Kaplan Mtb

Front 1

how do you treat cardiogenic shock

Back 1

ace, ugent revascularization

Front 2

how do you treat valve rupture

Back 2

ace, intraortic ballon pump

Front 3

canon a waves

Back 3

third decgree heard block

Front 4

abcixima

Back 4

iib,iiia for those undergoin gstent otherwise no benift, also eptifatide and tirofban

Front 5

what do both ace and arbs do?

Back 5

hyperkalemia

Front 6

what do you do for stable angina

Back 6

asa b blocker, nitrates, ace/arb (low ef, can do before angiograph) all need angiography to determine who is candidate for cabg

Front 7

when clopidogrel or pasugrel?

Back 7

acute mi cannot tolerat ASA

Front 8

statins?

Back 8

ldl >70-100 although greatss for >130

Front 9

goal LDL diabetes

Back 9

<70

Front 10

# 1 effect of statins--

Back 10

liver toxicity check lfeft routinely, rhabdo not the most common effect

Front 11

what do you stop with sildenafil?

Back 11

nitrates

Front 12

systolic vs diastolic heart failure?

Back 12

systolic lowe ef, diastolic normal ef, can't tell between symptoms

Front 13

63 yo with acute SOB rales on lung, s3 gallop and orthopena

Back 13

start o2 furosemide, nitrates and morphine.. Mainstate for acute pulmonary edam

Front 14

in ccs how many minutes

Back 14

no more than 15-30 or ER or ICU

Front 15

pulmonary edma and MI?

Back 15

go to ICU

Front 16

what tests for pulmonary edma

Back 16

cxr, ekg, sp02, echo

Front 17

positive inotrope for ICU pt with CHF

Back 17

dobutamine (also amrinone or milrinone--use after clocked moved forward 30-60 minutes and no response to preload reduction with nitrates and furosemide

Front 18

ventricular tachycardia and acute pulmonary edema?

Back 18

syncrhonized cardioversion

Front 19

nesiritiede

Back 19

synthetic atrial natiuretic pepdtied can reduce shortness of breaet

Front 20

when bnp?

Back 20

presentation is not clear vs copd

Front 21

cardio genic shock page 56

Back 21

?

Front 22

chf management

Back 22

both get metoprolol or carvedilol and a diuretic-- systolic spironolactione, ace, digoxin too

Front 23

what for EF <35?

Back 23

defibrillator-- most common cause of death arrhythmia

Front 24

whn biventricular pacemaker

Back 24

wide qrs ?120 in chf

Front 25

warfarin for CHF?

Back 25

no

Front 26

when no b blocker

Back 26

symptomatic bradycardia

Front 27

how does all valvular heart disease prsent?

Back 27

shortness of breath

Front 28

right vs left murmers

Back 28

rIght Increase with Inspiration (left exhalathion miral and aortic)

Front 29

turner's syndrome or aortic coarctation?

Back 29

bicuspid aortic

Front 30

palpitiation atypical chestpoin

Back 30

mitral valve prolape (young female)

Front 31

immigrant pregnant

Back 31

mitral stenonsis

Front 32

what murmers increase with Valsalva or Standing

Back 32

Valve prolapse Mitral, or Hypertrophic obstructive cardiomyopathy

Front 33

worse with handrip

Back 33

aortic reguge mitral regurge and vsd

Front 34

worse with amyl nitrate

Back 34

aortic steonis and hocm

Front 35

how does amyl nitrate worsen murmu?

Back 35

decreased afterload

Front 36

thrill in murmur

Back 36

goes to IV

Front 37

bes test for murmu

Back 37

echo

Front 38

most accurate test murmur

Back 38

left heart catheterizaitoon--- on ccs also do ekg and cxr

Front 39

when TEE

Back 39

only if TTE not diagnositic

Front 40

worse with handgrip treatment

Back 40

ace or arb afterload reduction

Front 41

valsalva improve murmur

Back 41

diuretics aortic stenosis, arotic reguge, mitral stenosis, mitral regurge VSD not for HOCM or MVP

Front 42

amyl nitrate improve murmur

Back 42

ace and aortic regurge and mitral regurg, and vsd

Front 43

how does aortic stenosis present

Back 43

chest pian-- 3-5 year survival if coronary disease, syncope=2-3 year and CHF 1.5-2 year

Front 44

dx aortic stenosis

Back 44

crescendo-decrescendo-- tte best initial tee more accurate left heart catch most acurate-- moderaate disease 30-70 severe dieseaesse >70

Front 45

biprosthetic vs mechanical valve

Back 45

bioprosthetic need replacement but not warfarin, mechanical other way

Front 46

watter hammer pulse

Back 46

corrigan's pulse-- aortic regurge

Front 47

how does aortic regurge preseet

Back 47

SOB and fatigue

Front 48

blood pressure higher in lower extremities

Back 48

hill sign aortic regurg

Front 49

tx aortic regurge

Back 49

ace, arb and nifedipine, for ccs loop diuretic surgery if EF <55

Front 50

hoarseness

Back 50

mitral stenossi pressure on recurrent laryngeal nerve also dysphagia and afib

Front 51

stroke in mitral stenossi

Back 51

second to afib

Front 52

diastoirc rumbele after snap

Back 52

mitral stenosis

Front 53

treast mitral stenosi

Back 53

diuretics or balloon valvuloplasty

Front 54

holosystolic murmur left lower sternal boarder

Back 54

vsd

Front 55

wide s2 split

Back 55

rbb, pulmonic stenosis RVH pulmonary htn

Front 56

paradoxical S2

Back 56

lbb, as, left vent hypertophy hypdertension

Front 57

fix s2

Back 57

asd

Front 58

when fix asd

Back 58

1.5 to 1 shuntin

Front 59

dilated cardiomyopathy tx

Back 59

same way as chf

Front 60

most common cause cardiomyopathy dilated?

Back 60

ischemia, alcohol, adriamycine, radiation, chagas tx with ace b blocker and spironolactone, digoxin does not prolong survival

Front 61

hypertrophic cardiomyopathy tx

Back 61

b blocker and diuretics

Front 62

restrictive cariomyopathy

Back 62

sacroid amyloid cancer, hemochromatossis,-- SOB and kussmal's sign (increse JVP ion inhalation

Front 63

tx restrictive cardiomyopathy

Back 63

diuretics and underlying cause

Front 64

pulsus paradoxus d

Back 64

decrease in blood pressue >10 on inhalation pericardial tamponod

Front 65

alterations axis of qrs complex on ekg

Back 65

electical alternans pericardial tamponade

Front 66

tx pericardial tamponade

Back 66

initial pericardiocentis, most effective pericardial window

Front 67

pericardial knock

Back 67

extra sound--- constrictive pericardidis also presents with edema jvd HEPATOSPLEONMEGALY like all right heart faiure

Front 68

dx constrictive pericardidits

Back 68

CXR-- calciviaktion, low voltage EKG, ct and MRI

Front 69

tx pconstrictive pericardidits

Back 69

diuretic most effective pericardial strippling

Front 70

sever chest pain to back and HTN`

Back 70

ive b blockers and ekg and CXR-- move forward and order CT angio, tee or MRA-- all 3 accurate for aortic disection

Front 71

how to tx aortic dissection

Back 71

b blocker, nitroprusside, surgical correction

Front 72

best test peripheral arterial disese

Back 72

abi initial (<0.9, most acurrate angiography

Front 73

pain less sitting worse standing

Back 73

spinal stenosis

Front 74

tx pad

Back 74

ace, exercise, cilostazole, ldl <100

Front 75

is pad an emergency?

Back 75

no move clock forard weeks then surgery if pain progressies or ischemia or gagrne or pain at rest

Front 76

CHADS`

Back 76

0-1 asa, 2 gets warfarin dabigatran or rivaroxaban

Front 77

stroke or tia in chads

Back 77

2 points

Front 78

ccs tests for afib

Back 78

echo (clots) thydroid, electrolytes, troponin ck/mb

Front 79

rate control in afib and aflutter

Back 79

bblocr usually, ccb for asthma or migrane, digoxin for hypotension

Front 80

treat multifocal atrial tchycardia

Back 80

no b blockers (polymorphic p waves)

Front 81

how does svt present?

Back 81

palpitations and tachycardia and occaisionaly syncope-- regular rhythm at vent rate of 160-180

Front 82

what do all dysrthymia get on ccs?

Back 82

transthoracic echo after initial set

Front 83

if ekg does not show SVT?

Back 83

holter or telemetry

Front 84

treat svt

Back 84

unstable cardiovert synchronized, stable vagal maneuvers valsalva ice, carotid

Front 85

if vagal maneuvers do not work in stabl svt

Back 85

INTRAVENOUS ADENOSINE

Front 86

best long term SVT

Back 86

radiofrequency ablation

Front 87

best tx for WPW

Back 87

procainamide if in svt or vt from wpw

Front 88

best therapy wpw

Back 88

radiofrequency ablation

Front 89

how does vtach present

Back 89

palpitation synchope cp or death

Front 90

how to diagnose vt

Back 90

ekg, telemetry, most accurate electrophysiologic

Front 91

treat vt

Back 91

amiodorone lidocaine procainamide mg. if stble if unstable synchronized cardiovert

Front 92

when unsynchronized cardiovert

Back 92

vfib

Front 93

where is synchronized cardiovert

Back 93

not in the T- afib

Front 94

vtach with undulating amplitued

Back 94

torsades magnesium

Front 95

first step vfip

Back 95

cpr, defibrillate, epi or vssopressin, defib, amiodorone/lido, defib, no intubate until breathing

Front 96

syncope criteria

Back 96

sudden or gradual

Front 97

sudden syncope

Back 97

cardiacc or neuro (seizures)

Front 98

gradual syncope

Back 98

toxic, hypoglycemia, anemia, hypoxia

Front 99

ccs test for syncope that's not clear

Back 99

vtilt table or elecrophysiological testing (holder)

Front 100

sudden or gradula regain of consciouness in syncope

Back 100

gradual is neurologic

Front 101

diagnostic testing syncope

Back 101

ekg, chemistries, oximeter, cbc cardiac enzyme

Front 102

focal neurologic exam or head trauma in syncope

Back 102

order ehad ct

Front 103

headache and syncope

Back 103

order head ct

Front 104

seizure syncope

Back 104

order ehad ct and eeg

Front 105

if not crear on ccs

Back 105

holdet, telemetry repeat ckm, urine and blood tox (tox early)

Front 106

most importat thing in syncope

Back 106

exclude cardiag etiology, vent dysrhythmia-- implatable cardioverty

Front 107

endocrine

Back 107

?

Front 108

diabetes dx

Back 108

1 random >200 with sympotms, abnormal GTT , two fasting 125 and A1c 6.5

Front 109

best initial diabestes thearpy

Back 109

metformin

Front 110

sulfonylurea and obesity

Back 110

auses weight gain

Front 111

when is metformin contraindicated

Back 111

renal insufficiency use of contrast agents (lactic acidosis in renal insufficincey)

Front 112

not in CHF

Back 112

rosiglitazone and pioglitazone

Front 113

glyburide, glimepride and glipized

Back 113

sulfonylreas-incerase insulin, weight gain, can

Front 114

causes SIADH

Back 114

sulfonylreas also hypoglycemai

Front 115

sitaglipit and saxagliptin

Back 115

dipeptyl peptidase IV inhibitors can use with metformin blcok metabolism or ingretin s like GLP

Front 116

rosiglitzone and pioglitazone

Back 116

increase peripheral insulin sensitivty- now with chf

Front 117

acarbose and miglitole

Back 117

alpha glucosidoese intestilan lining diarrhea abdominal pain and flatulence

Front 118

nateglinidie and rpaglinide

Back 118

like sulfonylreas cause hypoglycemia

Front 119

long actin insulin

Back 119

glargine (lantus) detemir, nph

Front 120

short actin insulin

Back 120

aspart lispro glulisine

Front 121

GLP-1

Back 121

exenatid eand liraglutide-- weight loss and lower glucose

Front 122

what promotes weight loss

Back 122

metformin exnatide and liraglutide mel decreases meals

Front 123

slows gastric emtpying

Back 123

enatide and liraglutide

Front 124

best test dka

Back 124

serum bicarb-- low implies anion gap- marker for severe dka

Front 125

b hydroxybutryrate

Back 125

makrker of ketone production-- level will change with ketones

Front 126

lab finding in dka

Back 126

hyperglycmea >250, hyperkalemai (then hypokalemia) low bicarb, low pH, acetone, acetoacteat b hydroxybutyrate levels elevated, aniogap pseudohyponatermia

Front 127

tx dka

Back 127

bolus saline and iv insulin

Front 128

diabetic htn

Back 128

goal < 130/80 normal pol 140/90

Front 129

lipid diabetes

Back 129

cad equivalen <100 or if CAD as well <70 when both

Front 130

how often for diabetec exeye exam

Back 130

yearly

Front 131

tx diabetic retinopathy

Back 131

laser photocoagulation, also ranibizumapb or bevacizumab

Front 132

urine microalbumin

Back 132

all diabeteics if any protein give ace

Front 133

how to treat diabetic neuropathy

Back 133

gabapentin orpregabalin-- no need for diagnostic

Front 134

erythromycin and gastric motility

Back 134

releases motilin a promotility gi hormone

Front 135

tender thyroid gland

Back 135

subacute treat with asa-- will have low RAIU

Front 136

silent hyperthryoidism

Back 136

no tx, nophycial finding

Front 137

tx graves

Back 137

radioactive iodine ablation

Front 138

raiu in graves

Back 138

elevated

Front 139

tx grave medically

Back 139

ptu or methimazol to get undeer control then radioactive iodine then propanolol to treat symptoms

Front 140

tx thyroid stomr

Back 140

iodine, ptu or methimaol, dexamethasone (blocks peripheral conversion) propanolol blocks target organ effect

Front 141

?

Back 141

?

Front 142

what to do with solitary thyroid nodule

Back 142

FNA-- ultrasound radioactive iodine scan are both wrong

Front 143

most common cause of hypercalcema

Back 143

primary hyperparathyroidism

Front 144

other causes of hypercalcemia

Back 144

malignancy, granulomatous disease (sarcoid makes vitamin d) vitamin d intoxication, thiazide, tuberculosis, histoplasmosis, berryllios

Front 145

how does hyperparthyroidsm present

Back 145

asymptomatic hypercalcemia-- kidney stones, osteoporosis/fx, confusion, constipation and abdominal pain

Front 146

Multiple endocrine neoplasia

Back 146

MEN syndrome solitary adenoma, four gland hyperplasia, cancer

Front 147

short qt syndrome

Back 147

acute sever hypercalcemia

Front 148

what does acute severe hypercalcemia cause

Back 148

confusion, constipation, polyuria and polydipsia, from nephrogenic diabetes insipidus, renal insuffincey, atn kidny stone

Front 149

tx acute hypercalcemia

Back 149

hydration, (3-4 l) furosemide after hydration, bisphosphonate (potent but slow, calcitonin if hydration and furosemide don't work, steroid if sarcoid

Front 150

what does hypocalcemia cause

Back 150

prolonged qt, neural twitching

Front 151

what cushing syndrome is supressed with dexamethasone

Back 151

pituitary tumor, ectopic acth and adrenal adenoma don't

Front 152

dx pituttary tumor

Back 152

mri or petrossal vein sampling

Front 153

dx cushings

Back 153

24 hour urine cortisol, 1 mg overnight dexamethasone test, 24 hour is more accurate fewer false positive

Front 154

after + cushign test what's next?

Back 154

acth 0 high ptuitary or ectoppic

Front 155

hyperpigmented skin, fatigue anorexea hypotension and weakness

Back 155

addison disease

Front 156

dx addison

Back 156

hyperkalemia with mild metabolic acidosis (can't excrete h or k b/c of loss of aldoseterone,… also hyponatermia

Front 157

best test for addisons

Back 157

cosyntropin (acth tes raises cortisol) or ct scan adrenal gland

Front 158

tx addison

Back 158

stable (nonhypotensive prednisone, acute (hypoadrenal crisis) give fluids and hydrocortisone, fludrocorisone is used for patient with adrenal insuficiency whoare hypotensive after intial replacement

Front 159

hypertension, hypokalemai and metabolic alkalosis

Back 159

hyperaldosteronism

Front 160

dx hyperaldosteronism

Back 160

low rening, htn, elevated aldosterone (despite salt loading)…

Front 161

tx hyperaldosteronism

Back 161

adenoma gets resected, hypplasia gets spironolactone

Front 162

nephrogenic diabetes insipidus

Back 162

occurs form hypkalemia in hyperaldosteronism

Front 163

tx pheo

Back 163

phenoxybenzamin then propanolol and surigical or laproscopic resection

Front 164

dx pheo

Back 164

ct or mri of adrenal, metastatic with MIBG scan

Front 165

congenital adrenal hyperplasia

Back 165

hypertension in 17,11; virilization in 21, 11--dicks rare #1

Front 166

labs in congenital adrenal hyperplasia

Back 166

low aldosteron and cortisol(hyponatremic)

Front 167

treat cah

Back 167

prednisone

Front 168

why genital efects in prolactinoma

Back 168

prolactin inhibits GNRH

Front 169

when to look for prolactinoma

Back 169

no pregnancy, no metoclopramide, no phenothiaizes or TCA's

Front 170

prolactin level in prolactinoma

Back 170

very high >200

Front 171

most accurate test in prolactinoma

Back 171

mri or petrossal vein sampling

Front 172

treat prolactinoma

Back 172

bromocriptine or cabergoline

Front 173

what are side effects of acromegaly

Back 173

other than growing--joint abnormalities from articular carlage, amenorrhea, cardiomegaly and htn, colonic polyps

Front 174

best test acromegaly

Back 174

insulin like growth factor, not gh level

Front 175

most accurate test acromegaly

Back 175

GH suppression test with glucose

Front 176

tx acromegaly

Back 176

surgical resection , octreotide, cabergoline or bromopciptine, pegvivomant (growth hormone receptor antagonist

Front 177

tall men

Back 177

klinefelter… xxy cariotype-- insesitivy of fsh and lh receptos, fsh and lh high but not testosterone tx with testosterone

Front 178

no dick can't smell

Back 178

callman's sydnroem

Front 179

kallman's dx

Back 179

low gnrh, fsh and lh, anosmia is key

Front 180

no whezing in asthma i

Back 180

ominous

Front 181

max dose of albuterol

Back 181

none

Front 182

what to give all sob pts

Back 182

oxygen sp02, chest xray and ABG ABG ABG

Front 183

tx acute asthma

Back 183

albuterol-- iv steroid bolus of methl prednisolone (4-6 hours) ipratoprium, oxygen and MAGNESIUM-- no use for epinephrine or terbutaline or inhaled corticosteroids

Front 184

where to send asthmatic

Back 184

icu if acidosis and retention; persistent respriatory acidosis gets intubation

Front 185

atopy and asthma

Back 185

montelukast add if not controled on abluterol

Front 186

copd and asthma

Back 186

add tiotropum or ipratopium

Front 187

hihg ige

Back 187

cromolyn then omalizuma (anti IgE

Front 188

extrinsic allergies such as hay fever and asthma

Back 188

cromolyn or nedocromil

Front 189

acute copd tx

Back 189

abg, cxr, albuterol, ipratropium, bolus of methy prednisolone chest heart extremity neuro exam

Front 190

fever, sputum, new infiltrate on xray and copd

Back 190

add ceftriaxone or azithromycine for community acquired pneumonia

Front 191

tram tracking

Back 191

paralell lines on x-ray--bronchiectasis--anatomic defect with profound dilation of bronchi usually childhoow infection

Front 192

how to dx bronchiectasis

Back 192

chest xray first then high resolution ct scan of the chet

Front 193

tx bronciectasis

Back 193

no cure chest physiotherapy and rotation abx

Front 194

dry velco rales , loud p2 heart sound in a patient with shorntess of breath and a dry nonproductive cough

Back 194

interstitial lung disease

Front 195

dx ILD

Back 195

cxr, high res CT, lung biopsy PFT

Front 196

PFT findings ILD

Back 196

all down but fev1/fvc is normal

Front 197

glass workesrs

Back 197

silicosis

Front 198

cotton

Back 198

byssinosis

Front 199

electronics/ceramics

Back 199

beryllios

Front 200

mercury

Back 200

pulmonary fibrosis

Front 201

ekg in ild

Back 201

pulmonar ht

Front 202

most common cancer in asbestosis

Back 202

lung cancer not mesothelioma

Front 203

BOOP vs ILD

Back 203

BOOP gets fever malaise and myalgias and ther eis no occupational exposure

Front 204

boop cxr

Back 204

bilateral patchy infiltrates

Front 205

boop chest ct

Back 205

intersitital disease and alveolitis

Front 206

most accurate test for boop

Back 206

open lung biopsy

Front 207

treat ild

Back 207

trial of steroids-- best response is berylliosis b/c it's granulomatous

Front 208

how to tx boop

Back 208

steroids no reponse toa bx even though fever-- boop normally responds to steroids while ild does not

Front 209

boop vs ild onset

Back 209

boop days to weeks, ild 6 montsh or more

Front 210

african american woman under 40 with cough SOB and fatique and rales on lung exam

Back 210

sarcoid

Front 211

other findins in sarcoid

Back 211

uveitis, 7thc crania nerve incolvement, purlple skin of fase (lupu pernio) restricive cardio myopathy cardiac conduciton defect, renal and hepatic invovlemetn, hypercalcemia

Front 212

best test for sarcoid

Back 212

initial chest x-ray enlarged lymph nodes, most accurate lung of lymph node biopsy showing noncaseating granulmoas

Front 213

sarcoid BAL

Back 213

helper cells

Front 214

tx saroid-

Back 214

steroids no reponse toa bx even though fever-- boop normally responds to steroids while ild does not

Front 215

pulmonary htn findings

Back 215

loud p2, tricuspid regurge, raynaud's right ventricular heave

Front 216

what causes pulmnary HTN

Back 216

mitral stseonos, copd, polycythemia vera intersitial lung disessae

Front 217

dx pulmonary htn

Back 217

tte, ekg righ axis, most accurate righ heart cath

Front 218

bosetan

Back 218

enothelian inhibitor tx pulmonary htn

Front 219

epooprotenol and terepostinil

Back 219

porstacyclin analogs act as pulmonary vasodilatoer

Front 220

other p htn tx

Back 220

ccb and sildenafil

Front 221

most common cxr finding PE

Back 221

atelectasis

Front 222

most common ekg fingin pe

Back 222

sinus tach, someitmes nonstpecicic st-t wave changes

Front 223

abg pe

Back 223

a-a gradient increase and mild resp alkalosis

Front 224

dx pe

Back 224

give heparin first-- spiral ct is test of choid if x-ray is abnromal, v/q scan must have normal x-ray, LE doppler (30% from pelfic false neg), d-dimer only if low probablity

Front 225

single most acurate test for PE

Back 225

angiography-- but risk of tdeath about 0.5%

Front 226

when greenfield filter

Back 226

pe and contraindication to anticoag

Front 227

when thrombolytics PE

Back 227

if hemodynamically undstable (hypotension-- thromboltics have essecntially replaced embolectoy

Front 228

best initial test pleuarl effusion

Back 228

chest x-ray decub flilms with patient lying on 1 side next to see if fluid is free flowin

Front 229

most accurate test pleural effusion

Back 229

throacentesis

Front 230

exudad

Back 230

high protein high LD - cancer and infection

Front 231

transudate

Back 231

low protein low ldh

Front 232

what test on pleural fluid

Back 232

gram sti, acid fast stain, total protein, ldh, glucose, cell count, triglycerides

Front 233

treat pleural effusion

Back 233

small diuretics esp if chf-- larger chest tube, if can't be corrected and recurrent pleurodisis-- bleomycin or talcum put itn, if pleurodesis fails decorticaiton (stripping

Front 234

dx sleep apnea

Back 234

polysogmnography

Front 235

# 1 cause of sleep apnea

Back 235

obstructive

Front 236

mild sleep apnea

Back 236

5-20 apnec periods anhour

Front 237

tx sleep apnea

Back 237

weight loss and CPAP if not effective surgery

Front 238

central sleep apnea tx

Back 238

avoid etoh and seadives, acetazolamide (causes a metabolic acidosis) and medoxyprogestrone-- stimulant

Front 239

asthmatic patient with worsenign symtoms coughing up brownish mucous plucs with recurrent infiltrates

Back 239

allergic bronchopulmonary aspergillosis

Front 240

labs in ABPA

Back 240

IgE level elevated, eosinophlia

Front 241

dx abpa

Back 241

aspergillis skin steting a. fumigatus specific antibodis

Front 242

tx abpa

Back 242

corticosteroids or if refrractory itraconazol

Front 243

ards dx

Back 243

normal wedge rpessure CXR patchy, p02/FIo2 ratio <200 with the FIO2 expressed as a decimal

Front 244

tx ards

Back 244

low tidal volume vent suport, PEEP, PRONE positioning, dirutecs, inotrops like dobutamine

Front 245

steroids in ards

Back 245

no

Front 246

most common CAP pneumonia

Back 246

pneumoccocall HAP is gram neg bacilli

Front 247

when to admit pneumonia

Back 247

elderlyhypoxic patietn swith or without a fever

Front 248

best initial test pneumonia

Back 248

cxr, high res CT, lung biopsy PFT

Front 249

most accurate test pneumonia

Back 249

gram stain and culture

Front 250

other tests for pneumoia

Back 250

x-ray, pulse ox, o2, abg

Front 251

tx outpatient pnumonia

Back 251

azithromycine, doxycyclin or clarithromycin, respiratory fluroquinolon, levoflaxacin, moxifloxacin

Front 252

treat inpatient pneumonia

Back 252

cetriaxone and azithromycin, or fluroquinolone as a single agent

Front 253

treat vettilator associated pneumonia

Back 253

imipenem or meropenem, pip tazo or cefepime; gent and vanc or linezolid

Front 254

recent viral sydnrome

Back 254

sataph

Front 255

alcoholics

Back 255

klebsiella

Front 256

gi symptoms and pneumonia/confusion

Back 256

legionella

Front 257

young heathy patients

Back 257

mycoplasma

Front 258

birth of an animal

Back 258

coxiella burnetii

Front 259

arizona contruscion workers

Back 259

coccidio

Front 260

hiv with <200 cd4 cells

Back 260

pneumocyss

Front 261

ldh and bilateral infiltrated

Back 261

thing PCP-- raises LDH

Front 262

tx pcp

Back 262

tmp/smx better than pentamidine, BAL needs to be done as is most accurate test-- steroids if P02<70 or a-a gradiet >35

Front 263

best test tb

Back 263

cxr but sputum acid fast stain and culture

Front 264

tx tb

Back 264

RIP for 7 months

Front 265

peripheral neuropathy

Back 265

isoniazid

Front 266

rifampid

Back 266

red/orage colored secretion

Front 267

pyrazinamdie

Back 267

hyperuricemia

Front 268

ethambutol

Back 268

optic neuritis

Front 269

when to tx tb longer

Back 269

osteo, menigigits miliary tb, cavitary tb, pregnancy

Front 270

ppd levels

Back 270

5mm close contacts and steroids, 10mm risk groups, 15mm normal, hiv are 5 and healthcare immigrantc alcoholics and prisoners 10

Front 271

patient never tested for ppd

Back 271

2 stage testing if first test neg wait 1-2 weeks

Front 272

IGRA

Back 272

interferon gamma release assa quantiferon--- latent tb

Front 273

risk of ppd and tb

Back 273

only 10 percent same with quantifernon

Front 274

if positive ppd

Back 274

cxr, if abnormal sputum staining for tb, if this is positive then full dose

Front 275

when isoniazid alone

Back 275

for 9 months to treat a positive ppd

Front 276

rheum

Back 276

?

Front 277

what finger joints rheum

Back 277

mcp pip

Front 278

test for rheumatoid

Back 278

x ray, rf, anticcp, esr, cbc and crp (aspiration of joint if swollen)

Front 279

tx ra

Back 279

nsaid and dmard --methotreaxate #1

Front 280

hydroxychloroquin

Back 280

use with mild disease and check for retinopathy

Front 281

sulfasalazine

Back 281

can suppress bone merrow

Front 282

alternate dmards

Back 282

rituximab (anti cd-20) anakinra, tociluzmab

Front 283

leflunomide

Back 283

pyrimidne antagonis similar to methotrexate

Front 284

most accurate test anklyosing spondylitis

Back 284

mri or petrossal vein sampling

Front 285

associations with as

Back 285

uveitis 20 arotitis 3 restricivie lung disesase 2-15 percent

Front 286

tx as

Back 286

nsaid, sulfasalazine, inflixmab, adalimab, no steroids

Front 287

urethitis, gi, genital lesions, conjuctiviits, kerataodablenorrhagium

Back 287

reactive arthrits tx with nsaids, hx of chlamydia, shigella, salmonella, yersinia or campylobacter

Front 288

tx psoriasis

Back 288

nsaid, methrotrexate for ristant, infliximab

Front 289

salmon colored rash, polyarthitis, lymphadenophathy fever

Back 289

jra

Front 290

test for jra

Back 290

none, high ferritin, elevated white cound, negative rheumatoid factoer and ana are essential

Front 291

treat jra

Back 291

nsaid steroids, then on to methotrexate

Front 292

diarrhea fat malabsorption and weight loss with joint patin

Back 292

whipple disease-- bowel biopsy with pas positiv eorganism treat with tmp/smx

Front 293

morning stiffness

Back 293

ra 1 hour, osteo 30 minutes

Front 294

dip joint

Back 294

heberden's oa, bouchards is pip

Front 295

best test for oa

Back 295

x-ray, get ana, esr rf anticcp to rule out, joint fluid low leukocyte count

Front 296

best test sle

Back 296

ana initial, most specific anti ds dna

Front 297

best test for lupus flare's

Back 297

complement drop in flare ups anti ds dna rise in flare's

Front 298

tx sleep apnea

Back 298

prednsone acute, joint pain nsaid,

Front 299

rash and joint pain in sle not responidn gto nsaid's

Back 299

hydroxychoroquin and antimalarials

Front 300

treat lupus nephritis

Back 300

steroids and mycophenolate mofetil

Front 301

sever disease releaps in lupus after steroids

Back 301

belimumab, azathiporine, cylcophosphamid

Front 302

most accurate test sjogren't

Back 302

lip biopsy

Front 303

loss of teach early age

Back 303

sjogren's

Front 304

drug induced lupus

Back 304

hydralazine, procainamide and isoniazid-- hip

Front 305

drug induced sle findings

Back 305

no cns or renal, complement and anti ds dna normal antihistone bodies are positive

Front 306

immobile fingers

Back 306

sclerodactyly

Front 307

antitoperisomerase

Back 307

antiscl70 scleroderma only in 30 percent of patients, ana is present in 95 perecetn

Front 308

treat renal involvment in scleroderma

Back 308

ace

Front 309

treat pulmonary htnin scleroderma

Back 309

bosentan, epoprostensl, sildenafil

Front 310

treat raynauds

Back 310

ccb and sildenafil

Front 311

treat gerd

Back 311

ppi

Front 312

treat lung fibrosisi

Back 312

cyclophosphamid

Front 313

what does crest spare

Back 313

htn, joint pain, heart involvment, lung involvemnt (except for pulmonary htn) kidney involvment

Front 314

antricentromere antibodies

Back 314

crest

Front 315

eosinophilia nad thickened skin

Back 315

eosinophilic fasciitis-- looks like scleroderma without hand, raynauds or heart/lung kidne… oragne pell appearance, tx with corticosteroids

Front 316

dermatomyositis vs polymysytis

Back 316

dermatomysoitis has rashes-- grotton's, heliptrope, shawl sign

Front 317

dx dermato/polymyositis

Back 317

order cpk, aldolse EMG, for CCS get LFT and ANA

Front 318

best test PM/DM

Back 318

biopsy

Front 319

anti - jo 1

Back 319

interstitial lung disease risk

Front 320

complication from PM/DM

Back 320

malignancy dm greater than pm

Front 321

treat fibromyalgia

Back 321

nsaids are not first line, exercise, milnacipracine, duloxetine or pregabalin… tca's like amitriptyline have more adverse effects

Front 322

profound pain and stifness of proximal muslce worse in mornting

Back 322

PMR-- ESR is up and amazing response to steroids

Front 323

labs in polymyalgia rheumitica

Back 323

all normal but elevated esr-- often fever

Front 324

treat vasculitis

Back 324

prednisone and glucocorticoids, cyclophophamide, azathioprine/6mercaptopurine, methotrexate

Front 325

polyarteritis nodosa

Back 325

diffuse symtpoms don't involve the lung, abdominal pain, renal involvemnt, pericarditis, htn testiclar invovlement

Front 326

test for pan

Back 326

biopsy of skin muscle or sural nerve

Front 327

best initial test pan

Back 327

angiography of abdominal vessels

Front 328

pan association

Back 328

hepatititis b surface antigen

Front 329

upper and lower respiratory findings

Back 329

wegner's

Front 330

wegner's test and tx

Back 330

c-anca elevated most accurate test is biopsy

Front 331

tx wegner's

Back 331

prednisone and cyclophosphamide

Front 332

asthma eosinophilia and vasculitis

Back 332

churg strause-- panc biopsy steroids

Front 333

young asian female with diminisehd pulses

Back 333

takayasu's arteritis

Front 334

tia and stroke

Back 334

takayasu's arteritis

Front 335

dx takayasus'a

Back 335

aortic arteriography or MRA, tx with steroids like all others

Front 336

cryoglobulinima

Back 336

like vasculitis-- has hepatitis c and renal involvment-- treat hep c with interfoeron and ribaviron-- step 3 lvoes

Front 337

oral and genital ulcers

Back 337

bechet's disease

Front 338

hyper activity to needle sticks

Back 338

sterile skin abscesses-- bechet's disease, also causes ocular involement, no speicific test treat with prednisone and colchicine

Front 339

pseudogout

Back 339

PPPPostively bifirngent

Front 340

what precipitates gout

Back 340

binge drinking, thiazides, nicotinic acid

Front 341

ccs and gout

Back 341

joint fluid exam for cell count culture, serum uric acid, x ray of toe, extremity exam for tophi

Front 342

uric acid in gout

Back 342

can be normal

Front 343

treat gout

Back 343

best is nsaids, colchicine in first 24 hours or when there is renal insufficincy, also steroids

Front 344

when steroids for gout

Back 344

when there is a contraindication to nsaids or insufficient response

Front 345

what does colchicine cause

Back 345

nausea and diarrhea/bone marrow suppressoin

Front 346

febuxostat

Back 346

alternative to allopurinal--answer when patient is intolerant

Front 347

allopurinal adverse effects

Back 347

rash, allergic insterstiial nephritis

Front 348

allopurinal during attack?

Back 348

no!

Front 349

what to expect when there is CPPD?

Back 349

positively birefingent RHOMBOID shaped crstals-- look for hemochromatosis, hypoerparthyroidism or hypothryodism

Front 350

tx cppd

Back 350

nsaids or steorids

Front 351

see chart page 139

Back 351

?

Front 352

bowing of tibias

Back 352

paget's disease

Front 353

best test paaget's disease

Back 353

alkaline phosphatase

Front 354

otsteolitic x-ray

Back 354

paget's or osteoporosis

Front 355

osteoblastic xray

Back 355

metatstatic prostate cancer

Front 356

best test paget's

Back 356

x-ray

Front 357

ccs and pagets'

Back 357

urinary hydroxyproline, serum calcium (normal) serum phosphate (normal) bonescan

Front 358

treat paget's

Back 358

bisphophonates and calcitonin

Front 359

platar fascitis vs tarsal tunnel

Back 359

trasal tunnel more painful with use, but platar fascitis has worse in morning… tarsal tunnely may need surgery or may have numbness

Front 360

hematology

Back 360

?

Front 361

what tests for anemai

Back 361

best initial cbc with smear,

Front 362

additional tests anemia

Back 362

reticulocyte cound, haptoglobin, ldh, total and direct bilirubin, tsh with t4, b12/folate, iron studies… also urinalys with micorsopic anlysis

Front 363

most accurate test iron deficiency

Back 363

bone marrow biopsy--don't do

Front 364

alcoholic, isoniazid or lead and anemia

Back 364

hhigh Fe thing prussion blue and sideroblastic

Front 365

treat sideroblastic anemia

Back 365

pyridoxine replacement if minor or major remove toxin exposure

Front 366

beta vs. alpha thal

Back 366

in hgb electrophoresis beta is elevated hga2 and hgf, alpha is normal--

Front 367

treat thalassemai

Back 367

none

Front 368

most accurate dx for alpha thallessemia

Back 368

dna sequenceing

Front 369

iron and dark stool

Back 369

iron makes stool dark but only hemoglobin or myglobin make guiac posiitve

Front 370

iron studies

Back 370

fe level, fe sat, ferritin, tibc

Front 371

see page 144 iron chart

Back 371

?

Front 372

smooth tongue and diarrhea

Back 372

b12 deficincy remember no neurologic sympoms in folate

Front 373

diagnostic tests for macrocytic anemia

Back 373

bilirubin and ldh (commonly levated) retics will be down and oval cells visible

Front 374

most accurate test b12/folate

Back 374

low levels

Front 375

b12 normal

Back 375

methylmalonic acid

Front 376

homocystein

Back 376

up in both b12 and folate, methylmalonic up only in b12

Front 377

after b12 replacemetn

Back 377

reticulaocytes improve first, neruologic improves last

Front 378

best test to figure out cause of b12 anemia

Back 378

antiparietal cell antibodies and anti intrinsic factor antibodies

Front 379

what does folate do to b12 deficicny

Back 379

fixes blood problems

Front 380

sudden weakness and fatigue

Back 380

hemolytic anemai--

Front 381

dx hemolytic anemai

Back 381

elevated indirect bilirubin, elevatd reticulocyte, elevated ldh, decreased haptoglobin

Front 382

what happens after b12 deficincy treatment

Back 382

hypokalemia

Front 383

what do you find with intravascular hemolysis?

Back 383

hemoblobinuria, hemosiderinuria, schistocytes helmet cells

Front 384

ccs and sickle cell

Back 384

o2 hydration and morphine.. Fever gets ceftriaxone, levofloxacin or moxifloxacin… get blood cultures, urinalysis, reticulocytes, cbc chest xray all on first screen do not wait

Front 385

when exchange transfusion in sickle cell

Back 385

visual disturbance, pulmonary infarction leading to abnormal xray, priapism, stroke

Front 386

what causes sudden drop in hematocrit in sickle cell

Back 386

parvovirus or b19/folate deficincy, all sickle cells should be on folate

Front 387

when discharging patient with sickle cell what to do?

Back 387

folate, penumococcal, hydoryurea to prevent furhter crisis if the happen >4 times per year

Front 388

d/c sickle cell patient

Back 388

folate, pneumoccocal hydroxyurea

Front 389

SC sickle cell

Back 389

mild version fewr crisis, hematuria, isothenuria (can't concnetrate) UTI-- no specific tx

Front 390

sickle cell trait

Back 390

hematuria and concentrating defect

Front 391

heinz bodies and bite cells

Back 391

g6pd

Front 392

most accurate test g6pd

Back 392

g6pd level, after 2 months have passed, will be normal on day of hemolysis

Front 393

how do you treat autoimmune hemolysis

Back 393

steroids

Front 394

autoimmune hemolysis

Back 394

warm IgG, goombs teset

Front 395

best test autoimmune

Back 395

spherocytes on peripheral smear most accurate goombs test

Front 396

what causes autoimmune hemolysis, sle, rheumatoid, cll, lymphoma, penicillin, alphamethyldopa, quinine or sulfa

Back 396

?

Front 397

warm autoimmune not responding to steroids

Back 397

IVIG

Front 398

what causes cold induced hemolysis

Back 398

mycoplasma or epstein barr

Front 399

cooms in cold

Back 399

negative

Front 400

complement in old

Back 400

positively birefingent RHOMBOID shaped crstals-- look for hemochromatosis, hypoerparthyroidism or hypothryodism

Front 401

how to tx cold agglutinin disease

Back 401

steroids, if no repsonse splenectomy or IVIG, if no repsonse RITUXIMAB

Front 402

medications that cause g6pd?

Back 402

sulfa, favabeans, primaquine, dapsone

Front 403

pyruvate kinase deficency

Back 403

presents like g6pd but not provoked

Front 404

bilirubin gallsotones

Back 404

hereditary spherocytosis,.. Also splenomegaly, elevted mchc

Front 405

best test hereidtar spherocytosis

Back 405

osmotic fragility

Front 406

tx spherocytossi

Back 406

splenectomy

Front 407

hus triad

Back 407

intravascular hemolysis, elevated bun and cratin, thrombocytopenia: ART Autoimmune hemolysis, Rental fialure, Thrombocytopena

Front 408

TTP

Back 408

FAT RN HUS+ Fever and neurologic abnormalities

Front 409

tx ttp or hus

Back 409

most better onown..no platelets or abxc may make it worse treat with plasmapheresis

Front 410

what causes death in Paroxysmal noctural hemoglobinurai

Back 410

large vessel venous thrombosis

Front 411

best test PNH

Back 411

CD55 and CD59 aka decay accelaerating factor

Front 412

treat pnh

Back 412

glucocorticoids, if transfusion dependent eculizumap

Front 413

dark urin in monring

Back 413

PNH, can transform into aplastic anemia or AML

Front 414

shortness of breath for no clear reason and clear lungs on exam and normal chest x-ray

Back 414

methemoglobinemai

Front 415

what causes methemoglobinema

Back 415

nitroglycerin, amyl nitrate, nitroprusside, dapsone, any anesthetic drugs that end in CAINE< can occur with dopical lidocaine

Front 416

brown blood

Back 416

methemoglobinemai

Front 417

tx methemoglobinemia

Back 417

methylen blue

Front 418

auer rods

Back 418

aml

Front 419

leukemia and dic

Back 419

M3 acute promylocytic leukemia

Front 420

best test leukemia

Back 420

peripheral smear-- they have fatigue bleeding and fucntional immunodeficincy

Front 421

tx M3 leukemia

Back 421

all trans retinoic acid

Front 422

treat all

Back 422

intrathecal methotrexate

Front 423

sob confusion and blurry visoin, WBC cound over 100K… acute leukemia--tx with leukapharesis (removes white cesll) and hydroxyurea

Back 423

?

Front 424

chemo for aml

Back 424

idarubicin (daunorubicin) and cytosine arabinoside

Front 425

pelger heut cell

Back 425

2 lobes assocaited with myelodysplasia

Front 426

2 lobes

Back 426

myelodysplasia--normal b12

Front 427

cause of death in myelodyslpasia

Back 427

infection or bleeding--usually need supportive transfusion

Front 428

5q minus myelodyslpasia

Back 428

lenalidomide-- tx myelodysplasia all otehrs azactidadine

Front 429

leukocyte alkaline phosphatase core

Back 429

cml will be low, lap is up in normal infected cells not cml

Front 430

most accurate test

Back 430

philadelphia

Front 431

tx cml

Back 431

glevac imatinib , bone marrow transplant cures but not best

Front 432

patient over 50 with eleveated which count that appears normal

Back 432

cll

Front 433

best test cll

Back 433

peripheral smear shows smude cells

Front 434

treatint cll

Back 434

do not treat asymptomatic, fludarabine is most likely to extend survival

Front 435

tartrat resistat acid phophatase

Back 435

most accurate test for hairy cell

Front 436

treat hairy cell

Back 436

cladribine 2-CDA

Front 437

pancytopenia and splenomegaly

Back 437

normal trap its myelofibrosis, hairy cell if elevated TRAP

Front 438

headach blurred vision pruritis after shower

Back 438

polycythemia vera high hematocrit with ypoxia and low mcv, low erythropeintin

Front 439

dx polycythemia vera

Back 439

abg to exclude hypoxia as cause of erthyrocytosis, if ccs or ERYTHROPOEINTIN level which will bel ow, test for JAK 2

Front 440

tx polycythemia vera

Back 440

phelbotomy intial, hydroxyureia lowers cell count and dail aspairin

Front 441

jak 2 mmutation

Back 441

both polycythemia vera and essential thrombocytopeni

Front 442

headach pain in hands

Back 442

essential thrombocythemia-- treat with hydroxyuriea, anagrelide

Front 443

bone pain or fracture under normal use

Back 443

multiple myeloma

Front 444

dx MM

Back 444

skeletal surve serum protein electrophoresis, urine protein electrophoresis, peripheral smear

Front 445

rouleaux

Back 445

mutliple myloma

Front 446

elevated calcium

Back 446

mm--osteolytic

Front 447

treat multiple myleopma

Back 447

mephalan and steroids, thalidomide, lenalidomid, or bortezomib

Front 448

most effective therapy multiple myleoma

Back 448

stem cell transplan autologuous

Front 449

MGUS

Back 449

elevation of IgG on SPEP-- doen b/c elevated total protein in elderly patient over 0 no treatment

Front 450

hyperviscosity--blurry vision cnonfusion and headache

Back 450

waldenstroms macroglobulin emaia enlarged nodes and spleen

Front 451

reed sternburg cell

Back 451

hodkin's lymphoma

Front 452

dx lymphoma

Back 452

both hd an dnhl-- exiciional lymphnode biopsy

Front 453

b symptoms

Back 453

fever weight loss night seates

Front 454

aplastic anemia

Back 454

pancytopenia-- bone marrow transplant or if not available anithymovyte glovulin

Front 455

dx lymphoma after biopsy

Back 455

stage with cxr, ct scan with contrast bone marrow-- no laparotmy

Front 456

epistaxis

Back 456

or bleeding from gums and vagina- VWD, a PTT elevated b/c destablizies factor VIII

Front 457

dx VWD

Back 457

ristocetin cofacot rasss and VWF level

Front 458

if vwf is normal

Back 458

ristocetin tells if woking

Front 459

tx vWD

Back 459

desmopressin or ddavp, release stores

Front 460

ddavp not efective

Back 460

factor VIII replacemetn

Front 461

factor type bleeding

Back 461

hemarthrosis or hematoma while platelet is prupura petechia, epistaxis gums vaginal gingival

Front 462

platelet bleeding and coun <50000

Back 462

ITP,

Front 463

dx ITP

Back 463

antiplatelet antibodies, sonogram (spleen normal) bone marrow for megakaryocytes, antiboides go gIIB, IIIa receptor

Front 464

treat mild ITP

Back 464

prenisone

Front 465

treat severe ITP

Back 465

IVIG platelet count sub 20,000, ao give rhogam

Front 466

uremia induced platelet dysfunctio

Back 466

normal platelet count in patietn with renal failure and normal ristocetin and VWF level

Front 467

best iniitial test for Uremia

Back 467

DDAVP

Front 468

clotting factor vs inhibitor antibody

Back 468

mixing study aPTT corrects with clotting not with antibodies

Front 469

platelets drop 50 percent

Back 469

hit

Front 470

dx hit

Back 470

platelt factor 4 antibodies or heparin induced antiplatele antibodies

Front 471

tx hit

Back 471

stop heparin and use direct trhombin inhibots like argatroban or lepirudin

Front 472

hit and unfractionated heparin

Back 472

dow not switch to lmwh

Front 473

viper venum

Back 473

lupus anticoagulant

Front 474

tx hypcoagualbe states

Back 474

heparin followed by warfarin

Front 475

skin necrosis with use of warfarin

Back 475

protein c deficincy-- tx heparin first then warfarin

Front 476

gastroenterology

Back 476

?

Front 477

dysphagia investication

Back 477

barium study first unless cancer or barret's

Front 478

if stomach problem

Back 478

endoscopy

Front 479

odynophagia

Back 479

pain ful swallowing thing HIV , HSV or candida

Front 480

soids and liquids dysphagia

Back 480

achalasia

Front 481

dx achalasia

Back 481

barium sawallow initial esophageal manometer most accurate

Front 482

hiv negative esophagitis

Back 482

endocopy

Front 483

hiv positive esophagitis <100cd4

Back 483

fluconazol and look for response

Front 484

when to treat helicobacter

Back 484

if assoceiated with gastritis or ulcer, not if with gerd or non ulcer dyspepsia

Front 485

gastic pain above 45

Back 485

must scope

Front 486

when stress ulcer prophylxis

Back 486

head truama, intubation, burns, coagulopathy and stoir use

Front 487

iv secretin

Back 487

zollingerellis dest, gastrin level and gastric acid level do no go down

Front 488

h2 blocker or ppi and gastrin

Back 488

all have elevated gastrin

Front 489

zes findigns

Back 489

lareg ulce multiple ulcer >1cm, distal location recurrent

Front 490

nuclear somatostatin scan- sensitve

Back 490

?

Front 491

ASCA

Back 491

crhons

Front 492

ANCA

Back 492

UC- not complete

Front 493

best treatment chron's and UC

Back 493

mesalamine

Front 494

sulfasalazine

Back 494

not best therapy for cd or uc because rash hemolytic anemia and interstitial nephritic

Front 495

budenoside

Back 495

glucocorditoid that controls acute exacerbations of IBD, extensive first pass effect so limited adverse effects

Front 496

azathiprine and 6 mercaptopruien

Back 496

ween patients off steriods

Front 497

metroidazol and cipro

Back 497

perinal involvmenet in cd

Front 498

surgery in IBD

Back 498

UC remove colon curative, cd recurs, but must do surgery in CD if obstruciotn or stricture

Front 499

treat diarrhea

Back 499

if blodd fever abdomanal pin or hypotension use cirpo- don't reat o157 h7

Front 500

pork diarrhea or rodents

Back 500

yersinia

Front 501

best initial test diarrhe

Back 501

fecal leukocytes

Front 502

fish and diarrhea within 10 minutes flushing

Back 502

schromboid

Front 503

tx giardia

Back 503

metronidzol

Front 504

treat amebic

Back 504

metronidazol

Front 505

liver abscess and diarhea

Back 505

amebic

Front 506

flushing chronic diarrhea nad hypotension

Back 506

carcinoid dx urinar 5 hiaa and tx with octreotide

Front 507

oxalate kidney stones

Back 507

all types of malabsoprtion

Front 508

best test malabsorption

Back 508

sudan black stain of stool for fat, most sentisive 72 hour fecal fat

Front 509

dx celiac

Back 509

antigliadin, ani endomysial anti tissue transglutamase

Front 510

mos t accurate celiac

Back 510

small bowel

Front 511

d-xylose

Back 511

abnormal in whipple celiac and tropical sprue

Front 512

celiac disease with negative antitissue transglutamase

Back 512

tropical stpure

Front 513

tx tropical sprue

Back 513

tmp smx for 3-6 months

Front 514

most acurrate test pancreatittis

Back 514

secretin stimulation

Front 515

tx whipple

Back 515

tetracycle or tmp/smx for 12 months

Front 516

tx irritable bowel

Back 516

fiber, then antispasmodic like dicyclomine or hycoamine or if no response amitriptyline

Front 517

3 family members 2 generations on premature

Back 517

lynch syndroem

Front 518

osteoma's on x ray what do you recommend?

Back 518

colonoscopy gardner's syndroem

Front 519

famlial ademoatous polyposis

Back 519

start screening at age 12

Front 520

melanotic spots on hlips

Back 520

harmartomatous polyps in colon-- peutzjehgers lifetime risk only 10 % of cancer no extra screening

Front 521

diverticulitus vs diveticulossi

Back 521

both llq pain and lower gi bleed, it is has fever and elevated WBC.

Front 522

tx diverticulois/it is

Back 522

osis-fiber it is cipro and metronidazole

Front 523

best stest for diverticular disase

Back 523

abdominal ct-- most accurate is colonsocop for diverticuloss

Front 524

orthostasis

Back 524

BP <100 or HR >100 = 30% volume loss or standing drop systolic >20 or hr up >10

Front 525

when to transufse

Back 525

hct <30 oldre or <20-25 younger w/ no heart disease

Front 526

when ffp

Back 526

elvated PT/INR

Front 527

when platelets

Back 527

bleeding or surger <50,000

Front 528

ccs orders for large volume GI

Back 528

fluid bolus, CBC, PT/Inr, type and cross, consultation with gastroenterology EKG

Front 529

variceal bleeding

Back 529

octreotide initially, upper endoscopy, if endoscopy not working then TIPS, never ice lavage.. Discharge with propanolol

Front 530

lower gi bleeding

Back 530

endoscopy then technium, if massive, angiography or laparatomy

Front 531

uncessary stres sulcer prophylaxis

Back 531

increases risk of pneumonia and Cdiff

Front 532

metabolic acidosis abdominal pain and elevated amylase in elderly patient with valve disease

Back 532

acute mestenerich ischmia-- most accuratte test angiography

Front 533

tx amesetneri ischemai

Back 533

surgery

Front 534

gastric surgery ansd sweathing shaking and weakness

Back 534

dumping syndroem-- tx frequent small meals

Front 535

best test pancreatitis

Back 535

amylase and lipase, lipase higher specificity

Front 536

most acurate test pancreatitis

Back 536

ct scan

Front 537

ct scan negative pangreattiic

Back 537

MRCP magnetic resonance cholangiopancreatiography

Front 538

dilation of bile duce without pancreatic head mass

Back 538

ERCP to look for stones or stricutres

Front 539

trypsisnogen activation peptide

Back 539

urinary test for severity of pancreatitis

Front 540

treat pancreatitis

Back 540

ercp

Front 541

necrotising pancreatitis

Back 541

when ct shows >30% necrosis- patietn should receive abx such as imipenem and ct guided bipsy- if infected necrotic pancreas then surgical depretment

Front 542

ast/alt

Back 542

alt is viraL, aSt is drugS

Front 543

first test elvated in hep b

Back 543

surface antigen, alt e antigen all symptoms after surface antigen

Front 544

vaccinated hep b

Back 544

surface antibody and no others

Front 545

healed /recovered hep b

Back 545

core antibody and surface antibody

Front 546

chronic hep b

Back 546

surface antigen beyond 6 months

Front 547

window period

Back 547

core antibody + no others

Front 548

acute and chronic hepatitis

Back 548

is surface antigen, e antigen and core antibody

Front 549

most accurate test for hep a,c,d,e

Back 549

serology IgM/IgG (chonic IgG)

Front 550

best test hep b

Back 550

antigen core antibody only associated with heb b

Front 551

bilirubin in hapatitius

Back 551

conjugated (direct) bilirubin-- found in urine or urobilinogen, uncongugated with hemolysis will not pass into urine

Front 552

hep b e antigen

Back 552

same as hep b na polymeraase or pcr for dna-- allindicate active viral replication

Front 553

most accurate test hepc c

Back 553

hep c pcr for rna

Front 554

liver biopsy in hep c

Back 554

staging

Front 555

treat acute hepatitis

Back 555

only 1 is hepc c that can be treated-- interferon an dribavirin

Front 556

best initial test hep c

Back 556

hep c antibody

Front 557

tx heb b chronic

Back 557

lamivudin, adefovir, entecavire, tenofovir

Front 558

what does ribavrin tx

Back 558

chronic hep c or acute hep c, chronic is compbined with bocepreiver or telaprevir-- adverse effec anemai

Front 559

interferon side effects

Back 559

flu like arthralgia myalgia thrombocytopenia, depression-- most common hep b drug with side effect

Front 560

tx cirrhotic edema

Back 560

sprionolactone and diuretics

Front 561

treat cirrotic encephalopathy

Back 561

lactulose

Front 562

when paracenteses

Back 562

new ascites, pain fever or tenderness

Front 563

SAAG

Back 563

>1.1 portal htn, <1.1 not portal htn or chf

Front 564

spontaneous bacterial peritonits

Back 564

cell cound >250 neutrophils

Front 565

tx SBP

Back 565

cefotaxime

Front 566

best test chronic liver disease

Back 566

elevated alkaline phosphatase with normal bilirubin for primarry billiary cirrhossis

Front 567

most accurate test pbc

Back 567

antimitochondiral antibody, liver biopsy

Front 568

anti smooth muslce antibody

Back 568

primary sclerosig cholangiis--- 80% associated with IBD-- has elevated bilirubin vs PBC

Front 569

tx pbc

Back 569

ursodeoxycholic acid

Front 570

Primary sclerosing cholingits findings

Back 570

beading on ERCP, anca positive, ASMA

Front 571

tx PSC

Back 571

ursodeoxycholic acid

Front 572

best test for wilson's

Back 572

slit lamp and ceruloplasmin, on ccs order both

Front 573

most accurate test wilson's

Back 573

liver biopsy better than urinary copper

Front 574

tx wilson's

Back 574

penicillamine or trientine

Front 575

most common cause of death in himocrhomatosis

Back 575

cirrhosis

Front 576

best test hemocrhomatosis

Back 576

elevated serum iron and ferritin levles with low iron binding capacity

Front 577

autoimmune hepatitis

Back 577

ana and antismooth muslce positive, other immune disease present… serum protein electrophoresis shows hypergammaglobulinemai

Front 578

most accurate test autoimmune hepittis

Back 578

liver biopsy better than urinary copper

Front 579

treat haautoimmune hepatitis

Back 579

prednisone

Front 580

treat non alcoholic steatohepatitis

Back 580

weight loss, diabets control

Front 581

aspirin in stroke

Back 581

not till ct

Front 582

best test stoke

Back 582

non contrast ct

Front 583

see arterial sympoms page 200

Back 583

?

Front 584

lower extremity wekness, urinary incontiences personality chances

Back 584

aca

Front 585

upper extremity weakness, aphasia, apraxia/neglect

Back 585

mca

Front 586

PCA

Back 586

prospagnosia-inability to regonize faces

Front 587

vertibrobasialr

Back 587

Vertigo vertical nystagmus and labile blood pressure

Front 588

PICA

Back 588

ipsilateral face contralateral body, vertigo and HORNER's syndrome

Front 589

Lacunar

Back 589

no cortical defects,

Front 590

mri vs HEAD ct for storke

Back 590

head ct 3-5 days to achieve 95% in nonhemorrhagic, MRI 95% in first 24 MRA for brainstem

Front 591

contraindications to thrombolytics

Back 591

hemorrhaic stroke, mass, active bleed or surgery within 6 weeks, bleeding disordedr, cpr within 3 weeks, stroke within 1 hear, cerbral trauma or surgery within 6 months, aortic dissetion

Front 592

antiplatelte for stroke

Back 592

aspirin or clopidogrel or aspirin combined with dipyridamonle

Front 593

stroke already on aspirin

Back 593

swith to clopidogrel or add dipyridamole

Front 594

heparin for stroke

Back 594

no!

Front 595

ticlodipine for stroke?

Back 595

no!

Front 596

post stroke workup

Back 596

after ct and thrombolytics do ECHO, cartoid dopplers, ekg and holter (warfarin if ekg)

Front 597

younger patient and sroke

Back 597

if <50 do sed rate, vdrl or rpr, ana dsdna, protein c, protein s factor v leiden antihopholipid syndromes

Front 598

seizure

Back 598

ativan, move 10-20 minutes then fosphenytoin, then 20-20 minutes then phenobarb, then indubate

Front 599

what tests on seizure

Back 599

sodium calcium glucose 02 cr and mg, head ct urgently, urine tox, mri if ct negative

Front 600

neurology consult on CCS for seizure

Back 600

always In 10 words ore lss never say anything

Front 601

single seizure treatment

Back 601

never drug unless abdnormal eeg, status epilepticus that requried benzo's, brain tumor, strong family hx

Front 602

seizure med stevents johnson

Back 602

lamotigrine

Front 603

levetiracem

Back 603

keppra, first line seizure along with valproidc acid, carbamazepine, phenotin

Front 604

most dangerous seizure med in preggers

Back 604

valproic acid

Front 605

tremor at rest and intention

Back 605

essentila tremor

Front 606

intention tremor only

Back 606

cerebellar

Front 607

resting tremor

Back 607

parkinsons

Front 608

over age 60 first line parkinsons

Back 608

amantadine

Front 609

under 60 parkinsons first line

Back 609

anticholinergic

Front 610

levodopa causes psychosis

Back 610

add quitiapine

Front 611

beset test MS

Back 611

MRI, csf if mri non diagnostic-- oligoclonal bands, no visual and auditory evoke potentials

Front 612

best therapy ms

Back 612

steroids

Front 613

natalizumab

Back 613

causes PML

Front 614

disesaes modifying for ms

Back 614

beta interferon, glatiramer, mitoxantrone

Front 615

additional medications for ms

Back 615

baclofen or tizanidine for spactiiciy

Front 616

ct showing diffuse symmetrical atrophy

Back 616

alzheimer's

Front 617

treat alzheimer's

Back 617

donepezil, rivastigmine and glanatime-- combinations not effective, metmatine ok

Front 618

14-3-3 protein in csf

Back 618

creutzfeld jakob

Front 619

eeg in cjd

Back 619

abnormal in whipple celiac and tropical sprue

Front 620

best test cjd

Back 620

brain biopsy-- if css do mri

Front 621

treat NPH

Back 621

wet weird wobbiliy, placemetn of a shunt, do a head ct to dx

Front 622

dx huntington's

Back 622

specific genetic testing

Front 623

lewy body

Back 623

parkinson't with dementia

Front 624

what do dementia patients need tested

Back 624

head ct/mri, vdrl, b12, t4

Front 625

best tx for migrane

Back 625

sumatriptan or ergotamine

Front 626

when head ct or mri fro migraine

Back 626

onset after 40 , sudden or sever, focal neurologic finding

Front 627

when s4 or more migraines a month

Back 627

b blocker propanolol- alternative ccb, tca or ssr

Front 628

tx cluster headache

Back 628

100% 02 or sumatriptan

Front 629

prhylaxis for cluster

Back 629

verapamil

Front 630

papilledema but normal ct/mri

Back 630

pseudotumor cerbri-- headach plus 6th nerve palsy visual field loss, pulsatile tiniitus

Front 631

tx pseudotumro

Back 631

weight loss acetazolamide-- vp shunt if fail

Front 632

best test pseudotumro

Back 632

Lp with elevted opening pressure

Front 633

vertigo dx

Back 633

all patietns hsould have MRI-- all patients will have nystagmus

Front 634

what type of vertigo has no hearing loss/tinnitus

Back 634

BPV or vestibular neuritis

Front 635

when does vertigo occur without position changes

Back 635

vestibular neuronitis or any of the hearing loss ones

Front 636

labyrinthiitis vs menier's

Back 636

both have tinnitus labrythitis is acute menier'es chronic

Front 637

tx bpv

Back 637

meclazine

Front 638

tx vestibular neuronits

Back 638

meclizine

Front 639

tx labyrnthitis

Back 639

meclazine

Front 640

tx menier'es disease

Back 640

diuretic and asalt restriction

Front 641

vertigo and ataxia and tinnitus

Back 641

acoustic neurmoma

Front 642

tx werneke korsakoff

Back 642

thiamine IV then later glucose with thiamine

Front 643

testing for wernekes'

Back 643

head ct b12 thyroid rpr or vrdl

Front 644

barotrauma and vertigo

Back 644

perilymph fistula fix hole surgically

Front 645

dx meningitis

Back 645

lumbar puncture if no focal findings, get head ct if seizure, altered conscous ness focal deficit cns disesea and give abx after blood cultures before ct

Front 646

gram positive bacilli menigitis

Back 646

listeria

Front 647

gram neg cocobacillary

Back 647

haemophilus

Front 648

hiv <100 cdd4 and menigeal signs

Back 648

india ink test best initial most accurat cryptococcal

Front 649

tx cryptococcus

Back 649

amphotericin

Front 650

tx lyme disease

Back 650

ceftriaxone or peniclline

Front 651

rash on wrist and ankles that moves to the center

Back 651

rocky mountain tx with doxycycline

Front 652

tb meningits

Back 652

very slow, high csf protein-- add steroids to RIPE, not acute onset

Front 653

standard menigitis when lumbar puncture neg but shows neutrophils

Back 653

ceftiraxone, amp and vanc… amp for lysteria

Front 654

petichial rash and meningitis

Back 654

neisseria menigitis esp in younger-- tx ceftriaxone and vanc place on isolation

Front 655

when listeria?

Back 655

elderly, neonatal, hiv positive patietns no spleed steroid immunocompromised

Front 656

when neisseria

Back 656

adolescent military

Front 657

who needs neiseria prophylaxis

Back 657

rifampin cipro or cefriaxone for houseold members hare utensil cups or kisses, routine contact do not

Front 658

fever + confusion

Back 658

encephalitis

Front 659

# 1 cause encepahlitis

Back 659

herpese

Front 660

best test encephalitis

Back 660

head ct-- temporal do not do prain biopsy most acurate PCR of CSF

Front 661

tx herpes encephalitis

Back 661

acyclovir or if resitent foscarnet

Front 662

brain abscess HIV neg

Back 662

brain biopsy-- if css do mri

Front 663

hiv positive brain absess

Back 663

tthink toxoplasmossis- tx with pyrimethamine and sulfadiazine for 2 weeks and repeate head ct

Front 664

what was that tx for toxo

Back 664

pyrimethamine and sulfadiazine

Front 665

tx pml

Back 665

treat hiv

Front 666

patient from mexico with seizure

Back 666

neurocystericosis-

Front 667

1cm cystic lesion multiple on head ct

Back 667

neurocystericosis-

Front 668

treat neurocystericosis

Back 668

albendazol and steroids to prevent rx

Front 669

loss of conciousness

Back 669

head ct

Front 670

concussion

Back 670

no focal defici and normal head ct

Front 671

contusion

Back 671

ecchymosis on head ct- admit

Front 672

large intracranial hemorrage with mass effect

Back 672

intubate imediately, manitol surgery

Front 673

best test Subarachnoid hemorrage

Back 673

head ct

Front 674

most accurate test for sah

Back 674

lumbar puncture-- ratio is 1 white cell for every 500 red cells

Front 675

tx sah

Back 675

angiography, embolization

Front 676

meds for sah

Back 676

nimodipine ccb that prevents stroke

Front 677

lumbrosacral strain vs cord compression

Back 677

strain does not give tenderness of the spine itself

Front 678

anterior spinal artery infartion

Back 678

all position lost but position and vibratory-- no therapy

Front 679

most urgent step in management of cord compression

Back 679

steroids-- hyperreflexia in cancer patient that is tender

Front 680

hyper reflexia and fasciulations/waisting

Back 680

als-- both upper and lower--

Front 681

treat als

Back 681

riluzole blocks accumulation of glutamate

Front 682

tx bell's palsy

Back 682

steroids or acyclovir, not clear acyclovir helps

Front 683

RSD/CRRPS

Back 683

tx with nsaids gabpentin nerve block

Front 684

Restless leg

Back 684

pramipexole or ropinrole

Front 685

tx guillan barre

Back 685

do a peak inspiratory pressure, ivig and plasmaphereis, steriods are not effective, lp shows elevated protein no cells

Front 686

best test myasthenia gravis

Back 686

antiacetylcholine antibodies,

Front 687

best tehrapy mg

Back 687

pyridostigmine or neostigmen

Front 688

theymectomy mg

Back 688

<60 if pyridostigmine doesn't work

Front 689

predisone mg

Back 689

if thymectomy doesn't work

Front 690

nephrology

Back 690

?

Front 691

when is renal failure acute

Back 691

normal kidney size normal hct, normal calcium… later all drop (calcium from loss of vitamin d hydroxylation)

Front 692

tests for kidney failure

Back 692

urinalysis, chemistry, renal ultrasound

Front 693

treat prerenal failures

Back 693

underlying ccuase

Front 694

finds in prerenal

Back 694

bun:cr 15:1 or higher, low urinary sodium, fena<1, urine osmolalti >500

Front 695

postrenal

Back 695

distended bladder, hydronephrosis, bilateral to cause renal fialure, urnilaterl usually not

Front 696

intrarenal findings

Back 696

bun:cr closer to 10:1 urin sodium >40 urine osmolatiy <350

Front 697

atn cause

Back 697

hypoperfusion or toxic injuries

Front 698

muddy brown casts

Back 698

atn

Front 699

what does pip tazo cause

Back 699

AIN-- also phenytoin, allopurinal cyclospoirne, quinidien, quiinolones or rifampin

Front 700

what cuases atn

Back 700

CAAC contrast (order mg level) amphotericin, aminoglycoides (hypomagnesemia suggestive of aminoglycoisde) chemotherapy such as cisplatin

Front 701

wright or hansel's stain

Back 701

will show eosi in urine- more senstive for AIN than blood or IgE level

Front 702

tx AIN

Back 702

resolves

Front 703

tx ATN

Back 703

none

Front 704

fever and rash and renal failure

Back 704

think AIN

Front 705

cyclophosphamide

Back 705

hemorrhagic cystitis not renal fialure

Front 706

tx rhabdo

Back 706

bolus, mannitol and diuresis, alkinilize the urine

Front 707

tests for rhabdo

Back 707

urine myoglobin, also the hypkalemia, hypocalcemia, chemistries fo rbicarb

Front 708

square crystals

Back 708

oxalate crystals

Front 709

antifreze ingestion

Back 709

metabolic acidosis with elevated anion gap tx fomepizol or ethinal with dialysis

Front 710

uric acid crystals

Back 710

usually post lymphtoma for tumor lysis syndrome

Front 711

crystal induced renal failure

Back 711

usually oxalate antifreeze or uric acid from tumorlysis

Front 712

most urgent step in rhabdo

Back 712

ekg

Front 713

tx hyperkalemia

Back 713

calcium gluconate, insulin and glucose

Front 714

prevent contrast renal fialure

Back 714

normal sailine, bicarbe, nacytly cystein or both

Front 715

when contrast renal prevention

Back 715

cr 1.5-2.5 slifgh elevation in cr= 60- 70% of renal funciton loss

Front 716

nasaid kidney damage

Back 716

direct and atn, ain, nephrotic vasoconstriction

Front 717

red blood cells /casts in urine and proteinuria

Back 717

glomerulonephritis may lead to nephrotic sydnrome need kidney biopsy

Front 718

linear deposists on renal biopsy

Back 718

good pastures anti basement membrane treat with plasmapheriss and steroids

Front 719

tx churg struase

Back 719

1. prednisone, 2 cyclophosphamide--

Front 720

dx churg strouss

Back 720

cbc for eos

Front 721

dx wegener's

Back 721

c-anca initial then biopsy

Front 722

tx wegner's

Back 722

cyclophosphamide and steroids

Front 723

mutliple morot and senory neuropathy with pain

Back 723

PAN purpuric skin lesions, stroke uveitis

Front 724

what does pan effect

Back 724

everythign but the lung

Front 725

best tests for pan

Back 725

esr, sural nerve biopsy most accurate, hep b+C, angiography showing beading

Front 726

painless recurrent hematuria in asia

Back 726

aga nephropathy berger's not breugers

Front 727

dx berger's

Back 727

renal biopsy

Front 728

tx bergers

Back 728

steroids/ace (all proteinuria) fish oil

Front 729

kid with raised non tender purpuic skin lesions, abdominal pain bleeding and joint involvment

Back 729

hsp

Front 730

best test hsp

Back 730

bipsy is most accurate but not necsary resolves over time

Front 731

tea colored urine with periorbital edmea after soare throat

Back 731

PSGN-- dx aso, antidnase, anthihyaluronidase,

Front 732

most accurate test for psgn

Back 732

bipsy shows IgG and C3, not done

Front 733

tx PSGN

Back 733

ppencillin and other abx diruetics

Front 734

hep c with renal involvment

Back 734

cryoglobulinemia/component levels (light chaisn Igm)

Front 735

tx cryglobulinemai

Back 735

biopsy

Front 736

hep c with joint pain and pupruic skin lesions

Back 736

cryoglobulinemai hep c with renal involvment

Front 737

lupus sle

Back 737

never drug-- do biopsy to dx extent of disease, sclerosis-- scar, mild steroids, advance myocophenolate mofeitl

Front 738

eye /ear/.kidneys

Back 738

albort no therapy

Front 739

platelet for hus or ttp

Back 739

no make it worse

Front 740

when nephrotic synrome

Back 740

more than 3.5g /day of urine

Front 741

what does nephrotic sydnrome cause

Back 741

low albumin, edema, hyperlipidemia, thromsobis b/co of loss of antithrombin prient c an dpotein s

Front 742

test for nephrotic sydnorme

Back 742

urinalysis , spot urine for proetien to cratingin = to 24 hour

Front 743

hiv heron and renal

Back 743

focal segmental

Front 744

hep c and renal

Back 744

membranoproliferative

Front 745

minimal change

Back 745

children

Front 746

cancer and renal

Back 746

membranous

Front 747

proteinuria workup

Back 747

repeat the ua, orthostatic? Protein creatinine ration, renal biopsy

Front 748

orthostatic proteinuria

Back 748

job wehre must stand allday

Front 749

dx orthostatic

Back 749

split the urine do not treat

Front 750

manifestation of esrd

Back 750

hyperphosphatemia, hypermagnesemia, anemia, ahypocalcemia

Front 751

when dialys ?

Back 751

hyperkalemia, metabolic acidosis, urenmia with encephalopathy, fluid overload, uremia with PERICARDIS

Front 752

dialyzable drugs

Back 752

lithium , ethylene glycol, or asa

Front 753

esrd hyperphosphatemai

Back 753

calcium acetate phophaate binder

Front 754

anemia

Back 754

epo

Front 755

hypocalcemia

Back 755

vit d

Front 756

hypermagnesmia

Back 756

dietar restricuion

Front 757

diabetes insibitus

Back 757

low urine asmolality, low urine sodium can be central or nephrogenic

Front 758

causes of nephrogenic

Back 758

insensitivyt to adh.. Hypokalemia, hypcalcemia, lithum toxicty

Front 759

treat diarrhea

Back 759

central DDAVP or vasopresin, nephrogenic-- thiazide and correct underlyin cause

Front 760

hypervolemic hypernatremia

Back 760

chf, nephrotic, cirrhois

Front 761

hypovolimic hyponatmeia

Back 761

diuretics, gi loss, skin loss

Front 762

addison's hyper or hypo

Back 762

addison's hyponatmerim with hyperkalemia and metabolic acidos

Front 763

euvolemic hypotnatermia

Back 763

SIADH, hypotheyroid, psychogenic polydypsia, hyperglycemia

Front 764

siadh causes

Back 764

cns, lung diseae, sulfonylreas or SSRI's, cance

Front 765

siadh urine

Back 765

high urine sodium inappropriate and high urine osmolality

Front 766

tx hyponatremia

Back 766

adh blocker tolvaptan, conivapan, hypertonic saline,

Front 767

tx chronic siadh

Back 767

demeclocycline or coivapan/tovaptan

Front 768

type IV renal tubular acidosis

Back 768

decreased aldosterone-- hyperkalmeia

Front 769

hyperkalemia ekg changes

Back 769

peaked t waves then loss of p wave then widen qrs

Front 770

hyper/hypokalemia and seizure

Back 770

no

Front 771

tx severe hyperkalemia

Back 771

calcium gluconate IV and insulin and glucose when tpeaked t waves

Front 772

moderate hyperkalemia

Back 772

no ekg changese, use insulin and glucose then bicarb when acidosis is causeing then Kayexalate orally

Front 773

hypokalemia

Back 773

proximal and distal renal tubular acidos, conn sydnrome, diuretics, vomiting, amphoteric, Barters'

Front 774

u waves

Back 774

between tand p hypokalemia

Front 775

muscle weakness in hypokalemia

Back 775

inhibits contraction

Front 776

glucose in hyopkalemia

Back 776

no

Front 777

muscular weakness and loss of dtr

Back 777

hypermagnesmia tx with saline and dialiysis if needed

Front 778

hypomagnesemia

Back 778

loop diruetic etoh withdawl, gentamycin, cisplatin

Front 779

torsades

Back 779

mg is required for pth release

Front 780

respiratory alkalosis and metabolic acidossi

Back 780

aspirin use-- causes hyperventalion and loss of aerobic metablism treat with bicarb

Front 781

intoxicated patient with visual distubance

Back 781

methanol intoxication

Front 782

dx tx methanol

Back 782

methanol level, fomepizol or ethanol administration

Front 783

metabolic acidosis with normal ag gap

Back 783

diarrhea or rta

Front 784

test rta type II

Back 784

bicarb-- can't absorb so urine becomes basic

Front 785

urin ph in rta

Back 785

high in type 1 low in others

Front 786

diarrhea vs rta

Back 786

urine na-urine cl-- if negative diarrhea b/c it's negative to have diarrhea

Front 787

stones in rta

Back 787

type 1 only

Front 788

treat type 1 rta

Back 788

bicarb (causes stones)

Front 789

rta with fractures

Back 789

type II

Front 790

tx type II

Back 790

thiazide and high dose bicarb

Front 791

treat type IV (high K)

Back 791

fludrocotisone

Front 792

metabolic alkalosis causes

Back 792

volume contraction (secondary hyperaldosteronism), conn syndrome, hypokalemia, milk alkali, vomiting

Front 793

most common cause of death in cystic disease of kidney

Back 793

not sah, renal failures, cuases hematurea stones, mvp, and diverticulosis-- most common site of extratenal cysts is liver

Front 794

tx urge incontinence

Back 794

behavior, oxybutynin, tolterodine, trospium dariflcan

Front 795

tx stess incontinence

Back 795

kegl or estorgen kcream

Front 796

htn workup ccs

Back 796

come back 1-2 weeks, takes 3, work up UA, EKG, eye exam, Cardiac exam

Front 797

when to investigate for secondary htn

Back 797

if 2 drugs don't control it

Front 798

first line htn

Back 798

thiazide, in diabetics ace or arb

Front 799

chlothalidone

Back 799

thiazide

Front 800

<30 or >60 patient with new onset htn

Back 800

thingk secondary

Front 801

best stest renal artery stenosi

Back 801

renal ultrasound, if small kidney then MRA, dublpex, nuclear renogram… most accurate renal angiogram

Front 802

onc

Back 802

?

Front 803

when start tamoxifen prophylaxis

Back 803

multiple first degree relatives start at age 40

Front 804

when adjuvant chemotherapy

Back 804

cancer in axilla or larger than 1cm

Front 805

trastuzumab

Back 805

her-2/neu

Front 806

colon cancer tx

Back 806

5 fluoruracil and resection

Front 807

when screen hnpcc

Back 807

25 then 1-2 years

Front 808

when screen fap

Back 808

age 12 then 1-2 yeasr

Front 809

when screen juvenile polyposis, peutz jergerhs, turcot's, gardner

Back 809

no additoina

Front 810

prostate cancer with mets

Back 810

(if spine steroids) then flutamide--- block tempary flaire that acopanies leuprolide or goserelin (gnRH) flutamide is receptor blcoker

Front 811

finasteride

Back 811

5 alpha reducatese BPH

Front 812

ca 125

Back 812

follow progression of ovarian not diagnosis

Front 813

needle biopsy of testicle cancer?

Back 813

no orchiectomy order afp, ldh BHCG, ct scan of abdomen and pelvis

Front 814

ASCUS

Back 814

hpv testing if hpv positive colposcopy

Front 815

when pap

Back 815

21

Front 816

who gets influenza vaccine?

Back 816

everyone, but best for >50, pregnant, health care workers

Front 817

who gets pneumoccal

Back 817

patietns ?65 asthma ettc

Front 818

hpv vaccination

Back 818

between 13 and 26

Front 819

who gets zostervax?

Back 819

everyoen above 60

Front 820

who gets menigococal vavvine

Back 820

age 11 or asplenic or terminal compliment earlier

Front 821

bone desniometry

Back 821

age 65

Front 822

AA screen

Back 822

age 65 who were smokers

Front 823

htn screen

Back 823

all pateints above 18

Front 824

hyperlipidemia screen

Back 824

men >35 women >45

Front 825

diabetes screen?

Back 825

htn

Front 826

tx pemphigus vulgaris

Back 826

glucocorticoids or azathioprien

Front 827

tx bullous pemphgoid

Back 827

steroids or tetracycle or nicotinamide

Front 828

what phemphigoid is life threatening

Back 828

vulgarus

Front 829

causes of vulgaris

Back 829

idopathic, ace, penicillamine

Front 830

which has nikolsky's isgn

Back 830

vulgarus

Front 831

what causes porphyreia cutatnea trada

Back 831

etoh, liver disea, hep c, oral contraceptives, diabetes

Front 832

tx pct

Back 832

no etho, no estrogen, phlebotomy to remove iron DEFEROXAMINE to remove iron if no phlebotomy, chloroquine inceases porphyrin exretion

Front 833

treat eerythema multifomre

Back 833

antihystamine

Front 834

treat stevens johnson

Back 834

burn unit if respiratory invovlemnt, iv ig, cyclophosphamide

Front 835

what causes sjs

Back 835

penicillins, sulfa drugs, nsaid, phenytoin and phenobarb

Front 836

does SJS involve the mouth?

Back 836

yes also conjuctivate and respiratory tract

Front 837

TEN

Back 837

most sever-- nikolsky's sign ten looks like SSS no ABX dx with skin biopys and do not give steroids

Front 838

fixed drug reaction-- same site always with repeaded exposure, tx with topical steroids

Back 838

?

Front 839

erythema nodosum tx

Back 839

analgesic andnassiads, causes are pregnancy, sterp, coccidiomycosis, hisoplasmiosis, sarcoid, ibd, syphilis, hepatitis

Front 840

treat hair or nail infection with fungus

Back 840

terbinafine or itraconazole… need to check lft's with terbinafine

Front 841

tx fungal c/o hair or nails

Back 841

take your pic ketoconazole etc

Front 842

pen allergic cellulitus

Back 842

don't use cipro, use macrolides or fluroquinoones

Front 843

impetigo tx

Back 843

mupirocin

Front 844

erysipleas

Back 844

tx with pen g or ampicillin if strep culture +.

Front 845

tx cellulitis

Back 845

dicloxacillin, cephalexin or cefadroxil

Front 846

folliculitus tx

Back 846

topicl mupirocin

Front 847

furnucle and carbuncle tx

Back 847

dicloxacillin or ceadroxil

Front 848

tx nec fasc

Back 848

ampicillin sulbactam, pip/tazo, ticarcillin clauvlonate. If definitley strep a, then clindamycin and penicillin

Front 849

tx varicella

Back 849

gernerally know unless child immunocompromised or adult primary then acyvclovir, valacyclovir or framicyclover

Front 850

dx herpes

Back 850

tzank smear or most acurate viral culture, serology not useful

Front 851

tx shingles

Back 851

acyclovir decrees risk of postherpteic neuralgia, gabapentin tca or topicalcaspaicin

Front 852

imiquiimod

Back 852

tx HPV instead of cryotherpay or podophyllin

Front 853

best test syphilis

Back 853

dark field examination in primary better than vdrl or rpr

Front 854

secndary syphyllis dx-

Back 854

vdrl and rpr

Front 855

tx syphillus

Back 855

both primary and secondary pnicillin g single dose. If pen allergic doxycycline for 2 weeks

Front 856

dx scabies

Back 856

(hands spares the head) scarping out organism after mineral oil applied ot aburrow

Front 857

tx scabies

Back 857

permetrhin, or severe ivermectin orrally

Front 858

dx pediculosis

Back 858

can be seen attached to hair, tx with permetrhin

Front 859

retianed foreign body

Back 859

toxic shock sydnrome

Front 860

tx anthrax

Back 860

cipro or doxy

Front 861

SSSS vs TEN

Back 861

SSS superficial layer not full thickness

Front 862

tx SSSS

Back 862

nafcillin, in burn unit

Front 863

stuck on appearance

Back 863

seborrheic keratosis benigh

Front 864

sun exposed tender lesion

Back 864

actinic keratosis, pre cancerous… remove with cryotherapy 5 FU

Front 865

ulceration on lip or sun exposed

Back 865

squamous cell, do biopsy and surgical remeoval-- mets are rare

Front 866

basal cell

Back 866

moh's microsuregery

Front 867

shiny or pearly

Back 867

basacl cell, mets rate only 0.1

Front 868

benign moles

Back 868

do not grow, smooth borders, diameter <1cm, homongeousn-- bipsy if ?

Front 869

extensor scaly

Back 869

psoriasis

Front 870

flexor scaly

Back 870

atopic

Front 871

salmon colored patch that spare spalms and sole and negative vdrl/rpr

Back 871

pitryiasis rosa-- chrismas tree patter, resolves on its own tx with topical steroids

Front 872

tx acnem mild

Back 872

topical antiboitix clindamycin, erythromycin sulfactamide, or topical retinoids

Front 873

tx moderate acne

Back 873

benzoyl peroxide and retinoids tazarotene, tretinon and adapaline

Front 874

sever cystic acne

Back 874

oral abx-minocycle tetracycline clindamycin and isotretinoin

Front 875

?

Back 875

?

Front 876

surgery

Back 876

?

Front 877

asymptomatic head injury with closed skull fx

Back 877

if no neurolgic signs and ct negative then clean lacs

Front 878

warm and flushed shock

Back 878

vasomotor--- medication use, (PCN allergy) spinal anesthesia or allergen (bee sting) give vasoconstrictors and fluids

Front 879

basal skull fracutre

Back 879

csf leak will stop by itself, steroids will resolve facial palsy symtopms that occur 2-3 days later…

Front 880

racoon eyes or behind the ear

Back 880

basal skull fracture-- ct head and neck not x-ray

Front 881

tx epidermal hematoma

Back 881

emergency craniotomy

Front 882

tx subdural hematoma

Back 882

steroids for conservative-- emergency craniotomy if lateralizing signs or midline displacement

Front 883

tx diffuse axonal injury

Back 883

decrease ICP

Front 884

head trauma then improves then progressive drowsiness

Back 884

elevated ICP, may have gradual dilation of one pupil get ct head

Front 885

managmeent eleaated icp

Back 885

head elevation, hyperventilation, avoid fluid overload,.. Then second line mannitol furosemide sedation

Front 886

primary peritonitis

Back 886

spontatneous in childrin with nephrosis or adult with ascities even if there is fever and leukocytosis-- medicall treat no surgery

Front 887

all other peritonitis

Back 887

surgery

Front 888

cholangitis

Back 888

emergecny ERCP not surgery

Front 889

pancreatitis complications

Back 889

10 days abcesss surgical drainage, 5 weeks pseudocysts-- <6cm and present <6 weeks observe, >6 cm or present >6weeks perc trainage

Front 890

chronic pancreattiis damage

Back 890

treat with insulin and pacreatic enzyme supplements

Front 891

abx an appendctomy

Back 891

before

Front 892

perforated appendic

Back 892

continue iv until fever and wbc normalized

Front 893

mesenterich ischmia in surgery

Back 893

perform embolectomy and revascularization

Front 894

if mesenteric ischmeia during angiography

Back 894

vasodilators or thrombolyzsis

Front 895

tx abdominal abscess

Back 895

drain either surgically or perc, give abx

Front 896

acute ascending cholangitis

Back 896

cholangitis except higher fever and higher whit cound and HIGH LEVLES OF ALKALINE Phosphatase

Front 897

tx acute ascending cholangitis

Back 897

iv abx and decompression of bile duct by ercp followed by surgery later

Front 898

billiary colic

Back 898

elective cholycestecomy

Front 899

when emercency cholecystecomy for acute cholycystitis

Back 899

gernerlized peritonitis or emphysematous cholecytsis

Front 900

post op fever

Back 900

atelectasis day 1, pneumoia uti day 3, dvt day 5 wound day 77 , dep abscess days 10-15

Front 901

post op disorientation

Back 901

most important is hypoxia other uremia hypoonatremia dt's iatrogenic-- get a blodo gas first

Front 902

temp 104

Back 902

if right afer anestheisa then malignant htn if 30-45 minutes after invasive procedure bactermia

Front 903

post op fecal or gastric fistula

Back 903

not an emergency if ok

Front 904

when i+d wound infection

Back 904

if abscess

Front 905

when PE

Back 905

day 7

Front 906

tx claudication

Back 906

smoking cessation cilostazol, if disablign surgery

Front 907

peds

Back 907

?

Front 908

best predictive test for RDS in kids

Back 908

lecithin sphingomylein ratio on amniotic fluid prior to birth

Front 909

cds vs pneumonia on cxr

Back 909

look same give abx if in doubt-- both show atelectasis air bronchograms ground glass

Front 910

all newborn repirstory distress

Back 910

abg blood clutures, clugose CBC, caranial ulrasound .. Give 02 and snasal cpa and empirc abx

Front 911

tx meconium

Back 911

ppv, nitric oxide

Front 912

meconium plug

Back 912

lower colon, hirschprug cystic fibrosis

Front 913

meconium ileaus

Back 913

lower ileum- cystic fibrosis

Front 914

tx ileus or plug

Back 914

gastrogaffin enema

Front 915

double bubble

Back 915

duodenal atresia-nasogastric decompression.. Look for polyhydraminos down's sydnreom

Front 916

pneumatosis intestinalis

Back 916

gas cysts in bowel wall instead of bowel lumen-- NEC

Front 917

treat NEC

Back 917

stop feed decompress gut broad spectrum

Front 918

when is jaundice pathologic in newborn

Back 918

1st day of life >5mg/dl .day, >12, direct >2

Front 919

when phototehrapy for jaundice

Back 919

>10-12mg/dl

Front 920

when exchange transfuion in jaundice

Back 920

bilirubin ecephalopathy

Front 921

early newborn sepsis

Back 921

gbs, ecoli, h flu, listeria

Front 922

lumbar puncture for spesis workup

Back 922

not if no lethargy

Front 923

tx newborn sepsi

Back 923

no menigits amp and aminoglycoide, if menigitis amp and cephalosporin (not ceftriaxone)

Front 924

best test enuriesis

Back 924

urnalysis

Front 925

best tx enuresis

Back 925

behavor and motivation, then trycilic, imipramine and desmopressin

Front 926

best test encoporesis

Back 926

abdominal xray- retentive constipation, non retenive abue

Front 927

tx encoporesis

Back 927

retentive disimpaction, stool softeners, non reetneive behavior modification

Front 928

x ray bronchiolitis

Back 928

hyperinflation patchy atelectasiss

Front 929

xdx bronchiolitis

Back 929

viral antigen testing

Front 930

tx bronchiolitis

Back 930

hospitalize if tachypnea >60.minute-- no steroids B agonist?-- no ribavirin

Front 931

high risk for bronchiolitis

Back 931

rsv ivig or palvizumab

Front 932

foreing body sites

Back 932

children>1 year larynx, children <1 year mainstem bronchus

Front 933

staccato cough , peripheral eosinophilia in 1-3 months old

Back 933

c. trachamotosu

Front 934

mos common bacterial in children >5

Back 934

s. pneumonia, m. pneumonia, c. pneumonia

Front 935

most common <5 year spneumonia

Back 935

rsv

Front 936

unilateral lower lobe intesrtitial pneumonia in not that iskc

Back 936

mycoplasmia-- igm titiers

Front 937

pneumonia in kids sputum cultures

Back 937

no adults only

Front 938

tx pneumonia

Back 938

amoxicillin, cefuorime, amoxicillin clavulanic acid

Front 939

hospitialzied pneumonia kids

Back 939

cefuroxime, add vanc if s . Aurisu

Front 940

chlamydia or mycoplasma

Back 940

erythromysin

Front 941

best test CF

Back 941

2 sweat chlorid concentrations

Front 942

dx secondary amenorrea

Back 942

progestin, then estrogen progestin bleed then no ovulation, if no bleed 3 week estrogen

Front 943

?

Back 943

?