Deck 1 Flashcards
Diffuse itching in absence of rash
Do general labs search for systemic cause (TFT, iron, CBC, CMP)
Liver dz, CKD, thyroid, HIV, IDA, age appropriate cancer screening
Psoas sign
pain on extension of hip - lumbar plexus compression from iliopsoas hematoma
FHx of mucocutaneous bleeding, no prolonged PTT, on OCP
vW dz
Newly Dx DM2 - what to do to screen
Urine alb-Cr ratio now
Do not use MDRD (only in pts with CKD - not accurate with preserved glomerular fxn)
Mycobacterium Avium Complex in middle aged woman with no pre-existing lung condition, has discrete nodules - exposed to soil in SW US, no smoking
Need to repeat sputum ctx for MAC - if still positive then BAL or video assisted thoraoscopy for bx
COPD tx FEV<60%
1st recommendation - long acting broncodilator (tiotropium)
don’t use budesonide (ie inhaled corticosteroid) - no benefit compared to long acting broncodilator
Depression screening
screen all adults as long as appropriate support available
Hep B screening
not routinely recommneded except pregnant women
Osteoporosis screening
Women > 65 or high risk (3 month corticosteroid, etoh, low body mass, smoking, dementia, anticonvulsant use)
Screening for H pylori in setting of GIB or PPI current use or abx use
ONLY H. Pylori serology
Cardiorenal syndrome
fluid overload from inpt saline/abx use decreases ability to excrete sodium - heart can’t compensate for inc’d preload in setting of CHF -> IV lasix (even with elev Cr)
Don’t use lisinopril, don’t use BB in setting of acute decompensated HF
Vaginal atrophy - pale walls, petechiae, whiff neg, no clue cells - no response for vaginal itching from lubricants
low dose vaginal estradiol/ring
don’t use oral estrogen (inc’d r/o CVA, CAD, VTE, breast CA)
Bacterial vaginosis
inc’d vaginal pH, clue cells, +whiff test, vaginal d/c
Tx: metronidazole
Yeast infections
thick white d/c, KOH + with hyphae
Tx: vaginal clomitrazole
Posterior mediastinal mass
schwannoma - benign neoplasm from NEURAL tissue - usually located in posterior mediastinum
could also be esophageal tumor/cyst
(cough, venous distention, hoarsness, CP, Back pain, asx)
Usually need removal if sx don’t regress or if dx in question
Anterior mediastinal mass
thyroid, thymus, lymphomas
Middle mediastinal mass
broncogenic cysts, pericardial cysts, LAD
Allergic contact dermatitis
eczema caused by environmental exposure, unusual geographic pattern (ie oval, rectangular patch) -> edematous erythematous then vesices/bullae if severe -> chornic - > lichenified, scaly, hyperpigmented
Ecthyma
saucer shaped ulcers, legs, feet -> strep
Nummular dermatitis
pruritic eczematous - annular coin shaped erythematous plaque - pinpoint vesicles, honey colors serous crusting
Pulmonary valve stenosis
JVD prominent A wave, RV heave, systolic thrill, ejection click (rapid opening of stenotic pulmonary valve leaflets) - click decreases with inspiration but INCREASES systolic murmur (R sided murmurs increase with inspiration) - 2nd LEFT ICS -> left clavicular region, dilated pulmary artery on CXR
ASD
fixed split S2,
Bicuspid aortic valve
with more AS, click less audible, diminished, delayed carotid pulsation (pulsus parvus et tardus), apical impulse sustained, late peaking murmur -> carotids, LVH
MVP/regurg
early systolic click, mid systolic murmur - with valsalva murmur longer but click moves closer to S1