DemoFileUnlockAppForCompleteData-2024-01-09-10-55-49-7151 Flashcards
1402592222774
Actinomyces spp. and {{c2::Nocardia spp. are both gram-positive bacteria that form long, branching filaments resembling fungi.
1402593770382
Which gram-positive, filamentous bacteria is associated with yellow sulfur granules ? Actinomyces spp.
1403219565935
Parotitis is a feature of Mumps that presents with a swollen neck and parotid glands.
1403584762248
Flucytosine is an antifungal agent that is used combination with Amphotericin B to treat Cryptococcus.Especially meningitis caused by Cryptococcus.
1405793592670
Tabes Dorsalis is a spinal cord lesion that is caused by tertiary syphilis and involves degeneration of the dorsal columns and roots.Hence this will present with impaired sensation and proprioception and progressive sensory ataxia.
What is the second most common cause of lower GI bleed in adults? Diverticulosis
What is the second most common cause of lower GI bleed in adults? Diverticulosis
For a patient on a ventilator, what is the best way to correct low PaCO2? Decrease respiratory rate or VT
For a patient on a ventilator, what is the best way to correct low PaCO2? Decrease respiratory rate or VT Tidal volume (VT) is more efficient to change.
Central Cord Syndrome is a spinal cord injury that is commonly seen in the elderly following forced hyperextension of the neck (i.e. a rear-end collision).
Central Cord Syndrome is a spinal cord injury that is commonly seen in the elderly following forced hyperextension of the neck (i.e. a rear-end collision).Results in:- Paralysis in the upper extremities- Burning pain in the upper extremities- Preservation of most functions in the lower extremitiesMay be accompanied by localized deficit in pain and temperature sensation; typically occurs with hyperextension injuries in elderly patients with pre-existing degenerative changes in the cervical spine
Which demographic has an especially high risk of suicide immediately following the initiation of pharmacotherapy for Major Depressive Disorder (MDD)? Young adults (18-24)
Which demographic has an especially high risk of suicide immediately following the initiation of pharmacotherapy for Major Depressive Disorder (MDD)? Young adults (18-24) Depression is also associated with an increased risk of suicide— weight risk vs. benefits (benefits outweigh the risks). Monitor closely!
Which class of anti-depressants are contraindicated with tyramine containing foods (cheese, red wine, cured foods) MAOIs
Which class of anti-depressants are contraindicated with tyramine containing foods (cheese, red wine, cured foods) MAOIs Can lead to hypertensive crisis.
Which tricycline antidepressant is used to treat OCD? Clomipramine (Anafranil)
Which tricycline antidepressant is used to treat OCD? Clomipramine (Anafranil) SSRI’s are 1st-line; Clomipramine is only TCA that can be used to treat OCD
Which atypical/heterocyclic antidepressant is especially associated with sedation? Trazodone (Desyrel)
Which atypical/heterocyclic antidepressant is especially associated with sedation? Trazodone (Desyrel) Hence it can be used in combination with another antidepressant in depressed patients with insomnia.
Rapid Cycling Bipolar I disorder is a subtype of Bipolar I Disorder that involves at least 4 mood episodes in 12 months.
Rapid Cycling Bipolar I disorder is a subtype of Bipolar I Disorder that involves at least 4 mood episodes in 12 months.Treatment with valproate e.g. cycle of MDE, mania, hypomania or mixedPoor prognosis.20% of Bipolar I Disorder patients.
Loosening of associations is a psychiatric term used to describe the flow of thought with random shifting of ideas from one subject to another.
Loosening of associations is a psychiatric term used to describe the flow of thought with random shifting of ideas from one subject to another.Vs. word salad which is uttering a sequence of words that have no logical connection (i.e. the words do not belong together)
What is the key difference between schizophrenic delusions and delusions in delusional disorder? Schizophrenic delusions are bizarre; vs. nonbizarre (plausible)
What is the key difference between schizophrenic delusions and delusions in delusional disorder? Schizophrenic delusions are bizarre; vs. nonbizarre (plausible)
Grandiose Delusional Disorder is a subtype of Delusional Disorder that involves delusions that the individual possesses exaggerated power, money or knowledge.
Grandiose Delusional Disorder is a subtype of Delusional Disorder that involves delusions that the individual possesses exaggerated power, money or knowledge.
Erotomanic Delusional Disorder is a subtype of Delusional Disorder that involves delusions that another person, usually of higher status, is in love with the individual.
Erotomanic Delusional Disorder is a subtype of Delusional Disorder that involves delusions that another person, usually of higher status, is in love with the individual.
Hyperprolactinemia is a side effect of typical antipsychotics that can present with amenorrhoea, galactorrhea, and gynecomastia.
Hyperprolactinemia is a side effect of typical antipsychotics that can present with amenorrhoea, galactorrhea, and gynecomastia.As always with these symptoms, suspect and rule out a pituitary tumour first.
What is the difference between Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD)? OCPD is ego-syntonic and lacks separate obsessions and compulsions
What is the difference between Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD)? OCPD is ego-syntonic and lacks separate obsessions and compulsions Ego Dystonic = patients know that their behaviour is problematicEgo Syntonic = patients are unaware that their behaviour is problematic (i.e. it is a part of their personality; they have little insight)
What is the diagnostic criteria of Posttraumatic Stress Disorder (PTSD)? Symptoms must be present for > 1 month
What is the diagnostic criteria of Posttraumatic Stress Disorder (PTSD)? Symptoms must be present for > 1 month Symptoms include:- Re-experiencing of traumatic events through intrusive thoughts, flashbacks and nightmares (can be confused with auditory/visual hallucinations)- Avoidance of stimuli associated with the trauma- Numbing of responsiveness through anhedonia, amnesia, restricted affect and/or detachment- Increased arousal through hypervigilance, insomnia, increased startle response, poor concentration and irritability- Also includes survivor guilt, personality changes, dissociation, aggression, depression, substance abuse and suicidality
Acute Posttraumatic Stress Disorder (PTSD) is a subtype of Posttraumatic Stress Disorder (PTSD) that involves symptoms present for 3 days to 1 month following >1 traumatic event.
Acute Posttraumatic Stress Disorder (PTSD) is a subtype of Posttraumatic Stress Disorder (PTSD) that involves symptoms present for 3 days to 1 month following >1 traumatic event.
Acute Stress Disorder is an anxiety disorder that presents similarly to Posttraumatic Stress Disorder (PTSD) but involves symptoms that last 3 days to 1 month.
Acute Stress Disorder is an anxiety disorder that presents similarly to Posttraumatic Stress Disorder (PTSD) but involves symptoms that last 3 days to 1 month.
What is the first line pharmacotherapy for Post-Traumatic Stress Disorder (PTSD)? SSRI/SNRI; Prazosin to improve sleep
What is the first line pharmacotherapy for Post-Traumatic Stress Disorder (PTSD)? SSRI/SNRI; Prazosin to improve sleep Higher than normal doses of antidepressants are required.Buspirone can be helpful.2nd line are anxiolytics, β-blockers and α2-agonists.
Borderline Personality Disorder is a type of Personality Disorder that involves marked impulsivity, an unstable sense of self/relationships, and recurrent suicidal ideation.
Borderline Personality Disorder is a type of Personality Disorder that involves marked impulsivity, an unstable sense of self/relationships, and recurrent suicidal ideation.There is an inability to control mood lability and chronic feelings of emptiness.
Atomoxetine (Strattera) is a non-stimulant drug for Attention-Deficit Hyperactivity Disorder (ADHD) that acts by inhibiting 5HT and NA reuptake.
Atomoxetine (Strattera) is a non-stimulant drug for Attention-Deficit Hyperactivity Disorder (ADHD) that acts by inhibiting 5HT and NA reuptake.2nd-line therapy for ADHD; no potential for addiction and favorable side-effect profile
What is the diagnostic criteria for adjustment disorder? Must arise within 3 months of the stressor, and unless it is a chronic stressor, it must resolve within 6 months
What is the diagnostic criteria for adjustment disorder? Must arise within 3 months of the stressor, and unless it is a chronic stressor, it must resolve within 6 months Axis I or bereavement criteria must not be met in order for this diagnosis to be given.Bereavement is when someone has died
La belle indifférence is a feature of Conversion Disorder that involves the patient showing a characteristic lack of concern .
La belle indifférence is a feature of Conversion Disorder that involves the patient showing a characteristic lack of concern .
Which SNRI is typically avoided in hypertensive patients? Venlafaxine
Which SNRI is typically avoided in hypertensive patients? Venlafaxine It can increase diastolic BP.
Which typical antipsychotic is associated with a purple grey metallic rash over sun-exposed areas and jaundice? Chlorpromazine
Which typical antipsychotic is associated with a purple grey metallic rash over sun-exposed areas and jaundice? Chlorpromazine
Which atypical antipsychotic has the highest risk of EPS and hyperprolactinaemia? Risperidone (Ripserdal)
Which atypical antipsychotic has the highest risk of EPS and hyperprolactinaemia? Risperidone (Ripserdal) FGA and risperidone (atypical) are the antipsychotics with the highest potential for increasing prolactin
What is the treatment for neurosyphilis in a patient with penicillin allergy? IV penicillin after desensitisation
What is the treatment for neurosyphilis in a patient with penicillin allergy? IV penicillin after desensitisation Allergy = treat with doxycycline Allergy + neurosyphilis or pregnancy = desensitization to penicillin
Denys-Drash Syndrome is a tumour syndrome that involves Wilms’ Tumour (Nephroblastoma), nephropathy and genital abnormalities.
Denys-Drash Syndrome is a tumour syndrome that involves Wilms’ Tumour (Nephroblastoma), nephropathy and genital abnormalities.Denys Dick Drash
What WBC level is seen on lumbar puncture in bacterial meningitis? >1000
What WBC level is seen on lumbar puncture in bacterial meningitis? >1000
What is the treatment for Streptococcal Pharyngitis with penicillin allergy? Macrolides; or Clindamycin
What is the treatment for Streptococcal Pharyngitis with penicillin allergy? Macrolides; or Clindamycin Both for 10 days.
Sydenham’s Chorea is a neurological feature of Acute Rheumatic Fever that presents with emotional instability and involuntary movements.
Sydenham’s Chorea is a neurological feature of Acute Rheumatic Fever that presents with emotional instability and involuntary movements.
Which class of asthma involves symptoms with ≥2 exacerbations per week but not daily? Mild persistent
Which class of asthma involves symptoms with ≥2 exacerbations per week but not daily? Mild persistent Exacerbations limit daily activity.
How many night symptoms are seen in severe persistent Asthma (Reactive Airway Disease)? 4-7 times per week (high-dose ICS + LABA)
How many night symptoms are seen in severe persistent Asthma (Reactive Airway Disease)? 4-7 times per week (high-dose ICS + LABA)
What is the antipsychotic drug of choice for anorexia nervosa after CBT and nutritional rehabilitation fails? Olanzapine
What is the antipsychotic drug of choice for anorexia nervosa after CBT and nutritional rehabilitation fails? Olanzapine
Annular rash with bright red outer border and partial central clearing is diagnostic for ___. Erythema migrans.jpg
Annular rash with bright red outer border and partial central clearing is diagnostic for ___.Erythema migrans (Lyme disease)
A capillary (fingerstick) lead level >5 mcg/dL needs to be confirmed with which test? Venous lead measurement
A capillary (fingerstick) lead level >5 mcg/dL needs to be confirmed with which test? Venous lead measurement
A patient is going to begin treatment for a HER2-(+) invasive ducal carcinoma and therapy containing trastuzumab is planned. What should be done prior to starting the medication in this patient? Echocardiography
A patient is going to begin treatment for a HER2-(+) invasive ducal carcinoma and therapy containing trastuzumab is planned. What should be done prior to starting the medication in this patient? Echocardiography Baseline assessment of cardiac function as Herceptin is cardiotoxic
Microscopic Polyangiitis is a small vessel vasculitis that presents similarly to Wegener Granulomatosis, but lacks nasopharyngeal involvement and granulomas.
Microscopic Polyangiitis is a small vessel vasculitis that presents similarly to Wegener Granulomatosis, but lacks nasopharyngeal involvement and granulomas.
Which type of primary headache may occasionally present with Horner syndrome? Cluster headache
Which type of primary headache may occasionally present with Horner syndrome? Cluster headache
What is the diagnostic test for Pseudotumour Cerebri (Benign/Idiopathic Intracranial hypertension)? Lumbar puncture with normal CSF but increased opening pressure
What is the diagnostic test for Pseudotumour Cerebri (Benign/Idiopathic Intracranial hypertension)? Lumbar puncture with normal CSF but increased opening pressure Remember, a negative CT/MRI is also required.
Which vitamin toxicity can be a cause of Pseudotumour Cerebri (Idiopathic Intracranial hypertension)? Vitamin A
Which vitamin toxicity can be a cause of Pseudotumour Cerebri (Idiopathic Intracranial hypertension)? Vitamin A Withdraw vitamin supplementation if this is suspected.
At what age is the herpes zoster (shingles) vaccine recommended in all adults? >60 years old
At what age is the herpes zoster (shingles) vaccine recommended in all adults? >60 years old To prevent shingles and mitigate symptoms if shingles does occur.
What head CT/MRI findings are associated with Huntington Disease? Caudate nucleus atrophy
What head CT/MRI findings are associated with Huntington Disease? Caudate nucleus atrophy
A patient with multiple sclerosis develops worsening focal neurological deficits while on chronic suppressive therapy. New MRI shows new, multiple white matter lesions. Which drug is most likely to have caused this? Natalizumab
A patient with multiple sclerosis develops worsening focal neurological deficits while on chronic suppressive therapy. New MRI shows new, multiple white matter lesions. Which drug is most likely to have caused this? Natalizumab It targets α-4 integrinIt has been known to predispose to progressive multifocal leukoencephalopathy (PML).
A patient presents with muscle atrophy, fasciculations of the tongue and extremities, upwards babinski and hyper-reflexia of the extremities. Which demyelinating disorder is the most likely diagnosis? Amyotrophic lateral sclerosis
A patient presents with muscle atrophy, fasciculations of the tongue and extremities, upwards babinski and hyper-reflexia of the extremities. Which demyelinating disorder is the most likely diagnosis? Amyotrophic lateral sclerosis Know the signs of UMN and LMN lesions!*Involves asymmetric UMN and LMN lesions, with LMN symptoms predominating in later stages.Typically spares the eyes and sphincters.There is no sensory loss no matter what the gunner says on rounds.Other symptoms may include emotional lability and weight loss.
A patient with known myasthenia gravis presents to the ER in life-threatening condition. She has diffuse, severe, overwhelming muscle weakness with respiratory involvement. Aside from intubation, what is the next best step? IVIG; or plasmapharesis
A patient with known myasthenia gravis presents to the ER in life-threatening condition. She has diffuse, severe, overwhelming muscle weakness with respiratory involvement. Aside from intubation, what is the next best step? IVIG; or plasmapharesis Don’t forget to manage and protect the airways!This is acute myasthenic crisis.
How do the brain CT findings in Alzheimer’s Disease differ from Pick’s Disease? AD = diffuse cortical atrophy (parietal and temporal)PD = frontal and hypothalamic degeneration (frontal and temporal)
How do the brain CT findings in Alzheimer’s Disease differ from Pick’s Disease? AD = diffuse cortical atrophy (parietal and temporal)PD = frontal and hypothalamic degeneration (frontal and temporal)
Which organic cause of dementia is associated with the triad of urinary incontinence, ataxic gait and dementia? Normal Pressure Hydrocephalus (NPH)
Which organic cause of dementia is associated with the triad of urinary incontinence, ataxic gait and dementia? Normal Pressure Hydrocephalus (NPH) aka Wet, Wobbly and WackyDue to decreased CSF absorption.
What is the treatment of choice in a depressed patient with poor appetite, weight loss, or insomnia? Mirtazapine
What is the treatment of choice in a depressed patient with poor appetite, weight loss, or insomnia? Mirtazapine -Increases appetite, weight gain, and sedation-Trazodone also helps with insomnia, but not weight gain
Body dysmorphic disorder is the diagnosis when patients have an imagined or slight defect in appearance, causing distress and impaired ability to function in a social or occupational setting.Treatment? CBT; SSRIs.
Body dysmorphic disorder is the diagnosis when patients have an imagined or slight defect in appearance, causing distress and impaired ability to function in a social or occupational setting.Treatment? CBT; SSRIs. -If the only concern is body shape and weight, anorexia nervosa is the more accurate diagnosis.-If the only concern is sex characteristics, gender identity disorder is the more accurate diagnosis.-Flaws are mild or not observable by others
What is the only illicit drug that causes vertical nystagmus? PCP
What is the only illicit drug that causes vertical nystagmus? PCP Can also cause horizontal and rotatory nystagmus.
What life-threatening reaction is associated with Nevirapine HIV therapy? Liver failure
What life-threatening reaction is associated with Nevirapine HIV therapy? Liver failure
A patient and his friends all present with headache, dyspnea, nausea, and vomiting. He states that they were camping and cooking food in their cabin. One patient has pinkish skin. What is the most likely diagnosis? Carbon monoxide poisoning
A patient and his friends all present with headache, dyspnea, nausea, and vomiting. He states that they were camping and cooking food in their cabin. One patient has pinkish skin. What is the most likely diagnosis? Carbon monoxide poisoning
A patient presents complaining of severe chest pain that radiates to the back in between his scapulae. Physical exam reveals BP of 169/108 in the left arm and 120/70 in the right arm. What is the best initial test? CXR
A patient presents complaining of severe chest pain that radiates to the back in between his scapulae. Physical exam reveals BP of 169/108 in the left arm and 120/70 in the right arm. What is the best initial test? CXR This is aortic dissection.While CXR is not as sensitive, it is quick, cheap and widening of the mediastinum on CXR is a big clue.CXR is the best initial testAngiogram is the most accurate testAll other tests are helpful, but have the same accuracy (MRA = CTA = TEE)
A patient presents complaining of severe chest pain that radiates to the back in between his scapulae. Physical exam reveals BP of 169/108 in the left arm and 120/70 in the right arm. What is the most accurate test? Angiogram
A patient presents complaining of severe chest pain that radiates to the back in between his scapulae. Physical exam reveals BP of 169/108 in the left arm and 120/70 in the right arm. What is the most accurate test? Angiogram This is aortic dissectionCXR is the best initial testAngiogram is the most accurate test but also the most invasive. It can cause anaphylaxis or AKI, but is the most sensitive and most specific.All other tests are helpful, but have the same accuracy (MRA = CTA = TOE)
Charcot joint (neurogenic arthropathy) occurs in diabetic patients and in other conditions where peripheral sensation is lost. It presents with deformed joints, mild pain, effusions, large osteophytes, and extra-articular bone fragments.
Manage with weight-bearing assisting mechanical devices and treat underlying condition
What is the treatment for intermittent asthma (symptoms <2 days/week, nighttime awakenings <2x/month)? A rescule inhaler (SABA PRN)
What is the treatment for intermittent asthma (symptoms <2 days/week, nighttime awakenings <2x/month)? A rescule inhaler (SABA PRN) Typically a SABA, but may be an inhaled anticholinergic as well
What is the treatment for mild persistent asthma (> 2 days/week, nighttime awakenings 3-4 times/month)? SABA + low dose ICS
What is the treatment for mild persistent asthma (> 2 days/week, nighttime awakenings 3-4 times/month)? SABA + low dose ICS
What is the treatment for moderate persistent asthma? SABA + low-dose ICS + LABA
What is the treatment for moderate persistent asthma? SABA + low-dose ICS + LABA You cannot give LABA without an ICS/steroids. That will increase mortality and is always the wrong answer.If the patient is on a LABA, they must be on steroids. Period.
A patient with ARDS is placed on PEEP after intubation. Shortly after, he develops hypotension. A medical student noticed tracheal deviation to the left during rounds. What test should be ordered to confirm the most likely diagnosis? CXR to diagnose tension pneumothorax
A patient with ARDS is placed on PEEP after intubation. Shortly after, he develops hypotension. A medical student noticed tracheal deviation to the left during rounds. What test should be ordered to confirm the most likely diagnosis? CXR to diagnose tension pneumothorax Complications of PEEP:- Barotrauma; typically involves worsening SOB after PEEP has been given to the pt- Pneumothorax; suspect this if the patient becomes hypotensive and mediastinal shift/tracheal deviation; diagnosed with CXR; treatment with needle decompression; can be secondary to barotrauma
What ECG findings are classically associated with pulmonary embolism? S1Q3T3
What ECG findings are classically associated with pulmonary embolism? S1Q3T3 Or right heart strain - ST depression and T wave inversion in the right leads (aVR, II, V5 and V6).This is rarely seen (sinus tachy is the most common!) S1-Q3-T3 - prominent S in lead I- Q wave in lead III- T-wave inversion in lead III- indicative of R heart strain
A patient is thought to have a pulmonary embolism but cannot tolerate IV contrast due to severe renal disease. What other diagnostic test can be ordered to help in the workup? V/Q scan
A patient is thought to have a pulmonary embolism but cannot tolerate IV contrast due to severe renal disease. What other diagnostic test can be ordered to help in the workup? V/Q scan
Which type of glomerulonephritis is associated with asthma alongside the hematuria? Churg-Strauss syndrome
Which type of glomerulonephritis is associated with asthma alongside the hematuria? Churg-Strauss syndrome Glomerulonephritis general key points:- the differential for the type of glomerulonephritis is extensive- RBC casts are typical of GN- Definitive diagnosis is via biopsy- Important to rule out nephrotic syndrome with UA spot test or 24 hr urine collection
A patient undergoing elective cholecystectomy receives an abdominal U/S that incidentally reveals a renal cyst. It is small, non-loculated, and non-septated. No echoes are seen on the U/S. What is the most likely diagnosis? Simple Renal Cyst
A patient undergoing elective cholecystectomy receives an abdominal U/S that incidentally reveals a renal cyst. It is small, non-loculated, and non-septated. No echoes are seen on the U/S. What is the most likely diagnosis? Simple Renal Cyst Simple Renal Cyst key points:- must be small, non-loculated, non-septated and no echoes on U/S- If truly simple, and asymptomatic, let it be- If signs and symptomsdevelop, consider excision or biopsy
A patient undergoing elective cholecystectomy receives an abdominal CT that incidentally reveals a renal cyst. It is large, septated, and loculated. What is the most appropriate next step? Biopsy (this is a complex renal cyst; CT-guided needle biopsy)
A patient undergoing elective cholecystectomy receives an abdominal CT that incidentally reveals a renal cyst. It is large, septated, and loculated. What is the most appropriate next step? Biopsy (this is a complex renal cyst; CT-guided needle biopsy) Complex Renal Cyst key points:- must be large, septated, or loculated- more likely to cause symptoms than simple cysts- common signs and symptoms: flank mass, haematuria, pyelonephritis, pain- If truly complex, biopsy that sucker to rule out malignancy- CT-guided needle biopsy is typically the method of choice
A patient presents complaining of dysphagia. He states that it feels like a knot or ball of food is stuck in his chest. You suspect achalasia. Barium swallow reveals a bird’s beak sign. What is the most appropriate next test? Manometry and Endoscopy (rule out cancer)
A patient presents complaining of dysphagia. He states that it feels like a knot or ball of food is stuck in his chest. You suspect achalasia. Barium swallow reveals a bird’s beak sign. What is the most appropriate next test? Manometry and Endoscopy (rule out cancer) Achalasia key points:- Ba swallow is the best initial test- Manometry follows here and offers more info- Endoscopy must be done to rule out cancer- treatment is preferred w/ Heller myotomy (balloon dilatation can cause perforation; botox is less effective)
A female patient with a past medical history of autoimmune disorders presents with AST and ALT in the 1000s after an outpatient lab test. You suspect autoimmune hepatitis. Which antibodies are associated with this disorder? Anti-smooth muscle; Anti-LKM
A female patient with a past medical history of autoimmune disorders presents with AST and ALT in the 1000s after an outpatient lab test. You suspect autoimmune hepatitis. Which antibodies are associated with this disorder? Anti-smooth muscle; Anti-LKM
Glomerular crescent formation on light microscopy is associated with ___. rapidly_progressive_crescentic_glomerulonephritis_02.jpg RPGN_1433340724955.jpg
Glomerular crescent formation on light microscopy is associated with ___.Rapidly progressive glomerulonephritis (RPGN)
Patients treated with methotrexate (MTX) should receive ___ supplementation.
Folic acid— Reduces incidence of ADRs
The clinical triad of dry eyes (xerophthalmia), dry mouth (xerostomia), and symmetrical arthritis is associated with ___.
Sjogren’s syndrome
What is the most effective treatment for stopping an acute attack of a cluster headache? 100% oxygen
What is the most effective treatment for stopping an acute attack of a cluster headache? 100% oxygen Ergotamines and Triptans are effective but not as rapid-acting as 100% oxygen.
TMP/SMX is used in HIV-positive patients to prevent opportunistic infections caused by Pneumocystis jiroveci and Toxoplasma gondii when CD4 count is < 200 for PCP, 100 for Toxo .Azithromycin is recommended for prophylaxis against MAC when CD4 count is < 50 .
TMP/SMX is used in HIV-positive patients to prevent opportunistic infections caused by Pneumocystis jiroveci and Toxoplasma gondii when CD4 count is < 200 for PCP, 100 for Toxo .Azithromycin is recommended for prophylaxis against MAC when CD4 count is < 50 .
Tick-borne paralysis is characterized by rapidly progressive ascending paralysis, absence of fever and sensory abnormalities, and normal CSF exam.The next best step is a meticulous search for a tick and removal of tick results in spontaneous improvement in most patients .
Tick-borne paralysis is characterized by rapidly progressive ascending paralysis, absence of fever and sensory abnormalities, and normal CSF exam.The next best step is a meticulous search for a tick and removal of tick results in spontaneous improvement in most patients .Guillain-barre may be hard to distinguish but is usually not as rapid, CSF abnormalities, and autonomic dysfunction. A meticulous tick exam is easy to perform and should be done first.
A brain that has seized for >5 minutes (status epilepticus) is at increased risk for cortical laminar necrosis due to excitatory toxicity.
A brain that has seized for >5 minutes (status epilepticus) is at increased risk for cortical laminar necrosis due to excitatory toxicity. Can lead to persistent neurologic deficits and recurrent seizures.
Patients with adult-onset asthma and symptoms that are worse after meals, exercise, or laying down are likely to have GERD as a primary trigger.When suspected, a trial of PPIs can be both diagnostic and therapeutic.
Patients with adult-onset asthma and symptoms that are worse after meals, exercise, or laying down are likely to have GERD as a primary trigger.When suspected, a trial of PPIs can be both diagnostic and therapeutic.Mechanisms by which GERD exacerbates Asthma1) Increased vagal tone2) Heightened bronchial reactivity3) Microaspiration of gastric contents into the upper airway
What is the best initial pharmacological treatment for Rosacea? Metronidazole
What is the best initial pharmacological treatment for Rosacea? Metronidazole Avoid triggers — hot weather, spicy food, alcohol, high temperature, etc.
Bacillary angiomatosis is a bacterial infection that presents in HIV patients with exophytic purple skin masses and visceral angioma-like blood vessel growths. yikes (2)_1390229673822.png
Bacillary angiomatosis is a bacterial infection that presents in HIV patients with exophytic purple skin masses and visceral angioma-like blood vessel growths. Treat with antibiotics
A 65 years old man with a past medical history of uncontrolled hypertension presents to the ER complaining of AMS, blurry vision, headache and dyspnea. Physical exam reveals a BP of 200/140 mmHg and papilledema. There are no other abnormalities. What is the most likely diagnosis? Hypertensive Emergency/Crisis
A 65 years old man with a past medical history of uncontrolled hypertension presents to the ER complaining of AMS, blurry vision, headache and dyspnea. Physical exam reveals a BP of 200/140 mmHg and papilledema. There are no other abnormalities. What is the most likely diagnosis? Hypertensive Emergency/Crisis Hypertensive Urgency vs. Emergency key points:- Urgency is > 180/110 without end organ damage and is treated with PO meds- Emergency/Crisis is >180/110 with end organ damage and is treated with IV meds (stroke, MI, papilloedema, flash pulmonary oedema, headache, chest pain, etc…)
Hepatitis C can be asymptomatic or develop fatigue, arthralgias, weakness, weight loss, and serum transaminases can be elevated or normal. Extrahepatic manifestations include:Heme: Essential mixed cryoglobulinemia Renal: MPGN Skin: Porphyria cutanea tarda , lichen planus Endocrine: increased risk for diabetes
Hepatitis C can be asymptomatic or develop fatigue, arthralgias, weakness, weight loss, and serum transaminases can be elevated or normal. Extrahepatic manifestations include:Heme: Essential mixed cryoglobulinemia Renal: MPGN Skin: Porphyria cutanea tarda , lichen planus Endocrine: increased risk for diabetes
An elderly patient presents complaining of back pain. He states that the pain shoots down his right leg, but is alleviated when he is hunched over forward. You suspect spinal stenosis. What is the best diagnostic test? MRI
An elderly patient presents complaining of back pain. He states that the pain shoots down his right leg, but is alleviated when he is hunched over forward. You suspect spinal stenosis. What is the best diagnostic test? MRI X-ray will show degenerative joint changes, but MRI is the best confirmatory test
Patients with aortic regurgitation present with wide pulse pressure (e.g., 150/45 mmHg), water hammer pulse, and LV enlargement that causes a pounding sensation and increased awareness of the heartbeat.
Patients with aortic regurgitation present with wide pulse pressure (e.g., 150/45 mmHg), water hammer pulse, and LV enlargement that causes a pounding sensation and increased awareness of the heartbeat.
A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. CXR reveals hilar adenopathy. What is the most likely diagnosis? Sarcoidosis
A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. CXR reveals hilar adenopathy. What is the most likely diagnosis? Sarcoidosis Sarcoidosis key points:- common in young, AA, females- presents as SOBOE with occasional fine rales on exam; no wheezing- can be associated with erythema nodosum and lymphadenopathy; if present, the diagnosis is likely- best initial test: CXR (hilar adenopathy seen in > 95% of cases)- most accurate test: lymph node biopsy to look for noncaseating granulomas- treatment is prednisone; if asymptomatic, do not treat
A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. You suspect sarcoidosis. What is the best initial diagnostic test? CXR
A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. You suspect sarcoidosis. What is the best initial diagnostic test? CXR Sarcoidosis key points:- common in young, AA, females- presents as SOBOE with occasional fine rales on exam; no wheezing- can be associated with erythema nodosum and lymphadenopathy; if present, the diagnosis is likely- best initial test: CXR (hilar adenopathy seen in > 95% of cases)- most accurate test: lymph node biopsy to look for noncaseating granulomas- treatment is prednisone; if asymptomatic, do not treat
A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. CXR reveals hilar adenopathy. follow up lymph node biopsy reveals noncaseating granulomas. She is diagnosed with sarcoidosis. What is the treatment? Prednisone (clear top choice and most patients respond)
A young, AA, female patient presents complaining of SOB on exertion. She is otherwise healthy and has no PMHx. Physical exam reveals erythema nodosum, lymphadenopathy and fine rales on lung auscultation. CXR reveals hilar adenopathy. follow up lymph node biopsy reveals noncaseating granulomas. She is diagnosed with sarcoidosis. What is the treatment? Prednisone (clear top choice and most patients respond) Sarcoidosis key points:- common in young, AA, females- presents as SOBOE with occasional fine rales on exam; no wheezing- can be associated with erythema nodosum and lymphadenopathy; if present, the diagnosis is likely- best initial test: CXR (hilar adenopathy seen in > 95% of cases)- most accurate test: lymph node biopsy to look for noncaseating granulomas- treatment is prednisone; if asymptomatic, do not treat
A patient presents with fever and cough. Physical exam reveals foul breath. CXR reveals a cavitary lesion in the right lung. You suspect a lung abscess. An incision and drainage with culture is done. Until the culture is complete, what is the most appropriate empiric treatment? Clindamycin
A patient presents with fever and cough. Physical exam reveals foul breath. CXR reveals a cavitary lesion in the right lung. You suspect a lung abscess. An incision and drainage with culture is done. Until the culture is complete, what is the most appropriate empiric treatment? Clindamycin Lung Abscess key points:- abscesses don’t just form out of nowhere; these patients typically have an aspiration risk- empiric treatment with clindamycin is recommended (again, due to the aspiration risk; most lung abscesses involve anaerobes)- aspiration risk is typically secondary to seizure, alcoholism, MS or stroke - give proper treatment once culture and sensitivity return
A patient presents with fever, cough, night sweats, weight loss and hemoptysis. He has risk factors for TB. You suspect TB. A CXR is positive. Follow-up AFB smear is also positive. What is the most appropriate next step in management? This is a diagnosis of active TB; start RIPE therapy (2 months of RIPE + 4 months of isoniazid and rifampin)
A patient presents with fever, cough, night sweats, weight loss and hemoptysis. He has risk factors for TB. You suspect TB. A CXR is positive. Follow-up AFB smear is also positive. What is the most appropriate next step in management? This is a diagnosis of active TB; start RIPE therapy (2 months of RIPE + 4 months of isoniazid and rifampin)
A patient presents with fever, cough, night sweats, weight loss and haemoptysis. He has risk factors for TB. You suspect TB. A CXR is positive. Follow-up AFB smear is negative. What is the most appropriate next step in management? INH for 9 months
A patient presents with fever, cough, night sweats, weight loss and haemoptysis. He has risk factors for TB. You suspect TB. A CXR is positive. Follow-up AFB smear is negative. What is the most appropriate next step in management? INH for 9 months Collect early morning sputum and get atleast 3 cultures 8 hrs apart.To help ensure a true result, get 3 early morning sputums 24 hrs apart.Your last ditch effort if you have a very high suspicion of TB is nucleic acid assay.
A patient has fever, headache, and a stiff neck. CT scan rules out intracranial mass, so an LP is safely performed. LP rules out bacterial meningitis. The patient also has a targetoid rash and recent travel to the north-east American coast. Lyme antibody testing returns positive. What is the most appropriate next step in management? IV Ceftriaxone
A patient has fever, headache, and a stiff neck. CT scan rules out intracranial mass, so an LP is safely performed. LP rules out bacterial meningitis. The patient also has a targetoid rash and recent travel to the north-east American coast. Lyme antibody testing returns positive. What is the most appropriate next step in management? IV Ceftriaxone Not doxycycline, which is used for Lyme arthralgia, not Lyme meningitis
A patient is diagnosed with syphilis and is given the appropriate penicillin treatment. Following treatment, the patient develops fever and his symptoms worsen. What is this phenomenon called? Jarisch-Herxheimer reaction
A patient is diagnosed with syphilis and is given the appropriate penicillin treatment. Following treatment, the patient develops fever and his symptoms worsen. What is this phenomenon called? Jarisch-Herxheimer reaction Treat with aspirin.This is secondary to widespread endotoxin release following the death of bacteria. - while classically associated with syphilis and other spirochete diseases, it can occur in other casesdue to rapid lysis of spirochetes; self-limited and resolves spontaneously within 48 hours
A patient presents complaining of pruritis. Physical exam reveals visible burrow marks on the skin and webbed spaces between fingers. You suspect scabies. What is the diagnostic test? Scraping and magnification of the burrows/lesions paste-103156524515331.jpg
A patient presents complaining of pruritis. Physical exam reveals visible burrow marks on the skin and webbed spaces between fingers. You suspect scabies. What is the diagnostic test? Scraping and magnification of the burrows/lesions
A patient is diagnosed with Lyme disease. She has erythema migrans, arthralgias, and AV block. What is the treatment? IV ceftriaxone
A patient is diagnosed with Lyme disease. She has erythema migrans, arthralgias, and AV block. What is the treatment? IV ceftriaxone
What is the notable side effect of the anti-HIV drug indinavir? Nephrolithiasis
What is the notable side effect of the anti-HIV drug indinavir? Nephrolithiasis indigo princess
Patient presents with swollen, erythematous lower left leg that has sharpy defined borders. Physical exam reveals a red, hot, swollen lesion with erythematous streaks. He also complains of fever and chills. What is the most likely diagnosis? Erysipelas
Patient presents with swollen, erythematous lower left leg that has sharpy defined borders. Physical exam reveals a red, hot, swollen lesion with erythematous streaks. He also complains of fever and chills. What is the most likely diagnosis? Erysipelas -the red streaks are characteristic of ascending lymphadenitis known to be involved with the condition
A 80 year old patient presents complaining of a pigmented lesion on his face. Physical exam reveals a large, brown, greasy-looking, and crusted pigmented lesion that appears stuck on the patients face. What is the most likely diagnosis? Seborrheic keratosis Screen Shot 2018-06-20 at 6.29.15 PM.png
A 80 year old patient presents complaining of a pigmented lesion on his face. Physical exam reveals a large, brown, greasy-looking, and crusted pigmented lesion that appears stuck on the patients face. What is the most likely diagnosis? Seborrheic keratosis Very common in the elderly
When discussing HIPAA information with employees, it is required to have verbal or written authorization.HIPPA does not require the provider to obtain proof of identity of phone callers.The best practice when giving HIPAA info is to disclose only the minimum necessary information .
When discussing HIPAA information with employees, it is required to have verbal or written authorization.HIPPA does not require the provider to obtain proof of identity of phone callers.The best practice when giving HIPAA info is to disclose only the minimum necessary information .
A 40 years old patient has a bullous/blistering disease with oral mucosal involvement. Physical exam reveals a positive Nikolsky’s Sign. What is the most likely diagnosis? Pemphigus vulgaris
A 40 years old patient has a bullous/blistering disease with oral mucosal involvement. Physical exam reveals a positive Nikolsky’s Sign. What is the most likely diagnosis? Pemphigus vulgaris
Which age group is typically affected by bullous pemphigoid? >60
Which age group is typically affected by bullous pemphigoid? >60 Pemphigus vulgaris = <60
A patient presents complaining of blistering/bullous disease. Physical exam reveals that the blisters are found in sun exposed areas only. He has hepatitis C. What is the most accurate diagnostic test? 24 hr urine collection (increased uroporphyrinogen is diagnostic) paste-137919989809155.jpg
A patient presents complaining of blistering/bullous disease. Physical exam reveals that the blisters are found in sun exposed areas only. He has hepatitis C. What is the most accurate diagnostic test? 24 hr urine collection (increased uroporphyrinogen is diagnostic)
A 24 hr urine collection to gauge for increased uroporphyrins is the most accurate test for porphyria cutanea tarda. Which enzyme is deficient in this disease? Uroporphyrinogen decarboxylase
A 24 hr urine collection to gauge for increased uroporphyrins is the most accurate test for porphyria cutanea tarda. Which enzyme is deficient in this disease? Uroporphyrinogen decarboxylase
A patient comes in complaining of spots on his skin. Physical exam reveals multiple, small, sharply-demarcated patches of hypo- and depigmentation on the face and hands. What is the most likely diagnosis? Vitiligo
A patient comes in complaining of spots on his skin. Physical exam reveals multiple, small, sharply-demarcated patches of hypo- and depigmentation on the face and hands. What is the most likely diagnosis? Vitiligo
A female patient presents with patchy hair loss. Her past medical history is significant for OCD. Physical exam reveals patchy alopecia and a headful of hair at different lengths. What is the most likely diagnosis? Trichotillomania
A female patient presents with patchy hair loss. Her past medical history is significant for OCD. Physical exam reveals patchy alopecia and a headful of hair at different lengths. What is the most likely diagnosis? Trichotillomania
A patient is diagnosed with trichotillomania. Which GI disorder should you worry about? SBO secondary to bezoar (eating hair)
A patient is diagnosed with trichotillomania. Which GI disorder should you worry about? SBO secondary to bezoar (eating hair)
A patient who develops polyarthralgia, tenosynovitis, and painless vesiculopustular skin lesions have the classic triad for disseminated gonococcal infection . mksap_lg.jpg
A patient who develops polyarthralgia, tenosynovitis, and painless vesiculopustular skin lesions have the classic triad for disseminated gonococcal infection .
Which antibodies are associated with autoimmune hepatitis? Anti-smooth muscle Ab
Which antibodies are associated with autoimmune hepatitis? Anti-smooth muscle Ab
Which antibodies are associated with Sjogren’s Syndrome? Anti-Ro (SS-A) and Anti-La (SS-B)
Which antibodies are associated with Sjogren’s Syndrome? Anti-Ro (SS-A) and Anti-La (SS-B) Ayrobeela = A-Ro, B-La
Which antibodies are associated with polymyositis? Anti-Jo ab
Which antibodies are associated with polymyositis? Anti-Jo ab Anti-Jo1, anti-SRP, anti-Mi2
A patient with a history of SLE presents complaining of severe joint pain. You suspect a lupus flare. Your smart medical student suggests that we should check complement levels. How do complement levels change in a lupus flare? Decrease
A patient with a history of SLE presents complaining of severe joint pain. You suspect a lupus flare. Your smart medical student suggests that we should check complement levels. How do complement levels change in a lupus flare? Decrease If complement levels are normal, it is likely not a flare.If complement levels are decreased, it is likely a flare.
Lupus nephritis and subsequent renal failure is a major contributor to mortality in SLE. What test is imperative in investigating the severity of lupus nephropathy? Biopsy
Lupus nephritis and subsequent renal failure is a major contributor to mortality in SLE. What test is imperative in investigating the severity of lupus nephropathy? Biopsy Performing screening UA’s are imperative. If things are off, perform biopsy.Only a biopsy will be able to tell us the severity of lupus nephropathy (i.e. nephritis, or glomerulosclerosis, or glomerular scarring). It also guides treatment (e.g. scarring is not treatable).
A patient with a history of SLE presents complaining of severe joint pain. She is diagnosed with a lupus flare. Labs also reveal proteinuria. What test must be performed before administering therapy? Kidney biopsy
A patient with a history of SLE presents complaining of severe joint pain. She is diagnosed with a lupus flare. Labs also reveal proteinuria. What test must be performed before administering therapy? Kidney biopsy Biopsy is indicated to establish histopathologic type and determine severity of of renal involvement
Vesicular rash in the trigeminal distribution and dendriform corneal ulcers are associated with ___. Herpes zoster ophthalmicus_1.jpg Herpes zoster ophthalmicus_2.jpg
Vesicular rash in the trigeminal distribution and dendriform corneal ulcers are associated with ___.Herpes zoster ophthalmicus— This is a medical emergency treat empirically with high-dose acyclovir and refer to ophthalmology to prevent blindness.
Which crystal deposition disease is associated with rhomboid-shaped crystals? Pseudogout (calcium pyrophosphate crystals)
Which crystal deposition disease is associated with rhomboid-shaped crystals? Pseudogout (calcium pyrophosphate crystals)
What is the first line treatment for acute pseudogout? NSAIDs (traditionally indomethacin)
What is the first line treatment for acute pseudogout? NSAIDs (traditionally indomethacin)
A 30 years old male patient presents complaining of lower back pain and morning stiffness. He states that the pain decreases with activity and increases with rest. What is the most likely diagnosis? Ankylosing spondylitis
A 30 years old male patient presents complaining of lower back pain and morning stiffness. He states that the pain decreases with activity and increases with rest. What is the most likely diagnosis? Ankylosing spondylitis This is a pretty unique feature of AS (back pain that improves with exercise and worsens with rest).
A patient presents complaining of dry eyes, dry mouth and some facial swelling. Physical exam reveals keratoconjunctivitis, xerostomia and bilateral parotid enlargement. You suspect Sjogren’s syndrome. What is the best initial diagnostic test? Anti-SS-A-(Ro) and anti-SS-B-(La) testing (best initial blood test); Schirmer tear production test (best overall initial test)
A patient presents complaining of dry eyes, dry mouth and some facial swelling. Physical exam reveals keratoconjunctivitis, xerostomia and bilateral parotid enlargement. You suspect Sjogren’s syndrome. What is the best initial diagnostic test? Anti-SS-A-(Ro) and anti-SS-B-(La) testing (best initial blood test); Schirmer tear production test (best overall initial test) Sjogren’s Syndrome diagnosis key points:- often a part of another autoimmune disease (esp SLE), but can be solo; diagnosis clinical but needs confirmation- best initial blood test is SS-A-Ro and SS-B-La testing- best initial overall test is the Schirmer tear production test with a fliter paper on the eye- most accurate test is a lip or parotid biopsy looking for the lymphocytic infiltration- Rose bengal staining reveals an abnormal corneal epithelium if performed
What is the best initial therapy for carpal tunnel syndrome? NSAIDs + wrist splint (immobilise the hand in a position that relieves pressure)
What is the best initial therapy for carpal tunnel syndrome? NSAIDs + wrist splint (immobilise the hand in a position that relieves pressure) Pts should also avoid manual activity.Steroid injections help if splint + NSAIDs do notSurgery can be curative and typically involves decompression by cutting open the flexor retinaculum
A patient is diagnosed with SLE and started on hydroxychloroquine. What toxicity should monitored for? Retinal toxicity (do dilated eye exams to gauge)
A patient is diagnosed with SLE and started on hydroxychloroquine. What toxicity should monitored for? Retinal toxicity (do dilated eye exams to gauge)
A female patient presents with rampant dental caries and dyspareunia. Which autoimmune disorder is the likely cause? Sjogren Syndrome
A female patient presents with rampant dental caries and dyspareunia. Which autoimmune disorder is the likely cause? Sjogren Syndrome Just a reminder that SS can cause both.Dental caries secondary to lack of salivaDyspareunia secondary to lack of vaginal secretions
What is the most dangerous complication of Sjogren Syndrome? Lymphoma
What is the most dangerous complication of Sjogren Syndrome? Lymphoma Increased risk of lymphomas (B-cell and MALT)
Which cause of megaloblastic anaemia is associated with an elevated level of methylmalonic acid? Vitamin B12 deficiency
Which cause of megaloblastic anaemia is associated with an elevated level of methylmalonic acid? Vitamin B12 deficiency Megaloblastic anaemia workup key points:- if MCV > 100, get a PBS to test for megaloblastic anaemia- if PBS reveals megaloblastosis, check B12/folate- if b12/folate is equivocal, check methylmalonic acid— if MMA is normal, it is a folate deficiency— if MMS is elevated, it is a vitamin B12 deficiency
What is the treatment for paroxysmal nocturnal haemoglobinuria? Eculizumab
What is the treatment for paroxysmal nocturnal haemoglobinuria? Eculizumab Complement-mediated hemolysis relies on factors C5-C9, among others. Eculizumab targets a key component of this mechanism reducing the intravascular hemolysis.
Which form of acute leukemia is associated withPAS, CALLA and TdT proteins? ALL
Which form of acute leukemia is associated withPAS, CALLA and TdT proteins? ALL AML = myeloperoxidase = makes sense with AML being myeloidALL = cALLa, PAS, + TdT = makes sense with ALL being lymphocytic
A patient suspected of having lymphoma undergoes an excisional biopsy of a nontender lymph node which reveals reed-sternberg cells. What is the diagnosis? Hodgkin’s Lymphoma
A patient suspected of having lymphoma undergoes an excisional biopsy of a nontender lymph node which reveals reed-sternberg cells. What is the diagnosis? Hodgkin’s Lymphoma Reed–Sternberg cells are large and are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an owl’s eye appearance). Reed–Sternberg cells are CD30 and CD15 positive. The presence of these cells is necessary in the diagnosis of Hodgkin’s lymphoma – the absence of Reed–Sternberg cells has very high negative predictive value.
A patient with lymphoma begins to develop cyclical fevers that come and go randomly over weeks. What type of lymphoma does he likely have? Hodgkin’s (these are Pel-Epstein fevers)
A patient with lymphoma begins to develop cyclical fevers that come and go randomly over weeks. What type of lymphoma does he likely have? Hodgkin’s (these are Pel-Epstein fevers)
A patient is diagnosed with multiple myeloma. What imaging should be performed? Full body XR skeletal survey looking for lytic bone lesions/pathological fractures
A patient is diagnosed with multiple myeloma. What imaging should be performed? Full body XR skeletal survey looking for lytic bone lesions/pathological fractures The bone lesions in MM are exclusively lytic.
Which plasma cell disorder is associated with hyperviscosity syndrome and peripheral neuropathy? Waldenstrom’s Macroglobulinaemia
Which plasma cell disorder is associated with hyperviscosity syndrome and peripheral neuropathy? Waldenstrom’s Macroglobulinaemia
What is the treatment for Thrombotic Thrombocytopenic Purpura? Plasma exchange
What is the treatment for Thrombotic Thrombocytopenic Purpura? Plasma exchange i.e. either take out the antibodies and give back lots of ADAMTS-13 or give ADAMTS-13 onlyDo…. not…. give…. fucking… platelets…..
The 1st line treatment of choice for adjustment disorder is psychodynamic psychotherapy or brief cognitive psychotherapy .
The 1st line treatment of choice for adjustment disorder is psychodynamic psychotherapy or brief cognitive psychotherapy .
Sublimation is a mature ego defense that involves replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system.
Sublimation is a mature ego defense that involves replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system. An aggressive person who channels their aggression into sports
Diabetic neuropathy is a common complication of diabetes mellitus. How often should it be tested for? Annually via monofilament
Diabetic neuropathy is a common complication of diabetes mellitus. How often should it be tested for? Annually via monofilament Just think of Dr. D in 3rd year and you will never forget this, brah.
Hypercalcemia of malignancy and hypervitaminosis D secondary to granulomatous disease both present with similar calcium lab panels (increased Ca, increased PO4, decreased PTH). What lab test can be ordered to discern between the two? 1,25-Vitamin D levels (to confirm hypervitaminosis); or PTH-rp levels (to confirm paraneoplastic syndrome)
Hypercalcemia of malignancy and hypervitaminosis D secondary to granulomatous disease both present with similar calcium lab panels (increased Ca, increased PO4, decreased PTH). What lab test can be ordered to discern between the two? 1,25-Vitamin D levels (to confirm hypervitaminosis); or PTH-rp levels (to confirm paraneoplastic syndrome) If you’re asked this, use the history to discern which one you need (i.e. history suggestive of sarcoid/TB vs. a lung mass)
Ulcerative colitis involves an increased risk of cancer as there is longstanding inflammation. As such, colonoscopy screening is important. When should it begin? Start 8 years after diagnosis and continue with q1y screening
Ulcerative colitis involves an increased risk of cancer as there is longstanding inflammation. As such, colonoscopy screening is important. When should it begin? Start 8 years after diagnosis and continue with q1y screening
Non-tender, firm, hyperpigmented nodules <1 cm in diameter and found most commonly on the lower extremities are likely to be ___. Dermatofibroma.jpg
Non-tender, firm, hyperpigmented nodules <1 cm in diameter and found most commonly on the lower extremities are likely to be ___.Dermatofibroma
Anti-U1-ribonucleoprotein (RNP) antibodies are associated with ___.
Mixed connective tissue disease-Varying clinical findings-Wink wink poke poke
What part of the brain is affected in Alzheimer’s? Nucleus basalis of Meynert
What part of the brain is affected in Alzheimer’s? Nucleus basalis of Meynert The hippocampus is also damaged. You will see cortical atrophy on imaging.
Sialadenosis (benign, non-inflammatory painless enlargement of the salivary glands) is associated with ___ (3). Sialadenosis.jpg
Sialadenosis (benign, non-inflammatory painless enlargement of the salivary glands) is associated with ___ (3).Advanced liver disease (e.g. alcoholic and non-alcoholic cirrhosis)Malnutrition (e.g. bulimia nervosa)Altered dietary patterns (e.g. diabetes mellitus)
Describe the setting changes that should be made for a patient on ventilator support when:1) PaO2 is too low2) PaO2 is too high3) PaCO2 is too low4) PaCO2 is too high
Describe the setting changes that should be made for a patient on ventilator support when:1) PaO2 is too low2) PaO2 is too high3) PaCO2 is too low4) PaCO2 is too high1) Increase FiO2 or positive end-expiratory pressure (PEEP)2) Decrease FiO2 or PEEP— Prevents free radical damage3) Decrease tidal volume (preferred) or respiratory rate4) Increase tidal volume (preferred) or respiratory rate
Lateral femoral cutaneous nerve compression causes pain and parasthesias over the anterolateral thigh.
Lateral femoral cutaneous nerve compression causes pain and parasthesias over the anterolateral thigh.Also called meralgia paresthetica It may be precipitated by a sudden increase in weight, an injury, or during pelvic surgery.
Which types of tumors may secrete EPO (causing polycythemia vera)? Renal cell carcinoma and hepatocellular carcinoma
Which types of tumors may secrete EPO (causing polycythemia vera)? Renal cell carcinoma and hepatocellular carcinoma
Identify the following EKG: Premature atrial contraction paste-11574936862721 (3).jpg
Identify the following EKG: Premature atrial contraction Also known as a PAC or Atrial Premature Beat, these occur when part of the atria sends out a depolarisation wave a little too early. Clues include: 1. The P wave of the PAC looks different from the other P waves, since it starts at a diff location in the atria 2. The P wave and subsequent QRS complex come earlier than would be expected. 3. The QRS and T wave are followed by a relative pause before the SA node repolarises and initiates a normal beat. Hence, the Normal, Short, Long pattern.
Tetanus toxin (tetanospasmin) travels via retrograde transport to the spinal cord.
Tetanus toxin (tetanospasmin) travels via retrograde transport to the spinal cord.GABA and glycine are inhibitory neurotransmitters, therefore, there is a lack of motor inhibition spastic paralysisVersus botulism is due to inhibition of Ach (excitatory) release, causing flaccid paralysis
Cleavage of SNARE proteins via tetanus toxins inhibits the the release of GABA and {{c2::glycine from Renshaw cells in the spinal cord.
Cleavage of SNARE proteins via tetanus toxins inhibits the the release of GABA and {{c2::glycine from Renshaw cells in the spinal cord.GABA and glycine are inhibitory neurotransmitters, therefore, there is a lack of motor inhibition spastic paralysisBotulism is due to inhibition of Ach (excitatory) release, causing flaccid paralysis
Does cleavage of SNARE via botulinum toxin prevent release of excitatory or inhibitory neurotransmitters? Excitatory (thus causing descending flaccid paralysis)
Does cleavage of SNARE via botulinum toxin prevent release of excitatory or inhibitory neurotransmitters? Excitatory (thus causing descending flaccid paralysis)
A 42 year old man has been fired from his job because of inappropriate behavior. For the past two months he has gradually developed very severe, “explosive” headaches that are located on the right side, above the eye. Neurologic exam shows optic nerve atrophy on the right, papilledema on the left, and anosmia. What is the most appropriate imaging study? MRI
A 42 year old man has been fired from his job because of inappropriate behavior. For the past two months he has gradually developed very severe, “explosive” headaches that are located on the right side, above the eye. Neurologic exam shows optic nerve atrophy on the right, papilledema on the left, and anosmia. What is the most appropriate imaging study? MRI Foster-Kennedy syndrome - tumour in frontal lobe (right sided in this patient).
An elderly man is involved in a rear end automobile collision. He develops paralysis and burning pain of both upper extremities while maintaining good motor function in his legs. What is the most likely diagnosis? Central cord syndrome
An elderly man is involved in a rear end automobile collision. He develops paralysis and burning pain of both upper extremities while maintaining good motor function in his legs. What is the most likely diagnosis? Central cord syndrome may be accompanied by localized deficit in pain and temperature sensation; typically occurs with hyperextension injuries in elderly patients with pre-existing degenerative changes in the cervical spine Spinal Cord Injuries1. Complete spinal cord injury: complete loss of motor and sensory function below level of lesion2. Brown-Sequard: clean cut injury (knife blade); ipsilateral paralysis and proprioception loss; contralateral pain and temp loss3. Central Cord Syndrome: elderly with forced hyperextension of neck (rear-end collision); paralysis, burning/loss of sensation in upper extremities, but distal extremities are spared 4. Anterior Cord Syndrome: burst fractures of vertebral bodies; distal paraplegia, bilateral loss of pain/temp; preservation of vibration and position (dorsal column unaffected)
Neurological symptoms with CD4 count <200; imaging shows multiple non-enhancing lesions PML (JC Virus)
Neurological symptoms with CD4 count <200; imaging shows multiple non-enhancing lesions PML (JC Virus)
The following neuroimaging is found in what congenital infection? CMV periventricular calcifications Screen Shot 2016-12-26 at 10.26.40 PM.png
The following neuroimaging is found in what congenital infection? CMV periventricular calcifications
What is the most likely diagnosis for linear ulcerations found in the esophagus on endoscopy? CMV
What is the most likely diagnosis for linear ulcerations found in the esophagus on endoscopy? CMV
Ecthyma gangrenosum is a black necrotic skin lesion seen in patients with Pseudomonas.
Ecthyma gangrenosum is a black necrotic skin lesion seen in patients with Pseudomonas. Ecthyma gangrenosum occurs from perivascular invasion and release of tissue-destructive exotoxins, causing vascular destruction and insufficient blood flowCommon in neutropenic, hospitalized, or burn patients, or patients with catheters
In rhabdomyolysis, urine is positive::+ or - for blood on dipstick and negative::+ or - for RBC on microscopy.
In rhabdomyolysis, urine is positive::+ or - for blood on dipstick and negative::+ or - for RBC on microscopy.Because dipstick picks up heme components, which myoglobin carries
What is the best noninvasive test to confirm diagnosis of H. pylori infection? Urea breath test
What is the best noninvasive test to confirm diagnosis of H. pylori infection? Urea breath test
The axillary nerve may be injured by an anterior dislocation of the humerus
The axillary nerve may be injured by an anterior dislocation of the humerus
The radial nerve may be injured by a fracture of the midshaft of the humerus
The radial nerve may be injured by a fracture of the midshaft of the humeruscauses weakness/paralysis of the hand and finger extensor muscles but sparing of the triceps (innervating fibers leave the nerve before it enters the radial groove)
The radial nerve may be injured by compression of the axilla (e.g. due to crutches or sleeping with arm over chair, Saturday night palsy )
The radial nerve may be injured by compression of the axilla (e.g. due to crutches or sleeping with arm over chair, Saturday night palsy )
Which nerve injury presents with wrist drop? Radial nerve injury
Which nerve injury presents with wrist drop? Radial nerve injury
What is the treatment for Whipple Disease? IV Ceftriaxone and maintenance TMP-SMX for 1 year
What is the treatment for Whipple Disease? IV Ceftriaxone and maintenance TMP-SMX for 1 year Lethal if left untreated
What is the toxic component in rhabdomyolysis that causes renal damage? Myoglobin
What is the toxic component in rhabdomyolysis that causes renal damage? Myoglobin
What rapid test can be done in the diagnosis of Histoplasmosis? Serum/urine rapid antigen test
What rapid test can be done in the diagnosis of Histoplasmosis? Serum/urine rapid antigen test
What systemic fungi can produce verrucous skin lesions when disseminated? Blastomyces
What systemic fungi can produce verrucous skin lesions when disseminated? Blastomyces
What MSK pathology is characterized by impaired relaxation after a single muscle contraction? Myotonic dystrophy
What MSK pathology is characterized by impaired relaxation after a single muscle contraction? Myotonic dystrophy
What β-lactam antibiotic can be used for left-sided endocarditis caused by Strep viridans and Strep bovis? IV Penicillin G
What β-lactam antibiotic can be used for left-sided endocarditis caused by Strep viridans and Strep bovis? IV Penicillin G Most Viridans group streptococci are highly susceptible to penicillin and should be treated with IV aqueous penicillin G (NOT ORAL) or IV ceftriaxoneOral antibiotics are generally not recommended as initial therapy in pt. With IE
What is the cutaneous complication of vancomycin and how do you treat? Diffuse flushing (Red-man syndrome) due to histamine release; manage by slowing the rate of infusion or pre-treating with antihistamines
What is the cutaneous complication of vancomycin and how do you treat? Diffuse flushing (Red-man syndrome) due to histamine release; manage by slowing the rate of infusion or pre-treating with antihistamines
All ischemic stroke patients should be given aspirin as prophylaxis for secondary stroke.
All ischemic stroke patients should be given aspirin as prophylaxis for secondary stroke.Aspirin is the only antiplatelet agent that is effective in reducing risk of early recurrence of ischemic stroke. Aspirin plus dipyridamole or clopidogrel is recommended for patients who have recurrent stroke on aspirin therapy
A patient has a stroke and an aspirin sensitivity. What drugs can be substituted in place of the aspirin? Clopidogrel or dipyridamole
A patient has a stroke and an aspirin sensitivity. What drugs can be substituted in place of the aspirin? Clopidogrel or dipyridamole
A patient has a stroke, and is given aspirin as prophylaxis against a secondary stroke. They subsequently experience another stroke - what anti-platelet medications should now be administered? Aspirin in addition to clopidogrel or dipyridamole
A patient has a stroke, and is given aspirin as prophylaxis against a secondary stroke. They subsequently experience another stroke - what anti-platelet medications should now be administered? Aspirin in addition to clopidogrel or dipyridamole
What drugs should be used to treat Toxoplasmosis? Pyrimethamine/sulfadiazine
What drugs should be used to treat Toxoplasmosis? Pyrimethamine/sulfadiazine
Pyrimethamine/sulfadiazine is used to treat what protozoal infection? Toxoplasmosis (HIV patient with headaches, FND, and multiple ring-enhancing lesions)
Pyrimethamine/sulfadiazine is used to treat what protozoal infection? Toxoplasmosis (HIV patient with headaches, FND, and multiple ring-enhancing lesions) pyramid hat = pyramethaminedyed eggs = sulfadiazine
Rapid DiagnosisTreatment of Nocardia Sulfonamides (TMP-SMX)
Rapid DiagnosisTreatment of Nocardia Sulfonamides (TMP-SMX)
What is the substitute for patients with H. pylori who are penicillin-allergic? Metronidazole
What is the substitute for patients with H. pylori who are penicillin-allergic? Metronidazole
What should be avoided with the use of Metronidazole? Alcohol due to disulfiram-like effect
What should be avoided with the use of Metronidazole? Alcohol due to disulfiram-like effect Disfulfiram is a drug given to alcoholics that inhibits aldehyde dehydrogenase-Can’t metabolize acetaldehyde and produces warmth, flushing, sweating (unclear mechanism)
Does Parkinson’s dementia develop before or after the diagnosis of Parkinson’s disease? Dementia after the diagnosis of Parkinson’s disease
Does Parkinson’s dementia develop before or after the diagnosis of Parkinson’s disease? Dementia after the diagnosis of Parkinson’s disease Dementia with Lewy Bodies: dementia develops before or at same time as ParkinsonismParkinson disease dementia: Parkinsonism predates cognitive impairment by >1 year
What anti-mycobacterial drug can cause drug-induced lupus? Isoniazid What antibody is characteristically elevated in drug-induced lupus? Anti-histone antibodies
What anti-mycobacterial drug can cause drug-induced lupus? Isoniazid What antibody is characteristically elevated in drug-induced lupus? Anti-histone antibodies
What nerve injury is caused by tight clothing, obesity, and pregnancy? Lateral femoral cutaneous ( meralgia paresthetica )
What nerve injury is caused by tight clothing, obesity, and pregnancy? Lateral femoral cutaneous ( meralgia paresthetica ) decreased anterior and lateral thigh sensation
What movements are lost with peroneal nerve lesion? eversion and dorsiflexion ( foot drop )
What movements are lost with peroneal nerve lesion? eversion and dorsiflexion ( foot drop ) PED = Peroneal Everts and Dorsiflexes
What nerve injury results in loss of hip abduction ( trendelenberg sign )? Superior gluteal nerve injury
What nerve injury results in loss of hip abduction ( trendelenberg sign )? Superior gluteal nerve injury injury is ipsilateral to extremity on which the patient stands
IFN-⍺ is a therapy useful for multiple sclerosis that may produce a flu-like syndrome.
IFN-⍺ is a therapy useful for multiple sclerosis that may produce a flu-like syndrome.
What antiretroviral therapy is associated with a type IV hypersensitivity reaction (Stevens-Johnson)? Abacavir
What antiretroviral therapy is associated with a type IV hypersensitivity reaction (Stevens-Johnson)? Abacavir
Abacavir hypersensitivity is associated with the HLA-B 57:01 allele.
Abacavir hypersensitivity is associated with the HLA-B 57:01 allele.
Didanosine is an NRTI most commonly associated with which adverse effect? Pancreatitis
Didanosine is an NRTI most commonly associated with which adverse effect? Pancreatitis
What anti-retroviral drugs can have hyperglycemia due to insulin resistance? Protease inhibitors
What anti-retroviral drugs can have hyperglycemia due to insulin resistance? Protease inhibitors
What anti-retroviral can produce nephrolithiasis? Indinavir
What anti-retroviral can produce nephrolithiasis? Indinavir indigo princess
What combination therapy is used for the treatment of Cryptococcal meningitis? Amphotericin B/Flucytosine .
What combination therapy is used for the treatment of Cryptococcal meningitis? Amphotericin B/Flucytosine .
Itraconazole is an -azole that is used to treat Sporothrix schenckii sporotrichosis.
Itraconazole is an -azole that is used to treat Sporothrix schenckii sporotrichosis.
What purine analog is used to treat Hairy cell leukemia? Cladribine
What purine analog is used to treat Hairy cell leukemia? Cladribine
{{c2::S. epidermidis is a coagulase-negative, gram + organism that infects prosthetic devices (hip implants, heart valves) and IV catheters by producing biofilms .
{{c2::S. epidermidis is a coagulase-negative, gram + organism that infects prosthetic devices (hip implants, heart valves) and IV catheters by producing biofilms .
What are the CNS complications of Nocardia? Brain abscess formation
What are the CNS complications of Nocardia? Brain abscess formation
Nocardia is a filamentous-branching gram-positive organism that can cause a brain abscess (fever + FND).
Nocardia is a filamentous-branching gram-positive organism that can cause a brain abscess (fever + FND).
A spiral fracture occurs in response to a twisting force on the bone.
A spiral fracture occurs in response to a twisting force on the bone.Highly specific for child abuse if seen in a child with a suspicious history (in questions anyways, in real life it seems a little more controversial)
What is the classical presentation for multiple myeloma? CRAB: Hypercalcaemia, Renal failure, Anemia and Bone pain (osteolytic)
What is the classical presentation for multiple myeloma? CRAB: Hypercalcaemia, Renal failure, Anemia and Bone pain (osteolytic) XR of affected sites, labs for hypercalcaemia, UA (Bence-Jones) and SPEP (first) (monoclonal spike)
What is the first choice treatment for anterior shoulder dislocation? Closed reduction
What is the first choice treatment for anterior shoulder dislocation? Closed reduction Check for neurovascular (axillary) injuries BEFORE closed reduction is attempted
What test is used to test for DeQuervain’s tenosynovitis? Finkelstein’s
What test is used to test for DeQuervain’s tenosynovitis? Finkelstein’s Due to inflammation of the abductor pollicis longus and extensor pollicis brevis and commonly seen in new mothers (strain from lifting new baby)Finkelstein test: patients make first while cupping the thumb abduct the wrist towards the ulnar side pain
What is the next step for blunt abdominal trauma in a hemodynamically unstable patient with an inconclusive FAST examination? Diagnostic peritoneal lavage (DPL)
What is the next step for blunt abdominal trauma in a hemodynamically unstable patient with an inconclusive FAST examination? Diagnostic peritoneal lavage (DPL) *DPL is only used for blunt, NOT penetrating abdominal trauma evaluation (penetrating trauma warrants immediate surgical laparotomy in this scenario)
What type of bursitis is seen with repetitive kneeling? Prepatellar bursitis ( housemaid’s knee )
What type of bursitis is seen with repetitive kneeling? Prepatellar bursitis ( housemaid’s knee )
How should displaced scaphoid fractures be managed? Surgical intervention
How should displaced scaphoid fractures be managed? Surgical intervention
What cardiac complication is associated with succinylcholine in patients with skeletal muscle trauma? Cardiac arrhythmia
What cardiac complication is associated with succinylcholine in patients with skeletal muscle trauma? Cardiac arrhythmia secondary to hyperkalemia due to efflux of K+ ions following binding of succinylcholine to post-synaptic ACh receptors; also may occur in patients with burn injury and stroke
What anesthetic is associated with adrenal insufficiency, especially in elderly and critically ill patients? Etomidate
What anesthetic is associated with adrenal insufficiency, especially in elderly and critically ill patients? Etomidate due to inhibition of 11β-hydroxylase
In patients with traumatic spinal cord injury, urinary catheter placement can assess for urinary retention and prevent acute bladder distention/damage.
In patients with traumatic spinal cord injury, urinary catheter placement can assess for urinary retention and prevent acute bladder distention/damage.
