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241 Cards in this Set

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Gastroparesis (DM) Rx
metoclopramide, erythromycin; symptoms: post-prandial fullness, hypoglycemia, sweating, dizziness, constipation
Drugs that lead to hypercalcemia
thiazides, lithium
Calcium greater than 12 or symptoms
NSS IV 3-6 L in 24 h, furosemide if necessary
Hungry bones syndrome
hypocalcemia post op removal of parathyroid adenoma
Sarcoidosis
increase in vit D levels
Familial hypocalciuric hypercalcemia
low 24 h urine calcium
Chronic thyroiditis (Hashimoto)
antimicrosomal antibodies
Drugs that lead to hypothyroidism
lithium, ASA
Large nodule (cold) in multinodular goiter (hot)
FNA; if follicular elements = excision
Psammoma bodies
papillary carcinoma of thyroid = MC type of thyroid cancer, RF radiation exposure, lymphatic spread
Thyroid cancer types
papillary, follicular (hematogenic spread), anaplastic, medullary (MEN); painful, low uptake, increased ESR
Graves disease Rx
bring the patient to euthyroid stae, then: radioactive iodine, steroids for ophtalmopathy
Plummer disease
long-standing multinodular goiters that become thyrotoxic later
Thyroiditis
low 24 h radioactive iodine uptake
Graves disease Dx
increased thyroid, "hot", proptosis, positive TSH Ig
Nitroblue tetrazolium test
chronic granulomatous disease; test phagocyte fuction, oxidative burst
Cellular deficiency disease
fatal infections after receiving live viral vaccines (MMR, varicella)
Ab deficiency disease
encapsulated organisms, sino - pulmonary bacterian infections, sepsis
Phagocytic deficiency disease
recurrent abcesses, lymphadenitis, periodontal infections, Gram negatives, catalase positives, e.g. CGD, Chédiak-Higashi
Complement deficiency dis
C2-C4: autoimmune dis; terminal: Neisseria; C3: encapsulated, unusual strains
Severe combined immunodeficiency
first year of life, decrease in T and B cells
Ig A deficiency
MC primary immune deficiency, major anaphylatic reaction to blood products
X-linked hypogammaglobulinemia Rx
IV Ig; defect in tyrosine kinase
X-linked lymphoproliferative disease
catastrophic after EBV infection
Chronic granulomatous disease
decreased intracelular and fungal killing; S. aureus, Aspergillus; Rx: prophylatic antibiotics (TMP/SMX, doxycycline), interferon gamma; vaccinate: Haemophilus, Pneumoccocus, Neisseria, viral vaccines
T-cell deficiency Rx
bone marrow transplant
Transfusion in cellular deficient patient
irradiated, leukodepleted, virus free product
C3 deficiency
increased number of pyogenic infections
Properidin and C5 deficiency
increased Neisseria infections
C1 inhibitor deficiency
hereditary angioedema
Decay accelerating factor deficiency
paroxysmal nocturnal hemoglobinuria
Clomiphene citrate use
ovulation induction (for patients with good estrogen production, such as in OPCD)
Pregnancy
increase in alkaline phosphatase does not indicate disease necessarily, may be normal finding
Primary hypothyroidism
may lead to increase in pituitary, amenorrhea, galactorrhea
Meconium ileus suspicion
barium enema
Cystic fibrosis tests
sweat test, nasal potential testing
Hepatitis B mother
breastfeed is OK!
Graves in pregnancy Rx
propylthiouracil
Cocaine use in pregnancy
placental abruption
Clue cells
bacterial vaginosis; Rx: metronidazole - counsel not to drink alcohol because of disulfiram-like reaction
Pruritic urticarial papules and plaques of pregnancy
third trimester
RF for ectopic pregnancy
age, PID, salpingitis, more than 3 pregnancies
Testicular feminization
dysfunction or absence of testosterone receptors; patient is XY, normal breast development, scant pubic and axilar hair, blind vagina, undescendent testicles, may be felt on the groin.
fever greater than 38 C in less than 4 m.o.
admission, IV antibiotics, full evaluation, multiple cultures
Pyloric stenosis
non-bilious emesis, midepigastric olive: Dx= USG; RF = erythromycin use
MCC of jaundice in pregnancy
viral hepatitis
Symptomatic biliary stones
pregnancy Rx = laparoscopic cholecystectomy
Asymptomatic biliary stones Rx
none
N. gonorrhea
Gram negative diplococci; Rx = ceftriaxone + azithromycin (to cover Chlamydia, which generally is there too); notify public health authorities
Trichomonas vaginalis
motile flagellated microorganisms in vaginal wet mount
Low grade squamous intraepithelial lesion (cervix)
CIN I; Rx = rescreen in 4-6 months
Abnormal vaginal bleeding in woman older than 35 yo next step
office endometrial pipelle biopsy
Small subchorionic henorrhage Rx
clinical and USG observation
Menorrhagis, anovulatory bleeding
order a TSH!
Group B strep prophylaxis
penicillin or ampicillin to mother during active labor, CBC and blood culture on the newborn
Low plasma bicarbonate causes
diarthea, renal tubular acidosis
Erythema infectiosum
not contagiuos during the rash (slapped face, lacy), only before it
Bleeding in pregnancy
order bood type, Rh, atypical antibodies
Bilious vomiting in infant
think malrotation with volvulus; if no peritoneal signs, flexible sigmoidoscopy is diagnostic and treatment at the same time
Bilious vomiting in newborn
remember the 3 Ds: duodenal atresia, double bubble on abd XR, greater incidence in Down's syndrome
Side effects of MgSO4 use for the NB
meconium plug syndrome; in this case, contrast enema is both diagnostic and curative
Polythelia
accessory nipple
Polymastia
extraglandular breast tissue
Hugh grade intraepithelial lesion (cervix) management
colposcopy + endocervical curetage + biopsy
Following a molar pregnancy
contraceptives for 1 year, monitor beta HCG, if it goes up, it could be choriocarcinoma
Fetal alcohol syndrome
cardiac malformation (VSD), CNS abnormalities, face deformities
Tuboovarian abscess Rx
IV atbtcs; surgery only if necessary - it's one of the few cases of abscess that are cured without incision!
Prostate cancer Dx
USG guided needle biopsy with 6-12 specimens
Metastatic prostate cancer Rx
GnRh agonists (flutamide), orchiectomy + chemo
Staging for testicular cancer
serum LDH, AFP, beta HCG, CT chest/abd/pelvis; Rx = radical inguinal orchiectomy + spermatic cord ligation
MC sites of melanoma
trunk for men, legs for women
Basophilic palisiding cells, pearl apperance, upper 1/3 of the face
basal cell ca (the MC skin ca)
Moh's micrographic surgery
for squamous cell ca (lower 1/3 of the face), makes 1-2 mm margins
MCC of encephalitis in adults
HSV; meningeal signs + focal neurological signs, temporal lobe changes on CT; Rx = IV Acyclovir 14-21 days
Listeria monocytogenes meningitis Rx
ampicillin; NB, elderly
Chronic sinusitis
longer than 3 months; clinical Dx, but if something is going to be ordered = CT sinus; Rx = amoxicillin +/- clavulanate +/clindamycin for 21 days, nasal steroid sprays, endoscopic surgery if necessary
Otitis media, ac. sinusitis Rx
TMP/SMX or amoxicillin +/- clavulanate
Otitis externa Rx
topical ofloxacin with steroids; remember to clean the ear before applying the Rx; Pseudomonas, swimmers
Chr carriers of group A strep Rx
clindamycin
Smoker with pneumonia, diarrhea, increased LDH
think Legionella; Dx = urine Ag; Rx = doxycycline
Cystic fibrosis pneumonia Rx
IV ceftazidime + IV levofloxacine = IV aminoglycoside; MCC = Pseudomonas
Aspiration pneumonia Rx
IV ceftriaxone + IV azythromycin + IV clindamycin; chronic, not presentiated, RF positive
Aspiration pneumonitis
acute event, presentiated by somebody, no need for atbtcs
PCP pneumonia Dx
silver stain of sputum, bronchial lavage; Rx = IV TMP/SMX or inhaled pentamidine, add prednisone if: PaO2 less than 70 or A-a gradient more than 35
TB Rx
RIPE for 8 w., then INH + rifampin for 16 w. more Add vit. B6 for INH; Keep an eye on uric acid for Pyrazinamide; Order ophtalmologic avaliation for Ethambutol
Latent TB Rx
nine months of INH (+ B6)
TB + HIV
use Rifabutin instead of Rifampin because of possible drug interaction
Ac. prostatitis Rx
TMP/SMX or fluoroquinolone for 14 d
Chr prostatitis Rx
fluoroquinolone 1 m. or TMP/SMX 3 m.
Primary/secondary syphilis Rx
Penicillin G 2.4 million U IM; if disease present for more than 1 year = three doses with 1 w. intervals; notify health department
Neurosyphilis Rx
Penicillin G IV for 14 days
DM Dx
random glucose test >200 + symptoms OR twice fasting glucose > 126 OR 75 GTT > 200 at 2 h. OR 50 g GTT > 146 at 2 h
Annual influenza vaccine
patients older than 50 yo, healthcare workers
OCPs
decrease risk for gonococcal PID
Osteoporosis Rx with drugs, not only calcium is indicated when
T-score < 1.5 OR < 2.5 + RF
Dual X-ray absorptiometry (DEXA) T-score
compared to young adults
DEXA z-score
compared to age and race matched population
Elderly + fall
do a home safety evaluation, avoid narcotics
Woman sexually active, younger than 25 yo or with RF
screen for Chlamydia
HTN Dx
2 separate readings with increased BP
Post exposure TB prophylaxis
2 drugs chosen according to bug susceptibility
Smallpox Rx
Cidofovir
Anthrax Rx and prophylaxis
ciprofloxacin (adults), penicillin (children)
Household with children
water heater < 120-130 F
Pneumococcal vaccine
q5 y for >50 yo with chr disease
Td vaccine
q10 y or once at age 50 yo
woman with relative with breast ca
mammogram 10 y before the affected person age + self breast examination
Men with relative with prostate cancer
annual PSA + DRE after 40 yo
Bipolar I
Hx of mania; major depression + or -
Bipolar II
Hx of hypomania + major depression; NO mania
Autism suspicion
order a hearing test before saying it is!
Gingko biloba + warfarin
increased risk of bleeding
1 yo vaccines
Hib, MMR, varicella, PCV
Adopted foreign child
serology hep B, C, HIV, syphilis, PPD, stool tests
HIV + CD4 , 200
TMP/SMX prophylatic for PCP pneumonia
Pediculosis, scabies Rx
permethrin lotion; in scabies: treat all household members
Necrotizing infection + DM Rx
X-ray, OR for debridement, amputation if needed
Infection in CRF + indwelling catheter Rx
vancomycin + gentamycin
Tinea versicolor Rx
topical ketoconazole
Waterhouse-Friderichsen syndrome
adrenal infarction after/during meningococcal meningits, decreased cortisol level
Postherpetic neuralgia Rx
amitriptiline
Mononucleosis
leukopenia with atypical lymphocytes, heterophile Abs
Bacteremia in a baby Rx
ampicillin + cefotaxime; covering group B strep, Listeria, E. coli
Hep. B window period
surface Ag and Ab negative (they cancel each other), Dx may be made through core Ag IgM Ab +
Rat bite fever Rx
penicillin G or tetracycline
HUS
ac. renal failure + anemia + thrombocytopenia; E. coli 0157:H7, raw meat
Tinea pedis Rx
topical antifungal for 2-3 w, if not gone = oral griseofulvin 6-8 w
Invasive aspergillosis
multiple bilateral lung nodules with surrounding hemorrhages
Post chemo fever Rx
hospitalize, broad spectrum atbtcs, antifungal if no response
HPV infection Dx when lesions not apparent
apply vinegar to the region
Cat scratch disease Dx
lymph node biopsy; treat only if = bact superinfection (S. aureus), encephalitis
Ac. post-infectious cerebellar ataxia
post varicella infection or vaccine; differential = poisoning
Fever + neutropenia Rx
antipseudomonal third generation cephalosporin OR antipseudomonal penicillin + aminoglycoside
First generation cephalosporin
cefadroxil, cefalexin, cefalotin, cefazolin
Second generation cephalosporin
cefaclor, cefuroxime; antianaerobe: cefotetan, cefoxitin
Thrid generation cephalosporin
cefixime, cefotaxime; antipseudomonal: cefoperazone, ceftazidime
Herpes zoster Rx
acyclovir
Crush injuries Rx
copious alkalinized IV crystaloid (for renal protection)
Exertional heat stroke
may lead to DIC and rhabdomyolysis; Rx = ice water, cold wet sheets + fan
Ecstasy intoxication
may lead to rhabdomyolisis
Ac. ethanol withdrawal Rx
chlordiazepoxide
Edrophonium
acetylcholinesterase inhibitor
Organophosphate poisoning Rx
atropine, pralidomide
Ac. tubular necrosis due to contrast prophylaxis
hydration, acetylcysteine; Avoid/suspend metformin use before tests with IV contrast (for renal protection)
Opioid intoxication
miosis, resp. depression, coma, hypotension, bradycardia; Rx = naloxone
Severe dehydration in elderly
may lead to ac. suppurative parotitis by S. aureus; Rx = IV hydration, sialogogues, atbtcs; surgical drainage if not better in 12 h
Priapism causes
TPN, sickle cell disease, crack/cocaine, trauma, spinal or general anesthesia, trazodone, leukemia
Alcohol withdrawal
happens in hours to 10 days
Urinary retention causes
BPH, prostate ca, prostatitis, urethral stricture, meds, blood clots
Cyanide toxicity (nitroprusside) Rx
sodium thiosulfate
Gallbladder rupture suspicion
exploratory laparotomy
Compartment syndrome signs
most sensitive is loss of DTRs, most ominous is loss of pulse; 6 Ps = pallor, pain, paralysis, paresthesia, pulselessness, poikilothermia
Hyperkalemia + EKG changes Rx
calcium gluconate
Motor vehicle accident with seat belt in place
may cause pancreatic fracture = order a CT scan with IV contrast
Carboxy hemoglobin level > 40% (>15% in pregnancy) Rx
hyperbaric O2 therapy
Methylene chloride (paint remover) intox.
carbon monoxide poisoning; use co-oxymeter
Methemoglobinemia Rx
Methylene blue
IV epinephrine
Rx of pulseless VT or VF (post eletric cardioversion try), not for hypovolemia
PCP intoxication
aggression, ac. psychosis, ataxia, violence, nystagmus, suicide, fever, hypersalivation, hyperacusis
QRS amplitude alternance
cardiac tamponade
ERCP complications
ac. pancreatitis, infected pancreatic pseudocyst formation, cholangitis, perforation
Disrupted/transected urethra suspicion next step
retrograde urethrogram; blood at meatus + high riding prostate
Leaking CSF (ears)
cribiform fracture = blind nasogastric or nasal intubations are contraindicated!
Femoral canal
NAVEL from lat. to medial
Radial head fracture (outstretched hand, Cole's fracture) Rx
sling 2-3 days, early exercises
Wound dehiscence
new onset serous discharge
CXR in pneumothorax
at maximal expiration
Compartment syndrome suspicion
measure compartment pressures, emergent fasciotomy if confirmed
In burn patients, ____________ use is contraindicated due to the risk of hyperkalemia
succinylcholine
Thioridazine S. E.
prolonged QT
Diuretic for sulfa alergic patients
etacrinic acid
Anabolic steroids S. E.
testicular atrophy, liver disease, gynecomastia, impotence
Concussion
head trauma + transient LOC + short amnesia, may have not serious late symptoms up to 6 m. later
Increased ICP first steps in management
intubation + hyperventilation
Lumbar puncture headache
positional, within 24 h.
Anterior spinal arterial occlusion
decreased motor function, decreased sensation, decreased pinprick, preserved proprioception
AST
less specific for liver than ALT; increased in alcoholic liver injury
Ketorolac
NSAID, IV, used in testicular torsion; S.E. = gastric ulceration, GI bleeding
Human bite Rx
ampicillin-sulbactam OR TMP/SMX + clindamycin; if HIV involved = don't worry, it doesn't get transmitted by bite (yet!)
Methanol toxicity
vision changes; order: ABG, electrolytes, osmolality; Rx = IV ethanol, dyalisis
Amytriptiline S.E.
constipation, ac. glaucoma, urinary retention, dry mouth, paralytic ileus; but the worst event in intoxication = cardiac arrhythmias
Electromyography
checks nerve and muscle integrity
Evoked potential studies
monitor transmission of motor impulses in the anterior columns of spinal cord
JC virus + HIV Rx
HAART
JC virus causes
progressive multifocal leukoencephalopathy
Epididimoorchitis Rx
Doxycycline 100 mg PO bid for 10 d + ceftriaxone 250 mg IM
HTN + BPH Rx
terazosin, doxazosin
Increase in AFP
embryonal, yolk sac elements (nonseminomas)
Increase in HCG
seminomas and nonseminomas
Hydrocele
Dx with USG, no Rx required
Metastatic prostate Ca Rx
leuprolide, goserelin OR bilateral orchiectomy
Priapism etiology
idiopathic (60%), leukemia, sickle cell dis, pelvic tu and infections
PSA > 4 next step
prostate biopsy
Chancroid
Haemophilus ducreyi, painful, unilateral lymphadenopathy, lesion with purulent base; Rx = ceftriaxone, azithromycin
Granuloma inguinale
C. granulomatis, painless, beefy-red lesion; Rx = TMP/SMX
Lymphogranuloma venereum
Chlamydia trachomatis, herpetiform vesicle with erosion, bilateral suppurative lymphadenopathy; Rx = doxycycline
Syphillis
Treponema pallidum, painless papula with clear, clean base, nontender, nonsuppurative lymphademopathy; Dx = RPR, VDRL, dark field mycroscopy; Rx = penicillin, doxycycline, erythromycin; notify health authorities
Hematospermia with normal PE and labs
observation and reassurance
Tertiary syphilis
not contagious
HAART indications
symptomatic HIV, CD4 < 200, pregnancy
CD4 < 200
PCP prophylaxis = TMP/SMX, dapsone or atovaquone
CD4 < 50
MAI prophylaxis = azithromycin weekly
Toxo Ig G + and CD4 < 100
TMP/SMX OR dapsone + pyrimethamine + leucovorin
TB contact OR PPD > 5 mm + HIV
INH + vit B6 for 9 m.
HIV Dx vaccines to be given
pneumococcal q 5 y., influenza q 1 y., hepatitis B
Mefloquine S.E.
bradycardia, neuropsychiatric symptoms, prolonged QT
NB of woman with SLE may have
congenital complete heart block
Chronic fatigue syndrome
fatigue + cognitive changes for 1 y. or more; infectious basis: virus, Chlamydia pneumoniae
Fibromyalgia
pain, tender points (11 of 18), sleep changes, psychological distress, allodynia, more than 3 m., realated to SLE, RA
Allodynia
even gentle touch is unpleasant
Avascular necrosis of femoral head causes
pancreatitis, alcoholism, fat embolus, sickle cell anemia, air emboli, steroids; Dx = MRI, SPECT
Idiopathic AVN (avascular necrosis)
Legg-Calve-Perthes disease
AVN (avascular necrosis) Rx
avoidance of activity, taper steroid
Pyogenic granuloma Rx
shave, electrodesiccate base, send it to pathology evaluation
Amelanotic melanoma
It can resemble pyogenic granuloma clinically
Temporomandibular joint disease
orofacial pain, noisy joint, restricted jaw function; Dx = MRI
Complication of hand/wrist trauma
AVN of scaphoid (navicular) bone
Osler-Weber-Wendu
hereditary hemorrhagic telangiectasia = epistaxis, GI bleeding, polycystic kydneys
Von-Hippel-Lindau dis.
cavernous hemangiomas, hemangioblastomas in CNS, retina, renal cell ca
Sturge Weber syndrome
facial port wine stain, seizure, ocular changes
Caplan syndrome
rheumatoid nodules in the lungs
Felty syndrome
splenomegaly + neutropenia in severe R.A.
Tuberous sclerosis
ash leaf macules (hypopigmented), calcified intracranial nodules, epilepsy, low inteligence, adenoma sebaceum
Leser-Trelat sign
multiple pruritic seborrheic keratosis associated with internal malignancy
Polymyalgia rheumatica
very high ESR; Rx = low dose corticoids; keep an eye open for possible temporal arteritis
Vitiligo Rx
topical sterois, phototherapy
Porphyria cutanea tarda
blistering in a sun exposed area + milia; Dx urine prophirin level + hepatitis panel
Dermatitis herpetiformis
chr. pruritic papulovesicular lesions on extensor surfaces, post. hairline; Rx = dapsone
Pemphigus vulgaris Rx
immediate high dose corticosteroids
Hypertensive urgency
the goal is to decrease the diastolic BP to about 100-105 mmHg within a period of 2-6 hours; Avoid nitroprusside infusion for more than 48 h (it may lead to cyanide toxicity)
Hypert. urg. in pregnancy Rx
hydralazine, labetalol
In pheochromocytoma, serotonin syndrome, cocaine use
IV phentolamine
In aortic dissection
nitroprusside + labetalol/metoprolol
Joint replacement in osteoarthritis indications
refractory pain, functional limit, inability for ADLs
Alendronate (Fosamax) S.E.
esophageal irritation, ulceration and it has to be taken with an empty stomach, so always counsel the patient to take it in the morning and sit or stand upright for 30 minutes
Achantosis nigricans
DM, hypothyroidism, Cushing's, Addison's, malignancy
Kaposi's sarcoma
vascular tu, purplish lesions, extravasation of erythrocytes
MCC of alergic contact dermatitis
nickel
Methotrexate, azathioprine, chloroquine, etanercept, infliximab
disease modifying antirheumatic drugs
Lumbar stenosis
pseudoclaudication, worse with hyperextending movements, better with leaning forward, normal ankle-brachial index; Dx = MRI of the lumbar spine
Knee ligament injury Dx
MRI