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105 Cards in this Set
- Front
- Back
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Lichen planus sx & treatment |
Sx: purple, polygonal, pruritic, flat papules Txt: Topical corticosteroids |
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What causes Red Man Syndrome? Txt? |
Cause: Rapid Vanc infusion Txt: Stop vanc, give diphenhydramine + ranitidine, re-start vanc at slower rate |
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What conditions are a/w erythema nodosum? How do you diagnose this? |
Dx: Biopsy; hypersensitivity; degranulation of mast cells Strep pharyngitis TB Fungal infection (coccidio, histo, blasto) IBD (Crohn's, UC) Pregnancy OCP use |
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What is the difference between Stevens-Johnson Syndrome & Erythema Multiforme? |
BOTH cause target lesions E.M.: immune-mediated, 90% occur after INFECTION (SJS is mostly d/t meds) |
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What is the cause and treatment for Erythema Multiforme |
Target lesions from INFECTION Etiology: HSV or Mycoplasma pneumoniae Txt: Self-resolves; topical CS, PO antihistamines, PO prednisone Acyclovir does NOT help!i |
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SSSS Treatment |
IV PCN (Nafcillin, Oxacillin) |
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Actinic Keratosis Treatment? |
Sandpaper feel, red, scaly, pre-cancerous; May lead to squamous cell cancer Txt: cryotherapy, curettage, topical 5-FU, topical imiquimod |
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Compare and contrast pemphigus vulgaris & bullous pemphigus |
Vulgaris = DAMN (Higher mortality, desmosome Abs, Acantholysis, Mouth, Nikolsky) Txt: SYSTEMIC glucocorticoids (Prednisone) +/- immunomodulator/azathioprine/mycophenolate Bullous Pemphigoid -tense, hard to rupture Txt: Topical Corticosteroids (clobetasol) +/- immunomodulator |
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Man with chronic Hep C develops blisters whenever he goes out in the sun. What it he dx & management |
Dx: Porphyria Cutanea Tarda (defective uroporphyrinogen decarboxylase) Txt: Avoid triggers (EtOH, Estrogens) PCT = Phlebotomy to decrease Fe load Chloroquine Treat Hep C |
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Pityriasis Rosea treatment |
Christmas tree salmon-colored rash Txt: Reassurance (self-resolves); topical CS, acyclovir in severe cases |
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Squamous cell description, location, mets, histology and miscellaneous information? |
Ulcerative, red, crusting, hyperkeratosis Hands, face, lower lip Local (no mets) Keratin pearls on microscopy **Actinic keratosis (sandpaper) precursor |
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Basal cell description, location, mets, histology and miscellaneous information? |
Rolled edges with central ulceration; pearly papules, telangiectasias Sun-exposed areas, UPPER lip (BASE on FACE) Local Palisading nuclei |
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Melanoma description, location, mets, histology and miscellaneous information? |
ABCDE, brown Sun-exposed DEPTH correlates to risk of mets Atypical pagetoid melanocytes **S-100 tumor marker** Dx: with punch biopsy to determine DEPTH |
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Infant with dry skin (despite moisturizing lotion), scratching, erythematous patches & scaling on face, neck, antecutibal and popliteal fossae...dx, risk of developing what dz later in life? |
Dx: Atopic dermatitis (eczema)-flexor surfaces Later may develop ASTHMA! |
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Treatment of furuncles & carbuncles |
Small: warm compress Large: I&D, abx with Clindamycin or TMP-SMX |
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Impetigo causative organisms, exam findings, treatment? |
imPETigo S. aureus Honey-colored crusted lesions on face Txt: Topical MUpirocin or RETapamulin or PO diclOXacillin or cephalexin (MOO, RAT, OX) |
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Erysipelas causative organisms, exam findings, treatment? |
Strep pyogenes Painful, red, raised lesions with clear demarcations -Txt: PO PCN or Amoxicillin, IV Cetriaxone or Cefazolin (Ancef, 1GC) |
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Cellulitis txt? |
PO dicloxacillin or cephalexin IV Cefazolin or Clindamycin |
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Skin infection (impetigo, erysipelas, cellulitis) txt? |
C's; meds may be interchangeable for the different dz Cephalexin-impetigo Clindamycin-cellulitis only diCloxacillin-any of th listed skin infections |
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Treatment of necrotizing soft tissue infection? |
Commonly caused by Group A Strep Surgical debridement IV Carbapenem + Clindamycin + MRSA coverage |
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MRSA txt |
TMP-SMX Vanc Clindamycin Doxycycline Linezolid Daptomycin Tigecycline |
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Seborrheic Keratosis txt? |
StucK on, greasy, warty Benign; cryosurgery + curettage |
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Toxic Shock Syndrome txt |
IVF, vasopressors Clindamycin + Vanc (MRSA) |
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Psoriasis txt |
Mild: emollients, topical CS (hydrocortisone, betamethasone, clobetasol), tacrolimus, retinoids, Vit D Severe: Phototherapy, systemic therapy (MTX, cyclosporine, retinoids, adalimumab, etanercept, infliximab) |
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What are the indications for emergent hemodialysis in acute renal failure? |
Metabolic acidosis High K (>6.5) Volume overload unresponsive to txt Toxic levels of dialyzable drugs & alcohol Uremia |
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What empiric abx are used for ppx against cat and dog bites? |
Amoxicillin-Clavulanate or 1 of these: PCN VK CeFUROXime DOXYcycline mOXIflOXacin TMP-SMX + CLinda or Metro for anaerobes |
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What empiric abx txt is used for an INFECTED cat or dog bites? |
IV Amp-Sulbactam PIp-Tazo Ticarcillin-Clavulanate 3GC + Metro FQ + Metro Meropenem |
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Treatment of clean, minor wound of lower extremity in fully immunized (3+ prior shots); last shot was >10 y ago |
Td if > 10 years (they're due for 1 anyway!) |
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Treatment of clean, minor wound of lower extremity in non/partially immunized (<3 prior shots) |
Td |
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Treatment of dirty, puncuture/crush injury in fully immunized pt (>3 prior shots) |
Td if >5 years since last shot |
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Treatment of dirty, puncture/crush injury in non/partially immunized |
Td + Ig IM @ other site --> schedule f/u to finish series |
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Treatment of malignant hyperthermia |
Stop agent 100% O2 Hyperventilate DANTROLENE If high K, give CaCl, Bicarb, Insulin & glucose |
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What causes malignant hyperthermia? |
Halothane Isoflurane Succinylcholine |
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What agents cause methemoglobinemia? |
Dapsone Topical anesthetics Nitrates Aniline dyes |
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Treatment of methemoglobinemia |
Fe3+ can't bind O2; Methylene blue, ascorbic acid Blood/Exchange transfusion Hyperbaric O2 |
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Prolactinoma txt? |
-1st: DA agonist: Cabergoline, Bromocriptine -Surgery if desire pregnancy or if meds fail or if tumor > 3 cm |
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A pt with hx of hypothyroidism is getting supratherapeutic doses of levothyroxine (labs show low TSH). What are the risks with this and what is the appropriate management? |
Increased bone loss Arrhythmias Txt: Decrease the Levothyroxine (T4) dose and re-evaluate in 6 months |
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What is the management of pt with painless solitary thyroid nodule? |
1) Thyroid ultrasound, TSH, Free T4 2a) If high T4 (hyperthyroid), do RAIU --> If Cold nodule, do FNA to r/o cancer. If hot nodule, treat as hyperthyroid (BBl, Iodine, Surgery...) 2b) If u/s, TSH, Free T4 are normal, do FNA 2c) If u/s, TSH, Free T4 show hypothyroidism (High TSH, low T4), do FNA |
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Ulcerative Colitis serology & treatment? |
P-ANCA + 5-ASA (Mesalamine) Steroids Immunosuppressants (Cyclosporine, Azathioprine, 6MP) Anti-TNFa (Infliximab) |
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Celiac dz serum antibodies? |
Abs: Anti-endomysial, Anti-tissue transglutaminase |
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Celiaz dz dx & txt |
Dx: Small bowel biopsy (confirmatory) **Anti-endomysial, Anti-tissue transglutaminase Abs BROW txt: Avoid Barley Rice Oats Wheat |
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Hereditary Hemochromatosis sx, dx, txt |
Sx: AST/ALT high, high Fe & ferritin & transferrin, bronze skin, diabetes Dx: HFE gene mutation, liver biopsy Txt: Phlebotomy |
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What stress ulcer ppx treatment is linked with an increased risk of C. dif infection? |
PPI + H2 blocker-it's the best treatment, but causes C. dif |
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How to diagnose achalasia? |
1st: barium swallow- bird's beak Confirm: manometry (no peristalsis seen) |
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Primary Sclerosing Cholangitis ERCP, blood findings? |
pANCA (like UC) Beading of the biliary system Increased alk phos, total bilirubin, direct bilirubin |
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Treatment of Primary Sclerosing Cholangitis? Associated malignancy? |
No proven medical treatment ERCP for dominant stricutre Liver transplant for advanced liver dz More likely to develop: GB cancer Hepatocellular cancer |
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Treatment of C. dif? |
Metronidazole. If this fails or diarrhea recurs, try: -PO Vanc (stays in GI tract) -Fidaxomicin + RIfaximin Fecal bacteriotherapy |
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Primary Biliary Cirrhosis dx & txt |
Dx: liver biopsy (definitive), ANA+, AMA+ Txt: Ursodeoxycholic acid, cholestyramine, liver transplant |
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HUS sx, cause, txt? |
RAT = Renal (Bun,Cr), Anemia, Thrombocytopenia Cause: E. coli 0157:H7 Txt: Transfuse RBCs, plt, dialysis, plasma exchange, Eculizumab |
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Treatment of young woman with low platelets, petechiae, nosebleeds, but no other severe bleeding? |
ITP = Isolated to Platelets Txt: IvIg, Prednisone, none if asx |
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Multiple Myeloma dx |
SPEP: monoclonal Ab spike (M spike) UPEP: monocolonal urine protein Definitive: Bone marrow biopsy |
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Polycythemia Vera sx, txt |
Burning pain in hands, feet, intense pruritus, blood clots (high hgb & sometimes high plt!!)
Txt: Phlebotomy, Hydroxyurea (prevents plt agg), low-dose aspirin (burning hand pain)
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Compare DIC, hemophilia, ITP, TTP, VWD |
DIC: high BT & PTT, very sick pt activity VWD: high BT & PTT, low Ristocetin TTP: low plts, high BT, nL PT/PTT, ADAMTS13 def; FAT RN
PT/PTT = coagulation cascade |
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TTP dx & txt |
TTP: low plts, high BT, nL PT/PTT, ADAMTS13 def; FAT RN Plasmapheresis Corticosteroids Splenectomy if recurrent or refractory to plasmophoresis and corticosteroids |
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Osteomyelitis empiric abx therapy? |
*Vancomycin - MRSA, coag - staph FQ (Ciprofloxacin)-'lones for bones 3GC (Ceftriaxone) 4GC (Cefepime) Debridement Hyperbaric O2 Negative pressure wound therapy |
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Diagnosis of septic arthritis? |
Joint arthrocentesis with joint fluid analysis: WBC, gram stain, cx, histology |
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Treatment of bacterial endocarditis? |
Fever, new murmur Empiric txt = Vanc x 4-6 weeks; valve replacement |
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Rheumatic Fever sx? |
JONES Janeway - nontender, splinter hemorrhages Cardiac Nodules Erythema migrans Syndenham chorea Roth spots |
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What antibiotic ppx should be used in infective endocarditis? |
2 g Amoxicillin for pts with prosthetic heart valves, prior endocarditis, congenital heart dz |
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RMSF treatment in non and pregnant pts |
Doxy Pregnant: Chloramphenicol |
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Diabetic with proteinuria should be started on what med? |
ACEI/ARBs |
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#1 cause of nephrotic syndrome and txt? |
FSGS FSGS Txt: glucocorticoidds to reverse proteinuria Statins to decrease CV risk ACEI/ARBs to decrease protein, improve kidney function |
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What meds can cause hyperkalemia |
Inhibitors, Beta blockers & Antifungals incr K!! ACEI, ARBs K sparing diuretics - Spironolactone Beta-blockers (Metoprolol) Digoxin NSAIDs Azole antifungals (Fluconazole) TMP-SMX |
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How rapidly can low serum Na be corrected? What if you correct it too fast? |
By 12 mEq in 24 hours (0.5 per hr) Paralysis, dysphagia, dysarthria |
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SIADH treatment |
Dilute serum Na (120), concentrated urine; Stop Ingesting Agua Diuretics (Loop) Vasopressin R antagonist: Conivaptan, Tolvaptan |
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What is the txt for each type of renal tubular acidosis |
Types 1 & 2: Bicarb + K + Diuretics |
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Pyelonephritis dx & txt |
Dx: CT confirmation Txt: Ceftriaxone, FQ |
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Hypercalcemia treatment |
IVF Calcitonin-increases kidney Ca excretion Bisphosphonates Glucocorticoids (for lymphoma, sarcoidosis, granulomatosis) |
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AFP is a tumor maker for what cancers? |
Hepatocellular Testicular Gastric |
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Chronic liver dz (d/t EtOH abuse, hemochromatosis, Hep B/C, cirrhosis, etc) with ACUTE decompensation such as ascites, jaundice, encephalopathy, variceal bleed, etc, indicates what disease? |
HCC |
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Sx, dx & txt of Carcinoid Syndrome |
Sx = "Be FDR:" Bronchospasm, Flushing, Diarrhea, R heart murmur Dx: 5-HIAA in urine, abdominal u/s Bronchopulmonary tree & small intestine are most likely site of PRIMARY tumor Txt for sx: Somatostatin analog (Octreotide) |
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What paraneoplastic syndromes are a/w small cell lung cancer? |
Small SAL has big problems (the big problem is that small cell cancer is NON resectable!); central, smokers SIADH ACTH --> Cushing Lambert-Eaton --> Abs to presyn Ca ch & NMJ |
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What para neoplastic syndromes are a/w squamous cell lung cancer? |
PTHrP-hypercalcemia with low bone density Pancoast tumor-Horner's (Ptosis, Anhidrosis, Miosis) FYI: Squamous = central location, smokers, surgery early, chemo/rad late |
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What is the mcc of lung cancer in non-smokers? |
Adenocarcinoma |
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What diagnostic test should be performed if suspect testicular cancer? What further testing should be performed before beginning treatment? |
1st do u/s to r/o hydrocele & varicocele Then get serum tumor markers (BHGC, AFP, LDH) Then imaging: CXR (lung mets), CT abd/pelvis (LN mets)
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Testicular cancer txt? |
Orchiectomy Eradicate Ball Cancer = Etoposide, Bleomycin, Cisplatin |
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Causes of transudates and exudates in pleural effusions? |
Transudate: volume overload; Na retention; increased hydrostatic P, decreased oncotic P Exudate: infection, inflmmn, cancer, lymphatic obstruction |
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How do you improve oxygenation and ventilation on respirator? |
To improve oxygenation: FiO2, PEEP To improve ventilation: TV, RR |
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Txt of idiopathic pulmonary HTN |
These pts are at increased risk for intrapulmonary thrombosis, so give long-term Warfarin |
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Txt of asx sarcoidosis in lungs |
No txt if no sx!! Symptomatic: give prednisone x 4-6 weeks |
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Lupus blood tests for dx? |
"ADS" = ANA, then dsDNA, then anti-Smith abs |
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What are the seronegative (HLA-B27) spondyloarthropathies? |
Psoriatic Arthritis- silvery skin plaques + nail pitting + arthritis Ankylosing: bamboo spine Reactive: can't see, pee, climb tree |
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RA blood test confirmation & txt? |
ACPA (Anti-Citrullinated Protein Ab) DMARDs early to prevent permanent injury (hydroxychloroquine, sulfasalazine, MTX, TNFa inhb,, rituximab) |
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Dermatomyositis serum markers, other dx studies, txt? |
High CK, aldolase, Jo-1, ANA, NORMAL ESR EMG; definitive = muscle biopsy Txt = high dose steroids |
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Anti-Histone Abs = |
Drug-Induced Lupus Sulfonamides Hydralazine INH Phenytoin Procainamide |
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Anti-La/SSB Abs |
Sjogren's |
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Anti-topoisomerase 1 Abs vs Anticentromere abs |
Anti-TI-1 Abs: Scleroderma (Diffuse Cutaneous Systemic Sclerosis) Anticentromere: CREST (Limited Cutaneous Systemic Sclerosis) (CREST = Calcinosis, Reynaud's Esophageal dysmotility, Sclerodactyly, Telangiectasias) |
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Raynaud's txt |
Avoid cold temp, smoking Long-acting CCB (vasodilators to prevent vasospasm) = Nifedipine, Amlodipine |
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Otitis externa treatment
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Gentamicin or FQ |
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Strep throat dx criteria and treatment
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3/4: tonsillar exudates, tender cervical adenopathy, fever, no cough Txt: Amoxicillin PO or PCN V; give macrolides if allergic to PCN |
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BPH Medicine Txt? |
5aR inh (Blocks T conversion to DHT): FInAsteRIde |
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What are indications for abx therapy in acute rhinosiusitis (<4 weeks) |
Doxy or FQ if allergic to PCN |
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Treatment of intermittent and persistent restless legs syndrome
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Persistent: DA agonists like Ropinirole, Pramipexole or Gabapentin, Pregabalin |
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Treatment of intrahepatic cholestasis of pregnancy (incrased bile acids)that causes itchyness on palms & soles, worse at night |
Ursodeoxycholic acid
Hydroxyzine for the itching Early delivery at 36 weeks |
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What agents can be used to induce labor? |
IV oxytocin Misoprostol (PGE1 agonist to ripen cervix) Dinoprostone (PGE2) |
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ASCUS workup |
<24: Repeat Pap in 1 yr. If positive, do colposcopy >25yo: HPV test; if +, do colposcopy |
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ASC-H workup HSIL workup |
ASC-H: Everyone gets a colposcopy!! HSIL: >25 may choose LEEP or colposcopy, but <25 only get colposcopy H = do a colposcopy!! |
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LSIL workup |
21-24: Repeat pap in 1 year 25-29: Colposcopy >30: HPV test. + get colposcopy; - get repeat PAP + HPV test in 1 year |
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What is the treatment for chorioamnionitis and what are the causes? |
IV Amp + Gent (broad spectrum abx) -use these abx because BABY parts are infected!! Causes of chorio: prolonged ROM, prolonged labor, multiple cervical exams, meconium fluid, internal monitors Txt of Endometritis (MOM is infected)= Clinda + Gent |
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Preterm Premature labor tocolytics, txt for fetal lung maturity, abx ppx to prevent infection |
Tocolytics: Indomethacin, Nifedipine Fetal lung maturity: IM Betamethasone PPx: Amp + Azithromycin |
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Mgmt of preeclampsia with severe features? |
BP >160/110 or end-organ damage Seizure ppx with IV MgSO4 Delivery! |
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Mastitis treatment |
Dicloxacilln ("2" breasts) or Vanc (if MRSA) I&D to drain abscess Keep breast feeding! |
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Treatment of Primary dysmenorrhea and endometriosis? |
NSAIDs Combined OCPs GnRH agonist (Leuprolide) Progestin Danazol Surgery |
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Treatment of heavy vaginal bleeding for a few days/weeks with unknown cause? |
First give high dose PO Estrogen to stop bleeding within days Once bleeding stops, give Progestin or combo OCPs |
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How to slow progression of macular degeneration? |
Stop smoking Daily supplement with Vit C, E, Zn, Cu, Lutein, Zeanxthin |
