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158 Cards in this Set

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these three suggest post nasal drip:
patient's recent upper respiratory infection, nasal exudate, and cobblestoning in the posterior pharynx
tx for postnasal drip
antihistamine/decongestant
Three ways to diagnose diabetes
symptoms of diabetes plus a casual plasma glucose concentration of 200 mg/dL or greater; a 2-hour plasma glucose concentration of 200 mg/dL or greater during an oral glucose tolerance test; and a fasting plasma glucose concentration of 126 mg/dL or greater
use of Fructosamine in DM
used to monitor glycemic control. It provides assessment of glycemic control over 3 weeks.
The infection begins with pustules on a red base that become eroded and confluent. Eventually, the rash evolves into a sharply demarcated, bright red patch (or patches), with small, pustular lesions at the periphery (satellite lesions).
Cutaneous candidiasis
Tinea cruris
subacute and chronic dermatophyte infection of the skin, involving the groin, pubic region, and inner thighs. Most patients who have tinea cruris also have tinea pedis. The condition is recognized as light pink to red papules and thin plaques, with scaling borders. The lesion has an “active border,” meaning that the border has more redness and scaling than the inner portion of the lesion, which may have central clearing.
ill defined (lack a distinct border), yellowish-red, and are of varying size, and are usually associated with a greasy or dandruff-like scale. It most commonly occurs on the scalp, central face, upper mid-chest, and other oily areas of the body.
seborrheic dermatitis
test for cushings dx
24-hour urinary free cortisol measurement
rhinitis medicamentosa
Chronic use of a topical nasal decongestant (for example, oxymetazoline) will result in rebound swelling after the vasoconstriction wears off. This condition can occur after 3 to 4 days of use.
presentation of rapidly progressive glomerulonephritis
glomerulonephritis with nephritic urine sediment, acute renal failure developing over a few days to weeks, and glomerular crescents on renal biopsy
ST segment elevation in leads V2, V3, I, and aVL
Anterior myocardial infarction
ST segment elevation in leads I, VL, V5, and V6
lateral infarction
Pericarditis can be distinguished from acute infarction by
the absence of Q waves, the concave and upward slope of the ST segments (infarction is associated with convex upward slope), and the absence of ST segment depression in reciprocal leads.
ST segment depression and prominent R waves in the anterior precordial leads (V1 through V3).
posterior MI
None
Pericarditis is characterized by
an elevation of ST segments, with upward concavity in many leads, including standard limb leads. The T wave remains upright at first, except in lead III, where it may be inverted. Later, there is widespread T wave inversion, but by this time, the ST segments have returned to baseline.
new onset of dyspepsia symptoms after age 50 w/u
upper endoscopy
maltese cross on urianalysis
fat droplet, assoc with nephrotic range proteinuria
Urinary eosinophils assoc with
acute interstitial nephritis, rapidly progressive glomerulonephritis, and renal atheroemboli.
pneumobilia
air in billiary tract
The ability to probe a diabetic foot ulcer directly to bone is correlated with
osteo
tx for c dif
metronidazole or oral vancomycin.
? For diagnosis and control bleeding in a patient with rapid lower gastrointestinal bleeding
arteriography
worst prognosis melanomas
located on the palms and soles
better prognosis melanomas
extremities compared with the trunk or face
Risk factors for drug-resistant S. pneumoniae
include age greater than 65 years, use of β-lactam antibiotics within the past 3 months, immunosuppression, multiple medical comorbidities, and regular exposure to a child in day care
Risk factors for enteric gram-negative organisms (lung)
all of those for S. pneumoniae listed earlier, as well as regular alcohol consumption and residence in a nursing home
Risk factors for P. aeruginosa
include bronchiectasis, daily corticosteroid therapy, recent broad-spectrum antibiotic therapy, and severe malnutrition.
Risk factors for Aspergillus pneumonia
include prolonged neutropenia or other significant immunosuppression, including human immunodeficiency virus infection.
Risk factors for anaerobic infections (lung)
significant witnessed or suspected aspiration
met prostate cancer tx
androgen ablation, if/when symptomatic
single most helpful distinguishing characteristic of tinea corporis
its peripheral expansion with central clearing, producing an annular lesion.
when to start statins
Intervention should be pursued for a serum LDL cholesterol level greater than 160 mg/dL, with medication recommended if the level is greater than 190 mg/dL and optional if the level is between 160 and 189 mg/dL
symptoms warranting upper endoscopy in dyspepsia
anemia, weight loss, anorexia, recurrent vomiting, dysphagia, and gastrointestinal bleeding.
who's considered for endocarditis prophylaxis
Persons with Doppler-demonstrated mitral regurgitation or an audible murmur of mitral regurgitation are considered to be at moderate risk for endocarditis and are candidates for dental prophylaxis, although mitral valve prolapse without regurgitation generally is not considered an indication for prophylaxis.
when to prophylax dental endocarditis
one dose of an antibiotic given 1 hour before the procedure.
None
urticaria
red, raised, pruritic papules and plaques, and each individual lesion lasts for less than 24 hours.
Sweet's syndrome
uncommon, recurrent skin disease characterized by painful plaques and inflammatory papules, usually associated with systemic symptoms, such as fever and arthralgias. Lesions of Sweet's syndrome may show urticarial plaques, but the individual lesions last for more than 24 hours.
Patients with diabetes or a history of stroke, coronary artery disease, or peripheral artery disease LDL target
between 70 and 100 mg/dL
who gets a pap smear/year
Women who have multiple sex partners, have a history of abnormal Pap tests, or have recently been diagnosed with a sexually transmitted disease are at higher risk for cervical cancer
interval for pap smears in low risk pt
q 3yrs
when to resect met colon (primary)
bleeding or obstuction
tx for met colon adeno
systemic chemo
HbA1c goal
6.5-7
in DM2, when sulfonourea fails?
add metformin (sensitizer)
most effective study for demonstrating a gastrinoma
octreotide scan
signs of marihuana use
panic attacks and gynecomastia
sympathomimetic syndrome
include tachycardia, hypertension, hyperthermia, mydriasis, agitation, and psychosis; seen w/cocaine
treatment of choice for drug-induced seizures
benzodiazepines
Patients with primary CNS lymphoma may be treated with
high-dose methotrexate and brain radiation.
Patients who are most likely to benefit from ACE inhibitors include
those with systolic dysfunction, anterior wall myocardial infarction, or clinical evidence of congestive heart failure.
what to add to asthma tx in addition to steroids
long acting b inhaler
peritoneal signs
fever, abdominal pain, tenderness to palpation, and preferential flexion of the hips and knees
where Coccidioidomycosis
southwest
atlantoaxial subluxation
hooting pains in her arms, hyperreflexia, and hypertonia secondary to erosion or stretching of the transverse ligament that holds the odontoid process in place anterior to the spinal cord
tx for restless leg syndrome
dopa agonist, iron (if def)
four causes of chest pain that can quickly lead to death:
acute myocardial infarction, aortic dissection, tension pneumothorax, and pulmonary embolus
osteoporosis definition
T score at or below −2.5
osteopenia def
T score between –1 and –2.5
vagal rx vs cardiogenic shock post mi
in shock: elevated jugular venous pressure, rales, and an S3 gallop
tx for vagal response post MI
atropine
peripheral blood smear shows a nucleated red blood cell
sickle cell disease and thalassemia, and with marrow-infiltrative diseases, such as myelofibrosis or metastatic cancer
Actinic keratoses
1-to 3-mm, elevated, flesh-colored or red papules surrounded by a whitish scale
classically presents as a pink, pearly or translucent, dome-shaped papule with telangiectasis
basal cell carcinoma
appearance of a new varicocele in a man older than 50 years that does not reduce when the patient lies down suggests
obstruction of the venous drainage
Which laboratory studies would support prior vaccination for hepatitis B virus?
Antibody to hepatitis B surface antigen
elevation in the hemoglobin A2 level is consistent with
β-thalassemia
features of Henoch-Schönlein purpura
joint pain, abdominal pain, rash on the lower extremities showing vasculitis and IgA deposition, and renal disease with nephritic sediment.
Fructosamine
is a short-term measure of average blood glucose
thoracic aorta aneurism Dx with
helical computed tomography scan
empiric tx for sbp
cephalosporin or a fluoroquinolone
delta–delta
winter's formula
bicarb*1.5 + 8 +/- 2
malaria prophylaxis
mefloquine, doxycycline, and atovaquone/proguanil
classic site for hypertensive hemorrhage
basal ganglia, thalamus/internal capsule, pons, and cerebellum.
Acinetobacter baumannii tx
carbapenems
Seminoma is associated with elevation of
only β-human chorionic gonadotropin.
Empiric antimicrobial therapy for pneumococcal meningitis
vancomycin plus a third-generation cephalosporin (either cefotaxime or ceftriaxone)
Megestrol acetate therapy
appetite stim, in cancer cachectic pts
Gottron's papules
dermatomyositis, red to purplish plaques on the dorsal hands, more prominent over the joints
next step in abnormal prostate exam
biopsy
inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, spondylitis) morning stiffness usually lasts more than
30 mins
First-degree atrioventricular block is associated with a PR interval
exceeding 0.20 seconds
diagnostic for ventricular preexcitation by an accessory atrioventricular connection
short PR interval, a prolonged QRS duration, and slurred onset of the QRS (delta wave) interval
Triamcinolone ointment is useful in the treatment of
inflammatory dermatoses
tb conversion time after exposure
4 to 7 weeks.
pe tx duration
3-6 months
herapy of choice for Listeria meningitis
ampicillin or penicillin G, combined with an aminoglycoside.
Condylomata acuminatum
HPV
Condylomata latum
treponema palludim/syphilis
Murmurs of dynamic subvalvular left ventricular outflow obstruction associated with hypertrophic cardiomyopathy __________ during Valsalva maneuver.
increase
First-degree atrioventricular block is also associated with acute reversible conditions,
inferior myocardial infarction, rheumatic fever, and digitalis intoxication
acute management of DM2
insulin
age of cancer occurrence for genetic testing
60
Systemic inflammatory response syndrome
two of the following conditions: temperature greater than 38 °C (100.4 °F) or less than 36 °C (96.8 °F), heart rate greater than 90/min, respiration rate greater than 20/min or arterial blood Pco2 less than 32 mm Hg, and leukocyte count greater than 12,000/µL or less than 4000/µL or with more than 10% immature band forms.
Sepsis
The systemic inflammatory response to a documented infection. In association with infection, the manifestations of sepsis are the same as those described for SIRS.
Severe sepsis
Sepsis associated with organ dysfunction, hypoperfusion, or hypotension
Septic shock
A subset of severe sepsis, defined as sepsis-induced hypotension, despite adequate fluid resuscitation, plus the presence of perfusion abnormalities. Patients receiving inotropic or vasopressor agents may no longer be hypotensive by the time they develop hypoperfusion abnormalities or organ dysfunction; however, they would still be considered to have septic shock.
anterior myocardial infarction
ST segment elevation in leads V2, V3, I, and aVL
Inferior myocardial infarction
ST segment elevation in leads II, III, and VF
lateral infarction
ST segment elevation in leads I, VL, V5, and V6
first-line regimen for chemoprophylaxis for TB
Isoniazid, 300 mg daily, for 9 months
Pain that occurs with walking, but not at rest, and “snapping” sensation is characteristic of
iliotibial band syndrome,
Meralgia paresthetica
pressure on the lateral femoral cutaneous nerve as it perforates the fascia of the lateral thigh, and is most common in overweight persons. It may cause pain, but dysesthesia is typically more prominent, and these symptoms are unrelated to activity.
trochanteric bursitis
pain of trochanteric bursitis may occur with walking, but is usually most severe when lying on the affected hip. On examination, tenderness is localized over the greater trochanter.
tx for carpal tunnel, nerve?
wrist splint, median nerve
isk factors for stroke in patients who have atrial fibrillation
history of stroke, a history of myocardial infarction, a history of hypertension, age older than 65 years, and diabetes
splenic artery pseudoaneurysm is manifested by blood collecting in the ______ side of the abdomen
left
gastroduodenal artery pseudoaneurysm is manifested by blood collecting in the ______ side of the abdomen
right
which CHF meds not used in pregnancy
ACE/ARBs
delta-delta in proximal renal tubular acidosis
<1
antidepressant w/o weight gain
buproprion
angular cheilitis,
s characterized by fissuring, erythema, and crusting at the angles of the mouth. It occurs in skin folds exposed to moisture, resulting in macerated skin. Candida overgrowth is common. This lesion is most commonly found in older people with ill-fitting dentures and in patients with mandibular atrophy or conditions associated with excess salivation.
tx for HSV encephalitis
IV acyclovir
a sawtooth pattern is present in leads II, III, and VF
a flutter
influenza vaccination
yearly
Coal tar is a treatment for
psoriasis
C-ANCA correlates best with
Wegener's granulomatosis
P-ANCA correlates with
microscopic polyangiitis and Churg-Strauss syndrome.
Anserine bursitis
finding of focal tenderness on the upper, inner tibia, about 5 cm distal to the medial articular line of the knee.
empiric tx for TB
Isoniazid, rifampin, ethambutol, and pyrazinamide
indications for total knee replacement in patients with osteoarthritis
pain and limitation of function to a degree sufficient to interfere with enjoyment of life.
mild persistent asthma
symptoms that recur more than 2 days per week and more than twice per month at night
erythroplakia
velvety, red mucosal abnormality
time for tPA intervention in stroke
within 3 hrs of last seen normal
prophylaxis for people at high risk for influenza
vaccine + 2 weeks of amantadine
LBBB
m in v4, paradoxically split s2
tx for excersice asthma
albuterol before
In the absence of cor pulmonale, oxygen is prescribed when the Pao2 is
55 mm Hg or less.
findings most predictive of the clinical outcome in cryptococcus meningitis in HIV
intracranial pressure
when to treat hypomagnesemia
Mg<1, symptomatic; necessary to correct other lites
ruptured baker's cyst mimics
DVT
preprandial target glucose values in DM1
80 to 120 mg/dL
bedtime values of glucose in DM1
100 to 140 mg/dL
Tx for cocaine tachy
diazepam
Manage acute atrial fibrillation associated with hemodynamic compromise
zap/cardiovert
diagnosis of bone met lesions to r/o spine compression
MRI
vegetative state
ondition of complete unawareness of the self or the environment, accompanied by sleep–wake cycles and preservation of brain stem and hypothalamic autonomic functions
normal TSH
.5-5
De Quervain's tenosynovitis
pain localized to the lateral wrist over the distal radius and a positive Finkelstein's test
two important conditions in which hypertrophic osteoarthropathy can be seen
Neoplasm (pulmonary, gastrointestinal, lymphoma) and infection
the serum-to-ascites albumin gradient in ascites from cirrhosis
>1.1
most likely noncompressive cause of right upper lumbar radiculoneuropathy
diabetes
recommendation to perform coronary angiography in patients who have undergone successful thrombolysis and meet the following criteria:
esidual myocardial ischemia (post–myocardial infarction angina, provocable ischemia on stress testing), hemodynamic instability, or clinical heart failure, with an ejection fraction of less than 40%.
It is usually associated with a 24-hour urinary potassium excretion greater than 30 meq in the setting of a serum potassium concentration less than 3.0 meq/L
primary hyperaldo
most common organisms infecting the airways of patients with bronchiectasis
Pseudomonas aeruginosa and Staphylococcus aureus
empiric antibiotic treatment directed at P. aeruginosa
fluoroquinolone and an aminoglycoside
tx for alcohol dependance
Naltrexone
tx for varicella pneumonia
IV acyclovir
competitively inhibit creatinine secretion in the distal tubule
Trimethoprim and other organic cations, such as cimetidine,
rotator subacromial bursitis (or cuff tendonitis)
tenderness over the supraspinatus tendon, nocturnal pain, and pain on abduction past 40 degrees.
treatment for actinic keratosis
Topical 5-fluorouracil
empiric therapy for treatment of community-acquired pneumonia for patients in the intensive care unit
recommend either cephalosporin/macrolide or cephalosporin/fluoroquinolone combinations
Rocky Mountain spotted fever
fevers, chills, and a petechial rash, which are characteristic of a rickettsial infection.
when paliative chemo in met lung adeno
if pt oob>50%
tx for anthrax w/CNS involvement
ciprofloxacin, doxycycline, clindamycin, and vancomycin
DVT prophylaxis for post op DVT
3 months warfarin
target cholesterol <130
h/o smoking, a high-density lipoprotein cholesterol level of less than 40 mg/dL, or a family history of premature coronary artery disease
target cholesterol <160
just high LDL