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366 Cards in this Set

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moa ipratropium bromide
prevents bronchoconstriction by blocking muscarinic receptors.
can ipratropium bromide be combined with albuterol
yes
problem with using theophylline
very low therapeutic index
what should you thinki about in a pt with recurrent pna in an elderly smoker
bronchogenic ca
whould would bronchogenic ca --> recurrent pna
bronchial obx
when are hemosiderin laden macrophages seen on bronch
wegener's
goodpasture's
what is the best way to evaluate non-resolving pna or pulmonary infiltrates
flexible bronchoscopy
what are the indications for an ivc filter
recurrent vte and contraind to anti-coag
h/o massive pe where recurrence of add'l pe would be life-threatening
chronic pe plus h/o pulm htn
how to calculate minute ventilation
resp rate x tidal volume
what is the value of fev1/fvc in obx lung dz
<80%
what is the value of fev1/fvc in nml lung
80%
what pft abnormality do you see in restrictive lung dz
decreased tlc
when to tx sarcoidosis
if there are pulm sx, cardiac, ocular or neurologic sx
what exam finding indicates airway hyperactivity
what might this indicate
cough induced by expiration
this is also a clinical clue to asthma
what is the link btwn air pollution and asthma
there is no proven link
what is considered a positive response to an asthma provocation test
drop in fev1/fvc by at least 20% from baseline
what is the #1 prognostic factor for obx lung dz
fev1 <40% of predicted value
how to evaluate a pulm nodule that is seen on cxr but there are no old films avail
get a high res ct
what are findings of a spn on ct that would indicate malignancy
eccentric calcification patterns
reticular or punctate calcifications
how to evaluate an spn that has characteristics suspicious for malignancy on ct
VATS to get bx
(FNA is not as good)
what is considered a favorable prognosis in sarcoidosis
erythema nodosum without any other sx
what pft finding would indicate that an asthma pt would need to be admitted to the hospital
peak flow drops at least 40-50% of baseline
criteria for ards dx
wedge p <18
PaO2:FiO2 <200:1
diffuse bilateral infiltrates on cxr
vent management in ards
keep peep high (around 9)
increase 02 concentration
low tidal volume
t or f: a low prob v/q scan rules out pe
false, if the clinical suspicion is high enough, get dopplers of le
relationship btwn tb and developing pleural effusion
features of effusion
how to manage
you can get a pleural effusion during the tx of tb in pts who are recovering
effusion is usually exudative with lymphocytic predominate
thoracentesis for dx and tx
how to manage a pt in whom you suspect osa
first r/o hypothyroidism, then get sleep study
clinical presentation of IgG3 deficiency
recurrent sinopulmonary infx
recurrent gi infx
what is common variable deficiency associated with
increased risk of malig
how fast will it take for a massive pe --> death
1-2 h
when should you treat a pt with vte x12 months
in setting of malignancy
anti-cardiolipin Ab
antithrombin deficiency
#1 cause for bronchiectasis
bronchitis
define bronchiectasis
permanent abnml dilation of the bronchial walls
describe erythema nodosum
red tender subq nodules over lower extremities
is EN + hilar LAD sufficient to dx sarcoid
yes
indications for getting home O2
PaO2 <55 or SaO2 <88%
or:
PaO2 56-59 or SaO2 <89% if cor pulmonale, hct >55%, right heart failure is present
who is at risk for aspergillosis
pts with underlying asthma
how to dx aspergillosis
First, check pin prick test and look for rxn to aspergillosis, then
IgE >1000 and precipitate serum AB to aspergillosis
how to tx aspergillosis
oral corticosteroids
benign calcification patterns of spn on ct
popcorn, concentric, or laminated calcification
central calcifications
diffuse homogeneous calcs
how does aspergillosis infx present
asthma with eosinophilia
what dairy product can lactose intolerant pts eat that is well-tolerated
yoghurt
studies/labs used to dx pancreatitis
lfts and lipase
which is more sensitive/specific for pancreatitis: amylase or lipase
why?
lipase
amylase is released in parotitis, intestinal d/o, fallopian tube tz, arf, cholecystitis
what about getting a ruq u/s to dx pancreatitis
pancreas is obscured in up to 1/3 of pts with pancreatitis (b/c of bowel gas) therefore this can delay the dx
what to do if a pt with pancreatitis tha twas previously afebrile becomes febrile
start broad spectrum abs (imepenam)
management of a pt with ascites, fever, and abd pain
do paracentesis to check for sbp
what do pts with variceal bleeding have an increased risk of
how to manage
sbp
respiratory infx
aspiration pna
primary bacteremia
tx with proph abx (cipro, moxi, or ofloxacin) b/c infx is a greater risk than renal failure
why dose arf occur in variceal bleeding
atn or hepatorenal syndrome
what is associated with angiodysplasia
aortic stenosis
borhaeve syndrove
esophageal perforation
complication of boorhaeve's syndrome
how does that present
acute mediastinits
dyspnea, epigastric pain, shoulder pain, pleural effusion, fever
40% mortality from mediastinitis in first 24 hours
best way to dx esophageal perforation
esophagogram with water soluble contrast (barium --> more mediastinal injury)
use of ct to dx esophageal tear
may miss a small tear, do an esophagogram instead
meds commonly associated with pancreatitis
diuretics
sulfasalazine
5-asa
azathioprine
l-asparginine
valproic acid
pentamidine
flagyl
tetracycline
t or f: pts s/p chole need a low fat diet
false, no dietary changes required
possible explanations for anti-HCV AB
how to confirm dx
1. persistent hcv infx
2. cleared infx
3. false positive

confirm with hcv rna (positive predictive value of a+ finding in a pt who is low risk with nml lfts is very low)
which medicationis most commonly associated with causing c diff
clindamycin
how to tx c diff if recurrent
flagyl for 1st and 2nd episode, then tx with oral vanc
effects of smoking on ulcerative coliits
quitting smoking can trigger flares
tx of severe ulcerative colitis
ivf
nutritional support
bowel rest
pain management
steroids
complications of uc flare
how to manage
toxic megacolon
if this develops and pt is refractory to tx x 72 h, do colectomy
initial evaluation of a pt with chronic diarrhea
stool analysis (wbbcs, parasites, fat, osmotic gap)
histologic changes seen in uc?
crohns?
superficial mucosal inflammation with infiltration of plasma cells
transmural inflammation
how to manage a pt with suspected mallory weiss tear
do endoscopy first, if no active bleeding, observe then do supportive care
common association in pts with mallory weiss tear
hiatal hernia
dx of lgi bleed
colonoscopy, however if this is not possible or if there is poor visualization, do a bleeding scan
how to manage dysphagia in als
it is progressive, pts will ultimately need a peg tube (peg is preferred to ngt b/c it decreases the risk of sinusitis, is more comfortable, and won't affect speech or breathing)
what is best initial study to order in suspected stomach perforation
axr
how to manage h pylori/ulcer workup
if pt <45 yo and has no warning signs (weight loss, dysphagia) thne can do non-invasive hp testing (stool ag is preferred)
if >45 yo + warning signs, do endoscopy
what do you see on manometry of diffuse esophageal spasm
increased amplitue of peristaltic contractions
LES wnl
how to tx diffuse esophageal spasm
anti-spasmodics
psych eval
diet modifications
presentation of zenker's divertic
food sticks in throat, pt p/w hallitosis, dysphagia, regurg. not painful
when does a colon polyp not require any followup
no further tx if:
<2cm, pedunculated and adenomatous
polyp is completely excised, it is well differentiated, ther eis no vascular or lymphatic involvement, and no extension of the polyp beyond a stalk
how to manage a >2cm sessile colonic polyp
f/u colonscopy 3-4 months after polypectomy
f/u if there are multiple adenomatous polyps removed during colonoscopy
scope in 3y
f/u in adenoma >1cm
scope in 3y
f/u in villous adenoma
scope in 3 y
f/u if high grade dysplasia seen on polyp
scope in 3y
f/u if 1-2 adenomas present <1 cm each
scope in 5y
etiology of peptic stricture
complication
gerd
obx dysphagia (difficulty with solids, prolonged chewing, swallowing in small portions)
how to manage acute cholangitis
ercp
what comprises triple therapy for gerd
amox (or flagyl), clarithromycin, PPI
how to determine if h pylori has been eradicated
4-12 wks after completing tx do a fecal ag test (urease breath test --> false neg b/c some forms of the bacteria have decreased urease activity)
presentation of febrile transfusion rxn
f/c, responds to nsaids, usually no hemodynamic abnormality and no renal dysfxn
pathophys behind febrile transfusion rxn
how to minimize this risk
rxn of hla specific antibodies in pts plasma to donor wbcs

leuko-depletion (ex: cell washing)
presentation of acute hemolytic transfusion reaction
f/c back pain
pink/red urine
how to confirm dx of acute hemolytic transfusion reaction
do coombs test and measure plasma free hb
ua +Hb
presentation of acute ischemic colitis
abd pain + bloody diarrhea (infarction most common at watershed areas)
initial management of fecal impaction
initally tx with enemas and suppositories
if this fails, may have to do colonoscopy
inications for a rectal tube
used to tx pseudoobx of colon, with dilated colon and abd distention
how to initially manage a pt with dysphagia
barium swallow is best initial test - it's better than doing endoscopy blindly --> perforation
f/u for pts with barrett's esophagus
if no dysplasia, do endoscopy q1-3y
with low grade dysplasia, endoscopy q6-12 mo
with high grade dysplasia, q3 mo or surgery
how to manage mild gerd
tx with h2 blockers and lifestyle changes, if this fails switch to ppi
chronic dietary management for chronic pancreatitis
low fat diet to prevent malabsorption of fat
what is psyllium used for
chronic constipation
indication for prophylactic abx in pancreatitis

which abx should be used
if they have severe sx, large fluid collections
pancreatic necrosis with >30% glandular involvement

imepenam
contraindication to alpha1 blockers
chf
benefits of alpha1 blockers other than bp control and bph
may increase insulin sensitivity
can lower ldl and raise hdl
what type of bp med should be used to tx all pts with ckd
why
ace-i
b/c it decreases intraglomerular pressure, prevents the progression of renal dz and decreases proteinuria
complications of proximal ureteral obx
hydronephrosis, infx, and hemodynamic instability (can be life-threatening)
how to tx a complicated ureteral obx
percutaneous nephrostomy, abx
when can shock wave lithotripsy be used
for uncomplicated kidney stones
presentation of hepatorenal syndrome
decresaed renal output, change in ms, elevated cr
suspect if no improvement of renal failure despite volume expansion
how to dx hepatorenal syndrome as the cause for renal failure
check urine na (<10)
incresaed urine osm
presentation of aspiratio pneumonitis
severely obtunded pt with h/o vomiting
sx develop within 2-5 hrs after aspiration
how to manage aspiration pneumonitis
no abx, supportive tx only
presentation of aspiration pna
pna occuring 1-5d after aspiration
organisms involved in aspiration pna
gpc
gnr
anaerobes
tx of aspiration pna
clinda
lab findings in non-bacterial prostatitis
urine shows >20 wbc/hpf
negative cx
tx of non-bacterial prostatitis
sitz bath
anti-inflammatories
ua findings in analgesic induced nephropathy
nephrotic range proteinuria
t or f:
the protein seen in multiple myeloma can be picked up on ua
false
tx of autosomal dominant polycystic kidney dz (ADPKD)
ace inhibitor to prevent renal decline
how to manage a pt with mild ADPKD
routine bp checks only, no invasive testing needed if pt has mild dz
t or f:
all pts with ADPKD should get mri to evaluate for berry aneurysms
false, only pts with fhx of sah need to be evaluated
#1 extrarenal manifestation of ADPKD
hepatic cysts
describe pathophysiology of htn in pts with ADPKD
intrarenal vasculature is compressed --> renal ischemia --> activation of RAS
what is the best way to screen pts who have fhx of ADPKD
renal u/s (need 3-5 cysts in each kidney to make dx)
presentation of schistosomiasis
microhematuria and anemia (often seen in immigrants)
how to dx renal artery stenosis
mra (if contraindicated, do cta)
contraindications of metformin
cr >1.5 (1.4 in females)
etoh abuse
liver dz
chf
--> lactic acidosis
which medications can cause decreased tubular secretions of cr
tmp
cimetidine
probenecid
organisms associated with emphysematous pyelo
e coli
klebsiella
tx of emphysematous pyelo
nephrectomy if abscess with gas extension into perinephric space
how to manage mild pyelo
precutaneous drainage
organisms associated with emphysematous cholecystitis
e coli
clostridium
most common immediate complication of turp (transurethral resection of prostate)
hyponatremia secondary to large amts of isotonic fluid used in procedure
Na can approach <100
complication of trazadone
priapism secondary to alpha blockade or serotonin receptor stimulation
tx of priapism caused by medication
phenylephrine or epinephrine
tx of priapism in sickle cell crisis
ivf
complications of splenic sequestration
severely decreased hb --> hypovolemic shock
pts MUST have transfusion
clincal features of mastocytoma
sclerotic bone lesions, diarrhea, eosinophilia, pud, gib
tx of mastocytoma
h1 antagonist, ppi, or cromolyn sodium
type of bone lesions seen in mm
lytic
most common primary ca to metastasize to brain
lung > breast > unk primary > melanoma > colon
t or f:
unilateal ureteric calculi --> arf
false
clinical features of cryoglobulinemia
arthralgias
palpable purpura
lad
hepatosplenomegaly
peripheral neuropathy
asx hematuria, proteinuria, renal failure
dz associated with cryoglobulenemia
hcv
complement lvls in cryoglobulinemia
low
complement levels in post-streptococcal glomerulonephritis
low
what is c-anca associated with
wegeners
goodpasture's
age --> relative contraindication for kidney donation
<18, >65 yo
how does survival compare with an organ from a living person compared with a cadaveric organ
donor from living person has greater chance of survival compared with cadaver, even if not a perfect hla match
clinical features of iga nephropathy
gross hematuria after uri
complement level in iga nephropathy
wnl
time frame for hematuria after strep infx
7-10 days
timeframe for hematuria in thin membrane dz
usually doesn't follow uri
how to differentiate post-streptococcal glomerulonephritis from thin membrane dz
if you can't tell clinically, do bx
tx of mixed cryoglobulinemia
ribaviron (can't be used in renal failure) or ifn alpha
complement level in pan
wnl
complement lvl in wegener's
wnl
#1 complication of turp procedure
retrograde ejaculation b/c the bladder neck doesn't close post-procedure
vision side effect of viagra
loss of blue-green differentiation
clinical features of urethral diverticula
post-void dribbling
dysuria
dyspareunia
--> infx, hematuria, stress incontinence
exam findings of urethral diverticula
vaginal wall fullness, when compressed --> blood and purulent drainage from urethra
how is definitive dx of uretrhal diverticula made
cystoscopy
stage 1 renal cell carcinoma
management
malignancy confined to the capsule

partial nephrectomy
extension of rcc into fascia
total nephrectomy
paraneoplastic syndrome associated with rcc
increased hb/hg secondary to increased epo release by hypernephroma --> rbc mass
gold standard to dx bladder or prostate ca
cystoscopy
moa metoclopramide
adverse effects
use in chemo
da antagonis
--> akasthisia, dystonia, eps
used to prevent chemo-induced emesis
#1 hereditary thrombophilia
factor v leiden
pancoast tumor
nsclc that arises from superior sulcus --> horner's syndrome and hoarseness
pathophys of horner's syndrome
invastion of paravertebral sympathetic chain
--> hoarseness if there is extension into recurrent laryngeal nerve
management of pancoast tumor
surgery and radiation unless there are distant mets, in that case just radiation
tx options for cml
bmt
oral chemo (hydroxyurea or busulfan)
ifn alpha
tyrosine kinase inhibitors
who is candidate for bmt in cml
pts in the chronic phase of dz, <50yo, stable
drawbacks to the oral chemotherapy agents used in cml
busulfan and hydroxyurea --> recurrence b/c they cause a cytologic remission, but not a metabolic remission
busulfan --> lung toxicity
management of lcis
since lcis is not considered a direct precursor to breast cancer, just makes a pt at increased risk for breast ca

close observation is usually the best option, but pts can be managed with tamoxifen or prophylactic b/l mastectomy
t or f:
lcis must be surgically exised
false
most common initial presentation of pancoast tumor
shoulder pain
complication of tamoxifen
how to manage
associated with endometrial hyperplasia
nothing special, just regular h&p, annual pap
secondary polycythemia
results from high epo levels usually to compensate for high altitude, copd, cardiac shunt
how to test for secondary polycythemia
check o2 sat
lab findings in polycythemia vera
elevated rbc, wbc, and plts
how to manage pt with multiple brain mets
steroids and whole brain radiation
(prolongs life by 2-5 months)
clinical features of svc syndrome
sob
cough
fascial fullness
neck pain
hoarseness, dysphagia, cp, syncope
association with svc syndrome
bronchogenic ca
when to use thrombolytics in dvt
only if there is signifiant swelling leading to arterial compromise
how much should 1 unit of plts increase a pts plt count
5000
when should plt response be seen after transfusion
what if there is no increase
10-60 mins
then, autoimmune destruction from alloimmunization
what if there is a nml response to plt transfusion in first hour, but then within 24 hrs, the plts decrease again
think dic
bleeding
sepsis
protective factors in colon ca
high fiber diet
long-term nsaid use
hrt
pathophys of eaton lambert syndrome
antibodies against presynaptic ca channels --> defective ACh release --> muscle weakness
how to dx eaton lambert syndrome
when doing an emg, repeat stimulation of muscle --> increased muscle response (opposite is true in myasthenia gravis)
pathophysiology of myasthenia gravis
antibodies against the ACh receptors
repeat stimulation of a nerve --> fatiguability
acute tx of anemia of chronic dz
epo transfusions (if pts epo <500)
otherwise, frequent blood transfusions
what is the best way to confirm anemia of chronic dz if diagnosis is in question
bone marrow bx to look for iron stores
when is primary cns lymphoma seen
in hiv pts with cd4 <50
etiology of primary cns lymphoma
ebv
t or f:
primary cns lymphoma commonly metastasizes
false, rarely mets outside of cns
how to tx epidural spinal cord compression secondary to malignancy
tx w steroids then immediately get mri to confirm dx, then start radiation tx
tx of supraventricular tachycardia
adenosine
best initial tx for head and neck ca
first give chemo and radiation. this may make the tumor operable
tx of hit
stop all heparin products
give argatroban or lepirudin (direct thrombin inhibitors)
t or f:
primary cns lymphoma commonly metastasizes
false, rarely mets outside of cns
how to tx epidural spinal cord compression secondary to malignancy
tx w steroids then immediately get mri to confirm dx, then start radiation tx
tx of supraventricular tachycardia
adenosine
best initial tx for head and neck ca
first give chemo and radiation. this may make the tumor operable
tx of hit
stop all heparin products
give argatroban or lepirudin (direct thrombin inhibitors)
contraindication for lepirudin
caution with renal insuff
contraindication of aragtroban
caution with hepatic dysfxn
how to minimize risk of hit
minimize use of heparin products to 5 days
how to tx itp
steroids then ivig if steroids fail
splenectomy is a last resort, rarely required
how to manage horomne sensitive prostate ca with bony mets
palliative tx with leuprolide
moa leuprolide
leutinizing hormone releasing hormone antagonist --> binds to lhrh in pituitary
lh initially increases --> increased fsh --> increased testosterone, but then after 1 wk, the receptors are downregulated --> lower lh --> lower fsh/testosterone
when is leuprolide contraindicated as a monotherapy
what is combined iwht it
when there are severe vertebral mets
if leuprolide is used alone, sx can get much worse, in these pts, give flutamide x1 wk prior to starting leuprolide
moa flutamide
anti-adronergic
tx of choice for scc of skin
local excision
(radiation if pt is not surgical candidate)
tx of cholangiocarcinoma
palliative ercp with stent placement
dz has usually met by the time dx is made
tx of acute hemolytic transfusion rxn
stop transfusion
give nss +/- DA infusion to maintain kidney perfusion
intial test of choice for pernicious anemia
if negative, but still suspect
anti-IF testing
if negative, but still suspect dx, do schilling test
association with pernicious anemia
associated with autoimmune metaplastic atrophic gastritis (autoimmune dz vs gastric mucosa) --> glandular atrophy and intestinal metaplasia
how to dx mm
spep
upep
skeletal survey (plain films)
bone marrow bx
what type of bony lesions are missed on bone scan
sclerotic
t or f:
alk phos is elevated in mm
false
t or f:
alk phos is elevated in mm
false
#1 cause of vision loss in elderly
macular degeneration + cortical cataracts
will pts benefit from cataract surgery if they have cataracts + macular degen
no
ophtho finding associated with diabetes
proliferative retinopathy
what is endophthalmitis
presentation?
infx of vitreous fluid
12-24 h of mild eye pain and decreased visual acuity.
swollen eyelids, edema, red conjnctiva, can't visualize retinal bv
how to confirm dx of endophthalmitis
aspiration and vitreous/aqueous humor cultures
how to tx endophthalmitis
vitreal abx
most common organisms associated with foreign body eye infx
staph
strep
h flu
pseudomonas
how to tx eye foreign body
remove foreign body, then
erythromycin
sulfacetamide
cipro or ofloxacin
who gets eye pseudomonas infx
contact lens wearers
what is seen in severe non-proliferative diabetic retinopathy
multiple retinal hemorrhages and cotton wool spots --> macular edema and impaired retinal circulation
how to manage severe non-prliferative diabetic retinopathy
there is no change in chance of visual loss in pts who get immediate laser photocoagulation than those who don't, so before tx, do detailed retinoscopic study to check for macular edema
what is seen in proliferative diabetic retinpathy
how to manage
disc neovascularization
immediate laser photocoagulation
how to manage vitreal hemorhage
vitrectomy
how to manage retinal detachment
vitrectomy
when to operate on a aaa
if >5 cm or if there is rapid growth
how to follow aaa
annual imaging
what is the major risk factor that contributes to aaa growth
smoking
tx of torsades
defibrillation
tx of vtach with hemodynamic compromise
defibrillation
how to manage torsades in a stable pt
first try mgso4, then temporary overdrive pacing, then cardioversion
when can sychronized cardioversion be done
\stable vtach, a fib, a flutter or svt
causes of acute heart failure
chordae tendonae rupture
chest wall trauma with compromise of valvular apparatus
sequelae of chrodae tendonae rupture
flash pulmonary edema and acute mitral regurg
effects of ehlers danlos syndrome on the heart
myxomatous degeneration of mitral valve --> chordae tendonae rupture
sx of tca overdose
hypotension
anticholinergic effects
cns manifestations
arrhythmias (qrs prolong, torsades, vtach, vfib)
how to manage cardiotox of tca o/d
nahco3
tx arrhythmias with lidocaine
what bv supplies the rv
rca
what bv supplies the ant wall of the lv
lad
what bv supplies the anterolateral wall of the lv
diagonal branches of the lad
what bv supplies the posterior-lateral wall of the lv
left circumflex
what complications occur 2-7 days post mi
chordae tendonae rupture
papillary muscle rupture
dressler's syndrome
leukocytosis
pleuritic cp
fever
pericardial rub
(autoimmune related)
tx of dressler's syndrome
first use nsaids
may also need steroids
what is the worst risk factor for cardiovascular death
dm
what cardiac med should be avoided in pts with ami
ccbs
murmur of mvp
mid-systolic click then late systolic murmur
apical holosystolic murmur
mitral regurg
cresc-decresc ejection murmur at lusb
pulmonic stenosis
murmur of mitral stenosis
low pitched rumbling, diastolic murmur at apex
when to use flecainide
to maintain nsr in pts without structural dz
complications associated with flecainide
--> fatal arrhythmias if used in structural heart dz
etiology of MAT
hypoxia
copd
hypokalemia
hypomag
cad
htn
valvular dz
meds
management of mat
correct underlying problem
if that doesn't work or if there is no correctable cause, tx with verapamil or bb
when is cabg preferred over angioplasty
better lt survival in dm with multi-bv disease or recent q wave infarct
pathophys of cocaine induced mi
--> vasospasm --> coronary artery thrombus
management of cocaine induced mi
need to get cath if there is no response to medical management
can you treat a pt who has severe angioedema with ace with an arb
no
etiologies for chf
CAD > HTN > valvular dz
murmur of aortic stenosis
cresc-decresc
which htn med --> photosensitivity
hctz
skin complication associated with lisinopril
aggravates psoriasis
skin complication associated with lasix
steven-johnson syndrome, urticaria
what is the first thing you should think of in horner's syndrome + unilateral ha
how to dx
how to tx
carotid dissection
get MRA
tx with anticoagulation
which class of medications are contraindicated in acute chf exacerbation
beta blockers
pathophys of aortic dissection
separation of intima and media
how to manage aortic dissection
tx with rapidly lowering bp by using beta blockrs
if still high, add nitroprusside
sbp goal 100-120, hr <60
initial drug of choice to tx htn
hctz
what is the most concerning cardiac risk factor pre-operatively
critical aortic stenosis
unstable angina
how to manage PAT
ccbs
metoprolol
esmolol
what study should be done before tx with the -rubicin chemotx
muga scan (aka radionuclide ventriculography or radionuclide angiography)
exam findings in tamponade
inspiratory decrease in bp >20
which rhythm has absent p waves and narrow qrs morphology
svt
how can wpw present
what happens if ccbs or bb are given
svt
conduction will be slowed at the av node and conduction through accessory pathway increases --> v-fib and death
most common cause for flash pulmonary edema
hypertensive crisis
tx of flash pulmonary edema secondary to htn crisis
lower bp with nitroglycerin or nitroprusside
1st test of choice in flash pulm edema
echo to evaluate valvular dz
when to order an exercise technetium 99 test
pts with lbbb or pacemaker
wpw
>1 mm ST depression at rest
inability to exercsie
prior h/o revascularization
when to order exercise ekg
1st test of choice in pts with indeterminant probability and nml resting ekg
when is asynchronous cardioversion used
vfib
when is synchronous cardioversion used
a-fib
which a-fib pt scan be managed with asa alone
<60 yo
no structural or functional cardiac abnormalities
etiology of non-sustained vtach
scarred myocardium from prior mi, cad, lvh
first test of choice in non-sustained vtach
2d echo
stress test
which medications increase dig levels
verapamil
amiodarone
quinidine
spironolactone
how to manage a pt with inr 5-9, no active bleeding
hold coumadin and give one small dose of vital k (oral)
how to manage pt with inr 9-20 without active bleeding
give higher dose of oral vit k k
when can sexual activity resume after mi
6 wks
how to tx bradycardia after inferior wall mi
sx are transient, but atropine should be given anyway
if sx persist or there is hemodynamic compromise, then tx with temporary cardiac pacing
nrti medications
-vudine
nnrti medications
efavirenz
nevirapie
delavidine
protease inhibitor medications
-navir
most effective haart tx
2nrti + 1nnrti or 1protease inhibitor
adequate response to haart
90% decrease in viral load in 8 wks, and undetectable in 4-6 months
cd4 count increases by 50 in 4-8 wks, then 50-100 each year
which hiv med is likely teratogenic
efavirenz
findings that indicate exudative pleural effusion
LD pleural fluid: serum >0.6
protein pleural fluid: serum >0.5
mechanism behind rash seen in mono pts tx with antibiotics
IgG and IgM against PCN derivatives
what are the different types fo nec fasc
type i: seen in pts with dm or pvd, usually involves staph, b. fragilis, e coli, gas, etc)
type ii: seen in healthy pts, usually after an injury, almost always involving gas
findings in type ii nec fasc
blisters
erythema
bullae
fever
malaise
rapid decline
what is nec fasc
infx of subq tissue that spreads along the fascial planes
management of type ii nec faisc
surgical debridement and clinda
immunocompromised pt with systemic infx, pulm and sinus sx, what infx do you think of
aspergillosis
why are pts with dka at risk for infx with mucormycosis
the acidic environment and high iron content are a great place for mucormycosis to grow
management of mucormycosis infx
tx with amphoterecin b and debridemetn
presentation of diphtheria
gray-brown pseudomembrane
pharyngitis
cervical lad
fever
how to dx diphtheria
loeffler's agar
how to tx diptheria
complications
antitoxin
--> anaphylaxis or serum sickness
eosinophilia + diarrhea
think helminths
hiv lipodystrophy
what is it
which med implicated
elevated ldl, tg, lfts
secondary to protease inhibitors
how to tx hiv lipodystrophy
gemfibrozil (if tg are the most elevated)
which medications penetrate the prostate the best
quinolones
bactrim
how long to tx prostatitis
6-12 wks
side effect of
didanosine
pancreatitis
side effect of
abacavir
hypersensitivity
side effect of
nrtis
lactic acidosis
side effect of
nevirapine
liver failure
side effect of
protease inhibitors
crystal induced nephropathy
who should be treated for salmonella enteritis
pts <12 mo
immunocompromised
>50 yo
how to tx salmonella
cipro
bactrim
ceftriaxone
what can often co-exist with lyme dz
systemic ehrlichosis
how to tx endophthalamitis
viterctomy and abx
how to manage a pt with fibrotic lung dz and +ppd
inh x 9 mo
pathology of pml
oligodendrocytes with intranuclear inclusions, demyelination and gliosis
pathophys of pml
reactivation of jc virus
presentation of pml
cognitive impairment
hemiparesis
aphasia
ataxia
natural course of pml, if no tx given
death within 3-6 mo
what are the centor criteria
way of determining management of sore throat
cirteria:
1. fever
2. tonsillar exudate
3. tender cervical lad
4. no cough
if one of two of the sx present, do rapid ag testing
if 3-4 are met, tx empirically
presentation of roseola
fever, which resolves, which is followed by rash from trunk -> extremities
presentation of rubeola
conugh, conjunctivitis, coryza
rash from head down
pts look very sick
presentation of rubella
similar to rubeola, but pts are less sick
when should mri be used to dx osteomyelitis
when spine is involved, or diabetic foot ulcer
how to manage an hbv vaccine non-responder when they are exposed to hbv
get HBiG
which heart valve is involved if the conduction system is not working well
aortic
when NOT to tx bacteruria in elderly
if pts are asx do not treat unless wbc >20/hpf
clinical features of erysipelas
red, painful, swollen elevated skin
fever, chills, malaise
incubation for non-gonococcal urethritis
incubation period for gonococcal urethritis
5-10 days
2-7 days
d/c in non-gonococcal urethritis
d/c in gonococcal urethritis
watery
purulent
how to tx non-gonococcal urethritis
azithro or doxy
if no response, add flagyl +/- erythromycin to cover for trich
tx of community acquired pna
azithro (or clarithro) + ceftriaxone
org responsible for tss
staph
tx of tss
IVF (pts may require up to 20L/d)
clinda +/- nafcillin
lp diagnostic clues for cryptococcal meningitis
opening pressure >200
WBC <50 with lymphocyte predominance
high protein, low glucose
+india ink
how to manage cryptococcal meningitis
amphoterecin b or flucytosine
serial lps to manage sx
how often should hiv viral load and cd4 count be monitored
q3-4 mo
at what cd4 level should haart tx be initiated
viral load
cd4 201-350
>55,000
how to determine hiv status if initial elisa is negative
if initial hiv elisa is negative, but hiv dx is still suspected, check hiv rna or p24 antigen
(seen in acute retroviral syndrome)
how to manage frequent post-coital uti's
post-coital antibiotic prophylaxis
tx of endometritis
clinda + gent
organisms responsible for endometritis
gbs, chlamydia, mycoplasm
inpt tx of pid
cefotetan + doxy
OR
gent + clinda
tx of lgv
doxy or erythro
organism in lgv
chlamydia
organisms in neonatal meningitis
gbs
e coli
listeria
tx fo neonatal meningitis
cefotaxime, amp, vanc
orgs of adult meningitis
n meningitidis
strep pneumo
h flu
management of adult meningitis
ceftriaxone + vanc
organisms of meningitis in adults >50
strep pneumo
n meningitidis
listeria
management fo meningitis in adults >50
ceftriaxone
vanc
amp