Lessons 2 Flashcards
Candida albicans
Topical azoles (vaginitis); nystatin, fluconazole, caspofungin (oral/esophageal); fluconazole, caspofungin, amphotericin B (systemic)
Cryptococcus neoformans
Induction with amphotericin B and flucytosine, maintenance with fluconazole (in AIDS patients
Sporothrix schenckii
Itraconazole, oral potassium iodide
Pneumocystis jirovecii
TMP-SMX (prophylaxis and treatment in immunosuppressed patients, CD4 < 200/mm3)
Toxoplasma gondii
Sulfadiazine + pyrimethamine
Malaria
Chloroquine, mefloquine, atovaquone/proguanil (for blood schizont), primaquine (for liver hypnozoite)
Trichomonas vaginalis
Metronidazole (patient and partner)
Streptococcus pyogenes
Penicillin prophylaxis
Streptococcus pneumoniae
Penicillin/cephalosporin (systemic infection, pneumonia), vancomycin (meningitis)
Staphylococcus aureus
MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal penicillins); MRSA: vancomycin, daptomycin, linezolid, ceftaroline
Enterococci
Vancomycin, aminopenicillins/cephalosporins
Rickettsia rickettsii
Doxycycline, chloramphenicol
Clostridium difficile
Oral metronidazole; if refractory, oral vancomycin
Mycobacterium tuberculosis
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
UTI prophylaxis
TMP-SMX
Influenza
Oseltamivir, zanamivir
CMV
Ganciclovir, foscarnet, cidofovir
Patent ductus arteriosus
Close with indomethacin; keep open with PGE analogs
Stable angina
Sublingual nitroglycerin
Buerger disease
Smoking cessation
Kawasaki disease
IVIG, aspirin
Temporal arteritis
High-dose steroids
Granulomatosis with polyangiitis (Wegener)
Cyclophosphamide, corticosteroids
Hypercholesterolemia
Statin (first-line)
Hypertriglyceridemia
Fibrate
Arrhythmia in damaged cardiac tissue
Class IB antiarrhythmic (lidocaine, mexiletine)
Prolactinoma
Cabergoline/bromocriptine (dopamine agonists)
Diabetes insipidus
Desmopressin (central); hydrochlorothiazide, indomethacin, amiloride (nephrogenic)
SIADH
Fluid restriction, IV hypertonic saline, conivaptan/ 338 tolvaptan, demeclocycline
Diabetic ketoacidosis
Fluids, insulin, K+
Diabetes mellitus type 1
Dietary intervention (low carbohydrate) + insulin 347 replacement
Diabetes mellitus type 2
Dietary intervention, oral hypoglycemics, and insulin (if refractory)
Pheochromocytoma
α-antagonists (eg, phenoxybenzamine)
Carcinoid syndrome
Octreotide
Crohn disease
Corticosteroids, infliximab, azathioprine
Ulcerative colitis
5-ASA preparations (eg, mesalamine), 6-mercaptopurine, infliximab, colectomy
Sickle cell disease
Hydroxyurea (fetal hemoglobin increased)
Chronic myelogenous leukemia
Imatinib
Acute promyelocytic leukemia (M3)
All-trans retinoic acid, arsenic trioxide
Drug of choice for anticoagulation in pregnancy or renal failure
Low-molecular-weight heparin
Heparin reversal
Protamine sulfate
Immediate anticoagulation
Heparin
Long-term anticoagulation
Warfarin, dabigatran, rivaroxaban and apixaban
Warfarin reversal
Fresh frozen plasma (acute), vitamin K (non-acute)
Cyclophosphamide-induced hemorrhagic cystitis
Mesna
HER2/neu ⊕ breast cancer
Trastuzumab
Osteoporosis
Calcium/vitamin D supplementation (prophylaxis); 462 bisphosphonates, PTH analogs, SERMs, calcitonin,
denosumab (treatment)
Osteomalacia/rickets
Vitamin D supplementation
Chronic gout
Xanthine oxidase inhibitors (eg, allopurinol, febuxostat); pegloticase; probenecid
Acute gout attack
NSAIDs, colchicine, glucocorticoids
Neural tube defect prevention
Prenatal folic acid
Migraine
Abortive therapies (eg, sumatriptan, NSAIDs); prophylaxis eg, propranolol, topiramate, CCBs, amitriptyline)
Multiple sclerosis
Disease-modifying therapies (eg, β-interferon, natalizumab); for acute flares, use IV steroids
Tonic-clonic seizures
Levetiracetam, phenytoin, valproate, carbamazepine
Absence seizures
Ethosuximide
Trigeminal neuralgia (tic douloureux)
Carbamazepine
Malignant hyperthermia
Dantrolene
Anorexia
Nutrition, psychotherapy, SSRIs
Bulimia nervosa
SSRIs
Alcoholism
Disulfiram, acamprosate, naltrexone, supportive care
ADHD
Methylphenidate, amphetamines, CBT, atomoxetine, guanfacine, clonidine
Alcohol withdrawal
Long-acting benzodiazepines
Bipolar disorder
Mood stabilizers (eg, lithium, valproic acid, carbamazepine), atypical antipsychotics
Depression
SSRIs (first-line)
Generalized anxiety disorder
SSRIs, SNRIs (first line); buspirone (second line)
Schizophrenia (positive symptoms)
Typical and atypical antipsychotics
Schizophrenia (negative symptoms)
Atypical antipsychotics
Hyperaldosteronism
Spironolactone
Benign prostatic hyperplasia
α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors
Infertility
Leuprolide, GnRH (pulsatile), clomiphene
Breast cancer in postmenopausal woman
Aromatase inhibitor (anastrozole)
ER ⊕ breast cancer
ER ⊕ breast cancer
Tamoxifen
Prostate adenocarcinoma/uterine fibroids
Leuprolide, GnRH (continuous)
Medical abortion
Mifepristone
Prostate adenocarcinoma
Flutamide
Erectile dysfunction
Sildenafil, tadalafil, vardenafil
Pulmonary arterial hypertension (idiopathic)
Sildenafil, bosentan, epoprostenol
Mitochondrial inheritance
Disease occurs in both males and females, inherited through females only
Intellectual disability
Down syndrome, fragile X syndrome
Vitamin deficiency (USA)
Folate (pregnant women are at high risk; body stores only 3- to 4-month supply; prevents neural tube defects)
Lysosomal storage disease
Gaucher disease
Bacterial meningitis (adults and elderly)
S pneumoniae
Bacterial meningitis (newborns and kids)
Group B streptococcus/E coli/Listeria monocytogenes (newborns), S pneumoniae/N meningitidis (kids/teen
HLA-DR3
Diabetes mellitus type 1, SLE, Graves disease, Hashimoto thyroiditis (also associated with HLA-DR5), Addison disease
HLA-DR4
Diabetes mellitus type 1, rheumatoid arthritis, Addison disease
Bacteria associated with gastritis, peptic ulcer disease, and gastric malignancies (eg, adenocarcinoma, MALToma)
H pylori
Opportunistic infection in AIDS
Pneumocystis jirovecii pneumonia
Helminth infection (US)
Enterobius vermicularis
Viral encephalitis affecting temporal lobe
HSV-1
Infection 2° to blood transfusion
Hepatitis C
Food poisoning (exotoxin mediated)
S aureus, B cereus
Osteomyelitis
S aureus (most common overall)
Osteomyelitis in sickle cell disease
Salmonella
Osteomyelitis with IV drug use
Pseudomonas, Candida, S aureus
UTI
E coli, Staphylococcus saprophyticus (young women)
Sexually transmitted disease
C trachomatis (usually coinfected with N gonorrhoeae)
Nosocomial pneumonia
S aureus, Pseudomonas, other enteric gram ⊝ rods
Pelvic inflammatory disease
C trachomatis, N gonorrhoeae
Infections in chronic granulomatous disease
S aureus, E coli, Aspergillus (catalase ⊕)
Metastases to bone
Prostate, breast > kidney, thyroid, lung
Metastases to brain
Lung > breast > melanoma, colon, kidney
Metastases to liver
Colon»_space; stomach > pancreas
S3 heart sound
ventricular filling pressure (eg, mitral regurgitation, HF), common in dilated ventricles
S4 heart sound
Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy
Constrictive pericarditis
TB (developing world); idiopathic, viral illness (developed world)
Holosystolic murmur
VSD, tricuspid regurgitation, mitral regurgitation
Ejection click
Aortic stenosis
Mitral valve stenosis
Rheumatic heart disease
Opening snap
Mitral stenosis
Heart murmur, congenital
Mitral valve prolapse
Chronic arrhythmia
Atrial fibrillation (associated with high risk of emboli)
Cyanosis (early; less common)
Tetralogy of Fallot, transposition of great vessels, truncus 298 arteriosus, total anomalous pulmonary venous return,
tricuspid atresia
Late cyanotic shunt (uncorrected left to right becomes right to left)
Eisenmenger syndrome (caused by ASD, VSD, PDA; results in pulmonary hypertension/polycythemia)
Congenital cardiac anomaly
VSD
Hypertension, 2°
Renal artery stenosis, chronic kidney disease (eg, 300 polycystic kidney disease, diabetic nephropathy),
hyperaldosteronism
Aortic aneurysm, thoracic
Marfan syndrome (idiopathic cystic medial degeneration)
Aortic aneurysm, abdominal
Atherosclerosis, smoking is major risk factor
Aortic aneurysm, ascending or arch
3° syphilis (syphilitic aortitis), vasa vasorum destruction
Sites of atherosclerosis
Abdominal aorta > coronary artery > popliteal artery > carotid artery
Aortic dissection
Hypertension
Right heart failure due to a pulmonary cause
Cor pulmonale
Heart valve in bacterial endocarditis
Mitral > aortic (rheumatic fever), tricuspid (IV drug abuse)
Endocarditis presentation associated with bacterium
S aureus (acute, IVDA, tricuspid valve), viridans streptococci (subacute, dental procedure), S bovis (colon
cancer), culture negative (Coxiella, Bartonella, HACEK)
Temporal arteritis
Risk of ipsilateral blindness due to occlusion of ophthalmic artery; polymyalgia rheumatica
Recurrent inflammation/thrombosis of small/medium
Buerger disease (strongly associated with tobacco) vessels in extremities
Cardiac 1° tumor (kids)
Rhabdomyoma, often seen in tuberous sclerosis
Cardiac tumor (adults)
Metastasis, myxoma (90% in left atrium; “ball valve”)
Congenital adrenal hyperplasia, hypotension
21-hydroxylase deficiency
Hypopituitarism
Pituitary adenoma (usually benign tumor)
Cretinism
Iodine deficit/congenital hypothyroidism
Thyroid cancer
Papillary carcinoma (childhood irradiation)
Hypoparathyroidism
Accidental excision during thyroidectomy
1° hyperparathyroidism
Adenomas, hyperplasia, carcinoma
2° hyperparathyroidism
Hypocalcemia of chronic kidney disease
Cushing syndrome
Iatrogenic (from corticosteroid therapy) 348 Adrenocortical adenoma (secretes excess cortisol)
ACTH-secreting pituitary adenoma (Cushing disease) Paraneoplastic (due to ACTH secretion by tumors)
1° hyperaldosteronism
Adrenal hyperplasia or adenoma
Tumor of the adrenal medulla (kids)
Neuroblastoma (malignant)
Tumor of the adrenal medulla (adults)
Pheochromocytoma (usually benign)
Refractory peptic ulcers and high gastrin levels
Zollinger-Ellison syndrome (gastrinoma of duodenum or 351, pancreas), associated with MEN1
Esophageal cancer
Squamous cell carcinoma (worldwide); adenocarcinoma (US)
Acute gastric ulcer associated with CNS injury
Cushing ulcer (intracranial pressure stimulates vagal gastric H+ secretion)
Acute gastric ulcer associated with severe burns
Curling ulcer (greatly reduced plasma volume results in 379 sloughing of gastric mucosa)
Bilateral ovarian metastases from gastric carcinoma
Krukenberg tumor (mucin-secreting signet ring cells)
Chronic atrophic gastritis (autoimmune)
Predisposition to gastric carcinoma (can also cause pernicious anemia)
Gastric cancer
Adenocarcinoma
Alternating areas of transmural inflammation and normalcolon
Skip lesions (Crohn disease)
Site of diverticula
Sigmoid colon
Diverticulum in pharynx
Zenker diverticulum (diagnosed by barium swallow)
Hepatocellular carcinoma
Cirrhotic liver (associated with hepatitis B and C, alcoholism, and hemochromatosis)
Liver disease
Alcoholic cirrhosis
1° liver cancer
Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, α1-antitrypsin deficiency, Wilson
disease)
Congenital conjugated hyperbilirubinemia (black liver)
Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile)
Hereditary harmless jaundice
Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia)
Hemochromatosis
Multiple blood transfusions or hereditary HFE mutation (can result in heart failure, “bronze diabetes,” andrisk
of hepatocellular carcinoma)
Pancreatitis (acute)
Gallstones, alcohol
Pancreatitis (chronic)
Alcohol (adults), cystic fibrosis (kids)
Microcytic anemia
Iron deficiency
Autosplenectomy (fibrosis and shrinkage)
Sickle cell disease (hemoglobin S)
Bleeding disorder with GpIb deficiency
Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor)
Hereditary bleeding disorder
von Willebrand disease
DIC
Severe sepsis, obstetric complications, cancer, burns,trauma, major surgery, acute pancreatitis, APL
Malignancy associated with noninfectious fever
Hodgkin lymphoma
Type of Hodgkin lymphoma
Nodular sclerosis (vs mixed cellularity, lymphocytic predominance, lymphocytic depletion)
t(14;18)
Follicular lymphomas (BCL-2 activation, anti-apoptotic oncogene)
t(8;14)
Burkitt lymphoma (c-myc fusion, transcription factor oncogene)
Type of non-Hodgkin lymphoma
Diffuse large B-cell lymphoma
1 degree bone tumor (adults)
Multiple myeloma
Age ranges for patient with ALL/CLL/AML/CML
ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: 432, adult 45–85
Malignancy (kids)
Leukemia, brain tumors
Death in CML
Blast crisis
t(9;22)
Philadelphia chromosome, CML (BCR-ABL oncogene, 434 tyrosine kinase activation), more rarely associated with
ALL
Vertebral compression fracture
Osteoporosis (type I: postmenopausal woman; type II: elderly man or woman)
HLA-B27
Psoriatic arthritis, ankylosing spondylitis, IBD-associated arthritis, reactive arthritis (formerly Reiter syndrome)
Death in SLE
Lupus nephropathy
Tumor of infancy
Strawberry hemangioma (grows rapidly and regresses spontaneously by childhood)
Actinic (solar) keratosis
Precursor to squamous cell carcinoma
Cerebellar tonsillar herniation
Chiari I malformation
Atrophy of the mammillary bodies
Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)
Epidural hematoma
Rupture of middle meningeal artery (trauma; lentiform shaped)
Subdural hematoma
Rupture of bridging veins (crescent shaped)
Dementia
Alzheimer disease, multiple infarcts (vascular dementia)
Demyelinating disease in young women
Multiple sclerosis
Brain tumor (adults)
Supratentorial: metastasis, astrocytoma (including glioblastoma multiforme), meningioma, schwannoma
Pituitary tumor
Prolactinoma, somatotropic adenoma
Brain tumor (kids)
Infratentorial: medulloblastoma (cerebellum) or supratentorial: craniopharyngioma
Mixed (UMN and LMN) motor neuron disease
Amyotrophic lateral sclerosis
Degeneration of dorsal column fibers
Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal,
spinocerebellar tracts affected)
Nephrotic syndrome (adults)
Membranous nephropathy
Nephrotic syndrome (kids)
Minimal change disease
Glomerulonephritis (adults)
Berger disease (IgA nephropathy)
Kidney stones
Calcium = radiopaque 598 Struvite (ammonium) = radiopaque (formed by urease
⊕ organisms such as Klebsiella, Proteus species, and
S saprophyticus)
Uric acid = radiolucent
Cystine = faintly radiopaque
Renal tumor
Renal cell carcinoma: associated with von Hippel-Lindau and cigarette smoking; paraneoplastic syndromes (EPO,
renin, PTHrP, ACTH)
Obstruction of male urinary tract
BPH
1° amenorrhea
Turner syndrome (45,XO or 45,XO/46,XX mosaic)
Neuron migration failure
Kallmann syndrome (hypogonadotropic hypogonadism and anosmia)
Clear cell adenocarcinoma of the vagina
DES exposure in utero
Ovarian tumor (benign, bilateral)
Serous cystadenoma
Ovarian tumor (malignant)
Serous cystadenocarcinoma
Tumor in women
Leiomyoma (estrogen dependent, not precancerous)
Gynecologic malignancy
Endometrial carcinoma (most common in US); cervical carcinoma (most common worldwide)
Breast mass
Fibrocystic change, carcinoma (in postmenopausal women)
Breast tumor (benign, young woman)
Fibroadenoma
Breast cancer
Testicular tumor
Seminoma (malignant, radiosensitive),placental ALP
Pulmonary hypertension
Idiopathic, heritable, left heart disease (eg, HF), lung disease (eg, COPD), hypoxemic vasoconstriction (eg, OSA), thromboembolic (eg, PE)
Hypercoagulability, endothelial damage, blood stasis
Virchow triad (high risk of thrombosis)
SIADH
Small cell carcinoma of the lung
Amiloride
K+-sparing diuretic
Amiodarone
Class III antiarrhythmic
Amlodipine
Dihydropyridine Ca2+ channel blocker
Benztropine
Cholinergic antagonist
Bromocriptine
Dopamine agonist
Buspirone
Generalized anxiety disorder (5-HT1A-receptor agonist)
Bupropion
Depression, smoking cessation (NE-DA reuptake inhibitor)
Cimetidine
H2-receptor antagonist
Cetirizine 2nd-generation antihistamine
Chloramphenicol
Antibiotic (blocks 50S subunit)
Chlordiazepoxide
Long-acting benzodiazepine
Chlorpromazine
Typical antipsychotic
Chlorpropamide
1st-generation sulfonylurea
Chlorpheniramine
1st-generation antihistamine
Chlorthalidone
Thiazide diuretic
Clozapine
5-HT2A-agonist
Clomipramine
Tricyclic antidepressant
Clomiphene
Selective estrogen receptor modulator
Clonidine
α2-agonist
Doxepin
Tricyclic antidepressant
Doxazosin
α1-antagonist
Eplerenone
K+-sparing diuretic
Propafenone
Class IC antiarrhythmic
Fluoxetine
Selective serotonin reuptake inhibitor
Fluphenazine
Typical antipsychotic
Duloxetine
Serotonin-norepinephrine reuptake inhibitor
Guaifenesin
Expectorant (thins respiratory secretions)
Guanfacine
α2-agonist
Mifepristone
Progesterone receptor antagonist
Misoprostol
PGE1 synthetic analog
Naloxone
Opioid receptor antagonist (treats toxicity)
Naltrexone
Opioid receptor antagonist (prevents relapse)
Nitroprusside
Hypertensive emergency (cGMP/NO)increase
Nitroglycerin
Antianginal (cGMP/NO)high
Omeprazole
Proton pump inhibitor
Ketoconazole
Antifungal (inhibits fungal sterol synthesis)
Aripiprazole
Atypical antipsychotic
Anastrozole
Aromatase inhibitor
Rifaximin
Hepatic encephalopathy (ammoniagenic bacteria)
Rifampin
Antimicrobial (inhibits DNA-dependent RNA polymerase)
Sertraline
Selective serotonin reuptake inhibitor
Selegiline
MAO-B inhibitor
Trazodone
Insomnia (blocks 5-HT2, α1-adrenergic, and H1 receptors)
Tramadol
Chronic pain (weak opioid agonist)
Varenicline
Smoking cessation (nicotinic ACh receptor partial agonist)
Venlafaxin
Serotonin-norepinephrine reuptake inhibito