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438 Cards in this Set
- Front
- Back
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TX for scabies
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Permethrin, low dose topical steroids
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TX for molluscum contagiosum
If genital? |
usually resolves spontaneously. if Gentital: Curretage, liquid nitrogen
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30% of skin involved, (+) Nikolsky, oral lesions. Dx? Common Causes?
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Toxic Epidermal Necrolysis
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10% of skin involved, target appearing rash
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Steven Johnsons
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Child <6, sandpaper rash, +Nikolsky, bullae, facial edema
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SSSS
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Skin condition seen in Parkinsons
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Seborrheic Dermatitis
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Chronic scratching, thickened plaques, hyperpigmentation
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Lichen Simplex Chronicus
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TX for tinea corporis
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Terbenafine
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fever, hypotension, rash that desquamates
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Toxic Shock Syndrome
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Hypopigmented lesions, periorificial, fingertips, TOTAL depigmentation
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Vitiligo
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Hypopigmented macules, Do NOT tan, scale on scrapping
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Tinea Versicolor
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Tx for tinea versicolor
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Selenium sulfide
Ketoconazole Shampoo |
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Painful swelling on eyelid, , nodular rubbery lesion?
If persistant, can lead too? Mimics what other condition? Dx Test? |
-Obstruction of Melbomian gland-chornic granulomatous
-Melbomian gland cancer -BCC Histopathology by biopsy |
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HSV 1/2 infection of hand, dentist?
TX? |
Herpetic Whitlow
Acyclovir, Bacitracin |
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Tailors with needle prick on finger that turns into an abscess?
TX? |
Felon
Tx: Incision, drainage, cephalosporin |
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Sandpaper texture paule on sun exposed areas
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Actinic Keratosis
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Stuck on appearing lesion, deep pigmentation/flesh colored, velvet/greasy surface
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Seborrheic Keratosis
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MAT for acromegaly?
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Oral glucose load. Measure GH, if it doesn't suppress, than + test (normally should suppress)
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Cause of adrenal insufficiency in developing countries?
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Adrenal TB
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Cause of adrenal insufficiency in developed countries?
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Autoimmune
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Decrease Calcium
Increase Phosphate Increase PTH DX? |
Secondary Hyperparathyroidism (renal failure)
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Tx for Prolactinoma (initial)
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Carbergoline, bromocriptine
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Thyroid Nodule that has a normal/high TSH, what next?
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Diagnositc ultrasound
if it appears malignant, get FNA |
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Parathyroid, Pituitary, Pancreatic (ZE) tumors
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MEN 1
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Medullary thyroid cancer
Mucosal Neuromas Pheochromocytoma |
MEN IIB
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Medullary Thyroid Cancer
Pheochromocytoma Parathyroid RET |
MEN IIA
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BITx DKA?
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Normal saline, regular insulin (0.9%)
Potassium Correct underlying cause |
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What is the MC type of thyroid nodule?
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Colloid
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2nd MCC of thyroid nodule
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Follicular
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Pt with Hashimotos has + risk for
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Thyroid lymphoma
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Antibody in thyroid Hashimotos
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Antithyroid peroxidase antibodies
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Antibodies in Graves
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Thyroid stimulation antibodies
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When will you see low urine Chloride (<10)
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factitious diarrhea
vomiting |
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TX hypotensive pt with diabetes insipidus
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normal saline
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Increased Renin
Increased Aldosterone Seen in? |
Renovascular HTN
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Decreased potassium
Metabolic Alkalosis Increased urine Cl Normal blood pressure |
Bartters Syndrome
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CAH
Virilization Hypotension |
21-hydoxylase def
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CAH
Delayed puberty Hypertension |
17 hydroxylase def
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Virilization
Hypertension |
11 b-hydroxylase def
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Most reliable index for measuring response to TX in DKA
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Serum Anion Gap
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Type 1 diabetics get what kind of coma?
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High glucose
Hyperosmolor Normal anion gap No ketones |
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Labs seen in DKA
Glucose? PH? HCO3? |
>250
<7.3 <15-20 KETONES+ |
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Decreased Ca
Decreased VitD Decreased Ph Increased PTH |
Osteomalacia
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Decreased Ca
Increased Ph Decreased PTH |
Hypoparathyroidism
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Normal Ca, Ph and PTH
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Osteoporosis
Pagets |
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Increased Ca
Decreased Ph Increased PTH |
Primary hyperparathyroidsm
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Tx for diabetic neuropathy?
What if elderly pt with urinary retention and orthostatic hypotension? |
TCA (amitryp)
Gabapentin |
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Tx for severe hyponatremia (<120)
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Hypertonic saline (3%)
Correct at 0.5-1/hr |
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BP and lipid level in pt with DM?
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<130/80
<100 |
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Best initial TX for HBP +DM
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ACEI
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TX diabetic gastroparesis
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Metoclopramide (drug of choice)
Bethanechol Erythromycin |
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Best initial test for primary adrenal insufficiency
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Cosyntropin (ACTH) stimulation test
If Cortisol >20 you can rule out the disease! |
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Tx hypercalcemia do to immobilization?
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Bisphosphanates
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What tumor secretes calcitonin?
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Medullary Ca.
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Thyroid cancer that invades capsule and blood vessels?
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Follicular Ca
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Thyroid cancer with psamoma bodies?
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Papillary Ca
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Thyroid cancer with Hurthle cells?
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Follicular and Papillary Ca
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Urine calcium in primary hyperparathyroidism
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200 in 24h
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urine calcium in familial hypocalciuric?
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<100
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Indications for parathyroid surgery if asymptomatic hyperparathyroidism
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serum ca>1mg
<50 years old Bone density -2.5 Decreased renal function |
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Lab tests for organic erectile dysfunction?
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TSH
Testosterone PRL |
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Correction for calcium/albumin?
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1g in albumin/0.8 Calcium
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Name thyroid cancer from MC to least common?
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Papillary
Follicular Anaplastic Medullary Lymphoma |
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What is "Low T3 Syndrome?
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Sick Euthyroid
decreased peripheral conversion fo T4-->T3 |
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Tx for central DI
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Intranasal Desmopressin
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Tx for nephrogenic DI
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Indomethacin, HCTZ
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Tx for SIADH
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Demeclocycline
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Tx for lithium induced DI
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Amiloride
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Increased PTH
Increased Ca renal stones osteoporosis |
Primary Hyperparathyroidism
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Increased PTH
Decreased Calcium |
Secondary Hyperparathyroidsm
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Increased calcium
Decreased PTH Metabolic alkalosis Renal failure |
Milk Alkali syndrome
Increase Ca Intake |
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Labs in sarcoidosis?
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Hypercalcemia (+ conversion of inactive to active vitamin D-->+ absorption of calcium)
Decreased PTH Increased ACE |
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How many hours apart should you give sildenafil and alpha blocker
|
4
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Dx test for pagets
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+ alk phos
+ Urinary n-telopeptide |
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hypokalemia causes
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muscle cramps
polyuria (ADH not working) + glucose |
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MCC of primary hyperaldosteronism
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adenoma (NOT hyperplasia)
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Def in vitamin D
Defective bone mineralization |
Osteomalacia
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Defective mineralization of bone AND CARTILAGE
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Rickets
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Disordered skeletal remodeling
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Pagets
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low bone mass seen in?
Abundant mineralization? Fibrous replacement of bone? |
Osteoporosis
Increased Vit A Fibrous dysplasia |
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Dx Diabetes
fasting? 75g, 2h? Random? |
2 glucose fasting >/= 125
75 g glucose, 25 >200 Random glucose with symp >200 |
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decraesed serum osmolality (<280)
+ Urine osmolality (100-150) Hyponatremia |
SIADH
|
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Abnormalities seen in hypothyroidism
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+lipid, +muscle enzymes
Anemia Hyponatremia |
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First step in non-ketone hyperglycemia?
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normal saline then switch to 0.45 saline
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rapidly developement with virilization?
Dx test? |
androgen secreting neoplasm (ovary or adrenal)
Get testosterone and DHEA-S levels |
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hypokalemia, hypotension, hypernatremia
Dx test? Conf test? Next step after confirming? |
Primary hyperaldosteronism
Plasma aldos/Plasma renin >30 Saline salt load should suppress aldosterone Adrenal CT |
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Counterregulartory hormones (epi, norep, glucagon) react to nocturnal hyperglycemia?
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Samogyi Effect
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Decreased insulin sensitivity between 3-8 so hyperglycemia d/t GH release?
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Dawn Phenomenon
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Normal middle of the night glucose, hyperglycemia first thing in the morning?
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Waning of Insulin
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Restrictive Lung Disease has what pattern of PFT
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FEV1/FVC is Normal
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Causes of Restrictive Lung Disease
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Sarcoidosis
Silicosis Asbestosis Pulmonary Fibrosis Scleroderma Rhematoid Lung |
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Air fluid level in Gallbladder
Severe RUQ pain Fever Organism? Dx? Tx? |
Emphysematous Cholecystitis
Clostridium, Ecoli, Stap, Strep, Pseudo, Kleb Xray Fluid/electrolyte, Cholecystectomy, antibiotics (amp/sulbactam, pip/tazo, AG+clinda or metro) |
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If mom has HEP B, what to do for the infant?
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give hep b vaccine and IG right after birth
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Isolated + in alk phos
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pagets
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HEP C with HCVRNA, Tx?
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Tx IFalpha and ribavirin
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fatty liver with encephalopathy seen in child that took aspirin after URI/influenza/varicella
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Reye syndrome
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Labs in Reye Syndrome?
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Increased ammonia
Increased PT Hypoglycemia Metabolic acidosis |
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Tx for Reye syndrome
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glucose, FFP, mannitol
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Dx for spontaneous bacterial peritonitis?
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PMN>250
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Pt does not want Gallbladder sx, then what?
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Avoid fatty foods, ursodeoxycholic acid
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MC source of mets to liver
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GI
LUNG BREAST |
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MC type of gallstone? Other type?
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Cholesterol
Calcium bilirubinate |
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Congenital abnormality involving intra/extra hepatic ducts?
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Choledochal Cysts
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Congenital abnormality affecting intra hepatic ducts only?
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Carolis syndrome
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2 unconj hyperbilirubinemia
2 conj hyperbilirubinemia |
Gilberts, Crigler najjar
Rotor, Dubin Johnson |
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Dubin Johnson has increased urinary?
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Urine Coproporphyrin 1
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Zenkers Diverticulum
Best initial Test? Best Initial Tx? DO NOT TEST with? |
Barium
Surgical Resection NGT or Endoscopy |
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Tx for scleroderma
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PPI
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Mallory Weiss tx if bleeding doesn't stop spontaneously
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Epinephrine injection
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Bet initial Tx for GERD? If inaffective?
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Lifestyle modifications
PPI |
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Dx test for GERD?
Tx for refractory disease |
24-hour pH monitoring
Nissen fundoplication or suture LES |
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Best initial test for esophageal cancer?
Best initial tx? Follow tx with? Used to determine extent of spread? Used to determine content of lesion? |
Endoscopy
Surgical resection Chemo/5fu CT/MRI PET SCAN |
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Rings and Webs
Best initial test? Best initial tx if plummer? Be?t initial tx if schatzki ring/peptic stricture |
Barium
Iron replacement Pneumatic dilation |
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Diffuse esophageal spasm/nutcracker esophagus
Most accurate test? Test during episode? Shows? Tx? |
Manometry
Barium-corkscrew pattern CCB, nitrates |
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Esophagitis
Test if HIV (-) Test if HIV (+) CD4<100? If inaffective? |
Endoscopy
Fluconazole Endoscopy, Bx |
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Gram negative diplococci
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Gonorrhea
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Dx for gonorrhea?
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Cervical/rectal/urethral culture
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Tx for gonorrhea?
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Cefixime
(Add azithromycin for chlamydia) |
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MCC of blindness in the world
Dx? Tx? Symptoms? |
Chlamydia
PCR or DNA proble Single dose azithromycin Mucopurulent discharge |
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HPV 6&11 cause
MC location? Dx? Tx? |
condyloma accuminata
Cervix Visual Inspection Topical podophyllin, TCA acid, imiquimod Ablative: cryotherapy, laser, excise |
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Multinucleated giant cells-STD
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HSV
|
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Painless ulcer with rolled edge
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Syphilis
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Painless ulcer, ragged edge
Dx Tx |
Chancroid
Dx with culture Tx with Azithromycin |
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Painless ulcer, + nodes
Dx Tx |
Lymphogranuloma Venereum
Dx with culture Tx with doxy or erythro |
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Beefy red ulcer, painless
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Granuloma Inguinale
Doxy or TMP/SMX |
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2 PAINFUL STDs
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Herpes
chancroid |
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Smooth, rubbery, nontender, mobile breast mass
Cancerous? |
fibroadenoma
NOT cancerous |
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What % of breast microcalifications are cancer
|
15-20%
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Bloody nipple d/c
|
intraductal papilloma
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RF for breast cancer
|
Age
White BRCA Ductal/lobular CIS Atypical hyperplasia FAM HX |
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What is mastectomy?
Modified Radical? Radical? |
Breast
Breast and axillary nodes Breast, Nodes, Muscle |
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MCC of breast cancer.
2nd MCC? |
Infiltrating Ductal Ca
Infiltrating Lobular Ca |
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Peau D Orange
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Inflammatory Cancer of the berast
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Eczema on breast
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Pagets
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MC location of breast cancer
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upper outer quadrant
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breast cancer usually mets to (2)
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liver and lung
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+Infections
(-) platelets eczema |
Wiskott Aldrich
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(-) platelet
large platelets normal PT, PTT |
Bernarld Soulier
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Sickle cell pt get what type of kidney manifestation
|
Papillary necrosis
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Defective platelet aggregation
Platelet, PT, PTT all normal |
Glazmann Thrombasthenia
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1-4 week after viral infection, look for what platelet problem?
|
Immune thrombocytopenic purpura
|
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+BT, +PTT, normal PT
normal platelets no response to ristocetin |
VWD
|
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MCC of nephrotic syndrome
|
FSG
|
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Focal segmental glomerulonephrosis seen in
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HIV, HBV IVDA (heroin)
|
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HEP C associated with what kidney problem?
|
membranoproliferative GN
|
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IgG and C3 deposits
|
minimal change disease
|
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SE of amiodorone?
Histo? |
LIVER, THYROID, LUNG
Foamy macrophages |
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Prophylaxis for malaria
|
Choloquine
Atovaquone/proguanil doxycycline if resistant-Mefloquine |
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Top 3 cancers in men-incidence
|
Prostate
Lung Colorectal |
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Top 3 cancers in men-mortality
|
Lung
Prostate Colorectal |
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Top 3 cancers in women-incidence
|
Breast
Lung Colorectal |
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Top 3 cancers in women-mortality
|
Lung
Breast Colorectal |
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rheum-nodule that does NOT transilluminate
|
Solid nodule:
gout, rhematoid nodule soft tissue sarcoma |
|
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rheum-nodule that transilluminates?
|
Cyst:
epidermal inclusion cyst(keratin) Ganglion Cyst (Trauma, herniation of synovial fluid) |
|
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Management for any NEW pleural effusion
|
thoracentesis
|
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Erythemia overlying palpale cords?
|
thromboplebitis
|
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migratory thromboplebitis associated with?
MC cancer? Other cancers? |
Visceral malignancies
AKA trousseau syndrome Pancreatic adenocarcinoma (get CT of abdomen) Lung, Prostate, Gastric, Colon |
|
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Tumor lysis syndrome
Labs? Tx? |
Hyperuricemia
Hyperphosphatemia Hypocalcemia Allopurinol Rasburicase IV hyrdation |
|
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PCWP
Measures? Normal Value Cardiogenic shock has? What does it mean? |
Left atrial pressure
2-14 Increased PCWP Left ventricular failure |
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Leydig tumors produce
|
androgens and estrogens in LARGE amounts
|
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Sertoli produce?
|
androgens and estrogens in SMALL amounts
|
|
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Embryonal carcinoma
Age? Labs? Other ca with same lab? |
30's AGGRESSIVE
+AFP Yolk sac tumor (children) |
|
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Yolk Sac
Age? Labs? |
CHILDREN
+AFP VERY aggresive |
|
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Teratoma
Age? |
Any Age
|
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Choriocarcinoma
Age? Mets to? Lab? |
30's
Lung and Brain BHCG |
|
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Seminoma
Age? Tx? |
40's
Radiosensitive HIGH cure rate |
|
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Amanita Phalloides Mushroom, toxic to
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Liver
|
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Tx acute pancreatitis
|
analgesics, IVF, NPO
|
|
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tx for unvaccinated needle stick with HEP B infection
|
HEP B IG and Vaccine
|
|
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single most impt test to assess liver function
|
PT
|
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tx for asymptomatic gallstones
|
No Tx
|
|
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Management for variceal bleed
|
insert 2 large bore IV needles
NGT decompression If still no control: vasopressin, octreotide, somatostatin |
|
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blue discoloration of flanks and >Retroperitoneal hemorrhage
|
Grey tullen sign
|
|
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blue discoloration of periumbilical region-->Retroperitoneal hemorrhage
|
Cullen sign
|
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|
Pruritus, + total bile acids in pregnancy, +LFTs, +alkphos
|
Intrahepatic Cholestaiss of Pregnancy
|
|
|
Safe anesthetic in lung and renal problem
|
atracurium
|
|
|
Dx of pancreatic pseudocyst?
Tx if? |
U/S
If persists longer than 6 weeks >5cm Secondary infection |
|
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Hepatic encephalopathy due to
Tx? If inaffective? |
+ ammonia
Lactulose ornithine aspartate infusion or oral sodium benzoate or add neomycin Decrease protein intake |
|
|
Tx for asymptomatic HEP C
|
None, get yearly LFTs
|
|
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Tx chronic hep c?
Pregnancy? C-sec required? |
interferon alpha & ribavirin
C/I in pregnancy! C-Sec not required |
|
|
If hep C +, vaccinate for what in pregnancy?
|
Hep A & B
|
|
|
Anaphylaxis SECONDS-MINUTES after transfusion, bronchospasm and hypotension, no fever
|
IgA def
|
|
|
decrease BP with MASSIVE increase in AST and ALT
|
ischemia hepatic injury
|
|
|
Chronic Hep C ass'd with?
|
Cryoglobinemia
ITP Lichen Planus BCell Lymhona Plasmacytoma Autoimmune diseases Membranoproliferative GN |
|
|
Alcoholic pt with cirrhosis should be screened for
|
esophageal varicies with endoscopy, if + give BB
|
|
|
Bilirubin in urine is
|
conjugated
|
|
|
% deaths from HCC in hemochromotosis
|
30%
|
|
|
next step in mng for conjugated hyperbilirubinemia
|
U/S or CT of abdomen
|
|
|
After acute attack of pancreatitis from gallstones, schedule for?
|
cholecystectomy
|
|
|
Most consistent reversible RF for pancreatic cancer?
|
Smoking
|
|
|
OCP user, liver pathology
|
hepatic adenoma
|
|
|
endemic travel, RUQ pain, single tin wall uniform cyst on u/s
organism? Dx? Tx? |
Amebic liver disease
Entamoeba Histolytica Stool for trophozoites, serology, u/s Metronidazole |
|
|
Contact with dog or cat, organism ?
|
Hydatid cyst
Echinococcus granulosus |
|
|
Best initial test to search for gallstones in pt with acute pancreatitis ?
Confirm tx? |
U/S
CT |
|
|
Difference between bile duct obstruction and gallstone in cystic duct from impaction
|
obstruction wil have +++ alk phos
Impaction will have SUDDEN RUQ pain, fever, vomiting , leukocytosis |
|
|
TX for hepatic hydrothorax (pleural effusion?
|
Salt restriction, diuretics
If inaffective: TIPS |
|
|
Hep B screening test?
|
HBsAG and ANTI HBC
|
|
|
hepatic encephalopathy that develops within 8 weeks of onset of acute liver failure?
|
Fulminant hepatic failure
TX with liver transplant |
|
|
HCC dx test?
|
AFP, CT/MRI
|
|
|
Where do you see ductopenia?
|
Primary biliary cirrhosis
|
|
|
Transfusion reaction:
Sec-min? 30min-1hour? Symp? |
IgA def
ABO-fever, chills, flank pain, coombs+ |
|
|
top cause of febrile non-hemolytic reaction in transfused blood
|
reaction to cytokines in transfused blood
|
|
|
calcium laden gallbladder
rim like calcifications with dark center Tx? |
Procelain gallbladder
Cholecystectomy because 33% will go onto adenocarcinoma of GB |
|
|
Jaundice + Pruritus?
Ab? Inflammation seen? |
Primary biliary cirrhosis
Antimitochondrial antibodies non-caseating granulomatous inflammation |
|
|
antimitochondrial antibodies
|
primary biliary cirrhosis
|
|
|
anti-smooth muscle antibodies
|
autoimmune hepatitis
|
|
|
3 RF for non-alcoholic steatohepatitis?
|
Obesity, DM, +TG
TX underlying cause |
|
|
2 reasons for post cholecystectomy pain
|
sphincter oddi dysfunction
common bile duct sotone GET ERCP |
|
|
jaundice 2-10 days after sx
|
post operative cholestaisis
+alkphos |
|
|
Non-seminomatous germ cell tumor produce
|
AFP and BHCG
|
|
|
wedge shaped infarction
|
PE
|
|
|
dx for bronchiectasis
|
High resolution CT scan of chest
|
|
|
pt with low risk DVT-dx test
mild to mod risk? gold standard? |
DDimer
Compression U/S Contrast Venography |
|
|
How to rule out PE in low risk pt
|
plasma D Dimer
|
|
|
new clubbing in COPD patient
|
lung cancer
|
|
|
SE of high dose inhaled bagonist
|
hypokalemia
tremor palpitations headache |
|
|
panlobar empysema
|
AAT def
|
|
|
excessive alcohol can lead to what kind of pneumonia
|
Aspiration pneumonia
|
|
|
indicators of severe asthma attack
|
normal CO2
speech difficulties diaphoresis altered sensorium cyanosis silent lung |
|
|
alopecia, skin lesions, impaired wound healing. DEF?
|
Zinc
|
|
|
antiendomysial antibodies
|
Celiac
|
|
|
antimitochondrial antibodies
|
primary biliary cirrhosis
|
|
|
anticentromeric antibodies
|
CREST
|
|
|
ANA
|
autoimmune hep, SLE
|
|
|
antiscl-70
|
scleroderma
|
|
|
tissue transglutaminase
|
celiac
|
|
|
what stimulates contraction of gallbladder
|
CCK (protein and FA response)
|
|
|
gallbladder stasis cause by
|
TPN which can lead to gallstones
|
|
|
eradication of what causes remission in some patients with gastric lymphoma
|
Hpylori
|
|
|
antral ulcer-->adenocarcinoma--?What next?
|
CT scan to determine extent and then surgical removal
|
|
|
MC complication of PUD
How to confirm Dx? |
hemorrhage
NGtube-blood, coffee ground emesis |
|
|
pt on anticoagulation with back pain and hemodynamic unstable
|
retroperitoneal hemorrhage
|
|
|
upper GI bleed with altered level of consciousness and ongoing hemetemesis. MNG?
|
intubate then endoscope to band or sclerotherapy
|
|
|
dyspnea, venous congestion of head, neck and arms BILATERALLY?
MC malignancy ass'd? Dx test? |
SVC
Small cell lung cancer, non-hod lymphoma Chest xray |
|
|
pt with high probability of PE, what next?
|
Heparin (if no C/I, if C/I then do dx test first)
|
|
|
pseudo allergic reaction caused by?
Tx? |
aspirin sensitivity syndrome
Avoid NSAIDS use leukotriene receptor antagonists |
|
|
type of pleural effusions ass'd with PE
|
exudative
|
|
|
PE causes what V/Q
|
perfusion defect without ventilation defect
|
|
|
Dx for allergic rhinitis
|
nasal smears for eosinophils
|
|
|
dx test for lactose intolerance
|
hydrogen breath test
Other: + stool for reducing substrates low pH of stool + stool osm gap |
|
|
absence of peristalic waves in lower 2/3 of esophagus with decreased LES tone
absence of waves + Increased LES tone? |
Scleroderma
Achalasia |
|
|
when do you use cryoprecipitate?
|
VIII, fibrinogen, VWF, XIII def
|
|
|
Tx for alcoholic coagulopathy?
|
FFP
|
|
|
asymmetric narrowing of esophageal lumen and barrets,weight loss
|
adenocarcinoma
|
|
|
symmetric, circumfrencial narrowing and barretts, no weight loss
|
peptic stricture
|
|
|
necrotizing dermatitis
weight loss anemia persistant hyperglycemia |
Glucagonoma
|
|
|
Tx for asymptomatic diverticuli
|
High fiber diet
|
|
|
Dysphagia for solids and liquids, next test?
|
Barium
|
|
|
Diarrea, hypokalemia, weight loss, facial flushing
Dx Confirmatory test Tx |
VIPoma
+ blood VIP CT/MRI to determine location-usually pancreas IV hydration, octreotide, surgery |
|
|
2 GI areas vulnerable to ischemia during systemic hypotension
|
splenic flexure
recto-sigmoid junction |
|
|
++ BUN/Creat (3 causes)
|
Prerenal renal failure
GI bleed Steroid |
|
|
Dx test for diffuse esophageal spasm?
Tx? |
Manometry
CCB and Nitrates |
|
|
BIT when pancreatic path suspected
|
Abdominal CT
|
|
|
Symptoms of carcinoma of head of pancreas
|
Non tender GB
Evidence of biliary obstruction (+direct bilirubin and alk phos) |
|
|
Flushing, diarrhea, valvular heart disease, wheezing
|
Carcinoid Syndrome
|
|
|
what is formed in Carcinoid Syndrome
|
tryptophan all goes into making SEROTONIN which causes niacin def
|
|
|
Dx test for Carcinoid Syndrome
|
5HIAA in blood or urine
|
|
|
Tx for Carcinoid Syndrome
|
octreotide
surgery if inaffective |
|
|
When to give packed RBCs in pt with heart heart disease
|
Hemoglobin 10
|
|
|
cat scratch
organism? Tx? |
bartonella henselae
azithromycin |
|
|
Lab values in bacterial meningitis
|
+ protein
+ WBC (-) glucose |
|
|
HHV8 causes
describe skin manifestation |
Kaposi sarcoma
Papules-->plaques + nodules light brown-->velvet |
|
|
Coccidiodomycosis
Location? |
Colorado
Nevada New Mexico Oklahoma TX Utah California Arizona |
|
|
Coccidiodomycosis
Skin? |
Erythema multiforme + nodosum
|
|
|
Cryptococcus
Describe? Causes? Treatment? CD4? |
Encapsulated yeast
meningitis IV amphotericin + flucytosine CD4<200 |
|
|
Histoplasmosis meningitis tx
|
Amphotericin B + Itraconozole
|
|
|
cryptococcus meningitis tx
|
IV Amphotericin B and flucytosine
|
|
|
Endocarditis in IVDA
Tx |
Staph Aureus
Vanco |
|
|
Painless ulcer on genital without lympadenopathy
Dx? Tx? If allergic? |
Syphilis
Single IM Benzathine Penicillin G If allergic: Doxy x 14 days or single does azithromycin |
|
|
Malaria
48 hour fever? 72 hour fever? |
42: vivax and ovale
72: malariae |
|
|
CD4<100, what organism?
Tx |
Toxoplasma Gondii (ring enhancing lesion)
TMP/SMX |
|
|
Newly dx HIV pt should receive
(9) |
1. 2 plasma RNA levels
2. CD4 count 3. VDRL 4. PPD 6. Anti toxoplasma ab titer 7. if <200, phenumococcal vaccine 8. HEP A & B serology, if (-) then get hep A and B vaccine 9. Physical exam, MMSE, HEME, counsel |
|
|
TX for pseudomonas in cystic fibrosis
|
AG+antipseudomonal penicillin
Ceftaxidime or cefexpime + AG AG + Cipro |
|
|
Quinolone in children cause
|
Cartilage destruction
Growth retardation |
|
|
Lyme disease dx?
Tx? Tx for late lyme? |
Serology (ELISA followed with western blot)
Doxy Ceftriaxone |
|
|
CD4 prophylaxis
|
PCP and TOXO: TMP/SMX or DAPSONE
MAC: Azithromycin toxo<100 mac<50 PCP<200 |
|
|
Endocarditis-->OBGYN procedure or G/U or GI manipulation
|
enterococcus
|
|
|
MCC endocarditis after a dental procedure
|
Strep Mutans (viridans)
|
|
|
UTI with alkaline urine, urease producer
|
Proteus
|
|
|
Dx and Tx Toxoplasmosis
|
Sulfadiazine and Pyrimethamine
THIS IS TX, NOT PROPHYLAXIS |
|
|
Screening test for HIV?
Confirmatory? |
ELISA
Western Blot |
|
|
Prophylaxis/Tx for human bite and dog bite
|
Amoxicillin + Clavulanate
|
|
|
HIV+ pain on swallowing. management?
|
Give fluconazole for 3-5 days
if inaffective, do endoscopy to determine if its Herpes which you would tx with acyclovir or CMV which you would tx with ganciclovir |
|
|
Lyme tx early localized disease in pregnancy
|
Amoxicillin (1)
Penicillin (2) |
|
|
Pneumococcal vaccine
CD4 count |
>200
|
|
|
MC valve affected in non-IVDA endocarditis
IVDA? |
Mitral
Tricuspid |
|
|
Prophylaxis for malaria in Africa/India
|
Mefloquine
|
|
|
UTI chronic indwelling catheter
4 causes? |
Proteus
Pseudomonas Klebsiella Candida |
|
|
Top 2 causes of typical pneumonia
|
Strep pneumo
H.influenza Moraxella |
|
|
3 causes of atypical pneumonia
|
Mycoplasma
Legionella Chlamydia |
|
|
Dx of legionella?
Electrolyte abnormality seen? |
Urinary antigen
Hyponatremia |
|
|
monotherapy for outpatient pneumonia
|
floroquinolone
|
|
|
tx for klebsiella
|
3rd generation cephalosporin
|
|
|
tx for coxiella brunetti
|
doxy
|
|
|
tx for chlamydia p. (birds)
|
floroquinolone
|
|
|
tx for neuro, cardiac and severe arthritis from lyme
|
Ceftriaxone, cefotaxime
Penicillin |
|
|
Pneumonia with no organisms in sputum
|
Mycoplasma
Legionella |
|
|
Complication of chronic bacterial sinusitis
|
Cavernous sinus thrombosis
Meningitis GET HEAD CT |
|
|
Pneumonia, diarrhea, increased LFT's, bradycardia
|
Legionella
|
|
|
side effect of didanosine
|
pancreatitis
|
|
|
side effect NRTI
|
lactic acidosis
|
|
|
side effect of NNRTI
|
steven-johnson
|
|
|
side effect of ethambutol
|
optic neuritis
|
|
|
side effect of isoniazid
|
peripheral neuropathy
|
|
|
side effect of pyrazinamide
|
GI intolerance
hepatitis |
|
|
side effect of rifampin
|
red/orange secretions
hepatitis |
|
|
side effect of streptomycin
|
ototoxicity, nephrotoxicity
|
|
|
faint holosystolic murmur that increases with respiration
|
TR
|
|
|
continuous machinery murmur
|
PDA
|
|
|
decresendo diastolic murmur
|
AR
|
|
|
holosystolic murmur radiating to axilla
|
MR
|
|
|
opening snap then mid-diastolic murmur
|
MS
|
|
|
Tx for aspergillosis
|
Voriconazole
(consider in neutropenic fever unresponsive to other antibiotics) |
|
|
MC cardiac manifestation of lyme
|
AV block
|
|
|
MC neuro manifestation of lyme
|
Facial nerve palsy
|
|
|
kids with lyme tx with
|
Amoxicillin or macrolide
|
|
|
non-hospitilized pt with pneumonia treated with
|
Macrolide
doxy or floroquinolone |
|
|
Hydatid cysts of liver
|
Tapeworm-echinococcus
Cysts have fluid under pressure so surgery and drainage is required and ethyl alcohol injection if clear fluid |
|
|
Entamoeba Histolytica
Causes? Tx? |
Liver abscess
Metronidazole |
|
|
How do you get schistosomiasis?
Affects? Tx? |
Contaminated water
Bladder, rectum, intestine, liver, spleen, lungs Praziquantel |
|
|
Tx for nosocomial acinetobacter baumanni pneumonia
|
Imipenem
|
|
|
Pig farmers can get?
Tx? |
Neurocysticercosis
Taenia sollium Albendazole + steroid |
|
|
Emperic tx for nosocomial infections that isn't associated with ICU/ventilators
|
Cipro or Levofloxacin
Ceftriaxone Amp/Sulb PIP/Tazo |
|
|
Gram (-) rods causing dysuria, most likely?
|
Ecoli
Tx with TMP/SMX or quinolone or nitrofurantoin |
|
|
Most accurate test for dx for HSV encephalitis
|
PCR of CSF
TREAT if suspected instead of waiting on results |
|
|
Tx for herpes zoster
|
Acyclovir/famciclovir and TCA (desipramine)
|
|
|
Ascarisis Lumbricoides
Symptoms Tx |
Wheezing, abdominal discomfort, migrating symptoms, obstruction, eosinophila
Mebendazole if pregnant use pyrantel pamoate |
|
|
when do you need endocarditis prophylaxis
|
1. Uncorrected cyanotic congenital heart disease
2. prosthetic valuve 3. previous endocarditis 4. valvulopathy in transplanted heart NO PROPHYLAXIS IN MR, AS, AR, HOCM |
|
|
Bone breaking hemorrhagic fever
dx tx |
Dengue (flavivirius)
viral serology supportive, may need platelets |
|
|
family member has (+) PPD, what to do with other family members
|
if PPD>5 mm prophylax with isoniazid
|
|
|
above diaphragm anaerobes tx with
|
clindamycin
Pip/tazo cefoxitin |
|
|
5 rashes involving hands and feet
|
RMSF
Coxsackie Treponema Kawasaki Scarlet fever |
|
|
Aspiration pneumonia seen in?
Tx? |
Alcoholics
Seizure disorder Clindamycin Amoxicillin/Clav |
|
|
If bite from wild animal that can't be observed for 10 days, give
|
5 vaccines and 1 dose IG (different sites)
|
|
|
Tx for onychomycosis
|
oral terbinafine or itraconozole
|
|
|
Tx for tinea pedis
|
topical antifungal (clotrimazole)
|
|
|
CD<200
<100 <50 |
PCP, histo, coccidiomycosis
TOXO, crypto, Disseminated HSV CMV, MAC, PML, CNS lymphoma |
|
|
Aspergillus can cause (4)
|
Allergic bronchopulmonary aspergiollosis
choronic necrotizing pneumonia aspergilloma invasive aspergillosis |
|
|
Mucomycosis seen in?
Dx? Tx? |
Uncontrolled DM, immunocompromised, pt taking deforxamine
KOH AMP B + debridement |
|
|
Gonorrhea
Gram stain Tx? if allergic? |
Gram (-) diplococci
Ceftriaxone Macrolide |
|
|
CMV in HIV patient presents with? (GI)
Colonoscopy shows? Bx shows? CD4 count? Tx? |
CMV colitis-bloody diarrhea, chronic abdominal pain with normal stool exam
Multiple mucosal erosions Cytomegalic cells with inclusion bodies <50 Ganciclovir or foscarnet |
|
|
Hematochezia and lower abdominal cramps in HIV (5)
|
CMV
C difficile Shigella E. histolytica Campylobacter |
|
|
CMV infects what 3 organs
|
lungs, intestine, eyes
pneumonitis seen in bone marrow transplant and shows as multifocal diffuse patchy infiltrates |
|
|
Organisms for post viral pneumonia ?
Which one has necrotizing penumonia and pneumatoceles and multiple pulmonary abscesses |
Strep pneumo, s. aureus, h. influenza
staph aureus |
|
|
Legionnaires disease, transmission?
|
Environmental water source
|
|
|
(+) PPD in HIV
Prophylaxis |
>5mm
Prophylax with isoniazid and B6 for 9 months alternate: Pyrazinamide with rifampin for 2 months or rifampin alone for 4 months |
|
|
Tx for active TB
|
Rifampin, isoniazid, pyrazinamide and ethambutol for 2 months and isoniazid and rifampin for 4 months
rifampin, isoniazid, pyrazinamide for 6 months |
|
|
MCC osteomyelitis in children in adults
what if nail puncture would? |
staph aureus
pseudomonas |
|
|
Actinomyces
Describe organism Locations? Tx? |
Anaerobic gram (+) branching bacteria
Cervicofacial, thoracic, abdominal high dose penicillin |
|
|
SE of protease inhibitors
|
Crystal induced nephropathy
saquinavir, ritonavir, indinavir, nelfinovir, amprenavir |
|
|
HSV encephalitis
Lobe? Dx? Tx? |
Temporal
CSF PCR for HSV DNA Stat acyclovir without delay of dx tests |
|
|
MAC prophylaxis
|
<50
Azithro |
|
|
Mumps virus?
Organs affected? MC complication? Other Complications? |
Paramyxovirus
Parotid glands, testes (usually unilateral so doesn't cause infertility) tx with cold compress Other complications arthritis, pancreatitis, aseptic meningitis, encephalitis, myocarditis |
|
|
tx for acute bacterial meningitis (+) neutrophils
|
Vancomycin, ceftriaxone adn ampicillin
V+C treat spneumoa, n,men, hinflue but bc of resistance have to add vanco amp treats listeria |
|
|
MCC of erysipelas?
MC site? |
Group a B hem strep
Leg Causes cellulitis |
|
|
Tx of pseduomonas pneumonia
|
Cefepime or
pip/tazo |
|
|
tx mucormycosis
|
Amphotericin B and surgical debridement
|
|
|
Tx nocardia
|
TMP SMX
|
|
|
Tx actinomyces
|
Penicillin
|
|
|
Substrates for ethylene glycol poisoning
|
glycolic acid (causes renal injury) and
oxalic acid (causes hypocalcemia) |
|
|
Alcoholic with flank pain, hematuria, anion gap metabolic acidosis
|
Ethylene glycol poisoning
|
|
|
Tx for ethylene glycol poison
|
Fomepizole
Sodium bicarb hemodialysis |
|
|
Confusion, drowsiness, dry mouth, dilated pupils, decreased bowel sounds, urinary retention?
Tx? |
Diphenhydramine poisoning
physostigmine |
|
|
What do you give to close contacts for n.men
|
Rifampin or
Cipro |
|
|
Test for infectious mono?
|
Heterophile antibody
|
|
|
How long do symptoms have to present for chronic fatigue syndrome
|
6 months or longer
|
|
|
What gives mono like symptoms with sore throat and lymphadenopathy and atypical lymphocytes but negative heterophile antibody test
|
CMV
|
|
|
What is echinococcus
2 breeds? Associated animals? Leads to? |
Parasite
E.granulosis and E. multiocularis Sheep and dog feces Liver and lung hydatid cysts cysts have daughter cysts inside |
|
|
cat bite treat with
|
Amoxicillin/clavulate
|
|
|
cat bite organism?
|
pasteurella multiocida
|
|
|
MC bacteria for subacute in preexisting valve condition
|
Viridans strep
|
|
|
secondary syphilis rash starts?
|
trunk and extends to periphery including palms and soles
|
|
|
Tx for hospitalized acute pyelonephritis
|
IV ceftriaxone
|
|
|
tx for strep pneumo meningitis
|
ceftriaxone plus vanco
|
|
|
tx for clostridum perfringes
|
clinda plus penicillin
|
|
|
tx for tuleremia
|
streptomycin is DOC
|
|
|
tx for actinomyces
|
penicillin
|
|
|
babesiosis causes?
tx? Dx? |
Hemolysis, jaundice
Giemsa stained thick and thin smear Quinine and clinda or atorvaquone and azithro |
|
|
head to extremity rash?
|
rubella
measles (cough, coryza, conj, koplik) |
|
|
complications of EHEC
|
HUS
TTP |
|
|
PCP pneumonia
Tx? Alternate? CXR? |
TMP SMX with steroids
IV Pentamidine bilateral interstitial infiltrates |
|
|
diptheria can cause what?
|
dilated cardiomyopathy
|
|
|
complication of infectious mono besides splenic rupture
|
autoimmune hemolytic anemia
may develop thrombocytopenia 2-3 weeks later |
|
|
acid fast bacilli on skin bx, dx test for?
|
dx for leprosy
|
|
|
infective endocarditis in IVDA?
Prosthetic valve? |
staph aureus
staph epidermidis |
|
|
hypopigmented plaques, nerve damage, muscle atrophy
Dx? Tx |
Mycobacterium leprae
Acid fast bacilli on skin bx |
|
|
Tx for syphilis if allergic to penicillin?
|
Doxy or Azithro
|
|
|
Ancylostoma Braziliense
|
Dog/cat hookworm
causes cutaneous larva migrans |
|
|
antibiotic for febrile neutropenia
|
IV ceftazidime or cefepime
|
|
|
Prophylaxis for PCP? Alternative? CD4?
|
TMP/SMX
DAPSONE <200 |
|
|
TX FOR MAC IN HIV
|
CLARITHROMYCIN AND
ETHAMBUTOL |
|
|
influenza, give meds within?
what tx? |
48 hours
neuraminidase inhibitors zanamivir, oseltamivir |
|
|
tx for herpes encephalitis? if resistant?
|
Acyclovir
Foscarnet |
|
|
When exposed to HIV when should you be tested
|
Immediately
6 weeks 3 months 6 months |
|
|
rapid reversal of anticoagulation (if serious brain bleed?)
|
FFP
|
|
|
headache
redness of eye ipsilateral tearing runny nose ipsilateral horners |
Cluster headache
|
|
|
prophylaxis for cluster headache
|
verapamil
lithium ergotamine |
|
|
Tx for acute cluster headache
|
100% oxygen
inhaled sumitriptan |
|
|
Tx for RLS
|
Dopamine agonist
pramipexole ropinerole levodopa |
|
|
two disease that cause ptosis
|
MG
Botulism |
|
|
Tx myasthenia gravis crisis
|
Intubation
withdrawal of anticholinesterases |
|
|
LOC, aura, autmatisms?
LOC, tonic/clonic? |
Complex partial
Partial with secondary generalization |
|
|
no LOC, patient remembers the seizure event well?
|
Simple partial seizure
|
|
|
Side effect of carbamazapine
|
aplastic anemia
|
|
|
tx for trigeminal neuralgia
|
carbamazapine
|
|
|
Tx for pseudodemenita
|
SSRI
|
|
|
test of choice for Multiple Sclerosis
|
MRI
|
|
|
Tx of choice for agitation in elderly
|
haloperidol
|
|
|
Dx for NPH?
Tx? |
normal LP pressure
+ ventricular size on CT/MRI LP if inaffective, ventriculoperitoneal shunt |
|
|
initial tx for patient with confusion
|
Thiamine, Dextrose, 02, Naloxine
Give thiamine before glucose!! |
|
|
Should you give thiamine before or after glucose
|
BEFORE
|
|
|
initial workup for delirium
|
u/a
electrolytes |
|
|
Sudden onset of vertigo, vomiting and occipital headache in HTN
|
cerebellar hemorrhage
|
|
|
ash-leaf hypopigmentation
cardiac rhabdomyomas kidney angioleiomyomas mitral regurgitation seizures |
tuberous sclerosis
|
|
|
axillary freckling
cafe au lait lisch nodules neurofibromas |
type 1 NF
|
|
|
NF 1
|
tumor of CNS, PNS, SKIN, VISCERA
|
|
|
MC nerve affected in DM?
Symptoms of nerve ischemia? If compression? |
III (oculomotor)
Ptosis, down & out Ptosis, down and out, fixed dilated pupil, no accommodation |
|
|
motor impairment without any high cortical dysfunction. visual field abnormal
|
posterior limb of internal capsule (lacunar infarct)
|
|
|
C/L hemiplegia
eye dev towards lesion hemianesthenia homonymous hemianopia aphasia if dominant hemi neglect inf non dominant |
middle cerebral artery occlusion
|
|
|
screening test for celiac
|
Anti-tissue transglutaminase
|
|
|
test for CGD
|
negative nitroblue tetrazolium test
|
|
|
what immunodeficiency syndrome do you see suppurative adenitis and granulomas
|
CGD
|
|
|
MC organisms in CGD
|
Staph, Burkholderia, pseudomonas, serratia, nocardia, aspergillus
|
|
|
tx for intussuseption
|
air contrast enema
|
|
|
Dx test for parvovirus b19
|
IgM antibodies
|
|
|
tx for e. histolytica
|
metronidazole
if disseminated paromomycin or iodoquinol |
|
|
meningitis in child with abscess formation
|
citrobacter koseri
tx with 3-4th generation cephalosporin and AG |
|
|
presence of what leads to an excellent prognosis for patient with juvenille RA
|
ANA
|
|
|
tx for botulism if <1
>1? |
IG
Antitoxin |
|
|
steps in neonatal resuscitation
|
radiant warmer
dry baby and stimulate baby to breath open the airway and provide Positive pressure venitilation (bag mask) with oxygen |
|
|
2 mcc of congenital cataracts
|
Rubella
galactosemia |
|
|
Child with edema, proteinuria, hyperlipidemia, hypoalbuminemia
Tx? |
nephrotic syndrome most likely minimal change disease
Prednisone |
|
|
If rash not presented and suspected lyme arthritis, next step?
|
serology using ELISA and confirmed with western blot
|
|
|
tx for lyme in children <8
|
amoxicillin
|
|
|
Tx for tinea capitis
|
oral griseofulvin
adjuvent tx with selenium sulfide shampoo can also be helpful |
|
|
Tx of RMSF regardless of age
|
doxycycline
if not a choice, pick cholramplenicol |
|
|
Ataxia telangiectasia has a decrease in what immunoglobulins
|
IgA and IgE
|
|
|
metabolic syndrome consists of what lab findings
|
high TG
low HDL High C reactive protein High fibrinogen |
