deck 37 Flashcards
acute liver failure definition
acute onset of severe liver injury with encephalopathy + impaired synthetic function (defined as INR greater than 1.5) in a patient without cirrhosis or underlying liver disease
management of bone pain in prostate cancer patients
radiation therapy
USPSTF mammogram recommendation
biennial after age 50 to age 75
antibiotic regimen of choice for immunosuppressed patients with bacterial meningitis
cefepime + vancomycin + ampicillin
abx for meningitis age 2-50
vancomycin + 3rd generation cephalosporin
abx for meningitis age over 50
vancomycin + ampicillin + 3rd generation cephalosporin
splenic abscess presentation
fever + leukocytosis + LUQ pain
- can also develop left-sided pleuritic chest pain, left pleural effusion, and splenomegaly
most common cause of splenic abscess
infective endocarditis
preferred treatment for hep b
tenofovir (most potent drug with limited drug resistance)
when to treat hep B patients
1) acute liver failure
2) clinical cirrhosis
3) high serum hep B virus DNA
when use dependence is seen
Class I (especially IC) and Class IV (CCBs) antiarrhythmics
when use dependence is seen
Class I (especially IC) and Class IV (CCBs) antiarrhythmics
other common causes of pancreatitis
hypertriglyceridemia
drugs (thiazides, azathioprine, valproic acid)
infections (CMV, aspergillus, legionella)
autoimmune hemolytic anemia presentation
normocytic anemia + splenomegaly + reticulocytosis + jaundice
autoimmune hemolytic anemia presentation
normocytic anemia + splenomegaly + reticulocytosis + jaundice
treatment for AIHA
high-dose glucocorticoids
treatment for AIHA
high-dose glucocorticoids
other exam findings with OA
- crepitus and pain with motion
- small joint effusion without erythema or warmth
- popliteal (baker) cyst behind the joint
- varus or valgus angulation of the tibia
classic pes anserinus pain pt
obese female
pes anserinus presentation
insidious + pain worse overnight or in the morning
pes anserinus pain syndrome strongly associated with
diabetes
lumbar spinal stenosis pain etiology
NOT cord compression
- neurogenic claudication
- considered subtype of OA
- narrowing of the spinal canal leads to compression of lumbar nerve ROOTS
lumbar spinal stenosis pain etiology
NOT cord compression
- neurogenic claudication
- considered subtype of OA
- narrowing of the spinal canal leads to compression of lumbar nerve ROOTS
workup for patients with suspected secondary raynaud’s phenomenon
UA
ANA and RF
ESR and C3/C4
common joint complication of sickle cell disease
osteonecrosis of the femoral head (end arteries supplying femoral head become occluded, leading to necrosis and collapse of periarticular bone and cartilage)
common joint complication of sickle cell disease
osteonecrosis of the femoral head
workup of patients with first unprovoked VTE
- need to be screened for cancer (colonoscopy)
- Scan if pt has symptoms of malignancy
when to work up VTE patient for coagulopathy
- age under 45, recurrent DVT, multiple or unusual sites of thrombosis, family history of VTE
most common cause of an isolated, asymptomatic elevation of alk phos in elderly patient
Paget disease of bone
paget’s presentation
- **most patients are asymptomatic
- bone pain + HA + hearing loss + spinal stenosis + radiculopathy + long bone bowing/fracture + arthritis
paget’s labs
- elevated alk phos + normal calcium and phosphorus
behcet’s presentation
recurrent, painful oral ulcers + genital ulcers + eye lesions (uveitis) + skin lesions (erythema nodosum, acneiform lesions) + thrombosis
goal INR
2-3
acute treatment of DVT and PE
- Xa inhibitors are preferred (rivaroxaban, apixaban) (rapid onset and don’t need lab monitoring).
- also LMWH
when to use thrombolytics for patients with DVT/PE
Used for PE patients that are hemodynamically unstable
vertebral compression fracture presentation
acute back pain + point tenderness after strenuous activity + pain at night
- decreased spinal mobility after bending, coughing, or lifting
trigger points in fibromyalgia
mid trapezius, lateral epicondyle, costochondral junction, greater trochanter
other way to differentiate upper vs. lower GI bleeding on labs
upper GI bleeds often lead to elevated BUN/creatinine ratio (increased urea production from intestinal breakdown of hemoglobin AND increased urea reabsorption in proximal tubule due to hypovolemia)
CD4 count at which CMV is common
very low, below 50
CMV colitis presentation
frequent small volume bloody stools + abdominal pain
management of CMV diarrhea
1) colonoscopy w/ biopsy
2) need ocular exam to rule out concurrent retinitis
patellofemoral syndrome patient
chronic anterior knee pain in young women that is worse when climbing stairs with extension at knee
patellofemoral syndrome test
patellofemoral compression test (pain elicited by extending knee while compressing the patella) + reproduced while squatting
presentation of bacillary angiomatosis in HIV patient
bright red, firm, friable, exophytic nodules in HIV patient
bacillary angiomatosis treatment
erythromycin
where does eikenella corrodes live
anaerobe, common constituent of normal human oral flora
CLL presentation
- almost exclusively elderly patients
- marked leukocytosis + mature lymphocytes + smudge cells
associations of mallory-weiss tear
alcohol abuse + hiatal hernia
management of GI bleeder with depressed LOC and ongoing hematemesis
intubate (need to protect airway. hematemesis is a major risk for aspiration)
cardiac index
cardiac output divided by body surface area
- reduced in HF
