Medicine Flashcards
1
Q
St. John’s Wort
A
- As effective as TCA/SSRI for mild-mod depression maybe.
- Interacts w/ OCP, antifungs, ART, anticoagulants, immunosuppressive drugs.
- Can cause SS w/ SSRI.
2
Q
Sjogren’s
A
- Keratoconjunctivitis sicca (dry eyes)
- Xerostomia (dry mouth) can lead to candidiasis, cavities, and esophagitis.
3
Q
Fibromyalgia
A
- Focus on cognitive problems, fatigue, and somatic symptoms.
- Need to rule out anemia, inflammatory arthropathy, and hypothyroidism. Autoimmune workup has low yield.
4
Q
Complex Regional Pain Syndrome
A
- Occurs usually after injury w/ pain out of proportion, temp change, edema, and skin discoloration.
- Type 1 w/o definable nerve lesion, type 2 w/.
- Increased sensitivity to sympathetic nerves and allodynia.
- 3 stages, 1: burning pain, edema, vasomotor changes, 2 progression of edema, skin thickening, muscle wasting, 3 limited ROM and bone demineralization.
- Treatment w/ local symp nerve block.
5
Q
Acute otitis media in children risk factors
A
- Horizontal eustachian tubes (all children)
- Absence of breastfeeding
- Day care attendance
- Pacifier use
- Secondhand smoke
6
Q
Cig smoke effects on otitis media
A
Impairs clearance of fluids and microbes from eustachian tubes.
7
Q
Acute Pericarditis
A
- Viral, SLE, uremic, or post MI (peri-infarction = early, dressler = late).
- Pleuritic, worse with laying down chest pain.
- friction rub is highly specific
8
Q
Viral pericarditis treatment
A
Nsaids/colchicine
9
Q
Peri-infarction pericarditis treatment
A
high dose ASA
10
Q
Peri-infarction pericarditis
A
<4 days after MI.
-Delayed reperfusion increases risk
11
Q
Likelihood ratio
A
Can assess value of a diagnostic test independent of prevalence.
- Pos likelihood value of a positive test
- Neg likelihood value of a negative test.
12
Q
Negative likelihood ratio interpretation
A
Smaller the LR the less likely the disease is present.
13
Q
Cervical cancer risk factors
A
- HPV infection w/ high risk strains (16,18)
- H/o STI
- Early onset sexual activity
- High risk sex
- immunosuppression
- OCP use
- low socioeconomic status
- tobacco use
14
Q
HPV in Immunosuppressed
A
At risk for persistent HPV due to inability to clear the virus.
15
Q
Features of cervical cancer
A
- Irregular vaginal bleeding
- Friable, exophytic cervical mass.
- Postcoital bleeding, watery, mucoid discharge.
16
Q
Cervical Cancer in pregnancy
A
Punch biopsy is safe.
17
Q
Trichoroacetic acid
A
Indicated in the treatment of condyloma acuminata.
18
Q
Viral Gastroenteritis
A
- Fecal oral transmission
- Most common = norovirus, age <2 is rotavirus
- clinical diagnosis w/ emesis, watery diarrhea, +/- fever.
- Supportive treatment.
19
Q
What exacerbates viral gastroenteritis
A
fruit juice, sorbitol causes osmotic malabsorption.
20
Q
Hemophilia A
A
X linked, deficit in coag factor VIII
21
Q
Standarized incidence ratio
A
measure used to determine if the occurrence of cancer in a small population is high or low relative to an expected value derived from a larger comparison population.
-Observed #/expected #
22
Q
Calcium and vit D intake for women >50
A
1200 mg of Ca, 600-800 IU of vit D
23
Q
Dexa Screening
A
For women >65
-For women <65 w/ risk factors = weight under 127 pounds, steroid use, smoking, malabsorptive disorders, or hx of hip/low impact fracture.
24
Q
Capnography
A
-Most reliable way to verify proper ETT placement
25
Syphilis in HIV
- Higher risk of neurosyphilis
| - Requires LP w/ neuro symptoms esp if CD4 <350, RPR >1:128. VRDL of CSF.
26
False positive syphilis in HIV
Low titer <1:16 and w/ negative treponemal testing.
27
Syphilis treatment by stage
- Primary, secondary, early latent (<12 months) - 2.4 million U IM benzathine pen G.
- Late latent (>12 months), unknown - benzathine pen G 2.4 mil U x3.
28
Neurosyphilis treatment
-Aqueous pen G, 3-4 million U IV Q4 for 10-14 days
29
Alternative treatment for syphilis
- Tertiary syphilis in pt w/ anaphylactic pen allergy can have 2 weeks of ceftriaxone.
- Late latent syphilis or latent syphilis w/ anaphylactic allergy - doxy x28 days
30
Jarisch-Herxheimer reaction
acute febrile illness within 24 hours of starting treatment for spirochetal infection.
-No effective treatment, self limited w/in 48 hours.
31
Lead toxicity treatment
Mild 5-44 = no meds
- Mod 45-69 = DMSA, succimer
- Severe >70 = EDTA + dimercaprol
32
Repeat lead testing
Elevated capillary needs confirmation w/ venous sampling.
- Mild tox should have repeat venous level in 1 month.
- <5 should have repeat at 1 year if at risk.
33
Other tests needed for lead toxicity
- abdominal XR for lead containing objects in GI track.
| - XR long bones to look for lead lines if mod toxicity.
34
Acute epididymitis
- Age <35 STI
- Age >35 bladder outlet obstruction (coliform)
- Unilateral testicular pain, epididymal edema, pain improved w/ testi elevation, dysuria.
- NAAT for chlamydia/gonorrhea, UA/cx
35
IgA nephropathy
- Deposition of IgA in the renal glomerulus.
- Gross hematuria following URI. Flank pain.
- Dysmorphic RBCs w/ red cell casts.
- Bad prog = Males w/ HTN and >1 g 24 hour urine protein.
- Complement levels normal.
36
Acute postinfectious glomerulonephritis
Follows throat/skin infection w/ a gap of more than 10 days before onset of renal disease.
-Frank hematuria uncommon. Complement levels are decreased.
37
Subclinical hyperthyroidism
- Suppressed TSH, normal thyroid hormone levels, may or not have symptoms.
- Graves, exogenous thyroid hormone, nodular thyroid disease.
- TSH persistently <0.1, TSH 0.1-0.5 + age >65, heart disease, osteoporosis, nodular thyroid disease
38
Reversible causes of urinary incontinence in the elderly
- Delirium
- Infection
- Atrophic urethritis/vaginitis
- Pharmaceuticals
- Psychological
- Excessive urine output
- Restricted mobility
- Stool impaction
39
Drugs that cause urinary retention
- Alpha antagonists
- Anticholinergics
- opiates
- CCB
- diuretics
40
BPPV
- Triggered by head motion.
- Lasts only a minute or 2
- Clinical diagnosis
- First line is Epley maneuver
- Plugging of the canal is a surg for intractable symptoms.
41
Serotonin Syndrome
Combo of serotonergic drugs or MAOI/linezolid
- Mental status change, autonomic dysregulation, neuromuscular hyperactivity
- Treat w/ support, benzos, cyproheptadine.
42
NMS
- Reaction to dopamine antagonists. Similar to SS but no neuromuscular hyperactivity (hyperreflexia, clonus, tremor).
- Muscular rigidity, bradykinesia.
43
SSRI + MOAI
At least 14 day washout when switching, but fluoxetine needs 5 weeks due to long halflife.
44
Pulmonary HTN
- Gradually worsening DOE, fatigue, CP, palpitations, and syncope/near-syncope.
- Loud P2, JVD, ascites, peripheral edema, hepatomegaly.
- PAP >25 mmhg. PCWP <18 rules out Left HF as cause.
45
WHO PHTN Groups
- Group 1 - Pulmonary Artery HTN
- Group 2 - L sided heart disease
- Group 3 - Chronic lung disease (COPD/ILD)
- Group 4 - Chronic PEs
- Group 5 - other (sarcoidosis)
46
Treatment for PAH
Endothelin receptor antagonists (bosentan, ambrisentan
- phosphodiesterase-5 inhibitors (sildenafil, tadalafil.
- Prostacycline agonists (epoprostenol, etc)
47
Acute Rheumatic Fever
- Peak incidence 5-15 years old.
- Twice as common in girls.
- Major:Migratory arthritis, carditis, nodules, erythema marginatum, sydenham chorea.
- Minor:fever, arthralgias, elevated ESR, CRP, prolonged PR interval.
- Treat GAS pharyngitis w/ penicillin.
48
Sydenham Chorea
- Emotional lability, decline in school performance, distal hand movements that progress to facial grimmacing and feet jerking. Often have decreased strength and delayed relaxation phase of patellar relfex, also pronator drift.
- 1-8 months after streptococcal infection.
49
Comedonal acne
- closed or open comedones on forehead, nose, chin
- May progress to inflammatory pustules or nodules.
- Treatment: topical retinoids; salicylic, azelaic, or glycolic acid
50
Inflammatory acne
- Inflamed papules (<5 mm) & pustules, erythema.
| - Treatment for mild: topical retinoids + benzoyl peroxide. Mod: add topical antibiotics. Severe: add oral antibiotics
51
Nodular (cystic) acne
Large (>5 mm) nodules that can appear cystic
- Nodules may merge to form sinus tracts with possible scarring.
- Treatment for Mod: topical retinoid, benzoyl peroxide, and topical antibiotics.
- Severe add oral antibiotics.
- Unresponsive severe: oral isotretinoin.
52
Sensitivity analysis
Refers to repeating primary analysis calculations after modifying certain criteria or variable ranges. Goal is to see if this significantly affect the results.
53
Propensity scoring
Typically weighs different variables in both the treatment and control groups to ensure that these variables are balanced between groups.
-An individual can be matched to another w/ a similar propensity score.
54
Dupuytren Contracture
- Male, age >50, fam hx, DM, tobacco, Etoh.
- thickening of palmar fascia in 3rd, 4th, 5th digits w/ discrete nodules along flexor tendons near palmar crease.
- Treatment w/ steroid injection, padded gloves, needle aponeurotomy, or surgery.
55
Best question to screen for etoh abuse
How many times in the past year have you had 5 or more drinks in a day? (4 for a woman)
56
Newborn Bilirubin levels
- Physiologic due to liver immaturity, lack of intestinal bacteria, high hgb turnover.
- Unconjugated hyperbili can be due to high RBC turnover from cephalohematoma, <37 weeks gestation, breastfeeding, east asian, or sibling requiring phototherapy.
- Use normogram to guide phototherapy.
- Toxic levels are >20-25 = exchange transfusion.
57
Clinical manifestation of intestinal helminths
- Travel to areas w/ poor sanitation of water/sewage.
- Have transient pulmonary symptoms followed by long term gastrointestinal symptoms w/ peripheral eosinophilia and + fecal occult blood.
- Usually Ascaris lumbricoides, Trichuris trichiura, and Ancylostoma duodenale.
- Treat w/ albendazole.
58
Eosinophilic gastroenteritis
Inflammatory condition of the GI tract that is treated w/ prednisone. Very similar to intestinal helminth, but w/o travel.
59
Genetic Syndromes associated w/ pheochromocytoma
-MEN2, NF1, VHL
60
Drugs that can alter testing of Urine/plasma catecholamines and metanephrines
TCA, decongestants.
| -Stop 2 weeks prior to testing.
61
Imaging for Pheochromocytoma
- CT or MRI first
| - If negative but high suspicion = MIBG scan, octreotide scan, PET
62
Sporotrichosis
Fungal, Sporothrix schenckii.
- Decaying plant matter/soil.
- Subacute/chronic, skin papule w/ nonpurulent drainage from ulceration.
- Proximal lesions around lymphatic chain.
- Treat w/ 3-6 months of itraconazole.
63
AOM
- Diagnosis requires: Effusion in middle ear, tympanic membrane inflammation.
- 1st line amoxicillin, 2nd line augmentin, pen allergy - clinda or azithromycin.
- Concurrent otitis media and purulent conjunctivitis = nontypeable H flu
64
Opioid withdrawal
- Treat w/ opioid or alpha 2 agonist (clonidine)
- Symptoms: N/V/diarrhea, cramping, tachy, HTN, diaphoresis, insomnia, yawning, myalgias, lacrimation, rhinorrhea, mydriasis
65
Bowel obstruction
-SBO w/ air in colon should get conservative treatment
66
Sicca syndrome
characterized by xerostomia and keratoconjunctivitis. Consider workup for Sjogren w/ Ro and La antibodies, RF, and ANA.
-Labial salivary gland biopsy is gold standard for sjogrens
67
SLE effect on CAD
Accelerated atherosclerosis due to increased HTN, HLD, and chronic inflammation + steroids.
-50 fold increase in risk of CAD compared to nonSLE women in certain age groups.
68
Juvenile mycoclonic epilepsy
- Adolescents, absence seizures, morning myoclonus, generalized tonic clonic seizures.
- EEG w/ bilateral polyspike and slow wave acivity.
- Treat w/ valproic acid, avoid triggers like etoh and sleep deprivation.
69
Valproic acid side effects
Thrombocytopenia, hepatotoxicity, pancreatitis, possibly pancytopenia, and neural tube defects as a teratogen.
70
Statin therapy for secondary prevention
- ACS, stable angina, arterial revascularization, stroke, TIA, PAD.
- Age >75 - mod intensity status.
- Age <75 - high intensity statin
71
Statin therapy in primary prevention
LDL > 190 high intensity statin
- Age >40 w/ DM - ASCVD risk >20% high intensity, <20% risk is mod intensity
- Estimated 10 year ASCVD risk >7.5-10% mod to high intensity.
72
PAD treatment
Step 1A: smoking cessation, BP/DM control, statin and antiplatelet.
Step 1B: supervised exercise program
Step 2: Cilostazol
Step 3: revascularization for persistent symptoms.
73
RV Strain
-New RBBB, atrial arrhythmias, and Q waves or ST segment changes in the inferior leads.
74
Laryngeal edema
- Post extubation stridor and respiratory failure.
| - Occurs in 30%, 5% require reintubation.
75
Vulvodynia
Chronic >3 months, raw, burning vulvar pain that occurs in the absence of a specific disorder.
- Dyspareunia, constant irritation, inability to wear tight clothing due to pain.
- Positive qtip test (pain w/ light contact)
- Pelvic floor physiotherapy, CBT.
76
Polymyalgia Rheumatica
- Age >50, bilateral and morning stiffness >1 month.
- Involves 2 of: neck/torso, shoulders or proximal arms, proximal leg/hip, or constitutional (fever, malaise, weight loss)
- Decreased ROM in shoulders, neck, hips.
- ESR >40, elevated CRP, normocytic anemia possible. ~20% normal studies.
- Normal CPK!
- Treat w/ steroids
77
Statin induced myopathy
- Elevated CPK level and normal ESR.
| - Can cause mild myopathy w/ normal CPK.
78
Early localized Lyme disease
-Viral like illness, rash w/ central clearing.
79
Lyme disease bacteria and vector
Borrelia burgdorferi is the spirochete.
| -Ixodes scapularis tick.
80
Second line therapy for Lyme
- Doxy first line.
| - In pregnancy use amoxicillin or cefuroxime.
81
Intentino to treat
Compares interventino groups in a randomized trial by including all subjects as initially allocated after randomization, regardless of what happens during study.
- Prevents crossover effect, attrition.
- More conservative estimate of effect, but more likely for effect to be real if it shows it.
82
Per protocol analysis
- Only date from subjects that completed the intervention originally allocated at randomization are analyzed.
- Overestimates effect of the intervention.
83
As treated analysis
Subjects evaluated based on the intervention they received, not the one randomized to.
84
Stratified analysis
Is used to evaluate the presence of potential confounding and effect modification at the analysis stage of a study.
85
Stress incontinence
- Leaking w/ coughing, sneezing, laughing, lifting.
| - Lifestyle modification, kegels, pessary, urethral sling surgery.
86
Urge incontinence
- Sudden, overwhelming, or frequent need to urinate
| - Lifestyle modification, bladder training, antimuscarinic medications
87
Overflow incontinence
- Constant dribbling or urine, incomplete bladder emptying.
| - Intermittent cath, correct underyling etiology
88
Genitourinary syndrome of menopause
- Vulvovaginal atrophy can cause urinary symptoms, but...
| - Usual symptoms: dyspareunia, vulvar irritation, and pelvic organ prolapse.
89
Contraindications for breastfeeding
- Active untreated TB
- HIV infections where formula is available
- Herpetic breast lesions
- Active varicella infection
- Chemotherapy or radiation therapy
- Active substance abuse
- Infant: Galactosemia
90
Infants born to HIV+ mothers
Zidovudine for at least 6 weeks after birth.
91
Hyperkalemia side effects and causes
- GI disturbances: N/V
- EKG changes, asystole if severe.
- Can be related to renal insufficiency, crush injury, or severe burns.
92
Electrolyte abnormality with massive blood transfusion
- Hypocalcemia 2/2 large amounts of citrate used to anticoagulate blood.
- Citrate chelates calcium.
93
Hypocalcemia
- Can happen during or after surgery, especially w/ large transfusions.
- Can cause hyperactive deep tendon reflexes, muscle cramps, and rarely convulsions.
94
Peroneal Nerve injury
- Acute foot drop, weakness in foot dorsiflexion and eversion.
- Sensory loss over dorsum of foot and lateral shin (superficial peroneal nerve).
- Injury at knee or lateral aspect of the fibular head.
95
Obturator nerve injury
- Pain/weakness in leg adduction, and sensory loss over medial thigh.
- Usually 2/2 pelvic trauma or surgery.
96
Saphenous Nerve
Branch of the femoral nerve.
| -Innervates the medial calf and arch of the foot.
97
HIV Intrapartum
- Avoid artificial ROM, fetal scalp electrode, operative vaginal delivery
- viral load <1000, ART and vaginal delivery
- Viral load >1000, ART + zidovudine + csection.
98
Postmarketing Surveillance
Monitoring of the safety of medications or devices after they have been released to market. True safety profile of any medication is really understood only after the medication has been on the market and used by a large number of patients.
99
Absolute contraindications for combined hormanal OCPs
- Migraine w/ aura
- >15 cigs/day AND at least 35
- HTN >160/100
- Heart disease
- DM w/ end organ damage
- Hx of VTE
- APL syndrome
- Hx of stroke
- Breast cancer
- Cirrhosis and liver cancer
- Major surgery w/ prolonged immobilization.
- Use <3 weeks postpartum
100
Uncomplicated pediatric pneumonia
- Features: fever, tachypnea, cough, lung sounds.
- Preschool age OR focal lung findings: Mostly S. pneumo: High dose amoxicillin.
- Older child OR well appearing w/ bilateral lung findings: Mostly M. pneumoniae: Azithromycin
101
Physician payments from pharm companies
- Just attending conferences: cant accept anything.
| - Lecturer: accept reasonable honoraria/reimbursement for travel. Must disclose fully.
102
COPD and V/Q mismatch
- Primary driver of hypoxemia. During exacerbation w/ mucus plugging and bronchospasm causes multiple areas of localized low V/Q in the lung.
- Supplemental O2 still reaches these alveoli and improve Q by relieving hypoxic vasoconstriction.
103
Angioedema from ACEi
- Effect of increased bradykinin as well as cough.
| - Not associated w/ itching or urticaria. Usually self limited. ARBs should be safe according to UWorld.
104
Latent TB
Health care providers w/ TST atleast 10 mm or greater at 48 hours but w/ normal CXR and no symptoms.
- Not infectious!!
- Treatment w/ Isoniazid for 6-9 months, Isoniazid/rifapentine weekly for 3 months under obs (not in HIV), or rifampin for 4 months.
105
When to have 2 step TST
- People exposed to TB several years prior may have false negative test.
- Preemployment 2 step testing w/ second TST 1-3 weeks later. First test acts as booster.
106
Most common reason for wanting euthanasia
-Loss of autonomy and control
107
Noninvasive CAD testing
- If able to exercise = exercise stress test, EKG unless baseline abnormalities such as baseline ST depression.
- Unable to exercise = pharmacologic stress test.
108
Exercise stress testing high risk features.
- Poor exercise capacity, exertional angina at low workload, fall in systolic BP, chronotropic incompetence.
- EKG: >1 mm ST depression (flat or downsloping, ST depression at low workload, ST elevation in leads w/o Q waves, ventricular arrhythmias.
- SHOULD GET A CATH
109
Risk factors for colorectal cancer
- family hx
- polyposis syndromes (FAP)
- IBD
- African americans.
- obesity
- smoking (>30 years usually)
- etoh use (moderate use even 2-3 drinks/day) and higher w/ increased use.
110
NYHA Class I
No limits to physical activity
| -Consideration for ACEi/ARB
111
NYHA Class II
- Slight limitation w/ physical activity
| - Ordinary activity causes fatigue, palpitations, or dyspnea.
112
NYHA Class III
- Marked limitation w/ physical activity.
| - Less than ordinary activity causes fatigue, palpitations or dyspnea.
113
NYHA Class IV
- Unable to carry out any physical activity w/o symptoms.
- Can have symptoms at rest.
- Consider transplant vs ventricular assist device.
114
Treatment for HF.
-Def ACEi/ARB for all. Diuretics for fluid.
-BB if EF <40% once euvolemic.
Spironolactone for EF <35% w/ stable renal function and K.
-Consider BiDil if AA next.
-Digoxin if symptomatic despite all other therapy.
-Cardiac resynchronization therapy if QRS >150 msec
-End stage consider transplant vs ventricular assist device.
115
Urinary Schistosomiasis
- urinary symptoms, terminal hematuria, and peripheral eosinophilia.
- Parasitic blood fluke from subsaharan africa.
- Diagnose with urine sediment microscopy to look for eggs
- Treat w/ praziquantel
- Increased risk of bladder cancer.
116
Bladder cancer hematuria
-Painless hematuria throughout micturition
117
Wallenberg syndrome
- Lateral medullary infarction.
- Vestibulocerebellar symptoms: vertigo, falling to side of lesion, diplopia/nystagmus, ipsilateral limb ataxia.
- Loss of pain and temp to ipsilateral face and contralateral trunk/limbs.
- Ipsilateral bulbar weakness and Horner's syndrome, hiccups, lack of automatic respiration esp during sleep.
118
Medial mid pontine infarction
-Presents w/ contralateral ataxia and hemiparesis of the face, trunk, and limbs. Perhaps also contralateral tactile and position sense loss.
119
Medial medullary syndrome
- Due to a branch of vertebral or anterior spinal artery.
- Alternating hypoglossal hemiplegia.
- Contralateral paralysis of the arm and leg and tongue deviation toward the lesion and contralateral loss of tactile and position sense if infarct extends dorsally.
120
Onychomycosis
Risk: advanced age, tinea pedis, DM, PVD
- Thick, brittle, discolored nails.
- Diagnosis: KOH, periodic acid-Schiff stain, culture
- First line: terbinafine, itraconazole
- Second line: griseofulvin, fluconazole, ciclopirox.
- 6 weeks treatement for fingernails and 12 for toenails.
121
Renal Cell Carcinoma
- Smoking hx, erythrocytosis, hematuria should raise suspicion.
- Involves renal parenchyma or pelvis.
- Paraneoplastic epo production common.
- CT scan of abdomen.
122
Polycythemia vera
-JAK2 mutation, aquagenic pruritis, HTN, arterial or venous thrombus.
123
RCC diagnosis and treatment
- Enhancing mass w/ thickened, irregular septa on imaging.
| - Treat w/ nephrectomy
124
Simple kidney cyst
- Require no treatment
| - Smooth walled, round, sharply demarcate. Do not enhance w/ contrast.
125
Complex kidney cyst
- Require surveillance w/ imaging.
- More septations, calcifications than simple cysts.
- Do not enhance w/ contrast.
126
Polycystic kidney disease
- AD inheritance.
- Multiple, bilateral kidney cysts that are round, thin walled, nonenhancing, and sharply demarcated.
- Check for PKD mutation and treat w/ ACEi.
127
Hyponatremia w/ serum osmolality >290
- Marked hyperglycemia
| - Advanced renal failure
128
Hyponatremia w/ urine osmolality <100 and serum osmolality <290
-Primary polydipsia/beer potomania
129
Hyponatremia w/ Urine osmolality >100 and serum osmolality <290 and Urine Na <25
- Volume depletion
- CHF
- Cirrhosis
130
Hyponatremia w/ Urine osmolality >100 and serum osmolality <290 and Urine Na >25
- SIADH
- Adrenal insufficiency
- Hypothyroidism
131
Postpartum thyroiditis
An autoimmune disorder that is a variant of Hashimoto thyroiditis.
- Brief thyrotoxic phase, then self limited hypothyroid phase that will eventually return to euthyroid.
- Mild disease doesnt require treatment but moderate to severe = levothyroxine.
132
Sarcoidosis
- often w/ elevated Ca, ESR, and alk phos (if liver is involved). ACE level increased in ~75%.
- Rule out similar disease (TB) and biopsy that shows noncaseating granulomas.
- Excisional lymph node biopsy for confirmation if a peripheral node is present.
133
How can sarcoid present?
- Bilateral hilar adenopathy, interstitial infiltrates
- Erythema nodosum, skin lesions.
- Eye involvement
- Reticuloendothelial (lymph, spleen, liver)
- acute polyarthritis or chronic
- AV block, dilated or restrictive cardiomyopathy
- Facial nerve palsy, central DI, hypercalcemia
- Lofgren syndrome
134
Lofgren syndrome
- fever
- migratory polyarthralgia
- hilar adenopathy
- Erythema nodosum
135
Screening for sarcoid
- Chest XR to look for bilateral hilar or mediastinal lymphadenopathy
136
Facial nerve palsy causes
- CNS TB, usually w/ meningeal signs
- Imaging if tumor is suspected w/ nerve irritation.
- Lyme w/ flulike presentation in endemic area.
- HSV meningitis usually has fever and AMS.
137
Supracondylar fracture
- Children w/ fall onto outstretched arm w/ pain, swelling and limited ROM.
- XR w/ posterior fat pad (occult), fracture line, or displacement.
- If displaced, surgical reduction. If not displaced, long arm splint and sling.
- Can have neurovascular injury or compartment syndrome.
138
Differentiate traumatic tap from SAH?
-Xanthochromia is discoloration of centrifuged CSF due to hgb breakdown and is characteristic for SAH.
139
Traumatic lumbar puncture
- RBC count >6000 (w/o xanthochromia)
| - Glucose high, protein high, WBC high but not like bacterial.
140
HCTZ common side effect (skin)
- Photosensitivity reaction
| - Treat w/ sunscreen and avoiding sun
141
Postmenopausal sex issues
- Vaginal dryness and dyspareunia
| - SSRI and SNRI can improve vasomotor symptoms but may need low dose vaginal estrogens as well for vaginal atrophy.
142
Dopaminergic side effects with parkinsons
- Reduce the least potent medications first in the following order:
- anticholinergics
- amantadine
- MAO-B inhibitors
- COMT inhibitors
- dopamine agonists
- lastly carbidopa levodopa
143
Pimavanserin
-Serotonin 5HT-2A receptor inverse agonist can be used for psychotic symptoms in parkinson disease
144
Epiglottitis
- Most commonly H flu type B
- Distress (tripod position, stridor), dysphagia, dysphonia, drooling, high fever
- XR shows thumb sign
- Intubate and antibiotics
- Prevent w/ vaccination
145
Bacterial vaginosis
- Gardnerella vaginalis
- Thin, off white discharge w/ fishy odor. No inflammation.
- pH >4.5, clue cells, whiff test + (amine odor w/ KOH)
- Metronidazole or clinda
146
Trichomoniasis
- Trichomonas vaginalis
- Thin, yellow-green discharge. Vaginal inflammation
- pH >4.5, mobile trichonomads
- Treat w/ single 2 g dose of metronidazole for pt and partner. Stop breast feeding for 24 hours.
147
Candida vaginitis
- Candida albicans
- Thick, cottage cheese discharge. Vaginal inflammation.
- Normal pH 3.8-4.5, pseudohyphae
- Treat w/ single dose fluconazole, no need to stop breast feeding
148
Treatment for bacterial prostatitis
-6 weeks of cipro of bactrim
