Medicine Part II Flashcards
Leukomoid reaction
high fever, infectious diarrhea, with increased metamyelocytes (late neutrophil precursors and high leukocyte alkaline phosphatase
Thrombocytopenia with thrombus progression 3 days into heparin therapy?
Type 2 herarin-induced thrombocytopenia
Acral lentiginous melanoma
Unevenly darkly pigmented patch mostly arises on the palmar, plantar, or subungual surfaces
Cytochemical features of hairy cell leukemia?
Tartrate-resistant acid phosphotase (TRAP)
cells iwth convoluted nuclei and highly vacuolated cytoplasm?
infectious Mononucleosis (EBV)
How to manage HIT?
Stop heparin and start non-heparin anticoagulation (fondaparinux or argatroban)
Physicial manifestations of Hemophilia A & B?
delayed/prolonged bleeding after mild trauma
Hemarthrosis, hemophilic arthropathy
Intramuscular hematomas
Gastrointestinal or genitourinary tract bleeding
How do you treat polycythemia vera?
Aspirin and phlebotomy
Auer Rods Cancer?
Acute Myeloid Leukemia
thrombocytopenia and microangiopathic hemolyutic anemia
Thrombotic microangiopathy
Pain, itching, red streaks on an arm that presented in a different location preciously?
Next step?
Migratory superficial thrombophlebitis (Trousseau’s syndrome)
CT of the abdomen due to association with pancreatic cancer
What drug is used to treat hairy cell leukemia? Side effects?
Cladribine; neurological and kidney damage
Ruby-colored papules on lips that blanch partially with pressure?
Arteriovenous shunting (Osler-Weber-Syndrome)
Gilbert Syndrome
Indirect hyperbilirubinemia, with normal hemoglobin and otherwise normal liver tests in an asymptomatic patient
How to you manage a patient who does not smoke ad had a small (less than 4mm) nodule on CT?
No follow-up imaging
Transfusion-related acute lung injury
Fever, dyspnea, diffuse pulmonary infiltrates and hypocia
What is the most common complication of HIT?
Additional venous thrombosis
What is the role of heptoglobin?
Binds free hemoglobin and promotes its excretion by the reticuloendothelial system
Facial Rash and symmetric oligoarthritis are highly suggestive of?
Systemic Lupus Erythematosus
How to manage a patient with a blood smear showing platelet clumping?
Repeat platelet count
Osteolytic lesions, fractures, hypercalcemia, anemia
Multiple myeloma
Inheritance pattern of Hemophilia?
X-linked recessive
MoA of HIT?
IgG autoantibody that coats the surface of platelets and forms complexes with platelet factor 4 (PF4)
Without a clear provoking factors, what procedures should be conducted?
Age-appropriate cancer screening and CXR
What vitamin deficiency is associated with pernicious anemia?
B12, megaloblastic anemia
Laboratory findings for lead poisoning
microcytic anemia,, basophilic stippling, high lead levels
G6PD deficiency laboratory signs?
Low hemoglobin, increased indirect hemoglobin, increased indirect bilirubin, increased lactate dehydrogenase, decreased haptoglobin
Heredity hemochromoctoma- risk factors?
Hepatocellular carcinoma
What factor contributes to Warfarin necrosis?
Protein C (primary) and S deficiency
Charcot Triad
Pain, fever, jaundice
How do you treat single nodule colorectal mets?
Regional hepatectomy
How to do treat BPH?
5-alpha reductase inhibitor
How are leukomoid reactions caused by severe infections?
Mobilization of mature and immature leukocytes from bone marrow
BRBPR and pain with defectation?
Anal Fissure
When do you see Auer rods? How does it present?
Acute myeloid leukemia
Presents with pancytopenia (bleeding or infection) and myeloblasts would be expected
Microscopic colitis?
chonic watery diarrhea without bleeding
Treatment for Ulcerative Colitis?
Mesalamine (left-sided only), sulfasalazine, balsalazine, olsalazaine
When do sideroblasts form?
When iron is available, but is unable to be incorporated into hemoglobin
IBS - Symptoms and Treatment
Recurrent abdominal pain or discomfort; marked change in bowel habit for at least 6 months, with syumptoms experience at least 3 days a month for 3 months.
Must have 2 of the following:
- Pain relived by a bowel movement
- Onset of pain in related to a change in frequency of stool
- Onser ot pain is related to a change in the appearance of stool
Tx- reassurance and high-fiber diet
What should you screen for in patients with hepatitis B?
Hepatocellular carcinoma
Signs of autoimmune hemolytic anemia?
Spherocytes and positive direct antiglobulin test
Biological role of vitamin B12?
Formation of thmidylate and purine molecules for DNA
First step in screening for thalassemia anemia?
Complete blood count
Isolated thrombocytopenia without anemia or leukopenia?
Idiopathic thrombocytopenia purpura
Chronic myeloid leukemia laboratory findings?
leukocyte alkaline phosphotase = low
high number of myelocytes to melamyelocytes
Presence of absolute basophilia
What should all patients diagnosed with ITP be tested for?
HIV
Target for treatment o
Side effect of phenytoin?
Treatment?
Mild megaloblastic anemia caused by reduction in folic acid levels
Tx- folic acid supplementation
Physical sign of acute cholecystitis?
Pain in the right upper abdominal area, positive Murphey’s sign
Lentigo Maligna?
Slow growing melanoma seen on the sun-exposed areas of the face
Signs of an epidural spinal cord compression?
lower extremity motor weakness, hyperreflexia, and bladder dysfunction
Signs of polycythemia vera?
Increased hemoglobin, increase leukocytes, increased platelets
What cancer has retinoic acid receptor present?
Acute promyelocytic leukemia, presents with pancytopenia
How to manage pain in terminal cancer patients?
- Try non-narcotics first (short-acting morphine is first)
- Do not be afraid to give narcotics
- Prescribe adequate amounts of medication
Brownish skin pigment? Disease?
Bronze diabetes, hereditary hemochromatosis
Hemophilia laboratory findings?
Prolonged aPPT, decreased or absent Factor VIII or IX activity
Mutations that causes primary polycythemia vera?
Jak2 mutation
Hard unilateral head and neck lymph nodes in an older patient with smoking history?
Squamous cell carcinoma
Acute treatment for PE or DVT with subtheraputic INR on warfarin?
Rivaroxaban
Management for epidural spinal cord compression?
Emergent MRI, Intravenous glucocorticoids, radiation-oncology and neurosurgy consultation
How to treat chemotherapy-induced nausea and vomiting?
Serotonin receptor antagonist (5HT)
Facial plethora with normal oxygen saturations and low EPO?
Polycythemia Vera
What anticoagulant can lead to low levels of Protein C and S?
Warfarin
Signs of lead poisoning?
Abdominal pain, constipation, fatique, irritability insomnia, neuropathies, neuropsychiatric disturbances and nephropathy, HTN
How to treat a patient with stage III colon cancer s/p hemicolectomy?
Adhyvant chemotherapy
What is the first step in managing iron deficiency?
Determining the cause (Fecal occult blood)
How does multiple myeloma cause infections? Most common types?
Impairs normal lymphocyte populations -> ineffective antibody production and hypogammaglobulinemia
Respiratory (streptococcal pneumonia) and UTI
How to you treat prostate cancer?
Androgen deprivation therapy
Signs of vitamin D toxicity?
vomiting, confusion, polyuria, polydipsia
Salvage therapy?
treatment for a disease when standard treatment fails
Leukoreduction
reducing the number of transgused leukocytes through filtering or other methods (washing). Reduces changes of HLA allommunization and transmission of CMV
Blood transfusion reaction that occurs between 1 and 6 hours?
How to prevent?
Febrile non-hemolytic transfusion
Leukoreduction
Multiple miscarraiges and DVTs with SLE?
Antiphospholipid syndrome
Monoclonal gammopathy of unknown significance
Presence of serum monoclonal protein of less than3g/L without evidence of anemia, kidney failure, bone disease, or other myeloma-related and end-organ damage
Neoadjuvant therapy?
Treatment given before the standard therapy
How long can it take a person with inadequate dietary intake, intestinal malabsorption, or hepatocellular disease to become vitamin K deficient?
7-10 days
What is leukocyte alkaline phosphatase?
An active enzyme found within mature blood cells
How to treat acute cholecystitis?
ERCP
Monorrhagia is common in which bleeding disorder?
Willebrand disease
Drop in platelets in 5-10 days puts a patient at risk for?
Arterial thrombosis
Bite cells with normal G6PD?
Glucose-6-phosphate dehydrogenase deficiency
Acute radiation proctitis-cause, diagnostic method
Patient who receive pelvic radiation exposure and develop diarrhea.
Diagnosis is done via flexible sigmoidoscopy
Look for mucosal telangiectasia and submucosal fibrosis and arteriole endarteritis
Lab findings in multiple myeloma?
Hypercalcemia and anemia, excessive production of a single monocloncal protein
Expansile and eccentrically places lytic area in the epiphysis of the distal femur?
Giant cell tumor, “Soap bubble” appearance
Renal findings in multiple myeloma?
Bland with granular casts; nephritic disease
What cancer contains reed sternberg cells?
Hodgkin’s lymphoma
How do you treat antiphospholipid syndrome?
Indefinately continue warfarin
Bleeding episodes and severe isolated thrombocytopenia with normal hematocrit and leukocyte count with normal fibrinogen and PT?
Immune thrombocytopenia (idiopathic thrombocytopenic purpura
Causes of macrocytic anemia?
Folate deficiency
B12 deficiency
Myelodysplastic syndrome
Acute myeloid leukemias
Drug induced (chemotherapy agents)
Liver Dx
Alcohol abuse
Hypothyroidism
How to manage blood products in a patient who has experiences prior anaphylatic reactions?
Wash samples
How to manage a patient with a PAP result of atypical squamous cells of undetermined significance?
Refer to colposcopy
a-thalassemia trait characteristics
mild anemia, microcytosis, hypochromia, target cells, and normal hemoglobin electrophoresis in adults
Elderly patient with severe lumphocytosis (>40000) lymphadenopathy, and bicytopenia suggests?
Chronic lymphocytic leukemia
How to treat diffuse large B-cell NHL?
Abbreviated course of chemotherapy followed by radiation
Most common drugs assoicated with dyspepsia? Alternative tx?
NSAIDS, Initiate PPI is unable to stop NSAIDS
How do you treat cancer-related anorexia/cachexia syndrome?
Progesterone analogs *megestrol acetate)
How often should a PAP smear be done in a woman who had a hysterectomy for non-malignant reasons?
Discontinue pap smears
Waldenstrom macroglobulinemia
production of monoclonal IgM antibodies
hymphadenopathy and hepatosplenomegaly may be present
How to diagnose CLL?
Flow cytometry of peripheral blood
Facial plethora and high hemoglobin?
Tx?
Polycythemia Vera
Phlebotomy, may add hydroxyuria in cases with high risk of thrombosis
Management of a patient with a new onset breast nodule that was negative on mammorgram?
Aspiration or Biospsy
When is the best time to initiate evaluation of thrombophilia?
2-4 weeks following completion of wargarin therapy
Stops false positives and false negatives
Foul-smelling diarrhea, weight loss, fatigue
Steatorrhea and malabsorption
Effect of malabsorption on calcium levels
Inhibits absorption of Vit. D -> low calcium, low phosphate
First step in the evaluation of a thyroid nodule > 1cm?
TSH levels and U/S
Effects of hypopituitarism?
glucocorticoid deficiency, hypogonadism, hypothyroidism
Features of glucogonoma?
Necrolytic migratory erythema- face, perineum, extremities
DM
GI- diarrhea, anorexia
Weight loss
Signs of glucogonoma?
Hyperflycemia with elevated glucagon > 500pg/mL
Painless thyroiditis
acute thryotoxicosis with mild thyroid gland enlargement and suppressed TSH
What DM medications cause weight loos?
GLP-1 agonists (exenatide)
What DM medications are weight neutral?
DDP-4 inhibitors (sitagliptin)
Treatment for diabetic neuropathy in young patients?
Older?
Young- amitriptyline
Old: Pregabalin
Signs of thyroid storm?
Palpitations, weight loss, irregular menses, impaired glycemic control, confusion, agitation, n/v
After confirming a normal TSH, what is the next step in working up suspected Cushings?
24 hour free urine cortisol, salicary cortisol, or low-dose decamethasone suppression
2 must be abnormal
Carcinoid tumors put you at risk for deficiency of what?
Niacin (diarrhea, dermatitis, dementia)
Patient with malignant throid mass, elevated serum calcitonin, and family hx of thyroid malignancy likely has an inherited form of?
MEN2a or 2b
Ret mutation
Milk-alkali syndrome
Overconsumption of calcium and absorbable alkali -> hypercalcemia -> renal vasoconstriction and decreased GFR
Workup for hypocalcemia?
Recheck-> drug-> PTH-> 25-hydrocy vitamin D levels
Signs of generalized resistance to thyroid hormones?
Normal TSH and high T3 and T4 with signs of hypothyroidism
Subclinical hypothyroidism
Mildly elevated serum TSH and normal T3 and T4
Do not have clinical signs
Signs of hypercortisolism?
Weight gain, psychiatric symptoms, HTN, hyperglycemia
oligomenorrhea, hirutism, elevated testosterone levels?
Tx?
Polycystic ovarian syndrome
Tx: Weight loss and oral estrogen/progestin contraceptives
Side-effect of radioiodine ablation?
Worsening of opthalmopahty
Role of large and small fibers in DM?
Large- numbness, proprioception, vibration
Smal- pain, paresthesias, allodynia
How does pregnancy affect thyroid levels?
Causes a 30% increase in the first trimester
How to you manage an adrenal incidentoma?
Overnight dexamethasone suppression test, 24-hour urine collection for metanephrines, measurement of plasma renin activity and serum aldosterone levels
Galactorrhea and signs of secondary amenorrhea, next step?
Obain prolactin levels
In a young patient with suspected DM, what should be the first step in management?
Check for pancreatic autoantibodies to rule in/out DM type 1
In a younger patient presenting with osteoporosis, what should be the first step in workup?
Find an underlying cause.
fatigue, weight gain, erectile dysfunction and hyponatremia suggest?
panhypopituitarism
How to treat pituitary apoplexy?
Neurosurgery consult and glucocorticosteroids
hypernatremia with hypokalemia with htn? Diagnostic test?
Hyperaldosteronism, aldosterone to plasma renin
How to diagnose cushing’s disease?
24-hour urine cortisol measurments
If a patient is taking steroids and gets sick, what should happen?
Increase dose of hydrocortisone during the intercurrent illnesses to avoid adrenal crisis
Calcium pyrophosphate dihydrate disease?
Presents like OA, but with atypical joints (hands)
Treatment for fibromyalgia with or without depression?
Serotonin-norepinephrine reuptake inhibtors (duloxetine, milnacipran
Presentation of OA of the hand?
Squaring of the first carpometacarpal joint (base of thumb) and DIP and PIP
How to treat a patient with SLE and suspected lupus nephritis?
High-dose steroids
Back pain in an individual with Chron’s disease?
Enteropathic arthritis
Henoch-schonlein purpura
purpuric rash predominately affecting distal lower extremities, artritis, abdominal pain, hematuria
skin biopsies reveal leukocytoclastic vasculitis
pain along the anteromedial proximal tibia distal to the joint like that worsens walking up stairs and at night
Pes anserine bursitis
Still disease
daily (quotidian fever) evanescent salmon-colored rash, arthritis, multisystem involvement, markedly elevated ferritin
Treatment for RA?
Methotrexate
In RA refractory to Methotrexate, what is next?
Add monoclonal antibody, etanercept
Inelastic pericardium - AKA? Signs? Risk?
AKA- restrictive pericarditis
Signs-increased JVP, peripheral edema, ascites, hepatic congestion with hepatomegaly
Risk- late complication of radiation therapy
dyspnea, third heart sound, bibasilar crackles, low ejection fraction?
decompensated congestive heart failure due to LV systolic dysfunction
Alcoholic cardiomyopathy
Dilated cardiomyopathy in an alcoholic, when everything else has been rules out
Reversible risk factors for premature atrial contracitons?
Alcohol and tobacco, caffeine, stress
Premature atrial contractions-treatment?
Cessation of alcohol, tobacco, caffeine, stress, initiation of beta-blockers (if symptomatic)
Ludwig angina
Rapidly progresive cellulitis of the submandibular and sublingual spaces
Ceftriaxome with azithromycin- treatment?
Community acquired pneumonia
vanomycin with piperacillin-tazobactam-treatment?
Hospital-acquired pneumonia
Low-pitched, early diastolic heart sound, think?
Heart failure (third heart sound)
dypnea, hypoxemia, diffuse pulmonary crackles with third heart sound?
decompensated heart failure
Treatment for severe heart failure associated with severe left ventricular systolic dysfunction and cardiogenic shock? MoA?
Dobutamine, beta-1 receptor
MoA- increased myocardial contractilit -> greater colume of forward blood efection -> decreased left ventricular end-systolic volume
holosystolic murmur that increases with inspiration?
Tricuspid involvement
Systemic murmur that increases when the patient stands up?
hypertrophic cardiomyopathy
Mechanical complications post MI?
RC failure- acute
Papillary muscle rupture- Acute, 3-5 days
Interventricular septum rupture/defect- Acute, 3-5 days
Free wall rupture- 5 days to 2 weeks
How to calculate attributed risk percent?
ARP= (RR-1)/RR
Signs of cardiogenic shock?
Hypotension, reduced urine outpout, cool extremities
Classic finding: Beck triad-hypotension, elevated jugular venous pressure, distant heart sounds
hypoxia vasoconstriction in the lung
vessels shrink and divert blood to maintain V and Q matching
Intrapulmonary shunting
shunting of blood away from blocked alveolar consolidation and shunts it to other areas -> can cause V and Q mismatch
Continuous murmur throughout thorax with high blood pressure and headaches? Imaging?
Coarctation of the aorta
X-ray findings- inferior notching of the third to eighth rib, “3” sign due to aortic indentation
ECG: Left ventricular hypertrophy
Echo: diagnostic confirmation
Upturning of the cardiac apex- AKA, cause?
boot-shaped heart, caused by Tetralogy of Fallot, d/t pulmonic stenosis
Commonly associated SLE rashes
Malar rash, discoid plaques, ulcers
What causes drug induced acne? What do they look like? Management?
Glucocorticoids, androgens, azathioprine, EGFR inhibitors, anticonvulsants, antituberculosis
Description, monomorphic papules or pustules, no comedones, cysts, nodules
Management: D/C offending medication, standard acne therapy unlikely to be effective
What populations have a 5mm PPD/TST induration limit?
HIV-positive, recent contacts of known TB, nodular fibrotic changes of CXR consistent with previously healed tb, organ transplant recipients, and other immunosuppressed patients
Treatment for latent tb?
Isoniaxid and pyriodoxine
Drug-resistent HTN, and a midabdominal bruit?
Rebal artery stenosis
Highly specific finding in renal artery stenosis?
syustolic-diastolic abdominal bruit
What drugs can lithium interact with to cause toxicity?
ibuprofen, NSAIDS, thiazide diuretics, ACE-I, tetracyclines, metronidazole -> decrease renal clearance of lithium
Back pain with increased ESR/CRP, but normal X-rays, next step?
MRI, bone scanning using gallium (if MRI contraindicated)
MoA of beta blockers?
reducing cardiac oxygen deman through a decrease in heart rate and myocardial contractility
Treatment regimine for stable angina?
Beta blockers, aspirin, sublingual nitroglycerine
Signs of Alcoholic cerebellar degeneration?
Trucal coordination impairment (tandem gait), wide-based gait, postural instability, with intact limb coordination (finger-nose test)
Signs of hypokalemia?
Muscle weakness, arrhythmias, EKG changes
Chikungunya fever? Vector?
High fevers, polyarthralgias, maculopapular rash, lymphop[enia, thrombocytopenia
Vector: Ades mosquito
Cyclosporine side effects:
Nephrotoxicity- hyperkalemia, hypophosphatemia, hypomagnesemia
HTN: renal vasoconstriction and sodium retension
Neurotoxicity: headache, visual disturbances, seizures
Glucose intolerace
Dermatofibroma
benign fibroblast proliferation
firm, hyperpgmented nodule, most often on lower extremties
epidermal inclusion cyst? Diagnosis?
Discrete benign nodule lined with dquamous epithelium, that containes semisolid core of keratin and lipid.
Diagnosis: clinical with a firm, freely movable, dome-shaped cyst iwth central punctum
Cor pulmonale? X-ray findings? Diagnosis?
exertion symptoms over time, loud P2, tricuspid regurgitation, elevated JVP, hepatomegaly
X-Ray- enlarged central pulmonary arteries, right ventricular hypertrophy, right atrial enlargement
Diagnosis- fold standard is right heart catheterization
Priapism
persistent, painful ereation that develops without sexual stimulation and has a long duration
Post-void residual volume in UTI?
Low, due to frequent urination
b-HCG and AFP producing tumors in young males?
Nonseminomatous germ cell tumors
Seminoma vs nonseminomatous germ cell tumors
Nonseminomatous germ cell tumors - product AFP and b-HCG
Seminoma produce b-HCG
Site of nonseminomatous germ cell tumors in young males
mediastinal mass, testicular
pityriasis rosea?
numerous oval, scaly plaques that follow the cleavage lines fo the trunk, often presents with an inital, larger lesion, a herald patch
TInea corporis
pruritic rahs with scaly, erythematous border and central clearing
Ichthyosis vularis? Treatment
Chronic inherited skin disorder with diffuse dermal scaling, caused by mutation in filaggrin gene
Treatment -emollients, severe cases male require keratolytics (coal tar, salicylic acid, and topical retinoids
How to calculate sensitivity? Specificity?
Sensitivity- TP/(TP+FN)
Specificity = TN/(TN+TP)
Untreated AIDS, progressive neurological symptoms, nonenhancing white matter lesions suggest? Diagnosis?
Progressive multifocal leukoencephalopathy, caused by JC virus
Diagnosis: LP with PCR for JC
HIV-associated dementia?
deep gray matter structures affected, causing subacute connitive, behavioral, and motor deficits
Subacute sclerosing panencephalitis
progressive, fetal disease caused years after measles infections
Signs of peripheral nerve compression
Transient, unilateral foot drop, impaired anbkle dorsiflecion, preseved plantar flexion
How to rule out primary psychiatric disorders in physical manifestations?
Symptoms are explained by distribution along a single nerve
Arteriovenous fistula signs?
widenedd pulse presure, brish carotid upstroke, systolic flow murmur, tachycardia, flushed extremities, left ventricular hypertrophy
Hypertrophic cardiomyopathy vs AVF murmur
HCM- crescendo-decrescendo, increasing with valsava
AVF- systolic murmur, no increase with valsava
Treatment for torsades de pointes?
IV magnesium sulfate
What drugs should be withheld 48 hours prior to cardiac stress tests?
Beta-blockers, calcium channel blockers, nitrates
Signs of secondary syphillis?
Diffuse rash (begins on the trunk, extends to the extremities, involsing palms and soles), widespread lymphadenopathy, grey mucosal patches, raised grey genital lesions (condylomata lata), epitrochlear lymphadenopathy (pathognomonic)
Disseminated gonococcus signs
tenosynovitis, polyarthralgia, skin rash consting of a few pustules
What causes cardiac tamponade?
Decreased left ventricular preload
Signs of restrictive pericarditis?
Progressive peripheral edema, ascities, elevated JVP, pericaridal knowck, pericardial calcifications
How often are mammograms performed?
Every 2 years.
Disseminated mycobacterium avium complex infection signs?
fever, cough, diarrhea, splenomegaly, elevated alkaline phosphatase
Most common cause of community acquired vacterial meningitis?
Strep pneumoniae
Drugs that can cause angioedema?
Ace inhibitors -> increased bradykinin
Organs affected in Goodpasteur’s syndrome?
Renal and pulmonary
How to improve quality of care when transitioning between facilities?
Pharmacist-directed interventions
Drugs with photosensitivity reactions
Tetracyclines, chlorpromazine, prochlorperazine, hurosemide, hydrochlorothiazide, amiodarone, promethazine, piroxicam
Side effects of Erythromycin?
GI upset, cholestatic jaundice (estolate base)
Cause of ARDS in pancreatitis?
Phosphilipase A2 crosses pulmonary capillaries and increases inflammatory response
What is the negative predictive value?
Probability of being free of disease, if the test is negative
Positive predictive value, meaning?
Likelihood that a positive test means you have the disease.
Tinea versicolor causal organism? Trreatment?
Malassezia species
Tx: selenium sulfide, ketoconazole
Signs of atrial fibrillation?
palpitations, weakness, dizziness, presyncope, dyspnea, and/or chest pain
Conditions associated with atrial fibrillation?
CHF, Hypertrophic cardiomyothy, hypertensive heart disease (most common), obstructive sleep apnea, obesity, endocrine
Valvular involvement in infective endocarditis?
Mitral-damaged heart valces
Tricuspid- intravenous drug abuse
Signs of CMV in an AIDS patient? CD4+ count? Diagnostic test? Treatment?
Frequent, small volume diarrhea; hematochezia’ abdominal pain
CD4+ < 50
Diagnostic test: colonoscopy with biopsy (eosinophilic intranuclear and basophilic intracytoplasmic inclusion
Treatment: ganciclovir
Epinephrine vs antihistamines
Antihistamines treat uticaria, pruritus in anaphalaxis, however, they do not relieve upper airway edema or hypotension
Streptococcus gallolyticus
Streptococcus bovis (biotype 1) highest risk of colon cancer
Vibrio vulnificus? Treatment? Manifestations?
Gram-negative, free-living in marine environments
Increased risk in those with liver disease
Manifestations: rapidly progressive, septicemia, cellulitis (hemorrhagic bullae, necrotizing fascitis)
Treatment: IV ceftriaxone, doxycycline
