TEST 10-13 Flashcards
What is the difference between ACUTE, SUBACUTE, and CHRONIC LOWER BACK PAIN?
ACUTE12 weeks
What is the management of ACUTE LOWER BACK PAIN?
1) Maintain moderate activity
2) NSAIDs/acetaminiophen
What is the management of CHRONIC LOWER BACK PAIN?
1) Intermittent NSAID/acetaminophen usage
2) Exercise therapy (stretching/strengthening)
Consider: TCA, duloxetine
PHARMACOTHERAPY/non-pharm TX for URGE INCONTINENCE?
PHARMACOTHERAPY/non-pharm TX for OVERFLOW INCONTINENCE?
URGE INCONTINENCE (Increased detrusor) - anti-muscarinic OXYBUTYNIN + bladder training/kegel pelvic floor exercises (=1st line)
OVERFLOW INCONTINENCE (Neurogenic, decreased detrusor) - cholinergic BETHANECHOL +/- INTERMITTENT CATHETERIZATION
What are some of the differences between CHRONIC BRONCHITIS vs CHRONIC BRONCHIECTASIS?
CHRONIC BRONCHIECTASIS
1) MUCOPURULENT SPUTUM: (>100mL sputum = larger volume)
2) Fever/hemoptysis
3) Association w/ infections (PSEUDOMONAS/ ASPERGILLOSIS)
What diagnostic testing is needed for initial diagnosis of CHRONIC BRONCHIECTASIS?
HIGH-RES CT SCAN OF CHEST
AFTER CHRONIC BRONCHIECTASIS is first confirmed by HRCT, what is the next step in management?
After this, what test needs to be done for FOCAL DISEASE? DIFFUSE DISEASE?
SPUTUM CULTURE- Analyze for bacteria and mycobacteria
AFTER sputum culture
1) FOCAL DISEASE: Get BRONCHOSCOPY - Localized airway obstruction
2) DIFFUSE - Congenital disorders/immune dysfn
FEBRILE d/o with PULMONARY (dyspnea/cough) + MUCOCUTANEOUS (papules/nodules) + RETICULONODULAR INFILTRATES on CXR + RETICULOENDOTHELIAL (LAD/HSM) + PANCYTOPENIA/ ELEVATED ALT/LDH in pt in OHIO/MISSOURI
DISSEMINATED HISTOPLASMOSIS
What is the Tx of DISSEMINATED HISTOPLASMOSIS?
1-2wk: SYSTEMIC IV amphotericin B
Post-2wks: ORAL ITRACONAZOLE for >=1yr for maintenance therapy
Which type of dementia characterizes LANGUAGE PROBLEMS (word recall) + VISUOSPATIAL problems (getting lost while driving) BEFORE executive function dysfunction?
ALZHEIMER’S DEMENTIA
Which type of dementia characterizes OCCASIONAL forgetfulness but does NOT interfere with ADL?
NORMAL AGING
Which type of dementia characterizes EXECUTIVE FUNCTION DECLINE after stroke inhibiting ADL + abnormal neuro findings (eg. HEMIPARESIS/PRONATOR DRIFT/ROMBERG SIGN) + early mild memory loss?
VASCULAR DEMENTIA
How is CREUTZFELDT-JAKOB DISEASE diagnosis confirmed?
1) BRAIN BIOPSY - spongiform changes on postpartem brain biopsy
2) Prion protein genetic mutations
What is PSEUDODEMENTIA? (Hint: Correlated with a psychiatric condition)
PSEUDODEMENTIA = Reversible cognitive decline changes associated with MAJOR DEPRESSION DISORDER
What is the Tx of ACUTE CHOLANGITIS?
- SUPPORTIVE CARE
- ANTIBIOTICS (Broad-spectrum): Beta-lactam/beta lactamase inhibitor + 3rd gen CEPHALOSPORIN + METRONIDAZOLE
- BILIARY DRAINAGE - by ERCP with sphincterotomy OR percutaneous trans-hepatic cholangiography
Common side effects of MTX (disease modifying agent for RA) = ?
What can be given as SUPPLEMENTATION to reduce incidence of AE?
HEENT: ORAL ULCERS +
ALOPECIA
LUNGS: PULM toxicity
CBC/BMP: ELEVATED ALT/AST +
BONE MARROW SUPPRESSION (Macro-ovalocytic anemia, leukopenia, thrombocytopenia)
FOLATE SUPPLEMENTATION
Difference between DKA and HHS: (Glc levels, ketones, AG, Sosm)
DKA: Glc 250-500, Ketones +, Elevated AG, Sosm600 (generally 1000), Ketones - , Nl AG, Sosm>320
Lab findings associated with SCHISTIOCYTOSIS:
1) HEMOLYSIS VALUES: Decreased haptoglobin + Increased LDH/bilirubin
2) THROMBOCYTOPENIA
3) HEMOLYTIC ANEMIA
When can one see NEW ONSET RBBB? When can one see NEW ONSET LBBB?
pathology wise
RBBB: pulmonary embolism
LBBB: Acute MI
ELECTRICAL ALTERNANS is fairly specific for “X”
What condition predisposes to developing X?
“X” + JVD/hypotension/muffled heart sounds = Y
X= PERICARDIAL EFFUSION
Often secondary to VIRAL PERICARDITIS
Y= developing CARDIAC TAMPONADE
What do EHRLICHIOSIS and BABESIOSIS have in common? How do you distinguish between them?
(Hint: Pt population + Sx)
Both = THROMBOCYTOPENIA + Mild LEUKOPENIA + do NOT have rash
BABESIOSIS: More common in pts who do NOT have a spleen or immunocompromised +
+ JAUNDICE [elevated ALT/AST]/ HEMOLYTIC SX
EHRLICHIOSIS: NO JAUNDICE/ HEMOLYSIS
Tx of BABESIOSIS = ?
Tx of EHRLICHIOSIS = ?
BABESIOSIS: Atovaquone - Azithromycin OR Quinidine-Clindamycin
ERLICHIOSIS: Doxycycline - EMPIRICALLY treat before confirmatory testing
What is the GOLD STANDARD test when OSA is suspected (daytime somnolence, snoring, morning headaches, poor concentration, restless sleep)?
NOCTURNAL POLYSOMNOGRAPHY
MEGAESOPHAGUS + MEGACOLON +/- CARDIAC DYSFUNCTION = what infectious disease?
CHAGAS DISEASE - protozoa Trypanosoma cruzi
How do you differentiate between LIPOMAs and EPIDERMAL INCLUSION CYSTS?
LIPOMAS - SOFT and rubbery/ do NOT regress and recur
INCLUSION CYSTS - FIRM, freely movable but stable, YES regress and recur (resolves spontaneously)
All probable BPH pts based on history should also get what 2 tests?
1) UA - Assess UTI + hematuria
2) PSA - Screen for prostate cancer
What are the two most common Sx in ALCOHOL WITHDRAWAL pt 12-48hrs after last drink?
1) SINGLE/MULTIPLE TONIC-CLONIC SEIZURES
2) ALCOHOLIC HALLUCINOSIS
What is the most common Sx in ALCOHOL WITHDRAWAL pt 48-96hrs after last drink?
DELIRIUM TREMENS
CN- poisoning can most commonly present in what 2 settings?
How does CN-poisoning present?
COMBUSTION FIRE
NITROPRUSSIDE during HTN EMERGENCY
LACTIC ACIDOSIS + AMS + COMA/SEIZURES
In a HYPERKALEMIC pt, what is the QUICKEST way to LOWER SERUM K+?
Out of 3 options (INSULIN/GLC, BICARB, BETA AGONIST ALBUTEROL) - INSULIN is the quickest
Generally don’t want to use ALBUTEROL in pt with STABLE ANGINA since it will cause TACHYCARDIA/ precipitate angina
In any pt with UNEXPLAINED ELEVATED CREATININE KINASE + MYOPATHY (proximal muscle weakness), what test should always be ordered first?
TSH and free T4 - r/o HYPOTHYROIDISM
SERUM TSH = MOST SENSITIVE TEST to diagnose HYPOthyroidism
**Hyperthyroidism - Myopathy + NORMAL CK, contrast to HYPOthyroidism with ELEVATED CK
Which murmur is best heard in LEFT STERNAL BORDER with pt sitting up/leaning forward/ while holding breath in FULL EXPIRATION?
AR
Holding breath in full expiration - DECREASED PRELOAD/ More volume stays in the systemic circulation during ejection
Ab associated with AUTOIMMUNE HEPATITIS = ?
What is 1st line of Tx?
anti-smooth muscle Ab
ORAL glucocorticoids
With cholestasis, what distinguishes INTRAHEPATIC vs EXTRAHEPATIC cholestasis?
RUQ ABDOMINAL US
INTRA-HEPATIC - No CBD dilation (PBC)
EXTRA-HEPATIC - YES CBD dilation (PSC)
YOUNG PT: Unexplained chronic hepatitis + LOW ceruloplasmin + ELEVATED urinary Ca excretion + KAYSER-FLEISCHER RINGS (greenish-brown deposits around both corneas)
WILSON’S DISEASE or HEPATOLENTICULAR DEGENERATION
What is the most common cause of AORTIC REGURG in YOUNG ADULTS in DEVELOPED countries?
How about in DEVELOPING countries?
DEVELOPED COUNTRIES: BICUSPID AORTIC VALVE
DEVELOPING COUNTRIES: RHEUMATIC HEART DISEASE
Staging of asthma and tx plans:
1) MILD INTERMITTENT - SABA albuterol PRN
2) MILD PERSISTENT - LOW DOSE IHC**
3) MODERATE PERSISTENT (FEV1 between 60 and 80) - LABA
4) SEVERE PERSISTENT (FEV1
HIGH FEVER/CHILLS + TENOSYNOVITIS + POLYARTHRALGIA + PUSTULAR LESIONS (trunk/extremities) in sex worker/risk factor for sex pt = ?
DISSEMINATED GONOCOCCAL INFECTION (N. GONORRHEA) - Blood cultures may be negative due to picky growth requirements of N.gonorrhea
(Need heated chocolate agar + VPN)
Ddx of SPHEROCYTES (multiple small round dense HYPERCHROMIC RBC)
HEREDITARY SPHEROCYTOSIS + G6PD DEFICIENCY + IMMUNE HEMOLYTIC ANEMIA
Differentiate IMMUNE HEMOLYTIC ANEMIA with others by IHA (Coomb test POSITIVE)
What anemia shows ELEVATED MCHC + ELEVATED RDW?
FE DEFICIENCY ANEMIA + HEREDITARY SPHEROCYTOSIS
TYPICAL CLASSIC TRIAD OF HEREDITARY SPHEROCYTOSIS
EXTRAVASCULAR HEMOLYSIS - autoimmune hemolytic anemia + jaundice + splenomegaly
Increased risk for bilirubin gallstones + Parvovirusb19 infn (aplastic crisis)
Maintenance Tx of HEREDITARY SPHEROCYTOSIS = ?
What can help reduce anemia and gallstone risk?
MAINSTAY - BLOOD TRANSFUSIONS + FOLATE SUPPLEMENTATION
SPLENECTOMY - Reduces anemia and gallstone risk
What is the most common cause of AA amyloidosis? (Hint: Inflammatory condition)
RHEUMATOID ARTHRITIS
What is the most common cause of AL amyloidosis? (Hint: Light chain)
MULTIPLE MYELOMA
ELEVATED CPK >=10x + anti-Jo1 (synthetase) + anti-Mi-2 (helicase) = ?
What are the most common associations?
DERMATOMYOSITIS
INTERNAL MALIGNANCY - Lung, stomach, pancreatic, ovarian, colorectal, NON-HODGKIN LYMPHOMA
Dermatomyositis pts must be screened for malignancy
Inflammatory diseases associated with AORTIC ANEURYSMS
BEHCET SYNDROME
VASCULITIS: Giant cell, takayasu
JOINT: RA, psoriatic arthritis, reactive arthritis
What are 3 conditions that predisposes to CALCIUM PYROPHOSPHATE PSEUDOGOUT?
How to distinguish between PSEUDOGOUT and GOUT?
- HEMOCHROMATOSIS
- HYPERPARATHYROIDISM
- JOINT TRAUMA
PSEUDOGOUT - CHONDROCALCINOSIS (xray- chronic calcification of articular cartilage) + rhomboid crystals
GOUT - monosodium urate crystals , yellow thin needles under parallel light, NO CHONDROCALCINOSIS
What is the hallmark of PROLONGED SEIZURES >5min - permanent injury in __ due to excitatory cytotoxicity
CORTICAL LAMINAR NECROSIS -
Cortical HYPERINTENSITY on DIFFUSION-WEIGHTED IMAGING = INFARCTION
FEMALE ATHLETE TRIAD = ?
DECREASED CALORIC INTAKE + OLIGO/AMENORRHEA + OSTEOPOROSIS (STRESS FRACTURES)
HYATID CYSTS mostly seen in the LIVER (75% - smooth round big cyst with daughter cysts) + LUNG is due to what disease?
Where do most of human infections originate?
TAPEWORM ECHINOCOCCOSIS
E. GRANULOSUS
MOSTLY FOUND IN SHEEP - Sheep breeders most commonly affected
What are the significant electrolyte abnormalities seen with CHRONIC ALCOHOLISM?
LOW MG
LOW K+
LOW PHOSPHATE
Known for refractory hypokalemia due to LOW Mg - Mg = important cofactor for K+ uptake and maintenance of intracellular K+ levels
CHRONIC HEP C + arthralgia + palpable purpura + LAD + neuropathy/nephropathy + IgM that precipitate in colder temperatures post-HepC infection
MIXED CRYOGLOBULINEMIA
What are precipitating factors of PREMATURE ATRIAL COMPLEXES?
What pharmacotherapy can be given to symptomatic pts?
ALCOHOL, TOBACCO, CAFFEINE = Triggering factors
BETA BLOCKERS
What is the most common adverse effect of INHALED CORTICOSTEROID (BECLOMETHASONE) usage?
THRUSH - oropharyngeal candidiasis
Difference between MYASTHENIA GRAVIS and LAMBERT EATON SYNDROME
MG: auto-Ab against post-synaptic Ach-R, thymoma, proximal muscle weakness worsens with muscle use, eye involvement, PRESERVED deep tendon reflexes
LES: auto-Ab against pre-synaptic Ca+ channels, SCLC, proximal muscle weakness improves with muscle use, no eye involvement, LOST deep tendon reflexes
What is the Tx of EPIDURAL/SUBDURAL HEMATOMA?
HEMATOMA EVACUATION
Which pathology is most commonly associated with SPLENIC ABSCESS - (Fever + leukocytosis + LUQ abodminal pain) + left-sided pleuritic chest pain, pleural effusion, spelnomegaly
INFECTIVE ENDOCARIDITIS most commonly associated with SPLENIC ABSCESS
How would LEVOTHYROXINE regimen change if HYPOTHYROIDISM Pt is started on ORAL ESTROGEN THERAPY?
Levothyroxine requirement INCREASES
ORAL ER, tamoxifen, raloxifene, heroine, methoadone - decreases hepatic clearance of THYROID BINDING GLOBULIN -> INCREASES TBG ->
1) TOTAL thyroid hormone INCREASES slightly or stays normal
2) DECREASES FREE THYROXINE (T4)
How is THYROID BINDING GLOBULIN and thus free THYROXINE (T4) levels affected by TRANSDERMAL ESTROGEN PATCH?
NO EFFECT
ESTROGEN (TRANSDERMAL) bypasses liver and does not affect hepatic clearance of TBG
DRUGS That decrease conversion of T4 (thyroxine) to T3 (tri-iodothyronine)
GC
BETA BLOCKERS
PTU
IOPANIC ACID (CONTRAST AGENT)
What is the defect in FAMILIAL HYPOCALCIURIC HYPERCALCEMIA?
AD Mutation in Ca Sensing receptor
1) Higher Ca required to suppress PTH - HIGH Ca, HIGH PTH
2) Defective CaSR -> INCREASED Ca reabsorption of Ca in renal tubules -
URINE (Ca/Cr)
How do you distinguish between FAMILIAL HYPOCALCIURIC HYPERCALCEMIA and PRIMARY HYPERPARATHYROIDISM?
FHH: UCCR
PRE-MENOPAUSAL WOMAN: Cyclic BILATERAL breast pain+ NON-FOCAL tenderness + NO discharge/LAD
FIBROCYSTIC CHANGES
PRE-MENOPAUSAL WOMAN: SINGLE, unilateral, mobile round breast mass varying in size/tenderness with menstrual cycle
FIBROADENOMA
POST-MENOPAUSAL WOMAN: UNILATERAL smooth painless, mobile, firm breast lump of variable size
PHYLLOIDES TUMOR
BLOODY/SEROSANGUINOUS DISCHARGE FROM NIPPLE DDx:
INTRADUCTAL PAPILLOMA + INFLAMMATORY CARCINOMA
SCREENING FOR COLON CANCER GUIDELINES for pts at AVERAGE risk of developing colon cancer
Age 50:
1) High Se FECAL OCCULT BLOOD TESTING (FOBT)
2) Flexible sigmoidoscopy every 5yrs + FOBT every 3 yrs
3) COLONOSCOPY every 10 years
What is the Treatment of GUILLAIN BARRE SYNDROME (nl CSF WBC, nl CSF Glc, elevated CSF protein 45-1000)
SUPPORTIVE
IVIG or PLASMPAPHARESIS
How is the diagnosis of PARKINSON’S MADE?
CLINICAL DIAGNOSIS
>=2/3 CARDINAL SX: Pill-rolling resting TREMOR (frequently in one hand and progresses to other side of body/LE) + RIGIDITY + BRADYKINESIA
How is the diagnosis of BRAIN DEATH made?
CLINICAL DIAGNOSIS
ABSENT cortical/brainstem functions (PERRLA, HR modification, spontaneous breathing)
**SPINAL cord is still functioning so DEEP TENDON REFLEXES may still be functional
Tx of INTERMITTENT ASTHMA
SABA PRN
Tx of MILD PERSISTENT ASTHMA:
SABA PRN + IHC (low-dose)
Tx of MODERATE PERSISTENT ASTHMA (FEV1 between 60-80% predicted)
SABA PRN + IHC (low-dose) + LABA
Tx of SEVERE PERSISTENT ASTHMA (FEV1
SABA PRN + IHC (high-dose) + LABA
Sometimes ORAL PREDNISONE
What electrolyte abnormality is seen with CUSHING SYNDROME due to EXOGENOUS STEROID USAGE?
CROSS-REACTIVITY TO MINERALOCORTICOIDS
HYPERVOLEMIC HYPERNATREMIA, HYPOKALEMIA
What is the most common infectious agent resulting in OSTEOMYELITIS in adult with NAIL PUNCTURE WOUND?
PSEUDOMONAS
Tx of HYPERCALCEMIA:
- SALINE IVF HYDRATION - Restore intravascular volume
- CALCITONIN - Inhibit bone resorption
- BISPHONOPHATES (Decrease osteoclasts -> Inhibits bone resorption
What are characteristic features of HYPOPITUITARISM? How do you differentiate this and PRIMARY HYPOADRENALISM?
LOW GC - HYPOnatremia, HYPOglycemia, eosinophilia, fatigue/loss of appetite
LOW TESTOSTERONE - Loss of libidio, erectile dysfunction, amenorrhea, infertility
LOW THYROID - Constipation, bradycardia
HYPOPITUITARISM - Spares HYPERPIGMENTAITON and HYPERKALEMIA (aldosterone synthesis is preserved)
What is the most common cause of PNEUMONIA in HIV pts?
S. PNEUMO - Encapsulated organism (Impaired immune system)
What is the most common EARLY side effect of LEVODOPA + CARBIDOPA (Dopamine precursor)?
Levi = leviosa
HALLUCINATIONS
+ Somnolence/confusion
What is the most common EARLY side effect of ENTACAPONE/TOLCAPONE (catechol-o-Metransferase inhibitors)?
Toca = dance
CHOREIFORM DYSKINESIA
What is the most common side effect of AMANTADINE?
AMANTADINE = manta ray on legs
LIVEDO RETICULARIS - mottled vascular pattern on legs
What Tx should RHEUMATOID ARTHRITIS pts receive?
What test should pt receive to be cleared before starting this? Which pt population is absolutely CONTRA-INDICATED?
Disease-modifying anti-rheumatic drugs (DMARDs) ASAP bec joint damage occurs early on in course = MTX (most preferred - efficacy and long-term safety )
HepB/C/ TB
CONTRAINDICATION: Pregnant OR expecting + RENAL INSUFFICIENCY/ LIVER DISEASE/ ALCOHOLIC
Drug of choice for ANTI-PSEUDOMONAL antibiotic for OTITIS EXTERNA (NECROTIZING)
FLUOROQUINOLONE - LEVOFLOXACIN, CIPROFLOXACIN
If fluoroquinolones don’t work, give PENICILLIN (PIPERACILLIN) or CEPHALOSPORIN (CEFTAZIDIME)
Erythema multiforme (papules targetoid rash) + PERIVASCULAR LYMPHOCYTIC INFILTRATE + EPIDERMAL NECROSIS is most commonly associated with __?
Most commonly - HSV infection
Also Mycoplasma infection + SLE/malignancy/drugs
FEVER + PAINFUL TESTES ENLARGEMENT + DYSURIA= ?
What is the most common infectious agent in sexually active YOUNGER PTS? non-sexually active OLDER PTS?
ACUTE EPIDIDYMITIS
YOUNGER PTS: NEISSERIA GONORRHEA + CHLAMYDIA TRACHOMATIS
OLDER PTS: GM- RODS (most commonly E.coli)
SKIN LESION that has a CENTRAL DIMPLE develop when lesion is PINCHED AT THE EDGES = ?
DERMATOFIBROMA
BOTULINUM TOXIN vs TETANUS TOXIN (TETANOSPASMIN)
Both endocytose and interfere with SNARE -> Inhibits Ach release from PRE-SYNAPTIC NEURON
BOTULINUM: flaccid paralysis
TETANOSPASMIN: spastic rigid paralysis
BENIGN vascular skin tumor that grows rapidly over weeks-months to a PEDUNCULATED /SESSILE SHINY MASS (commonly on LIP/ORAL MUCOSA) + BLEEDS WITH MINOR TRAUMA
PYOGENIC GRANULOMA
Most common ADVERSE effect of CALCIUM CHANNEL BLOCKERS = ?
PERIPHERAL EDEMA
+ HEADACHE/ FLUSHING/ DIZZINESS
ADVERSE EFFECT of BETA BLOCKERS:
WORSENING OF HEART FAILURE + BRADYARRHYTHMIA + Bronchospasm (asthma) + generalized fatigue + sexual dysfn
MILD LEUKOCYTOSIS (15K) + BILATERAL LOBAR INFILTRATES (CXR) =
INFLUENZA (Mild leuk)
PCP, S. PNEUMO (Significant leukocytosis)
Which regimens of chronic drugs will result in MEGALOBLASTIC ANEMIA? What should be given as supplementation?
3P'S + TM 1) Impairs FOLIC ACID reabsorption PHENYTOIN PHENOBARBITOL PRIMIDONE (anti-convulsant)
2) Antagonizes physiologic effects - Inhibit DHF reductase
TMP
MTX
CHRONIC WATERY DIARRHEA
BIOPSY: mucosal subepithelial collagen deposition
COLLAGENOUS COLITIS
CHRONIC WATERY DIARRHEA
BIOPSY: mucosal subepithelial collagen deposition
COLLAGENOUS COLITIS
What are the 4 most common types of TYPICAL PNEUMONIA?
S.PNEUMO
S. AUREUS
HAEMOPHILUS
KLEBSIELLA
What are the 4 most common types of TYPICAL PNEUMONIA?
S.PNEUMO
S. AUREUS
HAEMOPHILUS
KLEBSIELLA
Empiric Tx for CAP: HEALTHY OUTPT (CURB65
MACROLIDE or DOXYCYCLINE
Empiric Tx for CAP COMORBID OUTPT (CURB65
BETA LACTAM + MACROLIDE or FLUOROQUINOLONE
Empiric Tx for CAP: ICU (CURB65>=4)
BETA LACTAM + MACROLIDE or BETA LACTAM + FLUOROQUINOLONE
What are HODGKIN LYMPHOMA pts highly susceptible to developing?
SECONDARY MALIGNANCY from CHEMO AND RADIATION - Most commonly BLT “BG”: Breast, lung, thyroid, bone, GI
VIRAL URI + COUGH lasting >5days with typical yellow/purulent sputum = ?
What is the management?
ACUTE BRONCHITIS
YELLOW SPUTUM - due to epithelial sloughing NOT bacteria
MANAGEMENT = SYMPTOMATIC TX (OTC NDSAIDs/ acetaminophen/ bronchodilators). Do NOT use antibiotics!!
VIRAL URI + COUGH lasting >5days with typical yellow/purulent sputum
ACUTE BRONCHITIS
YELLOW SPUTUM - due to epithelial sloughing NOT bacteria
DIETARY REC for pts with RENAL CALCULI (kidney stones)
- INCREASED FLUID INTAKE
- LOW Na+ intake
- Nl Ca2+ intake
HEADACHE + FOCAL NEURO DEFICITS + SEIZURES + RING-ENHANCING LESIONS with edema on BRAIN MRI = ?
What is the Tx?
CEREBRAL TOXOPLASMOSIS
TX = SULFADIAZINE-PYRIMETHAMINE
