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