Facts Flashcards
1
Q
DM treatment options with weight negative effect
A
metformin
GLP-1 (liraglutide, exenatide)
SGLT2 (-flozins)
2
Q
Which DM medication should be avoided with history of genital mycotic infections
A
SGLT2 (-glflozin)’s
3
Q
colon cancer screening in UC
A
start 8-10 years after UC diagnosis and repeat every 1-2 years
4
Q
treatment of pulmonary arterial HTN
A
If + response to vasoactivity test –> CCB FIRST
no symptoms at rest, only activity – then start with oral meds
(PDE-5 inhibitors = sildenafil, viagra) or
(enothelian receptor antag = bosentan, ambristan)
5
Q
treatment of rising PSA after prostate cancer in past
A
radiation and leuprolide (androgen deprivation)
6
Q
pyoderma gangrenosum
A
non healing ulcer, culture neg
assoc with UC/ IBD
tx: prednisolone, cyclosporine
7
Q
goal BP for intracerebral hemorrhage?
A
<140 systolic
8
Q
ethylene glycol overdose clinical features and tx
A
CNS depression
inc anion gap metabolic acidosis
inc plasma osmolar gap (>10 difference bw measured and calculated serum osm)
renal failure
tx: fomepazole, HD IV bicarb (if pH <7.3)
9
Q
DM medications to lower cardiac risk
A
liraglutide
empagliflozin (dc all cause mortality, death by CVD and HF hospitalizations)
10
Q
BMI cut off for bariatric surg
A
> 40 or >35 with obesity related comorbidities
11
Q
lower incidence of statin induced myopathy with…
A
pravastatin, rosuvastatin
12
Q
criteria for lung transplant referral
A
FEV1 <25%, PaO2 <60, CO2 >50
13
Q
hidradenitis suppurativa tx
A
clindamycin-rifampin
infliximab
surgical excision
14
Q
normal ABI
PAD ABI
A
nl: 0.9 -1.4
PAD: <0.9
ischemic rest pain < 0.4
if borderline nl and symptomatic–do EXERCISE abi
if > 1.4 it indicates the presence of calcified, noncompressible arteries in the lower extremities and is considered uninterpretable.— do toe brachial index instead
15
Q
treatment of glioblastoma (IV)
A
surgical resection
followed by chemo (Temozolomide) + RT
16
Q
acute Wegners treatment to induce remission
A
steroids and rituxmab or cyclophosphamide
17
Q
DEXA score cut offs
A
osteoporosis < -2.5
osteopenia (-1 to -2.5
normal -0.9 to 1+
18
Q
Indications for antiresporptive treatment (ex: bisphosphonates, denosumab, raloxifene, teriparatide)
A
osteoporosis
osteopenia with FRAX > 20% major and >3% hip
fragility fracture
vertebral or hip fracture
moderate or high 10-year risk for a major osteoporotic fracture taking at least 2.5 mg of prednisone daily for 3 months
19
Q
risk of DKA with which diabetes med
A
SGLT-2 inhibitors (-flozins)
** DKA with normal glucose
20
Q
anti-HTN to lower serum urate
A
losartan
HCTZ and salicylates elevate it and predisposes to gout
21
Q
acute gout flare tx
A
NSAIDS (CI in PUD, CKD, HF, old, post op)
colchicine (CI in kidney failure)
glucocorticoids (oral vis intra-articular)
** do not change dose of allopurinol during acute flare
22
Q
indications for long term urate lowering therapy
A
2 attacks of gout
1 attack with CKD
uric acid nephrolithiasis
visible tophi
tx options: allopurinol, febuxostat (for non tolerance allopurinol), IV pegloticase (severe refractory)
**give NSAID/Colchine with when initiation and continue flare prophylaxis if active disease or tophi for 3-6 months
23
Q
tx for refractory gout
A
IV peglocticase
24
Q
tx of status epilecpticus
A
IV lorazepam then phenytoin or fosphyenytonin (not keppra)
25
meineres triad
senisuronal hearing loss, vertigo, tinnitus
26
Rhinne vs. Weber (tuning fork to forehead)
normal is air >bone.
conductive loss is bone >air
Sensorinural-- Weber louder in good ear (Ipsilateral)
Conductive-- Weber louder in affected ear
27
time cut off for tpa in acute stroke
4.5 hours (asa okay 24 hours after TPA given)
3 hours is <80yo, DM with prior infarct, on anticoagulation
(must get to PCI center in 2 hours for acute MI or get TPA)
door to balloon is 90 mins in STEMI
28
age for cc screening
50 -75 (if prior screening and up to date)
| if no prior screen can start up to age 85
29
when to FNAB a thyroid nodule
>1cm with normal TSH and suspicious features
<1cm with high risk features (calcifications, etc)
* after two negative FNAB can just follow clinically
** if suspect thyroid cancer/MEN check calcitonin (elevated in medullary thyroid cancer)
30
GFR cut off for metformin contraindication
<30
don't start with GRF <45
31
Pioglitazone C/I in?
chronic liver disease and HF
32
drug of choice for coccidiodies
fluconazole
33
best anti-seizure meds for older people
lamotrigine, levetiracem, gabapentin
34
low potency steroids for face
1% hydrocortisone validate
can use 0.1% triamcinolone for other body parts
35
indications for surgery in primary hyperPTH?
```
age <50
CKD with GFR <60
nephrolithiasis
T score < -2.5
Ca greater than 1 above the ULN
```
36
treatment of ILD in systemic sclerosis
mycophenolate
37
criteria for adequate stress testing
85% of age predicted maximum HR
| atleast 4 METs
38
H pylori Tx
triple therapy: PPI, amox, clarithromycin
Quad therapy in clarity resistant areas (asia, australia) or pcn allergy: PPI, bismuth, flagyl + tetracycline!
prior exposure to macrolides: amox, levaquin, PPI
** test for clearance at least 4 weeks after completing therapy
** do not test for H pylori until off PPI for 2 weeks and abx for 28 days
39
Tx of NON-small cell lung cancer based on mutations
EGFR -->
ALK/ROS1 -->
PD-L1 -->
EGFR --> erlotinib
ALK/ROS1 --> crizotinib
PD-L1 --> pembrolizumab
40
indications for airborne contact precautions
TB
disseminated varicella zoster
localized zoster in an immunocompromised
measles
** neisseria meningitis only needs droplet
41
characteristic of AVNRT on EKG
SVT--Narrow QSR tachycardia
RP < PR
P wave buried in QRS
pseudo R in V1
tx:
hemodynamically stable: vagal maneuver/carotid massage, adenosine (C/I in asthma exac bc risk of bronchospasm)
unstable: sync cardioversion
42
DM med assoc with risk of cholestasis, cholelithiasis, choleycystecomy
GLP-1 (eventide, liraglutide)
- bc rapid weight loss it causes saturation of cholesterol in bile and delayed release of bile
- also inc risk pancreatitis
43
reversal of dabigatran (direct thrombin inhibitor)
idarucizumab
44
AAA screening US age group
age 65-75 who smoked more than 100 cig
45
tx of DM caused by chronic pancreatitis
INSULIN only bc pancreatic beta cell destruction
46
hemolytic anemia, hypocellular bone marrow/ pancytopenia, and lack of CD55 and CD59.
portal vein thrombosis
Paroxysmal Noctural Hematuria
47
timeline for radiation pneumonitis vs. radiation fibrosis of lungs
radiation pneumonitits--typically 6-12 weeks
| radiation fibrosis---typically 6- 24 months
48
treatment for essential tremor
primidone or propanolol
49
interpretation of FeUrea
<35% = pre-renal
50
pre-renal findings
BUN: Cr >20:1
FENA <1%
U sodium <20 **
hyaline casts
51
ATN findings
BUN:Cr 10:1
FENA >2%
Urine sodium >40
muddy brown casts, tubular epithelial cells
52
AIN urine microscopy findings
leukocyte casts, eosinophilliura
53
mononeuritis multiplex assoc with
polyarteritis nodosum
* medium vessel vasculitis--mesenteric and renal vessels
* assoc with hep B
54
best seizure med for women on OCP/ reproductive age
Keppra
55
testing for lyme disease
TWO-tiered:
```
Enzyme assy (Lyme Ab EIA)
- if positive --> Western blot IgM and IgG (after 30 days will be present)
```
56
treatment after thyroidectomy for thyroid cancer?
if high risk -- > radioactive iodine
high risk:
size of the primary tumor (between 2 and 4 cm), the presence of vascular invasion and extrathyroidal extension and the number of involved lymph nodes (>5).
57
mitral regurg---indications for mitral valve repair
asymptomatic and LV dysfunction (EF <60%)
symptomatic and EF >30%
Pulm HTN
new onset Afib
58
dx west nile via
IgM ab
fever, meningitis signs
+ FOCAL neuro deficit
59
tx of PID in hospitalized patient
cefoxitin (IV cephalosporin) + doxycycline
60
OD with increased anion gap acidosis, and an elevated osmolal gap.
methanol (wood alcohol)
ethylene glycol (antifreeze)
Tx: fomepizole, HD( if severe)
isopropyl or ethanol OD have elevated osmolar gap but NOT elevation anion gap and no metabolic acidosis
61
tx of RA
Methotrexate then DMARD/TNF-a inhibitor (if that doesn't work then rituximab)
prednisone only for acute flares
62
how to prevent stroke after carotid a. dissection
aspirin
63
tx of partial seizure
| tx of generalized seizure
partial--carbamazepine
| generalized epilepsy-- valproic acid
64
safest anti epileptic in preg
levetiracetam (or lamotrigine)
65
reasons to treat after FIRST unprovoked seizure
```
age >65
h/o head trauma
focal findings on imaging/EEG
h/o partial seziure
h/o postictal weakness/paralysis
```
otherwise treat after 2 unprovoked
66
tx of relapsing-remitting MS
```
interferon B (C/I in liver disease or depression) or glatiramer
vit D supplementation
```
refractory --> Natalizumab (C/I with pos JC virus Ab)
```
IV methypred (high dose steroids) for acute exac
Interferon C/I in depression/liver disease
```
67
Travel
episodes of fever, polyserositis, arthritis, erysipeloid rash around the ankles, and elevated acute phase reactants
dx?
tx?
Familial Mediterranean fever
| colchicine
68
DM medication assoc with medullary thyroid cancer
liraglutide (GLP-1)
69
permissive HTN goals
- after ischemic stroke
- after/ before TPA
- after ICH
after ischemic stroke <220/120
before TPA <185/110
after TPA <180/105 (for at least 24 hours)
ICH -- <140
70
treatment of poison ivy
high potency topical steroid
| Type IV hypersensitivity
71
Chicungunya distinction from Dengue
fever recurrent + migratory polyarthralgias (small joints of the hands, wrists, and ankles) and much less thrombocytopenia.
Dengue has more myalgia, arthralgia, back pain (bone break fever)
72
Pneumocystis jirovecii prophylaxis after solid organ transplant
bactrim for 6-12 months
73
pusles paradoxus
systolic drop by >10 with inspiration
* seen in tamponade, constrictive pericarditis, asthma, COPD
74
Four statin benefit groups
1. Clinical ASCVD (ACS, MI, Angina, CVA, TIA, PAD, aortic aneurysm, Coronary a. calcium score >100) ---goal LDL <70 (add ezetimibe, then PCSK9)
2. LDL >190 (high int)
3. DM (mod inten) unless ascvd>20 then high
4. ASCVD >7.5% (mod int), ASCVD >20% (high int)
75
preferred SSRI in preg
sertraline, fluoxetine
| paroxetine is worse for preg
76
risky meds in preg
isotretitonin (X), warfarin (X), statins (X), bisphosphonates, ACE/ARB, valproic acid, SSRI, quinolone, tetracyclines
77
tx of alcoholic hepatitis to decrease mortality
indications?
prednisolone
Maddrey > 32, MELD >18
or encephalopathy + ascites
78
indication for MRI with headaches...red flags?
```
first/worst headache
change in pattern of headaches
aura lasting >1hr
focal deficit
new HA in age <5 or >50
```
79
psychiatric symptoms, seizures, autonomic instability, and choreoathetoid movements.
anti-NMDAR encephalitis
** strong assoc with ovarian teratoma
treatment can include tumor removal (if present), intravenous glucocorticoids, intravenous immune globulin, plasmapheresis, and rituximab
80
Differences between types of RTA
nl anion gap metabolic acidosis w/ positive urine anion gap: (Na+K) - Cl
Type 1-- distal
- urine pH>>6, low bicarb, hyperK
- ass cat phos stones, SLE, Sjogerns
Type 2--- proximal
- urine pH <5.5, glycosuria
- assoc MM
Type 4--
- urine pH < 5.5 low renin, low aldo, Hyper K
- assoc DM, develop severe HyperK with ace/arb
81
afferent pupillary defect, pain with eye mvmt, central scotoma
Optic neuritis, think MS
Get MRI brain
82
when to use vit K for supratherapeutic INR
oral vit K for INR >9
5-9 hold warfarin
IV vit K for life threatening bleeding only
83
Elevated LFTs, hemolytic anemia, unconjugated hyperbili
+neuro dysfunction
Liver biopsy to confirm Wilson’s disease
- unexplained acute liver failure in <40yo.
84
Indications for ICD
indications for ICD post-MI?
EF <35% and NYHA class 2 or 3 symptoms
Not class 4 unless patient is transplant candidate
inherited long QT
Brugada
high risk HOCM
VT/VFib arrest
sustained VT with syncope or structural heart disease
at least 40 days post MI - EF <30%
- at least 3 months since PCI/CABG
- life expectancy at least 1 year
85
Murmur of HOCM
Increases with valsalva, change from squatting to standing (dec preload)
decreases with hand grip or squatting
(inc after load)
** murmur improves/decreases with volume in heart.
Increased risk of death with dehydration
86
timing of pneumococcal vaccine
23 valent age 19-64 with COPD/asthma
repeat 23 valent (polysaccharide) at age 65 if 5 years has lapsed
everyone gets 13 valent (conjugated) at age 65 [ 1 year after 23 valent]
PSV23 and PCV13 are also indicated in patients with functional or anatomic asplenia, cochlear implants, persistent cerebrospinal fluid leak, and significant immunocompromising conditions. Preferably, these patients should receive PCV13 first followed by PPSV23 at least 8 weeks later. This patient will require another dose of PPSV23 at the age of 65 years.
87
broad vs. narrow anti-epileptics
broad: topiramate, lamotrigine, levetiracetam, valproic acid, and zonisamide
- for both generalized and partial epilepsy or if unknown
narrow: Carbamazepine, gabapentin, and phenytoin
- used to treat partial-onset epilepsies(specific auras (déjà vu or a rising epigastric sensation) and unilateral clonic shaking before onset.)
88
nephrotic syndrome with risk of thromboemobolism
membranous glomerulopathy
89
when to administer TDAP during preg
b/w 27-36 weeks with every pregnancy
90
treatment for cluster headache (acute and prevention)
oxygen
subQ sumatriptan
for prevention: verapamil
91
when to screen for diabetes
adults age 40-70 who are overweight or obese
92
surgery vs. medical management of aortic dissections
surgery with Type A (ascending or aortic arch) or complicated Type B
medical mgt with type B--IV BB to decrease HR below 60 then IV nitro
93
which MELD score to send for transplant
>15
| TIPS c/i for >20
94
follow up colonoscopy timing for sessile serrated polyp vs. adenomatous
serrated:
<10mm --- 5 years**
>10mm --- 3 years **
adenomatous:
1-2 that are <10mm --- 5-10 years
3-10, >10mm, villous, high grade dysplasia-- 3 years
>10 polyps -- < 3 years and eval for genetic cause
hyperplastic
if small and distal, regular 10 year interval
95
tests to screen for cushing's disease
24 hour urinary cortisol
1mg (low dose) dexamethasone test
evening salivary cortisol
* *NEED TWO ABNORMAL TO DIAGNOSE
* **NOT AM cortisol, bc it fluctuates
96
how to diagnosis CTEPH
VQ scan
97
diagnosis of sarcoidosis
bronch biopsy
98
biliary disease assoc with UC
Primary sclerosisng cholangitis (intra and extra hepatic ducts)
Primary Biliary cirrhosis is assoc with anti-Mitochrondrial ab.
99
treatment of rosacea
rosacea -- topical metronidazole
100
anterior knee pain that is slow in onset and typically made worse with running, climbing stairs, and prolonged sitting.
patellofemoral pain syndrome
101
lateral knee pain that is worsened by walking down an incline. On examination, there is frequently tenderness to palpation of the lateral femoral epicondyle,
illiotibial band syndrome
102
treatment of babesiosis
atovaquone + azithromycin
103
MEN syndromes
MEN1 -- diamond (pituitary (prolactinoma), parathyroid, pancreas(insulinoma) )
MEN2A --- square (parathyroid, pheo)
MEN2B --- triangle (neuroma, pheo)
2A and 2B assoc with medullary thyroid cancer
104
treatment of secondary hyperPTH due to CKD
calcitriol
105
agent for pharmacologic stress ECHO with COPD/Asthma
dobuatmine
* vasodilators, such as dipyridamole, adenosine, and regadenoson, can cause bronchospasm during cardiac stress testing; these agents can be used with caution in a patient with a history of COPD but are contraindicated in a patient who is actively wheezing.
106
size to warrant aortic aneurysm repair in men/women
5.5 cm in men and 5.0 cm in women
107
screening with annual low-dose CT in patients with
age 55 to 80 with at least 30 pack years and current smoker or quit within 15 years
108
treatment of lupus nephritis
```
class III and IV
- prednisone AND mycophenolate or cyclophosphomide
```
V
- prednisone AND mycophenolate
109
Treatment of ITP
Platelets > 30,000 and no bleeding
- clinical observation , repeat CBC in 1-2 days
PLT<30K---- prednisone.
2nd line = IVIG
3rd =rituximab/splenectomy
110
Colonoscopy follow up timeline after cancer
Follow up colonoscopy at 1year and 3year and if normal then every 5 years
111
Hip pain with FABER (flexion, abduction,external rotation) plus tenderness of SI
Sacroillitis
FABER causes--posterior hip pain in the presence of sacroiliac joint dysfunction, groin pain from an intra-articular cause, and lateral hip pain from greater trochanteric pain syndrome.
112
critera for extubation
RR <35 and O2 sat of at least 90%
113
indications and treatment of Essential thrombocytopenia
>60yo, h/o thrombus, PLT >1million
tx: hydroxyurea + asa
low risk patients-- asa only
stroke/TIA--platetletpharesis
114
time to get to PCI center for STEMI
<120 mins otherwise give TPA
(symptom onset within last 12 hours for giving TPA)
c/i if history of brain bleed, known AVM in brain, active bleeding, ischemic cva within 3 months, closed head/facial trauma within 3 month
door to balloon goal 90 minutes
115
vasculitis assoc with HepC and ear infarctios
cryoglobulinemia
-low C4, normal C3
116
small R wave and deep S wave in V1 lead
EKG with wide QRS and "W" in V1 and "M" in V6
LBBB
117
diagnosis of parkinson's
presence of bradykinesia and at least one of the other cardinal features of resting tremor, rigidity, or postural instability.
118
c-ANCA
p-ANCA
cANCA (anti-protinease Ab)
- Wegners (granulomatosis w/ polyangitis)
pANCA (anti-myeloperoxidase)
* *MPA-- microscopic polangitis**
- Churg Strauss (eosinophillic granulamtosis)
119
pneumonia vaccine time line
13 (conjugate)
23 (polysaccaride)
*see pic
120
treatment of myasthenia crisis
plasmapheresis
IVIG
** stop pyridostigmine during acute crisis due to it causing inc in resp secretions
121
treatment of status migraineous
intravenous infusions of dihydroergotamine
122
when to screen for HCC in HepB carriers
```
asian men >40, asian women >50
cirrhosis
famHx of HCC
persistant LFT elevation
african descent age 20
DNA levels > 10K
```
tx if ALT elevated and HBV DNA > 10,000
123
ICD vs. CRT placement (biventricular pacemaker)
ICD-- EF <35% and class 2-3 HF on GDMT
Cardiac resync therpy-- EF < 35% , class 2-4 symptoms on guideline-directed medical therapy, and ***LBBB with wide QRS****
124
dif b/w folate and b12 def
folate -- elevated homocysteine
| B12-- elevate homocysteine and MMA
125
pap smear screening guidelines
21 to 65 q3 years with cytology (Pap smear)
30 to 65yo- pap + HPV q5years
can stop at 65 if two neg HPV+pap in last 10 years
126
nephrotic syn assoc with HepB
membranous
127
treatment of sever or symptomatic Mitral stenosis
| **rheumatic heart dz = MCC
Percutaneous balloon mitral valvuloplasty is treatment of choice.
MV replacement if mod-severe mitral regur or LA thrombus
128
complement levels in lupus nephritits
low C3
| low C4
129
biliary disease assoc with UC
Primary sclerosis cholangitis
( beads on screen)
(diagnose with cholangiography)
130
compressive spinal cord lesion
steroids for anything compressive
imed RT-- if plasmacytoma or myeloma, leukemia, lymphoma, myeloma, and germ cell tumors
surgery--all other causes
131
ADAMSTS13 testing indication
suspicion of TTP (hemolytic anemia + low PLTS)
- treat with plasma exchange
ITP only has low platelets but no hemolytic anemia
132
positive direct antiglobulin (coombs) test
warm-Ab autoimmune hemolytic anemia
| tx= steroids
133
+flow cytometry for CD55 and CD59
| and how to treat?
PNH
no hemolysis---no treatment
tx for severe disease is eculizumab or HSCT
134
spherocytes
Autoimune hemolytic anemia (+coombs) or hereditary spherocytosis
135
anthrax tx
mild cutaneous-- PO cipro
inhlational--IV cipro + 2 other abx
painless ulcer with black eschar
Gram pos bacilli
widen mediastinum-- inhalation anthrax
136
small-vessel vasculitis affecting the skin, joints, kidneys, and gastrointestinal tract. Deposition of IgA
Henoch schonloin pupura
| treat with steroids
137
Kleinfelter (XXY)
he extra sex chromosome results in malformation of the seminiferous tubules and typically of the Leydig cells. Physical examination is likely to reveal small, firm testes and decreased virilization. Additional manifestations include oligospermia and infertility.
138
low testosterone
- - with high FSH/LH
- - with low or normal FSH/LH
high fsh/LH = testicular failure
**Klinefelter (check karyotype), mumps orchitis, prior pelvic RT
low or normal = secondary hypogonadism
* * OSA, hyper Prolactin, hypothalamus or pit disorders, use of opiates/anabolic steroids, glucocorticoids
- --> always eval prolactin, iron studies (hemochromatosis), pituitary MRI
139
what depth of melanoma requires sentinel LN biopsy
>1mm-- get LN biopsy and 2cm surgical margin
<1mm- get 1cm surgical margin
if greater than >4mm deep or LN involvement--immunotherapy with interferon alpha
140
treatment of melanoma with BRAF mutation
vemurafenib preferred over immunotherapy
141
treatment of anal cancer
squamous cell assoc with HPV
| --radiation with concurrent chemo
142
diagnosis of preeclampsia
HTN after 20th week gestation
PLUS
proteinuria or END ORGAN DAMAGE
low PLT <100K, Cr elevation, elevated LFTs, pulm edema, cerebral or visual symptoms
143
cardiac/pulm side effect of limited cutaneous systemic sclerosis
pulmonary HTN (pulmonary arterial pressure > 25)
--eval with ECHO
THEN maybe right heart cath
144
alternatives to colon cancer screening
age 50-75
- FIT Or high sens FOBT (gFOBT) yearly
- flex sig q5
- CT colonography q5
- flex sig q10 +FIT/gFOBT
- fecal DNA q3yr
145
how to determine surreptitious thyroid use
low thyroglobulin levels
146
treatment of hyperthyroidism in 1st trimester pregnancy and with thyroid storm
PTU
| other wise treatment is methamizole
147
when is radioactive iodine c/i for hyperthyroidism treatment?
pregnancy
| concurrent graves opthalamopathy
148
biggest side effect of hyperthyroidism tx
methamizole and PTU can cause agranulocytosis (severe neutropenia)
149
pre-op treatment of pheochromocytoma
IV phenoxybenazamine
150
first thing to do when evaluating hyper PROLACTIN
r/o hypothyroidism!!
151
dix hallpike differentiation b/w peripheral and central disease
peripheral
- latency bw maneuver and symptoms
- lasts <1min
- fatiguability
- horizontal w/ rotational
central (brainstem or cerebellar stroke)--get MRI
- no latency,
- Lasts >1
- not fatiguable
152
indications to monitor pericarditis as inpatient
high-risk features (fever, leukocytosis, acute trauma, abnormal cardiac biomarkers, immunocompromise, oral anticoagulant use, large pericardial effusions, or evidence of cardiac tamponade)
153
indications for BRACA testing
- breast cancer before age 45 years
- breast cancer at any age and a family history of breast and/or ovarian cancer
- triple-negative breast cancers diagnosed before age 60 year
154
treatment of burkett lymphoma
R-CVAD immediately bc it is aggressive
155
reasons for early surgical intervention in infective endocarditis (before 6 weeks)
```
heart block
veg >10mm
HF
left sided w/ staph aureus/fungal/resistent
persistant bacteremia >7 days
annular or aortic abscess
```
156
episcleritits vs scleritis
| uveitis
episcleritis
- painless
- no vision changes
scleritis
- painful, assoc w/ systemic AI diseases
- risk of vision loss, imed referral to optho
Uveitis
- most dilation at corneal edge
- Unitlateral
- assoc with HLA-b27
157
b/l painless gradual peripheral vision loss
| elevated IOP
open angle glaucoma
Macular degen causes central vision loss
158
initial evaluation of palpable breast mast
MMG (or US if <35yo)
then FNA or biopsy
159
c/i to combined OCPs
```
uncontrolled hypertension
breast cancer
VTE
liver disease
migraine with aura.
```
Estrogen-containing preparations are contraindicated in women >35 years who smoke
160
treatment of menopause hotflashes + vaginal dryness
if have uterus--- combined estrogen + progesterin
* **younger than 60 and within 10 years of menopause
* **max tx is 5 years
no uterus--can use estrogen alone
if just vasomotor hot flashes-- SSRI
if just vaginal dryness -- topical vaginal estradiol cream
161
indications for bridging
mechanical Mitral valve
mechanical aortic valve with afib or risk factors
recent VTE <3mos or afib and CVA <3 mos ago
162
time to wait for surgery after DES?
| Bare metal
DES-- atleast 6months, maybe 12
| Bare metal- 30 days
163
treatment of ankylosis spondylitis if NSAIDs aren't working
TNFa inhibitor for axial disease (adalimumab = humara)
MTX, sulfasalazine, HCQ for peripheral joint disease
164
initial tx of neutropenic fever
```
MONOTHERAPY:
zosyn
or
cefepime
or
meropenem/imipenem
```
**if signs of severe shock can add vanc simultaneously
no impvt in 4-5 days, add anti-fungal
165
ICD after MI
EF <35%
at least 40 days post MI
or 3 months post PCI
166
peripheral vertigo after URI
Vestibular neuronitis
- no hearing loss
Labrynthitis
- hearing loss
167
treatment of polycythemia vera (high Hgb, low EPO, +JAK2)
phlebotomy (goal HCT <45%)
asa 81
high risk-- hydroxyurea
* if EPO not low, consider a paraneoplastic syndrome, testosterone, chronic hypoxemia
168
treatment of ET
low dose asa (low risk)
high risk ( leukocytosis, >60yo, prior thrombi) ---hydoxyurea
if need rapid PLT reduct (stroke, MI)---platelet pheresis
169
fever, hypoxia, pulm infiltrate after ATRA for APML
differentiation syndrom
| - tx with dexamethasone
170
treatment of Afib when patient also has WPW
procainamide
| not BB, CCB, dig--> can cause VF
171
treatment of WPW
asymptomt tachycaridia--procainamide
sympt tachy-- ablation
unstable--- cardioversion
WPW conduction w/o symptoms--no treatment or investigation
172
treatment of pericarditits
asa (esp after MI) or NSAIDS
+
colchicine -- to prevent reoccurrence
173
topical vs. oral antifunal
oral terbinafine or itraconazole for onchomycosis, tinea capitus (head), extensive tinea corporis
topical clotrimazole or terbinafine for everything else
topical options:
imidazole, miconazole, clotrimazole, ketoconazole, ciclopirox, or terbinafine
174
tinea versicolor tx
topical treatment using ketoconazole 2% shampoo or selenium sulfide suspension is effective.
175
erythema multiforme
target with violaceous dark cente (multiple)
* * strong assoc with recurrent HSV or mycoplasma
* * also can be drug rxn
- -> supportive care
NOT to be confused with erythema migranes of lyme which looks like bullseye
176
abrupt onset severe psoriasis assoc w/
HIV
177
HIV post exposure ppx
3 drug regimen: tenofivir, emtricitabine, dolutegavir
4 weeks of tx
within 72 hours of exposure
testing at 0,1,3 months
178
indications for coronary a. calcium score test
10--year ASCVD is borderline (5-7.5%) or intermediate (>7.5%) to determine need for statin for PRIMARY prevention
179
pneumonia assoc with livestock
Coxiella Burnetti
aka- Q fever
tx: doxycycline
180
formula for serum Osm
Serum Osmolality (mOsm/kg H2O) = (2 × Serum Sodium [mEq/L]) + Plasma Glucose (mg/dL)/18 + Blood Urea Nitrogen (mg/dL)/2.8
181
TB skin test cut offs
```
>15mm = normal population
>10mm = IVDU, LTAC, healthcare, DM, homeless, recent arrival from prevalent country
>5mm = HIV, contact with active TB, CXR with old TB, organ transplant
```
182
SBP antibiotic prophylaxis reasons
1. ascites with GIB or variceal bleed-- 7 day course
2. chronic abx if hx of SBP
3. hospitalized with ascites protein <1.5 with (Na <130, Cr >1.3, or bill > 3)
tx: fluoroquinoles
183
indication for carotid endartectomy
greater than 80% stenosis
asymptomatic infarcts on brain imaging
an abnormal transcranial Doppler ultrasound study
rapid progression.
184
oral lesions in bullous pemphigoid or pemphigus vulgaris
oral lesions in pemphigus vulgaris (easily ruptured)
bullous pemphigoid--subepidermal vesicles and blisters that are tense and do not rupture easily, chronic, autoimmune
185
LVH on EKG
large S in V1
large R in V5/6
(S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm).
186
treatment of Bechets ulcers
topical steroids
| colchicine for preventing recurrent ulcers
187
examples of PSK9 inhibitors
alirocumab or evolocumab
** add if LDL still >70 with statin + exzetimibe
188
treating dermatitis herptiformis
gluten free diet
| dapsone (make sure not g6pd deficient first)
189
HTN on fundoscopy image looks like?
AV ratio <1 arterioles are very narrow compare to veins
flame-shaped hemorrhages; s
mall, white, superficial foci of retinal ischemia (cotton-wool spots);
yellow hard exudates
optic disk edema
190
acid base findings of asa overdose
HAGMA + Resp alkalosis
tx: alkalize urine with sodium bicarb
191
thin white vaginal discharge, fishy odor, no pain
+ wiff test
clue cells
pH >4.5
BV ( gardnerella)
tx: flagyl (clinda if preg)
candidas-- painfull/itchy, pH <4.5
192
what to give for lyme prophylaxis after tick bite and when?
doxycycline if tick has been attached 36 hours or longer and given within 72 hours of bite
otherwise just watchful waiting
193
asthma treatment directed at IgE?
| directed at high eosinophils?
IgE 30-700 -- Omalizumab
| Eospinophil count >150 --- Mepolizumab/reslizumab
194
hold long to hold NOAC pre-operatively
3 days
195
indications for closure of ASD
1. symptoms (dyspnea/embolism)
2. L to R shunt
3. RA or RV enlargement
196
acute onset nephrotic syndrome (without hematuria, just proteinuria) most likely?
minimal change disease
197
when to test for thrombophilla after unprovoked DVT?
NOT in acute setting
| NOT while on AC--- at least 2 weeks after discontinuation of anticoagulant therapy to minimize diagnostic error.
198
anticoagulant treatment of valvular afib
warfarin (IF mod/severe rheumatic MS or mechanical valve)
otherwise-- calc CHADS VASC and treat 2 or greater in men 3 or greater in women with NOAC
199
stool osm gap
secretory vs. osmotic
290 - [ 2(stoolNa + stoolK)
gap >100 osmotic diarrhea ( low vol, improves with fasting)
*lactase def
<50 secretory diarrheal (large vol, no improvement with fasting)
* celiac, infectious, collagenous colitis, VIPoma
200
old man with diarrhea, confusion (neurologic symptomatic), joint pains
Whipple disease
Dx: small bowel biopsy (foamy macrophages) and PCR from tropheryma whippelli
tx: 1 year abx (ceftriaxone then bactrim)
201
classification of chronic diarrhea
> 4 weeks (1 month)
| **first step is colonoscopy with biopsies
202
when to do EGD with GERD
alarm symptoms ( anemia, dysphagia, vomiting, wt loss)
refractory to PPI (once daily then BID for 4-8 weeks)
male >50yo with symptoms for more than 5 years and inc risk factors (nocturnal symptoms, hernia, inc BMI, smoker)
203
mgt of Barrett's
no dysplasia -- repeat EGD in 3-5 years
low grade-- ablation OR repeat in 6-12 most if not choosing ablation
high grade-- ablation
204
treatment of eosinophilic esophagitis
young adult with acute food impaction
EGD-- trachealization of esophagus (stacked rings)
tx: 8 week trial of PPI, if persistent diagnosis is confirmed and treat with swallowed fluticasone or budesonide
205
Zollinger- Elison syndrome
chronic diarrhea, PUD, esop ulcers
dx: fasting serum gastrin after stopping PPI for 7 days
206
first test to do with acute pancreatitis
RUQ US to rule out gallstones
CT only if severe, >48hours or complications suspected ( DO NOT routinely order)
207
who to treat with Hep B
1. compensated cirrhosis or acute liver failure
2. immunosupressed
3. polyarteris nodosum, membranous nephropathy, membranoprolifeerative
4. HbeAg +, LFTS > 2x ULN, DNA > 20,000 U/mL
IgG to core
5. HgeAg neg but ALT >2 ULN and HBV DNA > 2000
tx: entecavir or tenofovir
if also HIV-- emtricitabine-tenofivir
208
hemochromatosis
dx:
tx:
iron overload in multiple organs bc increased intestinal absorption (liver, heart, pit, pancreases)
- arthritis (destructive), ED, fatigue, DM, bronze skin
- hooked osteophytes
dx: fasting **transferrin**/ iron saturation
tx: phlebotomy (if elevated ferritin) otherwise monitor
* screen for HCC q6mos US
* * liver biopsy if elevated LFTs or ferritin >1000
209
first thing to r/o with RLS symptoms
** check ferritan/iron def
210
DAPT after stroke
asa + plavix for 21 days, then asa only
** only if initiated in first 24 hours (otherwise plavix only is more efficacious than asa only)
211
UMN + LMN signs and NO SENSORY deficit
ALS
- usually begins distally and asymmetrically
tx: Riluzole
UMN (hyperreflexia, spasticity, and an extensor plantar response
LMN (atrophy and fasciculation)
212
```
triad:
long standing RA
splenomegaly
neutropenia -->
** risk of infections/LE ulcers/lymphoma/vasculitis
```
Felty syndrome
| tx: agressive tx of RA
213
which carbapenem does NOT cover pseuduomonas
ertapenem
214
treatment of cyanide poisioning (house fire)
hydroxocobalamin
* house fire, lactic acidosis
* inappropriate high O2
* late-- hypoTN, heart block, arrythmia
215
A-a gradiant
normal <20
elevated-- causes?
normal (<20) -- hypoventilation
elevated- VQ mismatch, shunt, diffusion problem (fibrosis/vasculitis), empysema
Calculating A-a gradient = PAO2-Pa02
PAO2 = 150- (PaCO2/0.8)
216
vent strategy in ARDS
low TV (<6mL/kg ideal body wt)
high PEEP
allow for permissive hyperCapnia
217
cryptogenic organizing pneumonia
cough, fever, and malaise for 6 to 8 weeks that does not respond to antibiotics
patchy opacities on chest radiograph; and ground-glass opacities on CT scan that are peripherally distributed
tx: glucocorticoids
218
lung malignant assoc with hyponatremia
Small cell CA (bc SIADH)
219
treatment of CO poisioning
supplemental O2
Hyperbaric O2 (if LOC, ischemic ACS, neuro deficits, carboxyHgb level >25%
220
treatment of IPF
nintedanib or pirfenidone
221
management of a parapneumonic pleural effusion
empiric abx (anaerobe coverage)
```
If complicated (pH <7.2, glucose <60) or empyema (frank pus---->
CT drainage and TPA into pleural space if not completely drained
```
222
what therapies can decrease freq of COPD exac
roflumilast
| long term macrolide (azithro) therapy
223
lung + liver disease
| empyema with bullous changes in lung bases
alpha1-antitrypsin
224
causes of eosinophiluria
```
AIN (NSAIDS, PPI, Sjorgrens, Sarcoidosis)
post infectious GN
atheroembolic ideas
septic emboli
small vessel vasculitis
```
225
when to start 2 antiHTN at same time
BP >20/10 over goal
(>150/90) if goal is 130/80
226
D- lactic acidosis
increased anion gap metabolic acidosis in patients with short-bowel syndrome or other forms of malabsorptio
227
what kidney stone size cutoff is unlikely to pass spontaneously with supportive care/tamsulosin/nifedipine
urologic intervention for:
```
>10mm
any sign of infection
AKI
obstruction of solitary kidney
b/l obstruction
```
228
acute onset of severe hypertension, kidney failure, and microangiopathic hemolytic anemia.
scleroderma renal crisis
tx: ACEI
assoc with diffuse cutaneous system sclerosis
229
GFR when referral to kidney transplant center should be made
<20
**C/I if active malignancy, coronary ischemia, or active infections, no social support
230
eval of hematuria (not dysmorphic erythrocytes suggestive of GN)
1. exclude infection
2. CT (non contrast helical to exclude stones, and contrast to exclude renal cell ca)
3. IF >35, male, risk factors for malignant --> cystoscopy
IF age <35, female, no risk factors --> urine cytology then stop eval if normal.
231
mgt of renal a. stenosis
```
medical mgt (FIRST)-- add ACE-I
optimize HLD, cardiac risk factors, (if Cr rises >25% after addition of ACE it must be stopped)
```
Stenting --those who present with a short hypertension duration; fail medical therapy; or have severe hypertension or recurrent flash pulmonary edema, refractory heart failure, acute kidney injury following treatment with an ACE inhibitor or ARB, or progressive impaired kidney function
232
HyperCa
hyperCalciuria---> nephrocalcinosis/nephrolithiasis
+ b/l hilar adenopathy or granulomas
sarcoidosis affect on kidney
Hypercalcemia occurs due to peripheral conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D by activated macrophages
tx: steroids
233
which bicarb level to start oral bicarb supplement in CKD?
<22
234
when to give EPO in CKD?
If iron def r/o to maintain Hgb >10 (avoid Hgb >11.5)
goals with iron therapy in CKD:
maintaining transferrin saturation levels of >30% and serum ferritin levels of >500 ng/mL (500 µg/L).
235
GFR cut off for thiazide (chlorthalidone/HCTZ)
don't use with GFR <30
236
type of IVF treamtment of alcoholic ketoacidosis
** thiamine before glucose
| 5% dextrose in 0.9% saline
237
treatment of IgA nephropathy?
ACE-I (esp if have proteinuria)
asymptomatic hematuria 1-2 days after URI
nl complement levels
238
skin findings in various forms of lupus
acute cutaneous -- malaria rash --> develop SLE
subacute cutaneous -- papulosquamous, annular or polygonal photosensitive rash that usually spares the face
chronic cutaneous lupus erythematosus---discoid lupus erythematosus, usually presenting as scaly infiltrative papules and plaques or atrophic red plaques on sun-exposed skin surfaces
239
syndrome assoc with:
interstitial lung disease, myositis, Raynaud phenomenon, nonerosive inflammatory arthritis, constitutional findings such as low-grade fever, and mechanic's hands
anti-synthatese syndrome
anti-aminoacyl-tRNA synthetases antibodies, such as anti–Jo-1
240
tx of systemic sclerosis (scleroderma)
tx organ specific problems
** avoid steroids as them may precipitate a renal crisis
ILD-- mycophenolate
PAH -- treat similar to idiopathic PAH
renal crisis -- ACE-I
Raynaud-- avoid cold, CCB/ sildenafil/nitrogliycerin
241
localized pain inferomedial to the knee join
medial knee pain worsened with climbing or descending stairs or rising from a seated position.
pes anserine bursitis.
242
erythema nodosum +hilar adenopathy + inflam arthritis (usually ankles)
```
Lofgren syndrome (form of sarcoidosis)
- does not require any lymph node biopsy
```
243
spherocytes cause by
```
Autoimmune hemolytic anemia (pos Coombs/DAT with IgG)
Herediatry spherocytosis (neg Coombs/DAT
```
positive test-- shows agglutination
DAT = direct antiglobulin test
244
best screening test for hemochromatosis
transferrin saturation
245
treatment of MDS
low risk?
high risk?
-deletion of 5q?
low risk--no tx, infrequent transfustions
high risk-- allogenic HSCT (young pts), azacytidine/decitabine
5q deletion-- lenalidomide **
- favors good prognosis
246
lymphadenopathy +protein spike + organomegaly + lymphocytes in bone marrow
Waldenstrom macroglobulinemia
*asso with hyper viscosity syndrome--- needs emergently treated with plasmapheresis
247
hook like osteophytes on MCP
hemochromatosis
248
transfusing sickle cell patients
pre-op (surgery): simple transfusion to goal Hgb 10
if multi organ failure, ACS, CVA, retinal a. occlusion, fat embolism-- exchange transfusion to HbS <30%
otherwise avoid blood transfusions with simple vasoclusion or otherwise
249
reversal of dabigatran
idarucizumab (praxabind)
250
PLT cut off for treating ITP
PLT <30K
- steroids are 1st line
- if resistant--> IVIG or anti-D-immune globulin (if RhD pos)
- if still unresponsive to drugs or relapse after tapering steroids-- splenectomy or rituximab
251
mgt of Lobular carcinoma in situ (LCIS) on breast biopsy
no immediate mgt, consider high risk
** can consider anti-estrogen therapy like tamoxifen (risk of VTE, endometrial Ca), raloxifine (post menopausal only) or aromatase inhibitor (POST-menoupausal only, need DEXA q2 due to risk of osteoporosis)
252
examples of aromatase inhibitors
anastrozole
letrozole
exemestane*
-- only POST menopausal
risk of osteoporosis so need q2 year DEXA
253
prophylactic cranial radiation with which lung cancer
small cell
limited stage-- chemo & RT together
extensive stage-- chemo
for both-- prophylactic cranial irradiation
254
mgt of SVC syndome
get tissue diagnosis (mediastinoscopy) and then treat.
Do not need urgent stent unless patient crashing
can use steroids and diuretic for symptomatic tx while awaiting
255
tx of non- small cell lung ca (adeno, squamous, large)
I & II-- surgical resection plus cisplatin based chemo if >4cm and RT if positive margins
III-- (mediastinum or c/l mediastinal LN) -- chemo + RT
IV-- chemo, +/- immunotherapy
256
rule for surgical resection of liver mets?
"three lesions or less"
unless they have one of three conditions: tumor involvement of the common artery or portal vein or common bile duct; more than 70% liver involvement, more than six involved segments, or involvement of all three hepatic veins;
257
treatment of hairy cell leukemia
cladaribine
pancytopenia, splenomegaly, no LAD, "dry tap" bone marrow biopsy
thread-like projections off cells
258
smudge cells
indications for tx?
CLL
dx confirmed by flow cytometry with CD5 and CD23
asymptomatic-- observe
indications for tx: anemia, low PLT, symptoms, rapid doubling of WBC
tx: rituximab + chemo
older pts with late disease--- ibrutinib, chlorambucil
259
tx of renal cell cancer
early stage/localized-- nephrectomy
metastaticc--- debunking nephrectomy, immunotherapy with VEGF ( bevacizumab) or mTOR inhibitors (pemrolizumab, nivolumab)
** NO CHEMO is effective
260
tx of bladder cancer
transurethral resection of the bladder tumor followed by intravesical chemotherapy (BCG) and periodic cystoscopy
261
first thing to do for suspected testicular cancer
measures serum AFP and bHCG
CT A/P
inguinal orchiectomy -- NOT NEEDLE BIOPSY
262
seminoma vs. non seminoma testicular cancer
```
Seminoma (only HCG, never produce AFP)
non seminoma (produces HCG & AFP)
```
stage 1 (confined to scrotom)-- observe
stage 2,3-- cisplatin based chemo BEP
263
target cells assoc with?
thalassemia
264
EKG changes that make and exercise EKG stress test non reliable
LBBB, ST depressions, LVH, paced, WPW, digoxin use, prior CABG or PCI
265
cannon a waves
3rd AV block, VT
266
elevated RA pressure, PCWP and PA pressure with systemic hypotension
cardiogenic shock
nl PCWP <12
nl RA pressure <7
nl PA pressure 13-28/3-13
267
tx of PAD
1st line-- exercise training
med mgt-- cilostazol (C/I in HF**)
still not responding-- revascularlization
268
screening for AAA?
| tx cut offf>
MEN age 65-75 who have every smoked one time US
surgery if >5.5cm or >0.5cm/year
269
when to take abx prophylaxis for infective endocarditits?
which surgery?
usually amoxicillin, cephalexin, clinda
prosthetic valve
h/o IE in past
congenital heart defect (unrepaired cyanotic or repaired with prosthesis)
```
procedures:
dental procedures
incidiosn/biopsy of respiratory mucosa
procedure with GU or GI infection at same time
procedure on infected skin
placing prosthetic valves/heart surgery
```
270
paradoxical split of S2?
fixed?
persistent?
paradoxical-- delayed closure of aortic valve (LBBB, severe AS, HOCM)
fixed splitting-- ASD
persistant splitting-- PS, RBBB
271
treatment of afib development during with WPW
urgent cardioversion! can be life threatening
| procainamide while awaiting
272
which coronary after assoc with STEMI in
2,3,avF?
V1-V3?
1, avL, V4-V6?
2,3,avF? ---- RCA (inferior MI)
V1-V3? --- LAD ( anteroseptal MI)
1, avL, V4-V6? --- left circumflex a. (Lateral MI)
273
3 conditions with holosystolic murmur
VSD
Mitral regurg
TR
274
DM meds to use with with cardiac disease
GLP-1 (liraglutide, extend)
| SGLT2 (-flozins)--- reduce risk of CHF exac
275
indication for ASD closure
right heart enlargment or
large left to right shunt or
symptoms
percutaneous closure for ostium secundum (MC)
surgical closer for ostium primum
276
hypocalcium effect on QT
hypocalcium -- prolonged QT (>440 in men, > 460 women)
hypercalcium-- shortened QT
277
Anticoagulation of Afib with underlying HOCM?
Warfarin in everyone
(even with CHADSVASC not qualifying for anticoagulant
278
TTE vs. TEE for endocarditits
TTE
- 1st line
- can rule out IE with low probability
TEE
- for neg TTE in high probability patient
- for perivalvular abscess concern (prolonged PR)
- fungal or staph left sided IE
- HF
- congenital heart disease
- papillary muscle rupture
- AV block
279
when to treat THORACIC aortic aneurysm
surgery once >5 (or >4.5 with other heart surgery), or rate of growth >0.5/yr.
**marfans -- surgery >4.5
if >4.5 or rate of enlargement >0.5 per year then repeat US every 6 months other annual US
280
anticoagulant with mechanical prosthetic valve
warfarin **AND ASPIRIN**!!
goal INR 2.5 - 3.5 for aortic
goal 3 for mechanical mitral valve or aortic with risk factors (afib, dec EF, prior VTE)
281
GDMT for HF
ACE I
BB (metoprolol SUCCINATE, coreg, bisoprolol)
diuretics for vol OL
EF <40 + class 3-4 symptoms
- aldactone/eplerenone
- hydralazine + nitrates
```
ICD-- EF <35%, class 2-3 symptoms after minimum 3 pos GDMT
CRT- EF < 35%, class 2-4 symptoms, LBBB with QRS >105)
```
cardiac rehab
282
critical limb ischemia
ABI < 0.5
ischemic rest pain and ulceration
tx: immediate invasive angiography
283
congenital syndrom assoc with pulmonic stenosis
noonan syndrome
pulmonary stenosis, particularly those with short stature, variable intellectual impairment, unique facial features, neck webbing, hypertelorism, and other cardiac abnormalities, including hypertrophic cardiomyopathy, atrial septal defect, and ventricular septal defect.
284
indications for migraine prophylaxis?
drug options for prophylaxis?
>10 days/month
use of acute meds >8 days per month
disabling HA >4 days per month
not responding to therapy
tx?
propranolol, metoprolol, timolol, topiramate, valproic acid, effexor, amitriptyline,
285
myoclonus, rapid progressive dementia at young age, periodic sharp waves on EEG, MRI with increased signal in cortex and basal ganglia
Creutzfeldt-Jakob
286
who to treat for influenza
all inpatients
outpatient with high risk (immunocompromised, chronic lung disease, age >64, preg, DM, signifying comorbidities, BMI >40.
287
treatment of PCP in HIV pts
indications for steroids?
oral bactrim if mild
IV bactrim is more severe
(pentamidine or clinda+primaquine if sulfa allergy)
+steroids IF paO2 <70, or A-a gradient >35
PAO2 = 150- (PaCO2/0.8)
288
conjunctival suffusion
seen in Leptospirosis
exposure to animal urine or contaminated water/soil
dx: IgM serology
tx: doxycycline
289
treatment of toxo with ring inenhanocing brain lesions
sulfadiazine, pyrimethamine, folic acid
290
banana shaped gametocyte on peripheral smear
malaria (p. falciparum)
291
treatmetn of cat scratch disease
azithromycin for GN coverage of fastidious gram-negative bacterium Bartonella henselae
Other agents that can be used include doxycycline, rifampin, clarithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.
292
tx Yersina plague?
streptomycin/gentamycin
* safety pin
bipolar gram neg coccobacilli
bioterrorism
293
white painless plaques on side of tongue that cannot be scratched off in HIV patinet
oral hairy leukoplakia
| ** assoc with EBV in HIV/immunocompromissed
294
treatment of ESBL organisms?
carbapenems
295
brain lesion in AIDs patient
toxo or CNS lymphoma (EBV)
** need brain biopsy to differentiate
296
treatment of cryptococcal meningitis
liposomal amphotericin B and flucytosine
297
nonpurulent cellulitis tx
dicloxacillin, clindamycin, penicillin, cephalexin,
298
when can you stop bactrim for PCP prophylaxis
CD4 cell counts greater than 200/µL for more than 3 months
299
post transplant infection cause
first month--- same as general population
>1mos--- infection often CMV or EBV, JC virus causing PML, or polyomavirus BK causing nephropathy/hemorrhagic cystitis
>6 mos post transplant--- back to normal community acquired things
300
gram stain of neisseria
gram neg (pink) cocci
301
what to do for exposure to small pox?
Vaccinia immunization within 7 days of exposure
302
treatment of TB meningitis
RIPE + dexamethasone!
303
ecthyma vs. pyoderma gangrenous
ecthyma
- necrotic ulcers with tender erythematous border
- typically pseudomonas
pyoderma gangrenosum
- painful pustules or nodules become ulcers that progressively grow.
- not infectious
- assoc IBD, RA
304
lyme disease rash
erythema migrans
bullseye--- dark center with ring around it
305
recurrent gonnochial/meningiococcal infection
testing?
tx?
```
terminal complement deficiency
def of c5-c9
screen with CH50 assay
```
tx: standard antibiotics as needed, maintain currency of vaccinations (esp meningococcal)
306
erythema migrans lyme disease rash with neuro symptoms (facial n. palsy, headache, nuchal rigidity)
**must do LP prior to tx to determine no Neuroborreliosis, which necessitates parenteral therapy with ceftriaxone, cefotaxime, or penicillin.
in acute disease with just erythema migrans, fever, ha, arthralgia, myalgia, etc-- can just treat with empiric doxy without serologic confirmation first
307
treatment of histoplasmosis
pulmonary?
disseminated?
asymptomatic-- usually self resolves
subacute, chronic, pulmonary histo-- itraconazle
disseminated (hypotensive, diaphoretic, hepatosplenomegaly)--- liposomal amphotericin B
308
diarrheal illness assoc with IgA deficiency
Giardia
| tx: flagyl
309
treatment of cyclospora water diarrhea
bactrim
stool with modified acid fast stain
high risk HIV patients
travel
parasite is endemic, such as Peru, Guatemala, Haiti, and Nepal.
310
bloody diarrhea after solid organ transplant
CMV
311
CAP tx:
- outpatinet
- inpatinet
- ICU
outpatient
- macrolide OR doxy alone
inpatient
- beta lactam + macrolide
- fluroquinolne alone (levaquin/moxiflox)
ICU
-IV beta lactam + azithromycin/respir fluoroquinolone
if risk of pseudomonas-- double coverage
if risk of MRSA-- add Vanc or linezolid
312
strep gallolyticus
new name for strep bovis
| **check colonoscopy
313
abx with biggest interaction on warfarin
Bactrim (also avoid with MTX therapy!)
```
also raise INR:
amio
erythomycin
metronidazole
-zoles
tylenol**
```
314
treat of UTI while on warfarin
nitrofuratonin
pcn
cephalosporin
**caution with fluoroqunolones and AVOID bactrim!
315
drugs that cause peripheral edema
```
nifedipine, amlodipine, fedolapine
pioglitazone -- can trigger a HF exac
pramipexole
NSAIDS
estrogen
gabapentin/pregabalin
```
316
side effects of tramadol
seizures
suicidal ideation
hyponatremia
hypoglycemia
317
seizure med that causes non anion gap acidosis
topiramate
**can also cause calcium phosphate renal stones
318
Side effects of SSRI
hyponatremia
increased GI bleeding risk
sexual dysfunction
319
what percentage within 1 SD of mean?
| 2 SD?
68% within 1 SD
95% within two standard deviations
** see bell curve drawing
320
if 95% CI crosses ___ for a treatment it is NOT significant
| if 95% CI crosses ___ for a relative risk or odds ratio it is NOT significant
0
| 1
321
NNT formula
ARR formula
NNT= 1/ARR
ARR= % risk in control group - % risk in treatment group
322
positive LLR
| negative LLR
+ LLR = sens (1-spec)
| - LLR = (1-sens)/ spec
323
what are the high intensity statins?
atorva 40-80
| rosuva 20-40
324
age to start cholesterol screening?
M -- 35-65
F -- 45 - 65
** if any risk factors can start at age 20
325
low dose lung CT screening
| AAA US screening
lung CT-- YEARLY in age 55-80 with 30 pack years, current or quit within last 15 years
Abdominal US-- ONE TIME ages 65-75 (MEN ONLY) who ever smoked
326
drug interactions with lithium causing lithium tox
ACE-I ***
diuretics
NSAIDS
tx:
327
drug overdose causing teeth grinding (bruxity) and hypoNa after a young kid going to a party
ecstasy/NMDA
328
glaucoma on fundoxscopy
cup taking up most of the disc >2:1
329
treatment of bulimia
CBT and SSRI (fluoxetine or imipramine)
anorexia-- tx with CBT
330
1st line therapy for insomnia
CBT
331
when to give low dose asa
Low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and colorectal cancer is recommended for adults aged 50 to 59 years with a 10-year ASCVD risk of 10%
332
labrynthitis vs. vestibular neuronitits
both are peripheral vertigos that are preceded by URI
hearing loss in labrynthitis due to inflammation of CN8
333
treating combined ED and BPH
tadalafil**
334
vertigo + vertical nystagmus with no fatiguability
consider brainstem/verterbrobasilar infarct
335
Pre-operative measurement of serum electrolyte and creatinine levels necessary in?
patients with kidney disease and those who are taking medications that may affect kidney function or predispose them to electrolyte abnormalities.
336
evaluation of palpable breast lump
age <30 -- observere 1-2 menstural cycles, if persistant-- US
age > 30 -- Mammogram
337
treatment of prostatitis
GN coverage (cipro, levaquim, or bactrim) for 4-6 weeks
** know how to treat epididymitits based on age
< 35-- ceftriazone + doxy
>35 -- ceftriaxone + fluroquinoloen
338
preventing pressure sores
advanced static mattress or mattress overlay
339
bridging with afib
ONLY IF:
mechanical valve or
high risk: ischemic stroke, TIA, or VTE within the past 3 months.
340
low dose asa for primary prevention
primary prevention of ASCVD and colorectal cancer in adults aged 50 to 59 years with a 10-year ASCVD risk of 10% or higher
341
drugs causing peripheral edema
gabapentin
vasodilators (minoxidil, hydralazine, calcium channel blockers, α-blockers)
amlodipine, etc.
pioglitazone and rosiglitazone,
342
how to treat nephrogenic DI
- - if lithium induced: DC lithium, start amiloride
| - - if not drug induced: thiazide diuretics and salt restriction
343
PTH effect of Vit D def
Vit D deficiency causes SECONDARY hyperparathyroidism (high PTH, nl Ca, low phos, high alk phos due to bone turnover)
344
diagnosis of DM
need TWO abnl:
fasting >126
random glucose >200 with symptoms
a1c > 6.5%
OGGT test-- 2 hour post prandial >200
if disconcordance-- repeat the abnl test
```
PRE-DIM
fasting 100-126
random 140 - 199
OGTT 140- 199
A1c 5.7 - 6.4%
```
345
treatment of hyperthyroidism-- 3 options
1. methamizole (agranulocytosis/hepatoxic)
PTU (preg 1st trimester and thyroid storm)
2. radioactive iodine -- for multi nodular goiter of hyperfunctioining nodule
C/I in preg/ graves opthalmopathy
3. thyroidectomy -- if have opthalopathy
346
treatment of subacute painful thyroiditis
NSAIDS and glucocorticoids
BB for symptoms
synthroid is symptomatic hypothyroid
thyroid studies will normalize by themselves
347
treatment of myxedema coma (ams, hypoVent, hypothermic, hypoNa)
IV synthroid AND hydrocortisone
348
indications for thyroid nodule biopsy
> 1cm and euthyroid (nl TSH)
<1 cm with suspicious features = calcifications, increased vascularity, ireg boarders)
349
what to screen for incidentally adrenal adenoma discovery
Cushings-- *1mg overnight dex suppression test (cortisol should be < 3 after)
Pheo-- 24hr urine metanephrines
if HTN-- aldo to renin ratio
350
C/I for bisphosphonates (alendronate/risedronate)?
| alternate therapy?
oral CI with esophogeal disorder
**can use IV zoledronic instead (C/I with GFR <35)
can instead use:
denosumab (safe in CKD), twice yearly
teriparatide-- max tx is 2 years
351
best test for serum vit d levels?
25- hydroxyvitamin D
352
treatment of adrenal insuf
primary-- hydrocortisone + fludrocortisone
| secondary-- hydrocortisone only
353
rapidly progressive, or severe hyperandrogenism (hirsutism, frontal hair loss, etc)
consider androgen secreting ovarian tumor-- check pelvic US
354
MC cause of primary adrenal insufficiency (low cortisol, high ACTH)?
21-hydroxylase deficiency causing autoimmune adrenalitis
355
drug causing sudden peripheral neuropathy
Quinolones
**also assoc with aortic dissection, tendon rupture
356
drugs causing hypoNa
```
HCTZ
SSRI
carbamazepine
NSAIDS
NMDA (excstasy)
```
357
drug induced syncope in elderly
cholinesterase inhibitors
| ** donepizil
358
opioid induced constipation treatment
```
1st line-- stimulant +/- docusate (senna, biscodyl)
2nd line-- osmotic (miralax, lactulose
3rd line--
oral naldemedine
subcutaneous methylnaltrexone
naloxegol
```
359
Does IBD patient in hospital with acute flare and hematochezia need pharmacological dvt ppx?
YES!
| regardless of bleeding status need subQ heparin because increased risk of VTE with UC/Chron's
360
indications for choley if gallbladder polyp found
>1cm
any size assoc with gallstones
billiary collic
PSC
361
confusion, ataxia, nystagmus, discongugate gaze post gastic bypass
thiamine def-- wernikes
** give thiamine prior to glucose
362
mgt of liver lesion
usually biopsy unnecessary
if no decomp cirrhosis and single small lesion-- surgically resect
if cirrhosis and
up to 3 tumors <3cm or 1 tumor <5 cm -- liver transplant
363
IBS-C tx
fiber diet
hyoscyamine/dicyclomien short term
SSRI (for C predominant)
lupiprostone/linaclotide for IBS-C
```
IBS-D:
loperamide
TCA
eluxadoline
rifaximin
```
364
HELLP vs. AFLP
HELLP- hemolysis, inc ALT, low put
AFLP -- has encephalopathy and prolonged INR and hemolysis, low plt, elevated LFTs
tx of both is emergent deliver
365
development of fever, diffuse capillary leak (pleural effusions, pericardial effusion, pulmonary edema) after starting ATRA for acute promyelocytic leukemia
differentiation syndrome
tx: prednisone
366
determining readiness for extubation
RSBI < 105 = RR/ TV in Liters
few secretions
awake following commands
strong cough
367
non-motor symptoms of early parkinsons
loss of smell/taste
REM sleep disorder
constipation
depression
368
anti-UN-1RP (ribosomal Ab) assoc with?
MCTD
- synovitis, Raynaud, hand edema, myositis
- **pulmonary HTN
369
Stress test for someone with LBBB or pacemaker?
must be adenosine/vasodilator nuclear perfusion
** cannot do exercise or dobutamine
370
best test of unhealthy alcohol use?
single item screening test or
| AUDIT-C
371
hyperthyroid mgt in pregnancy
PTU 1st trimester
methamizole 2nd and 3rd
maintain mild hyperthyroid state
monitor thyroid studios every 4 weeks
372
Fever
polyarthralgia
transient macular faint salmon colored rash
pericarditits/pleuritits
Adult onset Still's
elevated WBC and ferritin
* know difference between this and Felty syndrome
373
drugs that can cause drug induced lupus
```
HCTZ
procainamide
isoniazid
TNF-a inhibitors
minocycline
```
+anti-histone Ab
374
abx with highest risk of cdiff
```
fluoroquinoles
cipro, levaqin
clindamycin
3rd/4th gen cephalosprins
augmentin
```
375
adverse effect of tamoxifen
VTE
| increased risk endometrial Ca
376
valvular abnormality assoc with GI bleeding due to AVM
aortic stenosis
377
metabolic disorders assoc with pseudogout
recent parathryroidectomy
hyperPTH
hemochormotosis
hypothyroidism
378
difference between myasthenia graves and lambert eaton
Lambert eaton-- muscle weakness IMPROVES with repetitive stimulation and have hypo reflexes
anti–voltage-gated calcium channel antibodies
assoc with small cell lung ca
Myasthenia
fatiguabiliy
assoc with mediastinal mass (thymoma)-- all need CT chest to screen for this
tx: pyridostigmine (if severe-- steroids, IVIG)
379
mgt of pituitary apoplexy (hemorrhage)
high dose IV steroids empirically until adrenal insufficiency rulled out
THEN surgical decompression
sudden HA, CN3 palsy, AMS, vision change
380
erlichiosis vs. anaplasmosis
fever, elev AST/ALT, **leukopenia, ** thrombocytopenia
ehrlichiosis--
lymphopenia, clumps in monocyte
anaplasmosis--
neutropenia, clumps in granulocyte
tx: doxy
381
acute onset HTN with flash pulmonary edema
renal a. stenosis
382
thyroid storm
high fever, tachy, agitation, hyperTN, N/V, tremor, lid lag, goiter
trigger = infection, surgery, trauma, recent iodine load
tx: BB, PTU, steroids
383
exudative pleural effusion with eosinophilic predom
asbestos
384
sensorineural hearing loss causes
meniere's
acoustic neuroma
presbycusis
ototoxic drugs (ahminoglycosides)
385
lymphadenopathy with leukocytosis
CLL if lmphocytosis
check peripheral smear and flow cytometry
(DONT BE TEMPTED TO BIOPSY LN)
386
pH level with bacterial vaginosis
>4.5
clue cell
thing grey discharge
+ wiff test
387
allergic conjunctivitis
vs.
viral conjunctiivits
allergic-- b/l, itchy, nasal congestion & sneezing
tx: topical antihistamine
viral -- u/l then b/l
tx: supportive
388
SAAG and protein eval of asities
SAAG < 1.1 -- nephrotic syn
SAAG >1.1 -- cirrhosis (protein <2.5) or HF (protein >2.5)
389
Nephrotic syndrome + HF
restrictive cardiomyopathy + nephrotic syn = amyloidosis
390
supine hypoxia
diaphragmatic paralysis
| dx: sniff test using fluoroscopy
391
daptomycin does not work for which infection
pneumonia! inactivated by pulmonary surfactant
392
alopecia aerata
round non scaring hairloss
exclamation point! hairs on margins
tx: intra-lesional IV corticosteroids
393
indication for CT or pleurodesis for pleural effusion
CT placement if > 2cm
pleurodesis if its the 2nd primary pneumo or any secondary pneumo
primary-- tall, thin, marfan, normal lung or blebs/bullae
secondary-- assoc COPD, CF, LAM, HIV and PCP pneumonia
394
difference between GBS and transverse myelitits
TM has a sensory deficit line and affects bowel/bladder function
tx: iV steroids (2nd line = plasma exchange)
GBS is mostly motor (may have some mild paresthesias)
tx: plasmapheresis, IVIG
395
C/I to NSAIDS for osteoarthritis
CAD, HF, CKD, Ulcer, h/o GIB, HTN, caution in >65
| -- use topical NSAIDS instead
396
tx of myasthenic crisis
plasma exchange or IVIG
| stop acetylcholinesterase inhibitors (pyridostigmine)
397
obstructive vs. restrictive lung disease
Obstructive -- Fev1/FVC <70%
restrictive-- TLC < 80%
398
what causes overdose with HAGMA + osmolar gap >10
tx?
Methanol
ethylene glycol
tx of both: fomepizole, dialysis if severe
399
what pathogen causes bubonic plague (swollen lymph nodes, high fever, lethal)?
how to tx?
Yersinia pestis
(GN cocobacillus, transmitted by fleas on rodents)
** rats
tx: tetracycline or streptomycin
400
when to give empiric antibiotics for a skin abscess after I&D
```
>2cm
extensive surrounding cellulitis
systemic fever
neutropenia
extremes of age
```
401
treatment of chronic urticaria (>6wks)
2nd gen H1 blocker -- loratadine, certirizine, fexofendine
402
what type of hypersensitivity is contact dermatitis
type IV
403
what exacerbates psoriasis
```
systemic steroids
anti-malarial
lithium
BB
NSAIDS
ACE-I
tetracyclines
```
404
tx of rosacea
topical metronidazole if inflammatory pustules and papules
405
drugs causing SJS (<10%) or TEN (>30%)
1-3 weeks after exposure
sulfa
allopurinol
anticonvulsants
NSAIDS
406
type of ezxcema rash in flexure skin folds
atopic dermatitis
407
extensive refractory seborrhagic dermatitis assoc with?
HIV
sebo keratosis assoc with GI malignancy
408
Pityriasis rosea reactivation of?
HHV 6 or 7
mimics Syphillus except spares palms and soles so rule out by checking RPR
409
effect of sarcoidosis on 1,25-vit D
elevated 1,25-vit d
410
congenital adrenal hyperplasia
virilization, frontal balding
deficient of 21-hydroxylase
** diagnosis with elevated 17- hydroxprogesterone
411
only lab required prior to giving TPA?
blood glucose level
412
treatment of osteoporosis or bone mets with CKD?
denosumab
| can't use bisphosphonates if CrCl <35%
413
difference between neuroleptic malignant syndrome and serotonin syndrome
both have fever, AMS, autonomic instability
NMS-- muscle rigidity, no clonus, dec reflexes
precipitated by anti-psychotics, promethazine, reglan, infection, surgery or stopping dopamine agonists
tx: dantrolene
serotonin syn-- agitation, rigidity, hyper-reflexia, myoclonus
tx: stop drugs, benzos
414
malignancy assoc with Klinefelters?
breast CA
415
Sjogern syndrome increase risk which malignancy?
B cell lymphoma
(large B cell, MALT)
** increased risk heart block in neonates
416
dx of gastroparesis
EGD 1st if acute symptoms then emptying study
if chronic symptoms--gastric emptying study
417
avoid bupropion if...
seizure DO
eating disorder
avoid chantix if active psychosis or suicidal ideation
418
treatment of toxoplasmossi
sulfadiazine + pyrimethamine + folic acid (or leucovorin)
419
renal angiomyolipomas, renal cell carcinoma, and cysts
hypo pigmented macules
pulmonary LAM (cystic lung disease)
tuberous sclerosis
420
1st line treatment of mitral stenosis?
C/I?
percutaneous mitral balloon valvotomy (to cut open valve)
C/I-- concurrent MR or LA thrombus
- would require surgical MV repair
421
first choice abx for non-purulent cellulitis
clindamycin
dicloxacillin
cephalexin
422
persistently elevated lipase and abdominal fullness after episode of acute pancreatitis?
pancreatic pseudocyst
-- most can just observe and spontaneously resolve
423
which nephrotic syndrome assoc with thrombosis?
membranous (MCC of nephrotic syn too)
424
DCM with left ventricular apical aneurysm-- which infection?
T. cruzi-- chagas disease
425
recurrent acute abdominal pain
dark urine
hyponatremia
acute intermittent porphyria
426
COPD tx based on FEV1
1st step--- SABA only
FEV < 60% or symptoms -- add LABA or LAMA
once having freq exacerbations-- add LABA + ICS (budesonide/formetrol)
427
gram positive rods meningitis
listeria
| tx: ampicillin
428
how long to continue anti-depressant once patient in remission
1st-- 6 months
2nd episode -- 1-2x the inter-episode interval
3rd-- lifetime
429
```
flushing
secretory diarrhea
telangiectasisa
bronchospasm
Rt sided valvular disease-- TR
```
carcinoid syn
430
secondary causes of ITP
drugs-- heparin, antibiotics
diseases-- HIV, HepC, hyperthyroid, SLE, CLL
* need to rule these out
431
C/I for triptans
CAD
cerebrovascular disease
hemiplegic migraine
brainstem aura (vertigo, aphasia, confusion, diplopia, tinnitus)
432
brain aneurysm size cut offs for surgical intervention
>12 mm anterior circulation
| > 7 mm posterior circulation
433
Bells Palsy tx?
prednisone if within 72 hours of onset
434
GBS tx?
IVIG and plasma exchange
435
c/i for donepizil for dementia
sick sinus syndrome, left bundle branch block, uncontrolled asthma, angle-closure glaucoma, and ulcer disease.
alternative is memantine
436
parkinsons symptoms + orthostatic hypotension
multiple system atrophy
437
screening test for hypogonadism?
am serum TOTAL testosterone
438
relapse of Wegners treated with cyclophosphamide the first time?
tx relapse with Rituxmab
439
treatment of aplastic anemia
cyclosporine + ATG (antithymocyte globulin)
| <50yo allogenic HSCT
440
BCR:ABL (9:22)
CML
441
acute leukemia assoc with DIC
APML
t(15:17)
tx: ATRA
442
indications for long term hydroxyurea in sickle cell patients
>2 pain crises per year
| Acute chest syn
443
c3 on Direct antigobulin (coombs) test?
cold agglutination dz
| tx: avoid cold and rituximab
444
```
shistosytes
hemolytic anemia
low pLT
fever
AMS
renal dysfunction
```
tx?
TTP or TTP-HUS overlap
tx: plasma exchange once peripheral smear done (don't wait for ADAMSTS13 deficiency confirmation)
445
When to check D-dimer
wells DVT < 1
| wells PE < 4
446
which GN diseases have low complements?
1. post infection GN (1-6 weeks post infection)
2. membranoproliferative (assoc SLE, hepC/hepB)
3. cryoglobulinemia
4. lupus nephritis
447
diagnosis of celiac disease
elevated anti-tTG IgA ab
AND
small bowel biopsy required for definitive diagnosis
448
PFTs with pulmonary HTN
everything normal except decreased DLCO
449
prophylaxis for travelers diarrhea
fluoroquinole (cipro, norfloxacin) or azithromycin
450
indications to treat pagets disease (focal bone remodeling + elevated alk phos)
bone pain
radiculopathy
involvement of weight bearing bone/joint (ex: hip)
-- need bone scan to determine extent of activity
tx: bisphosphonates
451
diagnosis of CTEPH
pulmonary HTN without left sided heart disease
| ** diagnosis with V/Q scan with evidence of chronic thromboembolism
452
center criteria for strep testing
1. fever
2. tender anterior cervical LAD
3. tonsillar exudate
4. no cough
3 or more should be tested with rapid strep test
all 4-- empirically treat
453
bicuspid aortic valve
aortic coarctation
and aortic aneurysm
Turners syn
| *short, webbed neck, broad chest with wide spaced nipple
454
diagnosis on esophageal rupture
water soluble contrast esophagogram (gastrografin)
455
continuous murmur
| femoral pulse delay
coarctation of aorta
| ** inc risk aortic dissection, intracranial aneurysm
456
tx of rectovaginal fistula in Crohn;s
mild symptoms-- abx
moder to severe-- anti-TNF, (infliimab)
457
protein cut off for nephrotic syn
>3.5 g / day
| >3500mg/24 hours
458
uric acid stones
tx with potassium citrate
459
lights criteria with active diuresis
** not reliable
Transudative if:
serum alb - pleural albumin > 1
or protein diff > 3
460
young patient with chronic pancreatitis should be tested for?
sweat chloride testing for CF
in older adults check IgG4 to exclude type 1 autoimmune pancreatitis (tx: steroids)
461
length of small bowel resection to empirically try cholestyramine
< 100
462
curb65
```
confusion
uremia
RR elevated
low BP
age > 65
```
2-- inpatient
3-- ICU
463
coxiella assoc with
livestock
464
treatment of latent TB
6 months izoniazid
or 4 months rifampin
9 mos isoniazid with HIV
465
patient with vitiligo should be screened for
TSH
| type 1 DM
466
treatment cut offs of sub clinic thyroid disorders
subclinical hypothyroidism-- treat TSH >10
subclinical hyperthyroidism-- treat TSH < 0.1 or atrial arrhythmia
467
warfarin mgt in preg
change to LMWH
| unless mechanical valve- then keep on warfarin
