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1144 Cards in this Set

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Pleural Effusions
Secondary medical Tx for chronic stable angina after first 5 (2)
1) If bp room add CCB
2) If refractory add Ranolazine
Dx Irregularly irregular rhythm, with no P waves
Who should get coronary angiography?
1) Lifestyle limiting angina despite medical tx
2) Markedly positive results on non-invasive stress testing
3) hx of Vtach
4) hx of Non specific CP with recurrent hospitalizations
Who should get coronary Ca testing?
Intermediate risk group (10-20% framingham risk score)
Dx short PR and delta wave
Wolf Parkinson White
(n.b. can become either orthodromic or antidromic AVRT)
Dx Wide QRS tachycardia in setting of known hx of ischemic damage
Tx for Left NSTEMI
Beta blocker
Dx New murmur and respiratory after recent MI (2). Dx study? Tx?
1) Acute MR
2) VSD
Dx study is Echo
Tx is IABP
Dx STEMI, respiratory distress, hypotension, new systolic murmur, and thrill.
Ventricular Septal defect
Dx 1-4 days after MI, heart failure, tamponade or pulseless electrical activity.
Ventricular free wall rupture
Dx Afib or Aflutter spurts between a baseline of bradycardia
Tachy-brady (a type of sick sinus sx)
Dx Baseline bradycaria with dropped beats
Sick sinus sx (sinoatrial node dysfunction)
Dx Drug induced heart block
Donepezil (ACh esterase inhibitor) causes increased vagal tone, bradycardia, and AV block
Tx for Hemodynamically unstable patients with arrhythmia
Electrical cardioversion
Dx study for Aflutter or AVNRT
Adenosine bolus
Dx study for Sinus tachycardia
Find underlying cause (e.g. TSH)
What is the CHADS2 risk score?
Age >75 years
Stroke or TIA (2 points)
-3 or greater get chronic anti-coagulation tx (warfarin)
*1-2 consider ASA vs warfarin
Tx chronic Afib
Beta blocker (or rhythm control e.g. verapamil) and Warfarin
Dx study and tx for asymptomatic PVCs
No studies or therapy needed
Tx for symptomatic PVCs
Beta blocker or CCB (e.g. verapamil)
Indication for ICD in CHF
EF less than 35%
Indications for pacemaker
1) Sick Sinus
2) symptomatic bradycardia due to 2nd or 3rd degree AV block
Tx for Cardiac arrest (Ventricular arrhythmias)
Medical management
1) ASA
2) Beta blocker
3) Statin
4) Plavix
5) ACE-I
Dx Recurrent syncope with cardiac arrest with family history of sudden death
Long QT syndrome
(cardiac arrest is in form of torsade de pointe)
Indication for Digoxin tx
Class III or IV heart failure (has no improved mortality, just keeps people out of hospital and makes them feel better)
Dx Dyspnea, S3 or S4, displaced apical impulse, and EF less than 45% after delivery
Peripartum cardiomyopathy
Dx study for new onset CHF (DOE or orthopnea or edema) in the setting of angina (including stable) +/-abnormal EF
Coronary angiography
Dx study for New onset CHF
Tx for Class I or II CHF (2)
(even if asymptomatic)
1) ACE-I
2) Beta blocker
3) Amlodipine only if refactory sx on 1 and 2
Suitable substitute for spironolactone in Class III or IV CHF (bc they got gynecomastia)
Tx for Class III or IV CHF
1) ACE-I
2) Beta blocker
3) Spironolactone
Dx Aortic regurg in pt with prosthetic valve
Prosthetic valve failure
Dx split S2, right ventricular heave
Atrial septal defect
Dx opening snap, low pitched middiastolic murmur best heard over mitral valve
Mitral stenosis
Dx and Tx for Short, soft (less than 3), midsystolic murmur in elderly patient
Usually aortic stenosis. No management needed.
Diagnostic criteria for DM
1) HbA1C greater than 6.5
2) Fasting glucose over 125
3) Random glucose over 200
4) 2 hour glucose tolerance test over 200
All of these have to be done twice except random BG with signs of hyperglycemia
Tx Prediabetes
Lifestyle modifications
Dx chronic pancreatitis with diabetes
Secondary diabetes
Tx Initial for T2DM
Metformin (and lifestyle modification)
Tx Inpatient for controlling hyperglyecemia
Long acting insulin with rapid acting insulin before meals (ISS)
Tx for proliferative diabetic retinopathy or macular edema
Laser photocoagulation
Tx for chronic hypogycemia in DM
Long acting and rapid acting prandial insulin
Dx BG over 250, anion gap acidosis (less than 7.3), bicarb less than 15, and positive serum or urine ketones.
Diabetic ketoacidosis (DKA)
Dx BG over 600, ph more than 7.3, bicarb more than 15, serum osmolality greater than 320, and absent urine or serum ketones.
Hyperglycemic hyperosmolar non-ketosis (HHNK)
IV fluids and identifying underlying cause
Insulin drip
Dx soft, non-tender, non-pruritic plaques on eyelids
Xanthelasma (see in familial dyslipidemia)
Tx for Isolated low HDL
Lifestyle changes:
1) Exercise
2) Smoking cessation
3) Weight loss
LDL goal for 0 or 1 CV risk factor
Less than 160
LDL goal for a diabetic
Less than 100
(diabetes is a CVD equivalent)
LDL goal for pts with hx of CVA or TIA
Less than 100
Mgmt for hypothyroidism
Treat - Levothyroxine
Hashimoto disease is the most common cause of hypothyroidism, confirmation via TPO antibody unnecessary.
Mgmt of Thyroid nodule
If greater than 1 cm --> biopsy
If less than 1 cm, biopsy only if cancer risk hx
Mgmt of Hypothyroidism in pregnacny
Monitor, bc Thyroxine requirements go up 30-50%, want T4 1.5 normal
Tx for Grave's disease
Methimazole and Beta blocker
(better than radiation bc can achieve euthyroid. Also better than PTU)
Mgmt of new Hyper or Hypothyroid post partum
Recheck TSH and T4 to diagnose Postpartum Thyroiditis
Mgmt abnormal thyroid studies in the setting of acute illness
Recheck TSH and T4 to diagnose Euthyroid Sick Syndrome
Mgmt of incidentally discovered adrenal adenoma in asymptomatic patient
Get plasma-free metanephrine levels and overnight dexamethasone suppression test
(want to rule out hypersecretion of glucocorticoids and catecholamines)
Dx study for Resistant HTN and hypokalemia
Serum aldosterone to plasma renin activity ratio to diagnose Primary Hyperaldosteronism
Dx study for High dose dexamethasone sensitive elevated ACTH
MRI of pituitary
Dx ACTH dependent hypercortisolism
1) High dose dexamethasone resistant
2) High dose dexamethasone sensitive
1) Ectopic ACTH tumor
2) Pituitary tumor
Mgmt of Palpitations, sweating, HA, HTN
Abdominal CT scan to confirm Dx of Pheochyromocytoma
Dx low ACTH, low cortisol, and high glucocorticoids in setting of exogenous corticosteroids
Adrenal insufficiency due to exogenous corticosteroids
Tx for Pts with adrenal insufficiency in setting of stress (as from illness or surgery)
Stress level doses of corticostreroids (Hydrocortisone or Dexamethasone)
Tx for Osteoporosis
Vitamin D, Ca supplementation, Bisphosponates (or zoledronate annually if cannot tolerate bisphosphonates)
When and with what to screen for osteoperosis
Screen with DEXA in women over 65 or women 60-65 with increased risk of osteoperosis (i.e. weight below 154 lbs)
Tx for Osteoporosis prevention
Vit D and Ca
Bone mineral density T score cutoffs for Osteopenia and Osteoperosis
Osteopenia: -1 to -2.5
Osteoperosis: -2.5 or more
Dx unilateral flank pain, n/v, gross or microscopic hematuria
Dx study for Nephrolithiasis
Helical abdominal CT scan
Dx study for Acute abdominal pain
Supine and upright abdominal radiographs (to look for air fluid level --> bowel obstruciton, and free peritoneal air --> perforated bowel)
Dx Abdominal pain, back pain, syncope
Abdominal aortic aneurysm
Dx Recurrent abdominal pain or discomfort, relieved with defecation, with diarrhea
Irritable Bowel Syndrome
Tx for Irritable bowel syndrome
Fiber and/or polyethylene glycol with reassurance
Dx crampy abdominal pain, with bloody stool, in eledery atherosclerotic patients
Ischemic colitis
Mgmt LLQ pain, fever, leukocytosis
Contrast enhanced CT scan to confirm Diverticulitis
Mgmt Chronic upper abdominal pain radiating to back, diabetes, steatorrhea, pancreatic calcifications
Abdominal CT to look for pancreatic calcifications to confirm Chronic Pancreatitis
Dx Thrombotic microangiopathy (schistocytes, elevated retic count, elevated LDH) and Thrombocytopenia
Hemolytic Uremic Syndrome
Dx Diarrhea and tenesmus within 6 weeks of radiation therapy
Radiation proctitis
Dx mid-epigastric abdominal pain, postprandial diarrhea, +/-DM
Chronic pancreatitis
Alarm criteria in IBS
1) Fever
2) Weight loss
3) Blood in stool
4) Abnormal PE
5) FHx of IBD or Colon ca
6 Pain or diarrhea that interferes with sleep
Dx 10-15 stool/day, lower abdominal pain, cramping, fever, leukocytosis in setting of Abx
C Diff
Tx for Salmonella gastroenteritis
Self limiting, no tx
Dx Anti-mitochondrial Ab
Primary Biliary Cirrhosis
Tx for Primary Billiary cirrhosis
Ursodeoxycholic acid
Which liver disease is associated with UC and Crohn's
Primary sclerosing cholangitis
Beading of the biliary duct
Pattern of bilirubin elevation
1) Prehepatic
2) Intrahepatic
3) Posthepatic
1) Prehepatic - Unconjugated hi
2) Intrahepatic - Both hi
3) Posthepatic - Conjugated hi
Dx Unconjugated hyperbilirubinemia with normal Hgb levels and otherwise normal LFTs
Gilbert Syndrome
Tx for Symptomatic gallstone disease
Dx Elevated bilirubin and alkphos with IBD
Dx fever, jaundice, RUQ pain and common bile duct obstruction
Acute cholangitis
Dx biliary colic, Murphy sign, fever, leukocytosis, mild biliruibin and AST/ALT elevation, thickened gallbladder wall.
Acute cholesystitis
Tx for Gallstone pancreatitis
ERCP with sphincterotomy and stone extraction
Dx epigastric pain radiating to back, n/v, fever, tachycardia, abdominal distension, hypoactive bowel sounds.
Acute pancreatitis
Dx Stones in gallbladder, dilated bile duct, and elevated AST/ALT with acute pancreatitis.
Acute pancreatitis due to gallstones
Tx for Severe acute pancreatitis
Enteral nutrition with nasojejunal feeding tube
Mgmt GERD sx with dysphagia
Upper endoscopy
(Dysphagia is an alarm sx)
Tx Erosive Esophagitis
Dx study for gastric ulcer
(all ulcers should be biopsied for possible malignancy)
Mgmt of dyspepsia with NSAIDs
Stop the NSAID
Tx for Functional dyspepsia
(i.e. dyspepsia/gastritis without visible organic pathology)
Dx study for GI Bleed of unknown etiology after endoscopy and colonoscopy
Repeat upper endoscopy
Dx LLQ pain, urgent defecation, red or maroon rectal bleeding not requiring transfusion usually in older people
Colonic ischemia
Mgmt of Upper GI bleed after fluid resuscitation
Upper endoscopy for Diagnosis, Prognosis, and possible therapy
Tx for GI bleeding in hemodynamically unstable patients
Fluid resuscitation
Dx Painless lower GI bleeding
Diverticulosis and vascular ectasia
Dx BRBPR and pain with defecation
Anal fissure
Screening for chronic Hep B infection
Liver ultrasound to look for hepatocellular ca
Dx Acute hepatitis, fatigue, n/v, jaundice, AST/ALTs over 1000.
Hepatitis A
Dx AST;ALT ratio greater than 2, elevated alk phos
Alcoholic hepatitis
Dx Elevated AST/ALTs, hi GGT, mild bilirubinemia, mildly elevated alk phos, present of auto antibodies.
Autoimmune hepatitis
Dx Positive HBsAg and Anti-HBc IgM
Acute HepB
(The IgM tells you its acute and not chronic infxn)
Dx anti-hepatitis C Ab
Exposure to Hep C or vaccine
Dx Cirrhosis, obesity, T2DM, and hyperlipidemia
Non-Alcoholic Steatohepatitis
Dx UC and marked elevation in alk phos
Dx Ascitic fluid analysis showing serum to ascites albumin gradient greater than 1.1
Portal hypertension
(caused by Liver disease, such as cirrhosis, right sided HF (congestive hepatopathy), or Budd-Chiari)
Tx for Hepatic Encephalopathy
Dx kidney dysfunction in setting of portal htn after exclusion of prerenal azotemia, intra renal disease, and renal obstruction.
Hepatorenal syndrome
Dx small, exquisitely tender nodules on shins in IBD
Erythema nodosum
Dx Contiguous inflammation of rectum proximally
UC (Ulcerative colitis)
Tx for Ulcerative colitis
Dx Chronic watery diarrhea without bleeding without findings on colonoscopy
Microscopic colitis
Which test characteristics are robust or sensitive to prevalence.
Robust - Sensitivity, Specificity, LR
Sensitive - PPV,. NPV
What is the relationship between LRs and Post Test Probability
LRs of 2, 5, and 10 increase Post test probability 15, 30, and 45% respectively
Screening recommendation for AAA
All men 65-75 who have ever smoked
Flu vaccine recommendations for COPD
All COPD patients regardless of age
Pneumovax recommendations
1) Anyone over 65
2) Smokers, COPD, or asthma can be younger
3) RE-Vaccination in everyone over 65 if last vaccination was more than 5 years ago AND before 65.
4) RE-Vaccination in immunosuppressed people if first vaccine more than 5 years ago
What is the best end point for any trial?
Zoster vaccine recommendations
All patients over 60 regardless of prior varicella/zoster hx
HPV vaccine recommendations
All women 9-26
Colon Ca screening recommendations
Starting at age 50
1) Colonoscopy every 10 years
2) Flex sig every 5 years with home FOBT every 3 years
3) Annual home FOBT
Dx Syncope in ischemic HF
How to diagnose orthostatic hypotension
Drop in systolic BP of 20 or 10 diastolic after 3 minutes of standing
Dx Syncope, nausea, lightheadedness, diaphoresis
Vasovagal syncope (situational)
Dx LOC irrespective of body position without preceding symptoms
Cardiac arrhythmia
Dx study for infrequent syncope
Implantable loop recorder
Tx for Depression after failing 1 antidepressant
A different antidepressant
Tx for Depressive sx of 2 weeks more than 8 weeks after death of loved one
Pharmacologic antidepressants
Tx for Acute cocaine intoxication
Tx for short term alcohol dependence
Tx for Acute opioid intoxication
Naloxone (narcan)
Tx for Spinal stenosis with neurologic deficits and pain refractory to NSAIDs and PT
Dx study for Vertebral osteomyelitis
Tx for Acute non-specific low back pain
NSAIDs or Acetaminophen
Dx Back pain, muscle weakness, and bowel or bladder incontinence
Spinal cord compression
Dx study for Spinal cord compression
MRI of spine
Mgmt Cough variant asthma
Albuterol inhaler trial for tx and dx
Mgmt for Chronic cough in non-smoker
Antihistamine/decongestant combination
2 Most common causes of hemoptysis
1) Bronchitis
2) Malignancy
Dx study for Hemoptysis with and without alarms for malignancy
1) CXR
2) If over 40, or more than 1 week, or 40 pyhx than Chest CT
Tx Acute bronchitis
Symptom management
Effects of smoking cessation on lung function (2)
1) Absolute improvement (minor)
2) Decreased rate of decline (major)
Tx for Smoking cessation
(Bupropion and nortriptyline effective but less so)
Indications for bariatric surgery
1) BMI over 40 regardless of comorbidities
2) BMI over 35 w/ comorbidities
When drug therapy was unsuccessful
Tx for Obesity after diet and exercise fail
Dx Nausea and vomiting within months of bariatric surgery
Stomal stenosis
Mgmt Unintentional weight loss with negative labs and imaging
Recheck in 6 months
(risk of ca low)
Most common cause of unintentional weight loss in ca negative patients
Medication that can cause weight loss
Dx Unintentional weight loss, skeletal muscle dysfunction, osteoperosis, depression
Tx for Menorhagia
Medroxyprogesterone for 10-21 days
(Menoroghia is heavy menstrual bleeding)
Dx Oligomenorrhea, hirsutism, acne, alopecia
Tx for Menopausal sx
Estrogen replacement therapy
Dx study for Amenorrhea after pregnancy rule out
FSH, TSH, and Prolactin levels
Dx study for Abnormal uterine bleeding in patients over 35
Endometrial biopsy
Dx Well-demarcated, rapidly spreading area of warmth, swelling, tenderness, and erythema +/- fever
Dx Erythematous, dry or greasy scales and crusts
Seborrheic dermatitis
Dx Light pink to red papules and thin plaques with scaling, active borders and central clearing
Dx Erythematous macules and plaques that progress to epidermal necrosis and sloughing on less than 10% of body
Steven Johnson
Dx Targetoid lesions of both skin and mucosal surfaces
Erythema multiforme
Tx for Zoster reactivation
Oral antiviral if within 72 hours of onset of rash
Dx Erythema, telangiectasias, papules, pustules, and sebaceous hyperlasia of the face and nasolabial folds
Dx brown to black, well demarcated, stuck on papules
Seborrheic keratoses
Tx Extensive or inflammatory acne
Oral abx
Dx Rapid appearance of wheal lasting less than 24 hrs
Acute uriticaria
Mgmt Solitary, mobile, LAD of less than 2 cm
No mgmt needed
Mgmt Enlarging, firm, axillary LAD in woman over 40
Screening for hearing loss in elderly
Whispered voice test even if claiming asymptomatic
Dx study for Fall in elderly patient
Get up and go test
Tx Urge urinary incontinence
Tolterodine or Oxybutynin
Mgmt of Non-specific dizziness in eldery patient
Initial Tx for Stage I HTN
Lifestyle modification for 6 to 12 months
(then you go to HCTZ)
Initial Tx for HTN in eldergy pt
HCTZ (more salt sensitive)
BP Goal in diabetics or CKD
Dx HTN, radial to femoral artery delay, rib notching
Coarctation of Aorta
Initial Tx for Stage II HTN
2 drugs, usually HCTZ and ACE-I
Dx Serum ferritin levels lower than 100-120
Iron deficiency anemia
Dx Pancytopenia, low retic count, hypoplastic bone marrow (usually with fat)
Aplastic anemia
Tx Iron deficiency anemia
Ferrous sulfate
Dx bite or blister cells
G6PDase Deficiency
Dx Low MCV and target cells with normal iron studies
Thalassemia minor
Dx Macrocytic anemia, thrombocytopenia, elevated LDH
Vitamin B12 deficiency
Dx study for suspected Vit B12 deficiency with low normal Vit B12
Methylmalonic acid and homocysteine
Dx Elevated LDH, decreased serum haptoglobin, and elevated retic count
Hemolytic anemia
Dx Hemolytic anemia, schistocytes, in setting of prosthetic valve
Prosthetic valve hemolytic anemia
Dx Microcytic anemia, hypochromia, variable size, and variable shape
Iron deficiency anemia
Dx Spherocytes on blood smear
Warm antibody-mediated hemolytic anemia
Dx Long PT and PTT, high D-dimer, low serum fibrinogen and platelets, and microangiopathic hemolytic anemia
Disseminated intravascular coagulation
Dx Long bleeding time, borderline PTT, low factor VIII wit FHx of coagulopathy
Von Willebrand
Dx Transient aplastic crisis in patients with chronic hemolytic anemia (e.g. sickle cell disease)
Dx Right sided heart failure in sickle cell anemia
Pulmonary HTN
(common in sickle cell anemia)
Tx Acute chest syndrome in sickle cell anemia
Dx study Osteonecrosis
MRI of the hip
Dx study for Sickle cell anemia
Blood smear
Dx Decreased platelets, thrombotic event in setting of recent heparin
Heparin induced thrombocytopenia and thrombosis
Dx Microangiopathic hemolytic anemia, thrombocytopenia with normal coagulation, CNS sx, renal failure, fever
Thrombotic thrombocytopenic purpura
Dx Large platelet clumps on stained blood film
Tx for Immune thrombocytopenic purpura
Tx for Antiphospholipid syndrome after thrombus
Warfarin for life
Dx Lupus anti-coagulant or anticardiolipin or B2 glycoprotein antibodies
Dx decreased AG with anemia, proteinuria, hypercalcemia, and renal failure
Multiple myeloma
Dx hypercalcemia, osteopenia, anemia, leukopenia, and renal insufficiency
Multiple myeloma
Dx M spike less than 3.0 with less than 10% plasma cells in bone marrow
Monoclonal gammopathy of unknown significance
Auer Rods
Dx BCR/ABL oncogene, granulocytes with left shift, and myeloid proliferation in bone marrow
Dx Blanching rythematous macules around wrists and ankles after tick exposure
Rock mountain spotted fever
Dx Very high or brief fever spikes and rapid defervescence without chills
Factitious fever
Dx Fever after inhaled anesthetics and depolarizing muscle relaxants
Malignant hyperthermia
Tx for Sepsis with hemodynamic instability
Flu vaccine recommendations for COPD
Annually regardless of age for everyone with COPD
Dx Low MCV, low serum Fe, elevated TIBC, and low transferrin saturation
Iron deficiency anemia
Tx Rocky Mountain Spotted Fever
Indication for Norepinephrine in septic shock
If MAP is less than 65 after fluid resuscitation
Criteria for Sepsis
1) Positive BCx or visible infxn
2) Systemic response to infxn, at least 2: fever, tachycardia, tachypnea, leukocytosis
aka SIRS with positive BCx
Criteria for Systemic inflammatory response syndrome (SIRS)
At least 2 of:
HR over 90
Respiration greater than 20 (or PCO2 less than 32)
Leukocytosis (or Immature bands 10%)
Criteria for Septic shock
Sepsis with hypotension or evidence of perfusion abnormalities with adequate fluid resuscitation (or on vasopressors)
Severe complications of Group A Strep (3)
1) Peritonsillar abscess (quinsy)
2) Post-streptococcal glomerulonephritis
3) Rheumatic fever
Tx for Acute otitis media
(Amox-clav or Ceftriaxone if not improved within 3 days)
Centor Criteria for Strep Throat (4)
1) Fever
2) Tonsillar exudates
3) Tender LAD cervical
4) Absence of cough
Mgmt according to Centor Criteria
0-1 Nothing
2-3 Rapid strep antigen test
4 Empiric Abx tx
Mgmt for Asymptomatic UTI in pregnant woman
Prostatitis refractory to Abx
Prostatic abscess
Asymptomatic UTI
No treatment
Fever, chills, sweats, n/v, diarrhea, and flank pain
Pyeloneophritis in non-pregnant woman
Oral Fluoroquinolone
Recurrent UTI in healthy women
Trimethoprim sulfamethoxazole (bactrim) PRN for days with symptoms
Mucoprurulent discharge or bleeding of os
Ceftriaxone with doxy or azithromcyin
Arthritis, tenosynovitis, sparese peripheral necrotic pustulues
Fever, HA, and painful, ulcerated vesicular lesions on junk
Genital herpes
Pelvic inflammatory disease
Ceftriaxone and oral doxycycline
CD4 less than 200, fever, dry cough, dyspnea for several days or weeks
Pneumocystis jirovecii
Pneumocystis jirovecii
and Steroids if hypoxic
HIV Abx prophylaxis by CD4 count and PPD
1) Less than 200 - Bactrim for PJP and Toxo
2) Less than 50 - Azithromcyin for Mycobacterium Avium
3) PPD positive but lungs clear - Isoniazid
Dx study for
Acute HIV infxn
RNA viral load
Ring enhancing lessions on MRI, neurologic deficits, in setting of HIV
How to reduce ventilator associated PNA
Semi erect positioning of patient
Infectious precautions for C Diff
Barrier protection and soap and water
Precautions for Meningoccocal meningitis
Droplet precautions (surgical mask)
Precautions for TB
Airborne N95 mask
Mgmt for
Positive PPD
PPD cutoffs by risk (3)
5 mm Immunosuppressed or highest risk (close contact with TB)
10 mm Immigration form endemic country or prison worker
15 mm for healthy people
What must you get tested before starting a TNF-alpha inhibitor
TB tested with PPD (and treat if more than 5 mm)
Severe, progressive PNA during flu season
Community acquired PNA
PE from valve endocarditis (Right heart valve)
Vancomycin plus cefepime
Left sided native endocarditis
Penicillin plus gentamycin
Ceftriaxone plus gentamycin
Positive BCx, vegetation on Echo, and new valvular regurg
Dx study for
Suspected Vertebral osteomyelitis
Spine MRI
Dx study for
Dx study for
Confirmed Osteomyelitis
BCx or Bone culture
Pneumovax is indicated in everyone after their 65th birthday or after 65 if there have been more than 5 years since last vaccine
Severe, progressive PNA during flu season
Community acquired PNA
PE from valve endocarditis (Right heart valve)
Vancomycin plus cefepime
Left sided native endocarditis
Penicillin plus gentamycin
Ceftriaxone plus gentamycin
Positive BCx, vegetation on Echo, and new valvular regurg
Dx study for
Suspected Vertebral osteomyelitis
Spine MRI
Dx study for
Dx study for
Confirmed Osteomyelitis
BCx or Bone culture
Confusion and agitation in setting of chronic dementia with recent anesthesia
Postooperative delirium
Acute delirium inpatient
Mental status changes, nystagmus, ophthalmoplegia, unsteady gait
Wernicke's encephalopathy
Wernicke's encephalopathy
Smudge cells
Proteinuria during day but not over night
Orthostatic proteinuria
AKI with sterile pyuria (PMNs in urine) and WBC casts
Dx study for
Persistent hematuria of non glomerular origin
Muscle pain, weakness, dark urine, elevated serum creatine kinase
AKI, thrombocytopenia, microangiopathic hemolytic anemia
Hemolytic uremic syndrome
Muddy brown casts in setting of drugs or prolonged renal ischemia
Tx for
Diabetic nephropathy
ACE-Is or ARBs
Indications for dialysis in CKD (4)
1) Hypervolemic
2) Hyperkalemic
3) Acidemic
4) Uremic
Proteinuria, HTN, and decreasing GFR
Diabetic nephropathy
Dx study for
AKI with suprapubic tenderness
Renal US
Dx study for
Non diabetic nephropahty (hematuria) in a diabetic
Renal biopsy
Bone disease, elevated PTH, hypocalcemic, and hyperphosphatemic
Bone disease 2/2 hyperparathyroidism in CKD
What does the Urine anion gap (UAG) tell you? (3)
If negative - Extra renal metabolic acidosis
If positive (30-50) - Normal
If positive in setting of metabolic acidosis - RTA
Formula for Serum osmolality
= Na*2 + BUN/2.8 + gluc/18
Hypokalemia with low urine K
Extra renal losses of K (laxatives or diarrhea)
Hypocalcemia in setting of acute pancreatitis
Free fatty acid chelation of Ca
Tx for
Hypercalcemia in Sarcoidosis
Corticosteroids (prednisone)
(decrease macrophages which produce 1alpha-hydroxylase which increases vit D)
Most common cause of hypercalcemia outpatient
Severe muscle weakness following glucose therapy in alcoholic
(Insulin release from glucose moves phosphate into cells which is low bc of low oral intake)
Risk for demented patients during surgery
General anesthesia
Tx for
Delirium inpatient
MS changes, ophthalmoplegia, nystagmus and unsteady gait
Wernicke's encephalopathy
Cause of wenicke's encephalopathy
Thiamine deficiency
Neurologic sx including vision loss, hallucinations, numbness, tingling, weakness or confusion prior to HA
Migraine with aura
Dull, bilateral, diffuse headache described as squeezing
Tension type headache
Dx study
For sudden worst HA of life
Non contrast Head CT
Tx for
Migraine prophylaxis
(indication more than 2 per week)
Amitrptyine (TCAs), Beta blockers, CCBs, valproic acid, topirmarate
Abortive Tx for Migraine
Triptans (5-HT1 agonists), NSAIDs, Ergotamine
Prominent memory loss, anomia, impaired recognition of illness, variable degree of personality change
Dementia of a few month onset with startle myoclonus
Parkinsonism, visual hallucinations, fluctuating symptoms, impaired learning and attention, less memory impairment
Dementia with Lewy bodies
Tx for
Mild Alzheimer's
(ACh esterase inhibitor)
Tx for
Moderate or advanced Alzheimer's
Resting tremor, bradykinesia, rigidity, postural instability
Parkinson Disease
Tremor with voluntary movement that resolves with alcohol
Essential tremor
Tx for
Essential tremor
Meningitis with Gram positive bacilli in immunocompromised
Listeria monocytogenes
Fever, HA, myalgia, purpuric rash that begins on wrists and ankles and spreads centripetally
Rocky mountain spotted fever
Bacterial meningitis with Gram negative cocci
Nisseria meningitidis
Empiric Tx for bacterial meningitis in patients over 50
Ceftriaxone + Vancomycin + Ampicillin
Empiric Tx for bacterial meningitis in patients under 50
Ceftriaxone + Vancomycin
When should rehab begin after stroke?
Tx for
Acute Stroke within 3 hrs of onset
Hold ASA until 24 hours after tPA
BP cutoffs to treat HTN in post ischemic stroke
Over 220/120
Dx study for
Sudden worst HA of life with negative non contrast Head CT
Agent in Bell's palsy
Rapidly progressive Ascending extremity weakness, paresthesias, and areflexia.
Wrist pain sparing palm, numbness and tingling in the median nerve distribution, weakness of thenar muscles
Carpal tunnel
Stocking glove paresthesias or painful dysesthesias
Diabetic neuropathy
Positive Finkelstein test
de Quervain tenosynovitis
Dx study for
New small breast mass on mammography
Persistent, scaling, eczematous, ulcerated lesion on breast around nipple
Paget disease of breast
(indicates invasive or intraductal cancer)
Dx study for
New breast mass
Palpation, Mammography, and FNA
Tx for
Small focal breast cancer tumor (3)
Sentinel node dissection
Colonoscopy screening for 1st degree relative
1) Starting at 40 or 10 years before relative
2) Every 5 years
Dx study for
Single positive FOBT in asymptomatic pt
Screening for colon ca in IBD
1) Starting 8 years after onset of disease
2) Every year
Dx screening for lung ca
Dx study for
Pulmonary nodule less than 4 mm in low risk population
No study necessary
Dx study for
Diagnosed lung cancer
Lymph node biopsy for staging
Tx for
Small cell lung cancer
Chemotherapy and radiation
(surgery is not effective)
Indications for prostate biopsy (2)
1) PSA over 4
2) Rising PSA
Tx for
Prostate ca
Dx study for
Atypical pap smear results
Colposcopy with biopsy
HPV vaccination recommendations
Females and males 9-26
Pap screening recommendations
1) Start at 21 or 3 years after first sex
2) Annually for 21-30
3) Every 3 years after if normal in 30-65
Berry like lesion
Nodular melanoma
Hyperkeratotic precursor to squamous cell carcinoma
Actinic keratosis
Pink, pearly, nodules with telangiectasias
Basal Cell carcinoma
Rapidly progressive, crater like firm nodule
Tx for
Surgical excision
(can cause tissue damage or become malignant)
How to treat cancer pain
1) Non narcotics
2) Short acting narcotics
3) Then from that determine there long acting narcotic needs and Rx short acting for break through pain
Tx for
Dyspnea in hospice ca care
Opioids (short acting)
Definition of unstable angina
Angina is new, worsening, or occurring at rest
Antihypertensive for a diabetic patient with proteinuria
Hypotension, distant heart sounds, JVD
Cardiac tamponade
Drugs that slow AV node conduction (3)
1) Beta blockers
2) Digoxin
3) CCBs
HOCM murmur
Systolic ejection murmur along lateral sternal border that increases with Valsalva maneuver and standing
Murmur aortic insufficiency
Diastolic, decrescendo, high pitched, blowing murmur best heard when standing up
Murmur aortic stenosis
Systolic crescendo/decrescendo murmur that radiates to the neck, increases with increased preload
Murmur mitral regurg
Holosystolic murmur that radiates to the axilla or carotids
Murmur mitral stenosis
Diastolic, mild to late, low pitched rumble
Tx for
Afib or Aflutter
1) If unstable
2) If stable
1) If unstable - Cardiovert
2) If stable - Rate control with Beta blockers
Tx for
Autoimmune complication 2-4 weeks post MI
Dressler's syndrome: fever, pericarditis, elevated ESR
Tx for
IV drug use with JVD and holosystolic murmur at left sternal border
Treat existing HF and replace tricuspid valve
Dx study for
Hypertrophic cardiomyopathy
Fall in systolic BP greater than 10 mm with inspiration
Pulsus parodoxus --> Cardaic tamponade
Classic EKG findings in pericarditis (2)
1) Low voltage
2) Diffuse ST segment elevation
Indications for surgical repair of AAA
Greater than 5.5 cm
Rapidly enlarging
or Ruptured
EKG findings in MI (3)
1) ST segment elevations
2) Flattened T waves
3) Q waves
Young patient with angina at rest, ST segment elevation, nl cardiac enzymes
Prinzmetal's angina
CHF, shock, altered MS
Silent MI
Agent that reverses effect of heparin
Endocarditis prophylaxis
1) Dental
2) GI or GU surgery
1) Dental - Amoxicillin
2) GI or GU surgery - Ampicillin + Gentamicin
Most common cause of HTN in young women
Most common cause of HTN in young men
Asplenic patients are susceptible to these organisms
Encapsulated organisms
1) Strep pneumo
2) Nisseria meningitidis
3) H flu
4) Klebsiella
Number of bac needed on urine sample to think UTI
Fever, malaise, cough, night sweats recent SW US travel.
Dx - Cocciodomycosis
Tx - Amphotericin B
Blueberry muffin rash
What should always be done before LP?
Check ICP with papilledema or head CT
Gamma globulins in CSF
Multiple sclerosis
Initial pruritic papule with LAD progresses to eschar in 7-10 days
Dx - Cutaneous anthrax
Tx - Penicillin or Ciprofloxacin
Tabes Dorsalis, general paresis, gummas, argyll robertson pupils, aortitis, aortic root aneurysm
Tertiary syphilis
Arthralgia, migratory polyarthropathies, Bell's palsy, myocarditis
Secondary Lyme disease
Cold agglutinins
Tx for
Candidal thrush
Nystatin oral suppression
When and what to begin in HIV opportunistic prophylaxis
1) Less than 200 CD 4 count - Bactrim for Pneumocystis jiroveci
2) Less than 100 - Clarithromycin/Azithromycin for MAI
Alcoholic and smoker with lung sx with no gram stain but positive silver stain
Legionella pneumonia
Acute onset monoarticular joint pain, bilateral bell's palsy.
Dx - Lyme disease
Tx - Doxycycline
Main organisms in endocarditis (2)
1) Stapy aureus
2) Strep epidermidis
Branching rods in oral infection
Actinomyces israelii
Painful chancroid
Haemophilus ducreyi
Dog or cat bite
Infection in gardner
Sporothrix (sporotrichosis)
Infxn pregnant with pets
Meningitis in adults
Neisseria meningitidis
Meningitis in elderly
Strep pneumo
Alcoholic with pneumonia
Currant Jelly sputum
Infxn in burn victims
Osteomyelitis from foot wound puncture
Osteomyelitis in sickle cell patient
HTN with hypokalemia
1) If renin activity low
2) If renin activity high
1) If renin activity low - Primary Hyperaldosteronism
2) If renin activity high - Renovascular HTN (renal artery stenosis)
Purpura in elderly on back of hands
Perivascular connective tissue atrophy
Tx - none
Palpable purpura, low complement levels, glomerulonephritis, arthralgias, hepatosplenomegaly,
Mixed Essential Cyroglobulinemia
Muscle weakness (extreme) that resolves with rest
Myasthenia gravis
Tx for
Benign essential tremor
Tremor with planned, voluntary movement only, family hx
Essential tremor
The 4 criteria of Nephrotic Sx
1) Proteinuria greater than 3 g/day
2) Hypoalbuminemia (less than 3.5)
3) Edema
4) HLD and lipiduria (waxy casts)
What kind of state is nephrotic sx?
Pharmacologic agents that shift K into cells in acute hyperkalemia
1) Insulin and glucose
2) Na bicarb
3) Beta 2 agonists
Nephrotic sx in Blacks with obesity, heroin, or HIV hx
Focal Segmental Glomerulosclerosis
Most common cause of nephrotic sx in adults
Membranous nephropathy
Most common cause of nephrotic sx in children
Minimal change disease
Lung and GI involvement in immunocompromised pt
Fever, hives, arthralgias, and LAD after infection (usually 7-10 days later)
Drug induced reaction (serum sickness)
New clubbing in COPD pt
Lung cancer
Recurrent pain, itching, and red steaks in arms in setting of weight loss
Trousseau's syndrome (migratory thrombophlebitis) caused by occult malignancy usually pancreatic or lung)
New HA, jaw pain, scalp pain, visual loss.
Temporal arteritis
Tx for
Temporal arteritis
High dose prednisone
(to prevent damage to retinal artery and other vessels)
Weakness, fatigue, hypotension, cold intolerance, brittle nails, bradycardia
Pituitary tumor causing secondary adrenocortical deficiency
Hyperpigmentation, amenorrhea in young adult
Congenital adrenal hyperplasia
Most common deficiency in Congential adrenal hyperplasia
21-hydroxylase deficiency
Dx study for
CP in young woman with no risk factors for CAD
Dx study for
Newly diagnosed Myasthenia gravis
Chest CT (to look for thymoma)
Tx for
Kidney stones in acidic urine
Potassium citrate
Palpable mass in RUQ with hyperbilirubinemia in child
Choledochal cyst
Tx for
Cocaine induced CP
(also nitrates and aspirin)
Epigastric pain with voluminous pale foul smelling diarrhea
Chronic pancreatitis
EKG shows flat and broad T waves, PVCs
Fever, ns, LAD, arthralgias, diarrhea
Acute HIV
New onset diabetes, arthropathy, and hepatomegaly
No pulses but telemetry shows beats
Pulseless electrical activity (PEA)
Tx for
PEA (pulseless electrical activity)
Chest compressions, ventilation with 100% oxygen
Door to therapy time for PCTA and fibrinolysis in MI
PTCA - 90 minutes
Fibrinolysis - 30 minutes
Most common cause of uncomplicated UTI in women
Ascending infection of urethra usually from sex (honeymoon cystitis)
Hazy lung fields, cough, dyspnea, fever, malaise in setting of farming or bird care
Hypersenstivity pneumonitis (bird fancier's lung or famer's lung)
Tx for
Hypersensitivity pneumonitis
Avoidance of antigen
Arthritis, lesions on shins, bloody diarrhea, P-ANCA positive
Ankylosing spondylitis and Ulcerative colitis share this HLA type
Most common sites of thrombus for PE
1) Iliac
2) Femoral
3) Popliteal
Elevated alk phos and bowed legs on xray
Paget's disease
RUQ pain, mildly elevated liver enzymes, firm hepatomegaly.
Mets to the liver (usually from GI)
High fever, chills, tenosynovitis, migratory polyarthralgias and pustular lesions on extremities, negative BCx
Disseminated gonococcus
4th and 5th finger decreased sensation and weakened grip
Ulnar nerve syndrome
(medial elbow compression)
Heel pain, +/- shoulder, hip, and shin pain
Enthesitis due to Ankylosing spondylitis
Blood lab findings in Vit D malabsorption (3)
1) V. Low phosphate
2) Low Ca
3) High PTH
Which vitamin increases INR
Vitamin E
High Ca, low Phosphate, abdominal pain, constipation, fatigue, excessive urination, urinary stones
Hyperparathyroidism predisposes to what arthralgia?
Which joint does pseudogout usually affect
Intermittent abdominal distension, flatulence, greasy stools, iron deficiency anemia
Celiac sprue
Skin condition associated with celiac sprue
Dermatitis herpetiform
Dx study for
BRBPR under 50 with no risk factors for colon cancer
Most common causes of osteomyelitis in sicke cell (2)
1) Salmonella
2) Staph
Smudge cells
Cause of erectile dysfunction following urethral surgery
Mechanism of fatty liver
Insulin resistance increases lipolysis leading to fat accumulation in hepatocytes
High PaCO2 and low PaO2
Alveolar hypoventilation
COPD with sudden onset of catastrophic worsening of respiratory sx
Pneumothorax (dilated alveolar blebs rupture in the pleural space)
Most common cause of osteomyelitis in children
Staph aureus
Air fluid levels in the gall bladder in elderly diabetic male
Emphysematous cholecystitis
Slow onset hazy visual loss
Focal site of increased radio active iodine uptake with otherwise decreased uptake in the thyroid
Toxic nodule
HAs worse in morning, n/v early in day, vision changes, somnolence, confusion, hypertension and bradycardia
Increase intracranial pressure
Bilateral lower extremity weakness following termporal arteritis tx
Steroid induced myopathy
Dx study for
New onset dyspepsia in
1) Over 55
2) Alarm sx of weight loss, dysphagia, vomiting
3) All others
1) Upper endoscopy
2) Upper endoscopy
3) PPI or H Pylori serology
Insidious onset dry cough in absence of constitutional sx, also with skin lesions and uveitis in african american women
Lower leg discomfort at night relieved by massage or movement of them
Restless leg syndrome
Tx for
Restless leg syndrome
Dopamine agonists
Dx study for
Adult with recurrent bacterial infections
Serum Ig levels to consider humoral immunity deficiency
Dx study for
Cancer patient with back pain and neurologic sx particularly bowel or bladder incontinence
MRI of spine
Tx for
Cancer patient with back pain and neurologic sx particularly bowel or bladder incontinence
Dexamethasone to decrease swelling on spine
(while awaiting MRI results)
Tx for
Lactic acidosis from septic shock (3)
1) Fluids
2) Vasopressors if necessary
3) Abx
In patients refractory to HTN tx always treat their lifestyle problems before adding more therapeutics
HA, n/v with enclosed air space occupation
Carbon monoxide poisoning
Dx study for
Elderly pt with new onset delirium
Urinalysis and electrolytes
Elderly male with dysphagia, regurgitation, foul-smelling breath, aspiration, possibly palpable mass
Zenker's diverticulum
Chest scan showing primary nodules with a halo sign
Acute pneumonia, cough, fever malaise, hilar lymphadenopathy on CXR, recent travel to Southeastern, mid Atlantic, and central US
Pneunomia with arthralgias recent travel to SW US
Liver cysts with multiple cysts inside of the cysts.
What exposure?
Hydatid cysts from Echinococcosis.
Sheep exposure
Right sided effusion with cirrhosis
Hepatic hydrothorax
Tx for
Hepatic hydrothorax
Tx Thoracentesis and diuretics
If refractory, TIPS
Common drugs that cause hyperkalemia
1) ACE-Is
3) K sparing diuretics (spironolactone and amiloride)
Hematemesis following multiple episodes of non-bloody vomiting
Mallory Weiss tear (ruptured submucosal arteries of distal esophagus)
Which HepB serology is most useful to determine acute Hep B infection? (2)
ABsAg and anti-HBc antibody
Corneal vesicles and dendritic ulcers
Herpes simplex keratitis
New onset lupus
Get kidney biopsy then start methylprednisone
Verrucuous, skin colored or pink papules around anus
Anogenital warts (HPV)
Tx for
Anogenital warts (HPV)
Tx for
Dopamine agonists (bromocriptine or cabergoline)
GERD with dysphagia, weight loss, odynophagia
Upper endoscopy
Prophylaxis for MAC when CD 4 count less than 50
Azithromycin for Mycobacterium avium complex
Most common type of thyroid malignancy
Papillary carcinoma of the thyroid
Normocytic anemia, hypercalcemia, renal failure, elevated total protein
Multiple myeloma
Dx study for
Multiple myeloma
Serum immunoelectrophoresis
Which compound is increased in androgen producing adrenal tumors?
FEV1/FVC ratio decreased and normal DLCO
Potential fatal side effect of succinylcholine
Ca low and Phos low
Vit D deficiency
Ca low but Phos high.
1) If If PTH v high
2) If PTH high
3) If PTH low
1) If If PTH v high - Pseudohypoparathyroidism
2) If PTH high - Renal failure
3) If PTH low - Hypoparathyroidism
Pronator drift localizes the lesion to where?
Upper motor neuron
What happens to Ca in alkalemia
It binds better to albumin causing effective hypocalcemia despite normal total serum Ca levels
Post partum woman fails to lactate with pituitary hormonal deficiency
Sheehan's syndrome (ischemic necrosis of pituitary gland following shock from childbirth)
Tender regional LAD, following cat laceration
Azithromycin for cat scratch disease (bartonella)
Hypercalcemia, constipation, abdominal pain, weight loss, polyuria, polydipsia
Vit D toxicity
Pruritic, papules and plaques on face, scalp, chest, and extensor surface of baby sparing diaper area
Atopic dermatitis
Very high Ca, low PTH, high Phosphate
Hypercalcemia of malignancy
Dx study for
Curtain drop loss of vision
Dx is amaurosis fugax and is usually caused by carotid embolization.
Get carotid artery doppler.
Ring shaped scaly patch with central clearing and distinct border
Dx - Tinea corporis
Tx - Antifungal cream (e.g. terbinafine)
Tx for
Myasthenia crisis
Endotracheal intubation and withdrawal of anti-cholinesterases
Pneumonia with targetoid lesions on extremities
Lesions are erythema multiform and the patient has mycoplasma pneumonia
Partially acid fast, filamentous, branching rods on sputum exam
Mgmt for
Severe symptomatic hyponatremia.
And what to watch out for...
1) Hypertonic saline
2) Central pontine myelinosis from too rapid increase in serum osmolality
What is low in macrocytic anemia when there is peripheral neuropathy?
Cobalmin (Vit B12)
id est not Folate which can correct the anemia but not the neuropathy
Progressive dyspnea and hypoxia in AIDS patient
Pneumocystis jiroveci
Vertigo, tinnitus, vomiting, nystagmus
Meniere's disease
Tx for
Meniere's disease
Salt restriction and caffeine, nicotine, and alcohol avoidance
Loud S1 and mid diastolic rumble
Mitral stenosis
Clotting history with lupus signs
Antiphospholipid antibody sx (lupus anticoagulant positive which is actually a hypercoagulable state)
Dx study for
Lupus anticoagulant
Russel viper venom test
Which way does PTT move in lupus anticoagulant
PTT increases (paradoxically bc hypercoagulable)
Drug whose side effect profile is
Nephrotoxicity, hyperkalemia, hypertension, gum hypertrophy, hirsutism
Drug whose side effect profile is
Nephrotoxicity, hyperkalemia, hypertension,
Drug whose side effect profile is diarrhea, leukopenia, hepatotoxicity
Drug whose side effect profile is bone marrow suppression
Tx for
Aortic dissection
Mgmt for
Targetoid lesions and malaise, HA, muscle pain, and joint pain
Doxycycline for Lyme (not testing necessary)
Weight loss, gynecomastia, testicular atrophy, telangiectasias
Chronic liver disease
(hyperestrogen state due to reduced clearance by shitty liver)
Hx of sudden cardiac death with syncopal episodes and hearing impairment
Long QT
Tx for
Long QT
Beta blockers
Hypercalcemia and stomach ulcer
Hyperparathyroidism and zollinger-ellison sx suggestive of MEN1
Diagnostic criteria for ARDS
1) Acute respiratory distress in setting of predisposing condition sepsis, pneumonia etc
2) Bilateral infiltrates
3) Normal PCWP
Normal FEV1/FVC with decreased DLCO
Interstitial lung disease
Clopidogreal indications post STEMI
1) Post UA/NSTEMI for 12 months
2) Post PCI 30 days for bare metal and 12 months for DES
Contralateral half body pain and temperature loss with cranial nerve defect
Lateral medulla
Contralateral half body paralysis and proprioception and vibratory loss
Medial medulla
Dx study for
Cough, mucopurulent sputum, hemoptysis that responds to abx
High resolution CT scan for Bronchiectasis
Terrible T's of anterior mediastinal mass (4)
1) Thymoma
2) Teratoma
3) Thyroid cancer
4) Terrible Lymphoma
Anterior mediastinal mass with elevated alpha feto protein and elevated beta human chorionic gonadotropin
Nonseminomatous germ cell tumor
Anterior mediastinal mass with elevated beta human chorionic gonadotropin
Prolonged PT before a prolonged PTT
Vit K deficiency
Grid test looks like curved lines
Macular degeneration
Parkinson like rigidity, psychosis, hallucinations, confusions, REM disorder, parkinson sx worse with neuroleptic (anti-psychotics)
Lewy body dementia
Early diastolic murmur
Aortic regurg
DEXA screening recs
1) Women over 65
2) Women 60-64 if risk of fracture
Yellow fever vaccine is for what countries
Sub saharan africa and S America
Vaccines in HIV
1) Tdap every 10 years
2) Pneumovax (revaccinate in 5 years)
3) Flu annually
4) Hep A and B
5) Meningococcus if asplenic or in college/military
6) HPV (only in high risk individuals)
7) H Flu (only if not given in infancy)
8) MMR and varicella if CD4 over 200
Recs for treated cervical neoplasia
1) Pap smear +/- colposcopy +/- curretage every 6 months until 3 negative results in a row
2) Then resume normal screening for age
AAA rec
ULTRASOUND OF ABDOMEN in all men 65-75 who ever smoked
Pressure ulcer preventino
Repositioning every 2 hours
Mammography frequency
Every 2 years from 50-75 years old
Pneumovax recommendations
1) Everyone over 65
2) Adults under 65 with cardiovascular, pulmonary, hepatic, renal, diabetes, or immunosuppressin
2a) Under 65 need a booster over 65
When colonoscopy starts for 1st degree relative
10 years before their onset
Give hep B vaccine and Ig if exposed with no known immunization history
Vaccines for hepatic disease
1) Tdap
2) Flu
3) Pneumovax
4) Hep A and B
Bladder cancer screening in at risk population
Not recommended ever
Onion skin appearance with moth eaten mottled appearance on bone xray
Ewing's sarcoma
Which metal causes type IV hypersensitivity
Auto-Antibodies in scleroderma (2)
1) Anti-Topoisomerase
2) ANA
Mgmt for
Familial colonic polyposis
Hematuria, deafness, and fhx of renal failure
Alport's syndrome
Pain mgmt in past drug abuser
Opioids (do not deny despite history)
Most common complication of PUD
Dysphagia, CP, food regurgitation, dilated esophagus, bird's beak deformity
Normal Ca, normal alk phos, low phosphate, and normal vit D with rickets
X-linked hypophosphatemic rickets
(phosphate wasting)
Aphasia localized an infarct to where?
Cortex usually on the Left side (dominant side given R handed)
Back pain, anemia, renal dysfunction, elevatd ESR
Multiple myeloma
High alk phos, normal liver tests, hearing loss
Paget's disease
Intense, focal back pain without neurological symptoms not relieved by rest
Vertebral compression
Apophyseal joint arthritis
Ankylosing sponylitis
Intervertebral disc degereneration
OA of the spine
Falling into chairs, can't raise arms above head, light tremors
Most common type of kidney stone
Calcium oxalate
Hip pain in setting of corticosteroids
Avascular necrosis of femoral head
Mgmt - needs MRI
Circumferential narrowing of distal esophagus with dysphagia
Peptic stricture
Dietary recs for kidney stones (4)
1) decreased protein and oxalate
2) Decreased Na
3) Increased fluid
4) Increase Ca
PAinful, rubbery nodule on eyelid
Mgmt - Biopsy
Mucoid, Gram negative rod
Weakness, weight loss, skin color changes
How to diagnose follicular cancer of thyroid from just adenoma
Invasion of capsule
Mucopurulent urethral discharge, no bacteria on culture
(think gonorrhea if purulent discharge)
Hypersegmented neutrophil
Megaloblastic anemia
Increased metabolite differences in Vit B12 and Folate deficinecy
Vit B 12 deficiency: Increased homocysteine AND methlymalonic acid
Folate deficiency: Just Homocysteine elevated
Motor hemiparesis of face, arm, and leg without other neurologic deficits
Internal capsule
Hemiplegia, aphasia, hemineglect
Middle cerebral artery
Contralateral weakness of lower extremities mostly, emotional disturbance
Anterior cerebral artery
Contralateral hemiplegia with Ispilateral cranial nerve involvement
Vertebrobasilar system (brain stem)
Most likely cancer in asbestosis
Bronchogenic carcinoma
(Not mesothelioma!)
Ascending paralysis, areflexia, 3-4 weeks after URI or gastroneteritis, CSF shows albumino-cytologic dissociation
Guillan barre
Guillain Barre
IV Immunoglobulins and plasmapharesis
Pruritis, tense bullae, uriticarial plaques, with IgG and C3 along basement membrane zone
Bullous pemphigoid
Follicular conjunctivitis with neovascularization of conjunctiva
Trachoma (chlamydia thrachomatis infection)
Side effect of Anti thyroid meds in grave's disease
Agranulocytosis and allergy
What causes orthostatic hypotension in elderly?
Decreased sensitivity of baroreceptors
AKI due to possible urinary retention
Straight cath (not US for residual volume)
Esophagitis in HIV
Fluconazole empiric tx for candidiasis
If refractory then upper endoscopy for CMV
Solid testicular mass
Radical removal of testis and cord
Prophylaxis for splenectomy
1) Pneumovax, h flu, meningococcus vaccines before surgery
2) Daily oral PCN for 3-5 years after
Painless hematuria
Bladder mass
People with hemachromatosis are suscpetible to what organism
Progressive proximal weakness with elevated serum creatinine kinase
Myositis and dermatomyositis
Tx for
Tx for
Metoclopramide (prokinetic)
Rapidly developing (over 3 months) male characteristics in woman
Hormone producing tumor
Serum testosterone --> ovarian source
Serum Testosterone and DHEAS --> Adrenal source
Fever, rash, occipital or posterior cervical LAD, and arthritis
Findings in OA
1) Crepitus
2) Bony enlargment
3) Bony tenderness
4) Stiffness without warmth
5) Over 50 yo
Need 3 for a diagnosis
Strongest risk factor for stroke
then smoking and DM
Traveler's diarrhea
E coli
Back pain on trauma with ankylosing spondylitis
Vertebral fracture
How to diagnose parkinson's
Physical exam:
HCG and AFP elevated
Nonseminomatous tumor
Acute Migraine tx
Prochlorperazine, chlorpromazine, or metoclopramide
Auto antibody in Primary biliary sclerosis
Anti-mitochondrial Ab
Autoimmune destruction of intrahepatic bile ducts with cholestasis
Primary biliary sclerosis
Lite's criteria for Exudate
1) Total protein ratio more than 0.5
2) LDH ratio more than 0.6
3) LDH greater than 2/3 of upper limit of normal
Decreased breath sounds on left after intubation
Accidental intubation of tight main stem bronchus
Renal complication of Hepatitis
Membranoproliferative glomerulonephritis
Causes of pulsus paradoxus (3)
1) Cardiac tamponade
2) Tension pneumothorax
3) Severe asthma
Vertigo, vomiting, and occipital headache
Cerebellar stroke
Hot potato voice and deviated uvula
Aspiration of abscess
Large basophilic cells (atypical lymphocytes) with negative monospot
Down and out eye with ptosis in diabetic
Ischemic CNIII palsy
BCx Then empiric Abx then if refractory US
Wedge shaped consolidation on CT scan of lungs
Pulmonary embolism
Respiratory monitoring in Guillain barre
Bedside Vital Capacity
40 yo male with back pain that is worse in morning and improves during the day
Ankylosing spondylitis
Tx for
Acute cholangitis
Supportive care and Abx
ERCP for biliary drainage and or to remove stone
Chronic hematomas and joint swelling
Dehydration: Crystalloids or colloids
Tx for
Cellulitis with systemic signs
IV Nafcillin
Tx for
Multiple sclerosis
Seizure without LOC or amnesia
Simple partial seizure
Seizure with LOC, aura, and autamatisms
Complex partial seizure
Seziure with LOC, tonic clonic activity
Partial seizure with secondary generalization
Mgmt for
Cat bite
Amox clav for pasteurella
Polyuria in sickle cell trait or disease
3 Mechanical complications post MI
1) MR due to papillary muscle rupture
2) LV free wall rupture
3) Interventricular septal rupture
Hypothyroidism, HAs, bitemporal blindness
ST elevation in II, III, and AVF
Right Coronary Artery occlusion
There are no pathologic changes in IBD!!
PPD cutoffs
1) Healthy people: 15 mm
2) 10mm for immigrants, drug users, high risk employees, diabetics
3) 5 mm for HIV, recent exposure to TB, TB on CXR, immunosuppressed PTs
Tx for
Latent TB
Isoniazid for 6 months
Tx for
Active TB
Iszoniazid, INH, rifampin, pyrazinamide for 8 weeks then 4 more months of isoniazid and rifampin
Essential tremor
Absent at rest but present with intentional movement
Tx for
Essential tremor
Beta blockers
Urinary side effects of antihistamines
Anticholinergic effect causes detrussor inactivity
Tx for
Gastric MALT without metastases
Triple H pylori regimen
(omeprazole, clarithromycin, and amoxicillin)
Dyspnea, fatigue, and peripheral edema following viral infection
Dilated cardiomyopathy due to viral myocarditis
For 1st degree heart block
No tx
Medial knee pain without positive valgus stress test
Anserine bursitis
Recurrent attcks of focal neurological sx at non predicatable intervals
MRI for MS
Initial presentation of impaired gait, dementia, and urinary incontinence
Normal pressure hydrocephalus
(Alzheimer's will have more memory and visuospatial impairments)
Nephrotic syndrome in children with Hep B
Membranous glomerulonephritis
Electrolyte impairments in alcoholism
Hypokalemia with exacerbating hypomagnesemia
also hyphophosphatemia
Pain and stiffness in the neck, shoulders, and pelvic girdle with morning stiffness and elevated ESR
Polymyalgia rheumatica
Tx for
Polymyaglia rheumatica without giant cell arteritis
Low dose prednisone
What drug to avoid in preexisting lung disease
Amiodarone (causes lung toxicity)