Medicine Qbank 3 Flashcards
unexplained congestive heart failure, low voltage, increased left ventrulcar wall thickness in patients w/o HTN
cardiac amyloidosis
h. pylori in gastric adenocarcinoma
not curative. (is in MALT lymphoma). treat if tumor is resectable after CT, PET
CD4 less than 200, or candidiasis
pneumocystis jirovecii, trimethoprim-sulfamethoxazole
oral candiasis is risk factor
CD4 less than 100
toxoplasma gondii, trimathoprim-sulfamethaxazole
CD4 less than 50
mycobacterium avium complex, azithromycin
CD4 less than 150
Histoplasma, itraconazole
ohio and mississippi river walleys
acyclovir and valacyclovir in HIV
used in recurrent herpes simplex regardless of CD4
fluconazole prophylaxis
for cryptococcal, but not done in US. treats candidiasis as needed
peripheral edema, hypoalbuminemia, urinary protein excretion greater than 3g/day
nephortic syndrome. (can cause dyslipidemia leading to athrosclerosis, stroke and MI.)
antipseudomonal betalactam that coversgram +/-; empiric tx for febrile neutropenia
piperacillin-tazobactam, cefepime or meropenem
10 minutes of morning stiffness
OA. More would suggest inflammatory arthritis. crepitus is also a sign of OA
treat osteoathritis that is refractory to NSAIDs and steriods
colchicine
calcium pyrosphosphate can be present in joints
three definitive tests for syphilis
VDRL, FTA-ABS, and spirochetes on dark field microscopy. Test positive syphilis pt for HIV
chronic epigastric pain (on and off), malabsorption (steathorrhea, wt loss), DM
chronic pancreatitis: alcoholic, CF, ductal obstruction or autoimmune
ELevated CA19-9 levels
pancreatic cancer. most patients die within one year
chornic cough, mainly nocturnal
check PFTs for asthma
tx hypersensitivity pneumonitis
(ground glass or haziness of lower fields, wt loss, clubbing, honeycombing)
avoid antigen! (parrots, molds). systemic steroids can treat acute symptoms
dull low-back pain, worse at night, improves throughout the day
inflammatory arthritis: AS, psoriatic arthritis, reactive arthritis, arthritis of IBD. AS affects apophyseal joints
high intraocular pressyre with cupping of optic disk, tunnel vision
open angle glacoma. AAs, runs in familys, diabetes.
poor nightvision, curtain falling with vitreous bleed, or floaters
DM retinopathy (leading causeof aquired blindness)
blurred vision, problems withnighttime driving, and glare
cataracts
immune rxn that lookslike acute syphilis
jarish-herxheimer reaction to dead syphilis in syphilis treated with penicillin
symptomatic relief in new diagnosis of hyperthyroidism
beta blockers
indication for propylthiouracil
when radioactive iodine is contraindicated,like pregnancy. inhibits thyroid hormon synthesis and conversion of T3 to T3. Relapse post-tx in 2/3 of patients
most common mets to the liver
GI, breat, lung
contraindications for liver transplant
cardiopulmonary dz causing prohibitive risk, incurable or recent cancer (
trimethoprim-sulfamethazole AE
rash, neutropenia, hyperkalemia, elevated transaminases
minimizepulmonry complications beforegiving antibiotics
give corticosteroids if PaO235
PAD tx
low dose aspirin, statin, smoking cessation, supervisedexerciseprogram
PAD tx persistent symtpomsdespite exercise therapy
cilostazol and percutaneous or surgical revasculazation
evaluated back pain: normal x-ray, increased ESR/CRP
MRI, then CTbiopsy if needed
asymptomatic or HA, deafness, neuropathy andbone/back pain
paget’s
DM screening
USPSTF: pts with BP over 135/80
ADA: all patients over 45
ABG inPE
High Aa,decreased PaCO2
Low testosterone workup
measure serum prolactin!pituitary MRI indicated in pt with elevated prolactin, testosterone
fixed splitting of s2
atrial spetal defects. also may have midsystolicpulmonary flowmurmur
fall in systemic arterial pressure more than 10mmHg during inspiration
pulsus paradoxus, cardiac tamponade
pulsus parvus and tardus
decreased amplitudeand delyaed upstroke, associated with aortic stenosis
Metabolic syndrome definition
Waist over 40 in men, 35 in women fasting glucose 100-110 blood pressure over 130/80 triglycerides over 150 HDL
indications for chest tube in pleural effusion
pH
weakness, back pain and dizziness in pt on warfarin
think bleeding. retroperitoneal hematoma!
nonspecific symptoms(fatigue, irritability, insomina), myalgias, hypertension, nephropathy, cognitive deficits, and neuropathy
lead toxicity. think occupational exposure
chronic renal failure in pt w/history of anagelsic use
papillary necrosis or chronic tubulointersistial nephritis
muddy borwn casts
acute tubular necrosis. ischemic or nephortoxic acute renal failure
hematuria (RBC casts), edema, hypertension, proteinuria
glomerulonephritis (nephritic syndrome)
chronic pylonephritis may cause
chronic tubulointerstitial nephritis (like analgesics cause. WBC casts)
HIV esophagitis: white plaques
candida, tx fluconazole
HIV esophagitis: large linear ulcers
CMV, tx ganciclovir
HIV esophagitis: vesicles and round/ovoid ulcers (“volcano-like”)
herpes simplex, tx acyclovir
HIV esophagitis: endoscopy with biopsy indications
sore throat w/nonresponse to two weeks of fluconazole for thrush
CT shows pulmnary nodules with halosign, or lesions with an air crescent
aspergillus
ucleratedpapule at sight ofinfection, then papules alonglymph flow
sprortrichosis
fever, dry cough, wt loss, pleuritic chest pain; erythema multiformeand nodosum, arthalgias
coccidiodomycosis (SWUS, central and south america)
joint deformation in SLE
SLE arthritis is nondeforming
distal phalangeal resorption, “pencil in cup”
psoriatic arthritis, mutilans varient
tx for fibromyalgia
regular aerobic exercise, sleep hygiene, duloxetine & TCAs if all else fails
(fibromyalgia pts have pt tenderness on midtrapezius, lateral epicondyle, costochondrial junction, and greater trochanter)
increased dental caries, enlargedsalivary lymph nodes, dry mouth and eyes
sjogren’s syndrome, serum antibodies aginst SSA (RO)/SSB (La)
acute pulmnary edema, new S3,peripheral edema and JVD
perioperativeMI
arthritic/gout symptoms after eneteric or genitourinary infection
reactive arthrits, tx NSAIDs
other signs: mouth ulcers, urethritis, enthesitis
waxy skin, macroglossia, asymptomatic nephrotic syndrome, restrictive cardiomypoathy, peripheral or autonomic neuropathy, bleeding diathesis
amyloidosis (can be primary AL or secondary AA to chronic inflammation as in RA, IBD, chronic infection. Can cuase nephoritc syndrome
chronic sterile granulomatous inflammation of meibomian gland (inner eyelid)
chalazion
purulent eyelid gland infection
hordeolum, usually staph
small external hordeolum, zeis or molls glands
stye
purulent arthritis without skin lesions
or triad: tenosynovitis of wrists, ankles, fingers, knees; dermatitis, migratory purulent arthritis
disseminated gonnacoccal infection. cultures may be neg, screening for hiv and syphilis recommended.
tx disseminated gonnacoccal infection
IV ceftriazone for 7-14 days, switch to po cefixime when clinically improved, empire azithromycin once or seven days of doxy for chlamydia
toxic shock presentation
diffuse rash, fever and HYPOtension
tx severe symptomatic hypercalcemia
vigorous IV normal saline (Ca over 12)
hemodialysis with calcium free dialysate if unresponsive.
long term tx is bisphosphonates
avoid loops except in heartfailure
hypercalcemia symptoms
salt wasting, volume depletion, dry membranes, high BUN/Cr ratio
arrhythmia in digoxin toxicity
atrial tach with AV block
tx chalazion
incision and cutterage ( v. hot compress for stye, plus antibiotic ointment if needed)
associated with hyperpigmentation
primary adrenal insufficiency, usually autoimmune. hyperkalemia, hyponatremia, hypotension
low cortisol, high ACTH, low aldo
primary adrenal insufficiency, autoimmune
low corticol, low ACTH, normal aldo
secondary adrenal insufficiency. possible hyponatremia, but no severe symptoms. usually from taking glucocorticoids, but can be lymphocitc invasion of pitiatuary or sheehans syndrome (pituiatry infarct) in paptpartum F
p waves unrelated to QRS, dx and tx
complete heart block, cardiac pacing
abscence of measurable erythropoetin in urine
polycythemia vera
increased bone marrow iron
hemachromatosis, anemia of chronic diseae, sideroblastic anemia
auer rods
acute promyelocytic leukemia
difference between AML and CML
fever is uncommon in AML and suggests infection, splenomegaly is rare, and peripheral smear shows myleoblasts
tartrate restitant acid phophatase
hairy cell
low leukocyte alkaline phosphate activity
chronic myelogenous leukemia (phil. chrom. BCR-ABL1 inhibits tk phos)
myeloblasts
AML
most common US leukemia
CLL
blast cells
lymphoblastic leukemia
reed sternberg cells
on biopsy in Hodgkins
leukocytosis, basophilia, splenomegaly
CML
pruritic rash on wrists and hands
scabies
scabies tx
permethrin 12%, oral ivermectin
lyme tx
orl doxycycline, IV ceftriazone if disseminate, severe, amoxicillin in pregnant or kids under eight
doxycycline in kids
discolors teeth, skeletal malformation
dx ankylosing spondylitis
xray showing fused sacroiliac joints or bamboo spine
prussian blue
when positive indicates hemolysis (presence of hemosiderin) in urine
dark urine after meds (antibiotics, antimalarials, nitrofuratoin) or infection
think G6P deficiency, oxidative stress. heinz bodies
hemolysis caused by alphahethyldopa or pencillin
autoimmune 2/2 igG binding to RBCs, Coombs +
epidural hematoma cause
middle meningeal artery (lentiform)
subarachnoid hemorrhage cause
ruptured aneurysm, sometimes trauma
subdural hematoma cause
torn bridging veins
Post-transplant patient w/pneumonia and colitis
CMV
IgG autoantibodies against platelet membrane glycoproteins
ITP: antecedent viral infection, petechiae and ecchymosis, mucocutaneous bleeding. tx systemic glucocorticoids
mild thrombocytopenia, giant platelets, disproportionate bleeding
Bernard-Soulier, AR absence of platelet glyocprotein Ib-IX-V
common acquired causes of aplastic anemia
parvovirus, EBV, drugs, chemo, radiation
platelets remain over 30,000; no clinical bleeding
hypersplenism
thrombocytopenia, microangiopathic hemolytic anemia, low clotting factors, long PT
DIC
recurrent chalazion tx
histology for sagacious carcinoma, basal cell carcinoma. Then steroid injection and/or incision and cuttrage
parenchymal atrophy due to calyceal dilation
obstructive uropathy
pathologic hallmark of diabetic nephropathy
nodular glomerulosclerosis, though diffuse is more common (Kimmelstiel-Wilson nodules, basement membrane changes
shoulder: decrease in passive or active motion, more stiffness than pain
adhesive capsulitis
shoulder: pain with abduction, external rotation, subacromial tenderness, normal range of motion
rotator cuff tendinopathy (tear in pts over 40)
anterior shoulder pain, with lifting, carrying, reaching overhead; weakness uncommon
biceps tendinopathy/rupture
uncommon trauma-induced gradually onset of deep/anterior shoulder pain. decreased active and passive abduction, external rotation
glenohumeral osteoarthrits
most important prognostic indicator in breast cancer
TNM stage (tumor burden)
prog in breast cancer, most to least
TNM, ER+ and PR+ (good), Her-2neu (bad), poor differentiation (bad)
most common neuro symptom in Lyme (borrelia burgdorferi)
facial nerve palsy
triad of ipsilateral facial pain, ear pain, and vesicles in auditory canal
Ramsay Hunt syndrome (herpse zoster oticus)
most common cause of idiopathic facial nerve palsy
herpes simplex and varicella zoster reactivation
graft v host pathogenesis
activation of donor T lymphocytes (affects skin, intestine, liver)
expansive soap-bubble lytic area on x-ray
giant cell tumor: benign and locally aggressive bone tumor of young adults, often on distal femur or proximal tibia near knee
pain at night, unrelated to activity but responsive to NSAIDs, cortical lesions with central lucency on xray
osteiod osteoma
osteoclast resorbtion of bone leads to fibrous replacement, brown tumors, salt and pepper on imaging
osteolitis fibrosa cystica (Von Recklinghausen dz of bone)
pain with flexing long finger while patient extends fingers and wrist
radial tunnel syndrome, may accompany lateral epicondylitis
anterior MI vessel and leads
LAD, V1-6
inferior MI vessel and leads
RCA or LCX. ST elevation in II, III, aVF
posterior MI vessel and leads
LCX or RCA, ST depression in V1-3, elevation in 1 and aVL (LCX), depression in 1 and aVL (RCA)
lateral MI vessel and leads
LCX, diagonal; ST elevation in Leads I, aVL, V5, V6; ST depression in II, III, and aVF
right ventricular MI vessel and leads (occurs in 1/2 of inferior MI)
RCA, ST elevation in leads V4-V6
leading cause of B12 deficiency
pernicious anemia! anti-intrinsic factor antibodies. associated with 2x risk of gastric cancer
microcytic anemia, elevated RBCs, hypochromia on smear with target cells
beta thalassemia
macro-ovalocytes, megoblasts and hypersegmented neutrophils on smear
cobalamin (B12) deficiency
treat iron overload in transfusion-dependent thalassemia or sickle cell
deferoxamine
tx anemia of chronic disease, CKD, transient bone marrow failure
erythropoetin
folic acid deficiency anemia
megaloblastic
increases hemoglobin f levels
hydroxyurea (sickle cell)
tx autoimmune hemolytic anemia
prednisone
tx symptomatic hereditary spherocytosis
splenectomy (also used in autoimmune hemolytic anemia, beta-thalassemia and hemoglobin H dz)
tx beta-thalessemia
no tx required
BUN/Cr in dehydration
greater than 20. give crystalloid solutions (normal saline. colloid solutions are used in burns, hypoproteinemia)
severe polyarthralgias, HA, myalgia, fever, rash, recent travel to tropical area
chikungunya fever (from aides mosquito). tx supportive
Direct Coombs +
Autoantibodies are on the surface of RBCs (autoimmune hemolysis)
Indirect Coombs
Screens for autoantibodies to RBCs in the serum. Used in cross matching, prevention newborn hemolytic disease
pyroxidine
tx sideroblastic anemia (isoniazid!). normo/hypochromic (is B6: also in EtOH, drug malnutrition)
acid-fast oocytes in stool of HIV pt
cryptosporidium (CD under 180)
spores in HIV pt stool
microsporidia
abx cause this type of hearing loss
neurosensory
hyperthyroid with low I uptake
thyroiditis, stroma ovari (rare, nonpalpable thyroid)
double duct sign
biliary obstruction in pancreatic cancer
vitiligo associated dz
autoimmune, including perncious anemia
risk factors for constrictive pericarditis
idiopathic, prior surgery(CABG or valve), TB, malignancy, anemia
constrictive pericarditis v cardiac amyloid
amyloid has LVH, periorbital purpura, heavy proteinuria and hepatomegaly
LH and FSH in PCOS
LH:FSH ratio increased
nonclassical congential adrenal hyperplasia
young adults w/hyperandrogenism, increased 17-hydroxyprogesterone
target BP in DM nephropathy
130/80
acute adrenal insuffiency symptoms
hypotension, ab pain, vomiting, diarrhea, wt loss, weakness, orthostasis
tx acute adrenal insufficiency
dexamethasone, fluids
thyroid storm symptoms
tachycardia, arrhythmia, HTN, mental status change and lid lag
anti-topoisomerase I
systemic sclerosis
extrapulmonary small cell lung cancer
endocrine (SIADH, hyperCa, cushings), heme (trouseaus’. DVTs), neuro (lambert-eaton, neuropathy), MSK (clubbing, dermo/polymyositis)
mobitz I cause and tx
AV block (avoid digoxin, beta-blockers, or calcium channel blockers.)
aminosalicylates
methalazine, sulfasalzine. anti-inflammatory, tx UC (IBD), Crohns, RA
raised, well-circumscribed itchy plaques, quick to form and resolve
urticaria: infxn, drugs, allergy. idio
Dubin Johnson v Rotor
Dubin has black pigmented liver
spared eye injury
hidden antigen response
SLE eye
circulated immune complexes
IgE reagin in eye
allergic conjunctivitis
beta blockers in CHF
bad in decompensation (systolic dysfunction)
cord-like veins in smoker
trouseau’s sign (hypercoag)! CT abdomen for occult visceral malignancy
Burr cells
ESRD
Howell-Jolly bodies
black pellets in RBCs, asplenia, post-splenectomy
spur cells (acanthocytes)
liver disease
target cells
beta-thal, liver dz
low in sick euthyroid
T3! T4 and TSH normal
false positive VDR-L
antiphospholipid. tx (in preg) w/low molecular weight heparin
rubella v measles
both start on face, spare palms. measles spreads more slowly, has fever over 104
anti-basement membrane, linear Ig (dx, symptoms)
Goodpasture’s (young coughing men w/bad kidneys)
sinitis, kidney problems, older adults, fever and malaise
Wegner’s
erythropoetin AE
increased CV risks, embolism, stroke
tx cardiogenic shock
nitrates can cause. give saline for hypotension, then dobutamine if needed (beta-adrenergic agonist like epi)
tx anaphylactic shock
epinephrine (hyotension, bronchospasm)
cardiac index
proportional to CO, refelcts left ventricular function
PCWP
reflects left atrial pressure
vit. D OD: symptoms, causes
hypercalcemia! ab pain, constipation, polydipsia. supplements, granulomatous dz (sarcoid), lymphoma
prolactinoma labs
prolactin over 200, low LH, norml TSH
prolactinoma symptoms (M, W)
men: infertility, impotence, gynocomastia. women: menopausal symptoms
asthma, rhinosinitis, nasal polyps
aspirin-exascerbated respiratory dz (AERD: pseudo-allergy, also caused by NSAIDs)
meniere’s triad
vertigo, tinnitus, fullness.
treat stones this size w/fluids and pain management
under 5mm
spider angiomas and gynocomastia
estrogen not converted to testosterone in liver dz
lung infilterates, diarrhea, confusion and fever (non-IC)
think of legionella! tx macrolides (-omycin), quinolones (-floxacin)
amoxicillin-clavulanate (augmentin)
fight bite, cat scratch, sinusitis, CAP (good for beta-lactamase producing haemophilus, moraxella)
cephtriaxone
beta-lactam, 3rd gen cephalosporine, active against gram positives, some gram neg (NOT for atypical pneumonias)
macrolides (-omycin) cover
gram positives, limited negatives (pertussis, h. flu). common substitute for penicillin if allergies
quinolones (-floxacin) cover
broad-spectrum gram pos and neg
uric acid stone tx
potassium citrate (alkalizes urine), hydration, low purine diet
furosemide and stones
increases urine Ca, increase Ca stones
HCTZ and stones
decreases urine Ca, may decrease Ca stones
most stones
Ca oxolate. (cysteine in IEM, struvite in proteus UTI)
ADAMST13
low in familial TTP
anti-cardiolipin antibody
high in anti-phospholipid syndrome (AV thrombus, miscarriage, microlytic anemia, neurofindings)
most common nursing home pneumonia
strep pneumo
dx rotator cuff tear
inject lidocaine to r/o tendonitis, then MRI
postmeal ab pain, obstipation, nausea
small bowel obstruction
prior surgery (cholesistectomy), acid suppression, motility disorders (DM, s.sclerosis), immunosuprression
SIBO! diarrhea, malabsorption and wt loss due to bacterial overgrowth
BRBPR and neg colonoscopy
RBC scintography (tagged RBC scan), less invasive than angiography
elevated C-peptide and proinsulin elevation
beta cell tumor (high insulin, hypoglycemia)
common phototoxic ance treatment
tetracyclines (doxy)
neuro deficits appear or worsen with folate
cobalamin (B12) deficiency
INR for DVT, a fib
2-3
INR for pros. valves
2.5-3.5
3 Ds of pellagra
diarrhea, dermatitis, dementia (and death! naicin deficiency from corn-based diets. Africa, india, china, alcoholics, carcinoid syndrome, Hartnup’s dz)
AR amino acid transport disorder, particularly affecting tryptophan
Hartnup’s dz, looks like pellagra (niacin def.)
smaller confidence interval
more precise. increaing sample size decrease CI
validity is measured by
sensitivity/specificity
lactose intolerance tests
positive hydrogen breath test, positive stool reducing agents, low stool pH, high stool osmotic gap
tx hypertrophic cardiomyopathy
BBs (it’s AD)
peripheral Ca blocker, arterial dilation
amlodipine
cardiac acting Ca blocker
verapamil, diltiazem, can treat hypertrophic cardiomyopthy
pericarditis and renal dysfunction
uremic pericarditis! tx dialysis
tx idiopathic or viral percarditis
indomethacin (NSAID) + colchicine
impaired osteoid matrix mineralization
osteomalacia. low Ca or Phos! malabsorption, sprue, CLD, CKD
defect in collagen I formation
osteogenesis imperfecta
prophylax for lyme with doxy if
deer tick (ixodes scapularis), and 36hr exposure (or engorged), and within 72hr, and lyme rate in area >20%, and doxy not contraindicated
meningococcal vaccine age
11-12, booster at 16-21
no live vaccines in patients on
TNF inhibitors (infliximab)
tx CKD anemia
erythropoetin and Fe
abdominal lymphoma and high IgA
heavy chain dz
hyperviscosity and high IgM
Wallenstrom’s macrogloblemia
causes of clubbing
malignancy, CF, cardiac shunting
Fe, ferritin, and tranferrin sat in iron deficiency
low, low, low
Fe, ferritin, and tranferrin sat in thalassemia
high, high, high
Fe, ferritin, and tranferrin sat in anemia of chronic dz
low, normal, normal
mupirocin
tx impetigo, and nares MRSA
AD ankyrin deficiency
hereditary sphereocytosis. high MCHC, high osmotic fragility on acified glycerol lysis test, abnormal eosin-5-maleimide test
hereditary sphereocytosis tx
folate, transfusions, splenectomy
hereditary sphereocytosis complication
bilirubin gallstones, aplastic crisis in parvo B19 infection
absent CD55
paroxysmal noctural hematuria
risks in mono
splenic rupture, AI hemolytic anemia and thrombocytopenia 2-3 weeks post infection
bethanechol
cholinergic agent for urinary retention, atonic bladder
tamsulosin
relaxes distal ureter (helps pass stones)
phenazopyridine
ureter analgesic, may promote stones
secondary amyloid causes
inflammatory arthritis, chronic infection, IBD, vasculitis, cancer.
BBS in pheochromcytoma
cause rapid elevation in heartrate. give with alpha blockers (-zosins, losins)
tx mysethnia gravis
pyridostigmine
leukocytosis w/lymphocytosis and smudge cells
CLL
ipratropium
inhaled nti-muscarinic agent for COPD
malaria prophylaxis in chloroquin resistant areas (subsaharan Africa, amazon basin, southern and SE Asia)
mefloquine, atovaquone-proguanil, and doxycycline
cutaneous and visceral angioa-like blood vessel growths
bartonella (immunocompromise)
most common cause of folate deficiency anemia (megaloblastic!) in the US
alcoholism
most frequent case of acute epididymitis
e.coli
postherpetic neuralgia tx
TCAs, acute antivirals (valacyclovir, acyclovir)
most common viral encephalitis in immunocompetent adults
herpes! simplex, varicella, EBV
CSF in viral encephalitis
high WBC (lymphocytes), normal glucose, high protein
empiric antibiotics: age 2-50
vanc plus 3g cephalosporin (N. menigitis, s. pneumo)
empiric antibiotics: over 50
vanc, ampicillin, 3g cephalosporin (n. meningitis, s. pneumo, listeria)
empiric anitbiotics: neurosurgery/shunt
vanc plus cefepime (GNRs, s. aureus, co-ag negative staph)
empiric antibiotics: immunocompromise
van, ampicillin, cefepime (s. pneumo, n. meningitis, listeria, GNRs)
empiric antibiotics: penetrating injury to skill
van, cefepime (GNRs, s. aureus, co-ag negative staph)
alternatives to cefepime
ceftazidime, meropenem
alternative to ampicillin
trimethoprim-sulfamethazole for listeria
potassium in addisons
high! Na is low! anorexia, fatigue, hyper pigmentation, vitiligo,
most gallstones
cholesterol or mixed, radiolucent
alpha-1-antitrypsin
emphysema! panlobular (not central as in smoking). also at risk for liver dz
PFTS in emphysema
low FEV/FCV, high TLC, low DLCO
common tumors that met to bone
lung, breast, thyroid, prostate
bone pain worse at night, constant, with point tenderness
metastatic cancer (more common that compression fracture in men under 65)
PPV/NPV in increased prevalence
PPV goes up, NPV goes down (PPV is proportional to prevalence)
new pneumonia w/in weeks of flu
s. aureus
SAAG over 1.1
cardiac ascites or cirrhosis (increased capillary hydrostatic pressure)
SAAG under 1.1
malignancy, pancreatitis, nephrotic syndrome, TB (increased capillary permeability)
periorbital swelling, hematuria and oliguria 10-20 days post throat or skin infxn
post-strp glomerulonephritis
drug induced interstitial nephritis presentation
fever, rash, arthralgia, hematurtia, WBC casts
hematurtia after URI w/normal complement levels
IgA nephropathy
rare cause of hematuria w/nephritis and and low complement
membranoproliferative glomerulonephritis
tx V. fib
(fibrillary waves w/o QRS. defib, and give epi)
cath in PE
elevated r. atrial and pulmonary arterial pressures, normal PCWP
AE: hypothermia
fluphenazine (typical antipsychotic, inhibits shivering)
AE: TCAs
wt change, dizziness, insomnia
numbness, weakness and swelling of arm, weakened radial pulse
thoracic outlet syndrome (vascular obstruction)
positive Neers
pain with passive arm raise over 60 degrees
murmurs that get louder w/standing and valsalva
decreased venous return! HCM, MVP
murmurs that get louder with squatting, handgrip
(increased BP and regurg fraction!) AR, MR, VSD
tx amebic liver abscess
metronidazole, plus luminal agent (paromomycin), do not drain!
mixed cryoglobinemia
HCV arthralgias, also associated with chronic vasculitic syndrome (palpable purport, lymphadenopathy, nephropathy, neuropathy)
tx acute closed angle glaucoma
NOT atropine! IV mannitol (diuretic), acetozolomide (carbonic anhydrase inhibitor, prevents aqueous humour formation), pilocarpine (opens schlemm channel, topical), timolol (BB, reduces humor)
wegner’s triad and tx
systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis. cyclophosphamide
loculated, abnormally contoured effusion with adjacent pulmonary infiltration
empyema in untreated pneumonia
velcro crackles
idiopathic pulmonary fibrosis
hepatic hydrothorax w/o response to dieuretics
TIPs
retrospective cohort study v. case control
both are retrospective. cohort compares disease incidence in risk factor + and - patients. cohort compares risk factor frequency in dz + and - patients
hep C treatment criteria
over 18, serum HCV RNA, fibrosis on liver biopsy and chronic hepatitis, compensated liver dz, stable labs
contraindications to hep C treatment
alcohol and drug use, uncontrolled major depression
hep c tx
peginterferon plus ribavirin, also protease inhibitor (tela/boceprevir) if genotype 1
thin discharge, fish odor, no inflammation. pH over 4.5, amine odor w/KOH
bacterial vaginosis (gardnerella), tx metronidazole
thin yellow-green frothy discharge, inflammation, pH over 4.5
trichomoniasis. motile trichomonads, metronidazole, treat sexual partner
thick lumpy discharge, inflammation, normal pH (3.8-4.2), pseudohyphae
candida vaginitis, tx fluconazole. (risk factors: pregnancy, DM, recent antibiotics)
nocturnal headaches and morning vomitting
red flags for intracranial pathology
diffuse abdomenal pain, tympani, hyperactive bowel sounds
consider SBO. most often adhesions (post-surgical)
bacterial meningitis in children
empiric abx (ceftriaxone and vanc) and LP; CT if coma, focal findings, or hx of neurosurg
eval signs of adrenal insufficiency
cortisol and ACTH levels, cosyntropin stimulation test
low basal cortisol, high ACTH, minimal response to cosyntropin
primary adrenal insufficiency (cosyntropin is ACTH analog)
low basal cortisol, low ACTH, suboptimal response to cosyntropin
secondary or tertiary adrenal insufficiency
bone malformation in DM, osteoporosis
osteoblast dysfunction
hypercalcemia in sarcoid, TB
overproduction of calcitriol (active vitamin d)
“mosaic pattern” of lamellar bone, high alk phos, femoral bowing
osteoclast dysfunction, as in Paget’s
severe or dirty wound, immunocompromised, or incomplete/uncertain vaccine hx
give TIG and TT booster (no one else gets TIG; booster for dirty would and more than 5y since booster)
Northern Africa vaccine recommendations
Hep A, Hep B, typhoid, and polio booster
yellow fever vaccine when
subsaharan africa, equitorial south america
when to get meningococcal vaccine for travel
some Asia, sub-Saharan Africa, pilgrims making the hajj to Mecca
initial treatment for SIADH
fluid restriction. demeclocycline rarely necessary
tx exercise-induced bronchospasm
inhaled albuterol 10min before (if not daily), otherwise corticosteroids or antileukotrienes (-lukasts)
rapid bilateral cellulitis of submandibular and sublingual spaces
Ludwig angina, causes by tooth infection. asphyxiation is fatal complication
complications of ulcerative colitis
sclerosing cholangitis, uveitis, erythema nodosum, spondyloarthropathy, colon cancer, toxic megacolon
UC colon cancer screening
beginning 8-10 years after diagnosis
causes Q fever via inhalation from livestock or unpastuerized milk
coxiella burnetii
restricitive lung dz in ankylosing spondilytis
diminished chest wall and spinal mobility
anti-intrinsic factor abs
pernicious anemia (leads to b12 def., shiny tongue, gastric cancer)
characteristics of Graves opthalmopathy
decreased convergence, diplopia, exopthalmos, gritty sensation