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242 Cards in this Set
- Front
- Back
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Generalized maculopapular rash (including palm and soles), generalized lymphadenopathy, elevated liver enzymes, flat velvety gray to white lesion in perineal area
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Secondary syphillis
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Treatment for secondary syphillis
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Benz Penicillin IM one dose or doxy for 2 weeks
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Treatment of condyloma accuminata
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Podophyllin - contraindicated in pregnancy
Trichloroacetic acid - first line of treatment in pregnancy |
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Causes of false positive serologic test for syphillis
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SLE
IVDU Chronic liver disease HIV |
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Cause of false negative test of syphillis
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In primary syphillis 30% may have negative serology as antibodies may not have developed
Prozone reaction - affects non treponemal test and is due to high titer of antibody |
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Which test do you use to monitor titer for syphillis after treatment
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Non treponemal
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Painful genital ulcer with sot and necrotic base with painful lymphadenopathy. Inguinal node may undergo liquefaction and present as painful fluctuant bubo
What is this Name bug Treatment |
Chancroid
H ducrei (gram neg rod, looks like school of fish on gram stain) Rx = Azithromycin or Ceftriaxone |
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Multiple small shallow ulcers in genital area, in early lesions may have vesicular painful lesion on erythematous base, may have bilateral tender inguinal lymphadenopathy
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Genital Herpes (HSV2)
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How do you confirm genital herpes
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Tzank preparation - multinucleated giant cells
Culture PCR |
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Treatment for genital herpes
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Acyclovir
Valacyclovir Famcyclovir Decrease duration of symptoms and viral excretion time |
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HIV patient with genital herpes resistant to acyclovir - how do you treat
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Foscarnet IV
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When do you you use daily supperessive therapy in treatment of herpes
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Recurrent infections > 6 episodes year
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Patient with bilateraly large inguinal lymph node with drainage sinuses
Groove sign + --> inflammatory reaction in superficial and deep inguinal lymph nodes What is this What causese it How do we treat |
Lymphogranuloma Venerum
L1-L3 Chlamydia Trachomatis Treat - Doxycycline |
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Painless large ulcerated lesion in genital area with BEEFY RED FRIABLE base of granulation tissue
Cause Diagnosis Treatment |
Granuloma inguinale
CALYMMATOBACTERIUM GRANULOMATIS Dx - tissue scraping contain DONOVAN BODIES Rx - tetracycline or erythromycin |
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Needle stick transmission - what has the greater chance of being transferred
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Hep B (30%)
(HEP C 3%, HIV 0.3%) |
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Patient with needle stick from HIV patient - what do you do
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Immediately with in 1-2 hrs start triple therapy - AZT + 3TC + Indinavir for 4 WEEKS - decreases transmission 75%
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Patient is on anti retrovirals for HIV and gets pregnant - what do you do
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Continue treatment except EFAVIRENZ which is teratogenic
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How do you prevent transmission of HIV from mom to baby
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AZT infusion at time of delivery and baby gets AZT for 6 WEEKS
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Can HIV mom breast feed
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NO
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Viral load of _ indicates need for treatment for HIV
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50000
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Viral load - what kind of PCR for adult
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RNA
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Newborn of HIV mother - test of choice
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HIV DNA PCR ( not RNA)
ELISA/Western blot not recommended as maternal antibodies persist for few months + after 18 months --> infected |
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CD4 count of _ indicates need for treatment for HIV
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< 200
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CD4 < 200 --> what do you start prophylaxis for
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PCP - BACTRIM or dapsone or aerosolized pentamidine or atovaquone
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CD4 < 100 --> what do you start prophylaxis for
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MAC --> Clarithromycin or Azithromycin
Toxoplasma --> Bactrim or Dapsone + pyrimethamine |
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do you prophylaxis against toxoplasma if IgG negative
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NO
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Rapid test for HIV - do you need to do anything else
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If positive need to confirm with ELISA/Western blot
If negative - dont do anything, except patients who are in window period for acute HIV - need to repeat after 12 weeks of exposure |
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Why is aerosolized pentamidine inferior to Bactrim for PCP prophylaxis
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Less effective in apical areas of lung - can still have apical PCP while on treatment, incresed incidence of PTX if has h/o PCP
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If someone on aerosolized pentamidine gets PCP - after treatment what do you prophylax with
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Bactrim or Dapsone
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HIV patient health maintenance:
PCV -? Influenza- ? Hep B - ? Hep A - ? MMR/Varicella - ? PPD - ? Pap smear - ? |
PCV at diagnosis and every 5 years
Influenza annually Hep B - if hep B surface antigen and antibody neg Hep A - if hep A IgG negative MMR/Varicella - if CD4 > 200 or > 15% of total lymphocyte count PPD - annualy if negative, if positive and has been treated for 9 month with INH --> annual CXR Pap smear - every 6 months in first year then annually |
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Vaccinations contraindicated in HIV
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Oral polio (OPV)
Yellow Fever MMR/Varicella --> if CD4 < 200 |
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Zidovudine (AZT)
Didanosine (DDI) Zalcitabine (ddc) Stavudine (d4T) Lamivudine (3TC) Abacavir Tenofovir Emtricitabine Combivir (AZT + 3TC) What type of HIV drug |
Nucleoside reverse transcriptase inhibitor
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Saquinavir
Ritonavir Indinavir Nelfinavir Amprenavir Lopinavir/ritonavir What type of HIV drug |
Protease inhibitor
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Enfuviritide - what type of HIV drug
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Fusion inhibitor - blocks entry of HIV into cells, used for multi drug dresistant HIV
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Most commonly used combination for HIV therapy
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2 nucleoside + 1 non nucleoside
OR 2 nucleoside + 1 protease inhibitor |
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Nevirapine
Delavirdine Efavirenz What type of HIV drug |
Non nucleoside reverse transcriptase inhibito
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Which HIV drug is teratogenic
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Efavirenz
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Which 2 HIV drugs cannot be used together (antagonists)
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AZT + d4T (stavudine)
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HIV drug that causes macrocytic anemia, neutropenia and myopathy
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AZT
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HIV drug that causes pancreatitis
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DDI
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HIV drug that causes acute renal failure
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Tenofovir
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HIV drug that causes liver toxicity, can also cause SJ
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Nevirapine
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HIV drug that causes kidney stones
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Indinavir
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Name CNS enhancing lesions in HIV patients
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Toxoplasmosis
CNS lymphoma Brain abscess |
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Name CNS non enhancing demyelinating hypodense lesions in white matter in HIV patients
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Progressive multifocal leukoencephalopathy
JC virus Pt presents with hemiparesis and cortical blindness Rx - anti retrovirals |
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HIV pt with fever, HA and negative CT of the head
Dx + RX |
Cryptococcal meningitis
Dx - crypt antigen + in blood and CSF, CSF with india ink shows encapsulated yeast Tx - Ampho B + flucytosine Fluconazole for life for prophylaxis |
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HIV pt c/o blurring of vision
Ophthalmoscopy - PERIVASCULAR HEMORRHAGE AND FLUFFY EXUDATES Rx? |
CMV retinitis
Rx= ganciclovir (not with AZT, causes severe neutropenia) Valganciclovir - increased PO bioavailability Cidofovir (nephrotoxic) Foscarnet (nephrotoxic) |
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HIV pt with centrally umbilicated papular lesion of the skin
Differential dx What test to differentiate Rx |
Molluscum contagiosum or cryptococcosis
Lab - crypto antigen and skin bx Rx - curretage or cryo with liquid N Fluconazole if crypto |
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HIV pt with papular reddish vascular lesion
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Bacillary angiomatosis - usually with FEVER - B hensellae, B quintana = confirm with bx, rx = Doxy or erythromycin
Kaposi sarcoma = NO fever, confirm by bx, rx = vincristine, vinblastine, alpha IFN |
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HIV pt with white lesion on tongue
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Hairy leukoplakia - on the lateral tongue, NOT removed by scraping, rx = acyclovir
Oral candidiasis = easily removed by scraping, rx = clotimasole, nystatin , if not improved oral fluconazole |
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HIV patient with dysphagia
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If has oral thrush - oral fluconazole for 2 weeks, does NOT improve = endoscopy
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HIV pt with dysphagia, diffuse white lesion on endoscopy
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Candida = treat with fluconazole
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HIV pt with dysphagia, deep, small multiple lesion on endoscopy
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Herpes - tx with acyclovir
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HIV pt with dysphagia, large superficial lesion on endoscopy
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CMV - treat with ganciclovir
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HIV patient with diarrhea - what do you order
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Acid fast staining of stool for ova and parasites
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HIV patient with diarrhea - found to have cryptosporidia - treatment?
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Paromomycin
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HIV patient with diarrhea - found to have Isospora or Cyclospora - treatment?
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Bactrim
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HIV patient with diarrhea - stool work up negative - what do you do next
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COLONOSCOPY with biopsy
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Patient with HIV has diarrhea, work up negative, gets colonoscopy shows large cells containing eosinophilic intranuclear and basophilic intracytoplasmic inclusions
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CMV colitis
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Gardener, pricked by thorn with har non tender subcutaneous nodules along lymphatic drainage
Treatment? |
Sporothrix shenkii
Rx = ITRACONAZOLE If HIV or systemic disease - ampho B |
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Patient after taveling to New Mexico with fever, cough, pleuritic chest pain, arthralgia
CXR = multiple nodular lesion with caivity |
COCCIDIOIDOMYCOSIS
Rx = itraconazole or fluconazole, severe - ampho B |
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Immunocompromised patient with HA and change in mental status - what do you think first
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Crypto meningitis
Ampho B + flycytosine |
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Patient from Ohio with hepatosplenomegaly, lymphadenopathy and oral ulcers, cough and SOB
Dx Rx |
HISTOPLASMOSIS
Dx - urine and serum for histoplasma antigen, histoplasma complement fixation test, fungal C/S Rx - Ampho B, itraconazole |
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Pregnant patient with histoplasmosis - what is the drug of choice
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AMPHO B
Itraconazole contraindicated |
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Patient from Midwest with raised verrucous lesion with central atrophic scar, wet mount shows multinucleated yeast cell with thick refractile cell wall
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Blastomycosis
Rx - itraconazole, doesnt respond - ampho b |
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Lyme disease - bug
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Borrelia burgdorferi
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Patient with Lyme disease, with erythema chromicum migrans
Rx |
Doxycycline
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Patient with Lyme disease with 1st degree AV block - treatment?
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Doxycycline
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Patient with Lyme disease with 2nd3/d degree AV block
Rx |
Ceftriaxone
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Pt with Lyme disease with Bells palsy or foot drop
Rx |
Doxycycline
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Patient with Lyme disease + symptoms of meningitis
Rx |
Ceftriaxone
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Pt with Lyme disease after year comes with arthritis
Rx |
Doxy
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Child or pregnant woman with Lyme disease - what cant you give, what do you give instead
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Cannot give doxycycline to child < 8 or pregos
Rx = AMOXICILIN or macrolide if pcn allergy |
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How do you diagnose lyme disease
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Early disease - clinical
Late disease - ELISA with western blot |
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Pt from tick endemic area comes with fever, drenching sweat, but NO rash
On peripheral smear - small ring in RBC What is this - rx? |
BABESIOSIS
Rx = Quinine + clindamycin |
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Patient from tick endemic area with fever, HA and h/o tick bite + LEUKOPENIA, thrombocytopenia
What is this - rx? |
EHRLICHIOSIS
Rx = doxy |
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Pt from tick endemic area with fever, HA, on 4th day develops macular rash on wrist, palm, ankle and feet which after two days becomes petechial
Rx |
RMSF
Rx = doxy |
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Child with fever for 4 days, becomes afebrile, next day develops maculopapular rash
Dx, rx |
Roseola infantum (exanthem subitum)
HHV6 Rx = self limited |
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Young child with rash on cheeks, slapped cheek appearance, on the body ash with reticular patter, lace like rash
Is the child infectious |
Erythema infectiosum (5th disease)
Parvovirus B19 Infectious only before rash appears, if has rash - can go back to school |
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Pt with cough, coryza, conjunctivitis, small red spot with white center on buccal mucosa, then fever and maculopapular rash that began on face and spread downward
What are the complications |
MEASLES (RUBEOLA)
Complications - subacute sclerosing panencephalitis, PNA |
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Child with mild fever, posterior cervical and post auricular lymphadenopathy, 5 days later has maculopapular rash that began on face and spread downward
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Rubella (German measles)
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Child with deafness, cataracs, PDA, MR and microcephaly
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Congenital Rubella
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Patient with facial palsy, vesicular lesion of external ear, vertigo, tinnitus and deafness
What is this and rx |
Ramsay Hunt syndrome - teat with acyclovir, famcyclovir or valacyclovir
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Patient with shingles and eye involvement - what do next
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Refer to ophtalmology
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How do you treat post herpetic neuralgia
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Amitryptiline
Opioids Topical capsaicin Gabapentine |
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Pregnant patient exposed to Parvovirus B19 - what to do next
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Test fo IgG and IgM - if IgG immune, IgM - acute infection, takes 10 days to be positive
IgM + and less than 20 weeks - tell about risk of fetal loss and fetal hydrops, no action From 24 weeks on weekly US Dont recommend to leave job is high risk job |
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Pt with sore throat, fever, lymphadenopathy, splenomegaly and palatal petechiae. Labs show atypical lymphocyte, heterophile +
Recommendation |
Avoid physical activity, do not give ampicillin - rash, tx - supportive
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in what cases do you treat asymptomatic bacteriuria
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Pregnant
Child with vesicoureteral reflex Before urological procedues After removal of blaadder catheter if was in less than one week |
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Who gets annual PPD
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HIV
Health workers, prison guards Residents of long term care facilities Medical condition that increases risk |
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HIV +
IS Recent contact with active case CXR - old fibrotic lesion What should PPD be to be + |
5 mm
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Recent immigrants < 5 years
IVDU Homeless Alcoholics Health care workers Resident and staff of long term care Pt with CA, DM, CRF, silicosis, gastrectomy, jejunoileal bypass, kids < 4 What should PPD be to be + |
10 mm
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Treatment for whooping cough
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Erythromycin
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Cat scratch disease - what causes, treatment
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Bartonela Henselae
Rx - azithromycin for adults, azithromycin and rifampin for kids |
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Pt with history of rat bite, relapsing fever and asymmetrical polyarthritis
Cause, rx |
Streptobacillus moniliformis
Rx - pcn if allergic - tetracycline |
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Injury in sea water or after cleaning fish - pt develops cellulitis with hemorrhagic bullae and necrosis
Cause + rx |
Vibrio vulnificus
Rx - doxy |
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Recurrent infection with encapsulated bacteria - whats missing
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C1, C2, C4
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Recurrent meningococcal and gonococcal infections -whats missing
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C5-C9
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Best single test to screen for complement deff
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CH50
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Pt from South America with dysphagia, constipation and CHF
Cause, treatment |
CHAGAS DISEASE
Trypanosoma Cruzi (Reduviid bug) Achalasia, megacolon, cardiomyopathy Labs - hemagglutination test for trypanosoma Rx - nifurtimox + benznidazole |
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Diabetic with bloody nasal discharge and black necrotic lesion of nose
Biopsy - hyphae broad, irregulary branched with rare septation Rx? |
Surgical debridement + ampho B, tight control of DM
MUCORMYCOSIS |
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Anti pseudomonal cephalosporins
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Ceftazidime
Cefepine |
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DOC for Legionella and Mycoplasma
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Erythromycin
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Abx used for VRE
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Quinupristin, Linezolid
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DOC for pseudomembranous colitis, giardia, entamoeba histolytica
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Metronidazole
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TB drug, causes hyperuricemia
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Pyrazinamide
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Rx for small pox
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Cidofovir
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Apgar score of 4-7
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Needs further resuscitation
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Apgar score < 3 - increased risk of _
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Cerebral palsy
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Newborn with purulent conjunctivitis, with profuse exudates and swelling of eyelids, 2-5 days after birth
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Gonococcal conjunctivitis
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Newborn, 2nd day after birth, with symptoms of conjunctivitis - what is more likely, what should you do
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Do gram stain to r/o gonococcal, more likely chemical if received silver nitrate - give erythromycin to prevent
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Newborn 10 days after birth, with watery eye discarge that becomes purulent with marked swelling of the eyelids and red, thickened conjunctiva
What is infant at risk for |
Chlamydial pneumonia
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Why do newborns need vit K at birth
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Immature liver
Low vit K in breast milk Sterile gut Poor placental transfer of vit K |
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Which influenza vaccine is live
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Intranasal
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Which influenza drug is for treatment only
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Zanamavir
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Which influenza drugs are for type A only
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Amantadine
Rimantadine |
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At what age do you see social smile
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2 months
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At what age do you see stranger anxiety
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Six months
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At what age do you see temper tantrums
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`15 months
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How do you manage scoliosis
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Less than 30 --> conservative with regular follow up and spine x ray
30-45 degrees - bracing > 45 = surgery |
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Patient with precocious puberty - do LH + GnRH stimulation - LH increased
What do you do next |
Means cental problem - either idiopathic or CNS tumor - next step is to do CT scan of the head
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Patient with precocious puberty you do LH + GnRH - no change in LH - what to do next
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Means Peripheral - ovarial or testicular tumor
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Triad of McCune Albright syndrome
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Precocious puberty
Cafe au lait spots Fibrous dysplasia of bone |
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15 year old boy didnt undergo puberty, you check and find GnRH defficiency - what does he have
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Kallmans syndrome
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Patient didnt undergo puberty, high LH and FSH
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Either Turners or Klinefelters
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Patient didnt undergo puberty, low FSH, LH
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Secondary hypogonadism - hyperprolactinemia, hypothyroidism, anorexia
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What is the algorithm for delayed puberty
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H&P --> x ray of left hand --> LH/FSH, estrogen/testosterone --> TSH, prolactin
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Patient with anosmia, red green color blindness, midline facial abnormalities, urogenital tract abnormalities, neurosensory hearing loss, hypogonadotropic hypogonadism
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KALLMAN
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Requirements for anorexia nervosa dx
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BMI < 17
Intense fear of gaining weight Body image distortion Amenorrhea |
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Middiastolic murmur at apex best heard with bell, presystolic accentuation, p2>a2, loud S1
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MS
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Holosystolic murmur at apex, radiates to axilla, increases on expiration
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MR
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Mid systolic click followed by late systolic murmur, increases with standing
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MVP
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Holosystolic murmur heard at LSB, increases on inspiration
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TR
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Holosystolic murmur, heard at LSB, increases on expiration
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VSD
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Midsystolic murmur, RUSB, radiates to carotids, increases on expiration
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AS
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Midsystolic murmur, LSB, inreases with standing, doesnt radiate
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HOCM
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2 murmurs that increase with standing and Valsalva
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HOCM + MVP
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Early diastolic, high pitched decrescendo murmur at LSB, increases with expiration, sitting up and leaning forward
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AR
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Midsystolic murmur, ULSB + middiastolic LLSB
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ASD
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Continuous machinery murmur at ULSB
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PDA
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Murmur that increases on inspiration
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R sided
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Murmur that increases wth expiration
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L sided
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All murmurs decrease with Valsalva + standing EXCEPT 2 - name
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MVP + HOCM
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All murmurs increase with squatting EXCEPT
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MVP + HOCM
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Which 2 murmurs decrease with hand grip
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HOCM
AS |
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Which heart sound coincdes with closing of mitral valve
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S1
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Which heart sound coincides with closure of aortic and pulmonic valves
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S2
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Fixed and wide splitting of S2
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ASD
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Opening snap - which murmur
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MS, TS
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Midsystolic click
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MVP
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Pericardial friction rub
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Pericarditis
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Pericardial Knock
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Constrictive pericarditis
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Palpable heave at apex
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LVH
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Left Parasternal Lift
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RVH
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Pulsus paradoxus (BP drops during inspiration > 10 mm) - name 3 conditions
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Pericardial tamponade
COPD Asthma |
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Patient with pulsus tardus (slow rising plse)
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AS
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PCWP reflects what?
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LAP
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Name 2 types of shock in which SVR is down
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Septic
Anaphylactic |
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Name 2 types of shock with increased CO
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Septic Anaphylactic
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Name type of shock with increased PCWP
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Cardiogenic shock (tamponade)
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PCWP up
CO down SVR up What type of shock |
Cardiogenic
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TX of cardiogenic shock
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O2
Dopamine --> dobutamine --> IABC Consider angioplasty, CABG, valve replacement |
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TX of tamponade
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O2
Pericardiocentesis |
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TX of massive PE
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IVF + dopamine and arrange for thrombolytics, if cant give thrombolytics --> surgical consult for embolectomy
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TX of hypovolemic shock
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IVF
PRBC Dopamine |
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Canon a wave
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Complete heart block
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Rapid x and y descent on JVP
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Constrictive pericarditis
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Rapid x descent only on JVP
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Cardiac tamponade
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For all valvular disease what is test of choice
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Transthoracic echo
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2 causes of acute MR
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Rupture of chordae tendinae
Endocarditis |
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Young thin female comes with occasional palpitations, mild chest pain, has midsystolic click, late systolic murmur which increases with Valsalva and standing
Tx? |
MVP
Beta blockers |
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Patient with dyspnea, hemoptysis, thromboembolism, hoarseness
Murmur heard |
MS
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Pt with MS w/out MR - which surgery
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Percutaneous mitral balloon valvuloplasty
Open mitral commisurotomy |
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MS + MR - which surgery
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Valve replacement
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You suspect pt has AS, pt has angina - would you order stress test?
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Order echo first
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Mother of 2 month old child comes with baby having SOB, not eating properly and looks sick on exam there is holosystolic harsh murmur best heard at LSB
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VSD
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Most common acyanotic congenital cardiac anomaly
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VSD
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SVT treatment
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Valsalva
Carotid massage Adenosine Verapamil, diltiazem |
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Pt on digoxin comes wiht SVT - what do you do?
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Do dig level, if high - hold digoxin and give digibind,
Even if hemodynamically unstable DO NOT do cardioversion |
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Short PR and delta wave at the onset of wide slurred QRS
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WPW
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Patient with WPW has palpitations, dizziness - tx of choice
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Radiofrequency ablation
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Drug of choice for WPW
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Procainamide
Disopyramide |
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Which drugs should be avoided with WPW
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Digitalis
Beta blockers Ca channel blockers Increase refractoriness of AV node and precipitat arrhythmisa |
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Pt with h/o syncope, palpitations, CAD comes with paroxysmal SVT that terminates with long pause followed by bradycardia
DX Test to order TX |
DX = sick sinus syndrome
Test - holter monitor TX = dual chamber pacemaker |
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Pt with AF unstable
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Synchronized cardioversion
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Pt with AF stable, duration less than 48 hours
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Cardioversion
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Pt with AF, duration unknown
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First rate control (IV metoprolol, verapamil, dig, diltiazem)
Start IV heparin, get TEE --> no thrombus - cardioversion Thrombus - anticoagulate for 3-4 weeks |
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Drugs that are used for pharmacological cardioversion
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Ibutilide or sotalol
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Pt with AF who DO NOT need anti coagulation
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Age < 60
No cardiac disease No DM/HTN Keep them on ASA |
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Pregnant woman with AF - which drug can you give
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Quinidine
Procainamide |
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BP > 220/125 + pt asymptomatic
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HTN urgency --> give PO anti HTN drugs
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BP> 220/125 + pt symptomatic with symptoms of end organ damage
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HTN emergency --> IV anti HTN and CCU/ICU admission
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Pt > 220/125 + symptomatic + papilledema
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Malignant HTN
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Beta blocker of choice in severe CHF
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Carvedilol
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Pt with HTN + chest pain - what do you want to give
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Nitroglycerine
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Pt on diuretic with ototoxicity -what is he on
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Furosemide
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Pt on diuretic with gynecomastia
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On spironolactone
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Unexplained HTN in young woman < 20 year old - what do you suspect
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Renal artery stenosis
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HTN pt with abdominal bruits - what suspect
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Renal artery stenosis
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Pt with difficult to control HTN, on more than 3 HTN drugs and BP not controlled
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Renal artery stenosis
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New onset HTN in elderly patient - what do you suspect
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Renal artery stenosis
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ACE inhibitor was started for tx of HTN - pt goes into ARF - what happened
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Renal artery stenosis
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Young patient with renal artery stenosis - cause
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Fibromuscular dysplasia
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Elderly with renal artery stenosis - cause
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Atherosclerosis
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You suspect renal artery stenosis - which test you order
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Doppler US
Captopril renography MRA |
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Young pt with renal artery stenosis - tx?
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Percutaneous angioplasty
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Evidence of ischemia on EKG
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T wave inversion
ST depression |
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Pt with COPD/asthma needs stress test - which drugs cannot use, which can
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CAN NOT use adenosine or dipyridamole
Use dobutamine |
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Indications for CABG (3)
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Left main disease
Triple vessel disease with low EF DM with > 2 vessels involved |
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Pt immediately after PTCA - what do you put them on
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GP IIb -IIIa inhibitor (Abciximab, Eptifibatide) for 48-72 hrs and on ASA + Plavix for 2-4 weeks, then can switch to asa only
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50 y o female with CP associated wth ST ELEVATION
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Prinzmetal angina - do cardiac cath, if no stenosis do ergonovine challenge test to precipitate vasospasm
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Prinzmetal angina - what do you start them on
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Acute - nitro
Long term - CCB BETA BLOCKERS CONTRAINDICATED |
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Pt with ST elevation in II, III, AVF - what to do next
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Check V4 for ST elevation on the Right
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pt with hypotension, elevated HVD, + Kussmaul sign, clear lung fields - symptoms of MI
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Right ventricular infarction
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Name main side effects of amiodarone
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Pulmonary fibrosis
Hypo/hyperthyroidism Photosensitivity Corneal microdeposits |
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Pt with endocarditis after cardiac surgery - which bug
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Staph epidermidis
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IV drug abuser with endocarditis - how do you tx
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Vanco + Genta (or Nafcillin + Genta)
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Pt with prosthetic valve or s/p cardiac surgery develops endocarditis - how do you treat
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Vanco + Rifampin + Genta
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Pt with endocarditis, cultures show HACEK - how do you treat
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Ceftriaxone
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Pt with cardiac history presents with anorexia, nausea, yellow vision, arrhythmia
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Dig toxicity
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Which meds elevate dig levels
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Verapamil
Diltiazem Erythromycin Tetracycline |
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Pt with Kawasaki - first thing to do
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ECHO - rule out coronary aneurysm
ASA + IVIG DO NOT give steroids |
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Pt with aortic dissection - what test do you order
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CT scan WITH contrast
Unstable --> TEE at bedside |
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Pain in legs during exertion or prolonged standing NOT relieved by rest, relieved by sitting
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Lumbar stenosis
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Pt with leg pain, pain decreased walking uphill
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Lumbar stenosis
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EKG - diffuse ST elevation, PR depression
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Pericarditis
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V tach with polymorphic QRS
Tx -> |
Torsades
Tx - IV mg |
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Trauma victim, conscious, normal voice but has neck hematoma/neck emphysema - what is airway management
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OROTRACHEAL intubation
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Pt with trauma, suspected cervical injury - airway management
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Nasotracheal intubation
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Conscious trauma patient with facial fracture + noisy breathing - airway management
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Cricothyroidotomy
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The most sensitive indicator of neurological dysfunction and best predictor of outcome in Glasgow coma scale
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Motor response
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Cushings triad of ICP
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Bradycardia
Respiratory depression HTN |
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Young male with clavicular fx - manage?
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Figure of 8 bandage, resume full activities in 3-6 weeks
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Upper humerus fx - which nerve damaged
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Axillary
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Shaft of humerus fx - which nerve damaged
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Radial nerve and brachial vessels
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Wrist, finger extensors and brachioradialis are weak, sensory loss over dorsum of hand - which nerve
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Radial
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Which fracture can cause Volkmanns ischemic contracture
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Supracondylar
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Leg got twisted while running, unable to straighen knee fully
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Medial meniscus tear --> arhtroscopic surgery
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Sudden pivot in the knee while running, swollen knee, excessive pain, lachmanns test +
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ACL tear
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Young adolescent male with localized swelling and tenderness in medial side of knee at tibial tubercle
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Osgood Schlatter
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Anemic pt - retic count is high - what does it tell you
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Hemolysis
Hemorrhage |
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Missing 4 alpha chains
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Hydrops fetalis - Hb Bart = death in utero
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Missing 3 alpha chains
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HbH (beta 4)
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