card review Flashcards
what is the definition and treatment of intermittent asthma
this is the lowest form of asthma. this is SABA use <2 days a week, <2 times a month of nighttime awakenings.
this is step 1 of indicated therapy
what is the definition and treatment of mild persistent asthma
this is the second lowest form of asthma. this is SABA use >2 days a week but not daily, 3-4 times a month of nighttime awakenings.
this is step 2 of indicated therapy
what is the definition and treatment of moderate persistent asthma
this is the a moderate asthma. this is SABA use daily, > 1 time a week nighttime awakenings.
this is step 3 treatment
what is the definition and treatment of severe persistent asthma
this is severe asthma. this is SABA use throughout the day. 4-7 times weekly. This is step 4-5 indicated therapy
what is step 1 asthma treatment
short acting beta-agonist therapy PRN
what is step 2 asthma therapy.
low dose inhaled corticosteroid
what is step 3 asthma therapy
low dose inhaled corticosteroids and long acting beta agonists or medium dose inhaled corticosteroids
what is step 4 of asthma therapy
medium dose inhaled corticosteroids and long acting beta agonists.
what is step 5 of asthma therapy
high dose inhaled corticosteroids and long acting beta agonists nd omalizumab for patients with allergies
what is step 6 in asthma therapy
high dose inhaled corticosteroids and long acting beta agonists and oral corticosteroids and omalizumab for patients with allergies
what does MEN1 syndrome consist of for tumors
pancreatic, pituitary and parathyroid adenomas
what is thromboangiitis obliterates
an occlusive vascular disease characterized by segmental inflammatory, nonathrosclerotic lesions of small and medium-sized blood vessels. history of tobacco is common. there are usually segmental occlusions in the arteries and veins and corkscrew collateral vessels.
what is thromboangiitis obliterates assocaited
strongly associated with smoking and cessation is the only management shown to be effective
what nutrient deficiencies are important in Roux enY bypasses
B12 deficiency is common in about 30% of patients
what is lichen sclerosis
usually widespread on the labia majora and involves both sides of the vulva. the skin will appear white and thin, usually described as parchment paper or cigarette paper thinness.
what is the treatment for lichen sclerosis
behavioral change such as hygiene nd minimizing scratching of the affected area. can be treated with topical steroids.
how does lichen planus present
white bands next to red, ulcerative lesions. they appear in the vulva and frequently occurs in the vagina./
what is pemphigus foliaceus
autoimmune disease characterized why thin walled blisters and it is caused by auotantibody demoglein-1.
what is epidermolysis bulls simplex
inherited disease affecting the adhesion of skin cells. the most common disorder resulting in blistering lesions that painful. this often shows up during childhood.
what is pemphigus vulgaris
severe form of pemphigus that affects both the cutaneous and mucosal surfaces. caused by autoantibody desmoglein-3
what is loeys-dietz syndrome
associated with bifid uvula, hypertelorism, and increased arterial tortuosity. it is highly associated with aortic aneurysms and dissections. regular screening with echocardiograms is indicated
what is the most likely origin of a bone mets in an elderly male
prostate cancer
what are the SE of cisplatin
nephrotoxicity, ototoxicity, nausea and vomiting, neurotoxicity.
what kind of drug is cisplatin
alkylating agent that cross links DNA thereby interfering with mitosis
what are the risk factors for endometrial hyperplasia
more likely to develop secondary to conditions that elevate estrogen, such as hormone replacement, granulosa cell tumors, obesity, anovulatory cycles, PCOS and null parity.
what are the characteristic findings in whipples disease
diarrhea, wasting, abdominal pain, joint pain.
what is the pathological findings for whipples
PAS positive in the lamina propria on small intestinal biopsy
what people are more likely to have whipples
farmers and people that work with soil and animals.
what is the causal organism for whipples
T. whipplei
gram positive
what is the treatment for whipples disease
antibiotics are first line treatment. IV Ceftriaxone for two weeks in people with nervous system involvement.
what are the conditions that can cause mediastinal mass
thymoma, teratoma, thyroid masses, and thoracic aortic aneurysm as well as Hodgkin lymphoma
what is the first line therapy for hypertension in pregnancy
labetolol is the first line treatment.
what hypertensive meds should be avoided in pregnancy
ACE and ARBs should be avoided.
Can thiazide diuretics be used in pregnancy
yes, but they should be avoided because they counteract the volume expansion
what drug use is associated with hepatic adenomas
sex hormone exposure, such as anabolic steroids. OCPs are also associated!
what to look for in a patient with streptococcus Bovis bacteremia
colorectal cancer can cause this need colonoscopy
what imaging finding is pathognomonic for asbestosis
pleural plaques
what is the treatment of patients with community acquired pneumonia in an inpatient setting
fluoroquinolone or beta-lactam and macrolide IV
what is the treatment for beta blocker overdose
glucagon. it increases cAMP
what is the treatment for iron overdose
deferoxamine –iron chelator
what is the treatment for methanol or ethanol overdose
fomepizole. inhibits alcohol dehydrogenase
what is familial hypercholesterolemia
genetic disorder of high cholesterol caused by a mutation in the LDL receptor
what is the treatment for familial hypercholesterolemia
statins such as atorvastatin
what is the treatment for ventricular tachycardia
immediate defibrillation
How should chemical burns such as bleach be handled immediately
with copious irrigation with water.
what does ceftriaxone cover
broad spectrum, but as a third generation cephalosporin it also has gram negative coverage
what is cefazolin
this is a first generation ceph. it has good gram positive coverage
what is cefuroxime
second generation cephalopods. this has good abroad spec coverage of gram positive
Is doxycycline used in children
no. tooth discoloration
what is penicillin
beta lactam. used for narrow spectrum gram positive streptococcal infections
what is ceftriaxone
third generation cef. with good gram negative ad positive coverage
what is one of the most common presentations of Hodgkins lymphoma
mediastinal masses are found in upwards of 75% of patients with HL.
what is the presentation of Hodgkins lymphoma
B cell symptoms (weight loss and fever), lymphadenopathy and splenomegaly, 25-50% of cases are EBV positive, mediastinal masses are very common, superior vena cava syndrome, cough and stridor.
eosinophilic esophagitis is what
autoimmune inflammatory conidtion of the upper esophagus that results in chest pain and trouble swallowing it is often seen with other allergic conditions like asthma, atopic dermatitis, and food allergies. there must be greater than 20 eosinophils on endoscope guided biopsy
what is the presentation and prognosis for lichen planus?
classically appears with the 6 ps purple, planar, polygonal, pruritic papule and plaques with a predilection to the flexor surfaces
what are the histologic findings of lichen planus
irregular acanthosis, of the epidermis colloid/civette bodies –immunoglobulins and degenerated keratinocytes
what is foster-kennedy syndrome
tumor on the inferior surface of the frontal lobe such as ol factory groove tour. the symptoms are anosmia, ipsilateral scotomna, and contralateral papilledemta.
what is the presentation of trichomoniasis
vaginal and vulvar erythema, burning and pruritic, foul, thin yellow-green discharge
what is the treatment for trichomoniasis
metronidazole or tinidazole –partner must take as well.
what is the presentation of chlamydia
Cervicitis from Chlamydia trachomatis infection is characterized by vaginal discharge, abnormal vaginal bleeding, and purulent endocervical discharge. Pain may manifest with an ascending infection causing pelvic inflammatory disease.
what is the presentation of gonococcal infection
Most Neisseria gonorrhoeae infections are asymptomatic in women. N. gonorrhoeae cervicitis can manifest with vaginal pruritus, mucopurulent cervical discharge, dysuria, or perilabial pain.
what is the presentation of von hippel Lindau
AD familial multisystem tumopr syndrom caused by mutations in the VHL tumor suppressor. hemangioblastomas of the cerebellum, renal cell carcinoma, pheochromocytoma and pancreatic islet tumors.
what is HIV associated lipodystrophy
this is the loss of subcutaneous fat in individuals infected with HIV. it results in changes similar to cushings.
what is one cause of HIV associated lipodystrophy
protease inhibitors that are used to treat HIV
such as indinavir
what is a halo nevi
a nevus with a surrounding area of depigmentation.
what is halo nevus associated with
associated with vitiligo, turner’s syndrome and malignant melanoma
what is a pleomorphic adenoma
the most common salivary gland tumor. they are almost always benign, but have the potential to become malignant. they are biphasic tumors and contain a mixture of epithelial components in a mucoid myxoid cartilaginous or hyaline stroma
How does typhoid fever present
fever, abdominal pain, rose spots and dysentery.
what does salmonella typhii look like
gram negative motile rod.
what is the treatment for salmonella
antibiotics that treat gram negative such as ciproflaxacin, third generation cefalosporins such as ceftriaxone
what is the treatment for hemochromatosis
serial phlebotomy
what is choriocarcinoma
cancer characterized by the growth of malignant placental cytotophoblasts and syncytioblasts that lack chorionic villi. these tumors spread hematogenously and can present as hemoptysis and shortness of breath.
what is the presentation of leptospirosis
jaundice, heptosplenomegaly, renal failure, and pulmonary hemorrhage, bilateral conjunctival injection
where is leptospirosis found
zoonotic diseases transmitted by urine in contaminated water or soil
what are the two most common causative organisms of pelvic inflammatory disease
chlamydia and gonorrhea
how does PID present
purulent cervical discharge pain and fever
what drugs do we give in acute coronary syndrome
anti-coagulants, anti-platelet, beta blockers and venous dilators are all recommended
what does Ibuprofen do to the kidneys
causes acute kidney injury.
what causes Acute kidney injury by NSAID
decreased production of prostaglandins which leads to reversible renal ischemia and reduced GFR.
what is found in acute kidney injury
elevated creatinine and hyaline casts
what is typically found with glomerular lesions or damage
significant proteinuria
what is acute tubular necrosis
This is one of the most common causes of AKI due to ischemia or nephrotoxic drugs. muddy brown casts of epithelial cells or granular casts
what is found in acute interstitial nephritis
white blood cells.
also pyuria, hematuria
what is acute interstitial nephritis
nterstitial nephritis is an inflammation of the interstitium of the kidneys surrounding the tubules. Commonly causes include infection, or reaction to medication such as an analgesic or antibiotics such as methicillin. This disease is also caused by other diseases and toxins that damage the kidney. Both acute and chronic tubulointerstitial nephritis can be caused by pyelonephritis, but the most common cause is by an adverse reaction to a drug.
what is chvostek’s sign and what does it show
this is tapping on the side fo the face and looking for muscle twitching. this is a sign of neuronal hyperexcitability. this is a sign of hypocalcemia
what is mackonkey media
this is for bacteria that ferment lactose
what is pseudomonas aeruginosa
gram negative rod that does not ferment lactose
enterobacter aerogenes
this is a gram negative rod that does ferment lactose. it is a frequent nosocomial infection that causes UTI
what is jarisch-herxheimer reaction
treatment of syphilis with penicillin G and characterized by headache, myelgias, hypotension, and tachycardia
what happens to lipids in nephrotic syndrome
they increase –hyperlipidemia
the mechanism is hypoproteinuria from increased liver production of both protein and lipids
what drugs cause interstitial nephritis
diuretics, NSAIDs, penicillins/cephalosporins/TMP-SMX, PPIs, rifampin
what is CURB65 criteria and what is it used for
treatment guide and location for patients with community acquired pneumonia
confusion
uremia >20mg/dl
respirations >30
blood pressure <90 systolic; 60 diastolic
65 age.
one point for each criteria and the higher the score the increased risk for mortality
what serum ascites albumin gradient indicates portal hypertension
> 1.1
what is the earliest sign of kidney injury in diabetic nephropathy
increased GFR or hyperfiltration
what does diabetes do the kidneys
thickens the GBM, mesangial expansion and glomerular sclerosis
what are the treatments for outpatient treatment of community acquired pneumonia for a healthy person
macrolide or doxycycline
what are the treatments for outpatient treatment of community acquired pneumonia for a person with comorbidities
fluoroquinolone or beta lactam + macrolide
what are the treatments for inpatient community acquired pneumonia Non-ICU
fluoroquinolone (IV) or
beta-lactam + macrolide (IV)
what are the treatments for inpatient community acquired pneumonia ICU
beta-lactam + macrolide (IV)
beta-lactam + fluoroquinolone
what is the most common cause of hematuria in adults and what is the presentation
IgA nephropathy
gross hematuria 5 days after URI
what does rhabdomyolysis do to the kidneys
causes acute tubular necrosis, hyperkalemia and elevated creatine kinase
what are the copper chelators
D-peniillimine and trientine
what is focal segmental glomerulosclerosis associated with
African American and hispanics, obesity, HIV and heroin use
what is membranous nephropathy associated with
adenocarcinoma (breast and lung), NSAIDs, HepB, systemic Lupus, renal vein thrombosis
what is membranoproliferative glomerulonephritis associated with
Hep B and C and lipodystrophy
what is minimal change disease associated with
NSAIDs and lymphoma
what is IgA nephropathy associated with
URI
what can happen after a tonic clonic
post ictal lactic acidosis
what nephrotic syndrome is associated with rheumatoid arthritis
amyloidosis
what is the description of amyloidosis
apple green birefringence, Congo red
what is Hep C infection associated with
cryoglobinuria
what is osmotic diarrhea
high stool osmotic gap >125mOsm/kg. due to non absorbed osmotically active agents, such as lactose.
what is a major side effect of amiodarone
drug induced interstitial nephritis
what is the characteristic of biliary stasis
elevated alkaline phosphatase.
what is the characteristic of extra-hepatic cholestasis
biliary dilation with elevated alkphos
what is the characteristic of intrahepatic cholestasis
NO biliary dilation with elevated alkphos
what are the causes of hyperbilirubinemia with normal LFTs and alkphos
dubin-johnson syndrome and rotors syndrome
what is hepatopulmonary syndrome
due to intrapulmonary vascular dilations in the setting of chronic liver disease. leads to platypnea and orthodeoxia
what is the test of choice for patient that has an intermediate risk for CAD
stress test
what is the test of choice for a patient with a high risk for CAD
coronary angiogram
what can beta-2 agonists cause
hypokalemia and thus muscle weakness
what is the most common cause of aortic dissection
hypertension
what physical exam maneuver can distinguish between hepatic and cardiac causes of edema
hepatojugular reflex. tilting the head to one side and pressing on the abdomen allows to test for JVD changes.
a positive test is suggestive of cardiac causes
what is the treatment for acute TB
RIPE therapy rifampin, isoniazid,pyrazinamide, and either ethambutol or streptomycin
what is the difference between primary hyperparathyroidism and familial hypocalciuric hypercalcemia
there is increased renal clearance of calcium in primary hyperparathyroidism
what are hexagonic crystals on urinalysis indicative of
cystinuria
How does renal failure cause coagulopathy
renal decreases urea clearance and this causes platelet dysfunction.
how is platelet dysfunction by uremia managed
Desmopressin or hemodialysis
what are the causes of reactive arthritis and how does it present
cant see, cant pee and cant climb a tree. conjunctival, urethral and polyarthalgia (achilles tendonitis), can also present with mouth ulcers
caused by various infections such as chlamydia, salmonella, etc.
first line treatment for reactive arthritis
NSAIDs
what is the laser tralet sign
multiple seborrheic keratoses begin associated with internal malignancy
what are the long and short term treatments for dermatitis herpetiformis
acute dapsone and long term is gluten free diet
what is the abortive and preventive therapies for prinzmetal angina
abortive is sublingual nitroglycerine and preventive is CCB.
what hormonal changes are present in small cell lung cancer
SIADH and entropic ACTH or cushings
how do we treat symptomatic bradycardia
acutely with atropine and one term itch pacemaker
what is beck’s triad and what does it indicate
JVD, muffled heart sounds, hypotension indicates cardiac tamponade
what is the EKG finding for cardiac tamponade
electrical alternans alternating low voltage QRS
what should you think when a person has wheezing, hypotension, respiratory distress after a transfusion
IgA deficiency causing anapohylacis
what is the presentation of Jarisch-herxheimer reaction
fever, headache, myalgia, diffuse macular rash on the palms and soles
what is the presentation of CMV in an immunocompromised person
lung, liver, gut.
dyspnea, LFTs and diarrhea.
what is the presentation of ehrlichiosis
flu-like illness after bite from lone star tick. licks the liver. elevated LFTs, leukopenia, thrombocytopenia
what is the recommended treatment for infective endocarditis with pen sensitive strep
IV ceftriaxone or IV penicillin G for 4 weeks.
what is the treatment for toxoplasmosis
sulfadiazine and pyrimethamine.
what are the dermatological presentations of dermatomyositis
gottrons nodules and periorbital heliotrope rash
what antibodies are associated with dermatomyocitis
anti-RNP, Jo-1, Mi-2
what is the characteristic sign of diversticulosis bleeds
usually painless, large volume and self-limiting.
what type of esophageal cancer is associated with smoking and alcohol consumption
squamous cell carcinoma.
what is the classic hematuria for glomerular disease
microscopic
what are the most common causes of glomerular disease
glomerulonephritis (post-strep, IgA) alport syndrome (basement membrane disease).
what are the characteristic findings of rheumatoid arthritis
soft tissue swelling, osteopenia, erosions, and joint space narrowing. later changes are subluxation causing ulcer deviation, Z-thumb, boutonnueire and swan neck deformities. as well as ankylosis
what is the most common feature of a mallory weis tear
hematemesis. distal esphageal rupture due to forceful retching.
what is the smell of bitter almonds or breath of bitter almonds indicative of?
cyanide poisoning
remember that chronic atopic dermatitis can cause what
lichen simplex chronicus
what is porphyria cutanea tarda
caused by deficiency of uroporphyrinogen decarboxylase and leads to a build up of porphyrins in the blood. symptoms are photosensitivity and tea colored urine. may be precipitated by alcoholism
what are the risk factors for porphyria cutanea tarda
alcoholism, hepatitis C, smoking, estrogen use,
what happens to potassium in DKA
there is usually high blood potassium, but low total body potassium. Potassium needs to be administered during DKA
what is the definition of euthyroid sick syndrome
when there is low t3 and or t4 with a normal functioning thyroid
how long do troponins stay elevated in someone with an MI
apporx a week
shortness of breath and hematuria with signs of nephrotic syndrome
goodpastures.
think lung and kidney.
what is the histology of good pastures
crescent shape of the glomeruli. antibody attack ruptures the basement membrane
what is a sign of intestinal transplant rejection
watery diarrhea.
Since the intestine is responsible for water reabsorption, lack of function is what you would see in rejection
what antibodies are associated with hashimotos
anti-TPO and anti-thyroglobulin
what is the most common cause of hypothyroid that is not iatrogenic
hashimotos
what are the risk factors for DVT
previous DVT active cancer immobilization/bedridden > 3 days tenderness along venous tracts unilateral leg selling pitting edema if score is greater than or equal to 2 DVT likely
give at least two examples of pro-kinetic agents for diabetic gastroparesis
metacloperamide and erythromycin
ovarian mass and hyperthyroidism
think struma ovarii or teratoma
which tumor causes torsion of the ovary
dermoid cyst
what is the gene for severe combined immunodeficiency
adenosine deaminase
what is the presentation and cause of MALT lymphoma
marginal zone B cell lymphoma is caused by H pylori infection. low grade type of non-hodgkin lymphoma.
what is the treatment of thyroid disease in pregnancy
methimazole
what is the treatment for community acquired cellulitis (even with nares positive MRSA)
TMP-SMX and cephalexin
vancomycin and clindamycin also cover staph.
how can you tell that its papillary adenocarcinoma of the thyroid
there are psommoma bodies
how does polymyositis present
PAIN and stiffness in the shoulders and weakness in the proximal muscles. there is elevated Ck, elevated aldolase and positive anti-jo-1 antibodies
what is the presentation of polymyalgia rheumatica
proximal muscle PAIN and STIFFNESS with NO weakness. normal CK and aldolase
increased ESR.
what cells are destroyed in MS
oligodendrocytes you asshol e
what type of RX is SJS/TEN
type IV hypersensitivity
what is the treatment for basal cell carcinoma or SCC in immunocompromised patients
MOHS
especially on cosmetically sensitive areas
what is a common cardiovascular SE of OCPs
hypertension
