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219 Cards in this Set
- Front
- Back
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Lung exam of someone with CHF?
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bibasilar crackles
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Blood gas hypoxia, hypocapnia, & respiratory alkalosis
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CHF, not COPD
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Hypoxia, respiratory alkalosis, widened A-a oxygen gradient
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PE
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Light’s criteria for exudative effusion?
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protein/serum protein ration >0.5, LDH/serum LDH ration >0.6, pleural fluid LDH >2/3 of upper limit of normal for serum LDH
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Other things to look for in exudative pleural effusion?
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acidosis (pH<7.2), low pleural fluid glucose (<60 mg/dL), seen with parapneumonic effusion (pneumonia), rheumatoid pleuristy, drug induced lupus, TB, & malignancy
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Drug induced lupus drugs?
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hydralazone, procainamide, isoniazid
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Ear discharge, severe pain, pain exacerbated by chewing, granulation tissue in external auditory meatus, bacteria that cause this?
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malignant otitis externa, Pseudomonas aeruginosa
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Contact with dog/cat feces, develop serpiginous, reddish, brown, elevated lesions, from sand, in tropical region (southeast USA)
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cutaneous larva migrans, from ancylostoma braziliense (hookworm larva)
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Exposure to cats with self-limiting lymphadenopathy
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cat scratch disease
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Gardner, papule on hand, ulcerates and lymphadenopathy?
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sporotrichosis
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22 y/o with several occurances of lightheadedness, weakness, and blurred vision, passes out for a few minutes, rapidly recovers, how do you diagnose
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vasovagal syncope, upright tilt table testing with or without isoproterenol provocation
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curtain falling down loss of vision, fundoscopy reveals whitened, edematous retina following distribution of retinal arterioles
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retinal emboli, check carotids
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sudden painless loss of vision, fundoscopy reveals palor of optic disc, cherry red fovea, boxcar segmentation of blood in both retinal arteries and veins
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central artery occlusion
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sudden loss of vision, patient has HTN, fundoscopy shows disk swelling, venous dilation, tortuosity, retinal hemorrhages, cotton wool spots
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cenral retinal vein occultions
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alcoholic, fever, abdominal pain, jaundice, nausea, and vomiting, diagnosis and treatment?
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severe alcoholic hepatitis, prednisone
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prevention of hypervolemia/ ascites in cirrhosis patient?
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low salt diet and furosemide
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rheumatoid test for lupus?
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ANA
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blood test for celiac disease?
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tissue transglutaminase antibodies
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euvolemic hypernatremia, severe polyuria and mild hypernatremia
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diabetes insipidus
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causes of central DI?
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decreased production of antidiuretic hormone, trauma, hemorrhage, infection, and tumors
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causes of nephrogenic DI?
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renal ADH resistence, hypercalcemia, severe hypokalemia, tubulointerstitial renal disease, and medications
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medications causing DI?
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lithium, demeclocycline, foscarnet, cidofovir, and amphotericin
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headaches, focal neurologic changes, visual problems, DI?
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craniopharyngioma
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smoker, cough, presents with partial ptosis, miosis, anhidrosis
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horners syndrome, think lung cancer
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handgrip test good for what murmurs?
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increased systemic resistence and increased afterload, aortic stenosis and mitral regurgitation (decrease and increase respectively)
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maneuvers to increase venous return?
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leg raising, squatting, recumbency
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Differentiate hypovolemic shock, cardiogenicshock, septic shock
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cardiogenic, wedge pressure goes up, septic shock, mixed venous oxygen saturation goes up (others go down)
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Widespread pain, fatigue, poor sleep, diagnosis and treatment
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fibromyalgia, treat with antidepressants like amytriptaline, age 20-50
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Pain and stiffness of shoulder/ pelvic girdle, age >50
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stiffness, no sleep issues, maybe associated with fever, weight loss, and headache, polymyalgia rheumatica
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Digoxin toxicity?
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anorexia, nausea, vomiting
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Cause? Prevention? Blood transfusion, high fever, normal urine, antiglobulin test and plasma free hemoglobin are negative
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caused by antibodies, washing cells
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Transfusion with fever, chills, back pain, red or pink urine?
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Hemolytic reaction, do coombs test, cross matching issue
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Timeline of post infarction complications?
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reinfarction (hrs – days), free wall rupture (hrs-5 days), ventricular septal rupture (hrs – 1wk), postinfarction angina (hrs-1month, papillary muscle rupture (2 days-1 wk), pericarditis (1day-3 months), left ventricular aneurysm (5 days-3 months)
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Characteristic of ventricular aneurisms
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persistent ST-degment elevation, deep Q waves in same leads
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Common presentation/ symptom of hemophiliacs?
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joint swelling, deficiency in factor VIII (hemophilia A) or factor IX (hemophilia B)
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Color perception screwed up, afferent pupillary defect, pain on eye movement, one eye involved
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optic neuritis
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Tumor lysis syndrome, what associated with, what happens to Ca, PO4, K, and Uric acid?
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burkitt’s lymphoma, ALL, sometimes AML, Ca down, PO4 up, K up, uric acid up (take allopurinol to prevent urate nephropathy)
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Ectopic foci for A fib is where?
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pulmonary veins
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Delta waves are seen in what arrythmeia?
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wolff Parkinson white, caused by atrioventricular reentry tachycardia, an accessory pathway
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Sawtooth flutter waves
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atrial flutter
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Treatment of bacterial meningitis, people over 55 too?
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vancomycin + ceftriaxone, covers strep pneumo, H. influenza, & neisseria meningitidis, add ampicillin to >55 years old, covers listeria monocytogenes
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< 3 months old bacterial mengitis?
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cefotaxime + ampicillin, ceftriaxone associated with biliary sludging
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how do nitrates function for cardiac pain?
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venodilitation, reduce cardiac preload, decrease myocardial oxygen demand
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elevated atrial pressure, pulmonary artery pressure, and pulmonary capillary wedge pressure can be seen in what conditions?
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Left heart disease, COPD, and PE (can have normal PCWP)
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HTN, bilateral abdominal masses, hematuria, erythrocytosis
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polycytic kidney disease, diagnose with abdominal ultrasound
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Can you give ribavirin to pregnant mothers for Hep C?
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NO, it’s teratogenic
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First line treatment for oasioarthritis, second line treatment?
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acetaminophen, NSAIDs
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Drug for prevention of gout?
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allopurinol
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Drug to prevent pseudogout (calcium pyrophosphate)?
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colchicine
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Dx and Tx? Erythematous papules, vesicles, and bullae on elbows, knees, upper back, and buttocks (associated with GI issue)?
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dermatitis herpetiformis, use dapsone to treat & gluten free diet due to celiacs
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Tx of scabies?
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permethrin cream
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Low sodium, serum osmolality low, urine osmolality higher than serum, lung nodule
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syndrome of inappropriate antidiuretic hormone secretion (SIADH), small cell carcinoma
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Where is coccidioidomycosis endemic?
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southwestern USA
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Dx: HIV patient with gram positive, weakly acid-fast, filamentous branching rods?
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Nocardia pneumonia, causes cavitary lesion
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When is succinylcholine ontraindicated?
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hyperkalemia, burn/crush injuries Guillain Barre, tumor lysis syndrome
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Rouleaux cells, bence jones proteins
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multiple myeloma
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Recent eye surgery, swollen eyelid, edematous conjunctiva, exudates in the anterior chamber
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postoperative endophthalmitis
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Blurred vision, moderate pain, conjunctival injection, constricted pupils
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uveitis, associated with HLA B27
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Drug toxicity: headache, insomnia, seisures, nausea, vomiting, arrhythmia in a COPD patient
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theophylline toxicity
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Patient presenting with chronic headache and painless hematuria
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think analgesic nephropathy, causing chronic tubulointerstitial damage (papillary necrosis)
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Deformed red blood cells, significant proteinuria, casts
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glomerular injury
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Dx, tests & Tx: pruritus, fatigue, hepatosplenomegaly, xanthomatous lesions in eyelids of skin & tendons
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primary biliary cirrhosis, see inflammation and destruction of medium sized bile ducts, confirm Dx with anti-mitochondrium antibodies, tx: ursodeoxycholic acid
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Anti-nuclear antibodies
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collagen vascular disease, SLE, type 1 autoimmune hepatitis
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Anti-smooth muscle & LKM antibodies
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acute and chronic hepatitis
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Anti-smith anibodies
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specific for SLE
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P-ANCA
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Churg-Strauss syndrome & microscopic polyangiitis
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Dx and test? Rheumatoid arthritis, enlarged kidneys, hepatomegaly
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amylodosis, deposits seen under polarized light with renal biopsy
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Renal Dx? Crescent formation on light microscopy
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rapidly progressive glomerulonephritis
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Renal Dx? Linear immunoglobulin deposits on immunofluorescence microscopy
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anti-glomerular basement membrane disease (goodpastures syndrome)
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Renal Dx? Granular immunologlobulin deposits
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immune complex glomerulonephritis (Lupus or poststreptococcal glomerulonephritis)
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Screening for aortic abdominal aneurism?
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age 65-75, smokers, do 1 abdominal ultrasound
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Dx?: pseudofractures, blurring of spine, low calcium, low phosphate, high PTH, low vit. D level
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osteomalacia, secondary hyperparathyroidism due to vit D deficiency
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Renal disease? Periorbital edema, HTN, renal insufficiency, proteinuria?
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acute glomerulonephritis
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Most common cause of painless hematuria in adults?
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bladder tumors
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Renal disease? Increased extracellular matrix, basement membrane thickening, mesangial expansion, fibrosis
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diabetes mellitus nephropathy, think excess glycans therefore everything becomes more thick
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Viral hepatitis, supportive treatment initiated, increase PT and decrease in transaminase levels?
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progression to fulminant hepatitis, there aren’t enough cells left to spit out bad aminotransferase levels
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4Ts of mediastinal masses?
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thymoma, teratoma, thyroid neoplasm, terrible lymphoma
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beta-HCG elevated, normal alpha fetal protein?
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seminoma
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elevated B-HCG & alpha fetal protein
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mixed germ cell tumor
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differentiation of follicular cancer from follicular adenoma?
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invasion of the capsule and blood vessels
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thyroid cancer with secretion of calcitonin?
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medullary cancer of the thyroid
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hurthle cells?
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seen in both follicular and papillary cancers
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thyroid cancer with psammoma bodies?
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papillary thyroid cancer, most common type of thyroid cancer, prognosis is excellent, even with metastasis
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Possible complication from mono?
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autoimmune hemolytic anemia
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Back pain, hearing loss, femoral bowing of legs Dx and cause?
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paget’s disease, osteoclast hyperfunction, increased bone breakdown and compensatory increase in bone formation, see elevated alk phos too
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Harsh systolic murmur over right sternal edge, increases with experation, 4th heart sound, radiation of murmur to carotids
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aortic stenosis
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When need surgery in aortic stenosis?
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any SAD symptoms, syncope, angina, and dyspnea
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Widened pulse pressure (150/55), pounding heartbeat, feels stronger when laying flat and on left side
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aortic regurgitation, feels stronger when heart near chest wall, widened pulse pressure makes if feel like a pounding heart
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Weak pusle, parvus et tardus
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aortic stenosis
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Treatment for aortic regurgiation?
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reduce afterload, nifedipine or ace inhibitor
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URI with glomerulonephritis in adults?
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IgA nephropathy
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What sided heart murmurs increase with inspiration?
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right sided murmurs
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Decreased cortisol, adrenal sex hormone, and aldosterone secretion
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primary adrenal insufficiency, addison’s disease
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Electrolytes in addison’s disease?
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deficiency in aldosterone causes hyponatremia, hyperkalemia, metabolic acidosis (normal anion gap)
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When do you excise a lung nodule?
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high suspiscion of cancer, positive on PET imaging, growth on serial CT
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Tx for non-compliated diverticulitis, test for refractory diverticulitis?
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antibiotics, CT scan if doesn’t get better
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Benign condition where defect in hepatic storage of conjugated bilirubin, leakage into plasma
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rotor syndrome, FYI – urine dipstick pciks up conjugated bilirubin
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Disease that causes icterus, unconjugated hyperbilirubinemia
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Gilberts syndrome
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Tx for HTN with A. Fib, patient having fatigue, difficulty concentrating, forgetfulness, gained weight
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hypothyroidism caused by amiodarone, need to check TSH regularly in these patients
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Tx side effect? Patient with HTN and impotence?
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beta blocker
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Highest risk factor for melanoma?
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recently changed mole
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Immunosuppressant that causes hypertrophy of gums & hirsutism?
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cyclosporine
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Immunosuppressant with dose-related diarrhea, leukpenia, hepatotoxicity
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azathioprine
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Side effect of mycophenolate
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bone Marrow suppression
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Earliest renal abnormality with diabetic kidneys?
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glomerular hyperfiltration, happens even at time of diagnosis, first quatitatable abnormality is thickening of basement membrane
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How many variables do the following compare? Two sample z test, two sample t test, chi-square test, anova
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two sample tests compare two samples, ANOVA 3 or more, chi-square 2x2 table
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Definition of Mobitz type I block
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increasing PR interval until a beat is droped
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Definition of mobitz type II block
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PR stays the same until beat dropped
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Definition of type III block
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no atrial impulses will travel to ventricles, atria and ventricles beat independently
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Definition of first degree heart block?
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prolonged, constant PR interval (>.2s)
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MEN type I?
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3ps, pituitary (10-20% prolactinoma, ACTH secreting, growth hormone secreting), parathyroid (>90% parathyroid hyperplasia, primary hyperparathyroidism), Pancrease/GI tract (60-70% gastrinoma, insulinoma, VIPoma, glucagonoma), suspect MEN I in people <60 with primary hyperparathyroidism!!!
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MEN 2A?
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Medullary thyroid cancer (>90%), pheochromocytoma (40-50%), parathyroid hyperplasia (10-20%)
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MEN 2B?
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Medullary thyroid cancer, pheochromocytoma, mucosal and intestinal neoplasm, marfanoid habitus
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Cats at home, painful rash, lymphadenopathy,"", multiple pruritic, erythematous vesicles and papules Dx and Tx?
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cat scratch disease, bartonella henselae, 5 days of azithromycin
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Hyperpigmentation, more promanantly on elbows, knees, face, dorsum of hands with vitiligo, dehydration and hypotension?
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Addison’s disease
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Peripheral blood smear of acute myeloblastic leukemia with maturation?
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myeloblasts predominate
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Acute promyelocytic leukemia blood smear?
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hypergranular promyelocytes, each has many auer rods, high incidence of DIC
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Acute lymphoblastic leukemia on blood smear
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lymphoblasts on peripheral blood film, PAS-positive
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Acute erythroleukemia on blood smear
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erythroblasts, irregular outline, high nuclear-cytoplasmic ration
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Acute monocytic leukemia on blood smear
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many monoblasts, promonocytes, and monocytes, monoblasts lack auer rods, peroxidase negative, nonspecific esterase positive
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1 year of severe, crampy abdominal pain after eating, weight loss, and food aversion, bloating, diarrheia, nausia after eating, atherosclerotic heart disease present
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atheroscleosis of the mesenteric arteries, bowel angina
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Tx for sudden loss of vision, painless, fundoscopy shows retinal whitening, right carotid bruit is heard?
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central retinal artery occlusion due to emboli (amaurosis fugax)occular massage and high flow oxygen
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Sudden, painful loss of vision, red eye treatment
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acute angle closure glaucoma, topical pilocarpine and beta blockers
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HIV patient with dysphagia/odynophagia Dx and Tx
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candidal esophagitis, fluconazole
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HIV patient continues to have pain with swallowing, endoscopy reveals large, irregular, linear ulcers
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CMV ulcerative esophagitis, ganciclovir
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HIV patient with multiple, small, well circumscribed (volcano Like)inclusions Dx and Tx
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herpes simplex virus esophagitis, acyclovir
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Common medical issue of people with hereditary spherocytosis?
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chronic hemolysis can cause jaundice and pigmented gallstones (calcium bilirubinate)
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Cause and treatment of goodpastures pulmonary renal syndrome
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circulating anti-glomerular basement membrane antibodies, early removal by plasmapheresis is imperative to minimize extent of kidney damage
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Treatment of wegener’s
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cyclophosphamide and steroids
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Dx and Tx: regular, narrow complex tachycardia
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paroxysmal supraventricular tachycarida, carotid sinus massage
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Dx and Tx of wide-complex tachycardia with fusion beats (see atrium beat right before QRS)
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ventricular tachycardia, if stable, amiodarone, if unstable (hypotention etc), synchronized cardioversion
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Schizophrenic, dilute urine, hyponatremia
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primary polydipsia
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Bipolar patient with hypernatremia with maximally dilute urine
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lithium induced ADH resistance, nephrogenic diabetes insipidus
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Hyponatremia and concentrated urine
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SIADH
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How do you distinguish between central and nephrogenic diabetes insipitous?
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administer exogenous ADH, central will correct because it’s a lack of ADH secretion causing delute urine, nephrogenic will not correct
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Causes and age distribution of aortic stenosis
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senile calcific aortic stenosis >70 years old, bicuspid aortic valves <70 years old, also rheumatic heart disease
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Major risk factors for squamous cell carcinoma of esphagous and adenocarcinoma of esphagous?
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smoking/ drinking for squamous, adeno=barrets esphagous caused by GERD
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HIV patient, cough, fatigue, night sweats, traveled to Ohio recently, temp 101.3, two small ulcers present on hard palate, liver is palpated 3 cm below right rib Dx, test, & Tx?
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Histoplasmosis, detect antigen in urine, can see pancytopenia with bone marrow involvement, itraconazole if mild, severe due amphotericin B for 2 wks, itraconazole for 1 year
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Region of histoplasmosis?
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Ohio River valley
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From latin america, had megacolon/megaesophagus & cardiac disease (CHF symptoms like S3, venous distention, cardiomegaly, pedal edema)
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think chagas disease, a protozoal disease
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What determines need for chest tube with pleural effusion and pnemonia?
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low pH(<7.2) indicates empyema and removal of fluid by thoracostomy, glucose <60 also indicates thoracostomy
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Umbilicated, firm, flesh-colored, dome-shaped papules on the trunk, limbs, or anogenital area, Dx and what predisposes you to them?
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molluscum contagiosum, pox virus, HIV infection or cellular immunodeficiency
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Immunodeficiency (ID), recurrent respiratory infections and chronic giardiasis
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IgA deficiency
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ID: severe, recurrent pyogenic bacterial respiratory tract and sinus infections
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C3 (complement) deficiency
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ID: Neisseria infections
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C5-C8 deficiency
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ID: hereditary angioedema
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C1 deficiency
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ID:severe pyogenic bacterial infections
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impairment of phagocytosis
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ID: hypersensitivity rashes
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circulating autoantibodies (type II-antibody dependent cellular cytotoxicity, blisters or bullae) or type III-immune complex deposition, erythematous & maculopapular
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First treatment for A Fib
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beta blockers or ca. channel blockers like diltiazem, don’t cardiovert if >48 hrs, then need to be on warfarin for 3-4 wks, do TEE before cardioversion
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Cause of syncope in patient with prolonged PR and QRS intervals?
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bradyarrthymia, caused by conduction disturbance
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Cause of syncope in patient with low ejection fraction and exercise induced syncopal episodes?
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decreased myocardial contractility
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Syncope with person with prolonged QT interval?
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torsades de pointes, caused by hypomagnesemia
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Syncope with orthostatic hypotension?
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autonomic dysfunction
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New diagnosis of SLE, what’s next step in management?
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kidney biopsy, determines drugs needed for therapy
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Drugs know to cause pancreatitis?
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diretics: furosemide, thiazides, IBD: sulfasalazine, 5-ASA, immunosuppressive:azathioprine, asparaginase, seizure/bipolar disorder: valproic acid, AIDS: didanosine, pentamidine, antibiotics:metronidazole, tetracycline
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Female, contraceptive use, palpable abdominal mass, biopsy reveals mildly atypical enlarged hepatocytes containing glycogen and lipid deposits
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hepatic adenoma, prone to rupture, bleeding, causing collapse (normally don’t biopsy!), Tx: non-symptomatic can stop contraceptives, monitor alpha fetal protein, or resect that mother!
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Treatment for central diabetes insipidous?
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desmopressin
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Treatment for nephrogenic diabetes insipitous?
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indomethacin(NSAID) and hydrochlorothiazide
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Tx for lithium-induced nephrogenic DI?
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amiloride
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What syndrome? Recurrent oral ulcers, recurrent genital ulcers, anterior uveitis, and skin lesion consistent with erythema nodosum (painful and nodular with areas of hyperpigmentation suggested by the old, healed nodules)
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Behcet’s syndrome, corticosteroids for relief
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AST 180, ALT 66, bilateral basal crepitation, S3, dilated left ventricle and systolic dysfunction, Tx?
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cease use of alcohol may reverse dilated cardiomyopathy (due to alcoholism)
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Daytime headaches, dizziness, nausea, polycythemia
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carboxyhemoglobinemia
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Method to diagnose coronary heart disease in patients who can’t undergo exercise?
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give dipyridamole, dilates coronary blood vessels, redistributing blood to non-diseased segments, showing diseased vessels due to no dilation, “coronary steal”
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Difference between bronchiectasis & bronchitis?
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bronchiectasis is mucopurulent, need CT to diagnose, airway dilatation, bronchial thickening, and lack of airway tapering, cystic fibrosis or immune suppression can cause, responds to antibiotics, bronchitis is non-purulent
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When use bronchoscopy and alveolar lavage?
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diagnosis pneumocystis pneumonia and certain lung cancers
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normal to symmetric thickening of the ventricle, primarily diastolic dysfunction, mild systolic dysfunction on echo
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Characteristics of restrictive cardiomyopathy
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Causes of restrictive cardiomyopathy?
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infiltrative disease (sarcoidosis, amyloidosis), storage disease (hemochromatosis-reversible carbiomyopathy, treated with phlebotomy), endomyocardial fibrosis
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Dx? Blood at beginning of urination?
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lesion in urethra, urethritis
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Dx? Blood at the endo of urination?
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prostatic or bladder cause, sometimes with clots, needs cystoscopy for possible bladder cancer
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Dx? Hematuria during entire urination?
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disease in ureters or kidneys
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Lives in ohio, fever, malaise, fatigue, and skin lesions, 1-2 cm warty, heaped-up, violaceous hue, sharply demarcated border, wet prep demonstrates yeasts?
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Blastomycosis, which can affect the prostate, lungs, skin, bones, and joints too, endemic to south-central and north-central US
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Fungus southeastern, mid-atlantic, and central US, presents as acute pneumonia, cough, fever, malaise, disseminated more common in HIV patients
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histoplasmosis
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Southwestern US, central and south america, pulmonary infection, erythema multiforme and erythema nodosum
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coccidioidomycosis
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Affects severly immunocompromised patients, particularly transplant patients or taking cytotoxic meds
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aspergillosis
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Abscesses near head and neck, drain sulfur granules, gram pos rods
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actinomyces
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Subacute pneumonia that mimics TB, gram positive rods
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nocardia
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Patient involving mining, shipbuilding, insulation, or pipe work, dyspnea without cough or sputum production, bibasilar end inspiratory crackles, and clubbing, mass in lung periphery
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asbestosis exposure, most common cancer is bronchogenic carcinoma, not mesothelioma, distinguish the two by location
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Method for testing for lactose intolerance?
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hydrogen breath test, indicates bacterial metabolism
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Urine test for reducing substances?
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checking for glucosuria, galactosuria etc
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Medications that cause hyperkalemia?
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beta blockers, Ace inhibitor, ARB, K sparing diretic, digitalis, cyclosporine, heparin, NSAIDs, succinylcholine, TMP-sulfa
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Meds that cause cholestatis?
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azithromycin, ceftriaxone (avoid in neonates)
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Waxing and waining transaminase levels for >5 years, arthralgias, myalgias?
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chronic hep C
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Nongonococcal urethritis, asymetic oligoarthritis (arthritis in knee, back pain-sacroiliac spine, achilles tendon), and conjunctivitis or mouth ulcers, Dx and Tx
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reactive arthritis, seronegative spondyloarthropathy, treat with NSAIDs
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How distinguish gonococcal septic arthritis from reactive arthritis?
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afebrile, mouth ulcers, low back pain, and enthesitis(pain where tendons meet bones) is consistent with reactive arthritis vs gonococcal
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Treatment of acute gout vs chronic gout?
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colchicine (decreases leukocyte activity) for acute, allopurinol for chronic hyperuricemia
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Taking TB drugs, elevated AST, ALT, liver biopsy shows mononuclear infiltration and hepatic cell necrosis
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hepatitis secondary to isoniazid usage
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Rash, arthralgias, fever, leukocytosis, and eosinophilia are common in patients with drug induced liver injury, what drug are they abscent?
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isoniazid usage
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What antibodies are positive in autoimmune hepatitis?
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ANA or smooth muscle antibody
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Bad possible side effect of hercepton (trastuzumab)?
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cardiomyopathy, do an echo prior to initiation of treatment
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Patients with hemochromatosis are at increased risk of what infections?
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listeria monocytogenes, yersinia enterocolitica, vibrio vulnificus
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Tx & Dx? Periodic substernal chest pressure with exercise, treadmill test shows horizontal ST-segment depression in leads II, III, and aVF, stress echo shows normal resting left ventricular systolic function, inferior wall hypokinesis at peak exercise
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stable chronic angina, first line treatment is beta blockers, can also use nitrates for symptoms and calcium channel blockers (diltiazem, felodipine)
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When use ace inhibitor?
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HTN in diabetes, chronic kidney disease CHF with reduced left ventricular systolic function
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Smoker with new onset fever, severe shortness of breath, using accessory muscles of respiration, Dx and Tx?
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COPD exacerbation due to concomitant infectious bronchitis, give supplemental oxygen, inhaled bronchodilator (B2 agonist and anticholinergics), broad spectrum antibiotics, 2 week corticosteroid taper, smoking cessation
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Open sore that bleeds, oozes, or crusts for > 3weeks, Dx and Tx?
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basal cell carcinoma, excision with 1-2 mm of clear margins
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Young female, nocturnal substernal chest pain, lasts 15-20 min, can climb two flights of stairs, Greatest risk for disease, Dx, and Tx?
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smoking, variant angina or Prinzmental’s angina, chest pain by vasospasm, treat with calcium channel blockers! Diltiazem, can see transient ST elevations on EKG
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When use digoxin?
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to increase contractility in CHF patients or as a rate control agent in patients with A Fib or flutter
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First step in suspected melanoma?
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excisional biopsy with narrow margins, pigmented basal cell carcinoma and some seborrheic keratoses and atypical nevi can mimic melanoma clinically, most important prognostic factor for melanoma is depth
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Presentation of mononucleosis without pharyngitis, negative heterophile test
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CMV mononucleosis
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Normal skin at birth, progresses to dry scaly skin, rough with horny plates, lizard skin
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ichthyosis vulgaris
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Pruritus in infant, involving cheeks, forehead, and limbs
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atopic dermatitis
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Silvery scales over extensor surface of elbows, knees, scalp, and trunk
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psoriasis
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Calculation to determine if ascites is transudative or exudative?
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subtract ascites albumin from serum albumin, if > (greater than or equal to) 1.1, it’s transudate caused by portal hypertension
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Tx for rheumatoid arthritis after initial diagnosis?
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treat with disease modifying anti-rheumatic drugs, fist line is methotrexate, others include hydroxychloroquine, sulfasalazine, leflunomide, etanercept, infliximab, and azathioprine
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Tx of DKA
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normal saline plus insulin, potassium correction, treatment of precipitating factor such as infection, once glucose reaches 200-250, D5% in 0.45% saline with potassium
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Treatment of sickle cell kid with acute storke?
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exchange transfusion to prevent likely hood of further stokes, stoke caused bysludging and occlusion of cerebral arterial vasculature
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Hep virus associated with fulmanent hepatic failure in pregnant women, how is it transmitted?
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fecal oral route, hep E, found in India, Asia, Africa, and Central America
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Most common predisposing factor to native valve endocarditis?
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mitral valve prolapse or mitral valve regurgitation
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Most common valve issue in infective endocarditis in IV drug users?
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tricuspid regurgitation
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When do and what do protein C, Protein S, and Antithrombin III deficiencies cause?
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hypercoaguble state, shows up in childhood
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Vacines and drugs transplant patient should take?
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TMP-sulfa for PCP, toxoplasmosis, nocardiosis, other (UTI or pnemonia). Get influenza, pneumococcus, and hep B vaccines
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What medication predisposises people to gout?
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diretics, hypovolemia associated enhancement of uric acid reabsorption in proximal tubule
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PFTs, decreased FEV1 and FVC, but FEV1/FVC ratio >80%
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restrictive lung disease, such as pulmonary fibrosis (caused by rheumatoid arthritis or scleroderma, smoking, bleomycin exposure), neuromuscular disease, alveolar edema, pleural fibrosis, and chest wall abnormalities, such as in ankylosing spondylitis (presented with back pain, HLA-B27 positive)
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FEV1/FVC < 80%
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obstructive lung disease, emphysema (terminal airway destruction), small airway obstruction (infection, inhalational exposure, asthma, COPD)
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Drugs you should take after MI?
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aspirin, beta-blockers, ace-inhibitors, lipid lowering statin drugs, if unstable angina or non-ST elevation MI, take clopidogrel too
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Highest risk for osteomylitis, most common pathogen?
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injection drug users (to the spine, tenderness on percussion), sickle cell anemia, immunosuppressed people, staph aureus
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Age >60, back pain radiating to butt and thigh, worsens with walking and lumbar extension, improves with lumbar flexion, maybe numbness and paresthesias Dx and test?
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Do MRI, lumbar spinal stenosis, narrowing of spinal canal with compression of 1 or more nerve roots
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Difference between Lynch syndrome I & II?
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I is specific to the colon, II develops other tumors, most common is endometrial carcinoma in females
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When do you use colloid solutions?
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used in burns or conditions of hypoproteinemia
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Patient is bleeding in lungs while intubated?
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broncoscopy if >100 mL/hr or 600Ml/24 hr, lay bleeding lung side down so doesn’t fill good lung)
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