facts Flashcards
What treatment should be added for patients with aspirin-exacerbated respiratory disease?
Leukotriene inhibitor, i.e monteleukast
3 tests for Cushings dz
low dose dexamethasone suppression test, late-night salivary cortisol, and 24-hour free urinary cortisol
patient with non-healing anal fissures should be screened for what?
chrons, colonoscopy
all patients with congenital long qt should be on what medication?
beta-blocker
Early Latent syphilis
postive labs w/ negative test w/i past year, only need one dose of penecillin
If lyme suspected by initial test is equivical?
Perform western blot
if you suspect CNS involvement in lyme?
do an LP
most common malaria found in travellers returning to the US?
plasmodium falciparum
tx for pyelonephritis?
fluorquinolone x7d
indications for IE abx ppx?
prosthetic valve, previous IE, structural abnormality, certain CHD
Fever + desquamating rash + multiorgan failure?
Toxic shock syndrome, tx w/ vanc and clinda
Indications to treat hep B?
> 4 weeks of symptoms + t. bili >3 OR acute liver failure
hypersensitivity pneumonitis or “hot tub lung” is caused by what?
MAC
dissemintated blasto
skin, GU, bone, lung involvement, ocular, look for CAP that doesn’t resolve + above symptoms
MAC dx?
two separate sputum cultures, tx w/ clarithromycin, ethambutol and rifampin
Actinomyces treatment?
penicillin
Pyrimethamine requires
leucovorin to decrease the risk of hematologic suppression
HIV patient with oral thrush and odynophagia should be treated for
candida esophagitis, no upper endoscopy is necessary
Patients with prior rheumatic fever c/b valvular heart disease should receive
continuous abx ppx w/ long acting penicillin g injections
Secondary Syphyillus:
maculopapular rash, systemic symptoms, cervical lymphadenopathy, patchy hair loss and mild hepatitis
High fever and cytopenias in a patient with suspected Lyme indicate co-infections with
anaplasma (causes human granulocytic anaplasmosis), has influenza-like symptoms with cytopenias, fever, and elevated transaminases
Immunocompetent vented patients with Candida on sputum cultures management
NOT be treated or re-cultured
LDH >450 is predictive of ___ rather than another pulmonary process
PJP
Thiazide diruretics increase risk of what?
T2D
Systemic Exertional Intolerance Disease:
fatigue >6mo, substantial reduction in pre-illness activities, post-exertional malaise, unrefreshing sleep, orthostatic intolerance or cognitive impairment
____ is an AGMA that can occur in patients receiving therapeutic doses of tylenol on a chronic basis in the setting of critical illness, poor nutrition, liver disease, CKD, vegan diet
Pyroglutamic acidosis
salicylate tox presents w/
respiratory alkalosis or with resp alk + AGMA
Scurvy is associated with
gingival hypertrophy, bleeding gums and petichiae
Obese patients have (higher/lower) pro-BNP levels than non-obese patients
lower
celiac patients need what vaccination?
pneumococcal due to hyposplenism
+LR
-LR
1-sens/spec
sens/1-spec
urge incontinence tx
first behavioral, then can try anticholinergic drugs i.e mirabegron, oxybutinin, solifenacin, tolterodine, trospium
Topiramate (carbonic anhydrase inhibitor) causes ____ in urinary citrate excretion and the formation of ____ urine that favors the creation of ____ crystals
Decrease, alkaline, ca Phos
BPH in patients with ED
For BPH and ED first line tx is PDE5i (tadalafil, sildenafil)
In patients with hypercalciuria and multiple kidney stones
can treat with Na restricted diet, which leads to decreased ca secretion by the kidneys
Early-stage laryngeal cancer should be treated with
radiation alone
Prolonged PTT that does not fully correct suggests
presence of an inhibitor
Acquired hemophilia A -
treat with activated factor VII (tx w/ factor VIII will not be successful due to inhibitor)
MDS patients requiring frequent transfusions should be started on
lenalidomide
Hook-like osteophytes are seen in
hereditary hemochromatosis
Asymptomatic INR elevation between 4.5- 10, manage w/
withholding warfarin
Polyclonal spikes can be caused by
inflammatory disorders, infections, and reactive processes and do not require further evaluation
Warm Agglutinin:
strongly positive IgG, negative compliment or weakly positive, anemia, jaundice, splenomegaly, spherocytes,
Cold agglutinin:
negative for IgG, positive for compliment
In symptomatic metastatic prostate cancer, first, treat with
anti-androgen (bicalutamide) rather than GNRH antagonist (leuprolide) bc GNRHa will cause worsening of symptoms initially
Sickle cell disease patients who have had a stroke can benefit from
monthly simple transfusions
In patients with metastatic prostate cancer assessment of _____ is required at the time of initiating androgen deprivation therapy
bone density
peripheral t cell lymphoma should be treated with
combination chemotherapy
If MM is suspected and SPEP is negative you should do
a UPEP and FLC analysis
Platelet dysfunction in chronic kidney disease should be treated first with
desmopressin
Hypoparathyroidism is associated with an ____ in the tubular reabsorption of phos
increase
____ defect can increase tubular reabsorption of phos, resulting in hyper Phos
FGF-23
Biotin can mimic _______
hypothyroidism by interfering with the assays that measure TSH and free T4
Most common cause of primary adrenal insufficiency is
autoimmune adrenalitis (antibodies to 21-hydroxylase in 90%)
Hypoparathyroidism: must monitor
urine ca bc hypercalciuria can limit therapy
hyperprolactinemia (mild) can be caused by
medications (metoclopramide, risperidone, phenothiazines)
amiodarone-induced hyperthyroid:
type 1 (hx of graves or multinodular goiter), type 2 no hx of thyroid disease
adynamic bone disease:
caused by over-treatment of secondary hyperparathyroidism in CKD. it is characterized by low bone turnover and low PTH
subacute (dequervian) thyroiditis should be treated with
steroids. patients present with anterior neck pain, diffusely tender thyroid and features of thyrotoxicosis
Acromegaly is associated with an increased risk of
cancer (skin, colon, esophageal)
Graves: tx w/
methimazole, PTU only for first trimester of pregnancy
Radioactive Iodine can ____ ophthalmopathy in patients with graves,
worsen, so avoid its use in these patients
Euthyroid sick syndrome: will need to check ____level
t3 level to confirm dx as they would be high in thyrotoxicosis
Suppression of TSH in patients with high-risk papillary thyroid cancer can lead to an increased risk for (3)
osteoporosis, afib and hypertension
if the patient does not respond to bisphosphonates after 1 year should
switch to teriparatide
best screening for cushings:
AM cortisol has low sensitivity and is not recommended for screening for cushings, better to use low dose dexamethasone suppression test, late-night salivary cortisol, and 24-hour free urinary cortisol
dexamethasone suppression test does not work if
you are on OCPs
X-ray shows thickening of the femoral neck with diffuse sclerosis of bone that is prominent in the left hemi pelvis.
Next step? bone scan. likely padgets disease of the bone
indications for parathyroidectomy in primary hyperpara:
age <50, symptomatic hypercalcemia, complications (osteoporosis, nephrolithiasis, CKD), elevated risk of complications (24hr urine ca >400, ca > 1 above upper limit of normal)
Toxic ademona w/ overt hyperthyroidism tx is
radioactive Iodide ablation therapy
Risk factors for cancer in thyroid nodules:
hx of ionizing radiation, elevated TSH, age <30 or >60, iodine deficiency
PCOS symptoms of hair growth need to be present for ___ months of OCP tx before consideration of MRA
PCOS symptoms of hair growth need to be present for SIX months of OCP tx before consideration of MRA
Gout lifestyle mods:
increased dairy, decrease seafood, decrease etoh, limited high-fructose foods and drinks
______ are indicated for the tx of Behcets related oral and genital ulcers,_____ can help prevent them
Topical glucocorticoids , colchicine
systemic sclerosis (scleroderma) 3 antibodies:
anti-topoismoerase I (anti Scl 70), anti-centromere, ana
Adult Onset Stills Disease
fevers, arthritis, leukocytosis (neutrophilic), rash, positive RF and elevated ferratin
Felty Syndrome:
Patients w/ RA, splenomegaly and neutropenia
Hypertrophic osteoarthropathy can be an early sign of ______ in a patient with a history of smoking and finger clubbing
lung cancer
Pseudogout: young patients with pseudogout should be tested for
hemachromotosis
Sweet syndrome:
acute febrile neutrophilic dermatosis, characterized by fever, painful erythematous lesions, neutrophilic infiltrate on biopsy w/o vasculitis, WILL have dramatic response to steroid
In SSc (scleoderma) patients watery diarrhea can be caused by
SIBO (small intestine bacterial overgrowth)
Antisynthetase syndrome:
interstitial lung disease, myositis, Raynaud phenomenon, nonerosive inflammatory arthritis, constitutional findings such as low-grade fever, and mechanic’s hands; anti-aminoacyl-tRNA synthetases antibodies, such as anti–Jo-1, are highly suggestive of the diagnosis
GPA relapse is treated with
rituximab
______ presents as intensely pruritic, pink to purple, flat topped papules or plaques, wickham striae can be seen on the surface
Lichen planus
Brachoradial pruritis “itch without a rash” is
a neuropathic itch characterized by deep, crawling, or tingling sensation on forearms, shoulders and upper back
_____ most effective topical tx for extensive AK
5FU cream is
_____ is a category of cutaneous sclerosis that involves only the skin in absence of other systemic manifestations
Morphea
Porphyria Cutanea Tarda characterized by
blisters, bullae, scarring, hypo/hyper pigmentation on sun-exposed skin, commonly associated with HepC, HIV, etoh, estrogen, smoking
senile solar purpura:
intermittent ecchymotic lesions primarily on hands and forearms
Multiple skin tags are associated with (3)
insulin resistance, pregnancy and chrons dz
UC flare: patients workup>
should undergo stool studies for routine pathogens, ova, and parasites as well as c diff
Primary Sclerosis Cholangigtis: must start screening for
colon cancer upon diagnosis and annually
Auto-immune hepatits:_____ antibody
anti-smooth muscle
Eosinophilic Esophagitis:
15 eos/ hpf, exclusion of other causes of esophageal eosinophilia
If h pylori testing obtained in the acute setting of UGIB is negative then
testing should be repeated
After diagnosis of celiac disease must perform
DEXA scan due to vit d def
Ileal resection leads to
bilesalt malbsorption and b12 deficiency
Microscopic colitis can be triggered by
medications including NSAIDS, PPIs and SSRI
Persistently elevated lipase and mild abdominal tenderness following acute pancreatitis is characteristic of
pancreatic pseudocyst
Cysteine stones show
hexagonal crystals
dyspepsia and age >60 =
endoscopy
gastroparesis requires
delayed gastric empty in absence of outlet obstruction; must get upper endoscopy prior to emptying study
anal fissures that do not heal,_____ screening is indicated
chrons
treatment of locally advanced rectal cancer:
preoperative chemoradiation, surgery, post-op chemo
______ deficiency can present in gastric bypass patients very similar to a b12 def (anemia, leukopenia, myeloneuropathy), exacerbated by zinc!!
Copper
Zoledronic acid toxicity classically causes
ATN
Voriconazole use is a risk factor for
development of skin cancer
If starting OCPs need to ____ the dose of lamotrigene
increase
Acyclovir IV should be given
with at least 2L NS per day to reduce the risk of kidney injury
Amiodarone induced hypothyroidism:
can cont amio and add levothyroxine
Phenytoin toxicity:
rash, horizontal nystagmus, ataxia. slurred speech, lethargy, coma
Valproic acid tox
hyperammonemic encephalopathy can happen after an increase in dosage, check and ammonia level
Calcimimetics in CKD (cinacalcet) can (list the benefit of taking this medication)
decrease the levels of PTH and lead to a decrease in parathyroidectomy
Weight neutral antipsychotic
aripiprazole, a second generation anti-psychotic is weight neutral
mtx tox
Folate deficiency and stomatitis can be caused by mtx, answer is to supplement folic acid
Combine ____ and ___ BP meds will reduce peripheral edema and improve CV outcomes
Combine ca channel blockers and ACEi or ARB will reduce peripheral edema and improve CV outcomes
Natalizumab: need to check _____ prior to starting
JC virus titiers
_____is characteristic of cholchicine induced myopathy
Cytosolic vasculozation
_____ presents with insidious onset fever, cough, DOE, wheezing, night sweats and weight loss, chest imaging shoes bilateral pleural based opacities
Chronic eosinophilic pneumonia
Aspirin induced respiratory disease will benefit from
leukotriene antagonist like monteleukast
Imaging modality for CTEPH:
VQ scan, mor senesitive than CTA
_____is the most common cause of ICH (intracerebral hemorrohage)
cerebral amyloid angiopathy
Neuroleptic Malignant Syndrome:
fever, confusion, muscle rigidity, autonomic instability (abnormal vitals, sweating)
Neuroleptic Malignant Syndrome (fever, confusion, muscle rigidity, autonomic instability) can occur when
withdrawling from parkinsons meds
Optic Neuritis:
acute monocular vision loss w/ washed out color vision and afferent pupillary defect, must get MRI to r/o MS
_______ should be suspected in a patient with morning syncope or pre-syncope (ie. putting on a tight collared shirt in the AM)\
Carotid sinus hypersensitivity
PAF associated with MV disease always requires ___ AC due to increased risk of stroke
warfarin
In hepatorenal syndrome intrapulmonary shunt can be confirmed with ______, symptoms consist of dyspnea that is worse when sitting up and improved supine]
contrast echo
Think _____ in pregnant patient with hypertension, chest pain and horners syndrome, first test is echo
Aortic dissection
_______should be avoided in myopericarditis as they have a higher rate of recurrence
glucocorticoids including prednisone
congenital long qt should be on
betablocker
nephrocalcinosis is
AKI caused by tumor lysis syndrome
_______ should be given for hypercalcemia, along with fluids. must avoid loop diuretics
Bisphosphonates
bacterial keratitis should be treated with
anti-pseudomonals
____ with high-dose glucocorticoids is an appropriate treatment for primary angiitis of the central nervous system.
Cyclophosphamide
Lupus flare can be seen in what antibody titer?
dsDNA antibodies
Anti-cytosolic 5′-nucleotidase 1A antibodies
have been identified in about half of patients with inclusion body myositis
gouty cellulitis tx
w/ pred
Screen for the ______ in a patient at high risk for allopurinol hypersensitivity.
HLA-B*5801 allele
_____ is the most appropriate initial immunosuppressive therapy in the treatment of isolated class V lupus nephritis, especially without kidney dysfunction.
Mycophenolate mofetil
Anti–Jo-1 antibodies
anti-synthetase syndrome
Anti-U1-ribonucleoprotein
MCTD, SLE
_______ is FDA approved as an addition to standard therapy in patients who have systemic lupus erythematosus with persistent mild to moderately active disease.
Belimumab
_______ is a noninflammatory condition that involves ossification of spinal ligaments and entheses and usually presents as back pain and stiffness; characteristic radiographic changes include confluent ossification of at least four contiguous vertebral levels, usually on the right side of the spine.
Diffuse idiopathic skeletal hyperostosis
________can present as annular with central clearing or papulosquamous with patchy erythematous plaques and papules, and both forms can be seen in the same patient;
Subacute cutaneous lupus erythematosus (SCLE)
first-line therapy for minimal change disease
prednisone
____ can lead to hypoaldosteronism and hyperkalemia
heparin
in patients with hypercalciuria ____ can help decrease urine Ca and decrease stone formation
HCTZ
Orthostatic hypotension associated with
increase in all-cause mortality
among antidepressants, ___ is associated with less weight gain and fewer sexual side effects
Buproprion
empiric tx of post-influenza pneumonia
cef+vanc+ azithro=
definition of severe acute chest
multi-lobar infiltrates on xray, O2 sat < 85%
bupropion is contraindicated
in seizure disorder
anorexia tx
1st CBT, 2nd olanzapine
after diagnosis of medullary thyroid cancer (3)
check RET, eval for metastatic dz, id co-existing tumors
patients with presumptive ITP should be tested for
HIV, Hep C
HIV patients with cryptococcus meningitis and increased ICP (opening pressure > 200) need antifungal plus ?
serial LP
n. memningitis requires what time of precautions?
droplet, surgical mask
AC in pregnancy
LMWH
primary biliary cholangitis
anti-mitochondiral
systemic sclerosis antibodies (scleroderma)
scl70, anti-centromere
in patients with nephrotic syndrome, ____ is a common presentation of renal vein thrombosis
Pulmonary embolism
anit- dna-histone antibodies
drug induced lupus
MCTD antibodies
anti-RNP (or U1-RNP)
limited scleroderma anti-body
anti-centromere
polymyositis antibody
amino-acyl t-RNA synthetase
microscopic polyangiitis anti-body
MPO (pANCA)
GPA ( wegners)
cANCA (Proteinase 3)
reduce the risk of recurrent nephrolithiasis in patients with ca oxylate kidney stones?
increase dietary calcium
