Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
305 Cards in this Set
- Front
- Back
|
Common exacerbating factors of psoriasis
|
HIV
Strep infections Skin injury (sun burn or drug rxn) |
|
|
5 Ps of lichen planus
|
Pruritic
Purple Polygonal Planar Papules |
|
|
Associations to Porphyria Cutanea Tarda
|
Heavy EtOH consumption
HCV Iron Overload |
|
|
Facial hirsutism
Milia Erosions Scars and tense bullae on the hands |
Porphyria Cutanea Tarda
|
|
|
Pemphigus vulgaris
|
Often involves the mouth (50%)
Diagnosed by immunofluorexcent studies of perilesional skin High fatality if not treated |
|
|
Erythema Nodosum
|
Think:
- Sarcoid - IBD - Strep infections - Drugs (OCPs -- most commonly) |
|
|
Erythema multiforme
|
"TARGET LESIONS"
Think: - HSV - Drugs (PCN, Sulfa, and Phenytoin most commonly) - Mycoplasma |
|
|
Acanthosis nigricans
|
Seen with obesity and diabetes and gastric cancers (60%)
|
|
|
Young patient with eruption of seborrheic dermatitis
|
Think HIV
|
|
|
Old patient with eruption of seborrheic dermatitis
|
Thinks Parkinson's
|
|
|
Alcoholic hepatitis AST/ALT ranges
|
AST levels <300 with trivial elevations of ALT and AST/ALT ratio >3
|
|
|
AST/ALT ratio in viral hepatitis
|
<1 --> if cirrhosis just barely >1
|
|
|
Common features of hemochromatosis and alcohol liver disease
|
- Hepatomegaly
- Glucose intolerance - Testicular atrophy - Cardiomyopathy |
|
|
NASH
|
Can mimic alcohlic hepatitis
USually occurs in middle-aged women with obesity, DM, and HTN Clinical features are hepatomegaly and elevated transaminases (usually AST>ALT) |
|
|
Most common causes of acute liver failure
|
Drugs (Aceteminophen) -- most common
Viral hepatitis Ischemia |
|
|
ANA + ASMA + Hyperglobulinemia
|
Autoimmune hepatitis
|
|
|
Wilson's Disease
|
Rare Autosomal Recessive D/o
Hepatitis Neuro sx Hemolytic Anemia Kayser-Fleischer rings around iris |
|
|
Drugs that cause cholestasis classically
|
-Chlorpromazine
-Gold -Chlorprpamide -OCPs -Erythromycin -Amoxicillin/Clavulanate |
|
|
Primary sclerosing cholangitis
|
Occurs in middle aged men with h/o UC
Past colectomy does not protect patient from this |
|
|
Variceal bleeds
|
-Sclerotherapy is effective in controlling acute variceal bleeding (75-90%)
-Serious complications limit its usefulness -Variceal band ligation is as effective but with less complciations -Beta-blocers are effective for prophylaxis of variceal bleeding |
|
|
SBP
|
usually cuased by GNRs
Tx with 3rd generation cephalosporin x5 days |
|
|
Crohn's disease
|
Most commonly involves the terminal ileum and cecal region (45%)
|
|
|
Extraintestinal manifestations of Crohn's disease
|
-Uveitis
-Spondylarthropathy -Erythema nodosum -Pyoderma gangrenosum |
|
|
Small intestine bacterial overgrowth
|
-Cause of malabsorptive diarrhea
Causes: - Scleroderma - Diabetes - High dose PPIs - Post-op Billroth 2) - Radiation enteropathy |
|
|
Whipple's Disease
|
Malabsorptive diarrhea + Arthritis* _ CNS involvement + uveitis + clubbing
|
|
|
Celiac Sprue
|
dermatitis herpetiformis
Increased risk for small bowel lymphoma selective IgA deficiency Cause of isolated ALT elevation |
|
|
ALT elevated
|
Think:
- celiac - gallstone pancreatitis |
|
|
Serologic testing for celiac sprue
|
IgA endomysial antibody + IgA TTG
|
|
|
Chronic watery diarrhea in a middle aged woman without weight loss or pain (secretory diarrhea)
|
Think:
- Microscopic (Collagenous) Colitis |
|
|
Treatment of choice for microscopic (collagenous) colitis
|
Bismuth
|
|
|
Diarrhea due to pancreatitic insufficiency
|
Has a greater amount of stool fat than other malabsorptive diarrheas and normal small bowel absorption tests (D-xylose and Hydrogen breath tests)
|
|
|
Colitis from these organisms can mimic the symptoms and appearance of UC
|
Campylobacter and occasionally amebiasis
Note: UC does not have skin lesions |
|
|
Pancreatic psudocysts
|
Pseudocysts >6 cm are at high risk for perforation, infection, and hemorrhage.
Surgical drainage should be performed if they do not resolve |
|
|
Initial evaluation of chronic pancreatitis
|
Plain AXR -- presence of diffuse calcifications in the pancreas is diagnostic (~40%)
|
|
|
Most sensitive imaging to visualize chronic pancreatitis if highly suspected and normal AXR
|
ERCP
|
|
|
Next step in evaluation of duodenal or gastic ulcers?
|
H. pylori testing
|
|
|
ALS
|
Presents with asymmetric weakness with bulbar or limb presentation.
No sensory, visual, or bowel or bladder abnormalities |
|
|
DVT + Stroke
|
Think patent PFO
|
|
|
ASA + Plavix vs. ASA for stroke
|
Choose ASA alone - no increased benefit with dual tx; increases risk of bleeding
|
|
|
Indications for carotid endarterectomy
|
Symptomatic patients with >70% stenosis
Asymptomatic patients with >80% stenosis who have a low surgical risk and an otherwise good 5 year survival |
|
|
TIA and meets CEA criteria
|
CEA should be done immediately after TIA
|
|
|
Statins and stroke
|
Decrease stroke risk by 20-30%
|
|
|
Hypokalemia + HTN
|
Think Secondary Causes:
- Hyperaldosteronism - RAS - Alcoholism |
|
|
Hypertensive
Hyperhydrosis Hyperglycemia Headache Hypotonsion (orthostatic) |
Think: Pheochromocytoma
|
|
|
Flash pulmonary edema and HTN
|
Think: RAS
|
|
|
Nephrotic syndrome and infections and thrombosis
|
Patients with nephrotic syndrome are at increased risk for infxns d/t urinary loss of IgG and complement.
They are also at risk for thrombosis d/t urinary loss of antithrombin III and an increase in coagulation factors |
|
|
Flank Pain + Hematuria + Enlarged Kidney on Ultrasound
|
Think: RENAL VEIN THROMBOSIS
|
|
|
Subacute nephrotic syndrome with very low albumin
|
Think Minimal Change Disease
|
|
|
Associations of minimal change disease in adults
|
-Hodgkin's lymphoma
-NSAID use -Atopy/allergy |
|
|
Most common cause of nephritis worldwide
|
IgA nephropathy
- usually presents as micro/macroscopic hematuria often within 48 hours of a URI |
|
|
Young male smoker with a h/o hydrocarbon exposure (mechanic) who presents with hemoptysis (following a URI) and hematuria and diffuse infiltrates on X-rays
|
Goodpastures
|
|
|
Gadolinium in CKD patient
|
Nephrogenic Fibrosing Dermopathy/Sclerosis
|
|
|
S/p angiography, aortic surgery or on institution of anticoagulation; clinical features inclue livedo reticularis, purple toes, and progressive renal dysfunction. Peripheral eosinophilia.
|
Atherembolic renal disease
|
|
|
Acute renal failure thrombocytoenia hemolysis and schistocytes
|
mirscopic angiopathy
|
|
|
Which patients with thrombotic microangiopathy do you definitely plasmaphorese?
|
TTP
Antiphospholipid syndrome Complement disorders |
|
|
Important causes of acute interstitial nephritis
|
Beta-lactams (esp PCNs)
NSAIDs Dilantin Allopurnol |
|
|
Calcium oxalate crystals in urine
|
Ethylene glycol toxicity
|
|
|
Refractory Asthma
|
Think of Reflux
|
|
|
Treatment of familial HyperCholesterolemia when all medical therapy fails
|
Plasmapharesis --- if this fails, liver transplant
|
|
|
Autoimmune thrombocytopenia + Autoimmune hemolysis (Coombs or DAT +)
|
Evans syndrome
Initially tx with steroids, then splenectomy |
|
|
Types of Asthma - mild, moderate, severe
|
Mild persistent—symptoms greater than 2×/week but less than lx/day with FEV1 >80%
Moderate persistent—daily symptoms greater than 2×/week with FEV1 >60 and <80% Severe persistent—continual symptoms with limited physical activity and FEV1 <60% |
|
|
FHx of Colon Cancer in family member who is >60 yo; when to begin colon cancer screening
|
Age 40 q10y after
|
|
|
(+)ve ANA with renal findings --- next step?
|
Biopsy the kidney!
|
|
|
Amiodarone + Hypothyrodism, next step?
|
Continue amio and start levothyroxine
|
|
|
When is amiodarone the answer in the tx of Afib?
|
Amiodarone also has some effect in converting AFib to sinus rhythm, but its effect on rate control is minimal. Amiodarone is the answer when a patient has been converted to sinus rhythm and you want to use a drug to maintain the patient’s sinus rhythm. Amiodarone is best used in patients with ventricular dysfunction.
Rate control and anticoagulation is superior to converting the rhythm. |
|
|
Middle Aged Man with dry tap on BMBx but eventually finding fibrosis + monocytopenia + splenomegaly
|
Hairy Cell
- characteristic findings - Tx with Cladribine |
|
|
Neutropenia from HIV drug
|
Think AZT -- switch to Stavudine typically
|
|
|
Monitoring of TB patients
|
Sputum Cx every month until negative
|
|
|
Why we give cyclophosphamide and glucocorticoids in Wegener's
|
Cyclophosphamide and glucocorticoids result in markedly improved patient survival and renal function survival
Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 163). Kaplan Publishing. Kindle Edition. |
|
|
Dendritic ulcer on eye -- tx?
|
Topical trifluridine and acyclovir x 10 days
|
|
|
Uveitis Tx
|
Steroid Eye drops
|
|
|
Most common arrhythmia associated with digoxin
|
Paroxysma Atrial Tachycardia with variable block
|
|
|
What can you do to the pacemaker to stop torsades if a patient has one
|
Accelerate tehheart rate with a pace maker -- this shortens the QT interval and effectively reverses the torsades
|
|
|
Tx of choice for vWD
|
Desmopressin
|
|
|
Hypothyroidism from lithium, next step?
|
Start Levothyroxine and continue the Lithium
|
|
|
Pt with coronary artery disease with acute cluster headache; tx?
|
Prednisone and High Flow O2
DO NOT GIVE ERGOTAMINES AND SUMATRIPTAN TO PATIENTS WITH CAD |
|
|
Most accurate way of assessing the EF?
|
MUGA - nuclear venticulopgram
|
|
|
Tx of MS related fatigue
|
Amantadine or Modafanil
|
|
|
How does drug induced lupus differ from actual SLE?
|
-Nephritis is NOT a feature of DILE
-M=W in DILE -No neuro symptoms in DILE -No Anti-DsDNA in DILE (but +ve anti-histone antibodies) |
|
|
Drugs associated with Drug Induced Lupus Erythematous
|
Isoniazid
Methydopa Chlorpromazine Hydralazine Procainamide Interferon Quinidine |
|
|
Tx of DIC
|
FFP + Cryoprecipitate
|
|
|
As the severity of mitral stenosis worsens, how with the opening snap change?
|
As the severity of mitral stenosis worsens, the opening snap moves closer to S2.
The opening snap is produced by the pressure in the atrium, resulting in the sudden opening of the mitral valve with an increased sound because of the fibrosis. As mitral stenosis worsens, the pressure in the atrium increases. This opens the mitral valve earlier. The more severe the mitral disease, the earlier the valve opens. Both S3 and S4 gallops are signs of the rapid entry of blood into the ventricle, not because the stenotic valve is blocking the rapid entry of blood into the ventricles. |
|
|
Tx of AML
|
Daunarubicin and Cytarabine is standard tx.
ATRA is added if APL subtype found. |
|
|
Tx of lupus nephritis in pregnancy
|
Treatment of active lupus nephritis in pregnancy is dependent on the absence of adverse effects of the medication on the fetus. High-dose prednisone can be used relatively safely. Hydralazine can be used to control the blood pressure. Azathioprine can also be used, with caution, if there is no evidence of leukopenia. Cyclophosphamide and methotrexate are absolutely contraindicated. Mycophenolate should be avoided in pregnancy.
Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 187). Kaplan Publishing. Kindle Edition. |
|
|
Initial test to detect secondary syphilis?
|
VDRL
|
|
|
Common drug associated with Minimal Change Disease -- stop this drug first?
|
NSAIDs
|
|
|
Side effects of Allopurinol
|
adverse effects of allopurinol are more severe than with other drugs and can include a severe toxicity syndrome, including eosinophilia, hepatitis, decreased renal function, an erythematous desquamative rash, and, occasionally, a vasculitis.
Mild rash can be treated with desensitization Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 198). Kaplan Publishing. Kindle Edition. |
|
|
Most specific test for Wegener's
|
Open lung biopsy
NAsal bx may be sufficient to confirm dx, however. |
|
|
Benzo of choice in panic d/o if it has to be given
|
Clonazepam (AVOID ALPRAZOLAM - short acting!)
1st Line -- SSRI + CBT |
|
|
Antidepressant with minimal side effects
|
Buproprion
Nefazodone |
|
|
Antidepressants that don't have weight gain
|
Buproprion
Nefazodone Venlafaxine |
|
|
Most weight gain with this anti-depressant
|
Mirtazapine -- good in elderly with poor po intake and weight loss
|
|
|
A 45 yo woman is seen with symptoms of major depression. She is very bothered by insomnia, and wants to be put on “a medicine that works fast!”. What would be the best option?
A) Citalopram B) Amitriptyline C) Escitalopram D) Mirtazapine E) Bupropion |
Answer - Mirtazapine
Compared to SSRI’s mirtazapinehad an odds ratio of 1.57 (CI 1.3-1.88) for response at 2 weeks, and OR of 1.82 for full remission compared to SSRI’s. At the end of 12 weeks mirtazapine had a slightly higfher reponse rate (OR 1.19). Mirtazapine more likely to cause weight gain and drowziness, less likely to cause sexaul side effects that SSRI’s Cochrane review Benefit of drug is rapid and weight gain (if wanted) but it does not have long term benefit over others. |
|
|
Augmentation options with pts with partial responses to tx despite maximizing tx
|
- Buproprion*
- Add T3 - Add lithium |
|
|
Contraindications to TCAs
|
Arrhythmias
H/o MI BPH |
|
|
Contraindications to Buproprion
|
Sz d/o
Eating D/o EtOHism |
|
|
Serotonergic Syndrome
|
Symptoms:Confusion, sweating, agitation, anxiety, vomiting, diarrhea
Signs: Tachycardia, hypertension, fever, muscle rigidity, hyperreflexia, tremor Usually caused by several serotonergic drugs combined: SSRI’s, tramadol*, linezolid*, meperidine*, dextromethorphan, TCA*, MAOI, buspirone, trazadone STOP THE OFFENDING DRUG! |
|
|
Pt with MRSA PNA with h/o depression, tx with linezolid develops confusion, tachycardia, HTN, fever, muscle rigidity
|
Suspect Serotonin Syndrome
|
|
|
CNS Effects of Quinolones
|
-Insomnia
-Nightmares -Hallucinations -Psychosis |
|
|
Common causes of delirium
|
-Anticholinergics
-Antihistamines -Steroids -Quinolones -- give the right dose -Sedatives/Hypnotics -Antipsychotics can have a paradoxical effects |
|
|
Tx of Chronic Bacterial Prostatitis
|
Fluoroquinoilone x1 month
|
|
|
Tx of Acute Bacterial Prostatitis
|
1 week course of TMP-SMX or FQ
|
|
|
Tx of central hypothyroidism
|
Levothyroxine + Glucocorticoids
|
|
|
Patients with small (≤2 cm) type I gastric carcinoid tumors
|
Should be followed with endoscopic surveillance every 6 to 12 months for at least 3 years after initial endoscopic removal.
|
|
|
Asymptomatic patients with indolent, well-differentiated metastatic carcinoid tumors.
|
Can often be managed with expectant observation and serial imaging studies
|
|
|
Iron Deficiency Anemia and A1c
|
Will falsely lower A1c not raise it
|
|
|
Useful in evaluating recurrent syncope in the absence of heart disease, to discriminate neurocardiogenic from orthostatic syncope, and to evaluate frequent syncope in patients with psychiatric disease.
|
Tilt-table testing
|
|
|
In patients with acromegaly whose insulin-like growth factor 1 and growth hormone levels remain elevated after transsphenoidal surgery, next step?
|
somatostatin analogues (octreotide) are commonly used to normalize levels and shrink any residual pituitary tumor.
|
|
|
Patients with large esophageal varices and contraindications to nonselective β-blockers
|
should receive endoscopic variceal ligation as prophylactic treatment for variceal hemorrhage.
|
|
|
BRAF + mutation
|
= Papillary Thyroid Cancer
V600E mutation tend to have a more aggressive long term course. BRAF mutations are frequent in papillary carcinoma and in undifferentiated cancers that have developed from papillary tumors. |
|
|
Presents with dull, aching groin pain that is indolent in onset; risk factors include corticosteroid use and excessive alcohol use.
|
Osteonecrosis of the hip
- During early stages X-rays may be normal - MRI is most sensitive |
|
|
isointense with slight contrast enhancement on a T1-weighted scan and hyperintense on a T2-weighted scan.
|
= Blood
|
|
|
Tx of large papillary thyroid cancers
|
Large papillary thyroid cancer (>4 cm) is treated with thyroidectomy and then with radioactive iodine to decrease the risk of recurrence and death.
|
|
|
Things that reduce mortality in ARDS
|
In patients with acute respiratory distress syndrome, a lung-protective strategy of low tidal volume (6 mL/kg predicted weight) and plateau pressure less than 30 cm H2O is associated with reduced mortality.
|
|
|
In patients with colorectal carcinoma with metastatic disease to the lung, what is the next step?
|
surgical resection is the primary treatment and is associated with good long-term survival.
|
|
|
In asthma, when should a LABA be added?
|
Long-acting β2-agonists should be added only if medium-dose ICS therapy fails to control symptoms.
|
|
|
The drop-arm test can be performed by the examiner passively abducting the patient's arm and then having the patient slowly lower the arm to the waist.
|
Supraspinatus tear
Get an MRI |
|
|
This disorder is more common in women than in men and is characterized by anterior knee pain that is made worse with prolonged sitting and with going up and down stairs.
|
Patellofemoral pain syndrome
|
|
|
Characterized by daytime hypercapnia (arterial PCO2 >45 mm Hg [6.0 kPa]) in an obese patient
|
Obesity Hypoventilation Syndrome
|
|
|
Important imaging diagnostic test after confirmation of Myasthenia Gravis
|
Patients with myasthenia gravis should have a chest CT to evaluate the presence of thymic hyperplasia or thymoma
|
|
|
The most appropriate treatment of Bell palsy
|
PREDNISONE, preferably administered within the first 72 hours
The use of antiherpesvirus agents, such as acyclovir, as monotherapy for Bell palsy has not been shown to be helpful. A prodromal viral illness can sometimes precede Bell palsy, as it did in this patient. |
|
|
Indications for cerebral aneurysm surgical tx?
|
Size and location are the major predictors of subsequent rupture for incidentally discovered cerebral aneurysms; the most prudent management is watchful waiting with repeated neuroimaging to monitor increasing aneurysmal size, particularly for anterior cerebral aneurysms less than 12 mm in diameter and posterior circulation aneurysms less than 7 mm in diameter.
|
|
|
IBS ROME III CRITERIA
|
The AGA criteria require abdominal pain or discomfort as well as diarrhea for diagnosis of IBS-D. The Rome III criteria for IBS require recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with two or more of the following: (1) improvement with defecation, (2) onset associated with a change in frequency of stool, and (3) onset associated with a change in form of stool.
Do further diagnostic testing if criteria is NOT met |
|
|
Slowly progressive solid-food dysphagia in a young man who has allergic diseases is likely due to what?
|
eosinophilic esophagitis.
|
|
|
Prevention of High Altitude Sickness
|
When gradual ascent is not feasibe (flying to colorado, ex), give Acetazolamide
Acetazolamide works via several different mechanisms to stabilize ventilation, improve oxygenation, counteract fluid retention, and induce a mild metabolic acidosis, all of which accelerate acclimatization and improve acute symptoms associated with the transition to high altitudes. Prophylaxis should be reserved for patients who are at risk for altitude-related illness (particularly those with a history of altitude-related illness) or patients with cardiopulmonary disease. |
|
|
Loss of Conscioussness with a concussion during a game (even if brief), next step?
|
Athletes with a grade 3 concussion, which is defined as a brief (seconds) or prolonged (minutes) loss of consciousness, should be prohibited from returning to competition until they are asymptomatic for 1 week.
|
|
|
The most important step in managing patients with toxic epidermal necrolysis or SJS
|
stop the suspected causative medication and initiate supportive care in an intensive care unit or burn unit
DO NOT GIVE IV STEROIDS!!!! |
|
|
An interruption of the normal hair growth cycle caused by stress and commonly follows childbirth
|
Telogen Effluvium
|
|
|
Most common type of hair loss overall. It tends to occur gradually rather than suddenly and in clearly identifiable patterns typically involving the crown of the head and temporal areas.
|
Androgenetic alopecia (male and female pattern hair loss) -- it is gradual.
|
|
|
Cervical dysphagia, halitosis, and aspiration pneumonia
|
suggests Zenker's Diverticulum
|
|
|
Intermittent non-progressive solid dysphagia
|
Schatzki's ring
|
|
|
Most common implicated drugs in pill esophagitis
|
-Tetracycline/Doxycycline****
-KCl** -NSAIDS and ASA -Iron** -Alendronate |
|
|
Patients with immunosuppression (especially HIV) can develop chronic anemia with this pathogen
|
Parvovirus B19
|
|
|
Treatment used for chronic anemia due to parvovirus in immunocompromised patients
|
IVIG
|
|
|
Major reservoir for rabies in the US
|
Bats
Skunks Raccoons Foxes Cayotoes |
|
|
Fevers, Myalgias, Noncardiac pulmonary edema, increased Hct, and Luekocytosis in SW camper -- what organism?
|
Think: Hantavirus
|
|
|
Bilateral 7th Nerve Palsy
|
Think: Lyme Disease
|
|
|
Aside from MRSA, what do 3rd generation cephalosporins generally miss?
|
Pseudomonas and Enterococcus
|
|
|
1st line tx for dog/cat/human bite; what if PCN allergic?
|
1st line - Amoxicillin + Clavulanate
PCN allergic - Clindamycine + FQ |
|
|
Recurrent Erythema Multiforme
|
Likely HSV related -- tx with acyclovir
|
|
|
Recurrent episodes of swelling usually beginning in childhood and frequently after trauma.
Episodes of abdominal pain are common. No urticaria What is the next screening test? |
C4 level ---> Suspect hereditary angioedema!
|
|
|
Associated conditions of acquired c1-esterase deficiency
|
B-cell lymphoproliferative disorders
Connective tissue diosroders Monoclonal gammopathies |
|
|
"Chicken Skin" around the neck/axilla
Angioid streaks on funduscopic exam Recurrent GI Bleeding Atherosclerosis |
Pseudoxanthoma Elasticum
- Aut Recessive, ABCC6 mutation on chromosome 16 |
|
|
Levothyroxine and drug interactions, specifically
|
Calcium
Iron Anatacids Cholestyramine Sucralfate |
|
|
Natural products that interact with warfarin
|
Generally begin with the letter "G"
Increases bleeding: Gingko, Ginger, Glucosamine/Chondroitin, and Garlic Decreases levels: Ginseng |
|
|
Drugs that cause Hyperkalemia
|
ACE-I
ARBs TMP/SMX K+ Sparing Diuretics NSAIDS |
|
|
Risk of rhabdomyolsis with statins increases when the drug is combined with these drugs?
|
Erythromycin
Cyclosporin Gemfibrozil (esp if on steroids) >>> Fenofibrate (by 10x) |
|
|
Fluoroquinolones and major side effects
|
Tendon rupture (***Highest if pt concurrently on steroids)
Confusion/Delirium in the elederly (esp if renal failure) QTc Prolongation (moxifloxacin) |
|
|
Classic drug that causes a NAGMA
|
Topiramate
|
|
|
Classic drug that causes AGMA
|
Salicylates (if combined with resp alkalosis)
Metformin (lactic acidosis) |
|
|
Distinguishing features that suggest HIV over mononucleosis
|
Rash --> acute HIV (70%)
Oral ulcers --> acute HIV (30%) Diarrhea --> acute HIV (30%) |
|
|
Exposure to cats in an immunocompromised patient characterized by the appearance of lesions or nodules of varying sizes all over the skin. The lesions are typically very small but can grow up to about 4 cm in diameter. These usually arise in groups. You can find as many as 50 papules at one time. These can vary in color and are generally bright red or almost black in appearance.
|
Bacillary angiomatosis --- think Bartonella species
|
|
|
HIV patient with dysphagia, next step?
|
Think oral candidasis
Start fluconazole Start PCP prophylaxis regardless of CD4 count |
|
|
HIV patient who has spontaneous pneumothorax was probably infected with what organism?
|
Pneumocystis (95% probability)
|
|
|
What is important to assess before starting HIV meds?
|
Patient compliance and willlingness to adhere to regimen
|
|
|
HIV associations to know:
Oral Hairy Leukoplakia PML Kaposi Sarcoma Bacillary Angiomatosis |
Oral Hairy Leukoplakia --> EBV
PML --> JC virus Kaposi Sarcoma --> HHV8 Bacillary Angiomatosis --> bartonella |
|
|
How do you distinguish oral hairy leukoplakia from oral candidasis?
|
CAn scrape off Candida with a tongue blade, often times leaving a bloody, painful denudation mark
Oral Hairy Leukoplakia --> white patch, which almost exclusively occurs on the lateral surfaces of the tongue, cannot be scraped off easily. |
|
|
HIV drug implicated in life-threatening hypersensitivity syndrome; what is the defect?
|
ABACAVIR
Test for presence of HLA-B*5701 |
|
|
Fever and Lymphadenopathy in an HIV patient with CD4 count <100; think what organism?
|
MAC
|
|
|
HIV drug associated with renal stones and sludging
|
Indinavir
|
|
|
HIV drugs associated with peripheral neuropathy and pancreatitis
|
D4T (STAVUDINE)
DDI (DIDANOSINE) DDC (ZALCITABINE) |
|
|
HIV drug class associated with lactic acidosis
|
NRTIs
Most will have hepatomegaly and abnormal LAEs as well D4T (Stavudine) is the msot associated |
|
|
Risk factors for disseminated candidal infections
|
Hyperalimentation
Central Venous Catheters DM Borad-spectrum antibiotics and steroid tx Consider giving Caspofungin |
|
|
Clinical features of disseminated candidiasis
|
Fever
Endophthalmitis Pulmonary infiltrates Hepatosplenic candidiasis most common in transplant of leukemic patients - fever, abdominal pain, HSM, increases alk phos |
|
|
RFs fo invasive aspergillosis
|
Prolonged granulocytopenia (neutropenic fever patients)Prlonged corticosteroid patients
Cytotoxic chemotherapy Tx: Voriconazole = Amphoterecin B (increasing resistance to itraconazole) ***NOTE: NOT COMMON IN AIDS PATIENTS*** |
|
|
Disseminated coccidoides are more common in what ethnicities
|
Blacks
Filipinos Asians AIDS Lesions can occur in bone, skin, meninges, and joints |
|
|
Key features of visceral leishmaniasis
|
Hepatosplenomegaly
Generalized lymphadenopathy Pancytopenia Fever Cachexia (resembles lymphoma) Epidemiology: Latin America, Mediterranean littoral, Middle East Cutaneous disease is obvious |
|
|
Liver abscess and E hystolytica
|
confirm dx with bx
|
|
|
Eating raw or uncooked pork
|
Trichinosis
Clinical features: severe muscle pain, periorbital and facial edema, subconjunctival and plinter hemorrhages, eosinophilia |
|
|
Frequent gonoccocal and meningococcal infections
|
Terminal Complement Deficiency Suspected
Check CH50 |
|
|
Most common cause of genital ulcers in the US
|
HSV2
|
|
|
Painful genital ulcers with irregular borders in SE Asia or Africa
|
Think: Chancroid
|
|
|
Causes of secondary rhinitis to know
|
Hypothyroidism
Pregnancy Wegener's granulomatosis Medical induced (nasal decongestant overuse, ACEI, Alpha-blockers) |
|
|
Intraoperative Anaphylaxis culprits
|
Latex allergies
Preoperative antibiotics Induction agents (esp thiopental) Opiates |
|
|
Tx of acute episodes of bradykinin mediated angioedema
|
IV C1 inhibitor concentrate
|
|
|
Long-term management of hereditary angioedema
|
Danazol and Stanazolol to elevated hepatic synthesis of C1 esterase inhibitor protein
|
|
|
A patient who is allergic to beta-lactams [This includes penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems] can still use this drug for tx if required
|
Aztreonam
Does not have cross-reactivity in regard to allergic reactions with beta-lactams with the possible exception of ceftazadime, which shares an identical side-chain. |
|
|
Equalization of diastolic pressures
|
Suspect tamponade
|
|
|
Pneumonia that may be associated with autoimmune hemolytic anemia, erythema multiforme, and bullous myringitis
|
Mycoplasma`
|
|
|
Incrased TLC
|
hyperinflcation
|
|
|
Increased RV
|
Air-trapping
|
|
|
Restrictive pattern on spirometry and lung volumes
Normal DLCO Reduced Max inspiratory and expiratory pressures |
Think: Neuromuscular Disorders
|
|
|
Bilateral PEripheral Infiltrates + Eosinophilia
|
Chronic Eosinophilic Pneumonia
|
|
|
Differences b/w secondary vs primary adrenal insufficiency
|
In secondary adrenal insufficiency:
Hyperpigmentation is absent More prominent hypoglycemia (d/t coexistent growth hormone deficiency) No hyperkalemia |
|
|
In critical care patients, adrenal insufficiency can be diagnosed if random cortisol is less than what number?
|
<12 --> Adrenal insufficiency is likely
A random serum cortisol level greater than 15 micrograms/dL (414 nmol/L) in a critically ill patient and a level greater than 12 micrograms/dL (331 nmol/L) in a critically ill patient who has hypoproteinemia (serum albumin level <2.5 g/dL [25 g/L]) make the diagnosis of adrenal insufficiency unlikely. |
|
|
Hyperchloremic NAGMA and Hyperkalemia
|
Think: RTA IV associated with Diabetes = Hyporeninemic Hypoaldosteronism
|
|
|
Cushing's Disease
|
Pituitary Over-secretion of ACTH
Clinical features: facial plethora, striae, easy bruisability, weakness, osteopenia (80%), glucose intolerance, centralized obesity, neuropsychiatric effects. |
|
|
How do you distinguisg adrenal vs. pituitary Cushing's
|
High Dose Dexamethasone Suppression Test will suppress patients with pituitary Cushing's to 50% of pre-test values
Ectopic/Adrenal tumors fail to suppress |
|
|
Common secondary causes of hyperlipidemia
|
Diabetes (increased TG)
Hypothyroidism (increased TG and LDL) Drugs (Thiazides/Beta-blockers) Nephrotic Syndrome |
|
|
Causes of Vitamin K deficiency
|
Malabsorption
Malnutrition Anticoagulants Cephalosporins (Cefoperazone, Cefotetan) |
|
|
Most common hereditary cause of unexplained VTE (esp in women taking OCPs)
|
Factor V leiden (APC resistance)
|
|
|
VTE + Elevated PTT that does not correct with a 1:1 mix
|
Antiphospholipid Syndrome
Also recurrent fetal loss Can be associated with SLE, some drugs, HIV |
|
|
When to get a BMBx in ITP
|
Very elderly and more than 2 cell lines down
|
|
|
Rectal Cancer requires...
|
Stage II/II rectal cancer are treated with preoperative (neoadjuvant) radiation tx and chemotx and post-op adjuvant chemotherapy alone
|
|
|
Stage IV Colorectal Cancer Tx
|
5fu + Leucovorin + Oxaliplatin +/- bevacuzimab
|
|
|
Follow up for Colorectal Cancer
|
CEA q3-6 mo x2 years then q6mo for subsequent 3 years
Colonscopy 1 year after resection, then 3 years later, then every 5 years CT of the Chest/ABD/Pelvis q1y for 3 years with perinerual invasion or poorly differentiated tumors |
|
|
CML -- look for this chromosomal abnormality
|
Philadelphia Chromosome t(9;22) tx with imatinib
Helps control disease but does not cure it |
|
|
Bone pain after drinking alcohol, eosinophilia, MCD, pruritis
|
Think: Hodgkin's Disease
|
|
|
Acute Febrile Neutrophilic Dermatosis (SWEET SYNDROME) associted with?
|
AML
|
|
|
Necrolytic Migratory Thrombophlebitis (spread of erythematous blisters and swelling across areas subject to greater friction and pressure, including the lower abdomen, buttocks, perineum, and groin)
|
Think: Glucagonoma
|
|
|
Cancers that cause fever
|
Hepatoma
Hypernephroma Lymphoma |
|
|
Order of decision making ability
|
Durable POA > Spouse > Parents > Children > Sibs
|
|
|
Acute tx of nephrolithiasis
|
Increased Fluids
Nifedipine AND corticosterodis or Tamsulosin for distal ureteral staones <10-15 mm in diameter IV ketoralc Shockwave lithotripsy |
|
|
High risk HCM
|
Syncope
SCD FHx Septum >30 mm ---> ALL SHOULD CONSIDER ICD |
|
|
Pregnancy and Heart Disease: If signs of MI --- think?
|
Coronary Artery Dissection
|
|
|
Classic Features of Ankylosing Spondylitis
|
Back Stiffness
Sacroilliac pain and iritis Upper lobe pulmonary fibrosis Aortic insufficiency |
|
|
Reactive Arthritis
|
symmetric arthritis
s/p dyssentry/NG urethritis peripheral arthritis affecting the lower extremities Swelling of the achilles tendon Conjunctivitis, Uveitis Urethritis Prostatitsi KERATODERMA BLENORRHAGICA (rash on soles/palms) CICINATE BALANITIS |
|
|
CPPD is associated with what 2 systemic diseases
|
Hyperparathyroidism and Hemochromatosis
|
|
|
Antibody that can be associated with Subacte Cutaneous Lupus
|
Anti-Ro Ab
|
|
|
Facial rash that involves the nasolabial folds
|
Rosacea (SLE SPARES NASOLABIAL FOLDS)
|
|
|
Asplenic individuals should get these vaccines
|
Pneumococcal
H influenza B Meningococcal |
|
|
Worrisome side effect of chronic Megestrol use
|
Adrenal Insufficiency
Megestrol is a progestational agent with strong glucocorticoid activity that is commonly used in patients with anorexia of different causes because it is a potent appetite stimulant. |
|
|
The offspring of mothers with prepregnancy obesity and gestational diabetes mellitus are at increased risk for...
|
childhood obesity
|
|
|
Severe and persistent mastalgia tx
|
1st try supportive bra
Medical treatment is typically reserved for women who have severe and persistent pain that interferes with their quality of life. Danazol is the only treatment that has been approved by the FDA for cyclical mastalgia, although it would not be appropriate in this patient without a trial of nonmedical therapy. |
|
|
Initial test of choice when there is a moderate or high pretest probability of endocarditis (i.e. staph bacteremia)
|
TEE
|
|
|
Provide nursing level services, such as intravenous medications and medication management, wound care, and other medical services in addition to low-level rehabilitation services. With further recovery, long-term care options may be reassessed and the most appropriate type pursued.
|
Skilled Nursing Facility
|
|
|
Focused on intensive physical and occupational therapy and other forms of rehabilitative treatment as needed. Although patients with active medical issues may be candidates for inpatient rehabilitation, these issues need to be stable, and patients are generally required to participate in therapy for a minimum of 3 hours daily.
|
Inpatient Rehabilitation
|
|
|
Provide care similar to that in an acute hospital setting but for patients who are considered stable with the need for hospital-based testing or interventions and with few anticipated changes in the care plan. This setting is overseen by physicians and is appropriate for patients who require significant medical monitoring but are expected to have a more prolonged (more than 25 days) time to recovery. This patient's medical needs are minimal and could be appropriately provided in a skilled nursing setting.
|
Long-term Acute Care Hospitals
|
|
|
Physician must feel that the expected prognosis is less than 6 months of life remaining.
|
Hospice Care
|
|
|
Ankle radiographs -- when should you get an Ankle X-ray?
|
should only be obtained in patients with acute ankle pain who are unable to bear weight or who have bony tenderness to palpation at the posterior edge of either the lateral or medial malleoli.
|
|
|
Should be considered in patients with chronic, nonproductive cough without an apparent cause
|
Check sputum eosinophils
--> Nonasthmatic Eosinophilic Bronchitis' Tx: inhaled corticosteroids |
|
|
Most common anterior pituitary hormone disorder after traumatic brain injury is?
|
Growth hormone deficiency, which can be suggested by a decreased serum insulin-like growth factor 1 level and is confirmed by a stimulation test measuring GH reserve.
|
|
|
First-line therapy for the treatment of allergic rhinitis?
|
Intranasal corticosteroid.
|
|
|
he best initial treatment for hirsutism in women with polycystic ovary syndrome
|
OCPs
|
|
|
Characterized by reduced total lung capacity and increased residual volume (owing to the patient's inability to fully exhale).
|
Respiratory Muscle Weakness due to neuromuscular disease
|
|
|
Immunocompetent persons who received the pneumococcal polysaccharide vaccine before age 65 years
|
Should receive a single booster vaccination at age 65 years, or 5 years after their first vaccination if they were vaccinated between the ages of 60 and 64 years.
|
|
|
Aside from Sjogren's disease, Anti-Ro/La (SSA/SSB) is positive in...
|
Mothers infants with neonatal lupus
Subacute cutaneous lupus erythematous |
|
|
Most likely neoplasm to present in a young never-smoker with evidence of endobronchial obstruction and a history of recurrent pneumonia.
|
Carcinoid Tumor
|
|
|
Intensive care unit admission in asthma
|
For symptomatic patients with an arterial PCO2 of greater than or equal to 42 mm Hg (5.6 kPa) or persistent FEV1 or peak expiratory flow less than 40% of predicted despite aggressive bronchodilator treatment.
|
|
|
When should you choose clopidogrel over ASA in patients with stroke?
|
he Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) study randomized patients with ischemic stroke, myocardial infarction, or peripheral arterial disease to aspirin versus clopidogrel, with a primary outcome of stroke, myocardial infarction, or death. Overall, clopidogrel was superior to aspirin in preventing the primary outcome, with the benefit being greatest among participants with peripheral arterial disease. The absolute risk reduction in clopidogrel versus aspirin for the primary outcome was 0.5% per year. The combination of aspirin and dipyridamole could be another appropriate option for secondary stroke prevention.
|
|
|
Mainstay 1st line tx of Asthma
|
SABA then INHALED CORTICOSTEROIDS [NEVER USE LABA WITHOUT INH CORTICOSTEROIDS]
|
|
|
Mainstay 1st line tx of COPD
|
SABA then Long Acting Anticholinergics (Tiotropium for FEV1<60%) and LABA (which can be used alone in COPD), then can add inhaled corticosteroids (Can't be used alone!) --- opposite of asthma
|
|
|
The initial treatment of anaphylaxis
|
intramuscular or subcutaneous epinephrine
Patients with wheezing should also receive treatment with an inhaled β2-agonist such as albuterol. Neither antihistamines nor corticosteroids have been shown to improve outcomes in anaphylaxis, and neither agent would reverse this patient's bronchospasm quickly enough. When these agents are used, it is usually in an attempt to prevent a delayed recurrence of symptoms, but even this is not supported by strong evidence of efficacy. |
|
|
Cherry red spot in the eye
|
Acute Central retina artery occlusion
|
|
|
blood and thunder in the eye
|
retinal vein occlusion
|
|
|
Can be used to manage musculoskeletal features of diffuse cutaneous systemic sclerosis.
|
Methotrexate
|
|
|
Surgical patients at high risk for venous thromboembolism, including those with previous venous thromboembolism, patients who have undergone orthopedic surgery, and patients with some cancers (especially gynecologic malignancy), should receive what VTE prophylaxis for how long?
|
Should receive extended (up to 5 weeks) prophylaxis of lovenox (usually).
|
|
|
An oral phosphodiesterase-4 inhibitor recently approved for use in patients with severe and very severe COPD associated with chronic bronchitis and a history of frequent exacerbations.
|
Roflumilast
|
|
|
Centor Criteria for Grp A strep
|
Fever >100.5 (>38.1)
Tonsillar Exudates Tender Cervical Lymphadenopathy Absence of Cough |
|
|
Metabolic syndrome is diagnosed by the presence of...
|
three or more of five abnormalities: increased waist circumference, elevated systolic or diastolic blood pressure, decreased HDL cholesterol level, elevated triglyceride level, and elevated fasting plasma glucose level.
|
|
|
CP that is typically sharp, pleuritic, retrosternal, worsened by recumbency, and improved by sitting forward.
|
Acute Pericarditis
|
|
|
vertigo, unilateral hearing loss, and tinnitus
|
Meniere's disease
|
|
|
here is pain with abduction of the right arm between 60 and 120 degrees. The patient is asked to hold the arm extended anteriorly at 90 degrees with the forearm bent to 90 degrees (at 12 o’clock), as if holding a shield. When the arm is internally rotated to cross in front of the body, the patient feels pain in the shoulder (positive Hawkins test).
|
Rotator Cuff Impingement
|
|
|
Palpable osteophytes may be present, and radiographs, if obtained, may demonstrate degenerative changes. It characteristically presents with pain that occurs with shoulder adduction and abduction above 120 degrees.
|
Acromioclavicular Joint Degeneration
|
|
|
Stage III pressure ulcers
|
defined by full-thickness tissue loss but without exposure of bone, tendon, or muscle, generally require debridement, proper dressing selection, and treatment of infection, if present.
|
|
|
Stage II ulcers
|
Can be treated using an occlusive dressing to keep the area moist.
|
|
|
Tx of yeast infection in pregnancy and patients with DM2/immunocompromising conditions?
|
Topical Imidazole (Clotrimizole) x 7 days
|
|
|
Effective treatment for moderate menstrual bleeding.
|
Medroxyprogesterone acetate for 10 to 21 days is
|
|
|
Cervical cancer screening in women >30
|
In women older than 30 years with no risk factors for cervical cancer or history of abnormal Pap smears, the cervical cancer screening interval can be extended to 3 years with cytology or 5 years with cytology and human papillomavirus DNA testing. Screen up to age 65 if all is negative.
|
|
|
Tobin Index
|
RR/TV <105 --> EXTUBATE
|
|
|
BP screening frequency guidelines
|
screening every 2 years for those with blood pressures of less than 120/80 mm Hg and every year for those with systolic blood pressures of 120 to 139 mm Hg and diastolic blood pressures of 80 to 89 mm Hg
|
|
|
Characterized by cyclic central apneas and hyperpneas during sleep that are associated with ascension to altitude; symptoms include repeated awakenings from sleep, sometimes with a sense of dyspnea, and fatigue related to poor sleep quality.
|
High Altitude Periodic Breathing
|
|
|
Loss of both active and passive range of motion
|
Adhesive Capsulitis
|
|
|
Effective for treating hypercapnic respiratory failure related to neuromuscular weakness
|
Bipap
|
|
|
Diagnosis of HF with an exudative pleural fluid
|
A serum to pleural fluid albumin gradient greater than 1.2 g/dL (12 g/L) or a serum to pleural fluid total protein gradient greater than 3.1 g/dL (31 g/L) is equally consistent with a transudative process under these circumstances.
|
|
|
An option for reducing LDL cholesterol levels in women with hyperlipidemia who wish to become pregnant.
|
Bile Acid Sequestrants -- Colesevalam
|
|
|
Dietary Guidelines for cholesterol
|
Saturated fat intake should be reduced to less than 7% of total calories (about 19 g of saturated fat for a 2500-calorie diet) and dietary cholesterol consumption decreased to less than 200 mg/d.
|
|
|
Pravastatin metabolism
|
Renally metabolized so has the least drug-drug interactions
|
|
|
Which statin has the least drug-drug interaction
|
Pravastatin - renally metabolized
|
|
|
Pain typically located along the anteromedial aspect of the proximal tibia distal to the joint line of the knee and characteristically worsens with step climbing and at night.
|
Pes Anserine Bursitis
|
|
|
Should be suspected in anyone with pharyngitis, persistent fever, neck pain and septic pulmonary emboli.
|
Lemierre's Syndrome -- Fusobacterium
Next step = CT of neck with contrast IV antibiotics (e.g. carbapenems or unasyn) indicated |
|
|
Goal BP target in HTN Emergency
|
mean arterial pressure should generally be lowered by no more than 25% in the first hour of treatment.
Over the next 2-6 hours target DBP <110 |
|
|
Goal BP targets in HTN urgency
|
Gradually decrease over 1-2 days using po agents
|
|
|
Tx of Aortic Dissection
|
IV beta blocker followed by nitroprusside
|
|
|
The greatest effect on the rate of progression to proliferative retinopathy is what intervention in diabetics?
|
Glucose Control
|
|
|
Pts who have never been PPD tested and are high risk should receive what testing strategy
|
2 stage testing if the first test is negative
|
|
|
Very low glucose level in pleural effusions
|
Think: RA** can have the lowest glucose level; and think infection
|
|
|
Right sided MSSA endocarditis -- duration of tx?
|
2 weeks (all others are 4-6 weeks) -- low risk endocaridits
|
|
|
Cancer patient with SIADH; appears chronic
|
Give Demeclocyline
|
|
|
Diarrhea in an HIV Positive PAtient -- no detected organism on stool cx --- what is the likely organism?
|
Cryptosporidium
The proper test to detect cryptosporidiosis is a modified acid-fast examination of the stool. There is no truly effective antimicrobial agent directly against cryptosporidiosis. The efficacy of paromomycin is partial at best. The management of cryptosporidiosis is to treat the underlying HIV. As the CD4 rises, the cryptosporidial infection will resolve. Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 263). Kaplan Publishing. Kindle Edition. |
|
|
Tx of TB in pregnancy
|
INH + Ethambutol + Rifampin x9 mo
|
|
|
Treatment of macular degeneration of the "wet" or "soft" variety?
|
Laser Photocoagulation
Macular degeneration is one of the most common causes of central retinal visual loss in the elderly. The “dry” type consists of the accumulation of yellow objects called “drusen” in the eye. Therapy for dry or drusenoid macular degeneration is with antioxidant vitamins such a vitamin C and E and zinc. “Wet,” or exudative, type responds to laser photocoagulation which does retard the progression of the disease. Nothing has been shown to restore vision that has already been lost. Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 266). Kaplan Publishing. Kindle Edition. |
|
|
Tx of Lyme CNVII Palsy
|
Doxycycline x 3 weeks
|
|
|
Contraindication of mefloquine
|
Psychiatric illness
|
|
|
Tx of uveitis (when it is obvious)
|
Topical Steroids --- otherwise avoid and refer to opthalmology
|
|
|
Selenium deficiency is assocaited with what?
|
Cardiomyopathy
|
|
|
Treatment of localized psoriasis when patient not tolerating long-term steroids
|
Calcipotriene (VITAMIN D ANALOGUES!)
Ultraviolet light is used to control unresponsive disease particularly when it covers extensive surface areas, not localized disease such as in this case. |
|
|
Major side effect of treating patients with Vitamin B12 deficiency (esp if they are pancytopenic)
|
Hypokalemia
It is one of the few circumstances in which cells can be made so rapidly that potassium can actually be used up and drop the serum level. The marrow is the only place in the body where cell production can be so rapid as to use up the potassium enough to drop the serum level. Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 269). Kaplan Publishing. Kindle Edition. |
|
|
Subsiding pain in chronic pancreatitis corresponds to what objective measures?
|
Diarrhea secondary to worsening exocrine function In persons with chronic pancreatitis, recurrent attacks of pain typically lead to a chronic level of pain. After progressive loss of pancreatic function, the pancreatic pain can “burn out.” This phenomenon develops as the gland becomes more damaged, worsening endocrine and exocrine function (e.g., worsening diabetes and diarrhea from malabsorption).
Fischer, Conrad (2009-10-06). Kaplan Medical Internal Medicine Question Book (p. 272). Kaplan Publishing. Kindle Edition. |
|
|
Patients with biliary colic -- next step?
|
Don't treat -- symptomatic tx only
|
|
|
Eggshell calcifications on Xray
|
Silicosis --- check TB
|
|
|
Major side effects of nitrofurantoin
|
Pulmonary Fibrosis
Drug-induced Hepatitis |
|
|
LLQ - Crampy - Acute GIB
|
Think Acute Ischemic Colitis -- likely from watershed area --- tx with iv fluids and supportive care
|
|
|
Pain out of proportion to abdominal exam
|
Think: Mesenteric Ischemia and get a CT Angiogram stat -- may need papavarine
|
|
|
Very high DLCO
|
Pulm Hemorrhage
|
|
|
Antibody to Hep B Core Antigen with negative Hep B Surf Antigen and negative HBV e Ag
|
Nonreplicating Chronic HBV infection
|
|
|
Surrepititious Insulin use
|
Low C peptide with high insulin levels
|
|
|
Sulfonylurea abuse
|
High C peptide, High insulin (that's b/c it is from an insulin secretogue)
|
|
|
Chronic Lupus Erythematosus =
|
Discoid Lupus -- no other associations
NOTE: SCLE is associated with (+)ve Anti-RO/LA antibodies |
|
|
Raccoon eye in adult after valsalva
|
AL Amyloidosis
|
|
|
Lichen planus association
|
HCV and liver disease - remember the 5 p's
|
|
|
Characterized by a rate of approximately 150/min and P waves of a single morphology, most clearly seen in lead V1 and at the end of T waves in other leads
|
Atrial Tachycardia
|
|
|
an escape rhythm in which the ventricular rate is between 30/min and 40/min. The QRS complexes are wide (as in all ventricular arrhythmias) and fairly regular, and there is no atrial activity (that is, no P wave). An idioventricular rhythm is considered accelerated when the rate is more than 50/min but less than 120/min.
|
Idioventricular Rhythm
|
|
|
Painful genital lesion found to have chancroid; causative organism?
|
Hemophilus ducreyi
The lesion begins as a papule, then evolves into a pustule that erodes to form an ulcer. Typical ulcers are between 1 and 2 cm in diameter with a red base and undermined, shaggy borders. The base of the ulcer is often purulent and appears as a “dirty painful ulcer.” |
|
|
Intracellular organisms
|
remember neisseria and listeria
|
|
|
Occurs in acutely or critically ill patients, is characterized by low total and free triiodothyronine (T3) levels (caused by conversion of thyroxine [T4] to reverse T3 rather than T3), normal or low T4 levels, and variable thyroid-stimulating hormone levels (usually normal or low, but sometimes elevated).
|
Euthyroid Sick Syndrome
|
|
|
characterized by extremely pruritic round or oval patches of eczematous dermatitis consisting of papules, scaling, crusting, and often serous oozing. Most lesions appear on the trunk and legs and are 2 to 10 cm in diameter.
|
Nummular Dermatitis
|
|
|
Paget's Disease of the Breast
|
Recognized as an eczematous eruption of the nipple and areola that is often associated with a yellow exudative discharge. Paget disease of the breast is strongly associated with underlying breast cancer despite a normal clinical breast examination and mammogram results. Diagnosis is established by skin biopsy.
|
|
|
causative organism for molluscum contagiousum
|
poxvirus
|
|
|
Leukocytoclastic Vasculitis
|
This condition should not be diagnosed without a very thorough physical examination and laboratory studies to exclude systemic involvement, particularly clinically occult glomerulonephritis
|
|
|
Cutaneous Anthrax
|
Cutaneous anthrax is the most common type of anthrax in the United States and results when causative microorganisms are introduced into a skin abrasion or cut. Cutaneous lesions are initially pruritic and painless and subsequently progress to vesicular lesions surrounded by nonpitting edema. The lesions then become hemorrhagic or necrotic, and satellite lesions may form. Finally, a central black eschar can develop and usually resolves over 6 weeks. Diagnosis is confirmed by culture of blood or exudate or by full-thickness skin biopsy.
Think of rancher in the western US. |
|
|
The first and most common clinical manifestation of acute GVHD
|
A maculopapular exanthem that can progress to bullae formation. The rash first appears at the nape of the neck and on the ears, shoulders, palms of the hands, and soles of the feet and may be pruritic or painful.
|
|
|
Erythema Marginatum
|
=Rheumatic Fever
|
|
|
Pathergy Test
|
Development of an erythematous papular or pustular lesion >5 mm 24 to 48 hours after skin prick by a needle
|
|
|
Purpura fulminans
|
A severe complication of meningococcal disease.
|
