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271 Cards in this Set

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B-thalassemia minor
Only one of β globin alleles bears a mutation. Individual will suffer microcytic anemia. Detection usually involves lower than normal MCV value (<80 fL). Plus an increase in fraction of Hemoglobin A2 (>3.5%) and a decrease in fraction of Hemoglobin A (<97.5%).
B-thalassemia major
If both alleles have thalassemia mutations. This is a severe microcytic, hypochromic anemia. Untreated, it causes anemia, splenomegaly, and severe bone deformities. It progresses to death before age 20. Treatment consists of periodic blood transfusion; splenectomy if splenomegaly is present, and treatment of transfusion-caused iron overload. Cure is possible by bone marrow transplantation.
Silent carrier
There is minimal effect. Three α-globin genes are enough to permit normal hemoglobin production, and there are no clinical symptoms. They have been called silent carriers. They may have a slightly reduced mean corpuscular volume and mean corpuscular hemoglobin.
Alpha thalessemia trait
The condition is called alpha thalassemia trait. Two α genes permit nearly normal erythropoiesis, but there is a mild microcytic hypochromic anemia. The disease in this form can be mistaken for iron deficiency anemia and treated inappropriately with iron.
The condition is called Hemoglobin H disease
. Two unstable hemoglobins are present in the blood: Hemoglobin Barts (tetrameric γ chains) and Hemoglobin H (tetrameric β chains). Both of these unstable hemoglobins have a higher affinity for oxygen than normal hemoglobin, resulting in poor oxygen delivery to tissues. There is a microcytic hypochromic anemia with target cells and Heinz bodies (precipitated HbH) on the peripheral blood smear, as well as splenomegaly. The disease may first be noticed in childhood or in early adult life, when the anemia and splenomegaly are noted.
Criteria for thrombolytics (in MI)
St elevation >1mm in 2 contiguous leads, ST segment depressions? 2mm in anterior leads (v1-v2)
Cefoxitin
gram - and anaerobic organisms. Used for abscesses
Physiologic jaudice
increase over 3 days to 15ml/dl
When do you give exchange transfusion for neonatal jaundice?
20ml/dl
Nl TSH
0.5-5
Repeat blood level in 3 months
10-14
Repeat blood level in 2 months
15-19
Repeat blood level in 1 wwek
20-44
Repeat blood level in 2 days start on succimer
45-69
70+
hospitalize and give dimercaprol and calcium EDTA
When to give a tetanus toxiod booster?
got tetanus toxiod between 5-10 years ago
When to give tetanus toxiod and immunogloblin?
More than 10 years ago and a dirty wound.
When to transfuse a young health persons
HCT<25%
Most frequent abnormality in antibody found Sjorgen's disease (most sensitive)
+ANA
Most specific for Sjorgen's
Ani ro and la
What disease is Rheumatoid factor always +
Cryoglobimenia (esp in hep C)
DDx: asymetric oligiodendritis
Reactive arthritis, psoaritic arthritis, ankylosizing spongolysis, gonococcal arthritis
Linezoid
thrombocytopenia/serotonin syndrome
Treatment for neutrapenic fever
antipseduomonial + gentomycin

If indwelling catheter add vanco
Sign/Symptoms BOOP
cough
dyspnea
influenza-like symptoms
febrile illness
widespread crackles
mild resting hypoxemia
On clinical examination, crackles are common, and more rarely, patients may have clubbing. Laboratory findings are nonspecific.

Almost 75% of people have symptoms for less than two months before seeking medical attention. A flu-like illness, with a cough, fever, a feeling of illness (malaise), fatigue, and weight loss heralds the onset in about 40% of patients
If a patient presents 3.5-4.5 hours after sx onset, what meds do you give
Aspirin or clopidegral +dyprimadole
Side effect of ribivan?
hemolysis-reduce dose
Side effect of inferon
depressed mood and flu like symptoms
Zidovudine side effect
reduced RBC production
When is the quad screen done?
15-20 weeks
Rx: spontaneous bacterial pertonitis
cefotaxime
Olazapine side-effect
weight gain, hyperlipedmia, hyperlipedima
Milestones: 18 months
walk down stairs while hold rail
sit on small chair
build a four cube block tower
Speak 10 words
Milestones:15 months
crawl up stairs
build a 3 block tower
communicate what he wants by pointing
Milestones:24 months
run, walk up and down stairs
build a 7 cube block tower
speak two-3 word sentences
use a spoon
Milestones:30 months old
stand on one leg
build a 9 cube tower
know their name and say I
Milestones:36 months old
rides tricycle
Triad of Henoch–Schönlein purpura
abdominal pain, joint pain, rash
most common early complication of hencoch palpable purpura
intussception
most common late complication of hencoch palpable purpura
renal involvement-check BP and do urinalysis
Triad of Henoch–Schönlein purpura
abdominal pain, joint pain, rash
Describe herpetidies multiformis
chronic, intensely pruritic rash, lesions appear symterically on extensor surfaces
Abx associated with seizures
carbapenems
When to treat a first time seizure
Abnormal EKG
Status epilecticus that did not resolve spontaneous (required meds)
Non-resolvable cause-such as a brain lession
Strong family hx.
meds that decrease mortality in CHF
spiralactone, B-blockers, Ace
Requirements for iron absorbtion
Intact dueodeum
Acidic environemt

Thus-celiac disease pt are iron deficient
Indications to give hypertonic saline
Na<110
patient acutely symptomatic:confusion, seizure, coma
optimal tidal volume in ARDS
500ml
(avoid baro trauma)
In poly/dermomytisis, which antibody is associated with interstitial fibrosis?
anti-jo
earliest manifestation of pelvic abscess
diarrhea
How low should the water heater be set to avoid burns
130
Treatment of choice for candemenia and emperic coverage of fungenima in neutrapenic patients
Echinocandians: caspofungin
micufungin,andulingufing
Don't cover crytococcus
rx for urge incontinence?
anticholinergics, e.g oxybutnin
rx: over flow incontience
tricyclic antidepressants.
Indications for PFO closure
Pulmonary HTN (e.g in COPD)
DVT
Bubble study showing shunting.
Recall, PFO is nl in 2/3 population
microcytic anemia + normal iron studies =
thalessemia
Only form of microcytic anemia with elevated reticulocyt count
Hemogloblin H disease
When are pregno's screen for DM
24-28 weeks
5 month old
Can babble, grasp, control head and arms, roll over, and make vowel sounds

Five letters in grasp
2 & 3 months olds
can coo and grunt, lift head while on stomach
7 month old
sit without support, creep, emotional attachment to mom
Risk factors for neonatal jaundice
ABO compatibility
Jaundice in first 24 hours
gestational age 34-36
Breast feeding with inadequate intake
Celphohematoma?
When is photo therapy indicated in hyperbili?
12>24hrs
15>48hrs
18>72 hours
Best way to confirm siderblastic anemia
Prussian blue
Normal urine Ph
<5.4
Indications for endocarditis ppx
prosthetic heart valves
Prior ho IE
Unrepaired cynanotic heart disease w/ shunt
t/f blood cultures should be drawn before initiating antibiotics in bacterial mengitis
True
What is the difference in diagnosis between adults and children who have hematuria 2/2 trauma
All children get CT
Only adults w/ hematuria & hypotension
True/false: heparin desolves preexisting clots
false
Most common manifestation outside the spine
Uveitis
What are the major criteria for Rheumatic fever
Migratory arthritis
Carditis
Syndeham chorea
Erythema marginata: subcutaneous nodules
When is Rhogam given (week)
28 week
Indications for inhaled corticoid steriods in COPD
FEV<50
More than 3 excerabations in a year
rx: diverticulosis
A clinical dx:
rx: cefutoxime and metro
When should bisphophates be given for osteoporesis
Post-menopausal women:
1) experience low impact trauma
2) T score <2.5
3) women with T score <1.5 w/ risk factors
Epigastric pain: when to scope
>45-55
Rx: achalesia
Myomectomy
When should a diabetic start a statin?
LDL 100-130
How to treat asthma attack in ER
Depends on baseline:
Mild-Moderate or Fev1 >40- albuterol x 3 doses in 1 hour; if recently on steroid give
Severe or Fev <40: corticoids, itraprium, Albuterol67
What conditions are associated w/ pseudo gout?
Hemochromatosis
Hypomagenia
Hyperparathyroidism
How many episodes of mania are required to dx bipolar syndrome?
1
Mandatory in osteomyletis
Bone biospy before abx: osteo rx is prolonged and there are many possible organisms
erythema nodasa is commonly associated w/ which illness
Strep throat
Treatment for Non-ST elevation MI
Beta blocker
Heparin
Aspirin
Abciximab
How to confirm disseminated gonorreah infection
Difficullt to culture
swap multiple sites (vag, rectum, ect)
Biggest risk factor for post-partum endometris
C-section
Echo-evaluation for cardiac surgery
end-systolic venticular demension of 55mm
Left venticular ejection fraction < 55%
Potential complication of typical antipsychotics
Long-QT
Check EKG
quetipine side-effect
orthostatic hypotension
What does Chlinda cover
Staph, strep, anerobes-no MRSA
First line therapy for cellulitis
Cefalozin
(unless multiple recurrences/hospitalizations)
Tetrology of Fallot
VSD
Pulmonary stenosis
Overriding aorta
R. ventricle hypertrophy
Cyanotic heart disease
Tet
transposition
truncus
total analous venous return
tricuspid atersia
Pulmonary stenosis
Treatment for PID
Doxycycline and cefoxitan/cefotatan
3 stages of lyme disease
early localized disease: erythema migranes
early disseminated disease: multiple EM, neuro sym (BL bell-palsy), Carditis
Late disease: large joint arthretis
Lyme disease Treatment (children)
Children under 8 can't get doxy
so give:
early: amox
Early disseminated: cefttriaxone
Dissemated disease: ceftriaxone
rx: disseminated lyme
Ceftriaxone
Cephasporins covering gram- rods
cefipime and cefitazidime
What do pippercillin and tigracillin cover
gram - rods
anerobes
Streo
pseudomonal coverage
Levofloxian
gatofloxin
moxifloxicin
carepenims
cover anerobes and sensitive staph
Cephasporins covering gram- rods
cefipime and cefitazidime
tigeracillin what does it cover?
MSRA, broad coverage of gram-
What do pippercillin and tigracillin cover
gram - rods
anerobes
Streo
pseudomonal coverage
Levofloxian
gatofloxin
moxifloxicin
carepenims
cover anerobes and sensitive staph
tigeracillin what does it cover?
MSRA, broad coverage of gram-
only cepholosporins with anaerobic coverage
cefoxititin and cefotetan
Which antibiotics have no anaerobic coverage
flouroquinolones
Cepholosporins exection?
Aminoglycocides
Azteranam
oxicillan/naficillin
minor strep infections could be covered w/
TPSMX
Clinda
Cefipime/ceftazidime
gram- rods
Carbepenems
cover anaerobes, strep, and sensitive staph
side-effect: fosocarnet
renal toxicity
gancyclovir side-effect
causes bone marrow suppression
rx: hep C
Rivaribin
True/false Ampotericin causes hyperkalemia
false
Which are the only types of osteomylitis that can be treated w/ oral antibiotics?
samenalla
Pseudo
What medication could be given if otitis media is not improving
amoxicillin-clavuic acid
True/false: strep pharyngitis does not cause cough or hoareness
True
Imepigo-MRSA community acquired
TMP-SMX
Rx: erypsella?
empiric: dicloxicillian
Confirmed: Penicillin V
Rx: minor cellulitis
dicloxicillin or cephafexilin orally
Rx: severe cellulitis
IV cefazolin, oxacillin, naficillian
best antifungal drug for hair and nail infections?
terbinafine (causes elevated LFTs)
rx: pregnant pt w/ std
Azthromycin and ceftriaxone
Rx: orchitis-epidymitis
<35 dox & ceftriaxone
> 35 floroquinolone
Name two causes of normal anion gap metabolic acidosis
RTA2
Diarrhea
How large of an induration can BCG cause?
usually can't get greater than 15
How does rabies present?
Prodome illness: fever & pharygitis
then neurological symptoms
Which factor is most important in estimating the 90 day mortality from liver disease
creatine
How low should viral load go after 6 months on HAART?
0-50 copies
Usual recommendation for post-exposure ppx HIV
2 nucleoside inhibitors for four weeks (unless pt has high viral load than add protease)
Treatment of community acquired pneunoma in hospitalized pt
Cover Typicals, eg. pneumococcal
Atypicals:azthromycin
Sig cardiovascular family hx
Female < 65
Male <55
When to chose Thallium over adenosine or dipyromole testing?
Can't read EKG b/c:
LBBB
Pace maker
Digoxin
When do ace/arbs lower mortality in MI?
if ejection fraction is low
Lowers mortality in MI
Aspirin
Clopidigrel
Thrombolytics
Angioplast
B-blockers
Statitins
Dx & treatment: cardiogenic shock
swan-guage catheter
Ace, urgent revascularization
Valve rupture: diagnosis and treatment
Echo
Nitroprussde
Ace
Intra-throatic ballon-bridge to surgery
T/F: handgrip softens the murmur of AS?
True: what is imp is the gradient
Handgrip/amyle nitrate decrease the murmur of MS?
These have negibile effect
INR 5-9 none or minimal bleeding
Hold Warfarin
Give low dose VIt K
INR>9 and no bleeding
Hold Warfrin
Give high does vit K
Dig toxicity
N/V, fatigue confusion, visual disturbances, cardiac abnormalities
INR<5 and none or minimal bleeding
Hold Warfrin for one or two days or lower dose
INR 5-9 none or minimal bleeding
Hold Warfarin
Give low dose VIt K
Most common cause of non-sustained V-Tach?
structural heart disease
INR>9 and no bleeding
Hold Warfrin
Give high does vit K
Dig toxicity
N/V, fatigue confusion, visual disturbances, cardiac abnormalities
INR goal for AVR mechanical valve
2-3
If sinus rhythm
Left atrium nl
INR goal for MVR valve repair/AO valve w/ a fib
2.5-3.5
First line rx paroxysmal afib. What is the cavet?
Calcium channel blockers
(unless CHF or conduction defect)
Define Sub-clinical hypothyroidism
Elevated TSH
Nl T4
Measure: antithyroid peroxidase antibody
Amiodarone' effect on thyroid fxn tests
TSH: nl
Total T4 elevated
T3 nl
Can hypo/hyperthyroidism
rx: papillary thyroid cancer
Near total thyroidectomy
OCPs effect on thyroid globin
Increase binding
Thus, increase levothyroxi for hypo thyroid pts
Contraindications for metformin (new!)
Alcohol
CHF
rx: hypercalcium 2/2 sarcoid
glucortiods
When to treat Sarcoid?
Symptomatic patient
Pulmonary function change
DONT treat erythema nodosum
Dx: allergic bronchopulmonary aspergillosis
skin prick test
allergic bronchopulmonary aspergillosis presentation
Asthmatic w/ fever, malaise, cough, brownish mucoid obstruction
Single most important factor in predicting survival in COPD
FEV1
Physiologic PEP
5
PEP in ARD should be ~ 10
Object for ARDS vent settings
Pa02 of 60
O2 sat ~ 90
Permissive hypercapnia
Low voltage qrs comlexes
think: pericardial effusion
High risk surgery
vascular surgery
test of choice for suspect malignant pulmonary nodule?
Video assisted throractic scope
large cell carcinoma. Where is it located?
Perpherially-can involve pleura
Typical feature of Squamus cell carcinoma of the lung
cavitory legion in the bronchus
associated w/ hypercalcemia 2/2 parathyroid like protein.
Suggest benign pulmonary lesion
pop corn, laminated, central, diffuse homogenous calcifications
Medications increasing warfarin metabolism?
Rifampin
Phenobarbital
First line rx: Chrons and UC?
Mesalime
NOT sulfasalizine b/c
Rash
Hemolytic anemia
interstitial nephritis
rx: perianal fistula
Acute: Cipro and metro
PPX: TNF alpha inhibitors
When to take someone with pancreatitis be biospied?
>30% necrosis on CT: if infected, necrotic, go for debridement
Hep B is associated w/ what vasculitide?
PAN
How could Hep B and C present
Serum sickness: joint pain, fever, uticaria
How are the LFT's different in Drug vs Viral Hep
Drug induced: Toast your AST
Viral: ALT (HIV Test)
Define chronic hep B?
>6 month positive serology: start antivirals
Serum to Albumin Ascites ratio (SAAG)
>1.1-cirrhosis or CHF
<1.1: no portal HTN
Most common causes of upper GI bleed in HIV positive
Lymphoma/karposi sarcoma
How to differentiate prerenal vs hepatorenal syndrome
Hep doesn't respond to fluid challenge
Urine sodium less than 10 vs less than 20 in prerenal
When is hypertriglyceremia considered a risk for pancreatitis?
>500
Side of effect of isoretion
hyperlipemia
Oliguria
<500 cc/day
<20cc/hr
Azathioprine
can cause acute pancreatitis
urobilinogen in a UA
suggests hemolysis
abx causing pancreatitis
metro, tetracyclin
DDX: isolated elevation of Alkaline phosphate
infiltrative disease: malignancy, granulomatous disease, infections certain meds
DDx: Euvolemic hyponatremia
SIADH
Hypothyrodism
Psychogenic polydipsia
What are the possibilities with a positive ELISA-anti-HCV antibodies?
Pesistant infection
Cleared infection
false positive
Confirm w/ HCV rna
Normal leukocyte count
4500-11000
When to give hypertonic saline?
Hyponateria w/ altered mental status/seizure
standard feeding regimine for hospitalized pt
30cal/kg/d
1g/kg/d proteint
Goal for correction in hyponatremia
8-10 meg/l/d
hyperplasic polyps
Surveillance colonoscopy every 10 years
1 or 2 small (<1cm) tubular adenomas w/o high-grade dysplasia
survilence every 5 years
3 or mor adenomas
High-grade dysplasia
Vilous feautes
Any adenoma 1 cm or large
survleillence every 3 years
What test to order to make diagnosis of hyponatremia
Pna, osmolarity, total protein, gluc, lipids
DDx: nephrogenic diabetes insipidus
Renal failure, hypercalcemia, lithuim, sickle cell
How to work-up hypokalemia?
Urine K:>20meq: kidneys waisting K
Stratifiy by acid base balance
Hypokalemia w/ metabolic acidois
RTA
Hypokalemia w/ metabolic alkalosis
Hyperaldosteronism
Cushings
diurection
NG sucton
Urine K<20
Non-renal source: trancellular shifts
GI losses
Complications of primary billary cirrosis?
Malabsortion of fat soluable vitamins:
Vit D: check for osteoporosis
When is resolution of H-pylori tested
4 weeks
Triple therapy for H-pylori
PPI, amoxicillin, clarthyromycin
(can substitute metro if allergy to PNC)
Quadrable therapy
PPI, bismuth, tetracycline, metro
Use if initial treatment failure
Associated malignancies in familial ademonas polps
Gastric and duodenal adenomas
Do upper endoscopy screen.
first-step in management pt w/ chronic diarrhea
Microscopic examination for stool
Sulfasalazine, 5-ASA
can cause acute pancreatitis
DDX: begin proteinuria
)Pulmonary edema, CHF, VA, orthostatic protinuria
1/3 of cases of nephrotic syndrome are caused by
Amylodosis
DM
SLE
Focal segmental glomerulosclerosis (patient profile)
Idiopathic, IVDU, HIV
Focal segmental glomerulosclerosis (Hx & PE)
young black man w/ uncontrolled HTN
Focal segmental glomerulosclerosis (labs)
microscopic hematuria
biospy shows sclerosis in capillary tuffs
Focal segmental glomerulosclerosis (rx)
prednisone, cytotoxic therapy
Most common adult nephropathy
Membranous nephropathy
Membranous nephropathy (hx & PE
ass w/ HB, sphilis, malaria
Membranous nephropathy( labs)
spike and done appearnce
Membranous nephropathy (rx)
prednisone and cytotoxic therapy for sever disease
Diabetic nepropathy (histology)
inc mesangial matrix
Membrano-proliferative nephropahty (hx and physical)
slow progression to renal failure
Membrano-proliferative nephropahty (histology)
tram-track double-lyaered basement membrane
decreased CS
diet for patient w/ calcium renal stones
nl calcium diet
low protein
First step in management
Hyperosmolar coma
Fluid resusitate
These pt have a total potassium decificent 2/2 lack of insulin
Rx: scleroderma renal crisishttp://www.flashcardexchange.com/mycards/add/1993314
Nitropruside + captopril
Normal serum bicarb
21-28
rx: hepatorenal syndrome
miloride + octride + albumin
three d of urtheral diverticula
post void Dribbiling
Dysuria
Dysparunia
K effect on GI track
Hypo K: ileus
Hyper: colic
CHIMPANZEES
Calcium supplimentation
Hyperparathyrodisim
Immobility
Milk-alki syndrome
Paget's disease
Addisons/acromegaly
Zollinger
Excess vit A
Excess vit D
Sarcoidosis
Corrected calcium
for every 1 deviation of albumin substract 1 from CA
Categorize the types of intrinisic renal failures
Interstitial
Glomerular
Tubular
Vascular
AEIOU
Acidosis
Electrolytes
Ingestion
Overload
Uremic
Work-up hematuria
Repeat UA
Treat any obvious infection-repeat UA
Check PPT, PT, plales

IF above -: look for upper tract problems
if -: cystoscope for lower tract
if - renal angiogram
Define proteinuria
>150g/d
Nephrotic syndrome
>3.5
imagining test of choice for urthreal diverticula
transvaginal U/S
Stage I renal cell carcimona
Confined within renal capsule- partial nephrectom
Stage II renal cell carcinoma
Extensive beyond capsule but not into fascia
screening test of choice for screening asymptomatic relatives of APKD
U/S
test of choice for renal artery stenosis
MR angiography
DDX: Hepatic encelopathy
GI bleeding
Hypokalemia
Hypovolemia
Hypoxia
Sedatives/trans
Hypoglycemai
Metabolic alkosis
Infectious (include SBP)
Rx: ureteral stone w/ sepsis
Fluids, abx, nephrostomy
Leriche disease
impotence, muscular, buttock claudation
When should prostate biospy be taken?
PSA>4
Prostate nodules or asymetry
Common problem after Turp
Retrograde ejactulation
Hypo calcemia vs hyper magnesia
HypOcalcemia causes hypERreflexia
HYperMagnesiam causes Hyporeflexia
PCA stroke
homonymous hemianopsia w/ macular sparing
Open angle glaucoma
African american with loss of perpheral vision
Lucunar stroke
Clumy hand-dyarthria syndrome
Pure motor or sensory deficiet
After how many hours can TPA be given for Basilar artery strokes?
6hours
Antibiotic associated w/ seizure
Flouroquinolones
Vertical nyastagums
Seen only w/ a central cause
Rotation nystagmus
Seen with perpheral causes
Brain stem lesions
Affect cranial nerves
Sensory loss on one side of the face and contralateral body
contral lateral paralysis of the arm and leg, contralater loss of tactile, vibratory, and position , tongue deviation to the affected side
medial medullary syndrome
Central midbrain lesions
abnormalities of CNIII
Side-effect Carbaazepine
neutrapenia
best prognosis in MS
sensory or cranial n involvment
How high should PB be allowed to go in stroke?
220/120
Best drug to give in opiate withdrawl
Clonidine
Damage to the dominate parietal lobe (Gerstaman syndrome)
acaluia,
Finger agnosia
Agraphia
Damage to Nondominant parietal lobe
Contruction apraxia: can't draw shapes when asked to copy
Dressing apraxia
Dominate temporal lesion
Homonynomous temporal anosia impaired perception of sounds
Dominat temporal lobe lesions
Always have aphasia
MMSE=dementia
<20
Lewy body Dementia
Need 2/3 : cognative flucuations
visual hallucinations
Parkinsoniam
Look for prominate flucations in symptoms
Best screening test for sarcoidosis
CXR: 90% have hilar adenopathy
Acceptable places to biospy sarcoid?
any palpable lymphnodes
Subcutaneous nodules, except erythema nodosa
Enlarged parotid
Lacrimal gland
Associated w/ diabetes insipidous
Craniopharyngiomas