Knowledge Plus Pearls Flashcards
Statins and LFT elevation
up to 3XN- continue
Stop if 5x or symptoms
Bell’s Palsy from PERIPHERAL lesion
upper AND lower face
Secondary Prevention of Stroke
- statin
- evidence for Plavix is weak
Atherogenic Dyslipidemia
obesity or insulin resistance
low HDL, high TGs
Glycemic Control in Criticially Ill ICU Patients
IV insulin preferred
goal 140-180
Inconclusive ABI testing next steps
borderline: after exercise
>1.4: toe-brachial index
Treatment of stable angina
ASA and one of the following:
BB
CCB
long acting nitrate
Organisms associated with post influenza bacterial pneumonia
strep pneumo
staph aureus
Ectopic Hormones associated with small cell lung cancer
ACTH (Cushings)
ADH (SIADH)
Hypercalcemia of Malignancy Treatment
Hydration IV bisphosphonate (pamidronate)
Leser-Trelat Sign
diffuse seborrheic keratoses
Acanthosis Nigricans in adults
association with gastric cancer
Left sided varicoceles
can be renal cell carcinoma
due to left testicular vein draining into left renal vein
Warning signs for varicoceles
does not diminish in size when supine
Giant Cell Arteritis can be associated with..
vertebrobasilar strokes/symptoms
polymyalgia rheumatic symptoms
Medications that cause gout/hyperuricemia
loops/thiazides
niacin
aspirin
RA- other features besides arthritis
flexor tendonpathy
bilateral carpel tunnel
Eczema distributions
extensor in children
flexor in all age groups
Acute MI + decompensated HF, avoid…
BB, CCB
Clue Cells
BV
Bacteria on epithelial cells
Fracture risk requiring bisphosphante therapy
10 year risk of 20% or more
Calcium supplementation
1200mg / day - dietary +/- supplementation
Excessive associated with kidney stones and CV events
Vitamin D Supplementation Recommendations
600IU
Synthroid- do not take with
calcium, iron
impairs ingestion
Secondary HyperPTH
low/normalCa
Elevated PTH
Hematological AE of Vancomycin
thrombocytopenia 2/2 vanc dependent platelet-reactive antibodies
Chronic Cause of Mild Leukocytosis
cigarette smoking
Proteus- specific properties
makes urine more alkaline and prone to nephrolithiasis
Treatment of ITP in adults
corticosteroids first line
Trousseau Syndrome
chronic DIC in cancer patients
superficial venous thrombophlebitis
Upper lobe emphysema in young adult, minimal tobacco use
idiopathic giant bullae emphysema
Smoking Cessation Therapy
Dual therapy (gum+patch)
Bupropion
Varenicline
How to treat transfusion associated circulatory overload
administer blood slowly
Symptoms of massive PE
systolic BP <90
poor tissue perfusion
Gastroenteritis timeline
w/in 24 hours- S aureus, Bacillus
24-48 hours- norovirus
Duration/Perferred anticoagulation in cancer patients w/ acute PE or DVT
indefinitely
LMWH > warfarin
Watery Diarrhea in elderly individuals, think
microscopic colitis
associations w/ ASA, PPI, ranitidine, SSri use, statins
Porphyria Cutanea Tarda
frequently acquired- alcohol, hep C
blistering skin lesions
elevated LFTs
Treatment of Porphyria Cutanea Tarda
phlebotomy
antiphospholipid syndrome - pulmonary complications
chronic thromboembolic pulmonary disease –> pulmonary HTN
Pulmonary Artery Hypertension- Exam/Labs
reduced diffusion capacity
prominent second heart sounds
Double Pseudomonal Coverage for PNA
pts with structural lung disease (like bronchiectasis, CF)
hypotension in intubated COPD pt
Autopeep
inadequate expiratory time –> hyperinflation –> increases intrinsic peep
Disconnect pt from ventilator
Cause of Tracheomalacia in adults
prolonged intubation
What to consider as cause of unexplained hyperlipidemia
hypothyroidism
Treatment of hirsuitism in PCOS
spirolactone
bisphosphonates
alendronate - oral
zoledronic acid - IV
Female Athlete Triad and Management
low energy (low BMI)
amenorrhea
BMD abnormalities —-> order DEXA
How to Diagnosis PSC (testing)
MRCP (may not be able to diagnose from U/S and safer than ERCP initially)
Population for HCC screening
pts w/ cirrhosis Male HBV Carriers of Asian descent >40y Female HBV > 50 y HBV carrier w/ family hx of HCC North American Blacks/African w/ HBV infection
HCC screening
twice yearly abdominal U/S
Why do we not use ACEI + ARB
more likely to reduce proteinuria BUT worse clinical outcomes
Oral Iron in CKD
transferrin sat less than 30% or ferritin less than 500
Surgical Intervention for thoracic aortic aneurysms
greater than 5.5 cm OR more than 0.5cm in one year
Duration of dual platelet therapy after stent
do not d/c for at least 1 mo after bare
6 months after drug eluting
Malignant HTN- optic/optho exam
optic disc swelling
Cr elevation after ACEI or ARB
renovascular HTN
How to Prevent Contrast Injury in CKD patients
infusion of NS continuing several hours after
lower osmotic contrast agents
AIN triad
fever, rash, eosinophilia
Number for post-residual void that is abnormal
more than 100 mL
PIGN and complement
low C3
low-normal C4
BPH treatment- first line
alpha blockers –> tamulosin
reduce smooth muscle
Proteinuria defined as
more than 150mg/day a
analgesic nephropathy classic CT findings
papillary calcifications
Nephrotic range proteinuria
more than 3.5g protein
Test for Mastocytosis
elevated tryptase level
Mastocytosis clinical features
urticarial pigmentosa, darier’s sign
anaphylaxis
Budd-Chiari, what it is and most common cause
hepatic venous outflow obstruction
often due to myeloproliferative neoplasms with polycythemia vera being most common
DVT prophylaxis for ortho surgeries
during hospitalizations and 6 weeks after when immobile
Benign Ethnic Neutropenia
neutropenia w/o symptoms
due to Duffy antigen receptor gene
protection against malaria
Cause of subacute meningoencephalitis with raised ICP
cryptococcous
immunosuppressed- steroids, DM, HIV
Antibiotic coverage for S pneumonia meningitis
Vanc due to ceftriaxone resistant strains
Steroids improve course
Candiduria treatment if asymptomatic
replace f/c
repeat UA
Symptomatic Candicuria w/ catheter placement or immunosuppression
renal US or abd CT
