IM COMAT Flashcards
What is the type of TB infection where the Xray findings shows 1- to 2-mm granulomas?What is a possible side effect?
Miliary TB - hematogenously disseminated tuberculosis–adrenal involvement in common=can cause ADRENAL INSUFFICIENCY
HIV pt w/ back pain/night sweats/Fever. Dx?
TB
Dx Waldenstrom
S-Pep +>10% Plasma CellsHyperviscosityTx: Rituxumab +Plasma Phoresis
What is the most common cause of death in dialysis patients?
Cardiovascular disease*also the most common cause of death in renal transplant patients
What is the most likely diagnosis:28 year old woman from Nigerial w 6 month history of persistent lower lumbar back pain, a/w low-grade fever, and night sweats. point tenderness over spinous processes of L4-L5
Tuberculous osteomyelitis (Pott disease)
A pt w chronic renal failure remains in the icu after a surgical procedure. The patient has diffuse microvascular bleeding from several puncture sites. Labs show normal PT/INR, aPTT, platelets.what is the cause?
Coagulopathy from uremia. —uremia causes platelet dysfunction - poor platelet adhesion
What is the most appropriate initial Abx choice:85 year old nursing home resident w hx of CHF, dementia. Presents w 3 day hx of fever, productive cough, CXR shows right middle lobe consolidation
IV cefepime:—nursing home = pneumonia is nosocomial not CAP=high incidence of gram negative—age, med hx = high risk = hosptialization and IV cephalosporin
complaining of RUQ abdominal pain. BP 75/46, HR 165/min, RR 18/min, O2 sat 97%, Temp 103.5 F. Phys exam shows scleral icterus and tenting of the skin. Elevated WBC’s
Ascending CholangitisCharcot’s triad (RUQ pain, fever, jaundice) starting to progress to Reynold’s Pentad (hypotension, altered mental status)
Pansystolic murmur post MI…
Septal rupture
Sign of DNA synthesis impairment
Hyper seg PMN
Giant Cell Sx…
Vasculitis,Fever, Anemia, ESR, Temporal HA
What vitamin deficiency commonly accompanies Carcinoid syndrome?
Vitamin B3 (Niacin) deficiency—Both serotonin and B3 are synthesized from tryptophan
What is the definition of Oligomenorrhea?
Menses occurring at infrequent intervals or more than 40 days or fewer than nine menses per year
When should valve replacement be considered in a patient with aortic stenosis?
aortic valve with an area less than 1 cm2
What is the diagnostic criteria for Amenorrhea1. primary2. secondary
- Absence of menarche by the age of 162. Absence of menstruation for 3 or more months in women w normal past menses
What therapy provides the greatest benefit to a patient with chronic stable emphysema and a resting oxygen sat of 86%
Supplemental oxygen used continuouslysmoking cessation–only medical therapies shown to decrease mortality among COPD pts
How is a latent TB infection treated?
Isoniazide for 9 months
Dx for AIHA
Coombs +IgM - ColdIgG - Warm
Dx for PNH
Flow Cytology, CD55- Cells
Walking on toes test nerve root ___
S1
What supplementation is often used along side Isoniazid?
Pyridoxine - prevent peripheral neuropathy
What is the definition of neutropenia? what are chemotherapy patients at risk for?
absolute neutrophil count less than 500 cells/mm3Neutropenic fever
Dx for Hereditary Spherocytosis
Blood Smear + Osmo Fragility Test
Med for uncomplicated Pyleonephritis
Cipro
What is the treatment of hyperkalemia?
C BIG K-Calcium, Bicarb/B-agonis, Insulin, Glucose, Kayexalate
What is the highest risk factor for cervical cancer?
Multiple sex partners - contracting HPV 16, 18, 45, 33, 58
What cardiac condition is related to a pattern of alternating amplitude of QRS complexes
Electrical Alternans - Cardiac tamponade
How is the BUN/serum CR ratio interpreted?
BUN/Cr >20:1 = pre-renal disease (ie volume depletion, renal A stenosis)BUN/CR = normal or 10 to 15: 1 = ATN, AIN
Identify cause:72 year old man w severe pain and swelling in knees post surgery. Intracellular and extracellular weakly positive birefringent crystals in synovial crystals
Pseudogoutgout - NEGATIVELY birefringent crystals
What are the tuberculin reaction sizes and the related circumstance required for diagnosis of latent M tuberculosis infection
- > 5mm - HIV, close contact w TB pt, Fibrotic lesions on CXR2. >10mm - Recently infected (<2y), high risk medical conditions3. >15mm - low risk persons
What is contraindicated in chemotherapy patients that are neutropenic?
Live vaccines (Varicella, Mumps)
What is the CHADS2VASc score? what is it used for/how do you interpret it?
prevention of cardioembolic stroke1. Congestive heart failure - 12. HTN - 13. Age >75 - 24. Diabetes Mellitus - 15. Stroke or TIA - 26. Vascular dz - 17. Age 65-74 - 18. Sc (Sex category) female = 10 = aspirin or no antithrombotis1 = aspirin or anticoagulant (warfarin)2+ = heparin bridged to warfarin to INR of 2-3
Acute back pain w/o other Sx, TX?
Cont daily activity w/o restriction
The feeding of a patient (alcoholic, anorexic, malnourished) causing generalized tremors of entire body with confusion.what is the cause?
Refeeding Syndrome - insulin causes uptake of phosphate by cells–compensatory respiratory alkalosis = further intracellular shift of phosphateHYPOPHOSPHATEMIA = myopathy, rhabdomyolysis, respiratory failure and severe CNS system dysfxn.
What are the ECG two criteria for Left Ventricular hypertrophy
Sokolow-Lyon:S (V1) + R (V5,V6) > 35Cornell:R (aVL) + S (V3) > 28(men) > 20(women)
What does a more than 20:1 BUN:Cr ratio indicate about the type of kidney injury?
Prerenal failure
What is the best initial treatment of alcoholic ketoacidois?
infusion of 5% dextrose w 0.9% saline
Which atypical organism is most likely responsible?65 year old smoker w hx of HTN, mild CHF, presents with worsening cough, fever, muscle aches, abdominal pain, diarrhea, non productive cough developing later that week and rapidly becoming worse.
Legionella pneumophila - typically presents w:1. myalgias2. abdominal pain3. diarhea4. severe pneumonia*consider because of history of smoking
Where is B12 absorbed?
Terminal Ileum
What would synovial fluid show in a patient with Gonococcal arthritis?
elevated (>72,000) WBC’s>75% Polymorphonuclear leukocytes
CAP, TX?
Oral Doxy or Macrolide
What vaccine should a patient recently diagnosed with DM Type II receive if not previously vaccinated?
Hepatitis B Vaccine–DM confers a 60% higher infection rate versus nondiabetics
Glanzmann Path
GPIIb-IIIa dysfxn
What are the urinalysis findings of:1. prerenal failure2. postrenal failure (what microscopic findings for which types of obstruction)
- high specific gravity and normal microscopic findings2. urine osmolality is equal to the serum osmolality,microscopic findings:—Hematuria = crystals or stones—leukocytes = prostatic hypertrophy—normal = extrinsic ureteral compression
Identify type of vitamin deficiency:54 year old presents with sensory and motor impairments, mostly of distal extremitieswhat is the most common cause?what are two presenting forms?
Vitamin B1 - Thiamine–most common cause of deficiency = alcoholismWernicke-Korsakoff syndrome - horizontal nystagmus, ophthalmoplegia, cerebellar ataxia, mental impairment, confabulation psychosisBeriberi- Dry = symmetrical peripheral neuropathy (motor + sensory)- Wet = neuropathy + CHF (cardiomegaly, lower extremity swelling, tachycardia)
Chemo Med that causes interactions/ allopurinol and gout, myelosuppression, hepatotoxic…
6-metacaptopurine
What is the next diagnostic step that should be taken when Alzheimer dementia is suspected?what is the best treatment?
Assess for depression and reversible causes of dementiaTx: Acetylcholinesterase inhibitor (donepezil, rivastigmine, galantamine) +NMDA receptor Antagonist (Memantine)
What is the therapy of choice for acute Otitis Media? when is observation appropriate?
High dose oral Amoxicillin-Pts > 2 yrs w recent onset of non-severe illness are observed to prevent the misuse of antibiotics when OM is caused by viral pathogen
Exacerbation of MS, Rx?
Methylprednisone
In the case of inflammatory arthritis what does Chondrocalcinosis or linear calcium deposition in joint cartilage suggest?
Pseudogout
Normocytic anemia includes
Sickle CellG6PDDHereditary SpherocytosisAutoimmune Hemolytic AnemiaParoxysmal Nocturnal Hemolysis
Labs that indicate Normocytic Anemia
Inc LDHDec HgbInc Bilirubin
45 year old admitted for acute pancreatis. after 3 months he still has epigastric but is able to eat solid food. amylase level is elevated at 260 IU/Lwhat is dx?
Pancreatic pseudocyst - presents as:1. abdominal pain/mass2. persistent hyperamylasemia
how do you differentiate arthritis from soft tissue disorders (ie cellulitis, or bursitis)?
True arthritis = swelling, redness, painful limitation of motion in all planes during ACTIVE AND PASSIVE motion.soft tissue disorder - joint movement is not limited by passive motion
UA positive for blood, but no RNC on micro + Elevated creatine kinase…
Rhabdomyolysis
Dx HITT
Platelet AbHosp pt on Heparin, 7-14 days post adminDx;: clinical, Plts decTx: D/C heparin, start Argotoban + Warfarin Bridge
Complications of renal failure
HyperkalemiaHypocalcemiaAnemiaHyperphosphotemiaHyperparathyroid
What therapy should be given to treat acute hypercalcemia in the following pt:62 yr old woman, asymptomatic. hx of multiple myeloma, hypercalcemia. no bone lesions or end organ damage
Bisphosphonates - inhibits osteoclastic bone reabsorption
identify type of vitamin deficiency:67 year old male w two day history of paresthesias and witnessed SEIZURESwhat are additional symptoms?
Calcium deficiency-paresthesias, peri-oral numbness, seizures, muscle cramps/spasms
What is the next best step in management:45 year old man w saddle anesthesia and decreased ankle reflexes bilaterally?
Cauda equina syndrome - immediate referral for advandced imaging and surgical evaluation for decompression to avoid long-term denervation
What microorganism should be considered in a pregnant woman with meningitis?
Listeria monocytogenes
Med for SSD
Hydroxyurea
Dx test for Kidney Stones
Helical CT w/o contrast
First line Tx for hemochromatosis
Phlebotomy
What is precocious anemia
Intrinsic factor production malfunction
What is the underlying cause of a DVT formation in a patient with nephropathy?
loss of antithrombin III in the urine
Polydipsia, polyuria, MSC… Dx?`
HHS»_space; Send to ER, inform ICU
What are urinalysis findings of Ischemic and Nephrotoxic ATN?
- Isothenuric (urine osmolality is equal to serum osmolality)2. proteinuria - containing muddy brown granular casts
How do you treat pregnant women with syphillis who are allergic to penicillin?
give penicillin after the women are desensitized
What is the best initial imaging test for acute abdominal pain?
CT abdomen
What artery is associated with transient monocular blindness (Amaurosis fugax)
Internal Carotid pathology
What is the usual diagnostic criteria for COPD?
FEV1/FVC <70%
MI complication post 14 days…
Free wall rupture
Med for N. Meningitidis
Cefotaxime
What is the therapy for an acute Hepatitis B infection?
Antiviral therapy:1. Tenofovir2. Disoproxil3. Fumarate–can also be used for an HIV infection too.
Ig elevated in MM
IgG
What type of lung cancer is most likely to appear as a CAVITARY LESION on CXR? what are the associated paraneoplastic syndromes?where in the lung is it usually located?
Squamous Cell Cancer–produced PTH-like hormone——-causes hypercalcemiatypically CENTRAL/HILAR
What cell produces IF
Parietal cells
What is the most likely organism in a chronic smoker with pneumonia. productive cough w greenish sputum.. Febrile w normal CXR. gram stain reveals gram-negative cocci
Moraxella catarrhalis
A patient with DKA dies secondary to a cardiac arrest. correction of what electrolyte abnormality could have prevented this patients death?
Potassium - DKA causes massive potassium loss–correction of DK Acidosis with insulin causes potassium export from cells into intracellular space—correction of acidosis causes renal loss of potassium = cardiac arrhythmias, arrest
Chemo Med that causes estrogen receptor antagonist…
Tamoxifen
Macro anemia that is Methylmalonic acid Positive
B12
What is the next diagnostic step when Acute Kidney Injury is suspected from a high BUN:Cr level?
Urinalysis and urine chemistries to determine whether the process is prerenal or renal or postrenal (less likely)
Post MI 2- 7days, New blowing murmur, pulmonary edema… Dx?
Papillary muscle rupture
What is the pharm therapy for a immune suppressed patient with a colonoscopy revealing large atypical cells with intranuclear inclusion bodies?
CMV colitis - use ganciclovir
What is the most probably diagnosis:82 yr old female with sudden onset right knee pain. PMH of DM type 1, alcohol abuse, total right knee arthroplasty 6 months ago. Phys exam shows hot, red, swollen knee, with limited range of motion.
Septic Arthritis - sexually active young adult - N. gonorrheaeveryone else - S. aureussudden onset joint pain, warm, erythematous, tender joint, limited range of motion.
Dx MM
CRAB Sx»_space; Hypercalcemia/RF/Anemia/Bone PainBence Jones ProteinsS-Pep +U-Pep +>10% Plasma CellsSkeletal Survey +Tx: >70 yo – Chemo (Mel/Thai/Bort +steroid) <70 yo/Donor – Stem Cells/Nothing
What is the typical outpatient therapy of community acquired pneumonia?
Macrolide Abx = Azithromycin, doxycycline, antipneumococcal quinolones (moxifloxacin, levofloxacin)
what is the statistical advantage of a D-dimer? what does this mean?
very high negative predictive value- can have false positives- if ddimer is negative no further testing for PE
What therapy should be administered in a patient with dry/cracked skin cellulitis? (what is the most likely pathogen)
most likely pathogen = Streptococci / StaphylococciNafcillin = first line therapy
what is the classic triad of acute cardiac tamponade
Beck’s Triad:1. Hypotension2. elevated Jugular Venous Pressure3. Small quiet heart**Look for Pulsus Paradoxus (decrease of >10mmHg systolic w inspiration)
Achalasia
Overly tight EG sphincter
What is septic shock?
“Severe Sepsis” (sepsis in a patient with signs of organ dysfunction)+unresponsive to fluid resuscitation for atleast 1 hour
Bernard-Soliel Path
GPIb dysfxn
What is the next suggested step after taking lead blood levels in a child that has been ingesting lead pain chips
Plain film radiograph of the abdomen to detect retained lead objects that may require surgical intervention for removal.
what is the pharm therapy for chronic hep B infection
interferon and oral Lamivudine
What is most appropriate next step when suspecting pulmonary edema?
Chest CT with intravenous contrast or other imaging study as indicated.
What is the most appropriate diagnostic modality for a patient with a Syncopal event and normal physical exam?
24-hour Holter monitor
What is the dx:35 year old female w vertigo, nausea, vomiting. Constant ringing in ear and hx of recent flu-like illness.Mild hearing loss, positive Dix-Hallpike maneuverWhat is the appropriate management?
Labyrinthitis - inflammation of labyrinth of inner ear. most often seen after viral upper respiratory tract infection.*both labyrinthitis and BPPV have a positive Dix-Hallpike maneuverTx: Meclizine (antihistamine), Prochlorperazine (antiemetic)
What is the best treatment for a DVT in a patient that presents with significant vaginal bleeding from cervical cancer?
vaginal bleeding = contraindication for anticoagulationuse Vena Cava filter
acute onset knee pain, rhomboid shaped crystals, positively birefringent
Pseudogout - positively birefringent (blue in parallel light)
Pt relives gastric pain by eating. Dx?
Duodenal ulcer
When should carotid endarterectomy be performed?
carotid artery stenosis greater than 70%—angioplasty is used for high surgical risk**Patients > 70yrs olf fare better w carotid endarterectomy
Tx for IgG AIHA
SteroidsRituxumabSplenectomy
What is the pharmacologic management of acute symptomatic hypocalcemia?
IV 10% Calcium gluconate
What type of movements are still present in a patient that is brain dead?
Spinal reflexes (outside the brainstem)ex: facial nerve twitching, fasiculations of trunk/extremities
What is the immediate support care for a patient with cardiac tamponade awaiting pericardiocentesis?
Intravenous fluids - pts with cardiac tamponade are preload dependent, fluids help maintain intravascular volume and cardiac output–diuretics, nitrates, morphine may cause pts to become hypotensive
What is the strategy of choice for cardiogenic shock
Emergency PCI
Hodgkin Lymphoma characteristics
Better PxB-sxReed-Steinberg CellsEBVPell-Ebstein FeverAlcoholic NodesSpreads through TzTx: ABVD, BEA-Copp
PCP Tx
TMP-SMX + Prednisone
What is the preferred daily medication for a patient with a history of asthma where symptoms occur >2/week, < 1/day, >2/month nocturnal symptoms?what is the classification?
Mild persistent asthma (>2/wk;<1/day symptoms, >2/month nocturnal awakening)–Low-dose inhaled steroids = preferred therapy
Fever, Flank pain, Discolored urine after transfusion, DX/TX?
Dx: Hemolytic Transfusion ReactionTx: Fluids, d/c transfusion
A pt treated for hypocalcemia with IV Calcium gluconate still shows hypocalcemia. What other electrolyte infusion should have been administered first?
Magnesium–hypomagnesemia can cause PTH resistance
right lower lobe nodule is found incidentally on CXR. follow up CT shows nodule to be 7mm with popcorn like calcificationwhat is dx?
Pulmonary Hamartoma - do not have malignant potential-composed of tissue elements normally found at site.
What micro-organism is most commonly associated with Septic Arthritis in of patients? (not sexually active)
S. aureus
What is the most appropriate management of aspiration pneumonitis?
Supportive care = observation w follow up CXR
what thyroid malignancy is associated with iodine deficiency?
Follicular carcinoma of the thyroid
What fluid characteristics suggest the need for chest tube drainage? (6)
- Empyema (frank pus in the pleural space)2. Positive Gram stain or culture of fluid3. Presence of loculations4. pH less than 7.20 (normal pleural - 7.6)5.Glucose less than 60 mg/dL6. LDH more than 1000 U/L
T2DM has an acute illness and is skipping insulin, next step?
Send to ER, provide H&P to ICU
In a patient with neutropenic fever, what should be done if infection is suspected to be from Catheter infection, skin/soft tissue infection, or mucositis?what if the infection has no obvious source?what if the fever persists?
Infection is probably gram-positive = IV Vancomycin plus antipseudomonal therapyNo obvious source = enteric gram negative = Antipseudomonal monotherapy (Cefepime, ciproflocacin, imipenem, beta-lactam + aminoglycoside)persistent fever = Antifungal therapy (fluconazole, amphotericin B)
Apical cavitary lesion w/ b/l patchy infiltrate
TB Reactivation
Dx MGUS
AsxS-Pep +< 10% Plasma CellsTx: Watchful Waiting
What is the criteria for Systemic inflammatory response syndrome (SIRS)?
2 or more of the following:1. Temperature >100.4 F (38C), < 96.8 F (36)C2. HR > 90 bpm3. RR >24 breaths/min4. leukocyte count > 12x10^3/mcL, <4x103/mcL or >10% bands
What microorganism is most commonly associated with septic bacterial arthritis in patients who are bit by another human?
Eikenella corrodens
What is the usual intial treatment for SIADH if the pt does not have severe neurological Sx?what if the pt has severe neuro sx?
No Neuro Sx: Water restrictionSevere Neuro Sx: rapid partial correction of sodium (HYPERTONIC Saline)
Empiric Tx for HAP
Moxifloxacin, Ceftriaxone, Augmentum, Levofloxacin, Ertapenam
What is the etiology of Transverse Myelitis
Neuro Sx usually presenting during recovery from infection1. Localized low back pain2. sudden paresthesias in legs3. sensory loss, paraparesis4. urinary bladder and bowel dysfunction5. possible allodynia
What follow up actions should be taken to assess End organ damage from HTN?
- fundoscopic exam2. auscultation of major arteries for bruits3. Palpation of organs for enlargment4. check for lower extremity edema
Identify type of vitamin deficiency?Immigrant from middle east with stunted growth and hypopigmented hair, frequent infections, decreased taste sensationwhat are other presenting symptoms?
Chronic deficiency–middle eastern countries–foods rich in zinc = oysters, beef, crabs, cereal–night blindness, decreased spermatogenesis–severe deficiency = diarrhea, alopecia, pustular dermatitis, decreased immunity
Non-Hodgkin Lymphoma characteristics
Worse DXStarry SkyExtranodal SxRecurr in 7-10 yrSpread through bloodTx: Rituxumab/R-Chop
What is the most common electrolyte abnormality in diabetic ketoacidosis?
hyperosmolar HYPONATREMIA–from the plasma dilutional effect of hyperglycemia
what is the responsible organism:HIV patient, noncompliant with meds, abdominal pain, bloody diarrhea, imaging shows free air under diaphragm
CMV colitis - mucosal perforation
The monitoring of which electrolyte is important in congestive heart failure?
Sodium - reduce sodium intake to control fluid retention
What is the treatment of Anaphylaxis??
- First assess ABC’s (Airway, Breathing, Circulation)2. Epinephrine (intramuscular in thigh)
what are the drugs of choice for congestive heart failure
ACE inhibitorsB-blockers
What is the first line therapy for treating Osteoarthritis?
NSAIDs - NOT Acetominophen
A patient that was maced presents w post syncopal episode, itchy burning eyes/mouth/throat w facial rash., red, raised perioral rashwhat was the offending agent?what is another possible compound? (what symptoms)
Phenacyl chloridepepper spray = Oleoresin Capsicum (capsaicin) = releases substance P=inflammtion = lacrimation, rhinorrhea, coughing
What is the management of an adrenal crisis?
- repletion of circulating glucocorticoids2. correction of water deficit + electrolyte imbalances (hypertonic saline)
What is the first line treatment of hyperkalemia with ECG changes?
Calcium gluconate
When should tPA or surgical embolectomy be used as primary therapy for a PE?
When the pt is at high risk if the embolism staysit pt has:1. Right heart failure2. Hypotension (systolic >90mmHg)
Dx VW Dz
Dec Factor VIII and VWFNormal plateletsDx: VWF AssayTx: DDAVP
Four common causes of B12 anemia
PrecociousCrohn DzGastric BypassUneducated Strict Vegan
Macrocytic Anemias
B12Folate
What disease is characterized byasymptomatic or dysuria, hematuria, urinary frequency+ the finding of leukocytes in the urine but negative bacterial cultures?
“Sterile pyuria” = Genitourinary TB
How would you confirm the diagnosis of Graves disease?what is the treatment?
Low serum TSHHigh free T4Tx: antithyroid drugs, radioactive iodine ablation, surgical removal of thyroid
What is the lab test to check for the following causes of hepatitis:1. Wilson disease2. Hemochromatosis
- Low serum ceruloplasmin2. High transferrin saturation (>45%), high ferritin
petechiae, vesicles, bullae, desquamation of the skin1. desquamation less than 10% of skin2. desquamation more than 30% of skin
- Steven Johnson syndrome2. Toxic epidermal necrolysis
What kind of kidney stones are formed in a patient with a hx of ileal resection for Crohn’s disease?
Oxalate stones–malabsorption of bile acids = bile unavailable to bind oxalates
What is the dx:4 year old African American child w fever, pallor, fatigue, back pain. Pallor of conjunctiva, rales at right lung base, petechiae diffusely over the body. Labs show high white blood cell count and anemia
Acute lymphoblastic leukemia
Granulomatosis w/ Polyangitis sx…
Vasculitis, Upper + Lower Resp sx, C-anca, Renal dysfunctions, Skin Sx, Eye Sx
What preventative medication should be used in a patient with gouty arthritis and renal disease?
Febuxostat (Allopurinol needs to be given in lower doses in patients with renal insufficiency)
What is the intial management of an acute arterial occlusion?
Anticoagulation w heparin to prevent propagation of the thrombus
A pt who recently had a new medication added to treat his cholesterol presents with acute gout. What was this medication?
Niacin–Side fx: glucose intolerance, pruritis, elevated uric acid
Dx of Sideroblastic Anemia …
Inc FeRingedFerritin/TIBC normal
Churg-Strauss sx include…
Vasculitis, P-anca, Eosinophilia, Asthma Sx
How do you interpret hematocrit levels of pleural fluid?
Hemothorax (trauma, malignancy) = pleural fluid HCT is >50% of Hct of peripheral bloodCancer, PE, Tuberculosis (pleural Hct <50% Hct of peripheral blood)
What criteria index used to risk-stratify pneumonia patients?
CURB-651. Confusion2. Urea >20 mg/dL3. Respiratory rate > 30bpm4. Blood pressure, systolic <90mmHg5. Age > 65score >2, pt should admitted to Hospital
what drug combo is helpful in the treatment of myeloma?
Dexamethasone + Thalidomide
What is the:MCVFerritinTIBCRDWin a 34 year old man of mediterranean descent with a fam hx of anemia
MCV - DecreasedFerritin - IncreasedTIBC - NormalRDW - Normal
What is the criteria for the diagnosis of at UTI in the elderly?1. clean catch2. specimen from catheterization
- 10^5 colony-forming units2. 10^2 colony-forming units
Chemo Med that causes skin rashes and birth defects
Tretinoin (PML-RARA)
What are patients with refractory H. pylori infections at risk for?
MALT lymphoma
How do you interpret the T-score of a DEXA scan?
Normal = Tscore > -1 Standard DeviationOsteopenia = T-score of -1 to -2.5 SDOsteoporosis = T-score less than -2.5 Standard dev
What do most patients presenting with hemoptysis require?
bronchoscopy—massive hemoptysis may result in death from asphyxiation
Incidental ASx thrombocytopenia, TX?
> 30,000 PLT: Observe<30,000 PLT: Glucocorticoid
What prophylaxis should be given to an AIDS patient with a CD4 count of 180 cell/mm3
TMP-SMX to prevent pneumocytic pneumonia
what micro-organism is responsible in an HIV patient with pneumonia, nonproductive cough, elevated LDH?What is the definitive diagnostic method?
Pneumocystis JiroveciiGiemsa or silver stain
Pt can’t write, do math, confuses R/L, Does not recognize fingers, can’t mimic movement. Dx?
Mid cerebral infarct in the inf parietal lobe
Elevated PT and PTT, Decreased put and bleeding from central lines, DX/TX?
DX: DICTX: Optimize ABx coverage
MDD signs
SigecapsSuicideInterestGuiltEnergyConcentrationAppetitePsychomotorSleep
What are ECG findings in a Left bundle branch block?
QRS duration > 120 msecno R wave in V1,Wide + tall R waves in I, V5, V6
What is the initial step in the management of acute pancreatitis?
(Early and aggressive fluid management) 0.9% Saline
What are the leukocyte levels in synovial fluid for:1. Inflammatory2. Septic?
- leukocytes: 2000-750002. leukocytes: >100,000
Chemo Med that causes cardiotoxicity, alopecia, myelosuppression…
Doxorubicin
AML Chracteritics
~67 yo>20% BlastsAuer Rods (M3 Variant)Exposure to Benzene/RadiationMyeloperoxidase +Dx: Smear»_space; BM BxTx: M3 Trans Vit A, all other get Chemo
Chemo Med that causes Renal Failure, Hemolysis, Thrombocytopenia
Mitomycin
Middle age pt, u/l claudication, unequal BP….
Takayasu
What artery is associated with dizziness and vertigo in a 67 year old woman w extensive atherosclerotic cerebrovascular disease?
Vertebrobasilar insufficiency
Thin Visceral pleural line displaced from chest wall on cxr
Spont Pneumothorax
Tx for urticaria Transfusion Reaction…
Benadryl
25 year old male with 20% total body surface burns to legs and chest. Rapid sequence intubation in successfully performed for airway protection. He later dies of from cardiac arrest. What happened?
Hyperkalemia - from Succinylcholine administration in burn patient
What is contraindicated in an unconscious patient that drank drain-O?
NPO - do not intubate - may exacerbate the damaged mucosa from the drain-O = can cause esophageal rupture
What test would reveal the underlying etiology:Pt with recurrent pneumonia infections, severe sinusitis, bloody diarrhea
Quantitative measurement of serum immunoglobulin levels(pt may has Common variable immunodeficiency
What is the most ideal site for a creation of an AV fistula for dialysis?
Radial arteryCephalic vein
What is the preferred daily medication for a patient with a history of asthma and nocturnal awakenings secondary to cough and occasional wheezing that occurs 3-4 times per week?what is the classification?
Moderate persistent (daily symptoms, nocturnal awakenings >1/week)–long acting B2-agonist = preferred therapy
CML Chracteritics
~47 yoMature EOS/BASO/PMNPhilidelphia 9:22 BRC-ABLDx: Diff CBC»_space; BM BxTx: ImatianibCan become AML»_space; “Blast Crisis”
anti-proteinase 3 Ab, no deposits, glomerulonephritis, hemoptysis, systemic inflammation… Dx?
Granulmatosis w/ Polyangitis (Wegner)
Chemo Med that causes pulmonary fibrosis…
Bleomycin
Identify the syndrome and cause of thrombocytopenia:Pt treated for Rheumatoid arthritis with chronic steroids. Fullness of upper left abdomen. Low platelets, neutropenia, anemia.
Felty Syndrome:1. rheumatoid arthritis2. neutropenia3. splenomegaly4. lymphadenopathy5. thrombocytopeniaSplenomegaly causes sequestration of platelets = thrombocytopenia
what is the type of arrhythmia?68 yr old female w hx of diabetes and HTN presents to the ED w weakness in the R leg. ECG shows a supraventricular tachyarrhythmia w an atrial rate of 425/min
Atrial fibrillation–atrial rate is > 400/min
What diagnostic test should be used to dx a gonococcal cause of arthritis?
gonococcal infection findings in urethra, cervix, pharynx–synovial fluid cultures are usually sterile in gonococcal arthritis–blood cultures are positive less than 50% of the time.
What is the sequence of diagnostic tests used for diagnosing PE?
- Chest CT2. Lung Scan (V/Q)3. Venous ultrasound to look for DVT4. Transesophageal Echo
If HIV is suspected…
Get an HIV Viral RNA Load
What are the glycemic goals of Diabetic pts?
A1c <7%preprandial glucose: 70-130 mg/dLpeak postprandial glucose < 180 mg/dL
What is the most useful nonimaging diagnostic test for a PE?
D-dimer ELISA
A pt on chronic corticosteroid therapy for SLE. I admitted to the hospital for a surgical procedure.What is the most important intervention?
Hydrocortisone IV before surgery and every 6 hours for 24 hours —prevent adrenal insufficiency before surgery
Pt dx w/ AF,TX?
Heparin/Warfarin first five days then d/c the Heparin.
Fever, malaise, Chills following a transfusion…
non-hemolytic Transfusion Reaction
Identify type of vitamin deficiency?13 year old male recently emigrated from china after being diagnosed with congestive cardiomyopathyname of dz?what other areas have this problem?what are foods rich in this vitamin?
Selenium deficiency = KESHAN dz–congestive cardiomyopathy, enlarged heart–China, New Zealand, Finland–selenium rich foods = fish, shellfish, eggs
What two microorganisms are comon causes of meningitis in patients following neurologic procedures (ie ventriculoperitoneal shunt)
S. aureusS. epidermidis
CLL Chracteritics
~87 yoMature LeukocytesTypically AsxDx: Diff»_space; BM BxTx: >65/Asx – nothing >65/Sx – Chemo <65/Donor – Stem Cells
Monoarthritis with sudden onset pain and swelling. Intra-articular fluid aspiration shows 10,000 leukocytes and negatively birefringent (yellow in parallel light) needle shaped crystalswhat is dx and risk factors?
Gout–male gender, diuretic use, alcohol abuse
Tx of non-hemolytic Transfusion Reaction…
COX inhibitor
What is the management of a solitary pulmonary nodule in relation to size?
nodules <8mm = follow radiographicallynodules >8mm = biopsy, consider surgical resection
What is the criteria to determine the difference between transudative and exudative fluid?
Light Criteria–EXUDATES meet at least one of the following criteria:1. Pleural fluid protein/serum protein ratio >0.52. Pleural fluid LDH/serum LDH ratio >0.63. Pleural fluid LDH >2/3 the upper limit of normal for serum LDH
What kind of kidney stone can be prevented with the acidification of urine (ie drinking cranberry juice)
Calcium Phosphate stones (form in alkaline urine)
What is the type of arrhythmia?57 year old male is brought to the ED unconscious after a witnessed episode of syncope. ECG shows wandering baseline and irregular complexes w faint pulse
Ventricular fibrillation(Afib has a irregular palpable pulse)
Woman, Pulmonary remodel, Dyspnea, Fatigue, Right Heave, Loud S2, Mitral Regurgitation. DX/TX?
Dx: Pulmonary HTNTX: Vasodilator (Epoprostenol/Sildenafil/Treprostinil) Endothelin inhibitor (Bosntan)
What is the Glasgow Coma Scale?
Eye Opening1-None2-Response to Pain3-Response to verbal command4.SpontaneousVerbal Response1. None2. Incomprehensible3. Inappropriate words4. Confused5. OrientedMotor Response1. None2. Extension to pain3. Flexion to pain4. Withdrawal from pain5. Localizing to pain6. Obeys command
What is the cause of 3.7g/day 24 hour protein in a patient with an acute hepatits B infection?
Membranous nephropathy
Chemo Med that causes peripheral numbness…
Vincristine
Med For UTI
Nitro
What is the CD4 level diagnostic of AIDS?
CD4<200
what is the use of aztreonam?
used with patients with penicillin allergy for gram negative rod infections (ie pseudomonas)
Chemo Med that causes hemorrhagic cystitis…
Cyclophosphamide
What ECG finding is associated with hypocalcemia?
prolonged QT interval
Tx for Iron overload
Defexoimine
What is the etiology of the pt sx:62 year old male w abdominal pain and blood clots in stool. CT scan shows gastric varices + thrombus in splenic vein
Chronic pancreatitis - most common cause of Splenic vein thrombosisTx for gastric variceal bleeding secondary to splenic V thrombosis = splenectomy
Dx DIC
Fibrin ClotPt very sick – Septic Shock then bleedingDx: Schistocytes, Pt/Ptt Increased, Plts Dec, D-Dimer Inc, Fibrinogen DecTx: Support, Transfuse PRN
What is the therapeutic drug of choice for delirium tremens from alcohol withdrawal?
Benzodiazepines
What are the stages of Chronic Kidney failure?
Assess by GFRStage 1: >90Stage 2: 60-89Stage 3: 30-59Stage 4: 15-29Stage 5: <15
Dx of Chronic Dz Anemia …
InflammationInc FerritinDec TIBCDec Fe
What are the characteristics of Coma?
Complete failure of arousal systemReflexes, postural responses are intactEEG shows auditory brainstem response
Non-tender, enlarged lymph node. DX..
lymphoma – Total Excisional Biopsy
How is urine Sodium interpreted in regards to kidney injury?
Urine sodium < 20 mmol/L = pre-renal azotemiaUrine sodium > 40 mmol/L = ATN, AIN
How does essential tremor usually present?
bilateral hand tremor (frequency 4 to 6 Hz) that exacerbates with actionsimprovement: beta blockers, anticonvulsants, small amounts of alcohol
Chemo pt becomes febrile during a chemo session…Tx?
Broad spectrum ABx
Cells that show G6PDD
Bite and Heinz
Which infectious agent is most likely associated with an infected central venous catheter in a neutropenic agent?
Staphylococcus epidermidis (coagulase negative)
Swollen. tender MCP/Hepatomegaly. At risk for___
CHF
ALL Chracteritics
Peds ~7 yoLeukocytes>20% BlastsCALLA +TdT +Dx: Smear»_space; BM BxTx: Chemo + ARA-C
What was the most common cause of constrictive pericarditis in the US in the past?what is the most common cause presently?
Tuberculosispresent: Radiation therapy, surgery, viral infection, uremia, malignancy
How does distributive shock differ from cardiogenic and hypovolemic shock?
distributive - often caused by sepsis—increase in cardiac output—inability to maintain systemic vascular resistance (inappropriate vasodilation)—***EXTREMITIES ARE WARM AND WELL PERFUSED = “Warm phase”can progress to “Cold phase” - intense vasoconstriction in an apptempt to maintain blood pressure - bad prognosis b/c sepsis should be caught during “Warm phase”
What are MRI findings in1. HSV meningitis2. TB meningitis?
- enhancement of temporal lobes2. enhancement of basal region
Which test is the most important to follow for a patient receiving isoniazid and rifampin for TB treatment?
Liver function tests
What use is Zoledronic acid reserved for?
zoledronic acid = IV bisphosphonate–used for prevention of skeletal fractures in patients with Multiple Myeloma and Prostate Cancer
what is dx?acute chest pain with free air under diaphragm on CXR
Perforated peptic ulcer
What is the treatment of choice for Graves disease in nonpregnant patients?
non-pregnant = radioactive iodinepregnant = PTU
Chemo Med that causes abortions/birth defects and myelosuppression…
Methotrexate
what is the treatment of an addisonian crisis?
- IV 5% glucose w normal saline to correct volume depletion and hypoglycemia2. corticosteroid therapy(given salt, sugar, steroids)
Dx of Iron Deficient Anemia …
Slow BleedInc TIBCDec FerritinDec Fe
What is dx:51 year old w diffusely erythematous skin rash w associated fever. pt takea tenolol and allopurinol for HTN and gout. Rash is tender and over over 90% of body. Lymphadenopathy noted in the neck and inguinal region. elevated eosinophils, AST, ALTwhat are some causes
DRESS syndrome (Drug reaction w eosinophilia and systemic symptoms)-extensive rash, fever, lymphadenopathy, hematologic abnormalities, hepatitis, involvement of atleast one internal organmeds that cause DRESS:allopurinolanticonvulsants, sulfa derivatives, antidepressants, NSAIDs, antimicrobials
What lab test can confirm an acute transfusion reaction?
elevated LDH levels
What are some criteria that suggest a dx of SIADH?
SIADH is a dx of exclusion1. Euvolemic2. Urine is not maximally dilute (150-200mmol/L)3. Urine sodium > 20mmol/L4. normal adrenal and thyroid function
What are the two most common precipitating factors for an adrenal crisis in a patient with Addison’s Disease?
- GI upset2. Fever
Describe the 5 parts of Thrombotic Thrombocytopenic Purpura syndromeWhat is the cause of TTP?
- microangiopathic hemolytic anemia2. thrombocytopenia3. neurologic abnormalities4. fever5. renal dysfunctionCause = ADAMTS13 deficiency = excess vWF = microvascular thrombi
What is the most specific test for diabetes?most sensitive?most acceptable?
most specific: Fasting glucose: > 126 mg/dLmost sensitive: 2hr oral glucose tolerance testMost acceptable dx test: HbA1c >6.5%
What is the underlying cause of a pt with ESRD and a easily fractured hip?
Hypovitaminosis D (impairment of absorption of Calcium in the GI tract
What is Ranson’s criteria?
Assess severity and predict mortality rate of acute pancreatitisAdmission:glucose >200Age > 55LDH >350AST > 250WBC > 16000Initial 48 hr exam:calcium < 8Decrease in HCT > 10%PaO2 <60Base deficit > 4mgBUN increase > 8mg/dLFluid sequestration >6L
What location in the lung does:1. primary pulmonary TB2. reactivation TBaffect?
- often in children - Middle and lower lobes2. Apical and posterior segments of upper lobes
identify type of vitamin deficiency:45 year old male from Africa with hyperpigmented scaling rash on the sun exposed area of his neck.what is the name of this?
Niacin (B3) deficiency–Casal’s necklace–3D’s (diarrhea, dermatitis, dementia)
What are abnormal Orthostatic vital signs?
Drop of:20mmHg Systolic10mmHg Diastolicupon standing
What is the appropriate next step after suspecting pleural effusion from history and chest xray?
Diagnostic thoracocentesis - diagnose cause of the pleural effusion and determine the necessity for fluid drainage
What its the initial therapy for Immune thrombocytopenic purpura?what should to performed if pts do not respond to medication chronically?
Oral Corticosteroids–Splenectomy if pt doesnt respond to medication chronically
What are most likely CXR findings in a patient with JVD, hepatojugular reflex, no crackles on lung auscultation, long hx of smoking?
Cor pulmonale = depressed diaphragm w prominent pulmonary artery
Cardiac markers, when present?
Myoglobin – >2hoursTroponin – 3-12 hoursCK-MB – 3-8 Hours
What the next best diagnostic step when COPD is suspected? what is the best initial treatment?
dx: ABG to assess oxygenation and acid-base statustx: oxygen by nasal cannula,, bronchodilators and steroids for airway inflammation
What distinguished hyperthyroidism from thyroid storm?
Fever and delirium (+bpm >140, fever (104-106))
Walking on heels tests nerve root ___
L5
What is a side effect of biologic DMARDs TNF antagonists (etanercept, infliximab, adalimumab)what should you do before prescribing?
increase risk of infection (reactivation of latent TB)–pts should be screened for TB
What is the most common cause of secondary HTN?
Renal dzin young pts - think fibromuscular dysplasia
Elevated Ca and PTH, Dx?
Hyperparathyroidism
A 65 asymptomatic male presents for a routine wellness examination. Hx of HTN, 30 pack year smoking hx. active lifestyle. Cardiac/lung exam are unremarkablewhat is the most appropriate prevention recommendation at this time?
Abdominal ultrasound–Abd US screening for Abdominal aortic aneurysm for all men aged 65-75 who have ever smoked in their lives
What type of malignancy are pts with hashimotos thyroiditis at a higher risk for?
thyroid lymphoma
Takayasu involves primarily the …
aorta
what is the best intervention to slow the progression of Diabetic Nephropathy?
Angiotensin inhibition–ACE-i–ARB
Tx for PNH
Support/Eculizumab
What is the USPSTF suggestion for screening for lung malignancy? in what patients?
low-dose helical scan of the chestAdults 55-80 w >30 pack-year hx+ currently smoke or quit within last 15 years
what is the type of arrhythmia?40 year old female w phm of rheumatic heart disease presents w fatigue and dyspnea. ECG shows narrow complexes at 150/min in a regular rhythm w F waves in leads II, III, and aVF
Atrial flutterF waves = sawtooth pattern, best seen in II, III, aVF
Abnormality on CBC w/ a pt w/ polycythemia vera
Increased EPO
What is the next step when a Transient ischemic attack is suspected?what medication should be administered? in what time frame?
NONCONTRAST CT of the brain.thrombolytics (IV recombinant tPA) - within 3-4.5 hours
Tx for Thyroid Storm…
Beta-blocker, Hydrocortisone, PTU, Iodine
What are the Microcytic anemias
Iron DeficientChronic DzThalassemiaSiderblastic
Pt has secondary HTN, Epigastric Bruit, confirm Dx w/…
Renal angiography»_space; Beads on a String
What are ECG findings that suggest a PE?
usually: Sinus Tachycardiararely:S1Q3T3 (inverted T wave in lead III)
Describe Hemolytic Uremic Syndrome
clinical complex consisting of 1. progressive renal failure2. microangiopathic hemolytic anemia3. thrombocytopenia
Young pregnant women w/ b/l hydronephrosis w/ or w/o ureteral or bladder dilation, clear UA DX?
Pregnant
What is the cause and treatment for a HIV patient with new onset seizures. CT scan shows multiple ring-enhancing lesion of the brain.
ToxoplasmosisTx: Sulfadiazine with pyrimethamine
What are extrapulmonary manifestations of Small Cell Lung Cancer?
SIADHectopic ACTH - CushingEaton-Lambert-peripheral neuropathy
Dx ITP
AutoimmuneAb against PltsDx: R/O othersTx: Steroids/IVIG/Spleenectomy/Rituxumab
What is the diagnosis?46 year old HIV positive male w SOB and profuse epistaxis. Bloody diarrhea and left flank pain. Diffuse petechial rash, non-focal neuro exam, tissue texture changes from T9-T11 bilaterally.Anemia, thrombocytopenia, acute renal failure, schistocytes in peripheral smearwhat study can confirm dx?
Hemolytic uremic syndromestool culture fro E. coli O156:H7
Large Dark WBC on Peripheral Blood Smear…DX?
EBV
Dx TTP
Hyline ClotAdam 13FAT RN – Fever/Anemia/Thrombocytopenia/RF/Neuro SxDx: Smear – SchistocytesTx: Exchange Transfusion
Dx of Iron Thalassemia Anemia …
Labs normal
Chemo Med that causes: Ototoxicity, Nephrotoxicity and nausea…
Carboplatin
what is the NYHA classifications of Congestive Heart Failure?
Class I (Mild) - No limitation of physical activityClass II (Mild) - slight limitation of physical activity, comfortable at rest, prolonged/moderate activity causes symptomsClass III (Moderate) - marked limitation of physical activity. walking across room, getting dressed causes symptomsClass IV (Severe) - Unable to carry out physical activity without discomfort
What is the managment of acute pericarditis?
NSAIDs,Aspirin, Ibuprofen, Indomethacin
How is FeNa calculated? how do you interpret results?
FeNa = 100x(Serum creatinine/Urine creatinine)/(Serum Sodium/Urine Sodium)<1% = prerenal azotemia (ie volume depletion)>2% = ATN, AIN
Dx APLA/APS
Lupus Ab – causes clots in arterial and venousDx: Russell Viper TestTx: Warfarin lifelong
Initial step in Giant cell arteritis…
High dose Steroids
Tx for Opioid Overdose
Naloxone
HTN and Hypokalemia, Dx…
Primary aldosteronism
When to CT the nasal sinus in regards to sinusitis…
Chronic/Recurrent
Dx Test for OSA
Polysomnography
Dx test for Aortic Dissection (Hem Stable)
Contrast CT
Lab to confirm Acromegaly
ILGF-1
Trauma to the CNS, Hypernatremia, Polyuria, Intubated…Dx
Central DI
Bronzing, DM, Fluid wave…Dx Test?q
Serum Iron panelHigh Ferritin and Transferrin Dx = Hereditary Hemochromatosis
LMWH MOA
Activate AT-III
Yellow deposits around macula, Progressive loss of central vision
Age related macular degeneration
PMH that contributes to Cholelithiasis
Hereditary Spherocytosis.
HIV, w/ CD4 <100, at risk for …
T. plasmodia
DM w/ HTN, Tx w/ …
Ace-i
Age to get a DEXA…
65
Backpain, osteoblastic lesion, prostate node.. Dx/Tx
Dx: Met Prostate cancerTx: GnRH Agonist/Antagonist – androgen deprivation
Tx for ETEC
ABX/Fluids/Anti-motility
Ring lesion, N, V, Constant HA…Dx
Gliablastoma
Muddy brown casts…
ATN
Tx for Raynauds Phenom…
avoid triggers
ANA Ab, Dx…
SLE
Anti-CCP Ab, Dx…
RA
Anti-centromere Ab, Dx…
CREST
Anti-dsDNA Ab, Dx…
SLE
Anti-Histone Ab, Dx…
Drug induced SLE
Anti-Jo Ab, Dx…
Polymyositis/Dermatomyositis
Anti-Mitocondrial Ab, Dx…
Primary Biliary Cirrhosis
Anti-Topsomerase Ab (Scl-70), Dx…
Scleroderma
Anti-Sm Ab, Dx…
SLE
Anti-TSHR Ab, Dx…
Graves
C-ANCA, Dx
Vasculitis (Wegner)
P-ANCA, Dx
Vasculitis, Micro poly
U1RNP Ab, Dx
Mixed CT Dz
Anti-RNA Poly III Ab, Dx…
Sys Sclerosis
Anti-la/ro
Sjogren
Anti-hu, Sx and DX
Paraneoplastic Cerebellar Degeneration, Ataxia, d/t SCC of the lung
Anti-yo Ab, Sx and Dx
Paraneoplastic Cerebellar Degeneration, Ataxia, d/t breast/gyn cancer
Med that causes toxic inflammatory lung disease, Foam Cells
Amiodarone
Colonoscopy starts at age…
50
Dx Test for Pulmonary HTN
Right Heart Cath
TST +, CXR -, Sputum - next step?
Latent TB Tx, no isolation
Broca Aphasia, wheres the occlusion…
L MCA Sup Div
Wernicke Aphasia, wheres the occlusion
L MCA Inf Div
Sx: Ataxia, Incontinence, Dememtia
Normal Pressure Hydrocephalus
Smokes, wt loss, jaundice, palpable gallbladder, Dx…
Pancreatic Cancer, Get a And CT
Common AF of Statins
Muscle pain
Fever, new UL HA, Neuro Deficit, Dx…
Dx: Brain Abscess
imaging for Renal Stones
Non contrast CT
Abd pain, Neuro sx, discolored urine
Acute Inter Prophyria
Acute Stroke imaging
Non Contrast CT
Imaging for ADPKD
U/S
Lab finding for Exudative (inflammation) Pleural Effusion
All musty be met, Ratio is Fluid /ProteinProtein > 50%LDH > 60%LDH > 66% of nl Serum LDH (~300)
Most common reasons for a Transudate Pleural Effusion
CirrhosisCHF
Common Exudative Pleural Effusions
CancerTBPnuemo
Pulmonary Fxn Test to differ Asthma and COPD
Diffusion Capacity
Fever, Malaise, Rigors, Recent Travel…Dx
Malaria
Test to Dx C.Diff
Stool ELISA for Toxins
When to get a mammogram and how often
50-74yo, q 2yrs
Ischemia of hands/feet, Different BP Right versus Left, Smoker…Dx
Thromboangiitis Obliterans
AI, Proximal Muscle Weakness, Purple rash on knuckles and per-iorbital, Anti-Jo…Dx
Dermatomyositis
Psychmotor slowing w/o aphasia
NPH
Magnetic Gait
NPH
Define Aphasia
Cant talk
Define Agnosia
Cant interpret sensation
Define Apraxia
Cant complete an intentional task
Tx for AML
Imatinib
Myeloid Leukemia, T15:17
AML-M3 (APL)
How to prevent in-patient Delirium
Remind of LocationSleep AidEliminate Restraints
Cres-Decres Mid-systolic mimer that radiates to the neck
Aortic Stenosis
Tender Subs nodules, Fever, Abd Pain, Arthralgia, Weakness, Myalgia, Liver/Renal Dys Fxn… Dx
Polyarteritis Nodosa
Polyarteritis Nodosa Tx
Steroids, unless Hep B/C pos, then Plasma Exchange.
1 Risk Factor for Stroke
HTN
Subdural bleed present as…
Crescent Shape/Concave away from skull/Passes sutures
RA sx w/o signs of inflammation, labs will show…
Elevated ESR
Sx of T. Saginata
Beef Tape wormN/Fatigue/D/Adb Pain/Weight Loss
Sx of T. Asiatica
Pork Tape worm found in ASIAN/Fatigue/D/Adb Pain/Weight Loss
Sx of T. Solium
Pork Tape worm found in AmericasAcute onset seizures/Neuro Deficits
Do not mix Sildenafil w/…
Nitros
NASH, Wt Loss, ABD Pain, Liver Mass…Dx
Hepatocellular Carcinoma
ASx pt, incidental liver mass…Dx
Hemangioma
Hemochromatosis can develop into…
Hepatocellular Carcinoma
Female taking OCP, RUQ Pain, Liver Mass…Dx/Tx
Dx: Hepatic AdenomaTx: D/C OCP, Resect tumor
Tx Osteoarthritis w/…
NSAIDs
Common Risk factor of acute sinusitis…
Recent Infxn
Anti epileptics (Valproic Acid, Carbamazapine, Phenytoin, Felbamate) may cause this bleeding disorder
aplastic anemia
Hereditary pediatric Aplastic Anemia d/t DNA Repair Defect
Fanconi Anemia
Dz cause of bone fibrosis
CML, Poly Vera
Tx of hyperthyroid in 1st trimester
PTU
Tx of hyperthyroid in 2nd trimester
Methimazole
Tx for frontaltemporal dementia
Occupational Therapy
HA, Hx of medullary thyroid ca, HTN…Next Step
Measure Urinary Metanephrines, possible Pheochromocytoma
Ocular finding on an uncontrolled DM pt
Wool Spots, Blot Hemorrhage, Retinal Microaneurysms
Cupping Disc…Dx
Glaucoma
Non-productive cough, Hypoxemia, DOE, CP…Dx
PCP
CKD, Hyperkalemia, Weakness…ECG will show
Wide QRS, Peaked T-waves
HIV pt w/ CD4 < 200, prophylaxis w/…
TMP-SMX, PCP
HIV pt w/ CD4 < 100, prophylaxis w/…
TMP-SMX, Toxo
HIV pt w/ CD4 < 50, prophylaxis w/…
AZT, Micro Avium
Smoker, Hyponatremia, SIADH…Dx
SSC of lung
Smoker, Hyponatremia, Hypercalcemia, Hypophophatemia…Dx
SCC of the lung
Central lung cancers
Squamous and Small Cell
Sheehan’s is suspected, next step…
IV Dexamethasone
Most important cell in osteoarthritis
Chondrocyte
Stones w/ a decrease in urine pH
Uric Acid, Cystine, Calcium Oxalate
Stones w/ increased Urine pH
Struvite, Calcium Phosphate
Imaging for acute abd
X-ray
Renal Bx shows double membrane with Sub-endothelial Deposits…Dx
MPGN
Renal Bx shows Thick Membrane and Mesangial Expansion…Dx
DM Nephropathy
Renal Bx shows Sclerosis and hyalinosis, Assoc w/ HIV …Dx
FSGN
Renal Bx shows Sub-endothelial deposits and Mesangial Expansion…Dx
SLE Nephritis
Renal Bx shows Thick Membrane and IgG, C3 Deposits, assoc w/ Virus/Ca/Med induction…Dx
Membranous Nephropathy
Tx for post strep erythema nodosum
NSAIDs, Potassium Iodine, Oral Steroids
Pt w/ asymmetric, hard prostate and a PSA >4…next step
Transrectal Bx
