Medicine #3 Flashcards
Diagnosis of viral myocarditis?
MRI with late enhancement of myocaridum
Gold standard: biopsy with lymphocytic infiltration and Viral DNA/RNA
most effective therapy for parkinsonism is? early side effects?
levodopa/carbidopa (dopamine precursor)
SE: hallucinations, HA, agitation.
Late SE: involuntary movements
how can you differentiate bronchogenic cyst from thymoma on cxray and CT scan?
bronchogenic cysts: middle mediastinum
Thymoma: anterior mediastinum
rupture of bridging veins?
subdural hematoma
multiple lesions at grey white matter junction in patient with afib
cardioembolic stroke
thunderclap headache and loss of consciousness?
subarachnoid hemorrhage
What things increase TBG?
Estrogens, acute hepatitis, tamoxifen
What things decrease TBG?
cushings, glucocorticoids, nephrotic, starvation, niacin, high dose androgens
Who do you treat with PPD induration >5?
HIV, recent contacts with TB, changes on x-ray consistent with TB, organ transplant recipients
Who do you treat with PPD > 10
Immigrants < 5 years, IV drug users, residents of high risk settings, diabetes, long term steroid therapy, renal disease, kids less than 4
Patients with + PPD and no signs of active TB on chest x-ray are treated for latent TB with?
isoniazid and pyridoxine
If an HIV patient has CD4 < 200 and has a negative PPD what should you do?
recheck PPD after starting antiretroviral therapy
pseudoallergic reaction to NSAIDs?
aspirin exacerbated respiratory disease (Not IgE mediated)
When are steroids given for PCP pneumonia?
pulse ox <92, PaO2 < 70, A-a gradient > 35
endemic mycosis in bat and bird droppings in caves?
histoplasmosis
hilar lymphadenopathy, tissue showing granulomas with narrow based budding yeast?
histoplasmosis
Unilateral infiltrate with ipsilateral hilar LAD with biopsy showing spherules and endospores.
coccidioidomycosis
measures to prevent urinary calcium stone formation?
increase fluids low sodium diet low protein diet moderate calcium intake less oxalate more citrate (fruits and veggies) hydrocholrathiazides alkalinize urine
hyposthenuria
inability of kidney to concentrate urine found in patients with sickle cell disease and sickle cell trait
radiolucent stones?
uric acid stones
needle shaped crystals on urinalysis indicate?
uric acid stones
Acute exacerbations of MS with disabling neuro symptoms are typically treated with? Patients refractory to that therapy?
IV methylprednisolone
Plasmapharesis
Leukemoid reaction vs chronic myeloid leukemia?
leukemoid is response to severe infection leuk > 50,000 with high alk phos and a lack of absolute basophils
LAP score?
high leukocyte alkaline phos: suggest leukemoid reaction
What do you give for ovulation induction in PCOS?
Clomiphene citrate
BRCA mutation testing is indicated for?
family history of ovarian cancer at any age or personal/fam history of breast cancer at age <50 in 1st degree relative
excessive collagen deposition in extracellular matrix around the alveoli?
IPF
granulomatosis with polyangitis (wegner’s)
upper and lower resp symptoms and glomerulonephritis
Patient with sinusitis, otitis, auditory canal ulceration, fatigue, anemia, microscopic hematuria
granulomatosis with polyangitis (wegeners)
what test should you order to confirm diagnosis of granulomatosis with polyangitis?
Proteinase 3-ANCA (c-ANCA)
Splenomegaly, Neutropenia, RA = what syndrome?
Felty syndrome
1st line therapy in conscious and stable patients with torsades de pointes?
IV magnesium
therapy for unstable patients with TdP?
defibrillation
sudden focal neuro deficits that gradually worsen over minutes to hours?
intraparenchymal brain hemorrhage
glomerulopathy aused by persistent activation of complement pathway?
membranoproliferative glomerulonephritis
Dense intramembranous deposits that stain for C3 is characteristic for?
membranoproliferative glomerulonephritis
compare/contrast HSV/VSV and CMV retinitis?
HSV/VSV: keratitis, conjunctivitis with eye pain followed by visual loss. widespread, pale, peripheral lesions and central necrosis of retina on opthal exam
CMV: painless, fluffy, granular retinal lesions (no conjunctivitis or keratitis)
most common cause of sudden cardiac arrest in immediate post-infarct period?
reentrant ventricular arrhythmias (vifib)
does a negative heterophile antibody test exclude mono?
no. often negative early in presentation
75-90% of kidney stones are made of?
calcium oxalate (envelope shaped)
Turkish, middle easter, asian decent with recurrent oral and genital ulcers have what syndrome?
Behcet (also uveitis, erythema nodosum, pathergy (exaggerated skin ulceration with minor trauma)
presentation of HA, nausea, vomiting, abdominal discomfort, confusion coma, pinkish red skin hue
carbon monoxide poisoning
obtain carboxyhemoglobin levels to diagnose
burning of rubber or plastic and bitter almond breath ?
cyanide poison
cyanosis and bluish discoloration of skin and membranes?
methemoglobinemia
Stroke with stuttering progression and period of improvement seen in patients with atherosclerosis
ischemic (thrombotic)
stroke onset is abrupt, usually maximal at the start, associated with afib, endocarditis, carotid bruit
ischemic (embolic)
focal neuro symptoms, followed by symptoms of ICP - hx of uncontrolled htn, coagulopathy drug use
intracerebral hemorrhage
severe HA acute. meningeal irritation (neck stiff), focal deficits, rupture of berry aneurysms
spontaneous subarachnoid hemorrhage
Alcohol use >10 years causes degeneration of?
purkinje cells of cerebellum leading to wide-based gait, incoordination of legs, impaired heal-knee-shin test
Painless jaundice in a patient with conjugated hyperbilirubinemia and markedly elevated alk phos should make you think of?
pancreatic or biliary cancer
most common form of parathyroid hormone independent hypercalcemia?
hypercalcemia of malignancy (caused by secretion of parathyroid hormone related protein by malignant cells)
how does chronic kidney disease lead to hypocalcemia?
decreased renal production of vitamin D, leading to hypocalemia, hyperphos and compensatory rise in PTH
A patient with hypercalcemia also has an elecated 1,25 dihydroxyvitamin D level? this should make you think of?
Sarcoidosis and lymphoma
bedside ice pack test (ice applied over eyelids for several mins leading to improvement in ptosis) helps support what diagnosis?
Myasthenia gravis
Why do you hear a single and soft second heart sound with aortic stenosis murmur?
Thickening and calcification of aortic leaflets leads to reduced mobility and causes a soft S2. second heart sound is also delayed so it syncs with pulmonic sound.
Acute liver failure is characterized by?
elevated LFTs, encephalopathy, elevated INR > 1.5
familial hypocalciuric hypercalcemia
benign AD disorder caused by mutation in calcium sensing receptor.. higher than normal levels of Ca are required to suppress PTH.
how to differentiate between primary PTH and or FHH?
Primary PTH have increased calcium excretion. Those with FHH have very low urinary calcium levels (<100/24hr).
Urine calcium/creatinine clearance = < .01 in FHH
and >.02 in primary HPTH
compare/contrast PMR to glucocorticoid induced myopathy
PMR: pain and stiffness in shoulder and pelvic girdle. tenderness with decreased ROM. elevated ESR (no weakness!)
Gluc induced: progressive prox muscle weakness and atrophy without pain (ESR, CK normal)
tick borne paralysis
rapidly progressive ascending paralysis (can be asymmetrical), absence of fever, no sensory changes, normal CSF. Ticks feed for 4-7 days to release toxin. Removing tic improves paralysis w/in sev days
classic appearance of glioblastoma multiforme on CT?
Butterfly
most common valve abnormality detected in patients with infective endocarditis?
mitral valve prolapse with mitral regurg
PAS-positive material in the lamina propria of the small intestine is a classic biopsy finding in?
Whipples disease
Whipple’s disease
arthralgias, weight loss, fever, diarrhea, abdominal pain
where do the ectopic foci for afib originate from?
pulmonary veins
aflutter reentrent circuit stes from the?
tricuspid annulus
bacillary angiomatosis
bartonella infection seen in patients with HIV with CD4 counts <100 (vascular cutaneous lesions)
treatment for bacillary angiomatosis
doxy, erythro, antiretroviral
keratoderma blennorhagicum associated with?
reactive arthritis
Why is sodium bicarb given in TCA overdose?
QRS interval > 100. (so drug stops inhibiting fast sodium channel in His-Purkinje)
increases serum pH and extracellular sodium, alleviating cardio-depressant action on sodium channels.
patients with nephrotic syndrome have increased risk for what disease?
atherosclerosis due to hyperlipidemia and AV thrombosis due to loss of antithrombin III
painless blurry vision, glares, halos around lights?
cataract
cupping of the optic disc with gradual loss of peripheral vision and consequent tunnel vision
open angle glaucoma
Induction and maintenance therapy for cryptococcal meningoencephalitis?
amphotericin B plus flucytosine (induction)
fluconazole (maintenance)
epidermal inclusion cyst
benign nodule containing squamous epithelium that produces keratin and has a small central punctum. can produce a cheesy white discharge.
benign fibroblast proliferation that appears as firm, hyperpigmented nodule most often on the lower extremities (dimpling in the center when area is pinched)
dermatofibroma
differentiate lipoma from epidermal cyst?
lipoma is soft and rubbery and irregular.
does a solitary liver nodule rule out metastatic disease?
no
protamine sulfate is used for?
urgent reversal of heparin
how to reverse bleeding exacerbated by warfarin?
IV vitamin K and prothrombin complex concentrate
Medications that cause esophagitis?
tetracyclines, aspirin, NSAIDs, alendronate, risedronate (bisphosphonates), potassium chloride, iron
Nonseminomatous germ cell tumors produce what biomarkers
AFP and Bhcg
what nephrotic syndrome is most commonly associated with renal vein thrombosis?
membranous glomerulopathy
most common form of glomerulopathy associated with HIV?
collapsing and focal segmental glomerulosclerosis “HIV related nephropathy” more common among blacks
Interstitial cystitis
painful bladder syndrome. idiopathic chronic condition worsened by filling and relieved by voiding. Dyspareunia, urinary frquency and urgency
most common cause of death in dialysis patients?
cardiovascular disease
most severe consequences of methanol intoxication?
vision loss. coma
methanol damages the eye. while ethylene glycol damages the…?
kidneys
necrolytic migratory erythema (what is it? what should it make you think of?)
Nec Mig Erythema: erythematous papules/plaques on face, perineum, extremities. lesions enlarge, coalesce over 7-14 days with central clearing and blistering and scaling at borders.
GLUCAGONOMA
glucagon levels > ____ clinch diagnosis of glucagonoma
500
high resolution CT scan is used to diagnose?
bronchiectasis
Patients suspected having pancreatic cancer who also have jaundice should have what imaging study done first? what about patients without jaundice?
US, CT
best markers of resolution of DKA?
Closing serum anion gap and decreased beta-hydroxybutarate
Treatment of amebic E. hystolytica Liver abscess
metronidazole
Should you drain an amebic E. hystolytica abscess? if so when?
Drain hydatid cyst due to echinococcus?
No- try to avoid. only drain if imminent rupture or mass effect.
Yes- u can drain hydatid cysts and treat with albendazole
malignant necrotizing otitis externa. what is it? caused by? commonly found in what patients? treat with?
severe infection of external auditory canal and skull base caused by pseudomonas. found in elderly patients with diabetes or immunosuppression.
Tx with ciprofloxacin
patient with intermittent foot drop likely has?
common fibular neuropathy
make diagnosis with electromyography and nerve studies
Treatment for severe hypercalcemia w/ Ca > 14?
Short-term (immediate)
Normal saline hydration plus calcitonin (inhibit osteoclast mediated bone resporption)
Long term: bisphospnenate (zoledronic acid)
Moderate Ca (12-14) treatment
not required unless symptomatic
Normal saline plus calcitonin if symptoms
most common cause of constrictive pericarditis in developing countries
tuberculosis
most common cause of epididymitis in ppl < 35?
sexually transmitted (chlamydia, gonorrhea)
Most common cause of epididymitis in ppl >35?
due to bladder outlet obstruction (coliform bacteria such as e. coli)
presentation and most common cause of vitreous hemorrhage?
sudden loss of vision and onset of floaters. most common cause is diabetic retinopathy. (important diagnostic clue is that fundus is hard to visualize)
Initial management for painless hard mass in testicle and suggestive ultrasound?
removal of testis and associated cord
Management for febrile neutropenia?
empiric antibiotic therapy with cefepime, meropenem, piperacillin-tazobactam
rapidly progressive thyroid enlargement with compression of surrounding structures in someone with hypothyroid disease is indicative of?
primary lymphoma of the thyroid
diffuse enlargement of thyroid around trachea (donut sign) suggeset what diagnosis?
lymphoma of thyroid
do negative blood cultures for N. gonorrhoeae rule out disseminated gonococcal infection?
NO
fever, polyarthralgia and pustular rash in someone with high risk sexual behavior?
Disseminated gonococcal infection
treatment for urge incontinence?
- bladder training
- pelvic floor muscle exercise
- antimuscarinic agents for nonresponderes to decrease detrusor activity (oxybutinin)
most common cause of vertigo?
BPPV
differentiate Menieres disease from BPPV
BPPV: very brief episodes of vertigo triggered by head movement
Meniere: vertigo can last 20 minutes (sensorineural hearing loss, tinnitus)
Vertigo in vestibular neuritis?
Acute single episode that can last days. follows virus. abnormal head thrust test
Epley maneuver?
canalith repositioning maneuver (can relieve symptoms for BPPV)
What should be avoided at all costs in patients with acute glaucoma?
mydriatic agents (atropine)
Treatment for acute glaucoma?
mannitol, acetazolamide, pilocarpine, timolol
Ist line treatment for acute episode of glaucoa?
IV mannitol
MOA for timolol in treating glaucoma?
decreases production of aqueous humor
MOA for pilocarpine in treating glaucoma?
opens canals of Schlemmm and allows drainage of aqueous humor
most common neoplasm to metastasize to the brain?
lung cancer
Multiple brain lesions can suggest metastasis from where?
Lung, malignant melanoma
solitary brain lesions can suggest mets from where?
breast, colon, RCC
Imaging modalities of choice for ureteral calculi?
ultrasound or non-con spiral CT
Diagnosis of PCP Pneumo can be done by?
ID of P jiroveci organisms in respiratory secretions from sputum sample or bronchoscopy with bronchoalveolar lavage
What is the only tinea not caused by dermatophytes?
tinea versicolor
Tinea versicolor is a fungal infection caused by?
Malassezia species
KOH prep of skin scraping showing large, blunt hyphae and thick walled budding yeast (spaghetti and meatballs)
tinea versicolor (malassezia)
Topical treatment for tinea versicolor?
selenium sulfide / ketoconazole / terbinagine
hypothyroid myopathy
myalgias, proximal muscle weakness, elevated CK often with additional features of hypothyroidism such as (fatigue, delayed reflexes)
treatment for solitary brain met vs multiple brain mets?
solitary: surgical resection
multiple brain mets: whole brain radiation
dendriform corneal ulcers and vesicular rash in trigeminal distribution
herpes zoster ophthalmicus
acute MR can be caused by?
MI and papillary muscle displacement
cutaneous larva migrans
creeping cutaneous eruption that comes from dog or cat hookworm larvae. found after walking barefoot in contaminated sand or soil.
Treatment for cutaneous larva migrans?
Ivermectin
chronic, anesthetic, hypopigmented lesions with peripheral nerve involvement
Leprosy
how to diagnose M. leprae
full thickness biopsy of skin lesion
How to treat leprosy?
dapsone and rifampin
primary anti-ischemic and antianginal effects of nitrates?
systemic vasodilation, including venodilation, reducing preload and LVEDV, reducing left wall stress and demand (also dilate arterioles reducing afterload but this has a smaller affect)
Increase or Decrease for following parameters in hypotensive shock? Preload/RA pressure: PCWP: Cardiac Index: SVR: MvO2:
Preload: down PCWP: down Cardiac index: down SVR: up MvO2: down
Increase or decrease in following parameters in cardiogenic shock? preload: PCWP: CI: SVR: MvO2:
Preload: increase PCWP: increase CI: low low SVR: increase MvO2: low
What might make hypokalemia very difficult to treat in a patient with chronic alcohol use history
hypomagnasemia (intracellular mag inhibits K secretion in collecting tubules)
symmetric duskiness and coolness of fingertips in a hypotensive patient receiving IV fluids and pressors suggests?
Noreepinephrine induced vasospasm
first line medical treatment for idiopathic intracranial htn?
acetazolamide +/- furosemide
fever, chills, left upper quadrant pain and splenomegaly is consistent with?
splenic abscess
infective endocarditis is associated with what other infectious process?
splenic abscess
treatment of splenic abscess
splenectomy for all patients (perc drainage if not great surgical candidates)
50% mortality rate with abx only
salvage therapy (definition)
treatment for a disease when standard therapy fails (radiation therapy for PSA recurrence after radical prostatectomy fails)
adjuvant vs neoadjuvant
adjuvant: treatment given in addition to standard therapy
neoadjuvant: treatment given before a standard therapy
A patient with sore throat, morning hoarseness, worsening cough at night, increased need for albuterol inhaler following meals has?
GERD
In patients with a new HPV diagnosis, what other screening should be offered
HIV
most common diseases causing liver mets
GI tract, lung, breast
Immediate action for patient in acute liver failure (PT >100, Serum Cr >3.4)
Liver transplant list
Graves disease
autoantibody to the TSH receptor.
Diffuse goiter, proptosis, periorbital edema
A high radioactive iodine uptake study suggests?
de novo hormone synthesis due to Grave’s disease (diffusely increased uptake)
Or toxic nodular disease (nodular uptake)
A low radioactive iodine uptake study suggests?
release of preformed thyroid hormone (thyroiditis) or exogenous thyroid hormone intake.
how do you differentiate between preformed thyroid (thyroiditis) and exogenous hormone intake as both show low radioactive iodine uptake?
Thyroglobulin level measurement.
Decreased thyroglobulin suggests exogenous thyroid supplementation
an elevated ratio of alpha subunit to TSH suggests?
pituitary adenoma
hypocalcemia and calcium oxalate deposition in kidneys should make you think of?
ethylene glycol poisoning
sodium thiosulfate is the antidote for?
cyanide poisoning
antidote for ethylene glycol poisoning?
fomepizole (a competitive inhibitor of alcohol dehydrogenase) (alcohol dehydrogenase metabolizes ethylene glycol to oxalic acid and glycolic acid)
Treatment for ethylene glycol poisoning
fomepizol or ethanol to inhibit alcohol dehydrogenase, sodium bicarb to correct acidosis, and hemodialysis
3 conditions that cause a profound anion gap metabolic acidosis bicarb <8?
DKA
lactic acidosis
ethylene glycol
Patients with CNS depression, disconjugate gaze, absent ciliary reflex, high osmolar gap, no increased anion gap, no metabolic acidosis
Isopropyl alcohol ingestion
common complication of the HIP in patients with Lupus who are on chronic steroid therapy?
Osteonecrosis (Avascular necrosis) (hip, groin, thigh, buttock pain worsened with activity
can be normal findings in the beginning but will often lead to reduced range of motion (internal rotation and abduction)
subchondral lucency (crescent sign) is a sign of?
osteonecrosis. avascular necrosis
Best test to diagnose avascular necrosis
MRI
First therapy to give in patient presenting with ACS?
Aspirin
Why is hypomagnesemia a cause of hypocalcemia?
hypomag causes decreased release of PTH and PTH resistance
graft vs host disease is caused by?
recognition of host major and minor HLA-antigens by the donor T cells and a cell mediated immune response affecting (skin, intestine, liver)
In an asplenic patient with sepsis what infections should you worry about?
Strep, Neisseria, H.flu as they require opsonization from splenic macrophages to destroy.
Without a spleen there is impaired antibody-facilitated phagocytosis
Impaired oxidative burst and recurrent bacterial or fungal infections due to catalase producing organisms (aspergilus, staph aureus)?
Chronic granulomatous disease
Recurrent skin and mucosal infections occur in what immunodeficiency
impared chemotaxis in leukocyte adhesion deficiency
Recurrent sinopulm, GI infections happen in what immunodeficiency?
Impaired B cell isotype switching
Splenomegaly, anemia, jaundice, reticulocytosis, fatigue suggests?
autoimmune hemolytic anemia
Treatment of warm AIHA?
high dose glucocorticoids (prednisone) to decrease autoantibody production
Etiology for warm agglutinin AIHA?
Drugs (penicillin), viral infections, autoimmune (SLE), Immunodeficiency, CLL
Diagnosis of AIHA?
Direct coombs positive with anti-IgG, anti-C3 or both
Etiology of cold agglutinin AIHA? and presentation
Mycoplasma pneumo, Mono, lymphoprolif disease.
Anemia, levido reticularis, acral cyanosis with cold exposure
Treatment for cold agglutinin AIHA?
avoid cold. rituximab, fludarabine
spinal cord compression characterized by upper or lower motor neuron dysfunction?
upper motor neuron dysfunction
Leuprolide MOA and is used for?
GnRH agonist. Treats endometriosis
Clomiphene citrate is used to treat?
infertility. used for ovulation induction (PCOS)
Differentiate SJS and TEN?
SJS: < 10% of body surface area
TEN: > 30% of body surface area
What conditions should you suspect in someone with hypokalemia, alkalosis and normotension?
surreptitious vomiting
diuretic abuse
bartter syndrome
Gitelman’s syndrome
Is G6PD activity a reliable test to diagnose the deficiency?
It can be used as a screening test but has significant reduced sensitivity during an acute hemolytic episode. Because most G6PD deficient erythrocytes are hemolyzed early in the episode and then reticulocytes with normal G6PD levels are circulating at high levels.
Nephropathy more common in A.A, hispanic patients, obese patients, heroin use, HIV?
FSGS
nephropathy associated with adenocarcinoma (breast, lung), NSAIDs, Hep B, SLE
membranous nephropathy
Nephropathy assocaited with Hep B, Hep C, lipodystrophy
membranoproliferative glomerulonephritis
nephropathy associated with NSAIDs, lymphoma (Hodgkin)?
minimal change disease
nephropathy assocaited with URI?
IgA (more commonly presents with hematuria-nephritis)
age of onset of ulcerative colitis?
bimodal distribution. 2nd peak between 50-80
Scleroderma renal crisis presents as?
acute renal failure without prev kidney disease. malignant htn (headache, blurry vision, nausea), proteinuria, thrombocytopenia, schistocytes
Patients with puncture wounds who have not received revaccination of tetanus in ____ years should receive vaccine
5
When should tetanus Ig be given?
Significant or dirty wounds or in ppl who have not previously received at last 3 doses of tetanus or whose vaccine status is unknown
classic triad of hemolytic anemia, jaundice, splenomegaly
hereditary spherocytosis
why elevated MCHC in HD?
membrane loss-> increased concentration
absent CD55 is MOA of hemolysis in?
paroxysmal nocturnal hemoglobinuria
define hypertensive urgency
servere htn >180/120 without symptoms or acute end organ damage
hypertensive emergency
severe htn with acute, life threatening, end organ complications
ECG finding for ventriular aneurysm
usually ST seg elevations resolve within a few weeks of MI. VAs present with persistent ST seg elevation after recent MI and deep Q waves in the same leads
test to order when stroke is suspected?
non con head CT
2 most common thyroid cancers?
- papillary thyroid cancer
2. follicular thyroid cancer
how do you differentiate follicular thyroid carcinoma from benign follicular adenoma?
carcinoma has invasion of tumor capsule with blood vessels
prolonged infusion of sodium nitroprusside at high rates can lead to?
cyanide toxicity
Drug of choice for treatment in primary biliary chlolangitis? why?
ursodeoxycholic acid (UDCA)
It delays histologic progression and can improve symptoms and survival
how can you differentiate alk phos from bone origin or biliary tract origin?
GGT levels
corrected calcium = ?
measured calcium + .8 X (4-albumin)
hypersensitivity pneumonitis
repeated inhalation of inciting antigen leading to alveolar inflammation
best treatment for hypersensitiviy pneumonitis
avoid the antigen trigger
What electrolyte abnormality is an independent predictor of adverse clinical outcomes in CHF patients?
Hyponatremia
major cause of delayed morbidity and mortality in subarachnoid hemorrhage?
Vasospasm (best be prevented with initiation of nimodipine)
what test is required to definitely exclude SAH?
LP
major cause of death within the first 24 hours of SAH?
rebleeding
hemolytic anemia, cytopenias, hypercoagulable states =?
paroxysmal nocturnal hemoglobinuria
Treatment for PNH
iron and folate supplements
Eculizumab
Atrial tachy with AV block is specific for toxicity with?
Digoxin
ludwig angina
rapidly progressive cellulitis of submandibular space arising from dental infections
side effects of isoniazid?
B6 deficiency and pyrimidal tract dysfunction.
Hepatitis!
Asymptomatic elevation of liver enzymes
presentation of food borne botulism
onset w/in 36 hours of cured fish, improper canned foods. blurred vision, diplopia, facial weakness, dysarthria, symmetric descending muscle weakness, diaphragmatic weakness
Treatment for food borne botulism?
Equine serum heptavalent botulinum antitoxin
effect modification
when an external variable positively or negatively impacts the effect of a risk factor on a disease of interest
how can you differentiate effect modification from confounding variable?
perform stratified analysis centered on the variable of interest
Prophylaxis for patients who travel to malaria endemic countries?
Mefloquine (due to high chloroquine resistance)
Treatment of patients with SIADH and mild symptoms:
Treatment of patients with SIADH and severe symptoms:
mild: fluid restrict
severe: hypertonic saline
how to diagnose metabolic syndrome?
- waist circumference>40 in men, >35 in Women
- fasting glucose >100-110
- BP >130/80
- Triglycerides > 150
- HDL: men <40, women <50
Haemophilus ducreyi
gram negative rod- causes STI chancroid primarily in developing countries. Lymphadenitis is common. painful, red base, well demarcated borders, purulent exudate.
** Buzz: trade sex for drugs and money
Treatment for H. ducreyi
azithromycin
Diagnosis of IIH involves?
ocular exam, neuroimaging, (MRI, magnetic resonance venography) and LP. CSF fluid will be normal with the exception of an elevated opening pressure
untreated hyerthyroid patients are at greatest risk for?
rapid bone loss from increases osteoclastic activity and cardiac tachyarrhythmias
Giemsa stain of blood showing intraerythrocytic parasites?
malaria
Foodborne illnesses where enterotoxin is ingested?
Bacillus cereus
Staph aureus
Enterotoxin is made in the intestine
C. perfringens
ETEC
Vibrio cholera
Bacterial epithelial invasion
C. jejuni
Nontyphoidal salmonella
listeria
polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions
disseminated gonococcal
Unilateral foot drop can be caused by?
L5 radiculopathy
Compression peroneal neuropathy
Triptans, NSAIDS, Acetaminophen, Antiemetics (metoclopramide prochlorperazine), Ergots are all abortive meds for?
Migraine therapy
Topiramate, TCAs, beta-blockers are all preventatitve therapy for?
migraines
Antimicrobial prophylaxis for lyme disease is not required if the tick is attached for < ____ hours
36
5 prophylaxis criteria for lyme disease
- attached tick is an adult ixodes scapularis
- tick attached for >36 hours or engorged
- prophylaxis started within 72 hours of tick removal
- local borrelia burgdorferi infection rate > 20%
- no contraindications to doxy (<8, preg, lactating)
severe headache, bilateral periorbital edema, cranial nerve III, IV, V, VI deficits should make you think of?
cavernous sinus thrombosis
causes of normal anion gap metabolic acidosis
diarrhea
fistulas (pancreatic, ileocutaneous)
carbonic anhydrase ihibitor
RTAs
hyperkalemic or type 4 RTA is commonly seen in what patients?
elderly diabetic patients
due to damage to the juxtaglomerular apparatus causing a state of hyporeninemic hypoaldosteronism
Thrombolytic therapy (IV alteplase) improves neuro outcomes in patients with ischemic stroke when given within ____ hours of symptom onset
4.5
