Clerkships-MEDICINE Flashcards
Which thrombolytic is bad to give repeatedly and why?
Streptokinase- immunogenic
Ddx for mid systolic murmur (“6”)
Aortic/Pulmonic Stenosis/Sclerosis Anemia Fever Thyrotoxicosis Pregnancy Hypertrophic Cardiomyopathy (younger)
What does valsalva do in a circulatory sense?
Decreases preload
What does valsalva do to AS and HOCM? Squatting? Why?
Valsalva decreases AS murmur and increases HOCM murmur because it reduces preload and therefore decreases the amount of blood going across the stenotic valve. Squatting increases AS and decreases HOCM because of increased venous return?
Louder with valsalva, click
MVP
Holosystolic w/ radiation to axilla
MR
Holosystolic murmur with with late diastolic rumble
Wide fixed and split S2
VSD
ASD
Close contact meningitis ppx?
Listeria - which two populations, and what tx?
If Instrumentation in the head?
Best first step in meningitis?
Lyme meningitis tx?
TB meningitis tx?
Most common organisms with meningitis? Tx?
- Rifampin
- Really young and old, ampicillin
- Staph, vanc
- CHECK FOR ICP, empiric tx!, then lumbar puncture to confirm
- ceftriaxone
- STEROIDS +ripe
-strep pneumo, n. gonnohrea, h. flu; ceftriaxone/vancomycin
Tularemia tx?
Birthed a cow dx tx?
HAP tx?
Old person with PNA, diarrhea, abdominal pain?
PNA after having the flu?
Young?
Streptomycin, Gentamycin q-fever from coxiella burnetti, tx. doxy MRSA, pseudomonas, klebsiella, ecoIi; Pip-tazo/imipenem+vanc Legionella MRSA, vanc atypical, mycoplasma, tx doxy, FQ, macro
Endocarditis MC bact for acute? MC bact for subacute? IVD? MC valves? Indication for colonoscopy screening?
Staph aureus (tx. PNC) Strep viridans (tx. nafcillin + gent/vanc), staph aureus Mitral, Tricuspid (IVD)
with strep BOVIS (colon cancer)
Threshold for treating HIV?
HAART Side effects, name the drug:
1) GI, leukopenia, MACROCYTIC anemia
2) Pancreatitis, Peripheral neuropathy
3) HSR, rash, n/v, muscle aches, SOB
4) nephrolithiasis, hyperbilirubinemia
5) psych and sleep disturbance
CD455000; pregnant - lower threshold (new guidelines?)
1) Zidovudine
2) Didanosine
3) Abacavir
4) indinavir (protease inhibitor)
5) efavirenz (non-nucleoside rev. transcriptase inhibitor)
Tx for post-needle stick HIV ppx?
triple therapy (“2+1”): lamivudine, nelfinavir, AZT (azidothymidine)
(2 reverse transcriptase inhibitors “-vudines?”+ N-NRTI/-navir (protease inhib) [+ritonavir]/entry inhibitor)
Suspicion for pna in AIDS?
BFS?
Tx 1st and 2nd lines?
When to ppx and with what? Other 2 ppx for the other 2 bugs
PCP
CXR, BALavage
TMP-SMX, TMP-Dapsone, (aerosolized) pentamadine, ATOVAQUONE (esp. in G6PD)
If CD4<50 MAC (mycobacterium avium complex), azithromycin
Ddx for ring enhancing lesion(s) on CT in AIDS?
Multiple: Toxoplasmosis (tx. pyrimethamine-sulfadiazine) for 6 weeks, if no improvement, consider CNS lymphoma. [EBV assoc.; tx w/ HAART]
Single: CNS lymphoma
De ja vu and 500 RBC in CSF in AIDS?
Meningitis in AIDS?
Hemisensory loss, visual impairment, babinski?
HSV temporal enephalitis (tx acyclovir asap)
Cryptococcal (tx. amphoterocin, flucytocine/fluconazole)
PML from JC polyomavirus, demyelination of the gray-white jxn, dx with brain bx
Rash at wrists/ankles/palms/soles, fever, headache.
cause? tx?
Rikettsiae, doxycycline
lyme disease signs (beyond targetoid rash)
tx? kids?
what about tick bite, no rash… myalgia, fever, headaches, thrombocytopenia, leukopenia, elevated ALT?
AV block, meningitis, facial nerve palsy
doxycycline, amoxicillin (peds), ceftriaxone (CNS)
erlichosis (dx. doxy)
aerobic, gram+, cavitary lung lesion, immunosuppressed, partially acid fast purulent sputum
neck/face infection, draining yellow material (sulfur granules), gram+ anaerobic
nocardia, tx. TMP-SMX
actinomyces (tx. high dose PCN)
When would you use a FEUrea instead of FENa
someone on diuretic. 35% is the new number
Definition of nephritic syndrome (4)
Definition of nephrotic syndrome
1) nephrItic range proteinuria (3.5g/day)
2) hyperlipidemia (waxy casts)
3) edema
4) hypoalbuminemia/hypoproteinemia
Differentiate berger’s IgA nephropathy and PSGN (and BFS) and HSP
IgA nephropathy 1-2 DAYS after a viral infection
PSGN 1-2 WEEKS after impetigo or pharyngitis (BFS ASO titer)
Kid s/p viral URI with purpura, arthralgia, RF, and abdominal pain (tx steroids/supportive)
Hematuria + Hemoptysis
Hematiura + Deafness
Pathophys?
Goodpasture’s
Alports
Both collagen IV def.
Painless hematuria?
Blood only at the end of the piss?
Bladder cancer
Bladder Cancer/Hemorrhagic cystitis (from cyclophosphamide?)
Cardiac patient s/p cath, was given TICLOPIDINE, now has thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, and RF. Dx/Tx?
Kid s/p hamburger, diarrhea, RF, petechiae, and MAHA. dx/tx?
TTP (thrombotic thrombocytopenic purpura); ticlopidine is the culprit. DO NOT GIVE MORE PLATELETS. treat with PLASMAPHERESIS.
HUS. Ecoli/Shigella. DON’T treat with abx.
Distinguish the lab findings in TTP, HUS, and DIC.
TTP/HUS, PT and PTT are spared
DIC, all 3 are fucked.
Distinguish Wegeners, Churg-Strauss, PAN and dxs and txs
Wegeners - c-anca, kidney, lung, sinus, steroids/cyclophosphamide (dx kidney biopsy)
CS - p-anca, kidney, asthma, eosinophilia, tx cyclophosphamide (dx lung biopsy)
PAN - p-anca, all vessels except NO LUNG, tx cyclophosphamide, hepB
Recite kidney stones and the (5) types of stones and 3 tx options based on size, and then individual tx.
CT, 2cm surgical resection, in between shock wave lithotripsy
1) calcium oxalate, tx HCT
2) chemo - uric acid stones, tx alkalinization of urine
3) struvite from klebsiella, proteus, staph, pseudomonas (AlMgPO4)
4) kids/hereditary - cysteine
5) s/p bowel resection - oxalate only (can’t absorb Ca++)
Sudden flank pain in someone w/nephrotic syndrome
Renal vein thrombosis (they’ve lost ATIII, C, S in urine)
CT/U/S stat
Nephrotic Syndromes:
1) MC Kids:
2) MC adults:
3) HIV/Heroin:
4) Chronic hepatitis/low complement:
Name some others
1) minimal change dz (tx steroids)
2) membranous nephropathy
3) FSGS
4) membranoproliferative
MM,
Microcytic Anemias (4) low MCV
[define RDW and its significance]
Macrocytic Anemias (3) high MCV
Hemolytic Anemias (6) normal MCV [name the other 3 labs]
1) Iron Def. - Ferritin low, TIBC high, RDW high
2) Chonic Dz - same as 1 except TIBC LOW
3) Thallassemia - ferritin low, TIBC high, RDW LOW, MCV very low
4) Sideroblastic - ferritin HIGH, TIBC LOW,
[RDW reflects how “different” the sizes of the RBCs are. So if it’s genetic like thalassemia, then you’ll have consistent sizes of RBC so LOW RDW]
1) Folate - NORMAL methylmalonic acid, increased homocysteine, decreased retics
2) B12 - INCREASED methylmalonic acid, increased homocysteine, decreased retics
3) Liver dz - Acanthocytes
[increased LDH, increased unconjugated bilirubin, decreased haptoglobin]
1) Sickle Cell Anemia - sudden drop in Hct, crisis from dehydration/acidosis
2) Cold Agglutinin - IgM, cyanosis, destruction occurs in LIVER
3) Warm agglutinin (after rifampin, PCN, cancer, sulfa)- IgG, destruction occurs in SPLEEN, tx with steroids/splenectomy
4) Spherocytosis - Splenomegaly, FH+, bilirubin, HIGH MCHC, tx splenectomy
5) PNH - dark urine in the morning, budd chiari
6) G6PDH def. - Sudden onset after primaquin, sulfa, fava beans, heinz bodies/bite cells
Which coag factors are not made in the liver?
Which one is depleted first
vWF, 8
7 (extrinsic pathway, so PT/INR affected)
Causes of DIC
Sepsis, Rhabdo, Gyn, Snake bites, adenocarcinoma, heastroke, tx of AML M3 type
Widended pulse pressure, strong peripheral arterial pulsation (brisk carotid upstroke), systolic flow murmur, tachycardia, flushed extremities (one warmer than the other).
Phys?
AV-fistula (high output CF)
Increased preload, increased CO, decreased SVR
