IM EOR Flashcards
screening for hepatocellular carcinoma in cirrhotic pt
abdominal US Q6 mo w/ CEA
At what initial age is it most appropriate to consider statin use for the primary prevention of cardiovascular disease?
40 y/o
tx of superficial thrombophlebitis
NSAIDs
Compression Therapy
Ambulatory
bronchiectasis
abnormal, permanent dilation and destruction of bronchial walls.
CURB-65
determine if admission is necessary for pneumonia
where is histoplasmosis found
ohio & mississippi river valley
MCC of a late systolic murmur
mitral regurgitation
importance of acid-base disturbance in status epilepticus?
acidosis is thought to have anti-sezure protection
aka - do not fix
tremor that is worse w/ movement & improves with alcohol
essential tremor
** considered autosomal dominant
inheritance of HD?
autosomal dominant
first line tx of fibromylagia?
TCA (amitryptiline)
confirmatory test for celiac disease
duodenal biopsy
pulmonary fibrosis
honeycombing of the lung parenchyma
gold standard acute angle closure glaucoma
goinometry
When does heparin-induced thrombocytopenia generally present, following exposure?
5-14 days post-exposure
needle shaped monosodium urate crystals
negative birefringence
GOUT
serum uric acid > 6.8
gout
tx gout
flare w/n 24 hr: colchicine
flare after 24 hr NSAIDS (naproxen/indomethacin) –> void aspirin
flare + CKD: glucocorticoids
chronic: allopurinol
serum uric acid levels
< 5-6 (depending on presence of tophi)
rhomboid, positively birefringent CCP crystals
pseudogout
xray findings in pseudogout
chondrocalcinosis
tsh goal post thyroidectomy
1-2
lung cancer screening
low-dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
LP findings in MS?
increase in oligoclonal bands
The only non-statin lipid-lowering agent that has proven to have additive effects on the prevention of cardiovascular adverse events is…
ezetimibe
blocks intestinal absorption of choleserol
RF assoc with pseudogout
OA
underactive thyroid
overactive parathyroid gland
MC & early sx of scleroderma
Raynauds phenomenon
another name of anti-jo ab
anti-histidyl-transfer RNA synthetase
sjogren syndrome increases risk of what cancer?
NHL
Metabolic Syndrome
- waist circ
- trigs > 150
- HDL < 40 m/<50 F
- > 130/85
- fasting BS > 100 mg/dL
etiology of primary hyperparathyroid
pth secreting tumor
etiology of secondary hyperparathyroidism
PTH inc 2/2 to hypocalcemia or vit D deficiency
MCC CKD
hypervascular bone
paget disease of the bone
paget disease on xray
lytic lesions / thickened bone cortices
pheo dx test
24 hour catecholamines
** NO solo bbb to prevent unopponsed alpha constriction –> life threate
what type hiatial hernia is most likely to present with GERD
type I (sliding)
MCC esophagtitis
reflux
tx of reflux esophagitis
trial PPI x 8 weeks w/ f/u repeat endoscopy
MCC of pancreatitis in children
mumps
MCC of esophageal strictures
untreated GERD
What are some medications that cause pill esophagitis?
Alendronate
ferrous sulfate
nonsteroidal anti-inflammatory drugs phenytoin
potassium chloride
quinidine
tetracycline
ascorbic acid.
tx esophageal strictures
high dose PPI
Surgery
IBS
abdominal pain + bloating x 1 day every week for 3 monthds
tx IBS-D
loperamide 2 mg 45 minutes before each meal.
loperamide, cholestyramine
tx IBS-C
1st line: polyethelyne glycol
2nd line: diet changes + anti-spasmoditcs (hyoscyamine and dicyclomine)
3rd line: TCA
psyllium, osmotic laxatives, lubiprostone
tx of chronic pancreatitis
low-fat diet
enzyme replacement
ERCP - assess for chole complications
utility of CEA in Colorectal cancer
NOT diagnostic
used as a prognostic indicator
HFE gene
hemochromatosis
R vs L sided Colon Cancer
Left-sided cancer: tends to obstruct
Right-sided cancer: tends to bleed
Iron deficiency anemia
full fluid resuscitation
30 ml/kg
celiac dz ab
- anti-tissue transglutaminase (anti-tTG) antibodies
- IgA antiendomysial (anti-EMA) antibody
suspected diverticulitis + palpable mass in LLQ
think abscess
What is midodrine and how is it used in the treatment of cirrhosis-induced hyponatremia?
Vasoconstrictor used to maintain mean arterial pressure in hyponatremic patients with low blood pressure due to third-spacing of ascites.
alpha-1 agonist
cirrhosis labs
low platelets and albumin
high INR, Alkaline phosphatase, Bilirubin, and GGT
hepatic carcinoma cancer screening
abdominal US Q6 mo for pt with chronic hep C or advanced liver cirrhosis
hepatocellular carcinoma tumor marker
AFP
is surgery curative for chron disease?
NO
chrons disease ab
(+) ASCA
tx of acute upper GI bleed
must do fluid resuscitation prior to blood transfusion
colonscopy f/u after fidning polyps
- Those with polyps that are considered benign, such as tubular adenomas under 10 mm, should receive surveillance colonoscopy at 5- to 10-year intervals.
- high risk polyps require colonoscopy Q3 years
What serologic markers may be associated with gastric cancers?
CEA
CA 125,
CA 19-9.
antibody (+) in RA
RF
anti-CCP
morning stiffness in OA vs RA
< 15-30 mins = OA
> 15-30 mins = RA
tx of lupus nephritis
corticosteroids
cyclophosphamide
sjogren sicca tx
1st line: pilocarpine (oral anti-cholinergics)
2nd line/specficially ocular sx: cyclosporine drops
1st line med for raynaud’s syndrome
varnecicline
sjogren findings on biopsy
mononuclear cell infiltration
antithrombin III deficiency
- recurrent venous thrombosis & PE
- think repetative IUFD
tx: only if symptomatic – high dose IV heparin w/ thrombotic events & PO anticoagulation for life
ITP labs
isolated thrombocytopenia w/ normal CBC & smear
plt < 100,000
tx ITP
steroids for plt < 30,000
IVIG for plt <30,000 & CI or refractory to steroids
splenectomy = last line
IDA timeline
6 mo to correct
6 mo to replete
recheck blood counts Q3 mo x 1 year
hodgkin lymphoma
painless LAD + reed-sternberg cells + B sx
** associated with EBV
** speads to local lymphom nodes
non-hodgkin lymphoma
HIV pt + IG sx + painless LAD
** spreads to peripheral lymph nodes
sickle cell trait vs disease
hb ss = disease
hb sa = trait
sickle cell transfusion limit
hgb < 6
TTP triad
decreased plt
anemia
schistocytes
TTP sx
FAT RN
fever
anemia
thrombocytopenia
renal failure
neuo sx
+ purpura
ttp coombs test
(-) coombs test
folate vs B12 deficiency labs
folate: inc homocystine, NO MMA
B12: inc MMA & homocystine
s/sc botulism
diplopia
dry mouth
dysphagia
dysphonia
muscle weakness
respiratory paralysis
when do you prophy for cryptococcus
CD4 < 100 [ fluconazole]
histoplasmosis
- bird/bat droppings
- ohio/mississippi river valleys
- CD4 100
HIV opportunistic infx by CD4 count
< 250: coccidiomycosis - fluconazole
< 200: PCP - bactrim
< 150: histoplasmosis - itraconazole
< 100: toxoplasmosis/cryptococcus - prevention not rec
< 50 = MAC - no prophy
prophy for neutropenic fever
levoquin
PCP
- usually CD4 < 200
- elevated LDH
- Bactrim prophylaxis
rabies post exposure prophylaxis
vaccine day 0,3,7,14
syphilis
primary - painless chancre (persists 3-6 wk)
secondary - rash on palm & soles or condyloma lata
tertiary - widespread systemic involvement, permanenet CNS changes, gummas
congenital - hutchinson teeth (notches), saddle deformity, TORCH
intracranial calcificiations in AIDS pt w/ CD4 < 100
toxoplasmosis
requires prophy in all pt with CD4 < 100
TB induration size in individuals w/o risk factors
> 15 mm
TB tx
RIPE x8 wks
RI x 16 weeks
bronchiectasis on cxr
“tram tracks”
MCC Carcinoid tumor
GI tract cancer that has metastasized to the lungs
elevated 5-HIAA in 24 hr urine excretion
** a main metabolite of serotonin
think carcinoid tumor
** can pretx w octreotide to decrease serotonin secretion from tumor
screening required in ind w 30 pack year hx
low dose CT scan
ABG in emphysema vs chronic bronchitis
emphysema: resp alkalosis
COPD: respiratory acidosis
what O2 sat do you initiate O2 therapy in COPD pt
88%
why should you use azithromycin in pulmonary dz tx (e.g. COPD exacerbation)
pulmonary anti inflammatory properties
definition of chronic bronchitis
cough > 3 mos x 2 years
MCC cor pulmonale
COPD
silicosis
from mining, sandblasting, stone work
asbestos
from insulation, demolition, construction
complication = mesothelioma
berylliosis
high tech field/nuclear work
** must tx w chronic steroids
sarcoidosis mimicking disease
histoplasmosis – also has hilar lymphadenopathy
CURB65
confusion
urea > 7
RR > 30
SBP < 90 / BPD < 60
age > 65
0-1 = low risk, consider home tx
2 = probable admission vs. close OP monitoring
3-5 = admission, manage as severe
pt w lung nodule, hypercalcemia & elevated PTHrp
squamous cell carcinoma of the lungs
lupus pernio
chronic, violaceous plaques & nodules on cheeks/nose/eyes
SARCOID
hypercalcemia
ACE levels 4x normal
sarcoidosis
confirmatory dx w / endotrachial biopsy
↓ breath sounds + dull percussion + ↓ tactile fremitus
pleural effusion
lung cancer screening
annual low dose CT for pt age 50-80 w/ 20 pack year smoking hx and currently smoke or have quit in the last 15 years
latent TB treatment
isoniazid + pyroxidine
legionella pneumonia
abd sx
diarrhea
elevated liver enzymes
hyponatremia
CT findings in idiopathic pulmonary fibrosis
fine reticular pattern
calcified pleural plaques & bilateral infiltrates
asbestos
fungal infx to most commonly present with pulmonary sx
coccidiomycosis
pneumonia, verrucous skin lesion , osteomyletisi in immunocompromised pt in midwest
blastomycosis
What are the four primary types of malignant mesothelioma?
Pleural (most common), pericardial, peritoneal, and testicular.
construction worker w/ sx of lung cancer
mesothelioma
aspiration pneumonia
think klebsiella (1st mc) or pseduomonas (2nd)
another name for philadelphia chromosome
BCR-ABL1 gene
translocation of 9 and 22
what procedure eradicates the carrier state of salmonella
cholecystectomy
salmonella can colonize in the gallbladder
MCC of osteomyelitis in sickle cell children
salmonella
tx RMSF
ALWAYS doxy (even in children)
tx of GCA
high dose prednisone = if no vision loss
IV methylpred = if vision loss
cluster HA prophy
verapmil
sudden onset, BL ASCENDING weakness
guillane barre
MCC of guillane barre
campylobacteri jejuni infection
LP findings in guillane barre
- increased CSF protein
- normal cell count
“albumino-cytological dissociation”
tx of bells palsy vs ramsay hunt
ramsay hunt requires antiviral medications
complex regional pain syndrome
non dermatomal limb pain following truama/surgery; pain disproportionate to injury
** often assoc with skin discoloration
atrophy of the caudate nucleus
huntington disease
aseptic meningitis on LP
normal OP
increased WBC
Normal ABI
0.9-1.3
ABI in mild-moderate PAD
< 0.9
ABI in critical limb ischemia
< 0.4
ABi > 1.3
calcified arteries?
dx for PAD
ABI
** CTA/US/MRi all used for surgical planning phase of tx for PAD
what inflammatory condition is smoking protective against
UC
preferred agents for HTN during pregnancy
hydralazine
labetalol
methyldopa
nifedipine
SVT caused by single excitable electrical focus
a flutter
** common in COPD (#2 MC, #1 is MAT)
tx of DVT in pt with CrCl < 30
unfractionated heparin w/ bridge to warfarin
Laplace law in aortic dissection
as vessel lumen size increases & vessel wall thickness decreases, wall stress increases
S3 gallop
dilated cardiomyopathy or HFrEF
management of VT
pulseless: defib
VT, unstable: synchronized cardioversion
monomorphic VT, stable & known structural cause: amiodarone 150 mg over 10 min, lidocaine, procainamide 100 mg over 10 min
polymorphic VT (Torsades): IV Magnesium
incomplete RBB
saddleback ST elevation
Causes sudden death, occurs in sleep & MC in asian men
brugada syndrome
tx of afib in pt w/ sx for > 48 hours
anticoagulation for 21 days then cardioversion
use of CHADS2-VASc vs HAS-BLED
CHADS2-VASc: determine need for anticoagulation in afib
HAS-BLED: monitor bleeding risk in anticoag pt who have afib
tx of type Ii second degree heart block
hemodynamically unstable: transcutaneous pacing
hemodynamically stable: permanent pacemaker
acute vs subacute endocarditis
acute: severe sx, < a few weeks (staph aureus)
subacute: midl sx, >6 weeks (strep viridans)
monitoring in aortic aneurysm
4.0-4.9 cm: U/S annually
5.0-5.4: U/S Q6 mo
5.5 or greater –> surgical repair needed
s3 vs s4
S3 = common in systolic HF (dilated/overflowing ventricle)
S4 = common in diastolic HF (still ventricle - think LVH)
tx of HCOM
- BB
- CCB
(avoid positive inotropes & nitrates)
murmur of HCOM increases w what maneuvers
valsalva/standing up
tx prinzmetal angina
CCB, nitrates
AVOID BB
PE of restrictive pericarditis
JVD
Hepatojugular reflex
pericardial knock
tx of pericarditis
HDS: colchicine + NSAIDs
HDUS: percardiectomy
acute pericarditis in ekg
diffuse ST elevation & PR depression
low pitched descrescendo holosystolic murmur w/ thrill radiating to axilla
MR
tv of CVI in pt who fail conservative measures
percutaneous endovenous thermal ablation [in pt w/ reflux > 1000 ms]
first line tx for htn in pt w/ ckd
Acei /ARB
s/sx of pericardial tamponade
- hypotension
- JVD
- distant heart sounds
- narrow pulse pressure
- pulsus paradoxus
what is kussmaul sx
abnl lack of decrease in JVP during inhalation - sign of constrictive pericarditis
tx that lowers mortality in stable angina
aspirin
BB
[be careful of bb therapy in pt w/ COPD]
primary indications for CABG
three vessel disease
>50% stenosis in LAD
Left ventricular dysfx
MC sx of mitral stenosis
exertional dyspnea
sinus node dysfx sx
- disease in SA node
- tachy-brady syndrome
- mc sx is syncope
pt most likely to present w atypical ACS
older women w/ DM
tx native valve endocarditis
pcn/amp + gentamicin
(+) vanc in IVDU
cover for s aurues, strep viridians
tx of prosthetic valve endocarditis
vanc + gent + rifampin
HLD goals
- Total Cholesterol < 200
- HDL > 60
- LDL < 100
- Trigs < 150
tachycardia disproportionate to fever or pain
think myocarditis
tx of hypertensive emergency
nicardipine
labetalol
preferred pressor in septic shock
norepi (previously dopamine)
sx of uncal herniation
unilateral dilated & fixed pupil
acute complication of MI
free wall rupture (MC in first 24-48 hr)
what level bilirubin does jaundice occur?
> /= 3
>/= 3 mg/dL
affects of obesity on BNP
decreased (possibly 2/2 breakdown of bnp in obesity)
med CI in diastolic HF
Digoxin ( no benefit in inc contractility - that is not the issue)
Med that is known to prolong life in chronic angina
BB
chronic pancreatitis inc risk of what disease?
diabetes (3c)
dx TOC in chronic pancreatitis
MRCP
** ERCP can be apart of tx
s/sx of thyroid storm
hyperpyrexia
nausea
vomiting
diarrhea
mental status change
JAUNDICE
HTN
diaphoresis
jaundice 2/2 hepatic tissue hypoxia d/t inc peripheral O2 use
TX of thyroid Storm
- propanolol
- PTU
- Iodine (after thiomaide)
- Glucocorticoids (slows peripheral conversion of T4 –> T3)
- Bile acid sequestrants
inheritance of PCKD
Autosomal Dominant
HTN w/ elevated DIASTOLIC BP
think PCKD
medication used to tx hyponatremia & PCKD
tolvaptan
medicine used when correcting for hyponatremia too fast
DDAVP
what valvular d/o is assoc w/ PCKD
MVP
at what age is it appropriate ot consider statin use in CVD?
40 y/o +
40-75 should get their 10 year ASCVD risk score [>10% requires statin tx]
best way for initial eval/ biopsy of lung lesions
endobronchial biopsy (least invasive)
bilateral hilar lymphadenopathy w/ reticular opacities in upper lung fields
scaroidosis
lab finding in pt w/ chronic pulm HTN
polycythemia 2/2 chronic hypoxemia
mean pulmonary artery pressure that is dx of pul htn
> /= 20 mmHg
cyanosis & inc intensity of second heart sound
pulm htn
confirmative test for suspected pneumoconiosis
CXR
eggshell calcifications throughout the lungs
silicosis
grade II/VI late systolic murmur heard best in the fifth intercostal space i
mvp
what induction agent prior to intubation is best for asthma patients?
ketamine
[2/2 its ability to improve pulm fx in asmthatics]
confirmatory test for celiac disease
duodenal bx
CD4 count < 50
CMV
MAC
jarisch-herxheimer rxn
- rxn in first 24 hours of tx w/ spirochete infx (aka syphilis)
- s/sx fever + constitutional sx
- tx w/ NSAIDs
pt e/ hx of ARF require what chemo prophylaxis?
PCN G benzathine IM Q21-28 days
tx of chronic hypercalcemia 2/2 malignancy
IV Zoledroic Acid
tx of hypercalcemia refractory to bisphosphonates
denosumab
hypercalcemia on ECG
short QT
Unilateral right-sided varicoceles are uncommon and should alert the clinician to possible underlying pathology causing obstruction of what vessel?
inferior vena cava
way to avoid steroid tx in Chrons pt and aloow them to enter remission
TPN
s/sx neurogenic shock
hypotension
bradycardic
yet still warm extremitites & good cap refill
```
~~~
spinal shock
- loss of spinal reflex activity below a complete or incomplete spinal cord injury
- s/sx flaccidity, loss of movement, loss DTRs
what DMARD is safe up until pregnancy?
hydroxychloroquine
how to avoid osmotic demyelination syndrome
never correct > 8 meq/L in 24 hr
utility of CKMB in stemi w/u
helpful for assessment of reinfarction
ab w highest sensitivity for luus & best for screening
ANA
drug induced lupus
hydralazine
INH
procainamide
phenytoin
sulfonamides
what COPD med has a narrow TI
theophylline (nearly last line tx in chronic COPD, dont use in exacerbations)
tx of HCOM
BB
(avoid inotropes & nitrates – worsen obstrution)
myasthenia gravis sx
ptosis, diplopia, dysphagia, dysarthria, proximal muscle weakness
1st line tx myasthenia gravis
pyridostigmine
hep c screening
ages 18-79
n patients without cystic fibrosis, what is the most common organism recovered in patients with bronchiectasis?
h.flu
CF –> pseudomonas
CURB-65
CONFUSION
UREA > 7
RR >30
SPB <90 mmhg / DBP < 60 mmhg
Age > 65 1
most common finding of polymyositis
proximal muscle weakness w/o pain
dx of DM
- sx of random plasma glucose > 200
- fasting glucose > 126
- plasma glucose > 200 after OGTT
- hbA1c > 6.5%
normal intraocular pressure
12-22 mmHg
types of scleroderma
diffuse & limited
MUDPILES
Methanol
Uremia
DKA
propyleme gycol
indications for subacute endocarditis prophy
- hx of bacterial endocarditis
- prosthetic valves
- exisiting heart defects
- heart transplant pt
empiric abx treat of native valve endocarditis
pcn (amp/sulbactam or oxacillin) + CTX + gentamicin
empiric abx in prosthetic valve endocaritis
vanc + gent + rifampin
empiric abx in fungal endocarditis
amphotericin B
MC valve in endocarditis
mitral valve
prostate zone pathology
transitional zone - BPH
peripheral - prostate ca
type 1 HIT vs type 2
hit = drop in plt by 50% while on heparin
type 1: plt recover w/ cessation of meds , occurs first few days
type 2: autoimmune, occurs ~14 days later
TOC for RMSF
doxycycline (even in children)
NYHA HF classifications
I: asx during daily activities
II: mild sx w/ reg activities
III: mod sx w/ minimal activity
IV: sx at rest, limitations w all activity
Tx of acute decompensated HF
L-lasix
M- morphine
N- nitroglycerine
O- oxygen (NIPPV)
P- position of body
(+) dobutamine for hypotension
findings on electrophoresis in b Thalassemia major
beta: high HbF
cause of individual w. complete absence of alpha globin
hydrops fetalis /still birth
standard of care for localized NSCLC
** this is MC type of lung cancer (adenocarcinom)
surgical resection
CSF findings in MS
(+) oligoclonal IgG bands
tx of pyelo
OP: cipro, levo, bactrim,
what size lung nodule should be worked up for malignancy
> 8 mm
pulmonary fx test in pt with restrictive lung dz
normal or increased FEV1/FVC
MCC of atypical pneumonia
Mycoplasma
Tx HAP
- pip/tazo + cefepime
if concern/(+) MRSA → linezolid, vancomycin
The regimen includes
1) piperacillin-tazobactam, cefepime, ceftazidime, meropenem, or imipenem, [pseudomonas cvg]
2) plus ciprofloxacin, levofloxacin, or aztreonam [pseudomonas cvg]
3) plus vancomycin or linezolid [MRSA cvg]
PJP in HIV
Aka PJP pneumonia → common in HIV pt with CD4 < 200
s/sx :fever, Pt will have a VERY LOW 02 saturation
Dx :
- CXR → diffuse interstitial pr bilateral perihilar infiltrates
Methenamine silver stain
Tx :
-Bactrim (pentamidine if allergy exists)
- O2 supplementation if Pa02 < 70
- Steroids if Pa02 < 70 mmHg
skin d/o in sarcoidosis
Erythema nodosum
prophy for pcp in pt w/ sulfa allergy
dapsone
V/Q in chronic bronchitis
emphysema: no V/Q mismatch
C.bronchitis: mismatched
DLCO in COPD
emphysema: LOW
CB: NORMAL
Tx of Aortic stenosis
aortic valve replacement w/ mechanical valve: pt > 50 who can take warfarin
aortic valve replacement w/ biprosthetic valve: pt > 70 who cant take anticoagulation
high intensity statins
atorvastatin 40-80 mg
rosuvastatin 20-40 mg
CAC score requiring statin therapy
> 100
LDL goal for pt w/ high risk of MI
< 70 mg/dL
MCC of aortic dissection
HTN
treatment of prinzmetal angina
CCB + Nitrates
MC valvular d/o in US
mitral regurgitation
bb that preserves LV function
carvedilol
1st line meds in HTN urgency/emergency
nifedipine
labetolol
gradually reduce BP by 10-20% first hour & then 5-15% over next 23 hours
s/sx psychogenic seizures
> 2 mins
eye closure
avoidance of painful objects
shouting
lack of tonic phase
asymmetric limb jerking
lack of postictal phase
normal EEG
NO headache
when does dressler syndrome appear in post-MI
weeks-months later
meds CI in R ventricular infarcts (RCA)
nitrates
diuretics
tx of Parkinsons Disease
levadopa-carbidopa
prophylaxis for migraines
BB
ACEi
CCB
ocular or generalized muscle weakness, bulbar weakness (dysarthria, dysphagia), ptosis and diplopia
myasthenia gravis sx
at what age can you administer pneumococcal vaccine
65 +
nutcracker syndrome
compression of L renal vein by aorta and SMA
diet to slow progression of CKD
restrict protein intake to 0.8 g/kg/day
tx of lupus nephritis
corticosteroids +
cyclophosphamide
polymyositis ab
anti-jo-1
c/b proximal symmetric muscle weakness
sjogrens increases risk of what maliganncy?
non-hodgkin lymphoma
hodgkin vs. nonhodgkin lymphoma sx
HL: b sx, painless cervical lymphadenopathy
NHL: painless disseminated lymphadenopathy
patho of G6PD
reduction in gluthione levels in red cells
dx of acromegaly
- obtain serum IGF-1 , if high –> OGGT w/ GH levels
- suppression of GH is Normal
- no suppresion of GH = acromegaly
- obtain pituitary adenoma
tx of dopamine agonist of choice for refractory acromegaly
cabergoline
Dx of AIDs
CD4 count < 200 or an opportunistic infx assoc w/ advanced HIV disease
LVH on ECG
deep S wave in V1 and a tall R wave in V5.
pcv vaccine
- All healthy individuals 65 years of age and older who have not previously received pneumococcal vaccination are recommended to receive either one dose of PCV20 only or one dose of PCV15 followed by one dose of PPSV23 at least 1 year later.
- unvaccinated patients under 65 years of age with underlying medical conditions such as chronic renal failure, malignancy, long-term steroid use, diabetes, alcohol use disorder, smoking, and chronic heart, lung, or liver conditions should be administered the same regimen as that for healthy individuals aged 65 years and older.
first line tx for primary ITP
corticosteroids
IVIG (2nd line)
mgmt pulm nodules
> 30 mm = surgical resection
6-30 mm (high risk)= resection
6-30 mm (low risk) = repeat imaging Q3 months
< 6 w/ benign hx = CT Q12 mo
** high risk = previous CA, smoking hx
how to tx pulm nodules
peripheral = percutaneous resection
central = transbronchial resection
fever, fatigue, pharyngitis, cervical lymohadenopathy + leukocytosis w/ atypical lymphs
c/f mono [EBV]
what can cause elevated serum ACE
Sarcoidosis
T2DM
