Buzz words Flashcards
age for starting dexa scans
males 70, females 65
dexa score for osteopenia, osteoporosis?
osteopenia 1-2.4, osteoporosis 2.5
1 fracture for compartment syndrome
tibial shaft fracture
+ smith antibodies & + double stranded DNA antibodies Dx?
Lupus
where are bouchards nodes
PIP joint
can an x-ray show an acute osteomyelitis
Nothing only chronic osteo
best imaging osteo
bone scan or an MRI
22 yr old male septic joint and lesions on knee and hands pathogen?
Neisseria gonorrhoeae
wbc if septic joint
> 50,000 at minimum
painless mass in R wrist
Ganglion cyst
age range for osteosarcoma? Where most likely in body
15-25 yo males and knees
think pt has osteoid osteoma, x-ray pending, in the meantime what med do you start?
if it is osteoid osteoma ibuprofen will resolve the pain
clicking or locking of the knee is what diagnosis
meniscal tear
65 year old woke up severe pain in his great toe. It is swollen, red and very tender. dx?
gout #1, consider infection
uric acid level that confirms gout
> 7.5
medical treatment for gout?
Allopurinol, colchicine
+ birefringent crystals dx?
pseudogout
pt with hx of hepatitis B presents complaining of bilateral knee pain, fever and weight loss. Dx?
polyarteritis nodosa
suspect polyartheritis nodosa. Test for dx and what is Tx?
biopsy, high dose steroids
ulnar deviations and swan neck deformities, dx?
rheumatoid arthritis
+ Neer’s test dx?
rotator cuff impingement
3 meds that cause lupus
procainamide, isoniazid and quinidine
what test for Sjogren’s syndrome
Schirmer test
A pt with RA is heading to OR, what x-ray do you need?
C-spine, due to concerns about instability of C1 & C2
What carpal bone has a high rate of non-union and occult fracture
Scaphoid
med used for pts with lupus
systemic steroids
Scleroderma limited version has 5 main characteristics for which CREST acronym is used, what are those 5 things?
Calcinosis Raynaud's Esophageal dysmotility sclerodactyly telangiectasia
there is a sunburst appearance on x-ray, what is the most likely Dx?
osteosarcoma
where are 80% of clavicle fractures anatomically
middle third
path shows negatively birefringent crystals. most likely dx?
gout
4 muscles of the rotator cuff
SITS supraspinatus infraspinatus teres minor subscapularis
characteristics of a lytic lesion on x-ray
speculated, elevated periosteum, bone destruction
most common injured ligament in ankle sprain
ATFL
anterior talofibular ligament
dx?
vasculitis with a hep B hx
polyarteritis nodosa
most common fracture in children
clavicle
fat pad sign on a lateral elbow x-ray means?
it is blood in the joint indicating a fracture even if a fracture line is not seen
progressive neck and proximal muscle weakness
PE- see a reddish purple maculopapular rash
lab- anti-jo-1 antibodies
dx?
polymyositis
what way does a collies fracture angulate dorsal or velar?
smith fracture?
colles - dorsal
smith - volar
tenderness over anatomical snuffbox, fx?
scaphoid
most common fracture in pt with osteoporosis?
compression fracture vertebra then hip
15 yo night pain in pelvis
x-ray - mass with an “onion skin appearance” dx?
ewing sarcoma
name of 4th and 5th metacarpal fx from throwing a punch
boxer’s fracture
new mom with pain over the radial wrist
+ Finkelsteins test
dx?
de Quervain’s tenosynovitis
+ McMurry
dx?
meniscal tear
McMurry test
the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole with the other hand. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress in order to identify a valgus deformity. The other hand rotates the leg externally while extending the knee. If pain or a “click” is felt, this constitutes a “positive McMurray test” for a tear in the medial meniscus.
1st line treatment for carpal tunnel
night splint
most common cause of c-spine fracture
MVC
medical term for hunchback?
kyphosis
another term for podagra
gout
saddle anesthesia and loss of bowel and bladder function
dx?
cauda equina
pt with HIV
severe groin pain
dx?
avascular necrosis of the femoral head
antiretroviral meds increase risk for AVN
short, ext rotated leg dx?
hip fracture
instructions when taking biphosphonates?
tx?
tx osteoporosis
upright for 30 mins
#1 cause hip dislocation? anterior or posterior?
MVC
posterior
most common injured rotator cuff muscle
supraspinatus
tennis elbow aka?
lateral epicondylitis
1st line tx for RA
methotrexate
baseball bat to knee, unable to extend knee
dx?
patella fracture
most common shoulder dislocation anterior or posterior?
anterior
most useful physical exam for ACL tear?
Lachman’s followed by anterior drawer
Lachman’s test?
The therapist holds the patients knee between full extension and 30 degrees of flexion.
The patient’s femur is stabilized with one of the examiner’s hands (the “outside hand) while the proximal aspect of the tibia is moved forward with the other (“inside”) hand.
most common knee injury
medial meniscal tear
where are heberden’s nodes found?
DIP distal interphalangeal joint
knee pain after soccer
joint line tenderness medically and locking from time to time
what 2 physical exam tests?
medial meniscal tear
McMurry and apply tests
Pt with conjunctivitis, urethritis, arthritis and oral lesions
dx?
other lab that is +
reactive arthritis
HLA B-27
limping, feels like kicked in back of leg but wasn’t
dx?
Achilles tendon rupture
Anti-Jo-1 antibodies should make you think of what dx?
Polymyositis
+ crossover test dx?
AC joint injury
acromioclavicular joint
crossover test
Adduct arm across front of chest
Touch opposite Shoulder
+ Hawkins test
dx?
Rotator cuff impingement
Hawkins test
Forward flexion of the shoulder to 90 degrees and internal rotation
+ Finkelstein’s test
dx?
de Quervain’s tenosynovitis
Finkelstein’s test
examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. If there is an increased pain in the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons, then the test is positive for De Quervain’s syndrome.
+ Phalen and Tinel’s sign
dx?
carpal tunnel
bamboo spine
dx?
Ankylosing spondylitis
+ straight leg test
dx?
herniated disc
straight leg raise
If the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disc is likely to be the cause of the pain
African American female
malar rash + double stranded DNA antibody
dx?
lupus
carpal tunnel which nerve?
parts of hand?
median nerve
thumb, pointer and ring finger
thenar wasting
advanced carpal tunnel
The thenar region of the palm refers to the group of muscles in the thick pad just underneath the thumb.
silver fork deformity on x-ray
dx
colles fracture
+ Apley dx?
meniscal tear
Apley test
the patient lays prone (face-down) on an examination table and flexes their knee to a ninety degree angle. The examiner then places his or her own knee across the posterior aspect of the patient’s thigh. The tibia is then compressed onto the knee joint while being externally rotated. If this maneuver produces pain, this constitutes a “positive Apley test”
5 meds migraine prophylaxis
beta blockers tricyclics calcium channel blockers NSAIDS Valproic acid
unable to understand speech
which aphasia?
wernicke’s aphasia
facial paresis, arm drift and abnormal speech
first 3 tests
brain CT or MRI
glucose
o2 sat
seizure without LOC
dx
simple partial seizure
stroke no evidence hemorrhage
within 48 hours thrombolytics
painful ipsilateral third nerve palsy
dx?
posterior communicating artery aneurysm
seizure med that causes overgrowth of gums
phenytoin
sudden thunderclsp ha
dx
subarachnoid hemorrhage
Kernig’s sign
pt lies supine, flex hip while keeping knee straight
back pain is +
definitive test subarachnoid
LP
lateralized throbbing ha
N/V photophobia
type ha?
migraine
middle age male
unilateral periorbital ha daily for weeks
ha type
cluster ha
3 drugs that tx cluster ha
O2, immitrex, stadol (butorphanol)
34 yo relapsing and remitting x weeks,
vision issues, weakness R arm
dx
MS
tremor with motion in hands
meds?
beta blocker like propranolol
shuffling gait
dx
parkinson’s
2 classes of drugs for parkinsons
dopaminergic (levodopa)
anticholinergics
decreased GABA and substance P
dx?
huntington’s
Huntington’s autosomal dominant or recessive
dominant
weakness in lower legs and now in knees and hips b/l
progressive
dx
Gullain-barre
% stroke ischemic
hemorrhagic
I- 80%
H - 20%
believe stroke
aphasia, loss hearing in 1 ear, loss vision L eye
blockage posterior or anterior circulation
posterior
when would asa or clopidogrel (plavix) as TIA prophylaxis
antiplatelet meds
used unless known cardiac etiology for embolism
if cardiac use heparin or coumadin
asymptomatic what % blockage of carotid for sx?
symptomatic?
> 70% asymptomatic
>60% symptomatic
worst ha of life
bp?
subarachnoid
bp elevated
abortive meds for migraines
triptans (immitrex, zolitriptain)
ergotamine
EEG shows focal rhythmic discharges at the onset of the seizure
dx?
simple partial seizure
most important concern status epilepticus
airway then management hyperthermia
brudzinski’s sign
lift its head the pt bends his hips, knees
3 meds break a seizure
diazepam - valium
lorazepan - ativan
phenytoin - dilantin or fosphenytoin - cerebrex
MRI result of multiple foci of demyelination in the white matter
dx?
MS
3 meds to tx MS
steroids
interferon beta
copolymer 1
most common cause dementia
alzeimers 80%
4 chromosomes linked dementia
1, 14, 19, 21
ankle jerk reflex of lumbar or sacral origin
sacral
intracellular neurofibrillary tangles and extracellular neuritic plaques
dx?
alzheimer’s
aching ha which feels like band around head
dx?
tension ha
tremor R hand
gone after a beer
dx
benign essential tremor
familial tremor
2 meds tx essential tremor
beta blocker - propranolol
primidone
age huntington’s appear
30 years old
35 yo increasingly irritable and moody, restless
CT shows cerebral atrophy, atrophy of the caudate nucleus
dx?
huntington’s disease
med for tourette’s
haloperidol
slit lamp shows Kayser-fleischer rings
dx
wilson’s disease
wilson’s build up of what mineral
copper
genetic characteristics of wilson’s
autosomal recessive
chromosome 13
bells palsy which nerve
7
LP for bacterial menigitis
wbcs, glucose, protein
wbc elevated
glucose decreased
protein elevated
classic migraine
aura
elevated circulating acetylcholine receptor antibodies
dx
myasthenia gravis
Duchenne’s and Becker’s muscular dystrophy
genetics
x-linked recessive
age range for duchenne’s muscular dystrophy
3-5 years old
EEG shows spikes and associated slow waves
dx
generalized or absence seizure
most common primary intracranial neoplasm
glioma
most common cause subarachnoid other then trauma
ruptured cerebral aneurysm
most common primary cancer sites that met to brain
lung, breast and kidney
resting or pill-rolling tremor
dx
parkinson’s
weakness and numbness in L hand blockage of which carotid
right
intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes
which lobe
temporal
looking for lesions with MS
with or without gadolinium
with contrast
defining sx of Alzheimer’s
progressive memory impairment
which nerve root for knee jerk reflex
L3, L4
EEG shows interictal spikes
dx
complex partial seizure
most commonly herniated disc
L4-L5 followed by L5-S1
3 sxs are classic for normal pressure hydrocephalus
gait disturbance
dementia
urinary incontinence
unable to speak
R sided weakness
understands and follows commands
aphasia type
broca’s aphasia
alcohol major factor encephalopathy
wericke’s
muscle weakness, fatigability improves with rest
dx
myasthenia gravis
lead pipe or cogwheel rigidity
dx
parkinson’s
how long panic attack last
10-20 mins
most common hallucination with schizophrenia
auditory
cause anorexic its to have osteopenia
a decrease in estrogen
benzos for acute or chronic tx
acute
most common cause PTSD in women
rape
pt male that is hyper vigilant and hyper startle response
dx
PTSD
are its with phobias aware they are strange
yes
sudden development stage freight
tx
beta blocker
propranolol
doughnut shaped burn
issue?
child or elder abuse
generic prozac
fluxetine
how long sxs for ADD
6 months
no friends, seldom leaves house, terrified meeting people
avoidant personality disorder
ADD sxs at school not at home
add?
no must be in both
18 months, no speaking, does not point, no eye contact
dx
autism
3 + sxs schizophrenia
Hallucinations, delusions, movement disorders
typical onset tourettes
3-8 yo
anorexia egosyntonic or ego-dystonic
bulimia?
anorexia - egosyntonic
bulimia ego-dystonic
Egosyntonic
referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s ideal self-image.
deny issue
Egodystonic
ewers to thoughts and behaviors (e.g., dreams, impulses, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person’s ideal self-image.
aware issue
3 cluster A personality disorders
“mad” schizoid
schizotypal
paranoid
amenorrhea time
3 months if use to be regular, 6 if irregular
16yo changed schools
quiet, mossy and not himself
6 months back to nl
adjustment disorder
pt with major depressive disorder
once sxs resolved how long to still treat
a 6 month minimum
meds for PPD while breast feeding
sertraline - zoloft
strange magical thinking
dx
schizotypal personalty disorder
4 sxs serotonin syndrome
hyperthermia
seizure
MSC
tremor
chronic mild depression greater 2 years
dysthymia
whats needed for bipolar 1 dx
1 manic episode
no depressive episode needed
major concern with using lithium
very narrow therapeutic window
monitor blood level q 4 weeks
pt thinks 15 yo sleeping with mailman, no evidence, not interfering with DAL but thinking about a lot
dx
delusional disorder
BMI hospitalized for anorexia
BMI < 17.5 or 20% below IBW
term for being afraid of being out in a terrible situation with no help available
agoraphobia
borderline personality disorder is on the border of what 2 psychological disorders
neurosis and pychosis
waxy flexibility, dx
catatonic schizophrenia
how long before normal grief resolves
about a year
pt always craves attentions, often using sex
acts like a child when doesn’t get their way
dx?
histrionic personality disorder
ADD sxs before what age
7
russell’s sign
abraded knuckles from forcing oneself to vomit
how long sxs before schizophrenia
6 months
posturing
dx
catatonic depression
pt with acute paralysis left arm, doesn’t bother him
neuro work up neg
dx
conversion disorder
psych pt with confusion, fever, lead pipe rigidity
dx
neuroleptic malignant syndrome
occurs with high dose antipsychotics
pt concerned that she has breast ca, full negative work up, still unsatisfied and convinced
dx
hypocondriasis
time frame for 1st sxs withdrawal alcohol
tremor in 8-18 hours
tx alcohol withdrawl
benzos
list the 4 cluster B personality disorders
“bad” antisocial
borderline
histrionic
narcissistic
2 cluster C personality disorders
“sad” avoidant
obsessive compulsive
med clearly contraindicated in anorexia and bulimia
bupropion (wellbutrin) in can increase risk of seizures
2 psychiatric issues more common in males then females
autism and ADD
pt works at home, seldom leaves, no interest in meeting others and happy to be home alone
dx
schizoid personality disorder
SSRIs
Fluoxetine - prozac paroxetine - paxil sertraline - zoloft citalopram - celexa escitalopram - lexapro dapoxetine zimelidine mesembrine seproxetine
pt concern can’t trust anyone, everyone out to get him, everyone else’s fault
dx
paranoid personality disorder
pt charming, no concern for hurting or using others, no remorse
dx
antisocial personalty disorder
antisocial personality disorder can’t be dx till what age
18 yo
antisocial personality disorder but only 14 yo
dx
conduct disorder
pt splitting, all others as all good or all bad
dx
borderline personality disorder
type behavioral therapy works best for borderline pts
dialectical behavior therapy
pt is arrogant with an inflated self image, feels he is special and should be treated that way
dx
narcissistic personality disorder
Is obsessive compulsive disorder egosyntonic or ego-dystonic?
obsessive compulsive personality disorder?
OCD is ego-dystonic. OCPD is egosyntonic.
2 things needed dx bipolar 2
one major depressive and 1 hypomanic episode
good 1st med bipolar 1 and 2
lithium
how is acute stress different then PTSD
acute within 1 month of event and resolved in 1 month
PTSD about 1 month after event last indefinitely
spinal fx
dx
elder or child abuse
“i have been anxious for as long as I can remember”
dx
generalized anxiety disorder
are hallucinations normal during a normal grieving period
yes as long as they are not persistent or intrusive
side effect stop ACEI
cough
orthostatic hypotension
drop in systolic >20 when standing
vibrating pulse
thrill
3 differentials for paradoxical pulse
cardiac tamponade
pericarditis
obstructive lung disease
paradoxical pulse
abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration.
the drop is more than 10mm Hg
on palpation nl size aorta
<3cm
a fixed consistent split S2
dx
atrial septal defect
pathologic S3
dx
CHF
mid systolic click
click
MVP
opening snap
dx
mitral stenosis
continuous murmur, area heart
septal defect
continuous machine like murmur
dx
PDA
patent ductus arteriosus
3 meds used for pharmacological stress test
adenosine
dobutamine
dipyrudamole
persantine
gold standard CAD
cardiac cath
stage 1 htn
systolic 140-159
diastolic 90-99
tx goal dm with htn
130/80
most common cause secondary htn
chronic kidney disease
can’t control htn no matter meds
hyper pigmented skin and truncal obesity
dx
cushing’s disease
3 sxs of pheochromocytoma
thin diaphorectic tachy agitated hypertensive
pt with pheochromocytoma
while waiting for sx, alpha or beta blocker
alpha
never use beta blocker
young boy
elevated bp, no palpable femoral pulse
dx
coarctation of the aorta
nl BMI
18.5-24.9
1st line tx stage 1 htn
thiazide diuretic
after thiazide diuretic start in pt with dm
and ACEI or ARB
after MI med for htn
beta blocker
paroxysmal nocturnal dyspnea
dx
CHF
most common cause CHF
CAD
EF for pt with CHF
35-40%
most likely dx young man who experiences sudden death while playing sports
hypertrophic cardiomyopathy
bat wing vessels or kerley B lines on CXR dx?
CHF
BNP level rules out CHF
<100
INR goal after valve replacement
2.5-3.5
1st line inotropic agent with cardiogenic shock
dopamine
dx IVDA with heart murmur and fever
endocarditis
dx abc prophylaxis for “dirty procedure”
Prosthetic valve
valve repair with any prosthetic material
prior endocarditis diagnosis
congential cyanotic heart defect.
abx for dental work with MVP
no now mod risk not high risk
3 major criteria for endocarditis
2 + blood cultures
+TEE
new murmur
painful and found on fingers and toes
osler nodes
4 minor criteria for endocarditis
fever
embolic event (janeway lesios, perechiae, splinter hemorrhages)
immunological event (osler nodes, glomerulonephritis
1 + blood culture
5 components of tetralogy of fallot
ventricular septal defect R ventricular hypertrophy R ventricular outflow obstruction (pulm valve stenosis) overriding aorta R sided aortic arch
gold standard dx myocarditis
myocardial biopsy
where do most aortic dissections occur
the ascending or descending thoracic aorta
severe pleuritis chest pain worse with leaning forward
dx?
pericarditis
1st line tx for pericarditis
ASA and NSAIDS
syndrome that involves pericarditis several days after MI
Dressler syndrome
ER with CP
EKG shows diffuse ST elevations in all of the leads
dx
pericarditis
paradoxical pulse
large difference in pulse pressure between inhalation and exhalation
pulsus alternans
EKG waveform changes from beat to beat
definitive tx for cardiac tamponade
pericardiocentesis
harsh systolic murmur along the R sternal border
dx?
aortic stenosis
wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space
dx?
aortic regurgitation
location to hear aortic valve issues?
2nd R intercostal space
location to hear pulmonary valve best
2nd L intercostal space
2 abx for endocarditis
vanc and ceftriaxone together
2 valvular issues with Marfan’s syndrome
Aortic regurg and MVP
2 main causes of aortic stenosis
congenital bicuspid valve
calcification of the valve due to CAD
elderly pt with dyspnea, angina and syncope on exertion
EKG nl
dx?
aortic stenosis
harsh blowing pan systolic murmur at the apex
dx?
mitral regurgitation
suspect mitral regurgitation, how to dx
TEE
pt with MVP what physical characteristics
thin female
best patient position to hear aortic regurg and aortic stenosis
sitting up and leaning forward
Tietze syndrome
costochondritis
are most pulmonary valve problems congenital or acquired
95% congenital
INR after organic valve replacement
2 to 3
60yo male in ER severe dizziness and back pain
BP dropping +abd pulsatile mass
dx
ruptured aortic aneurysm
pt with aortic stenosis, will the PMI be medially displaced, normal or laterally displaced
laterally displaced due to LVH
severe crushing CP
EKG shows ST segment elevations
all labs negative
dx?
prinzmetal’s angina
key hx of prinzmetals angina
cocaine use
+ stress test
drop in BP
new arrhythmia
increase in angina sxs
st depressions
ulcers from venous insufficiency painful or painless
painless
how long after cardiac stent on asa and plavix
1 year
issues with mitral valve best heard
apex
initial tx MI
MONA
morphine, oxygen, nitro, asa
clot busting drugs within 3 hours of which 2 cardiac events
STEMI, new LBBB
3 catastrophic complications of a MI
papillary muscle rupture
myocardial wall rupture
L ventricular aneurysm
EKG shows a regular heart rate of 200 bpms
QRS narrow
dx?
supraventricular tachyacrdia
most common cause of sudden death
ventricular fibrillation
acute endocarditis is most commonly caused by what organism
staph aureus
3 congenital heart diseases
ASD - atrial septal defect VSD - ventricular septal defect coarctation of the aorta PDA - patent ductus arteriosus tetralogy of fallot
most common cause of an atrial septal defect
patent foramen ovale
atrial septal defect best heard murmur
at the left second or 3rd interspace
a CXR shows a “3” sign with notching of the ribs
dx
coarctation of the aorta
tx for a patent ductus arteriosus
indomethacin
blalock procedure corrects what congenital heart condition
tetralogy of fallot
loud, harsh pulmonary murmur along the left sternal border
dx?
ventricular septal defect
subacute endocarditis caused by what organism
strep viridans
most common place for an aortic aneurysm
in and and below the renal arteries
males or females more likely to have an aortic aneurysm
males are 8 times as likely
accessory pathway known as the james bundle, what syndrome
Lown - Ganong - Levine syndrome
what imaging before OR with aortic aneurysm
CT
risk factors for an aortic dissection
htn
marfans syndrome
bicuspid aortic valve
pregnancy
tearing CP rad to back
dx
aortic dissection
CXR for pt with aortic dissection shows
widened mediastinum
best test to dx an aortic dissection
CT
6 P’s of an ischemic limb
pain paresthesias pallor pulselessness poikilothermia paralysis
pt with pulses paradoxes
dx’s?
pericarditis
pericardial effusion
obstructive lung disease
pt ℅ of pain in legs with walking
goes away after sitting
term for sxs?
dx?
intermittent claudication
peripheral arterial disease
giant cell arteritis
what disease?
polymyalgia rheumatica
sawtooth pattern on EKG
dx
atrial flutter
what accessory pathway is associated with wolff-parkinson-white syndrome
the bundle of kent
a biphasic P wave should make you think of what dx
left atrial enlargement
gold standard for dx giant cell arteritis
biopsy of the temporal artery
tx for giant cell arteritis
high dose prednisone
virchow’s triad (3)
stasis
vascular injury
hypercoagulability
calf pain
dx?
DVT
best hear issues of the tricuspid valve
along the left sternal border
most common congenital heart disease
VSD - ventral septal defect
ulcers from arterial insufficiency painful or painless
painful
3 contraindications of ACEI
bilateral renal artery stenosis
hx of angioedema
pregnancy
both lead I and AVF have + QRS complexes
axis?
normal
what med might you switch pt to for cough on ACEI
ARBs
angiotensin receptor blocker
class of cardiac meds not used in asthma
Beta blockers
blocks receptors for brochodilators
boot shaped heart on CXR
congenital dx
tetralogy of fallot
RSR prime in leads V1 or V2
dx?
RBBB
labs monitored in pt taking aldosterone antagonist
K
may have hyperkalemia
dest test dx CHF
echo
what cardiac med is used to help with contractility after optimizing most others?
Digoxin
blockage of which artery causes an anterior wall MI
left anterior descending artery
what lab result will increase the risk of digoxin toxicity
hypokalemia
hypercalcemia
a pt presents in acute CHF what class of drug is 1st choice
loop diuretics
pt has a GFR of 25 and HTN
class of htn med
Loop or thiazide
loop will work no matter how low the GFR is
Thiazides will only work with a GFR over 30
anterior wall MI
V1, V2 and V3
do loop diuretics cause hyperkalemia or hypokalemia
hypokalemia
statins drug of choice for which dyslipidemia
elevated LDL
pt recently started lipitor
now with aches and pains
test to order?
serum creatinine kinase
at risk for rhabdomyolysis
how does ezetimibe (zetia) work
decreases intestinal absorption of cholesterol
which hyperlipdemia med may cause flushing
niacin
4 med “classes” for reduction in LDL
statins
ezetimibe
niacin
nicotinic acid
2 fibrin acid derivatives
fenofibrate (tricor)
gemfibrozil (lopid)
3 class 1a antiarrhythmics
disopyramide (norpace)
quinidine
procainamide
counting boxes to determine rate
300, 150, 100, 75, 60
U wave on EKG
dx?
hypokalemia
what will heart rate be if the AV node is pacing the heart
40-60 bpm
cardiac med may cause gynecomastia
spironlactone
lead I up
AVF down
axis?
LAD
Osborne or J wave on EKG
dx?
hypothermia
1st line med for symptomatic bradycardia
atropine
HR tachy or bradycardia
Tachy >100
brady <60
on EKG there is an early but o/w nl PQRS complex
then a slight pause then nl rhythm continues
term for 1 beat
PAC
tx for polymyalgia rheumatica
low dose prednisone
management of pt with SVT
vagal maneuvers
carotid massage
adenosine
1st line med for atrial flutter
adenosine
82yo with ha and jaw claudication
dx?
giant cell (temporal) arteritis
EKS shows irregularly irregular narrow QRS waves
dx?
atrial fibrillation
EKG shows a regular rate of 50 bpm
QRS is narrow no p wave
dx
junctional rhythm
common cause junctions rhythm
dig toxicity
EKG shows 2 PVC look very different
term?
multifocal PVCs
most common cause sudden cardiac death
V fib
pt with no pulse
keg wide irregular complexes, irregular rate
in V Fib
tx defibrillation
Tall peaked T waves
dx
hyperkalemia
define 1st degree AV block
PR interval is longer then 0.2 seconds or one block on EKG
another term for mobitz type I
wenckebach
complication of giant cell arteritis
blindness
2 labs to monitor in a pt on an ACEI
serum creatinine
serum K
HR irregular can’t count boxes
another way to determine rate
count QRS waves in a six second strip and multiply by 10
tx for mobitz II AV block
pacemaker
see regular P waves and reg QRS complexes, not correlated
dx?
3rd degree AV block
aldosterone antagonists (2)
spironolactone (aldactone)
eplerenone (inspra)
short PR interval and a delta have on keg
dx?
wolff parkinson white syndrome
what 2 leads determines axis
lead I and AVF
axis I and AVF nl
+/+
axis I and AVF LAD
+/-
axis I and AVF RAD
-/+
RSR prime in leads V5 or V6
dx?
LBBB
worse LBBB or RBBB
new LBBB is a STEMI
RBBB normally not a problem
med class to lower triglycerides
fibrin acid derivatives
tall peaked P waves
dx?
R atrial enlargement
list 3 causes of RAE
pulmonary htn
severe lung disease
pulmonary valve stenosis
which leads to dx an anterolateral MI
V5 and V6
3 inferior leads
II, III and AVF
lateral wall MI which artery
left circumflex artery
depressions greater then 1mm on EKG -
ischemia
rheumatic fever most commonly affects which valve
mitral valve
cyanotic congenital heart disease
tetralogy of fallot
EKG shows early wide QRS complex with no P wave
then pause and NSR
term 1 beat?
PVC
definitive tx recurrent VT
implanted defibrillator
EKG gradually lengthening PR interval and then a missed QRS complex, repeats
what AV block?
mobitz I or wenckebach
side effects of digoxin
N/V anorexia confusion arrhythmias (sinus brady, av block) fatigue vision disturbances
1st line tx for torsades de pointes
magnesium sulfate
why tx actinic keratosis
it may progress to squamous cell carcinoma
1st line tx for rosacea
metronidazole
tetracycline 2nd
where are 90% of basal cell lesions found on the body
on the head and neck
purple pruritic polygonal papule on PE
dx?
lichen planus
ABCDE of melanoma
asymmetry border color diameter elevation/irregular evolving
+ auspitz sign
dx
psoriasis
auspitz sign
Auspitz’s sign is the appearance of punctate bleeding spots when psoriasis scales are scraped off
This happens because there is thinning of the epidermal layer overlying the tips of the dermal papillae and blood vessels within the papillae are dilated and tortuous, which bleed readily when the scale is removed
key indicator for the prognosis of melanoma
thickness of the lesion
tx melaonma
wide local excision
waxy stuck on appearance
dx?
seborrheic keratosis
5yo in jan with a red itchy rash behind knees and on flexor surfaces of elbows
dx?
atopic dermatitis
term satellite lesion
dx
candida diaper rash
coin shaped plaques
dx
nummular eczema
30 yo female with pustules on face that spare vermillion border
hx using topical steroids
dx
perioral dermatitis
pt presents with flaky skin in the nasolabial folds and in hair
dx
seborrheic dermatitis
tx stasis dermatitis
compression stockings
tapioca blisters
dx?
dyshidrosis
usually on the hands and feet
tx dyshidrosis
topical steroids
giant cells on tzanck smear
dx
herpes simplex virus
tx lichen simplex chronicus
get the pt to stop scratching it
herald patch
dx
pityriasis rosea
tx pityriasis rosea
reassurance
pt with hx herpes now with target lesion
dx
erythema multiforme
rhinophyma
dx
acne rosacea
silvery scales
dx
psoriasis
teardrop lesion after a course of strep throat
dx
guttate psoriasis
are lesions from psoriasis found on flexor or extensor surfaces
extensor
1st line tx for tine corporis
topical azoles
2 most common organisms for cellulitis
strep and staph
pitting nails
dx
psoriasis
nummular eczema is most like what?
atopic dermatitis
honey colored crusts
dx
impetigo
2 herpes viruses for condyloma aceminata
6 and 11
double comedone
dx
hiradenitis suppurativa
tx molluscum contagiosum
self limiting but can removed
tx for seborrheic keratosis
benign no need to treat it
can be removed if unsightly
hyper pigmented velvety plaques
dx
acanthosis nigricans
melanoma most common which pts
women of childbearing age
extremely pruritic lesions with burrows in runs
scabies
1st step in tx atopic dermatitis
behavioral modifications
reduce bathing
only use soap on face and genitals
natural breathable fabrics
tx for bad brown recluse spider bite
debridement
venom causes tissue necrosis
salmon - colored scales
dx
psoriasis
depigmented patches of skin
dx
vitiligo
spaghetti and meatball on KOH
dx
tinea versicolor
What dermatologic finding is associated with insulin insensitivity
acanthosis nigricans
slowly growing nodule with a central depression and a pearly border
dx
basal cell carcinoma
dermatologic findings associated with asthma
atopic dermatitis
christmas tree pattern
dx
pityriasis rosea
oval patches of hair loss
dx
alopecia areata
1st line tx genital warts
imiquimod (aldara)
pearly dome shaped lesions with a central umbilication
dx
molluscum contagiousum
best test scabies
microscopic exam under oil immersion
2 hormones are secreted by posterior pituitary
oxytocin antidiuretic hormone (adh, vasopressin)
sheehans syndrome
ischemia of the pituitary due to volume depletion during or after childbirth
how do giltazones work
they improve insulin sensitivity
most common pituitary adenoma
prolactinoma
large doughy hands
dx
gigantism
DM insipid us is caused by a deficiency of which hormone
vasopressin
how much more potent is T3 than T4
3-4x
1st line tx for pheochromocytoma
alpha blocker
never use a pure beta blocker
best imaging for a thyroid nodule
US
pt with ED and complains of some numbness in feet
also with significant polyuria and polydipsia
dx
diabetic neuropathy
pretibial myxedema
dx
graves disease
35 yo F heat intolerance, wt loss and palpitations
hyperthyroidism
1st line tx for pt with palpitations and nervous with hyperthyroidism
beta blockers
hashimoto’s disease
an autoimmune cause of hypothyroid
how does levothyroxine work
it is a synthetic T4
most common thyroid cancer
papillary makes 80% of thyroid cancers
pt with hyperthyroidism, tsh elevated or decreased
decreased
how do fib rates work to affect the lipid profile
inhibit synthesis of VLDL and elevate lipoprotein lipase
med prior to thyroidectomy in a pt with hyperthyroidism
methimazole or
PTU propylthiouracil
while’s triad of hypoglycemia
hx of previous hypoglycemia
serum glucose of <40
immediate recovery upon admin of glucose
+ antithyroid peroxidase and antithyroglobulin antibodies
dx
hashimoto’s
tx for myxedema
levothyroxine and slow warming
most common cause hypoparathyroid
post thyoidectomy with the complication of parathyroidectomy
chvostek’s sign
tap on facial nerve and get a twitch with low Ca
cortical adrenal insufficiency aka
addison’s disease
trousseau’s sign
inflate BP cuff and hold for 3 minutes
pt with low Ca will get carpel tunnel sxs
most common cause of hyperparathyroidism
single parathyroid ademona in 80% of cases
cushing’s disease is ACTH elevated or decreased
elevated
graves disease
most common cause of hyperthyroidism
an autoimmune disease
what specific breathing pattern is associated with diabetic ketoacidosis
kussmaul respirations
least aggressive thyroid cancer
papillary
2 tests you might use to rule out cushing’s
24hr free cortisol urine test and dexamethasone suppression test
3 ectopic tumors that may produce ACTH and give a patient cushing’s sndrome
small cell lung cancer
pancreatic islet cells
thymomas
tx for addison’s disease
hydrocortidone or prednisone
test to begin with if you suspect pheochromocytoma
24 hour urine for catecholamines
exophthalmos
dx
hyperthyroidism
%dm in US type 2
80-90%
HLA-DR gene is a marker for what endocrine disorder
DM type 1
main function of parathyroid hormone
increase serum ca
4 diagnostic criteria for dm
random glucose >200
fasting glucose >126
2hr postprandial >200
HgA1c > 6.5%
moans, groans, stones and bones
what dx
hyperparathyroid
stocking glove should make you think of what dx
diabetic neuropathy and B12 deficiency neuropathy
fruity breath
dx
DKA
dm
dawn phenomenon
reduced insulin response between 5 and 8am
most common cause of hypopituitarism
tumor
how does metformin work
decreases the hepatic glucose production and increases peripheral glucose uptake
how do sulfonylureas meds work
stimulate the production of insulin
what class of meds does pioglitazone (actos) fall into
thiazolidinediones also known as glitazones
suffix associated with sulfonylureas
ide
ex: glipizide, tolbutamide, tolazamide
1st med in DM 2
metformin
how ofter do u check HgbA1c goal?
every 3 months
(rbi life 90-120 days)
below 6.5%
5 criteria for metabolic syndrome
HDL 135/85
Triglycerides >150
Fasting glucose >100
waist >40 men, >35 women
1st class of meds for lowering LDL
statins
lipid med may cause flushing
niacin
life threatening side effect of statins
rhabdomyolysis
does niacin increase or decrease HDL
increase
class of med is metformin (glucophage)
biguanide
5 insulins in order of peak efficacy
lispro 1-2 hrs regular 2-4 hrs NPH 5-7 hours lente 4-8 hrs ultralente 8-14hrs
metformin contra or indicated in renal failure
contraindicated
most common cause of DM type 1
autoimmune destruction of the islet cells in the pancreas
PE in cushings (6)
moon face buffalo hump purple striae central obesity suprclavicular fat pads easy bruising
propranolol what class meds
beta blockers
while pregnant tx for hyperthyroidism
PTU
4 thyroid cancers
papillary
follicular
medullary
anaplastic
what heparin complication is relevant to endo
adrenal infarct leading to a Cushing’s syndrome
how does nicotinic acid work to affect the lipid profile
it inhibits secretion of VLDL
hyper pigmentation of the skin along creases
dx?
addison’s disease
most agressive thyroid cancer
anaplastic
how do statins work to affect the lipid profile?
they slow the rate limiting step of cholesterol synthesis
will ACTH be elevated for decreased in Addison’s
elevated if the problem is at the adrenal glands
what role does C-peptide play in the diagnosis of DM
it is a marker of insulin production
Elevated C-peptide points to DM2
Decreased C-peptide points to DM 1
2 most common pathogens acute sinusitis
strep pneumoniae
haemophilus infuenzae
oral herpes is best treated with systemic or topical antivirals
topical is 1st line
systemic antivirals will help but are only indicated for severe cases
pt with several episodes of vertigo over the past several weeks
intermittent unilateral hearing loss and a “blowing” in his ears
dx?
meniere’s disease
white oral lesion which cannot be scraped off
dx?
oral leukoplakia
what type of hearing loss is associated with aging
sensory
which is the most commonly affected sinus in acute sinusitis
maxillary
pt with a hot potato or muffled voice
dx?
peritonsillar abscess
time frame for chronic sinusitis
> 3 months
list the time of year when each of the following allergens is most prominent:
pollen, grass, mold and ragweed
spring: pollen from trees and flowers
Summer: grasses
Fall: mold and ragweed
how long pressure for nose bleed
15 mins
4 things that suggest group A beta-hemolytic strep
fever
tender anterior cervical adenopathy
no cough
exudate in the throat
child with erythematous sandpaper rash
scarlet fever
pt with sensorineural hearing loss what will be the results of the weber test
pt will hear the sound louder in the unaffected ear
4 complications of untreated strep throat
scarlet fever
glomerulonephritis
rheumatic fever
local abscess
pt with round ulcer in her mouth that is yellow-grey with a red halo
on buccal mucosa
painful
dx?
aphthous ulcers
pt with drooling, stidor and in tripod position
dx? treatment?
epiglottitis
2nd or 3rd gen cephalosporin like cefuroxime or ceftriaxone
oral lesions that can be scraped off leaving punctate bleeding
dx?
oral candida
3 treatments for peritonsillar abscess
needle aspiration
I&D
tonsillectomy
virus that causes mumps
paramyxovirus
tx for allergic rhinitis
intranasal corticosteroid
antihistamines
tx for strep throat
penicillin
amoxicillin
erythromycin
unilateral hearing loss and decrease in speech discrimination
difficulty with balance over a week
dx?
acoustic neuroma
acute swelling and pain in the cheek that increases at meals
dx?
sialadenitis
salivary gland infection
staph aureus
when is watchful waiting with a dx of acoustic neuroma an appropriate plan
if tumor is very slow growing
watching a small tumor in an elderly pt is appropriate tx
what type of hearing loss would be caused by cerumen impaction
conductive
how do you administer the weber hearing test
tuning fork placed in the middle of the forehead
14 yo with adenopathy, white purple exudates in throat and palpable spleen
dx
mononucleosis
how do you administer the weber hearing test
tuning fork on the mastoid and then move it next to the ear
results of a weber hearing test in pt with conductive hearing loss
pt will report sound louder in the affected ear
x-ray of the skull reveals coalescence of mastoid air cells
dx?
mastoiditis
abc 1st line sinusitis
amoxicillin or bactrim
45 yo female complains of feeling the ground rolling under her feet at times
dx?
vertigo
pt with hx of smoking presents with new onset hoarseness, persistent for 2 weeks
dx?
laryngeal squamous cell carcinoma
pt presents with acute onset of continuous severe vertigo for the past 5 days
hx URI 2 weeks ago
dx
labrynthitis
what does kiesselbach’s plexus refer to
group of veins in the anterior nose which bleed a lot
small grouped vesicles on the vermillion border
dx
herpes
most common type kidney stones
calcium 85% of stones
most specific imaging for kidney stones
CT
will a spermatocele transillumnate
yes
a stone of what size will likely pass
less than 5mm
3 possible treatments for stress incontinence in women
kegels
estrogen therapy
surgical placement of a urethral sling
65 yo male presents with frequency
on rectal exam elastic moderateley enlarged prostate
dx
BPH
a PSA above what is concerning
> 4
risk factors for ED
DM, htn, depression, CAD
1 major risk factor for bladder cancer
smoking
paraphimosis
foreskin is retracted and cannot be reduced
which is an emergency phimosis or paraphimosis
paraphimosis
phimosis
the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis.
what is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis
peyronie’s disease
both testicles should be descended by what age
3 months
feeling a bag of worms in the scrotum
dx?
varicocele
fluid filled painless mass found in the scrotum which transilluminates
dx?
hydrocele
1st line treatment for a variocele
watchful waiting unless there is a question of fertility
prehn’s sign
decreased pain with scrotal elevation
meaning prehn’s sign
the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion
maltese crosses in the urine
dx?
nephrotic syndrome
imaging for bladder cancer
cystoscopy and bx
free floating, painless, cystic mass found posterior and superior to the testis
dx?
spermatocele
age range is typically associated with testicular torsion
10-20 yo
where is the epididymis found
posterior upper pole
best imaging to rule out testicular torsion
doppler US for decreased blood flow to the testes
2 most common causes epididymitis
gonorrhea
chlamydia
med classes to prevent chronic renal failure in DM pts
ACEIs or ARBs
will epididymitis feel better with scrotal elevation
yes
nl level serum bicarb
24
tx epididymitis
ceftriaxone and doxy
1st line abc for cystitis
bactrim
most common organism for bladder infection
E.Coli
1st line abx for postatitis
bactrim 4-6 weeks
risk factors for prostate cancer
advancing age
african american
+ family hx
high fat diet
what do you feel on a digital rectal exam on a pt with prostate ca
enlarged prostate
hard nodules
priapism
painful persistent erection
how many samples from a prostate bx
6 to 12
painless hematuria
dx
bladder cancer
most common bladder cancer
transitional cell cancer
phimosis
foreskin can not be retracted
head of the penis curves downward for upward at the junction of the head and shaft of the penis
chordee
often associated with hypospadias
tx urethritis
ceftriaxone and doxy
3 yo boy with hematuria and a painless and mass
dx
wilms tumor
3 possible causes of pre renal renal failure
CHF
severe dehydration
hemorrhage
most common cause post renal failure
BPH
post renal renal failure is secondary to an outflow obstruction
muddy brown sediment in the urine
dx
acute tubular necrosis
tea colored urine with red cell casts
dx
glomerulonephritis
2 common predisposing factors in chronic renal failure
HTN
DM
sponge like prostate on rectal
dx
prostatitis
you can cause sepsis with a rectal exam
is serum potassium decreased or elevated in renal failure
elevated
urine protein of >3.5 gm/day
dx
nephrotic syndrome
hereditary of polycyctic kidney disease
autosomal dominant
nl ph of blood
7.35-7.45
how to dx urethritis
urine PCR
nl PCO2
40
abg shows ph 7.2 bicarb 25 pco2 50 respiratory or metabolic acidosis
respiratory co2 is elevated
WBC casts
dx
pyelo
what area of the prostate is affected by BPH
transitional zone
what area of the prostate is the primary side for prostate cancer
peripheral zone
involuntary loss of urine during coughing or laughing
stress incontinence
nl bladder function but can not get to the bathroom
functional incontinence
what type of incontinence is seen with BPH
overflow incontinence
the bladder can not empty sufficiently
at what age do you start screening for prostate cancer, how?
50 with rectal and PSA
often caused by chlamydia what syndrome is characterized by urethritis, arthritis and conjunctivitis
reiter’s syndrome
most common type of testicular cancer
nonseminoma
nl range for MCV
80-100
most common microcytic anemia
iron deficiency anemia
anemia of chronic disease is
normocytic
2 main causes of a macrocytic anemia
malnutrition
severe blood loss
does an increase in reticulocytes indicate a decrease or an increase in RBC production
an increase
reticulocytes are newly released baby RBCs
auer rods
dx?
acute myeloid leukemia
what molecule binds iron in the blood stream
transferrin
koilonychia
spoon shaped nails
microcytic anemia
will the serum ferritin be high or low in a patient with iron deficient anemia
almost always be low
a low retic count and a normal serum ferritin
dx?
anemia of chronic disease
what level consider transfusion
8
asplenism secondary to sickle cell disease increases a patient’s risk for what type of infections
capsulated organisms like strep pneumo and H flu
AA teen presents with avascular necrosis of the R femoral head
dx?
sickle cell disease
tx for sickle cell
fluids
oxygen
pain meds
transfusion
in sickle cell unconjugated bill high or low
high
which anemia has Howell-Jolly bodies
sickle cell
due to the functional asplenia
also in folic acid deficiency
G6PD inheritance
X-linked
3dx for Heinz bodies
G6PD deficiency anemia
chronic liver disease
alpha thalassemia
pica?
eating non-food items
target cells in mild or severe iron deficiency anemia
severe
also in
alpha thalassemia
chronic liver disease
asplenia
level of iron in iron deficiency anemia
30
B12 deficiency anemia
micro, normo or macrocytic
macrocytic
4 regions for alpha thalassemia
southeast asia
china
middle east
africa
mediterranean descent which anemia
beta thalassemia
level of folic acid in folic acid deficiency
< 150
pica which anemia?
iron deficiency anemia
inability to absorb vitamin B12 due to lack of intrinsic factor
dx?
pernicious anemia
stocking glove paresthesias
2dx?
B12 deficiency neuropathy
diabetic neuropathy
RBCs size in B12 deficient anemia
macrocytes
retic count in B12 deficient anemia
retic count will be low
schilling’s test used for
test for the cause of B12 deficiency
Strict vegans are at risk for which anemia
B12 deficiency anemia
sickle cell
micro, macro or normocytic
microcytic
will hemolytic anemia have elevated or decreased retic count
elevated
4 dx with basophilic stippling
lead poisoning
beta or alpha thalassemia
sideroblastic anemia
arsenic poisoning
anemia of pregnancy
iron deficiency
dx?
philadelphia chromosome
chronic myeloid leukemia
white curd like vaginal dc
dx?
yeast
owl eye inclusion bodies
dx?
CMV
cytomegalovirus
+ blood cultures for canidida
1st line drug?
amphotericin B
tx for pertussis
erythromycin x 7 days
a leukemia pt has a CT of the liver which shows punched out lesions
dx?
hepatosplenic candida
what disease does rickettsia rickettsii cause
Rocky mountain spotted fever
india ink stain showing cysts
dx?
cryptococcosis
COPD pt has apical cavities and calcified nodes on CXR, he has a pet bat and a few birds
dx?
histoplasmosis
HIV pt with a nonproductive cough and CXR with diffuse interstitial infiltrates
dx?
PCJ / PCP
pneumocystis jiroveci pneumonia
honey and babies
dx
botulism
what type organism causes botulism
gram + rod
clostridium botulinum
tx for botulism
antitoxin
ER pt with acute progressive weakness, diplopia and very dry mouth
dx?
clostridium botulinum
rice water stool
dx?
cholera
is diphtheria a gram + or negative organism
gram-positive
a stuck on grey membrane in the pharynx
dx?
diphtheria
4 steps in treating diphtheria
antitoxin
pcn
remove membrane
report case to CDC
clinical name for whooping cough
pertussis
what type organism for tetanus
gram + rod
clostridium tetani
pt ate out last pm today with cramping and bloody diarrhea
organism?
salmonella
diarrhea with blood and mucus
dx?
shigella
best test to dx malaria
peripheral blood smear
organism for reactive arthritis
shigella
reactive arthritis has a + HLA-B27
tx for shigella
bacterium or fluroquinolones and hydration
organism for lyme disease
borrelia burgdorferi
minimum Amt of time needed for a tick to transfer lyme disease to a human
24 hours
drug of choice to treat lyme disease in kids or pregnant women
amoxicillin
drug to treat C. difficile
flagyl
pt in woods yesterday and today with erythema migrains
dx
lyme disease
drug to treat or prophylaxis of malaria
chloroquine
pt was camping a few days ago
now has rash that began on his wrists and ankles
dx
rocky mountain spotted fever
drug of choice for rocky mountain spotted fever
doxycycline
drug of choice for syphilis
pcn
any reference to dark field microscopy should make you think what organism
treponema pallidum
staph gram + or -
gram +
pt being treated with pen for syphilis
develops fever, chills, muscle pain and ha
do u stop tx?
no
this is a jarisch-herxheimer rxn
pt must be closely monitored
it is a response to released endotoxin from the death of the spirochetes and not an allergic reaction
what organism is believed to cause PUD
h. pylori
painless, clean base chancre
dx
primary syphilis
pseudomonas
gram + or -
gram -
rash on palms and soles
fever, chills
painless chancre a few weeks ago
dx?
secondary syphilis
most contagious
tx for cholera
fluids
drug of choice for cytomegalovirus
ganciclovir
herpes virus that causes epistein-barr
herpes 4
pt education for mono
no contact sports - splenic rupture
no kissing - contagious
exudative sore throat, malaise
PE- posterior chain lymphadenopathy, mild splenomegaly
dx?
epstein-barr virus
1st sxs rabies infection
pain and anesthesia at the site of the bite
definitively dx rabies
pathology of the brain of the animal using fluorescent antibody stain
pt bit by rabies animal
what days do you give human diploid cells
0, 3, 7, 14, 28
diaper rash with satellite lesions
dx
canidida
3 serious reactions to vancomycin
nephrotoxicity
ototoxicity
stevens-johnson
tests done to screen for HIV
ELISA and then if +
confirm with western blot test
drug of choice for lyme disease
doxycycline
trismus?
lock jaw
often secondary to tetanus
tx amebiasis
flagyl
