Rosh Material #3 Flashcards
primary PTX mc occurs in what pt pop
tall, thin boys
men aged 10-30 yo
what do you think when you see: abrupt onset of SOB, decreased chest excursion, diminished breath sounds, decreased tactile fremitus
PTX
what do you think when you see: hypotension, tachycardia, mediastinal/tracheal shift
tension PTX
what do you think when you see: visceral pleural line that can be seen only on expiratory films
PTX
increased radiolucent costophrenic sulcus on CXR
contralateral shift in the mediastinum
deep sulcus sign → PTX
order of tx for PTX based on severity
- obs and O2
- simple drainage w. small bore catheter
- small bore chest tube
- chest tube w. suction
which PTX require chest tube w. suction
large PTX
tension PTX
secondary PTX
severe sx
tx for recurrent PTX
thoracoscopy
OR
open thoracotomy
4 types of PTX
spontaneous → primary (tall, thin men) vs secondary (chronic dz)
iatrogenic
traumatic
catamenial → result of thoracic endometriosis
what drug is used for prevention of pneumocystis PNA
bactrim
what do you think when you see: HA, aquagenic pruritis, ruddy facial plethora, palpable splenomegaly, erythromalagia
polycythemia vera
leading cause of death in polycythemia vera pt
thrombosis
what gene mutation is associated w. polycythemia vera
JAK2
complications of polycythemia vera
malignancy
myelogibrosis
AML
myelodysplastic syndrome
tx for polycythemia vera
- phlebotomies to maintain Hct <45
- low dose ASA
- cytoreductive therapy for high risk → hydroxyurea or interferon
- anticoagulation
bone marrow bx findings of: hypercellularity for age w. trilineage growth (panmyelosis), prominent erythroid, granulocytic, and megakaryocytic proliferation w. pleomorphic mature megakaryocytes
polycythemia vera
pruritis following a warm bath or shower
polycythemia vera
what is Budd Chiari syndrome
disorder that occurs when the hepatic venous outflow is obstructed dt a thrombus w.in a hepatic vein
what do you think when you see: pallor, jaundice, dark urine, anemia, hepatosplenomegaly
beta thalassemia major
iron storage disorder in which iron absorption is increased and stored as hemosiderin in the liver, heart, pancreas, pituitary testes, kidneys and adrenals
hereditary hemochromatosis
sx of hereditary hemochromatosis
fatigue
arthralgia
arthropathy
hepatomegaly
skin pigmentation
hepatic dysfxn
cardiac enlargement/failure
DM
ED
liver bx showing Prussian blue stain
hereditary hemochromatosis
→ due to intense iron stores in the liver
how much etch intake/day increases risk of developing cirrhosis
>30 grams
how much etch intake/day increases risk of developing cirrhosis
>30 grams
dx for hereditary hemochromatosis
MRI
OR
liver bx
also HFT genotype
which DM med has been shown to lower A1C levels and reduce the risk of CVD in adults w. T2DM
empagliflozin
pneumococcal vaccine is recommended for what 2 pt pops
adults 65 or older
adults < 65 w. rf
mc s.e of isoniazid
peripheral neuropathy
hepatitis
rash
mild CNS
mc s.e of rifampin
hepatitis
flu like
GI bleed
kidney failure
mc s.e of Pyrazinamide
hyperuricemia
hepatotoxic
rashGI
joint aches
mc s.e of ethambutol
optic neuritis
mc s.e of streptomycin
CN VIII damage
nephrotoxic
how many mm of induration will be present on a pt w. HIV and TB who undergoes TB skin test
5 or more
6 p’s of acute arterial embolism
paresthesia
pain
pallor
pulselessness
paralysis
poikilothermia
childhood condition that is most acute
follows viral infxn
sx include: petechiae, gingival bleeding, epistaxis, menorrhagia, GI bleeding, intracranial hemorrhage
immune thrombocytopenia of childhood
management of immune thrombocytopenia of childhood
supportive
platelets
corticosteroids
IVIG or anti-D immunoglobulin
splenectomy
emergent care if severe sx (ex GI bleeding)
labs associated w. immune thrombocytopenia of childhood
isolate thrombocytopenia w. normal Hgb, Hct, and WBC
platelet count < 100,000
autoantibodies associated w. immune thrombocytopenia of childhood
glycoprotein IIb/IIIA complex
what steroid sparing agents are appropriate for chronic immune thrombocytopenia in children
rituximab
thrombopoietin receptor agonists (romiplostim, eltrombopag)
azathioprine
mycophenolate mofetil
meds that commonly cause pill esophagitis
abx
NSAIDs
bisphosphonates
KCl
quinidine
vitamin C
iron
3 abx that commonly cause pill esophagitis
tetracyclines
bactrim
clindamycin
gradually progressive dysphagia to solids
can be due to GERD, pt’s undergoing xrt, eosinophilic esophagitis
esophageal stricture
first line tx for benign esophageal strictures
esophageal dilation
2 mc presenting sx of colorectal ca
painless hematochezia
change in bowel habits
bowel obstruction and change in bowel habits are mc with __ sided colorectal ca
left
hematochezia and IDA are mc seen w. __ sided colorectal ca
right
what does “apple core lesion” make you think of
circumferential colorectal carcinoma
anemias w. low MCV
IDA
sideroblastic
thalassemia
anemia of chronic dz
anemias w. high MCV
B12/megaloblastic/pernicious
what does basophilic stipling make you think of
lead poisoning
thalassemias
etch
heavy metal poisoning
only anemia associated w. increased TIBC
iron deficiency anemia
mc cause of large bowel obstruction in older pt
neoplasm
mc cause of PUD
h pylori
NSAIDs
duodenal ulcers affect what pt pop
gastric ulcers affect what pt pop
duodenal: young
gastric: older
gs dx for peptic ulcers
endoscopy
gs testing for h. pylori
urea breath test
fecal antigen assay
serology
quadruple therapy for h. pylori
bismuth
metronidazole
tetracycline
omeprazole
areas of macrolide resistance
triple therapy for h. pylori
omeprazole
clarithromycin
amoxicillin
metronidazole if pcn allergy
most sensitive test for h. pylori
urea breath
where in the stomach are the most benign ulcers found
antrum
chronic insomnia is defined as
sx at least 3x/week for at least 3 months
first line tx for insomnia
CBT
when would you order polysomnography for insomnia
cases where organic cause is suspected
ex OSA
pharm for insomnia
benzos
non benzo receptor agonists
sedatives
melatonin agonists
suvorexant
antipsychotics
2 mc relaxation based strategies for insomnia d.o
progressive muscle relaxation
diaphragmatic breathing
pt takes a deep breath while examiner palpates upward in area of gallbladder fossa
murphy sign
cholecystitis PLUS elevated bilirubin and alk phos is concerning for (4)
biliary obstruction
cholangitis
choledocholithiasis
mirizzi syndrome
order of dx tests for cholecystitis
- US
- cholescintigraphy (HIDA) → if dx unclear
- CT
preferred definitive tx for cholecystitis
cholecystectomy
test to order for cholecystitis with coexisting elevated bilirubin, elevated liver enzymes, or e.o bile duct dilation on US
MRCP (magnetic resonance cholangiopancreatography)
to r.o choledocholithiasis
what is Charcot triad
jaundice
fever
RUQ pain
hyperesthesia, increased or altered sensitivity below the right scapula
boas sign → cholecystitis
painful linear tear in the anal canal
anal fissure
causes of anal fissure
low fiber diet
passage of hard or large stools
anal trauma
what do you think when you see “severely painful BM and bright red blood per rectum during BM”
anal fissure
primary anal fissures are located __
and caused by __ (6)
posterior midline
local trauma, constipation, diarrhea, vaginal delivery, anal intercourse
lateral anal fissures are located __
and caused by __
lateral
Crohn dz, granulomatous dz, malignancy, communicable dz
management of anal fissures
topical nifedipine or nitroglycerin
topical analgesic
stool softener
sitz bath
fiber
what do you think when you see “erythematous ulcer on anal margin”
Crohn dz
what do you think when you see: “perineal induration” accompanied by erythema, fever, drainage
anorectal abscess
what do you think when you see: “tender palpable mass on anal margin” and rectal bleeding
external hemorrhoids
less painful than anal fissure
if anal fissures are located __,
search for pathologic etiologies
laterally
what is second-line tx for persistent anal fissures
topical nitroglycerin or nifedipine ointment
mc type of lung ca
not associated w. smoking
adenocarcinoma
acute purulent inflammation of the eyelid
mc at or near eyelash follicle
hordeolum (stye)
mc cause of hordeolum
staph aureus
tx for hodeolum
warm compress
abx are rarely effective
blocked oil gland on eyelid
mc found above eyelashes on upper lid
firm, painless
chalazion
tx for chalazion
warm compress
steroid injxn
surgery
diffuse eyelid inflammation
often associated w. rosacea or seborrhea dermatitis
blepharitis
sudden and rapid rise in intraocular pressure
acute angle closure glaucoma
classification finding on fluorescein stain for HSV keratitis
dendritic branches
what is this showing
basal cell carcinoma
slow growing
waxy/pearly nodule
rolled borders
telangiectasias
basal cell carcinoma
tx for basal cell carcinoma
topical imiquimod
5 fluoracil
curettage and electrodessication
excision
mohs micrographic sx
which tx for skin ca has the highest cure rate and results in least amount of tissue loss
mohs micrographic sx
painless, firm, shiny, flesh colored or bluish-red nodule on sun exposed area
rarely has ulceration or crusting
merckle cell carcinoma
non healing ulcers/warty nodules
may crust or bleed
common in pt who sunburn easily
squamous cell carcinoma
which type of Hodgkin lymphoma is mc
non-hodgkin
what pathogen mc causes prostatitis in men > 35 yo
e.coli
also: proteus, enterobacteriaceae, pseudomonas
fever, urinary retention, irritation w. voiding, fever
warm, edematous, exquisitely tender prostate
often in setting of recent urinary catheter
prostatitis
tx for prostatitis
bactrim
fluoroquinolone
x 4-6 weeks
pathogens associated w. prostatitis in men < 35 yo
Neisseria gonorrhoeae
chlamydia trachoma’s
tx for prostatitis associated w. STI
ceftriaxone
doxycycline
uniform, enlarged, firm prostate w. a palpable median sulcus
BPH
what class of med is recommended in the initial tx for symptomatic prostatic hyperplasia
alpha-1 adrenergic antagonists → tamsulosin, terazosin
avoid what tx for prostatitis
vigorous prostatic massage
what type of bacteria is associated w. struvite stones
proteus mirabilis
urease producing bacteria → magnesium phosphate crystals
what do you think when you see: pyuria and WBC casts
pyelonephritis
imaging of choice for pyelo
abd/pelvis CT
what do you think when you see: f/c, recent UTI, flank pain, CVA tenderness, n/v
pyelonephritis
mc bacteria associated w. acute pyelonephritis
e.coli
proteus mirabilis
klebsiella
staph
op management for pyelonephritis
cipro, levo
OR
bactrim
inpt tx for moderate pyelonephritis
ceftriaxone
OR
cipro/levo
inpt tx for severe pyelonephritis
cefepime
OR
zosyn
OR
meropenem
how many colony forming unites of a single organism on urine culture are suggestive of UTI
100,000
mc pathogens associated w. acute bronchitis
influenza A and B
parainfluenza
coronavirus
rhinovirus
RSV
bacterial causes of acute bronchitis
mortadella pertussis
mycoplasma pneumoniae
chlamydia pneumoniae
sx of acute bronchitis
cough lasting 5 days or more
purulent or non purulent d.c
+/- preceding URI
widening of bronchioles d.t chronic infxn
persistent cough w, mucopurulent sputum
recurrent lung infxns
hemoptysis
bronchiectasis
differentiating factor between bronchitis and PNA
f/c
anorexia
abnormal vitals
lung consolidations on CXR
what is the name of the pulmonary PE test performed by placing the ulnar aspects of both hands agains the pt’s chest while pt says “99”
tactile fremitus
mc location for disc herniation
L4-5
L5-S1
test to order if you suspect cauda equina
MRI
2 mc surgical procedures for lumbar radiculopathy
open discectomy
microdiscectomy
pain down the back of the leg is associated w. which myotome
S1
pain down the lateral leg is associated w. which myotome
L5
pain down the anterior leg is associated w. which myotome
L4
pain down the medial leg is associated w. which myotome
L3
what condition is a kyphoplasty used to treat
vertebral compression fx
mc tick borne (vector) illness in US
Lyme dz
lime dz is caused by
Borella burgdorferi
3 stages of Lyme dz
early localized
early disseminated
late disseminated
what rash is associated w. Lyme dz
erythema migrans
erythema migraines and cardiac sx CN palsy occur in which stage of Lyme dz
early disseminated
erythema migraines is associated w. which stage to Lyme dz
early localized
rheumatologic sx, encephalopathy, and polynephropathy are associated w. which stage of Lyme dz
late disseminated
tx for prophylaxis of Lyme dz (w.in 72 hr of tick removal)
single dose of doxy 200 mg PO
no alternative if doxy can not be taken
tx for early disseminated Lyme dz
doxycycline
duration of tx for late disseminated Lyme dz
30 days
bacterial spirochete responsible for Rocky Mountain spotted fever
rickettsia rickettsii
tx for pregnant pt w. Lyme dz
amoxicillin
__ is pathognomonic for Lyme dz
bilateral facial nerve palsy
hypo pigmented spots on the abdomen and chest
oval shaped macules
KOH prep shows hyphae w. spores
tinea versicolor
what do you think when you see “malassezia”
tinea versicolor genus
tinea versicolor worsens w.
sun exposure
what do you think when you see “spaghetti and meatballs appearance” on KOH prep
tinea versicolor
management of tinea versicolor
topical antifungal → selenium sulfide 2.5% or ketoconazole
oral if severe or refractory
benign, self limited, common skin condition in kids
characterized by hypo pigmented macule and patches on the face
likely related to atopic dermatitis
pityriasis alba
superficial fungal dz
characterized by erythematous, annular, patchy plaques - often w. raised border
irritating, pruritic
tinea corporis
well circumscribed, depigmented, macule and patches
not painful or pruritic
associated w. AI d.o - ex thyroid abnormalities
affects face, neck, arms, feet, fingers, trunk, scalp
vitiligo
which anti fungal is no longer recommended as first line oral tx d.t risk of drug induced hepatitis
ketoconazole
excruciating unilateral orbital/supraorbital/temporal pain
associated w. autonomic sx → ptosis mitosis, anhidrosis
associated w. nasal congestion/lacrimation
mc in men
cluster HA
how long do cluster HA last
how often
short lived → 15-180 min
daily in clusters, followed by remission
tx for cluster HA
100% O2
sumatriptan
t/f: cluster HA can be bilateral
F!
always unilateral, but can switch sides with new attack
similar to cluster HA but shorter attacks and less severe sx
occur 5 or more times daily
mc in women
proxysmal hemicrania
gradual nonspecific unilateral HA with impaired vision, hormone deficiencies
worsen over time
pituitary adenoma
what are the 4 types of trigeminal autonomic cephalagias
cluster HA
paroxysmal hemicrania
short-lasting unilateral neuralgiform Ha attacks
hemicrania continua
prophylaxis for cluster HA
verapamil
which congenital heart disorder is associated w. Turner syndrome and intracranial aneurysms
coarctation of the aorta
what do you think when you see: new onset murmur, early-onset HTN
difference in brachial and popliteal bp
rib notching on CXR
coarctation of the aorta
what is 3 sign
rib notching on CXR
tx for coarctation of the aorta
end to end anastomosis
balloon angioplasty
stent
what congenital heart disorder is associated w. recurrent respiratory infxns, failure to thrive, exertion dyspnea
commonly asymptomatic until 30 yo
atrial septal defect
continuous machinelike murmur heard best on pulmonic area w, wide pulse pressures
patent ductus arteriosus
tetralogy of Fallot is relieved by the patient __
squatting
what would ECG for pt with coarctation of aorta show
LVH
primary adrenal insufficiency
addison’s dz
dx test for addison’s
morning serum cortisol
rapid ACTH test
tx for Addison’s
lifelong supplementation of glucocorticoids → prednisone, hydrocortisone, dexamethasone
and mineralocorticoids → fludrocortisone
in addison’s dz, the HPA axis is __
cortisol levels are __
and ACTH levels are __
intact
decreased
increased
mc cause of addison’s
AI destruction of adrenal cortex
in secondary adrenal insufficiency the HPA axis is __
and ACTH is __
not intact → impaired stimulation of adrenal glands
low
which endocrine disorder is associated w. skin pigmentation
addison’s dz
which food craving is characteristic of primary adrenal insufficiency
salt
presenting sx of addison’s
abd pain, vomiting, diarrhea
fever
confusion
criteria for diagnosing DM (4)
sx PLUS a random BG 200 or higher
OR
fasting BG 126 or higher on 2 separate occasions
BG over 200 2 hr after 75 g OGTT
A1C 6.5 or higher
should be repeated for confirmation unless 2 or more clinical criteria are met
what type of obesity is associated w. insulin insensitivity
visceral dt accumulation of fat in mental and mesenteric regions
classifications of rhino sinusitis
acute → < 4 wees
subacute → 4-12 weeks
chronic → > 12 weeks
recurrent acute → 4 or more episodes/year w. interim resolution
mc pathogen associated w. bacterial rhino sinusitis
strep pneumo
also common: m. cat, strep pyogenes
mc cause of chronic sinusitis (lasting > 12 weeks)
staph aureus
major s.e of pseudoephedrine (esp if used > 3 days)
rebound congestion
tx for bacterial sinusitis lasting 10 days or more
augmentin
chronic abdominal pain relieved w. BM, and altered bowel habits
absence of any organic cause
IBS
4 subtypes of IBS
predominant constipation → IBS-C
IBS w. predominant diarrhea → IBS-D
mixed → IBS-M
unclassified IBS
tx for IBS-D
loperamide
cholestyramine
rifamixin or alosetron
tx for IBS-C
psyllium
polyethylene glycol → Miralax
lubiprostone
antispasmodic meds for IBS to treat abd discomfort/pain
dicyclomine
hyoscyamine
alarm features that suggests alternative dx to IBS
more tha minimal rectal bleeding
wt loss
unexplained IDA
nocturnal sx
fam hx colon ca
IBD
celiac
rome IV criteria for IBS
recurrent abd pain at least 1/week for 3 months associated w. 2 or more:
related to defamation
associated w. change in stool frequency
associated w. change in stool form
erythema multiforme is a __ sensitivity
type IV
what is this showing
erythema multiforme
raised, blanching, target shaped lesions with 3 concentric zones of color change
erythema multiforme
mc cause of erythema multiforme
HSV
also mycoplasma
blanching, erythematous macular rash that becomes petechial over time
classically begins on ankles and wrists → spreads to trunk
rash associated w. Rocky Mountain spotted fever
what spirochete causes syphilis
treponema pallidum
diffuse, macular or papular rash affecting trunk and extremities
macule appear copper, red, or brown
scaly or smooth
secondary syphilis rash
t/f: HSV 1 can not cause genital herpes
F!
drugs that commonly cause erythema multiforme
SOAPS:
sulfa
orał hypoglycemics
anticonfulsants
pcn
NSAIDs
menière disease triad
episodic vertigo
sensorineural hearing loss
tinnitus
dx for meunière disease
2 spontaneous episodes of rotational vertigo lasting 20 min or more
audiometric confirmation of sensorineural hearing loss
tinnitus or perception of aural fullness or both
type of hearing loss associated w. menière disease
low frequency sensorineural loss over 8-10 years
management of meniere disease
avoid salt, caffeine, etoh, nicotine, msg
diuretic
benzos
betahistine
diuretics
prednisone
what do you think of when you see high frequency sensorineural hearing loss
prebycusis (age related hearing loss)
causes of conductive hearing loss
cerumen
otitis media w. and w.o effusion
cholesteatoma
which disorder is characterized by progressive unilateral sensorineural hearing loss, disequilibrium, and facial numbness 2/2 to compression of CN VIII
vestibular schwannoma
aka acoustic neuroma
mc cause of meniere disease
too much inner ear endolymph → increased pressure w.in inner ear
neck circumference > __ is rf for OSA
16 in
questionnaire for OSA
STOP-Bang →
snoring
tiredness
observed apnea
high bp
bmi
age
neck circumference
gender - male
first line dx test for OSA
polysomnography
first line tx for OSA
CPAP
complications of OSA
CVD mortality
metabolic syndrome and T2DM
NAFLD
first line tx for OSA in kids
tonsillectomy
what is pickwickian syndrome
hypoventilation dt obesity
acute sharp pain described as ripping
+/- syncope, stroke, MI, HF
aortic dissection
pleuritic cp accompanied by dyspnea and cough
pulmonary embolism
sharp pleuritic cp that improves w. sitting up and leaning forward
pericarditis
egg findings of pericarditis
diffuse ST elevations
PR depressions
lesion in which vessel is indicated by ST elevations in V1, V2, V3. V4
LAD
initial tx for acute invasive fungal sinusitis
IV amphotericin B
surgical debridement
what pear shaped protozoan has four flagella at its anterior end and can be seen on urine microscopy
trichomonas vaginalis
what food borne illness is associated w. reactive arthritis
salmonellosis
tx for severe salmonellosis
ciprofloxacin
what food borne illness is associated w. staph aureus
mayo
what food borne illness is associated w. ingestion of raw hot dogs
listeria
what food borne illness is associated w. ingestion of raw seafood
vibrio spp
which virus is associated w. outbreaks of gastroenteritis on cruise ships
norovirus
what 3 foods are associated w. salmonellosis
poultry
meat
eggs
labs for salmonellosis
fecal WBCs
what food borne illness is associated w. osteomyelitis in kids w. sickle cell
salmonellosis
what is seen on coronary angiography in vasospastic angina
coronary vasospasm w. IV ergonovine or acetylcholine administration
5 rf for vasospastic angina
htn
smoking
dm
obesity
cocaine
transient ST elevations
normal cardiac enzymes
pain at rest
vasospastic angina
tx for vasospastic angina
CCB
nitrates
phases of a migraine
prodrome → hours to days
aura → 5-60 min
HA → 4-72 hr
postdrome → 24-48 hr
tx for acute migraines
OTC analgesics
triptans
dihydroergotamine
antiemetics
prophylactic tx for migraines
bb
ccb
amitriptyline
valproic acid, topiramate (1st line)
botulinum toxin
which med for migraine prophylaxis is not recommended for women of child bearing age
and can cause weight gain, hair loss, tremor
valproate
prophylactic migraine med that may be good for older pt, smokers, or pt w. Raynaud
verapamil
common s.e of topiramate
paresthesias
anomia
wt loss
anorexia
metabolic acidosis
nephrolithiiasis
first line prophylactic migraine med that can aid in wt loss
topiramate
contraindications for triptans and DHE
HTN
CVD
mc pain presentation of migraines
gradual onset
unilateral
mc nonverbal STI infxn
trichomoniasis
frothy, greenish yellow vaginal d.c
hyperemic, friable cervical mucosa → strawberry cervix
pH > 5
WBCs
trichomoniasis
wet mount findings: flagellated motile trichomonads
trichomoniasis
tx for trichomoniasis
metronidazole 2 g po single dose
OR
metronidazole 500 mg bid x 7 days
2nd line: tinidazole
vulvar/vaginal itching/burning
external dysuria
odorless, thick, cottage cheese d.c
budding yeast
acidic pH
vaginal candidiasis
what causes BV
gardnerella vaginalis
fishy vaginal d.c
thin ivory to gray homogenous d.c
pH > 4.5
clue cells
BV
STI affecting membranes of urethra, cervix, uterus, Fallopian tubes
yellow to greenish urethral d.c, dysuria
or asymptomatic
Neisseria gonorrhoeae
nonmotile diplococci in pairs
Neisseria gonorrhoeae
which test can be used to confirm dx of trichomoniasis
NAAT
3 mc causes of aortic stenosis
calcific dz
congenital abnormality
rheumatic heart dz
dyspnea on exertion, decreased exercise tolerance, exertional dizziness, exertional angina
delayed/diminished carotid pulses
paradoxically split S2
narrow pulse pressure
aortic stenosis
crescendo decrescendo murmur heard best at second right ICS
harsh
radiates to carotid arteries
aortic stenosis
tx for aortic stenosis
aortic valve replacement
harsh crescendo decrescendo systolic murmur heard best at the apex and lower left sternal border
increases w. standing up, valsalva, and with nitro
decreases from standing to sitting, handgrip, passive leg elevation
HOCM
holosystolic murmur heard best at apex
mc blowing and high pitched
radiates to axilla
mitral regurgitation
mc causes of mitral regurgitation
degenerative dz w. prolapse
CAD
low pitched diastolic rumble heard best at apex
opening snap
mitral stenosis
mc cause of tricuspid stenosis
rheumatic heart disease
3 rf for aortic stenosis
age
DM
HTN
aortic stenosis murmur __ with valsalva
decreases
what drug is considered first line for dyslipidemia that is recalcitrant to lifestyle mods
statins
med used in HFrEF and SVT
digoxin
meds for AA w. HFrEF
hydralazine
PLUS
nitrate
med for HFrEF 35% or less with persistent sx despite therapy
spironolactone
which class does sacubitril-valsartan belong to
ARNI
gastronomes that secrete excessive gastrin
multiple peptic ulcers
Zollinger Ellison syndrome
for how long should psi be discontinued prior to performing urea breath tests and fecal antigen assays
7-14 days
spiral shaped gram negative rod
h pylori
mc causes of acute gastritis
- NSAIDs
- etoh
types and causes of atrophic gastritis
A chronic → pernicious anemia
B chronic → h. pylori
cosyntropin stimulation test is used to dx
addison’s
measures cortisol after ACTH is injected
2 tests for addison’s
1, cosyntropin stimulation
- CRH stimulation
what androgen is androstenedione converted to
testosterone
what are these showing
aphthous ulcers → canker sores
painful condition affecting oral and genital mucosa
recurrence of small, painful, round to oval ulcers
last 1-2 weeks
aphthous ulcers
ulcer with peripheral rim of edema surrounding yellowish, central exudate
aphthous ulcer
what type of mucosa do aphthous ulcers appear on
nonkeratinized mucosa
4 tx for aphthous ulcers
chlorhexidine mouth rinse
topical lidocaine
dexamethasone elixir
oral prednisone if refractory
when is prophylactic antiviral therapy recommended for HSV
at least 6 outbreaks/year
differentiating factors btw aphthous ulcers and HSV
HSV appears outside the mouth
HSV has prodrome
HSV break open and crust over
which virus causes a flesh colored cauliflower like genital lesion
HPV
conductive hearing loss w. cholesteatoma is mc dt erosion of which of the ossicles
distal portion of incus
rounded bilobed cells w. 2 nuclei
owl’s eye appearance
reed-sternberg cells → Hodgkin lymphoma
3 rf for hodgkin lymphoma
Epstein barr
immunosuppression
AI dz
chemo tx for Hodgkin lymphoma
ABVD →
doxorubicin, bleomycin, vinblastine, decarbazine
gallium 67 uptake in a pattern assembling lambda
sarcoidosis
granulomatous inflammation w, caseation necrosis
tuberculosis
monomorphic medium sized cells w. basophilic cytoplasm
starry sky appearance
Burkitt lymphoma → aggressive non hodgkin lymphoma of jaw or face
tumor lysis syndrome
what is the waldeyer ring
pharyngeal ring of lymphoid tissue made up of adenoid, tubal, palatine, lingual tonsils
painless cervical LAD, pruritis, fever, night sweats, wt loss, frequent infxns
hodgkin lymphoma
dx for hodgkin lymphoma
lymph node bx → reed sternerg cells
first line med for generalized epileptic sz
valproate
preferred tx for focal onset sz
can worsen generalized epilepsy
carbamazepine
med used for status elepticus
can worsen generalized epilepsy syndrome
phenytoin
term used to describe periodic paralysis following a seizure
Todd paralysis
what med has been shown to reduce suicide risk in depressed pt
lithium
fx of proximal ulnar shaft w. radial head dislocation
monteggia fx
distal radius fx
distal radioulnar joint dislocation
galeazzi fx
distal radius fx
distal radioulnar joint dislocation
galeazzi fx
fx of the distal radius w. volar angulation
smith fx
fx of proximal fibular and tear of tibiofibular syndemosis and interosseous membrane
Maisonneuve fx
radiographic finding that describes metaphyeseal triangular portion in a salter II fx
thurstan holland fragment
when should prenatal visits be scheduled
q 4 weeks from 4-28 weeks gestation
q 2 weeks from 28-36 weeks gestation
weekly after 36 weeks gestation
what 4 things are done at every prenatal visit
weight
bp
fetal heart rate
UA for infxn protein, glucose
when is fundal height measured
each prenatal visit beginning at 20 weeks
what should be done btw 6-12 weeks gestation
random BG
CBC
syphilis
chlamydia
rubella titer
varicella titer
HIV testing
Hep B surface antigen
ABO/Rh
what is a maternal quad screen
when is it performed
alpha fetoprotein, hCG, estradiol, inhibin A
performed during second trimester
tests for aneuploidy and spina bifida
when is testing for group B strep done in prenatal care
35-37 weeks gestation
at which point of gestation is chrionic villus sampling typically performed
10-13 weeks
