Miscellaneous Flashcards
Infectious Endocarditis. What organisms are responsible in Community acquired vs healthcare associated setting?
Community Acquired - Strep Viridans species - S. Sanguinis, S. mitis, S. oralis etc. E.g. After oral or dental procedure or any respiratory intervention Healthcare associated (mechanical valves, catheter, IV drug use) - Staphylococcus
What is Nocardia and how do you treat it?
Norcardia is a gram +ve, crooked, branching, beaded weakly acid fast bacillus. It is treated with Bactrim (TMP-SMX).
Thrombocytopenia (low platelets) and thrombus formation within days of starting anti-coagulation therapy is HIT. If PTT is also increased, which form of anticoagulation was used?
Unfractionated heparin
What happens to DTRs in the setting of hypocalcemia? Hypermagnesemia?
Hypocalcemia - increased DTRs
Hypermagnesemia - absent DTRs if severe. Reduced if mild.
When do you use a 24 hr Holter monitor?
When you are trying to capture a SYMPTOMATIC arrhythmia that has not yet been captured on EKG.
What do you do for symptomatic premature atrial contractions?
Use a beta-blocker.
What do you do for ASYMPTOMATIC premature atrial contractions?
Lifestyle changes (less alcohol, less tobacco)
A right upper lobe cavitation in an HIV infected or immunosuppressed person can be what else in addition to TB?
Nocardia
- What change on EKG leads to torsades de pointes?
- Who is at risk of developing torsades de pointes?
- What is the treatment?
- Prolonged QT interval
- Familial long QT, hypomagnesemia (malnourished, alcoholics), certain meds
- Stop offending meds, start MAGNESIUM SULFATE
What are the ABCDE of melanoma?
A is asymmetry B is border (irregular) C is color change D is diameter (>6mm) E is evolving
What are Baker’s cysts? How do they arise?
Excessive fluid from inflamed synovium like in Rheumatoid arthritis, osteoarthritis, or cartilage tears accumulates in popliteal fossa. Baker’s cysts are tender to the touch.
What do you do to treat frostbite?
Rapid re-warming in warm water
What are the presenting symptoms of a cerebellar HEMORRHAGE? What is the treatment?
HTN is a major risk factor for all intracerebral hemorrhages.
Cerebellar hemorrhage: ataxia, facial weakness, gaze palsy, vomiting, occipital headache. There is NOOO hemiparesis.
Treatment: EMERGENT surgical decompression
Glucocorticoid deficiency signs
Eosinophilia, weakness, fatigue, loss of appetite.
Panhypopituitarism
Glucocorticoid deficiency - low cortisol, eosinophilia, weakness, fatigue,
Aldosterone secretion from the zona glomerulosa is ACTH-independent so aldosterone levels will be normal in secondary adrenal insufficiency
What common anti-histamine drug is an example of anti-cholinergic intoxication when taken in large amounts? What is the treatment?
Diphenhydramine -
Treatment: AChesterase inhibitor - Physostigmine
What is the cardinal sign of PCP intoxication? What are some of the other presenting symptoms?
Vertical nystagmus. Other signs: agitation, tachycardia, dissociative symptoms, pupillary dilatation.
Gross, painless hematuria is most often associated with …
Bladder, renal or ureter malignancy until proven otherwise
How do you make the diagnosis of ovarian cancer in a SYMPTOMATIC patient?
If a patient has no family history or is not symptomatic what do you do?
Use a pelvic ultrasound and serum CA 125 levels. A pelvic ultrasound is NOT a transvaginal ultrasound. Transvaginal ultrasounds have not been shown to have benefit in identifying ovarian cancer.
2. No screening
How does a patient on TPN or prolonged fasting get gallstones?
Gallbladder stasis and slugde which also increases risk of cholecystitis
For post-cholecystectomy syndrome what is the work-up?
Abdominal imaging followed by ERCP.
Charcot’s joint is a neurogenic arthropathy that happens in the setting of nerve damage in diabetes. It presents as…
It affects weight bearing joints. Decreased proprioception, temperature
Focal spinal pain, UMN deficits, and sensory deficits (esp in the setting of a recent infection, and/or fever) suggest…
Treatment is:
Work-up is:
Risk factors:
Epidural abscess.
Treatment: Immediate surgical decompression.
Work-up: MRI of the spine with gadolinium
Risk factors: IVDU, immunocompromised state, surgery or trauma
A patient who presents with focal neurologic deficits concerning for stroke that then becomes unresponsive/reduced alertness, bradycardic, and has vomiting/nausea (signs of incr intracranial pressure) has probably progressed to…
Intracerebral hemorrhage
In an HIV patient, severe acute retinal necrosis can be caused by what 2 (herpesfamily) viruses?
How is CMV retinitis different?
HSV, VZV
CMV retinitis is painless.
Greater than normal plasma osmolality should make me think of this condition…
Treatment:
Diabetes Insipidus.
Common nephrogenic cause (ADH resistance): Lithium (used as treatment for bipolar disorder)
Treatment: Stop Lithium and restrict salt intake.
Primary hyperaldosteronism presents with…
Low renin
High Aldo
High PAC/PRA
High bicarbonate (metabolic alkalosis)
What short/mid-systolic murmur best heard at the apex disappears with squatting (increased preload) and is increased by Valsalva?
Mitral valve prolapse. The only other murmur that does this is HCM.
What drug is 1st line for rheumatoid arthritis?
What 3 infectious agents should people be tested for before starting the first line therapy?
When do you add another drug if there is no response?
Which drugs could you add?
Which pts should not get the 1st Line agent
Always treat with 1st Line + ____ if no response.
What is a concerning side effect of first line treatment?
- MTX
- TB, Hep B, Hep C
- 6 months
- Add TNF alpha inhibitor: etarnecept, infliximab etc.
- Patients who are pregnant, looking to get pregnant or are renally insufficient
- Hepatocellular injury
Heparin induced thrombocytopenia puts someone at risk for…
Arterial thrombosis!!!
An S4 is likely due to…
HTN or restrictive cardiomyopathy
Any pain, including abdominal pain, that radiates to the scapula or arms deserves a _____ test for initial work up.
EKG
Chest pain that worsens at night, be very suspicious for…
GERD. Especially if there is dysphagia and chronic cough. In this setting the initial treatment is a PPI or H2RA
Prolactin usually has to be greater than _____ ng/mL to suggest a prolactinoma
200
Elevated PT and then PTT suggest _____ deficiency.
This usually occurs in what setting:
Vit K deficiency
Occurs in setting of intestinal malabsorption, inadequate dietary intake or hepatocellular disease.
Factor V Leiden can prolong PT or PTT on testing. These patients are pro-_______
Thrombotic
Lupus anticoagulant prolongs ____(PTT/PT). It is pro-______
Thrombotic
HTN due to primary hyperaldosteronism would be associated with ________.
Hypokalemia
Resistant HTN could be due to
Diagnosis:
Treatment:
Renal artery stenosis - flash pulmonary edema, peri umbilical bruit, asymmetric kidney size, diffuse artherosclerosis, elevation in serum Cr>30% upon starting ACE-i or ARB
Diagnosis: Renal arteriogram. DO NOT USE if patient is renally insufficient because of contrast dye nephrotoxicity. Do MRA instead.
Treatment: Percutaneous transluminal renal angioplasty. If not successful, surgical bypass.
Coarctation of the aorta is associated with _______ on X-ray
Rib notching
Chronic dry cough is a symptom of ______ this class of anti-HTN
ACE-I
Immobilization can lead to ________ especially in younger patients. Treat with _______
Hypercalcemia
Treat w/ hydration and bisohosphonates
Bilateral eye itching equals with watery discharge and no purulent discharge
Allergic conjuctivitis
Ankylosing spondylitis is associated with what ocular symptom?
Anterior uveitis
Most common complication of PUD?
Hemorrhage
Michigan is not endemic for Histoplasmosis. What is the treatment for Histo?
Itraconazole
With a CD4 count less than 50cells/ul you should start prophylaxis against _______. The drug of choice is _______.
To treat this condition: ______
MAC/MAI. Azithromycin.
Treatment: Clarithromycin + Ethambuthol
With a CD4 count less than 100 in a histoplasmosis endemic area, you start prophylaxis with ______
Itraconazole
PCP prophylaxis is ______
Bactrim
99% CI that does not contain the null value corresponds to a p value of ______
A 95% CI that does not contain the null value corresponds to a p value of _______
P<0.05
Metformin should be _____ in the setting of acute renal failure, sepsis, or hepatic failure. It is associated with __________ in this setting.
Discontinued
Lactic acidosis.
Vast majority of head and neck cancer (submandibular or cervical region) is _______ cancer
Squamous cell carcinoma
Condolymata acuminata = HPV
Condylomata lata = syphilis
Treatment for Condylomata acuminatum is podophyllin
Hematomachrosis is associated with increased risk of _____ cancer?
Hepatocellular carcinoma
Brain tumors are associated with Von-Hippel Lindau and Neurofibromatosis.
Pancreatic cancer is associated with Peutz-Jeghers and Lynch syndrome.
Repeat
Trihexyphenidyl is an anti-cholinergic drug (constipation, blurry vision etc) that treats the tremors of ______ disease.
Parkinson’s.
Propanolol is used to treat _______ and ________
Benign essential tremor and portal HTN
In the absence of carbidopa, levodopa causes…
Nausea and vomiting
Hypertension, bilateral flank masses, and microscopic hematuria should make me think of ______ condition. _____ aneurysms are associated with this condition leading to intracerebral hemorrhage. Hepatic cysts are also common in this condition.
Diagnosis:
Treatment:
Autosomal dominant polycystic kidney disease.
Diagnosis: ULTRASOUND (multiple cysts in kidney)! CT or MRI are alternatives
Treatment: nothing curative. can drain a symptomatic cyst. Treat infection with Abx. Control HTN.
Exudative (malignancy, infection - TB, pneumonia, pulmonary embolism, connective tissue diseases) vs transudative pleural effusion (CHF, hypoalbuminemia). What is the criteria?
Pleural fluid/serum fluid Pleural LDH/serum LDH >0.6 Pleural protein/serum protein >0.5 Pleural LDH > 2/3 upper limit of normal serum PE causes exudative process.
Molluscum contagious lesions are…
Centrally umbilicated dome shaped papules that are non-pruiritic.
Bright, red, friable nodules in an HIV infected patient are probably…_______. Is it gram Positive or Negative? What is the treatment?
Bacterial angiomatosis caused by Bartonella, Gram -ve bacterium. Treatment is erythromycin.
Megaloblastic anemia can be caused by which 2 Vitamin deficiencies?
Which Vit Deficiency is associated with neurologic/neuropathic changes (I.e. chronic ____ deficiency can present as tingling toes?)
Folate and Vit B12 (cobalamin)
Cobalamin
Low leukocyte alkaline phosphatase is characteristic of which Heme malignancy?
CML - chronic myelogenous leukemia
Seborrheic dermatitis is increased in HIV and Parkinson’s. Treat with?
Treat with topical antifungal agents
SLE causes pancytopenia by ______
Immune destruction
In a patient who received a beta 2 agonist for asthma and has myopathy. What should you check?
Serum electrolyte levels. Beta-2 agonists like albuterol drive potassium into cells and cause hypokalemia. Be on the look out for arrhythmias, EKG changes, headache.
Addison’s disease presents with ____natremia, ______kalemia and a ______ gap metabolic acidosis
Hyponatremia, hyperkalemia, non-gap metabolic acidosis.
Do ultrasound to assess for biliary obstruction then ______.
ERCP -
Hypoxemia in OSA does what to RBCs? Treatment:
Increases EPO levels.
Treat the OSA
When I see a patient with urinary incontinence and dementia, I would pay attention to their gait. If it is impaired, their symptoms are concerning for…
Another hint is seeing enlarged ventricles on imaging.
Normal pressure hydrocephalus. Treatment is large volume lumbar punctures and ventriculoperitoneal shunt.
In a patient who has been to Mexico, had GI symptoms and now has a liver cyst, you are concerned about…_______. Treat with _____
Ameobic abscess
Treatment: Metronidazole
For Hyatid liver cyst, you need contact with which animal vector?
Dog
Amitriptyline is used for _______
It is a ______ (type of drug)
Depression
Anticholinergic
Urinary 5-hydroxyindolacetic acid is associated with ______
Carcinoid syndrome
Mild hyperglycemia, easily controlled by insulin. Eythrematous, necrotic plaques in the perineum, extremities, face with central clearing and blistering and crusting at the borders suggests….
Glucagonoma
Glucagon levels >500pg/mL
What is the most common valvular manifestation of rheumatic heart disease?
Mitral stenosis - Loud S1, mid-diastolic rumbling
Vit A deficiency causes …
Blindness, dry skin, impaired immunity
Zinc deficiency causes…
Occurs in which setting:
Alopecia, abnormal taste, bullous pistols lesions surrounding orifices, growth retardation in kids
Setting: TPN, absent jejunum (site of absorption of zinc), IBD
Selenium deficiency causes…
Cardiomyopathy
Hairy cell leukemia is associated with
Tartrate resistant acid phosphatase.
You see a ____cytic anemia in end stage renal disease
Normocytic
You start recombinant EPO in someone with kidney disease when Hgb <_____. What are the most common side effects?
10g/dL
HTN, headaches, flu-like symptoms
What’s the most common cause of severe pain during defecation and bright red blood per rectum? How do you treat it acutely? Chronically?
Anal fissure. Treat with dietary modification (high fiber, fluids), analgesics and stool softener. Lateral sphincterotomy for chronic fissures.
Pernicious anemia (antibodies to _____) is associated with increased risk of _____ leading to _____ (cancer)
Intrinsic factor.
Atrophic gastritis leading to gastric cancer.
Presenting symptoms: neuropathy, macrocytic anemia, glossitis
Whipple’s Disease. What is the histologic finding? What are the presenting symptoms? Who gets it?
PAS-staining material in lamina propria. Presenting symptoms and demographic: White Male (40s-60s), weight loss, arthralgias, weight loss, fever, diarrhea, abdominal pain, generalized lympahdenopathy.
Severe ear pain and drainage with fever. Granulation tissue seen. Population?
Malignant otitis externa. Due to pseudomonas. Treat with
Ciprofloxacin
Elderly patients with poorly controlled diabetes.
Reducing smoking _____(does/does not) affect blood pressure. The way to reduce blood pressure in terms of lifestyle changes is to adhere to ______.
Does not
DASH diet
Suspect tropical sprue if someone has lived in endemic area > ____ (time)
1 month. Chronic lymphocytic infiltrate with eosinophils, plasma cells, lymphocytes and chronic diarrhea. Megaloblastic anemia and cheilosis seen.
Palpable purpura, proteinuria, and hematuria, glomerulonephritis, arthralgias, low complement, hepatosplenomegaly …suspect ______. Test for often present _____ (virus).
Mixed cryoglobunemia. There is often HCV infection. Test for it.
What imaging study is indicated after diagnosing myasthenia gravis?
Chest CT … Thymoma
Chronic liver injury from cirrhosis can result in ___________
Hypogonadism (esp in cirrhosis due to alcohol or hemochromatosis), erectile dysfunction, testicular atrophy
Reduced total T4, T3 (not free T3, T4 but total because TBG is synthesized in the liver and production is reduced in setting of cirrhosis)
Gynecomastia (high estrogen production in cirrhosis)
Telangiectasias (high estrogen)
Palmar erythema (high estrogen)
Saline responsive metabolic alkalosis has urine chloride
20mEq/L
Hypovolemia
RAAS
Open angle glaucoma presents with:
Treatment is:
Closed angle glaucoma presents with:
Treatment:
Which is an emergency?
Increased intraocular pressure, loss of ganglion cells (cupping)
- Open angle glaucoma is most common (90%) - silent progression - treatment: topical beta-blocker, alpha agonist, carbonic anhydrase inhibitor, prostaglandin analogue, surgery if refractory
- Closed angle - e.g. Acute angle closure glaucoma - leads to vision loss in hours - ophthalmologic emergency - red painful eye, blurred vision, n/v, dilated non-reactive pupil
Treatment: Pilocarpine drops, IV acetazolamide, oral glycerin, surgery
In a patient with COPD presenting with acute onset chest psi and SOB, I must always suspect a ______. What physical exam findings would be consistent ?
Pneumothorax
Acute onset chest pain, Markedly decreased breath sounds (esp on one side),
Portal HTN presents as ________. Treatment is _______.
Hematemesis, melena, hematochezia
Treatment: TIPS shunt (transjugular intrahepatic portal shunt) - lowers portal pressure.
Esophageal varices often seen in _________ (condition). Treat with: ________ (prophylactically). If actively bleeding, give _______ to stabilize patient. Give IV ________ (prophylactically in setting of bleeding), give IV ______(to stop bleeding). Perform emergent _______ (procedure).
Cirrhosis Prophylactically: beta-blocker Bleeding: 1. IV Fluids 2. IV Abx 3. IV Octreotide 4. Emergent endoscopy Give beta-blockers long-term
To determine the origin of ascites fluid, calculate the _______. If >_____, (______) is likely. If <_____, (_______) is likely.
Serum albumin ascites gradient = Serum albumin - ascites albumin. Normally, the SAAG is 1.1 = portal HTN. (if total protein is high, it is due to heart failure or Budd-Chiari, if total protein is low, it is due to cirrhosis.
<1.1 = low albumin in serum (nephrotic syndrome, TB or pancreatitis)
A patient with FAP, an autosomal __________ (genetic pattern of inheritance) needs a prophylactic _______ esp. if he/she is symptomatic.
Colectomy.
What is one of the classic findings (heard on auscultation) after an MI?
A 4th heart sound (S4) - diastolic dysfunction from an MI may lead to a stiffened left ventricle.
When is pulsus paradoxus seen?
Seen in cardiac tamponade with a sudden drop in systolic blood pressure on inspiration. Also COPD.
Diabetic retinal changes can be categorized as ________, ______, or _______.
Treatment is _______
Simple/background - retinal edema, retinal hemorrhages, microaneursyms
Pre-proliferative - cotton wool spots
Proliferative - neo-vascularization
Treatment: argon laser photocoagulation
Low-grade fever, bloody nasal discharge, nasal congestion and eyes involvement (diplopia, chemosis, proptosis) especially in an immunocompromised patient like a not well-controlled diabetic a concerning for ______. Responsible organism is usually ______.
Treatment:
Mucormycosis. Rhizopus.
Treatment: Surgical debridement and Amphotericin.
GI loss esp gastric loss results in a metabolic _______. This is characterized by ____(low/high) Cl-, ____(low/high) K+, ____ (low/high) bicarbonate. Replete with______.
Alkalosis.
Low Cl-
Low K+
High bicarbonate
Replete with isotonic saline and potassium
What is the first step in evaluating melanoma? Next step?
- Excisional biopsy
- Excision with clear margins - if 99% 5-yr survival.
If >1mm depth, need sentinel lymph node biopsy.
Breslow depth
How do you manage peripheral artery disease once you have the ABI?
- Smoking Cessation. Lipid-lowering agent (Statin). Screen for HTN/DM.
- *EXERCISE THERAPY must be suggest first for all pts with intermittent claudication. See if symptoms improve. If not, then advance to more invasive options.
- Cilostazol and surgical revascularization.
Asymptomatic PVCs should be ______
Treat symptomatic PVCs with a _____
Observed
Beta-blocker
What are the symptoms of hypercalcemia? There’s a great mmenomic for it!
Stones
Bones - bone pain
Groans - Muscle pain/weakness, Pancreatitis, PUD, Constipation, Gout
Psychiatric overtones - depression, sleep disturbances
In which condition is the chloride/phosphorus ratio > 33:1
Primary hyperparathyroidism due to chloride wasting that occurs secondary to renal bicarbonate wasting which is a direct effect of PTH.
A calcium >13mg/dl should make me suspicious of ______. To confirm, the PTH is usually <____ (numerical value)
Malignancy
<20pg/ml
Any patient with symptomatic moderate hypercalcemia (12-14) or ANY sever hypercalcemia (>14) should IMMEDIATELY get ______ before any further work-up.
- IV Fluids
- Next give calcitonin which is active over 4-6hrs.
- For long-term management, give bisohosphonates.
Diffuse bone pain, muscle weakness, muscle cramps, waddling gait in the setting of low/normal calcium and low phosphate are concerning for osteomalacia which is a defect in the MINERALIZATION of bone (not enough calcium, phosphorus or Vit D). It is characterized by ______. What are some causes/assns?
High PTH
Impaired absorption (Celiac Sprue, Malabsorption, intestinal bypass surgery)
Chronic liver disease
Chronic kidney disease
Characterized by pseudofractures (looser regions on radiology)
Lab abnormalities expected: low Ca2+, low phosphorus, low Vit D, high PTH, high Alk Phos, low urine calclium
Diffuse interstitial infiltrates and hilar lymphadenopathy is consistent with ______
Sarcoidosis
Diabetic nephropathy is characterized by ____ on histology
GBM thickening, mesangial expansion, glomerular hypertrophy. Patients usually get microalbuminuria after the first 5-10 years of their diagnosis. Nodular glomerulosclerosis (Kimmelsteil-Wilson nodules) are pathognomonic.
Hereditary spherocytosis. Inherited in an autosomal _____ pattern. Dysfunctional protein is _______, ________.
Clinical symptoms triad:
Lab abnormalities?
Treatment?
Autosomal dominant
Clinical symptoms: hemolytic anemia, jaundice, splenomegaly
Ankyrin, Spectrin
Lab abnormalities: High mean corpuscular Hgb concentration, osmotic fragility on acidified glycerol lysis test, abnormal eosin-5-maleimide binding test, spherocytes
Treatment: Folic acid supplements, blood transfusions, and splenectomy
Senile purpura which appears as purpura on the dorsum of the forearms of elderly people or ppl with lots of sunlight exposure occurs from…
Perivascular tissue atrophy. Loss of elastic fibers by vasculature.
First degree AV block with a narrow QRS that is asymptomatic (no syncope) should be _______
First degree AV block with a wide QRS is concerning for _____ and should undergo an ________ (study)
Observed
Bundle branch conduction delay; Electrophysiologic study
Paroxysymal nocturnal hemoglobinuria is caused by …_____
One of the common associations is _______
Diagnose with _____
Treat with _____
GP1 is abnormal so CD 55 and CD 59 cannot bind to the cell membrane surface. This results in an intravascular hemolytic anemia.
Commonly associated with hepatic venous thrombosis. Also, mild thrombocytopenia.
Diagnose with flow cytometry for CD55, CD 59
Treat with glucocorticoids (prednisone) and if no response, bone marrow transplant.
Hodgkin’s lymphoma is associated with _____?
Minimal change disease
Renal cell carcinoma can present with following lab abnormalities:
Physical exam findings:
Appropriate work-up is:
Erythrocytosis or anemia
Thrombocytosis
Left-sided scrotal varicoceles (that fail to empty when pt is recumbent)
Large abdominal mass
Diagnosis: Abdominal CT
Bell’s palsy
Treatment: none of less than 1mo. Prednisone and acyclovir if Lyme is not suspected.
DDx: Lyme, Trauma, Tumor, Herpes Zoster
What are some UMN signs?
Spasticity, Hyperreflexia, Clonus, Positive Babinski’s sign
A positive ANA, anti-Smith antibodies make you think…
SLE (Lupus)
Anti-histone antibodies should make you think…
Drug-induced lupus antibodies. Examples of common offenders: hydralazine, procainamide.
Anti-centromere antibody is associated with what auto immune condition?
CREST
Sjogren’s is associated with what concerning condition that is most common cause of death?
Non-Hodgkin’s lymphoma
Schirmer test is…
Test for Sjogren’s where filter paper is placed in your eye. A biopsy of the salivary gland is most accurate BUT BY NO MEANS NECESSARY for diagnosis.
Anti-RNP antibodies are associated with…
Mixed Connective Tissue Disease (mix of SLE, systemic sclerosis, RA, Polymyositis)
Rheumatoid arthritis tends to have ________ characteristic pleural effusion finding?
What is the time period required for symptoms before a diagnosis of rheumatoid can be made?
Very low glucose (and low complement).
6 wks
If a patient has acute gout, which medication do you want to treat with?
If a patient with gout is on a diuretic, what do you have to realize?
NSAID - indomethacin (or any other)
If the patient is on a thiazide or loop diuretic, realize they increase risk of gout.
In older patients, dermatomyositis (gottron’s papules over MCP, DIP, PIP) is usually associated with?
Malignancy. Often dermatomyositis due to malignancy remits once it is removed.
Otherwise treat dermatomyositis with corticosteroids. If no response, advance to alkylating agent.
Polymyalgia rheumatica - elderly, 70 year olds, hip and shoulder stiffness (esp after inactivity), pain on movement.
Diagnosis:
Treatment:
Diagnosis: Clinical, usually high ESR
Treatment: Corticosteroids (1-7 days is when response is seen). 4-6 wk taper.
Ankylosing spondylitis is associated with ______ (HLA).
Diagnosis:
Treatment:
Concern:
HLA B-27
Diagnosis: imaging of spine, – sacroilitis (sclerotic changes), bamboo spine
Treatment: NSAIDs (indomethacin), TNF- alpha inhibitors, physical Therapy, surgery if serious deformity.
Concern: Even minor trauma where they complain of neck or back pain requires immobilization due to concern for spinal cord injury.
Reactive arthritis is associated with ______ syndrome which presents with _______ (triad of symptoms). The most common offending agents are: Salmonella, Shigella, Campylobacter, Chlamydia, and Yersinia. Look for a GI or GU infection 1-4 wks before. HLA B-27
Diagnosis:
Treatment:
Reiter syndrome
Triad - can’t see (uveitis)’ can’t pee (urethritis or cervicitis), can’t climb a tree (arthritis)
Diagnosis: send off synovial fluid to rule out crystals or infection
Treatment: NSAIDs, Sulfasalazine, Aziothioprine,
A patient >50 years, with palpable/tender temporal artery, with severe headache, with jaw claudication is expected to have ______ (diagnosis) and _______ (lab abnormality). Biopsy is required for diagnosis. Start treatment BEFORE getting definitive diagnosis. Associated diagnosis: _______
Treatment:
Temporal arteritis/Giant cell arteritis
High ESR
Treatment: Prednisone. If visual loss is present, admit patient for IV steroids.
Associated diagnosis: Polymyalgia rheumatica
Sinusitis, with purulent or bloody nasal discharge, oral ulcers, pulmonary symptoms, and glomerulonephritis, and conjunctivitis scleritis and arthralgias/myalgias should make me think of ______ (disease) associated with ________ (serology)
Diagnosis:
Treatment:
- GPA
- C-ANCA, also elevated ESR, abnormal CXR, anemia. Open lung biopsy needed for definitive diagnosis.
Treatment: most pts die in 1 yr of diagnosis. Cyclophosphamide + corticosteroids can be tried.
Polyarteritis nodosa never involves this organ: _______. It is associated with fibrinoid necrosis and intimal proliferation.
Diagnosis:
Treatment:
Lungs
Diagnosis: Biopsy of involved tissue and mesenteric angiography
- ESR elevated, p-ANCA present
- FOBT
Treatment: Poor prognosis. Corticosteroids. Add cyclophosphamide if severe.
Fatty casts in a UA suggest…
Nephrotic Syndrome
A mild transaminitis, elevated bilirubin with negative Hepatitis serologies, and Mallory bodies, and hepatocellular necrosis of biopsy with resting tremor, muscular rigidity, clumsy gait, slurred speech, and drooling in a young person who only occasionally drinks should be concerning for…
Diagnosis:
Treatment:
Wilson’s disease
Diagnosis: Low serum ceruloplasmin, urinary copper excretion, Kayser-Flesicher rings on slit lamp.
Treatment: D-penicillinamine, Zinc. Definitive if unresponsive: transplant.
Plasma osmolality equation
2*Na + BUN/2.8 + Glu/18
Microalbuminuria can be an early sign of ….
Diabetic Nephropathy
Fusion of foot processes on renal electron microscopy should make me think of ______ (disease). Associations: _______ (2 malignancies).
Treatment:
Minimal change disease.
Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
Treatment: Steroid therapy (4-8 wks), excellent prognosis.
Goodpasture’s syndrome. ________ (antibody).
Clinical presentation:
Treatment:
IgG anti-GBM antibody
Clinical presentation: hemoptysis, cough, dyspnea, rapidly progressive renal failure. Lung disease precedes kidney disease by days to weeks.
Treatment: Plasmapheresis
Renal papillary necrosis results from…
Diagnosis:
Treatment:
Analgesic nephropathy, diabetic nephropathy, sickle cell disease, chronic alcoholism, UTI or urinary tract obstruction, renal transplant rejection.
Diagnosis: excretory urogram
Treatment: stop the offending agent
What is the electrolyte abnormality of a distal, Type ___ RTA?
Clinical presentation:
Treatment:
Type 1 Distal RTA - Hypokalemic, hyperchloremic metabolic acidosis (normal anion gap)
Clinical presentation: Renal Stones, inability to acidify urine below pH of 5.5, Rickets/osteomalacia in children.
Treatment: Sodium bicarbonate
What is the major defect in Proximal, type ____ RTA?
What clinical presenting symptom is ABSENT in this diagnosis that distinguishes it from other RTAs?
Treatment:
Type 2 RTA
There are no stones in proximal RTA. It is a hypokalemic, hyperchloremic metabolic acidosis like distal, type 1 RTA so beware.
Treatment: Sodium restriction
Pellagra is often caused by ________. It is characterized by the mmenomic: ______, _______, _______, and ________.
Treatment:
Niacin deficiency/ Vit B3.
Diarrhea, dermatitis, dementia, death.
Treatment: Nicotinamide
Flank pain radiating to the groin should make me think of _____
Diagnosis:
Treatment:
Renal colic
Other clinical features include: hematuria, n/v, UTI
Diagnosis: CT scan W/O contrast. If pregnant, renal ultrasound.
Treatment: IV morphine, IV NSAIDs (ketorolac), IV Fluids. Antibiotics if UTI is present. Manage pts outpatient unless they have fever, are anuric, have stone >1cm, UTI, uncontrolled pain.
Consider urology consult if a stone does not pass spontaneously in 3 days.
Thiazide diuretics _________ urinary calcium. I.e. cause ______calcemia.
Loop diuretics _________ urinary calcium. I.e. cause ______calcemia
Thiazides cause hypercalcemia by decreasing urinary calcium excretion.
Loop diuretics increase urinary calcium excretion and thereby cause hypocalcemia.
Air fluid levels in the gallbladder on abdominal radiograph or curvilinear gas shadowing in the gallbladder on ultrasound in the setting of n/v, RUQ pain, and low grade fever is concerning for….
Demographic:
Treatment:
Emphysematous cholecystitis
Demographic: Elderly diabetic males
Treatment: Amp-Sulbactam, Pip-Tazo, Aminoglycoside or Floroquinolone + Clindamycin, Metronodazole.
Offending agents: Clostridium, Escherichia, Staph, Strep, Pseudomonas, Klebsiella
COPD Exacerbation is characterized by the following 3 symptoms:
Oxygen target saturation:
Incr cough, incr SOB, incr sputum production (change in color, volume)
Oxygen target saturation: 88-92%
Smudge cells on peripheral smear in the setting of extremely high WBC count with lymphoctyic predominance suggest: ______.
Other clinical clues:
Demographic:
Diagnosis: ________
Treatment: ________
Chronic lymphocytic leukemia
Clinical clues: Painless generalized lymphadenopathy; splenomegaly.
Age: >50-60 years old.
Diagnosis: Flow cytometry
Treatment: Chemotherapy for symptomatic relief.
Unexplained hemolytic anemia and thrombocytopenia in a patient with neurologic symptoms and renal failure suggests…
Treatment:
Schistocytes on a blood smear suggests:
TTP-HUS
Treatment: Plasmapheresis
The presence of schistocytes suggests a micro angiostatin hemolytic anemia.
DIC is essentially ________ (pathogenesis).
It is characterized by _________
The paradox is that ______ and ______ occur
Most common cause:
Treatment:
Intravascular activation and consumption of the coagulation cascade.
Characterized by: thrombocytopenia, microangiopathic hemolytic anemia, prolonged PT and PTT. Low levels of fibrinogen, factors V and VII.
Paradox: simultaneous bleeding and thrombosis
Most common cause: Gram -ve sepsis
Treatment: If severe bleeding: FFP (clotting factors), platelet transfusion, cryoprecipitate (clotting factors + fibrinogen), oxygen, IV Fluids
Bloody diarrhea is often caused by which 3 agents: ________.
If it is EHEC, the diarrhea goes from watery to bloody. Diagnosis for EHEC: ______. Treatment: _____.
Escherichia Coli, Shigella, Campylobacter
EHEC diagnosis: Stool assay for Shiga Toxin.
EHEC Treatment: DO NOT treat EHEC with antibiotics as this has been shown to increase HUS risk.
Scaly patches with central clearing and clear borders on skin is concerning for ________.
Tinea corporis (dermatophyte). On microscopic exam with KOH, you should see hyphae.
Treatment: Topical antifungal (terbinafine) or systemic (griseofulvin).
With a PSA<4ng/mL that is symptomatic for BPH, just start ________
Tamsulosin, doxazosin (alpha-1 antagonist)
Increase in pH ________ (increase/decrease) albumin’s affinity for calcium.
What are the clinical manifestations of the ensuing _____calcemia (hypo/hyper):
Increases. Meaning alkalosis means more calcium BOUND to albumin.
Hypocalcemia: carpopedal spasm, paresthesias, crampy pain)
Anaphylactic shock is marked by ______ (2 vital sign abnormalities)
Treatment:
Hypotension, tachypnea
Treatment: Intramuscular epinephrine
Mild persistent asthma that is currently being treated with a Short acting beta agonist should have what added to the regimen?
Inhaled corticosteroids.
Pronator drift is a sign of _______ (type of disease)
UMN lesion.
Benign essential tremor’s tremor is usually more apparent as people are reaching for sthg. Treatment:
Propanolol.
Hepatocellular carcinoma is associated with _____ (low/normal/high) AFP.
High AFP
People with HIV infection should be vaccinated against…
Pneumococcus (unless they received a vaccination in the past 5 years). If their CD4 count is less than 200, the vaccine should be repeated again once their CD4 count is over 200.
Asplenic HIV pts should be vaccinated against HiB and Meningococcus.
MSM and IVDU HIV+ pts should be vaccinated against Hep A.
All HIV+ pts should get yearly flu vaccine. DO NOT give live attenuated vaccine to pts with CD4 count less than 200.
Hypovolemic Hypernatremia should be treated with…
Normal Saline if severe and then D5 1/2 NS.
Sympathetic ophthalmia can occur in a spared eye when the other has been injured resulting in floaters, blurred vision in the spared eye. It is thought to be due to _________.
Uncovering of hidden antigens
Bactrim + _________ should be given to HIV+ patients with PO2< 70 or A-a gradient >35 as it has been shown to abate initial worsening with antibiotic induced therapy.
Corticosteroid
Sideroblastic anemia is marked by abnormality in RBC Iron metabolism. ______ (low/high) serum iron, _____ (high/low) ferritin, normal TIBC, ringed sideroblasts in bone marrow.
High serum iron
High ferritin
Normal TIBC
Vit B12 deficiency leads to increased MMA and homocysteine. Folic acid deficiency leads to just increased homocysteine.
Repeat.
Treat HCM with ___________ or __________. Where is the murmur best heard?
Beta-blocker or CCB like diltiazem.
Best heard at left sternal border as opposed to AS (R sternal border).
Squamous cell carcinoma of the lung is associated with _______ (paraneoplastic product) that results in ________ (metabolite abnormality) which presents as increased thirst, anorexia, constipation, easy fatigability.
PTHrp
Hypercalcemia.
Small cell carcinoma of the lung is associated with _______ and ______ paraneoplastic syndromes.
Ectopic ACTH,
SIADH
Dypyridamole and adenosine are coronary vasodilators. When administered to a normal heart, they increase coronary blood flow. When administered to a diseased heart, the blocked vessels are already maximally dilated so the incr bloodflow is redirected to non-diseased parts of the heart. This process is known as ________________.
Coronary steal.
Brain death required confirmation of ___ physicians. It is defined as:
Absent cranial reflexes, fixed and dilated pupils, no spontaneous breaths and agreement of TWO physicians.
All neurogenic tumors are located in the ________ mediastinum.
Posterior
Dilated cardiomayopathy secondary to alcohol presents as:
Macrocytosis (high MCV), transaminitis, and thrombocytopenia in the setting of dilated cardiomyopathy.
Bactrim, methotrexate, and anti-epileptic drugs like phenytoin can cause a macrocytic anemia that results from _______ deficiency.
Folate
An elderly person with back pain, hypercalcemia, and renal failure has _________ until proven otherwise. (anemia may also be a clue).
Multiple myeloma.
Paraproteins (Bence Jones proteins) lead to renal failure.
Valgus stress tests tests the integrity of the….
MCL
Anserine bursitis is suggested by pain in what location?
What test fails to reproduce the pain?
Anteromedial part of the tibial plateau just below the joint line.
Valgus tests fail to reproduce pain.
X-rays are normal.
Avoid beta blockers if someone is __________ or _________.
Hypotensive or bradycardic.
People with PAD have a 20% 5-yr risk of having a _____ or _____.
MI or stroke.
Only 1-2% have risk of critical limb ischemia leading to limb amputation.
What is the most common cause of death following an acute MI?
Reentrant ventricular arrythmia (V.Fib).
For a solitary brain metastasis, standard of care is…
Resection of the mass followed by WHOLE brain radiation.
For multiple brain metastases, standard of care is…
Palliative WHOLE BRAIN radiation.
Approximately ___% of actinic ketatoses become squamous cell carcinoma.
1%. Actinic ketatoses are considered pre-malignant lesions.
Initial management of fibromyalgia is…
If the initial treatment is failed, two meds that can be used are ______ and _____
Patient education, regular aerobic exercise, and good sleep hygiene.
Duloxetine and TCAs.
What is the most common type of pituitary tumor?
Presenting Symptoms:
Prolactin producing tumor or lactotroph adenopathy accounts for 50% of all primary pituitary tumors.
Symptoms: Hypogonadism and galactorrhea
For the PPD test, people with low risk of infection are considered to have +ve PPD if it is >= ____ mm.
For people with prolonged healthcare exposure, children ____mm.
For immunocompromised or ppl with exposure to a confirmed case or ppl with CXR consistent with previously healed TB, +ve result is > ____ mm.
15 mm (low risk etc.)
10mm (healthcare exposure, IVDU,
Palatal ulcers, chest x-ray findings of hilar adenopathy (w/or w/o interstitial pneumonitis, and hepatosplenomegaly, lymphadenopathy) in a (HIV+) immunocompromised pt are concerning for…
Histoplasmosis
Signs of venous overload, Sharp x and y descents and pericardial calcification are concerning for ______.
In the US, common causes are:
In endemic areas:
Constrictive pericarditis.
US: Viral or idiopathic (40%), radiation therapy (30%), cardiac surgery (10%), connective tissue disorders.
Endemic areas: TB
What condition is common in new mothers who hold their infants with thumb outstretched:
Passive stretch elicits pain.
De Quervain’s tenosynovitis.
Affects abductor pollicis longus and extensor pollicis brevis.
Treat variant (Prinzmental) angina which usually occurs in young female smokers with virtually no evidence of CV disease with ________ or ________. The angina in this condition is due to ________.
Beta blockers or CCBs.
Cornonary vasospasm
Dull, tympanic membrane that is hypomobile and especially in an immunocompromised patient is concerning for …
Serous otitis media (non-infectious effusion)
A concerning adverse effect/concerns of following anti-thyroid drugs:
Methimazole -
PTU -
Both - agranulocytosis. PTU is preferred in 1st trimester of pregnancy. Also MMI causes cholestatic jaundice.
In acute hepatitis, AST and ALT are elevated with ____ elevated more so. This is followed by elevated bilirubin and alkaline phosphatase.
ALT elevated more than AST.
Rash, arthritis, very high fever is concerning for…
Adult’s Still’s disease. This is RARE
A testicular tumor that produces lots of estrogen (and can present w/gynecomastia) is…
Leydig cell tumor
Testicular tumor. Which testicular tumor presents with elevated AFP?
Yolk sac tumor.
A pt with minimal BRBPR who is less than 50 should get what procedure first? This does NOT include blood intermixed with stool.
Anoscopy
Toxic epidermal necrolysis and Steven’s Johnson are in the same spectrum. Both involve oral mucosa. TEN involves > ___% of body, Steven’s Johnson up to ___%.
Steven’s Johnson: up to 10%
TEN: >30%
NSAIDs, Barbituates, Phenytoin, Sulfonamides
Use a thiazide diuretic to prevent hypercalciuria in calcium stones (nephrolithiasis).
Repeat.
Also limit sodium intake.
For first stone, no need for intervention: hydrate and Watch.
Bartonella, cat-scratch disease presents with:
Treatment:
Local skin lesions: vesicular, erythematous, papular phases.
Localized regional lymphadenopathy: tender, may be suppurating.
Treatment: Azithromycin
Acne treatment & presentation.
Comedomal:
Inflammatory:
Nodular (cystic):
Comedomal: Topical retinoids. Add salicyclic acid if it fails. Closed and open comedomes on forehead/chin/nose.
Inflammatory: Benzoyl peroxide (and topical retinoids). Inflamed papules (<5mm), pustules and erythema.
Moderate and moderate-to-severe: doxycycline
Recalcitrant or severe: Oral isotretinoin
What is the mainstay treatment for prolactinomas <10mm (microadenoma) and macroadenomas?
Dopaminergic agonists (cabergoline, bromocriptine)
Low serum C3 levels, red blood cell casts and proteinuria, hematuria, hypertension after a skin or throat infection are concerning for…
Post-streptococcal glomerulonephritis.
The common medication combo used for Parkinson’s is:
Why are its early and late side effects?
Levodopa/carbidopa
Side effects:
Early: Hallucinations, dizziness, headache, agitation.
Late: (5-10yrs) involuntary movement
In anemia of chronic disease, the iron study reveals
Low serum Fe, Low TIBC, High serum ferritin, low transferrin levels.
Treatment: Treat the underlying disease. DO NOT GIVE IRON.
B12 deficiency leads to demyelination of the ______ and _______, _______ tracts leading to….(symptoms)
Posterior columns, lateral corticospinal and spinocerebellar tracts.
Symptoms: loss of position/vibratory sense in lower extremities, ataxia, and UMN signs
How do you diagnose and treat sickle cell anemia?
Diagnosis: hemoglobin electrophoresis is req’d for diagnosis, peripheral blood smear plays a role
Treatment of pain crises: IV hydration, morphine, keep to warm, if hypoxia is present, use supplemental oxygen.
A peripheral blood cell showing bite cells and Heinz bodies in the setting of hemolysis especially after starting a drug is concerning for _______
Diagnosis:
Treatment:
G6PD deficiency.
Diagnosis: Peripheral blood smear
Treatment: avoid drugs. ONLY transfuse if necessary.
ITP - immune thrombocytopenia purpura should be treated with ________
While TTP thrombotic thrombocytopenic purpura should be treated with ________
ITP - Steroids, IV immunoglobulin, splenectomy
TTP - Plasmapheresis – DO NOT TRANSFUSE PLATELETS
A prolonged bleeding time in she setting of epistaxis, easy bruising, excessive bleeding, gingival bleeding is highly suggestive of _______(disease).
Risocetin induced platelet aggregation is also reduced in this condition.
Treatment is:
VWD (Von Willebrand deficiency)
Treatment: 1. DDAVP, 2. factor VIII concentrates
Community acquired pneumonia occurs in the community of the first ____ hrs of a hospitalization. Most common pathogen: ________
2 recommended methods of prevention:
Treatment:
Treat until ____
72 hrs.
Pneumococcus
Prevention
- Flu vaccine
- Pneumococcal vaccine - >65yrs and younger ppl at high risk (pulm dx, sickle cell, Asplenic, alcoholic cirrhosis, diabetes, heart dx)
Treatment: Doxycycline, Floroquinolone, in older pts: Floroquinolone or 2nd or 3rd gen cephalosporin.
Treat until pt has been afebrile for 48 hrs
Hospital acquired pneumonia. Pathogen: ________
Treatment: _________
Pathogen: Gram -ve rods
Treatment: ceohalosporin with pseudomonas coverage (ceftazidime or Cefepime), Carbapenems, or Piperacillin-Tazobactam
Symmetric, descending flaccid paralysis in the setting of n/v, abdominal cramps and consuming home-canned foods is concerning for …
Observe _______ (clinical status indicator) carefully
Botulism
Diagnosis: need to ID toxin NOT pathogen
Treatment: admit, Observe respiratory status
Chlamydia is the most common sexually transmitted bacterial infection. Treat with:
One oral dose of Azithromycin or 7 day Doxycycline
Treat gonorrhea with ______
One IM dose of ceftriaxone.
Reflexively add one dose Azithromycin for chlamydia coverage.
Treat syphilis with _______
Benzathine penicillin (one dose IM)
What organisms are responsible for necrotizing fasciitis?
Symptoms:
How do you treat it?
Streptococcus pyogenes, Cloristidium perfringens
Symptoms: Fever and pain out of proportion to early symptoms
Treat with EMERGENT surgical debridement and then broad spectrum Abx
Trismus (lockjaw), face locked in a grin, and arched back in the setting of recent wound are concerning for ______
Treatment:
Concerning for tetanus
Treatment is a diazepam for tetany after ICU admission and then IM tetanus immunoglobulin.
How long and how should your treat osteomyelitis?
What pathogens are usually responsible?
IV Abx for 4-6 wks.
Pathogens: S. aureus and coag-negative staph
Rabies is characterized by the appearance of ______ histologically.
Treatment:
Negri bodies
Treatment: Rabies immunoglobulin or IM anti-rabies vaccine
A patient with a desquamating rash over their palms and soles who has a high fevers and a tampon in is concerning for _______(syndrome).
Treatment:
Toxic Shock Syndrome
Treatment: IV Fluids and even vasopressors, removal of source of toxin and anti-staph agent like oxacillin, nafcillin.
An elderly pt complaining of limited neck rotation and lateral bending, neck pain, and decreased pinprick sensation in his forearm has ________ (disease). On x-ray, one would find _______.
Cervical spondylosis. The limited neck rotation and lateral bending is due to osteoarthritis.
The radiculopathy is caused by Osteophytes (bony spurs). Other X-ray findings: sclerotic facet joints, narrowing of the disk spaces, hypertrophic vertebral bodies
In an HIV infected pt, bloody diarrhea with normal stool examination is highly suspicious of _______ (pathogen). Work-up should include: ___________ (procedure) which will show ______.
Treatment:
CMV colitis
Work-up: Colonoscopy w/biopsy
Findings: Colomoscopy: multiple ulcers, mucosal erosions. Biopsy: Eosinophilic Intranuclear and basophilic intracytoplasmic inclusion bodies.
Treatment: Ganciclovir
Liver metastases are most likely to originate from ________, _______, ________.
Colon, Lung, Breast
Which colonic polyps have the greatest risk for developing into cancer?
- Villous adenomas (greatest risk), OR Sessile adenomas OR Polyp greater than 2.5cm.
<1% of all adenomatous polyps (pre-malignant) become malignant.
Hyperplastic polyps and non-neoplastic polyps DO NOT require further work-up.
The only drug currently approved for use in ALS is?
Riluzole - Glutamate inhibitor. It may prolong survival time and time to tracheostomy.
If I see low complement, high RF, increased liver transaminases in the setting of palpable purpura and a glomerulonephritis with nephrotic range proteinuria, I should think _______(disease). The pathogen with which it is associated is ______ (pathogen).
Mixed Cryoglobunemia
Hepatitis C Virus
MGUS vs Multiple Myeloma
MGUS: Usually less than 3g/dL of protein in the SPEP and less than 10%plasma cells in the bone marrow.
Aspirin sensitivity syndrome should be suspected in the setting of persistent nasal blockage, aspirin ingestion, and periodic bronchoconstriction. It is a ______ (type of reaction). Treatment is _____.
Pseudoallergic reaction.
Treatment: Stop NSAIDs. Use Leukotriene Antagonists.
Crops of yellow-red papules in the setting of pancreatitis without gallstones and alcohol history are concerning for _______. Start work-up with ________.
Eruptive Xanthomas due to hypertriglyceridemia (>1000)
Start work-up with fasting lipid levels.
Chronic knee pain worsened with climbing stairs esp in a young woman is concerning for _______. Treatment is _______
Patellar-femoral syndrome. No need for MRIs or X-rays.
Treatment: stretching and strengthening thigh muscles and avoid activities that worsen the pain.
Brain abscesses are usually due to ______ (type of organism).
Anaerobic.
Aerobic/anaerobic streptococcus and Bacteriodes are usually responsible.
A study that takes diseased vs not diseased patients and retrospectively looks at their risk factor frequency is a ________ study.
A study that takes exposed vs unexposed people and looks at their incidence of an outcome is a _______ study.
A study that looks at past records to determine exposed vs unexposed ppl and then determine the presence of disease in each of those groups is a ________.
A case control looks at diseased vs undiseased people and attempts to identify their risk factors.
A prospective cohort study looks at exposed vs unexposed people and determines disease incidence in each.
A retrospective cohort study reviews records to determine exposed vs unexposed.
Cohort studies are considered stronger than case controls.
An anion gap acidosis, hyperemic optic disc and increase osmolar gap are concerning for… _______. The most common consequences are _____ and ____.
Methanol poisoning.
Vision loss and coma.
Central retinal artery occlusion is treated with ____.
Fundoscopic findings:
EMERGENT ocular massage and high flow oxygen.
Fundoscopic findings: pallor of the optic disc, cherry red fovea, and boxcar segmentation of blood in retinal arteries and veins.
A well known complication of giant cell arteritis is ________. As a result, patients with GCA should have _______
Aortic aneurysm.
Follow with serial CXRs.
Non caseating granulomas are characteristic of _______ (Crohn’s vs UC)?
Crypt abscesses are characteristic of ______(UC vs Crohn’s)?
Non caseating granuloma: Crohn’s
Crypt abscesses: UC
Cutaneous larva migrans infection is obtained through the sand. Lesions appear as pruiritic, elevated, serpiginous lesions
Repeat
Corkscrew esophagus especially in the setting of chest pain and dysphagia should make me think of ________
Diffuse esophageal spasm.
Diastolic murmurs should ALWAYS be worked up whether or not they are symptomatic.
Systolic murmurs that are loud or symptomatic should also be worked up. An asymptomatic systolic murmur in a young person is usually benign and does not need work up.
Appropriate work-up is ______
Echocardiogram
Thiazides can INCREASE LDL, increase triglycerides and cause hyperglycemia.
They are also associated with hyponatremia, hypokalemia, and hypercalcemia.
Repeat.
What drug reduces frequency of relapse and disability in relapsing-remitting MS?
Interferon-beta
Hepatolenticular degeneration is known as ________
Wilson’s disease.
Macrophages in the lamina propria or brown discoloration of the colon with lymphoid patches shining through is concerning for …
Melanosis Coli due to laxative abuse.
If a patent is on mechanical ventilation esp with an FiO2 >40%, look to see if they are hypoxemic (PO2 less than 60). If they are, one of the appropriate next steps is ________.
Consider adding PEEP.
A patient with localized small swelling along the margin of his eyelid has _________. Most likely pathogen is _______. Initial treatment is ________ and then ________ if there is no resolution in ____hrs.
Hordeolum or stye
Pathogen: Staphylococcus
Treatment: warm compresses. After 48 hrs if there is no resolution, perform incision and drainage.
Hypercalcemia due to malignancy should be managed with a …
Bisphosphonate
Only attempt surgical revascularization in PAD in someone who has _________
Limb threatening complications (Non-healing ulcers)
Significant limitation in their daily activity
Failure to respond to exercise and pharmacotherapy
Trichnellosis (roundworm from undercooked pork) should be suspected in setting of initial abdominal pain, n/v/diarrhea, and then “splinter hemorrhages”, conjunctival and retinal hemorrhages, periorbital edema and chemosis. Lab abnormalities: eosinophilia.
Repeat
What is the most common cause of mitral regurgitation in developed countries?
When is the murmur heard?
Mitral valve prolapse (Myxomatous degeneration of mitral valve.
Mid-systolic click and mid-to-late systolic click murmur.
Dressler’s syndrome is a pericarditis that happens ______ (days, weeks, months) after an MI. Treatment is: _________
weeks
NSAIDs (or steroids if NSAIDs are contraindicated)
Transient visual loss associated within “like a curtain falling down” loss of vision and whitened, edematous retina on funds optic exam is concerning for _______. Work-up: _______.
Amaurosis fugax (retinal emboli usually from ipsilateral internal carotid artery) Work-up: Carotid ultrasound
Treatment for ethylene glycol poisoning is \_\_\_\_\_\_\_\_. The \_\_\_\_\_\_\_ (organ) is at risk in ethylene glycol poisoning because ethylene glycol breaks down into oxalic and glycolic acids and the oxalic acid binds to calcium.
Symptoms:
Findings:
Fomepizole or ethanol
Symptoms: Flank pain, hematuria, oliguria,
Findings: acute renal failure, anion gap metabolic acidosis
Patients with HIV should receive the following vaccines:
Hep B vaccine
Pneumococcus
Influenza
Td booster every 10 years. Patients less than 65 who never received a Tdap should get one first and then Td booster subsequently.
80% of gallstones are cholesterol or mixed stones (w/calcium bilirubinate) that are radiolucent.
Repeat
The biggest risk factor for a stroke is not smoking, it is …
Hypertension
