BZD OD?

A

Flumazenil

142
Q

What is a sign of lithium toxicity

A

Tremor

Also hypothyroidism

143
Q

Side effects of accutane

A 
Alopecia 
Pseudotumor 
Teratogenic 
Hepatitis and pancreatitis 
Photosensitive 
? Psychosis
144
Q

What is treatment for histoplasmosis and blastomycosis?

A

Itraconazole

145
Q

What is treatment for PCP Pneumonia

A

Bactrim

146
Q

What infection shows ring enhancing lesions on CT?

A

Toxoplasmosis

147
Q

What virus causes kaposis sarcoma?

A

HHV8

148
Q

What are symptoms of botulism?

Home canned food and honey babies

A 
Diplopoda
Dry mouth
Dysphasia and dysphonia
Respiratory paralysis 
Muscle weakness
149
Q

What are tx options for Lyme disease

A

Doxycycline
Amoxicillin
CEFTRIAXONE

150
Q

What organism causes cervix petechia like strawberry?

A

Trichomonas

151
Q

What is initial tx for syphilis

A

Benzathine penicillin G or doxy x 14 days

152
Q

Virus associated with Bell’s palsy

A

HSV1

153
Q

What is empiric tx for meningitis?

A

Vancomycin+CEFTRIAXONE +|~ ampicillin

154
Q

What organism causes hot tub follicles

A

P. Aeruginosa

155
Q

What diarrhea causes rice water stool

A

Cholera

156
Q

Severe effect of E COLI

A

Hemolytic uremic syndrome

ARF + thrombocytopenia + anemia

157
Q

Shigella

Daycare

A

Quinolone or Bactrian or Z

158
Q

Campylobacter

Chicken

A

Quinolone

159
Q

What is difference between colles and smith fracture of distal radius?

A

Colles fracture is displaced dorsal and smith is displaced volar

160
Q

What is most common bone cancer in children?

A

Osteosarcoma

161
Q

What tumor causes onion skin appearance on X-ray

A

Ewing sarcoma

162
Q

What endocrine disorder caused bitemporal hemianopsia

A

Pituitary adenoma

PANRE (1 decks)

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