Pearls_01 Flashcards by Striker 13

Patient presenting with diarrhea predominant IBS -> screen for what disease?

celiac dz

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screen for celiac dz when what GI syndrome presents primarily with diarrheas?

IBS

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Patient with exacerbation of IBD -> test for what?.

Cdiff

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test for C.diff with an exacerbation of what bowel disorder?

IBD

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f/u colonoscopy s/p polypectomy

in 3 yrs if…
in 5-10 yrs if…

3 yrs
- > 1cm, high grade dysplasia, 3 or more polyps

–> 5-10yrs if

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w/u for thyroid nodule

- first thing you check

TSH level

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w/u for thyroid nodule

- check TSH and if low, get what?

RAIU

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w/u for thyroid nodule

- check TSH, and if not suppressed, do what?

Thyroid U/S

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for a thyroid nodule, when would you do a biopsy?

If nodule is > 1cm or if thyroid u/s shows messed up thyroid (microcalcifications, increased vascularity, hypoechogencity, irr borders)

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young person with newly diagnosed diabetes -> Order what two things and why?

islet cell
glutamic acid decarboxylase (GAD) Ab titers

bc they det if TI or TII

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young person with newly dx diabetes gets and islet cell test and glutamic acid Ab titer to help dist btw TI and TII. What would you do if TI? If TII?

TI
- prescribe insulin immediately

TII

lifestyle changes, or
oral meds

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Pregnant woman with Graves hyperthyroidism -> give what in the first trimester? what in second and third trimesters?HINT: PTU = Pregnancy Trimester Uno

1st
- propylthiouracil (PTU)
(*P*regnancy *T*rimester *U*no
2nd/3rd
- methimazole

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Patient with high risk behaviors presenting with flu-like symptoms (fever, sore throat, myalgias) and lymphadenopathy (sounds like mono) -> think what type of syndrome? -> Diagnose ___ in the window period with viral load/PCR

acute retroviral syndrome

Dx HIV in the window period with viral load/PCR

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Do NOT give HIV patients what type of vaccines?

live vaccines

Yellow Fever
Influenza nasal
MMR
Varicella
Small Pox

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HIV pts cant take live vaccines, but do need what vaccines?

coccal

pneumococcal
meningococcal
Hep A
Hep B
HPV
Influenza (not nasal because it is live)
Tdap

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Prophylaxis for AIDS patients.

If CD4

CD4

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Patient with rheumatoid arthritis, splenomegaly, neutropenia, often with leg ulcers:

name syndrome
tx?

Felty’s Syndrome

Tx:

treat the RA
methotrexate is first line, - then steroids or other DMARDs

Mnemonic:
- SANTA with “Felt” on his “Belt”

Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis

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SANTA mnemonic

Felty Syndrome
- SANTA with a belt of felt

Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arhritis (RA)

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Patient with daily fever, salmon-colored rash (usually truncal), arthritis, elevated ESR and HIGH ferritin -> think what? Tx and what does it depend on?

Adult Onset Still’s Disease

Treatment depends on severity -> NSAIDs, then steroids, then DMARDs.

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Patient with asthma, rhinosinusitis, mononeuritis multiplex, and peripheral eosinophilia.

Dx? (hint: now called eosinophilic granulomatosis with polyangitis)

Lab test that confirms it?Often p-ANCA positive

Treatment?
- and what would you add if severe organ involvment?

Churg-Strauss

P-ANCA positive

Tx:
- steroids!!

Add cyclophosphamide to the steroids if severe organ involvement.

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breast cancer facts:
- Carcinoma in situ -> treatment is ___ OR ___ plus ___.

Remember _____ biopsy if invasive

When would you do adjuvant chemo?

carcinoma in situ Tx:

mastectomy, or
lumpectomy + XRT

sentinel lymph node if invasive

Adjuvant chemo if: (2 reasons)
- >1cm OR positive lymph nodes.

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breast cancer facts?

Most important prognostic factor for breast cancer?

-> lymph nodes/distant mets

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lymph nodes/distant mets is most important prognostic factor for what type of cancer?

breast

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breast cancer facts:

If ER/PR positive and PRE menopausal, Tx with?

If ER/PR positive and POST menopausal, tx with?

PRE
- Tamoxifen

POST
- aromatase inhibitor

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breast cancer facts: If HER 2 positive, tx with? What would you do prior to starting therapy?

Trastuzumab | - get heart scan or ECHO prior to starting because it can cause heart failure

Name conditions when breast cancer would be tx with the following? Tamoxifen Aromatase Inhibitor Trastuzumab

Tamoxifen - ER/PR positive in PRE menopause Aromatase inhibitor -ER/PR positive POST menopause Trastuzumab - HER 2 positive

what breast cancer drug needs ECHO prior to starting and why?

Trastuzumab | - can cause HF

Nephrotic Syndrome: | - name the characterisitcs

- HTN - Hyperlipidemia (think of lipids filling in for lost protein) - proteinuria (real foamy) = urine protein-Cr ratio > 3.5 - worsening renal failure

Name the nephropathy: - kidney bx with • diffuse glomerular membrane thickening • IgG deposits and C3 along capillary loops by immunofluoresence • subepithelial electron-dense deposits on EM (notice the pattern of deposits and thickening) What is this nephropathy assoc with? (3)

Membranous Nephropathy - assoc with Hep B - solid tumor cancers - renal vein thrombosis

Hep B, solid tumor cancers, renal vein thrombosis are assoc with what type of nephropathy?

Membranous Nephropathy

Name the nephropathy: Kidney biopsy with light microscopy showing scarring or sclerosis involving some (focal) glomeruli, which are affected only in a portion of the glomerular capillary bundle (segmental) What 3 co-morbidities is it assoc with?

FSGS -> assoc with HIV and IVDU (heroin), parvo B19 *remember it because all the abbreviated letters go together

What to order to confirm a type of nephropathy

kidney bx

name the nephropathy: - Kidney biopsy with immunofluorescence microscopy are normal (minimal change), with electron microscopy demonstrating characteristic fusion and effacement of podocyte foot processes This is assoc with what two conditions?

Minimal Change Disease | -> assoc with atopic diseases and Hodgkins lymphoma.

HIV and IVDU (heroin) and Parvo B19 are assoc with what type of nephropahty?

FSGS

atopic diseases and Hodgkins lymphoma are assoc with what type of nephropathy?

minimal change disease

Middle aged female with pruritus and fatigue found to have high alkaline phosphatase, normal bilirubin, and positive anti-mitochondrial antibodies - Dx? - Tx?

Primary Biliary Cirrhosis | -> treat with ursodiol.

Primary Biliary Cirrhosis - age and gender seen in? - name two main LFT findings? - what specific test to order for confirmation?

- middle aged female - high AlkPh - normal bili - confirm with anti-mt Ab's

Painless jaundice -> CT scan reveals diffusely enlarged pancreas “sausage-shapped”. Also elevated IgG4 -> Dx? Tx?

Autoimmune Pancreatitis -> treat with steroids

Autoimmune Pancreatitis -> treat with steroids Describe how it presents; What image would you order and what ischaracteristic finding

painless jaundice | - get CT --> "sausage-shaped" pancreas (diffusley enlarged)

Young patient with acute liver failure and psychosis and a very LOW alkaline phosphatase -> Dx? Order what lab and will it be high or low? Tx?

Wilson's Disease-> order a ceruloplasmin (will be low) -> treat with chelation therapy drugs like penicillamine.

Penicillamine (chelation therapy) is used in what disease?

Wilsons

Give condition of when you tx human bites | - and what if they are allergic to PCN?

If human bite, ALL human bites get PROPHYLACTIC Augmentin; If allergic to PCN --> Clinda + FQ

Give condition of when you tx animal bites | - two conditions

Animal bites - IF it *appears* infected, or if it involves joints, tendons, deep tissues Give augmentin - if allergic PCN --> give Clinda + FQ

TB - If PPD or QuantGold is positive -> order what imaging? If imaging shows ACTIVE TB, then Tx with what and for how long? If imaging is negative, then consider ___ TB as the dx and Tx with?

CXR If ACTIVE TB, tx with: - RIPE x 2 months --> then RI for 4 months If CXR is negative, dx is *Latent* TB - Tx with Isoniazid and B6 (pyridoxine bc isoniazid causes peripheral neuropahty and B6 helps control this) x 9 months

RIPE therapy x 2 months then RI x 4 months for TB if...?

PPD or QuantGold is positive and screening CXR shows ACTIVE TB

Isoniazid + B6 - is used for TB if... - what type of TB is this?

...If PPD or Quant Gold is positive, but CXR is negative This is Latent TB

PPD testing for TB - the sicker the pt, the less the size needed of the skin bump to dx with TB Examples: - greater than 5mm is positive for what ppltns? - greater than 10mm is positive in what ppltns? All others are greater than 15mm is positive

Greater 5mm is positive for: - HIV - cancer - transplant/chronic steroids - prior TB - known TB exposure Greater 10mm is poisitve for: - healthcare workers - prisoners - IVDU - homeless

GU infections: Vaginal discharge with a “strawberry cervix” Dx? Tx? and who gets tx?

Trichomonas -> treat with Metronidazole and treat partner

GU infections: Nonpurulent discharge, fishy odor, +whiff test, clue cells Dx? Tx?

Bacterial Vaginosis -> treat with Metronidazole

GU Infections: Thick white discharge, +KOH stain Dx? Tx?

Candida -> treat with Fluconazole

GU Infections: Mucopurulent discharge, often with bleeding after intercourse Dx? Tx? (2) - who all gets tx?

GC -> treat with Rocephin and Azithromax -> tx pt and partner

GU infections: Mucopurelent discharge, often with bleeding after intercourse - with cervical motion tenderness, adnexal tenderness DX? Tx?

PID | - rocephin and doxy

GU infections: Mucopurelent discharge, often with bleeding after intercourse - with epididymitis in males DX? Tx?

PID | - rocephin and doxy

GU infections | - name two dx in which you treat the pt and the partner

Trichomonas | GC

Metronidazole | - name two STD/GU infections it treats

Trichomonas (strawberry cervix) BV

Fluconazole tx what STD/GU infection

candida

rocephin and azithromax treats what STD/GU infection? rocephin and doxy treats what STD/GU infection?

rocephin+azithro - GC rocephin+doxy - PID

Osteoporosis -> obtain what imaging?

DEXA

Osteoporosis | - obtain DEXA for what ppltn of females?

DEXA - all F >65yo - OR >50yo with high risk factors (low body weight, smoking, alcohol) - OR anyone taking steroids >7.5mg for 3 months

Osteoporosis | - obtain DEXA for what ppltn of males?

DEXA - all M >70 (one time only if normal) OR >50yo with high risk factors (low body weight, smoking, alcohol) OR anyone taking steroids >7.5mg for 3 months

Osteoporosis | If T score

If T score Tx If T score between -1 and -2.5 (osteopenia) --> calculate FRAX

Osteoporosis: | If FRAX is >20% for major fracture OR 3% hip fracture -> next step?

treat

Osteoporosis - when would you give bisphophonates? name three reasons not to give them

normally give them, unless: - GERD - upcoming dental procedures - CKD

Osteoporosis | - if you cant give bisphophnates, give an alternative

Prolia | denosumab

Man with fatigue, decreased libido, erectile dysfunction: Dx? Check what lab?

hypogonadism -> check morning serum total testosterone

Man with fatigue, decreased libido, erectile dysfunction --> think hypogonadism --> check morning serum total testosterone What is the normal level? What is diagnostic level? When would you confirm?

Normal is >350

Man with fatigue, decreased libido, erectile dysfunction - -> think hypogonadism - -> check morning serum total testosterone If its btw 200-350, then check what?

01. free testosterone

When would you check free testosterone (as opposed to total test) in hypogonadism (male with fatige, decr libido, eretile dysfx)?

01. if total test is between diagnostic and normal levels (i.e btw 200-350) 02. if the patient is elderly or obese.

For hypogonadism, before starting testosterone replacement, what must you obtain? (2)

PSA and Hematocrit and monitor on therapy

Patient in the hospital with refractory hypotension, hypoglycemia, hyponatremia, OR outpatient with fatigue, anorexia, weight loss, nausea/vomiting Dx? Check what?

think adrenal insufficiency -> check 8am cortisol level.

Adrenal Insuff (Patient in the hospital with refractory hypotension, hypoglycemia, hyponatremia, OR outpatient with fatigue, anorexia, weight loss, nausea/vomiting) You draw an 8am cortisol, name the follwoing conditions: it is 18 it is btw 3-18, then you need to do what? and name the conditions of this test to r/i and r/o AI

8 am cortisol 18 rule out AI btw 3-18 - do a cosyntropin stim test - > if cortisol stims to >18 then rules AI out if

Best way to assess for respiratory decline in a patient with neuromuscular disease?

-> bedside vital capacity

Patient with recurrent sinopulmonary infections, nasal polyps, and clubbing Dx? DxM? - what number shows it is positive?

CF | -> diagnose with sweat chloride test -> if it is >60 = positive

Patient with fever, weight loss, high risk behavior (or TB exposure) with an exudative, lymphocyte predominant pleural effusion - > best test for TB in this case? - -> what level of this test is highly specific? - what tx would you start them on?

adenosine deaminase - > ADA >70 is highly specific - > start on RIPE therapy