IM Flashcards
anaphylaxis sx
rash
hTN
tachycardia
SOB/wheezing/stridor
anaphylaxis tx
epic
antihistamines
glucocorticoids
airway protection
angioedema management
- airway
- FFP or ecallantide
- long term: danazole and stanazole
angioedema dx
decreased C2 and C4
C1 esterase inhibitor
non- chemical causes of uticaria
pressure
cold
vibration
how long is the acute phase of HIV
first 4 weeks
sudden SOB, hTN, tachycardia, new blowing diastolic murmur
aortic regurg
eyelid erythema/edema, eye pain, opthalmoplegia, proptosis
orbital cellulitis
polymyositis vs dermatomyositis
skin involvement (duh): butterfly/scaly knuckles/V/shawl/telangiectasias
if you dx dermatomyositis, what do you check for
malignancy
joints affected in polymyositis/dermatomyositis
hips, shoulders, neck
direct vs indirect hernias
direct: medial to inf epigastric art, not external inguinal ring
indirect: lateral to inf epigastric art, through ring
BUN/Cr ratios and etiologies
< 15: think intrinsic causes
>15: think postrenal
>20: think prerenal
prerenal causes
hypovolemia shock sepsis anaphylaxis hepatorenal syndrome renal artery stenosis fibromuscular dysplasia NSAIDs/ACE-Is
postrenal causes
nephrolithiasis
prostate probs
congenital
bladder/pelvic masses
what kind of renal dz –> increased urine osm (>500) + why
prerenal (decreased renal blood flow –> decreased GFR –> attempt to conserve vol –> retain Na and water/concentrate urine –> increase BUN and Cr)
young, HTN female w/ abdominal bruit
fibromuscular dysplasia is most likely
vessels affected by fibromuscular dysplasia
renal and carotid arteries
renal mass found on ultrasound workup
Sx: refer to urology
no sx: get a CT w/ contrast if there are some signs of septa, calcifications or other masses
renal mass found on CT: workup criteria
Bosniak’s Classification of Cystic Renal Masses
Bosniak’s Classification
(for cystic renal masses)
Class I: benign –> no actions till there are sx
Class II: probable benign (have septation, minimal calcification, or are high density) –> serial CTs every 6 - 12 mo
Class III: some malignant signs (thick/irregular borders, irregular calc, loculated, enhance w/ contrast) –> MRI then bx/ablation/excision
Class IV: clearly malignant (enhancing, heterogenous, “shaggy”) –> surgical excision
when would a positive renal bx result in ablation rather than excision
high risk pts
unwilling to have surgery
brocas aphasia: which vessel is occluded
middle cerebral artery (superior branch) of dominant side (L for right handed)
wernicke’s aphasia: which vessel occluded
middle cerebral artery (inferior branch) of dominant side (L for right handed)
brain infection w/ CD4 < 100
toxoplasmosis encephalitis
brain infection w/ CD4 count < 50
CMV
brain lesions in HIV pts
ring enhancing: toxoplasmosis (MC, multiple), primary CNS lymphoma (solitary, well-defined)
non-enhancing: progressive multifocal leukoencephalopathy (+demyelination); HIV dementia (more symmetric, less well demarcated)
acute hemolytic blood transfusion reaction possible sx
fever, flushing, rigors, dyspnea, chest pain, abd pain, n/v, hTN, hematuria
type II DM dx criteria
random gluc > 200
fasting > 126
A1C > 7
what to worry about with a fam history of medullary thyroid cancer
MEN 2A/B
check for pheo
all the weird details about multiple myeloma
elevated IgG (--> renmal problems) lytic lesions (esp in skull) hypercalcemia fried egg plasma cells with "clock face" chromatin (tons of them on marrow bx = plasmacytosis) rouleaux formations of RBCs Bence Jones (Ab light chains) in urine
all the weird details about Waldenstrom’s macroglobulinemia
elevated IgM rouleaux formations of RBCs hyperviscocity cryoglobulinemia cold agglutinins NO bone lesions/hyperCa
all the weird details about Langerhan’s Histiocytosis
Birbeck granules (tennis racket)
lytic bone lesions
eosinophilic granulomas
brown-purple skin lesions
transfusion rxns by time frame
minutes: allergic (uticaria, pruritis, anaphylaxis)
1st few hours: febrile nonhemolytic rxns
1st 24 hrs: acute hemolytic rxns
days after: delayed hemolytic rxns
what to bx in suspected Wegners (granulomatosis w/ polyangiitis)
lung
can do kidney, but lots of false negatives
polyarteritis nodosa vs granulomatosis w/ polyangiitis
PN spares the lungs
PN has transmural vascular necrosis where GWP has granulomas
definitive tx for achalasia
myotomy of LES
TRAP+ cell leukemia
hairy cell leukemia
t(9; 22)
CML (usually) (middle age)
can be ALL (teen)
smudge cells
CLL
auer rods
AML/APL
treated with all-trans-retinoic acid
APL (of AML)
dx of BPHG
pelvic U/S w/ post void residual
dx of vesiculoureteral reflux
voiding cystourethrogram
neurogenic bladder dx
urodynamic testing
poison ivy hypersensitivity type
type IV (delayed, T)
ABO transfusion rxns hypersensitivity type
type II (IgG)
TSH/thyroxine levels in primary vs secondary hypothyroidism
primary: increased TSH, decreased thyroxine
secondary: decreased both
causes of secondary hypothyroidism
pit tumors, brain surgery, cranial radiation
what causes hyperpigmentation in adrenal insufficiency
increased levels of ACTH
painless, unilateral scrotal swelling that transilluminates
hydrocele
when to fix a hydrocele
if pt has pain or pressure
DM, hyperpigmentation and cirrhosis
hereditary hemochromatosis
iron study results for hemochromatosis
increased ferritin and transferrin saturation
transferrin is more sensitive
hypertrophic CM heart description
asymmetric hypertrophied non-dilated L ventricl
amyloid CM heart description
concentrically thickened ventricles w/ diffuse fibrin deposits
systolic murmur worse w/ valsalva, better w/ squatting
hypertrophic CM
valsalva does what to preload
decreases
squatting does what to preload
increases
young smoker with hand/feet ischemia
thromboangiitis obliterans (Buerger dz)
conditions that can have erythema nodosum
post-strep infection
sarcoidosis
IBD
TB
tx for erythema nodosum
treat underlying if can
NSAIDs, oral steroids, potassium iodide
people at increased risk of renal cell carcinoma
von Hippel-Lindau, tuberous sclerosis
cancers people w/ tuberous sclerosis are at risk for
cardiac rhabdomyomas
astrocytomas
renal cell cancer
intellectual disability, seizures, hamartomas, renal failure
tuberous sclerosis
pernicious anemia at risk for what
gastric adenocarcinoma
myesthenia gravis pts at risk for what cancer
malignant thymomas
paget dz risk of what cancer
fibrosarcoma of bone
sx of HCa
weakened bones, lethargy, depression, nausea/vom/constipation, kidney stones
(bones, stones, abdominal groans and psychiatric moans)
HCa EKG
shortened QT
arrhythmias
hypercalcemia/hyperPTH ddx
lithium (Ca + PTH)
thiazide diuretics (Ca)
parathyroid adenoma (Ca + PTH)
familial hypocalciuric hypercalcemia (Ca + PTH)
malignancy (Ca)
vit D def (PTH) usually from kidney failure
hypercalcemia, metabolic alkalosis and renal insufficiency
milk-alkali syndrome
CXR in bleomycin toxicity
interstitial pneumonitis w/ honeycombing
positive obstructive atelectasis cause
mucus plug
signs/sx of ventilator-associated pneumonia
new fevers, purulent tracheobronchial secretions, leukocytosis
CXR: focal lung consolidation
pemphigus vulgaris
flaccid blisters that start in MM, tear easily, IgG/C3 in epidermis
bullous pemphigoid
tight blisters that spare MM, often post uticaria/pruritic rash, don’t tear easily, IgG/C3 in subepidural BM
IgA deposits in papillary dermis
dermatitis herpetiformis
IgA deposits in BM of skin
linear IgA dermatosis
spontaneous pneumothorax risk factors
male 10 - 30, tall and thin
ABCDE of melanoma
asymmetry border color diameter (>6mm) evolving
ruptured esophageal varices: Tx
immediate EGD w/ banding
other dz a/w celiacs
dermatitis herpetiformis
type 1 DM
selective IgA deficiency
oculomasticatory myorhythmia
rhythmic movements of eye convergence w/ masticatory muscle contractions
seen in whipples
whipples tx
ceftriaxone then TMP-SMX
hemophilia coag
aPTT
von willebrand coag
bleeding time, aPTT
ristocetin cofactor assay
which vessel?: vertigo, horners, nystagmus, face sensation down, opposite body sensation down
(same side as face)
posterior inferior cerebellar artery
Wallenberg’s syndrome
which vessel?: return of primative reflexes (rooting, grasping, suckling)
anterior cerebral artery
which vessel?: vertigo, vertical nystagmus, dysarthria, ataxia, face sensory changes, “drop attacks” or labile BP
vertebrobasilar artery
fever, new/severe unilateral HA, acute onset focal deficit
brain abscess (usually hx of chronic sinusitis, otitis media, mastoiditis, dental cavity, etc)
sinusitis – when to give Abx
Abx: > 10 days, complications like facial swelling or tooth pain (give amoxicillin)
No Abx: everything else (give nasal saline and decongestants)
sinusitis – when to get a CT
chronic (ongoing for > 12 weeks)
do nasal culture too
cancers at high risk for brain mets
lung, breast, melanoma
MC brain tumor in adults
mets
MC primary brain tumor in adults
glioblastoma multiforme
HA worse in the AM w/ nausea/vomiting is a sign of?
increased ICP
constant HA worse in the am w/ n/v and ring enhancing mass on CT
glioblastoma multiforme
HIV pt w/ HA, personality changes, neuro deficits, seizures
primary CNS lymphoma
primary CNS lymphoma tx
high dose methotrexate then radiation
organism in neurocysticercosis
taenia solium
risk of crazy high sugar in DM
hyperglycemic hyperosmolar state
tx for hyperglycemic hyperosmolar state
fluid replacement and insulin drip
spontaneous DVT or PE with hx of miscarriages
factor V leiden mutation
double layer basement membrane
membranoproliferative GN
RF for membranoproliferative GN
hep C
what does amiodarone pulm-tox look like?
dyspnea, cough, fever
CXR: ground glass
BAL: PMNs, T-cells, “foamy” macs
severe diarrhea –> what kind of electrolyte imbalance?
non-anion gap metabolic acidosis
decreased potassium, increased Cl
how to calculate anion gap
sodium - chloride - bicarb
< 12 = non anion gap
> 12 = anion gap
anion gap dx
Methanol, metformin Uremia DKA Propylene glycol Iron, INH Lactic acidosis Ethylene glycol Salicylates, starvation
1st line tx CAP
azithromycin
stevens johnsons vs toxic epidermal necrolysis
> 30% of total body surface –> toxic epidermal necrolysis
causes of toxic epidermal necrolysis
meds: sulfonamides, allopurinol, carbamazepine, lamotrigine, phenobarbital and piroxicam
infections: viral, mycoplasma pneumonia
angiofibroma, ash-leaf spots, shagreen patch, intellectual disability, epilepsy
tuberous sclerosis
treatment for ventricular fibrillation
...defibrillation then epi (or vasopressin) if didn't work (while doing cpr)
tx for ventricular tachycardia w/ pulse
lidocaine
cherry red macular spot
central retinal artery occlusion (caused by carotid atherosclerosis or cardiogenic emboli)
yellow deposits (drusen) around macula
dry age related macular degeneration
night blindness –> dry eyes
vit A def
blood/vessels in subretinal space
wet age related macular degeneration
old, acute abd pain, bloody diarrhea, leukocytosis (hx of atherosclerosis)
acute mesenteric ischemia
1st line tx acute cluster headache
high flow 100% O2
suspect acute bacterial meningitis: management
- non-contrast head CT to r/o mass lesions, strokes, hematoma
- LP
(if can’t LP/delay –> start Abx)
abx for acute bacterial meningitis
1 mo - 65: vanco, ceftriaxone
baby or old: vanco, ceftriaxone +ampicillin
+ PPD size in HIV +
> 5 mm
vaccinations for HIV +
hep A hep B pneumococcal HPV annual flu
prophylactic abx for HIV (<200)
TMP-SMX against pneumocystis jiroveci
prophylactic abx for HIV (<50)
azithromycin (or clarithromycin) against mycobacterium avian
prophylactic abx for HIV w/ thrush
TMP-SMX against pneumocystis jiroveci
pathophys of hepatic encephalopathy
bacteria in gut make ammonia, can’t be taken out by damaged liver
serum-ascites albumin gradient(whats the over under)
> 1.1 = transudative
< 1.1 = exudative
transudative causes of ascites
cirrhosis, CHF
exudative causes of ascites
malignancy, infection, pancreatitis, nephrotic syndrome
light’s criteria
for pleural effusions transudative if: effusion to serum protein > 0.5 effusion to serum LDH > 0.6 effusion LDH > 2/3 normal
transudative causes of pleural effusions
cirrhosis, CHF, nephrotic syndrome
MC kidney stone
Ca oxalate
when to work up back pain presenting normally
> 6 wk duration (+) straight leg raise red flags (suspect tumor, infection, or cauda equina)
when to get an MRI for back pain
hx cancer or weight loss
fever, chills
incontinence, bilateral leg weakness, saddle anesthesia
when to get an xray for back pain
suspect fractures: trauma or osteoporosis
> 6 wk pain with conservative management
heart thing a/w diff BP in arms than legs
coartaction of aorta
heart thing a/w forceful arterial pulse with rapid collapse
aortic regurg
initial tx for pylonephritis
cipro
sickle cell w/ acute chest pain, dyspnea
acute chest syndrome
wolf parkinson white ecg changes
short pr
wide qrs
delta wave
hyperkalemia ecg
peaked T waves
widened qrs
when do you see u waves
hypokalemia
kidney problems a/w Crohns
CaOxylate stones (fat malabsorption –> ca not absorbed –> hyperoxaluria)
thrombocytopenia management
Asx, > 30000 –> nothing
Sx, > 30000 –> glucocorticoids (or IgG if cant); then splenectomy if need or rituximab
Asx, < 30000 –> tx as above
when to give oseltamivir
flu for 2 or fewer days
Hep B markers: vaccine vs. natural immunity
vaccine: (+) Anti-HBs (surface)
from infection: (+) Anti-HBs and (+) Anti-HBc
Hep B markers: acute vs chronic infection
both (+) HbsAg and (+) Anti-HBc
Acute also has (+) IgM Anti-HBc
best initial screening for cushings
low dose dexamethasone suppression test
epigastric pain – awakens pt from sleep
duodenal ulcers apparently
cause of anion gap acidosis in septic shock
decreased organ perfusion –> lactic acidosis
well differentiated papillary thyroid cancer tx
- surgery
- radioactive iodine ablation
- T4 (levo)
Graves tx
radioactive iodine ablation + levo
what else to consider w/ achalasia
SCCAN Sarcoidosis Chagas CA (esp gastric) Amyloidosis Neurofibromatosis
kidney stones dx
helical CT w/o contrast
hypercalcemia workup
- serum parathyroid
- check for cancers
- bone density (not for dx)
hyperkalemia tx
calcium gluconate (stabilize <3)
insulin/glucose
albuterol
keyexolate (Na polystyrene sulfonate)
time frame: chronic sinusitis
> 12 wks (3 mo)
non hemolytic febrile transfusion rxn tx
tylenol (+ stop transfusion)
uticarial allergic transfusion rxn tx
diphenhydramine (+ stop transfusion)
inflammatory bowel dz dx
fecal lactoferrin
pheochromocytoma tx
- alpha blockers
- beta blockers
- surgery
large bowel vs small bowel ischemia
large: low grade pain + hematochezia
small: severe pain OOP, vomiting
cause of pigmented (black) gallstones
chronic hemolysis
cirrhosis
Asian…?
cholesterol gallstone RFs
fat, female, forty, fertile (birth control)
+ estrogen replacement therapy
paraneoplastic Abs
Anti-Hu (small cell lung)
Anti-Yo (breast/gyn)
brain complication of autosomal dom polycystic kidney dz
cerebral aneurysms –> subarachnoid hemorrhages
subarachnoid hemorrhage dx
non contrast CT
why does that smoker have cough + low sodium
SIADH from small cell carcinoma
polycythemia ddx
high altitude life
obstructive sleep apnea
carbon monoxide
sports cheating (exogenous EPO, steroids)
paraneoplastic (renal cell, hepatic, pheo, fibroids)
polycythemia vera (LOW EPO)
polycythemia vera dx
JAK-2 mutation
polycythemia vera tx
ASA, phlebotomy
abdominal pain, psych stuff, red/pink urine
acute intermittent porphyria
triggers for acute intermittent porphyria flares
alcohol
barbiturates
OCPs
hep C
chemo drug that –> hemolytic uremic syndrome
mitomycin
aortic dissection tx
- beta-blocker or nitroprusside
2. surg: graft/ or endovascular stent/graft
why do you get increased Ca in lung cancer
paraneoplastic – release parathyroid hormone-RELATED protein
tx primary pulmonary HTN
sildenafil
PE Dx
D-dimer to r/o PE in low risk
high risk get a CTA
V/Q scan for those who can’t CTA
metastatic prostate Ca tx
less androgens:
GnRH agonists (leuprolide, goserelin)
adrenal inhibitor (ketoconazole)
or @ receptors (flutamide)
diff btwn asthma and COPD
- asthma is reversible
2. diffusion capacity for CO (normal for asthma, down in COPD)
recurrent oral/genital ulcers in young person (not herpes)
Behcet’s
lewy body dementia tx
levodopa (parkinson sx) acetylcholinesterase inhibitors (behavioral/hallucinations) clonazepam (sleeping crap)
acute urinary retention management
try to pass a foley
suprapubic if can’t
then surg consult
supplement to give w/ isoniazid (and why)
B6, avoid neuropathy
electrolyte weirdness in kidney failure
down phosphorus
up potassium
down calcium
MCC osteomyelitis
staph aureus (even in DM pts)
when can you give anti-motility in diarrhea
non-invasive, non-bloody
erythematous, scaly plaques on the face w/ remission and relapse
seborrheic dermatitis
benign esophageal strictures tx
endoscopic dilation
drugs causing aplastic anemia
chloramphenicol
valproate, carbamazapine, phenytoin
phenytoin toxicity sx
vertical nystagmus sedation, hTN arrhythmias GI distress
hemolytic anemia ddx
autoimmune paroxysmal noctural hemoglobinuria sickle cell malaria/babesia hereditary spherocytosis G6PD deficiency microangiopathic (DIC, TTP, HUS) mechanical (heart valve)
dx paroxysmal nocturnal hemoglobinuria
flow cytometry
dx sickle cell
hb electrophoresis
dx autoimmune hemolytic anemia
Coombs
dx hereditary spherocytosis
osmotic fragility test
hemolysis, thrombosis, pancytopenia
paroxysmal nocturnal hemoglobinuria
psychomotor slowing w/o aphasia
NPH (part of whacky)
pts > 50 w/ bilateral shoulder and hip pain/stiffness
polymyalgia rheumatica
labs for polymyalgia rheumatica
ESR > 50
what else to check for with polymyalgia rheumatica
temporal arteritis
tx for secondary lymphedema (ex: post lymph node bx)
compression + skin care
thyroid enlargement weeks after infection
subacute thyroiditis
when to bx prostate
abnormal DRE
PSA > 4
gradual bilateral loss of central vision
age related macular degeneration (dry?)
cupping of optic disc
open-angle glaucoma
kid with edema and heavy proteinuria – most likely cause
minimal change disease
dx minimal change disease
renal bx and electron microscopy
cause of shock liver
not adequate liver perfusion –> ischemic hepatitis
chemo pt w/ fever and decreased WBCs
neutropenic fever
tx for neutropenic fever
start broad spectrum abx, and get blood/urine cultures
dx Conn’s syndrome (also, wut is it)
aldosterone secreting tumor
measure aldosterone-renin ratio (+ is > 20)
palpably enlarged but non-tender gallbladder
sign of extrahepatic biliary obstruction (courvoisier’s sign)
tx: ball cancer
- inguinal orchiectomy (not simple – leads to seeding)
- retroperitoneal lymph node dissection
- radiation/chemo
management: guillain barre
- hospitalize + get serial PFTs
2. IgG (non-ambulatory only) or plasma exchange for tx (combo not better)
dx: guillain barre
Clinical but may see
LP: up protein, normal WBC
PPD (+) for close contacts
> 5 mm
shiny, umbilicated, dome-shaped papules
molluscum contagiosum
how does Mg affect K?
hypomagnesemia –> renal potassium wasting
so if Mg is low you can’t fix the K no matter what
1st line tx for severe acne
oral isotretinoin
viral diarrhea time limit
14 days
tx: uncomplicated pylonephritis
cipro/levofloxacin
unilateral joint pain/stiffness (better in first 30 min) w/ crepitus or effusion
osteoarthritis
osteoarthritis tx
PT
weight loss
NSAIDs
fever, leuks, LLQ pain
diverticulitis
diverticulitis dx
CT
diverticulitis tx
bowel rest
broad-spec Abx
IV fluids
HTN and hK
think excess aldosterone
bilateral sacroiliitis in teen
ankylosing spondylitis
weird ankylosing spondylitis things
HLA-B27 +
elevated ESR
bamboo spine
pain improved w/ moving/hot showers
confluent hyperpigmented or hypopigmented macules on upper torso and arms
tinea versicolor
healthy-ish old person w/ 2+ cytopenias on peripheral smear
myelodysplastic syndrome
myeloid cell lines
granulocytes (neutrophils, eos, basophils) erythrocytes megakaryocytes/platelets monocytes mast cells
dx: sarcoidosis
biopsy (lung usually)
non-caseating granulomatous infiltration (w/o orgs)
ddx: hypernatremia
6 Ds: diuretics dehydration diabetes insipidus docs (iatrogenic) diarrhea dz of kidney
hypernatremia workup
- check urine osms
- high = dehydration
low = diabetes insipidus - water deprivation/desmopressin
1 RF for ischemic and hemorrhagic strokes
HTN
central DI tx
desmopressin
CML treatment
imatinib
stem cell transplant if fail and young
skin findings in hypercholesterolemia
xanthomas:
lipid deposits (yellow pustules)
tuberous masses on tendons
xanthelasma (eyelids)
OCPs up risk of what in RUQ
`hepatic adenoma
NASH puts you at risk for what
hepatocellular carcinoma
MS exacerbation Tx
steroids
thyroid nodule, no problems – next step?
fine needle aspiration
blood smear for mono
large, dark lymphocytes
HTN med for pts w/ CKD
ace inhibitors
hyperthyroid treatment for preggers
propylthiouracil 1st trimester
methimazole 2nd, 3rd
tx tension pneumo
needle thoracostomy
contact dermatitis hypersensitivity type
type IV
pseudotumor cerebri
idiopathic intracranial HTN
management for pseudotumor cerebri
- MRI/CT
2. LP
MEN 1
pit adenomas
parathyroid hyperplasia
panc tumors
MEN 2A
parathyroid hyperplasia
medullary thyroid carcinoma
pheo
MEN 2B
mucosal neuromas
marfanoid
medullary thyroid carcinoma
pheo
gas gangrene tx
- surgical debridement
2. hyperbaric/Abx
generalized maculopapular rash days to weeks after starting bactrim (and what to do)
drug eruption
stop drug, give antihistamines
1st MI blood level to rise (and how fast)
myoglobin (1st 2 hours)
when does troponin increase/peak (hours)
up at 3-12
peak @ 24
dull flank pain, hematuria, bilateral kidney masses
ADPKD
autosomal dominant polycystic kidney dz
tx kawasaki
IVIG and hi dose ASA
right ventricular heave, loud P2 and tricuspid regurg
primary pulmonary HTN
tests for primary pulmonary HTN
CXR, EKG, Echo
R heart cath is most definitive
when do you get the shingles vaccine?
60
when do old people get the pneumonia vaccine? (and which one?)
old folks get the 23 polysaccharide vaccine @ 65
peripheral lung lesion in young non-smoking female
adenocarcinoma
clotting factors affected by warfarin
II VII IX X (1972)
what needs to change if postprandial and fasting glucose levels are high
increase basal insulin
levels in tumor lysis syndrome
sudden increase in K, phos (which can –> hypocalcemia), and uric acid from dying cancer cells
prevention of tumor lysis syndrome
allopurinol and IV bicarb (+ aggressive hydration)
cancers to look out for tumor lysis syndrome
ALL
Burkitt’s lymphoma
other high grade lymphomas
dx testicular torsion
doppler u/s
what do you worry about w/ strep bovis infxn?
colon cancer
causes of eosinophilia
NAACP neoplasm asthma/allergy addisons collagen vascular d/os parasites
tx for polyarteritis nodosa complicated by hep B/C
- corticosteroids
2. plasma exchange
spontaneous bacterial peritonitis (SBP) dx
paracentesis:
neuts > 250 or + fluid culture
asthma drug sequence
SABA (albuterol) ICS qD (fluticasone or budesonide) LABA qD (salmeterol or formoterol) hi dose ICS oral corticosteroid (prednisone)
MC EKG finding in PE
sinus tach
how do you know if its chronic vs acute pancreatitis
amylase/lipase: way high in acute
x-ray: calcifications in chronic
dermatomyositis dx
muscle biopsy: pathology only in one portion of muscle fascicle
lead poisoning tx
adults: Ca-EDTA (dimercaprol is old)
kids: succimer
T scores mean…
-1 to -2.4 = osteopenia
< -2.5 = osteoporosis
when do you get a dexa scan?
65
hx trauma
hx glucocorticoid use
which vessel: oculomotor palsy (ptosis, diplopia, down+out, non-reactive mydriasis)
posterior communicating artery (–> subarachnoid hemorrhage)
arteries that can –>. subarachnoid hemorrhage (SAH)
circle of willis: internal carotids ant cerebral ant communicating post cerebral post communicating basilar
unequal pulses or unilateral claudication
takayasu disease
granulomatous thickening/stenosis of aortic arch
fund: retinal microaneurysms, blot hemorrhages and cotton wool spots
diabetic retinopathy
GERD tx
- lifestyle
2. antacids, H2 blockers, or PPIs
when can you get sheehan syndrome
right after childbirth or even months/years later
tx for acute sheenhan syndrome
IV dexamethasone
then MRI the head to r/o other crap
MCCs of otitis externa
pseudomonas
staph aureus
NF1 vs NF2
1 has axillary freckling and ocular findings (optic gliomas or iris hamartomas)
work up for neurofibromatosis
slit lamp (gliomas/iris hamartomas) (1 only) plain films (bony lesions) head imaging (gliomas) auditory (b/l vestibular schwannomas) (2 only)
bone lesions in NF-1
x-ray: done dysplasia, vertebral defects, sphenoid wing dysplasia, fibromas
cafe-au-lait spots, fibrous skeletal dysplasia, precocious puberty
McCune Albright (not NF-1)
tx for lyme
No CNS/cardiac involvement: doxy
preg/breastfeed/kids < 8: amoxicillin
CNS/cardiac: ceftriaxone
IBD + jaundice
primary sclerosing cholangitis (a/w UC)
dx malaria
thick and thin blood smear
tx thyroid storm
beta blocker (propranolol)
PTU
hydrocortisone
stable iodine (1 hr post PTU)