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465 Cards in this Set
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Dx patient w fatigue, fever, weight loss, non deforming arthritis, oral ulcers, serositis, hem abnormalitis, proteinuria, and rash.
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SLE. The arthritis most likely affect the MCP and the PIP joints.
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Dx patient with swelling of the head, with veins of the anterior chest wall appear engorged.
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Superior Vena cava syndrome due to obstructions of some sort. Get an Xray.
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Etiology of Baker Cyst
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excessive fluid in the synovium due to inflammation. Teh fluid builds up creating a tender mass.
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Isoniazid SE
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peripheral neuropathy, hepatitis, it is important to start them on pyridoxine.
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Mgmt for unstable sv tach
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cardioversion.
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Tx for someone who has SIADH
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fluid restriction.
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Risk factors for PAC
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tobacco and alcohol
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Dx patient with triad of dermatitis, diarrhea, dementia
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Pellagra, the late stage of niacin deficiency.
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Dx patient who develops fever urticarial rash, polyarthralgia, and lymphadenopathy after being adminisstered penicillin
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Serum sickness like reaction
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Infection acquired through sad leading to pruritis erythematous papules over the arm, which progress to elevated lesions evident bilaterally on the extremeties
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Cutaneous larva migrans
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Tx of patient with a pheochromoctoma
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If you give beta blocker first, you will lead to a rise in blood pressure. Need to alpha block them first, then the beta blocker.
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Vision loss thats associated with head movement
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usually papilledema.
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Dx patient with thyrotoxicosis and low iodine uptake
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1. painless thyroiditis, 2. granulomatous thyroiditis (dequervians), 3. iodine induced thyroid toxicosis 4. drug od 5. struma ovarii
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Fxn of dipyridamole
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and adenosine works as coronary vasodilators. Diseases vessels cant dilate. Thus the other vessels steal away from teh diseased vessels.
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Mgmt of patient w metastatic breast cancer that is resectable
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resect it.
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Dx patient with elevated levels of 17 alpha hydroxyprogesterone.
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Congenital adrenal hyperplasia. Due to a 21 hydroxylase deficiency.
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Mgmt of patients who recieved blood transfusions before 1986
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all of them need hep b and c testing. If before 1992, need hep C.
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Dx patient with cape like distribution of loss of pain and temp. with preserved position and vibration. Also areflexic weakness.
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Syringomyelia caused by cord cavitation.
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Which is more common in young people, septic or gonocchocal arthritis
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GA. Will usually have preceding polyarthritis features.
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Secondary pneumonia causeing pneumatocoeles
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staph infection.
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Dx patient w vasculitis, upper and lower airway granulomatous inflammation and glomerulonephritis
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Granulomatosis with polyangiitis. Wegeners. Cutaneous manifestations include subcutaneous nodules, palpable purpura, or pyoderma gangrenosisum like lesions as above.
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Dx patient with increased calcium, normal PTH levels, and low calcium clearance
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familila hypocalciuric hypercalcemia.
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Dx patient with palpable purpura, glomerulonephritis, arthralgia, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia
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Cryoglobulinemia. Low complement
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Tx for tinea corporis
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terbinafine, or other topical antifungals.
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Dx patient w struvite crystals
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Most likely has alkaline urine because of infection w urease producing bacteria. have a UTI
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Most common cause of kidney stones
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Calcium oxalate. Envelope shaped crystals.
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Side effects of methotrexate
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stomatitis, nausea, anema, and hepatotoxicity.
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Mgmt of patient w new onset dyspepsia over 55
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Failing antacids is indication for endoscope, but you dont start them on people, test for h pylori in patients over 55
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Dx patient with sacroiliac jt involvement, p anca, and bloody diarrhea
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IBD. if no diarrhea, just ankylsing.
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Cutaneous manifestations of UC
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erythema nodosum or pyoderma gangrenosum. Episcleritis, arthritis, and cholangitis. P anca is positive in UC.
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Mgmt of patient diabetic neuropathy
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TCAs. Can cause urinary symptoms and orthostatic hypotension due CV autonomic neurpathy. Also helpful is gabapentin or NSADS.
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Genetic testing in patient with breast cancer
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Needs to get oncogene amplification by FISH. Looking for teh HER2 gene which will allow therapy with trastuzumab and anthacycline chemo.
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Dx patient wtih hemiparesis of face arm and leg wo higher cortical dysfunction or visual field abnormalitis
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internal capsule
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Mgmt of patient diabetic neuropathy
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TCAs. Can cause urinary symptoms and orthostatic hypotension due CV autonomic neurpathy. Also helpful is gabapentin or NSADS.
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Genetic testing in patient with breast cancer
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Needs to get oncogene amplification by FISH. Looking for teh HER2 gene which will allow therapy with trastuzumab and anthacycline chemo.
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Dx patient wtih hemiparesis of face arm and leg wo higher cortical dysfunction or visual field abnormalitis
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internal capsule
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Patient with less than 30 min of pain in the mornings
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usually associated with OA. Will also have low cell count, joint narrowing, and osteophyte formation
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hyperreflexia after surgery
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is indicative of hypocalcemia. Other changes are will be muscle cramos, and convulsions.
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treatment of hypovolemia hypernatremia
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correct the volume problem first, then deal with the concentration issue, mainly giving half normal saline.
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tx of toxic megacolon
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steroids, nasogastric decompression and fluid managment, antibioitcs.
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Tamoxifen increases the risk of what cancer
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endometrial cancer. Tamoxifen works as a mixed agonist and antagonist acitivyt on estrogen receptors, increasing the risk of endometrial cancer and venous thrombosis.
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Nystagmus is present in which intoxications
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alcohol and phenytoin intoxication
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Most frequent cause of prosthetic septic joint arthritis
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staph aureus
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Changes associated wtih hypovolemic shock
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decreased CO, increased SVR, decreased wedge, decreased BP, increas HR
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Mechanism of hypertension in patients w thyrotoxicosis
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hyperdynamic flow
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Mechanism of hypertension in hypothyroidism
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increased SVR
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Dx pathophys of ALS
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amyotrophic lateral sclerosis has both upper and lower motor neuron symptoms, due to lesions in both areas.
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Dx sustained muscle contraction resulting in twisting repetitive movements
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dystonia
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sensation of restleness that causes pt to move frequently
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akathisia
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Dx patient with brief irregular unintentional muscle contractions
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Chorea
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Dx patient with rhtymic contraction or relaxation
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myoclonus
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Back pain with pt tenderness and fever
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probs osteo, need to get the MIR
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Pt with RET proto oncogene mutation
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Has MEN IIa syndrome. Remove teh thyroid.
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Abx of choice in COPD flares
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need to use levo, its newer and covers atypicals. Older ones like fluoro, isnt as good for strep coverage.
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Common co morbidity of dermatomyositis
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thye have a high incidence of ovarian cancer, Rememver that these patients have the heliotrope sign and on teh back they have a shawl sign. The knuckles and elbos are known as gottrons papules.
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Dx patient with anti Mi2 antibodies (helicase)
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Dermatomyositis.
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What is the immunologic features of bullous pemphigoid
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THey have IgG and C3 depositis at teh dermal and epidermal junction.
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Ot with IgG deposits between the epidermal cells
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most likely PV
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Tx for patient with crypto
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THey need amphtericin plus flucytosine
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Tx of peritonsilar abscess
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needs to be drained and then taken to surgery
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First step in severe hypercalcemia
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need to have saline hydration first then loop diuretics
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Dx patient who is black w painless hematuria
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sickle cell
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Cauda equina syndrome mechanism
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Spinal nerve root impingement. Symptoms will include low back pain, bladder dysfunction, saddle anesthesia, sciatica, perineal anesthesisa, reflex abnormalitis, and an elevated post void volume. Need to get an emrgent MRI.
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Most common SE of EPO administration
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hypertension. THen headaches adn flues. Iron supplemets before EPO. Indicatiosn are a hematorice less than 30 or hgb less than 10.
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Dx patient w tick bite, systemic symptoms, thrombocytopenia, and elevated LFTs
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Ehrlicosis. Treat w doxycycline. Caused by three diff gram negatices. No rash,
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Tx for RMSF in pregnant women
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chloramphenicol.
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Dx patient w body temp of 105, hot adn dry, DIC, adn ARDS
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heat stroke.
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Dx patient w body temp of 105 with hypertension and neuromuscular hyperactivity
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these patients either have serotonin syndrom or neuroleptic malignant syndrome
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Tx strategy for hepatic encephalopathy,
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lactulose, neomycin or rifaximen, and laxatives
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Main complication of rhabod
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Acute renal failure. Need to treat with hydration, mannitol, or urine alkalization
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Side effects of isoniazid
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Peripheral neuropathy, hepatotoxicity. Mild LFTs might occur, less than 100, and you dont need to wrry baboutt his.
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Dx patient with lymphocytes of various forms, w convuluted nuclei, and vacuolated cytoplasm
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These are the findings typical of infection mono,
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Dx 11 yo patient wtih proteinuria who is HBV positive
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most likely membranous.
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Dx patient with flushing, valvular heart disease, and diarrhea
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Carcinoid syndrome. Carcinoid tumors are common, which secrete sertonin. These patietns are at risk for developing niacin deficiency. Due to the icnrease formaiton of serotonin from tryptophan.
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Tx strategy for single brain met w stable extracranial disease
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surgical resection, followed by radiation
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Congenital cause of fanconi anemia
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due to an autosomal recessive disorder than causes poor groth, macrocytic anema. due to chromosomal breaks
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Mgmt of patient who presents with acute limb ischemia
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embolectomy. Start heparin and then either due it my embolectomy or intra arterial fibrinoylis.
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Therapy for patient w progression of clot and subtherapeutic INR
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they need heparin bridging. Warfarin for at least 6 moths in these patients.
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Pain and guarding while passively moving the arm above the head
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a positive neer test, which indicated impingement and tendiniits.
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Pathophys of patient with huntingtons
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they ahve atrophy of the caudate nucleus. Also enlargement of the lateral ventricles.
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Dx patient with sudden increase in CK and myopathy
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alwasy think hypothyroidi induced myopathy.
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Tx for patient with mallory weiss tear
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they need vasopressin, endoscopic injection or electrocautery if it doesnt resolve on its own
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Fungal infection with sin, bone and pulm manifestations
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sounds liek blasto. Lesions are characterized as well circumscribed, verrucous, crusted lesions
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Dx patient with flushing, valvular heart disease, and diarrhea
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Carcinoid syndrome. Carcinoid tumors are common, which secrete sertonin. These patietns are at risk for developing niacin deficiency. Due to the icnrease formaiton of serotonin from tryptophan.
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Tx strategy for single brain met w stable extracranial disease
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surgical resection, followed by radiation
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Congenital cause of fanconi anemia
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due to an autosomal recessive disorder than causes poor groth, macrocytic anema. due to chromosomal breaks
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Mgmt of patient who presents with acute limb ischemia
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embolectomy. Start heparin and then either due it my embolectomy or intra arterial fibrinoylis.
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Therapy for patient w progression of clot and subtherapeutic INR
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they need heparin bridging. Warfarin for at least 6 moths in these patients.
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Pain and guarding while passively moving the arm above the head
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a positive neer test, which indicated impingement and tendiniits.
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Pathophys of patient with huntingtons
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they ahve atrophy of the caudate nucleus. Also enlargement of the lateral ventricles.
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Dx patient with sudden increase in CK and myopathy
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alwasy think hypothyroidi induced myopathy.
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Tx for patient with mallory weiss tear
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they need vasopressin, endoscopic injection or electrocautery if it doesnt resolve on its own
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Fungal infection with sin, bone and pulm manifestations
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sounds liek blasto. Lesions are characterized as well circumscribed, verrucous, crusted lesions
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TEst of choice for reocclusion after MI
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CK MB. CK MB levels go down teh fastest and would be teh most useful, they go down i 1-2 days, whceras Trop T levels take up to 10 days to do it.
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Dx patient with PMN of 315 in the paracentesis, and aSAAG of 1.2
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this is portal hypertension and bacterial peritonitis. A PMN count greater than 250 is definitive.
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Dx patient with ear pain, drainage, and granualtion tissue near teh canal. Leading to facial nerve pathology
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Malignant otitis externa, most likely caused by pseudomonas. Treat w cipro.
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How do you dx suspected adrenal insuficiency
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Need to do the cosyntropin test. Cosyntropin is an anolog of ACTH.
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Immunizations for someone getting splenectomy
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they need pneumovax, haemophilus, and meningococal vaccinations . theyre risk for sepsis is over 30 years
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Patient with desire for ICE, clay dirt or paper products
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is PICA. THis is a mineral deficiency. and is indicative of an iron def.
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Best test for suspected diverticulitis
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get a CT scan
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ADvice for photo protection
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avoding being outside from 10 am to 4 m.
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SE of amiloride
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Amiloride is a k sparing diuretic, so can lead to hyperkalemia
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Tx for patient w condylomata acuminata
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treat with podophyllin. Caused by HPC, characterized by verrucuous, papilliform, andskin colered. LATA is more flat or velvety.
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Age cutoff for HPV vaccine
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from 9-26.
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Appetitite stimulant in patient with cancer
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Progestin or corticosteroids. Examples are megestrol acetate or medroxyrogesterone acetate.
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Stroke management in patient w sickle cell
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exchange transfusion, want to remove as many sickle cells as possible and prevent second infract. Sickling cant be fixed by fibrinolytics.
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Dx patient w swollen eyelids and conjunctiva, hypopyon, corneal edema and infection
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postoperative endopthalmitis
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co morbidities of lynch syndrome II
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common extracolonic tumors are endometrial carcinoma.
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Common SE of loop diuretics
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can cause permanent hearing loss or tinnitus
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Tx forHIV patient presenting w esophagitis
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treat w oral fluconazole.
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Indications for screening for chlamydia
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all sexually active women under the age of 24 should be checked.
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Most common cause of post flu pneumonia
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staph aureus. Gram cocci in clusters.
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Dx patient w widened mediastinum, unilateral effusion, and chest pain, after vomitting
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esophageal perforation
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Most common cause of osteomyelits in infants and children
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staph aureus.
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Patient presenting with stiff neck, shoulders and hips for 3 months
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has polymyalgia rheumatica. Treat with low dose prednisone.
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Dx patient w low LH, and infertility, and small testes
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probably was taking steroids.
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Significant hyperfaclcemia w low PTH
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think malignancy induced.
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Cause of infection bloody diarrhea
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think EHEC, enterohemorrahge E coli.
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SE of dig toxicity
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nausea, vomiting, diarrhea, vision changes, and arrhytmias
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Dx patient with constipation, abdominal pain, polyuria and polydipsia
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hypercalcemia, possible secondary due Vit D intoxication.
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Abx of choice for human or dog bite
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amoxixillin-clavulanate is the therapy of choice
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Imaging of choice for NF II
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Need to get MRI w gadolinium. They have hearing loss
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Treatment of hoice for chemo induced nausea and vomiting
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Serotonin antagonists that block 5ht3 receptors.
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Dx patient who worisk w pigs and has fluid filled cysts in the brain parenchyma
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Neurocysticerocosis.
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Tx of choice for NPH
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put a shunt in.
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Work up for stroke
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TPA yo.
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Dx patient with neuropsychiatric symptoms and liver problems
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Wilson disease. Hemocrhomatosis doesnt really have neuro symptoms.
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Tx of patient with first degree relative wi colon cancer
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need to get colonoscopy 10 years before he got the cancer
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Dx patient w hypotension, tachycardia, and SOB and history of DVT
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had a PE leading to dialted righ ventricle.
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What is the therapy of choice for acute cluster headace
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100% o2 yo. Prophylazis is done using CCBs.
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Dx patient with isolated elavation of systolic bp
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has still arteries, especially if they are old.
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Tx of choice for rosecea
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topical metronidazole. Pustules and papules may be presents.
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Dx patient who is PAS psositve, w arthralgia, weight loss, fever, adn abdominal pein, and diarrhea
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whipples disease. Also seen is skin hyperprimgentation. You can have heart involvement as well.
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Calcification of the adrenal gland
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this is classic for TB.
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Mgmt of patient w suspected aortic dissection
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Need to lower BP first, then get a TEE.
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Dx patient limited neck mobiliy and numbness in teh foream
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cervical spondylosis, they have bone spurs.
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Dx patient w neck pain and stiff and tender neck muscles who just took metoclopramide
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Has a metoclopramide induced dystonic reaction. IT is a dopamine receptor antagonist to treat nausea vomiting and gastroparesis,. Can lead to a dystonia.
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Dx patient with sun burst femur and sclerotic lesion
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osteosarcoma. Codmans trinalge is anoter feature.
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Dx patient with central scotoma, afferent pupillary defect, changes in color percetpion
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optic neuritis.
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Which hyperthyroid med will cause a thyrotoxic state
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radioactive iodine may initially cause an exacerbation
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anti centromere antibodies
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limited cutanenous.
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Dx patient w a non healing isolated ulcer in the vermillion zone of the lip with sun exposure
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squamous cell.
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Tx of choice for torsades
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Magnesum sulfate.
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Dx patient with large level of bands and segs, and low number of retic os promyelocytes or blasts
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CML. These patiets will also have a decreased leuk. alkp phos. Thats the leukomodi reactin.
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Common cause of Gout in a 60 yo man
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Occurs commonly in myeloproliferative disroders. Pvera can cause splenomegaly and pruritis w hot baths due to large amounts of histmine. 40% of patiets w PVERA have gout.
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Dx patient with gout, behaviroal problems, and neurologic disability
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Lesch nyhan syndrome, def of hypoxanthing guanine
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Tx for essential tremor
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first line is beta blocker, second line is primidone
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Tx for parkinsonian tremor
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Treat wtih trihexyphenidyl
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Diarrhea due to seafood
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vibrio parahaemolyticus
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Diarrah due to pork
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sporadi yersiniosis
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Diarrhea due to chicken
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campy
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diarrhea due to day care center or institituions setting
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shigella
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diarrreah due to ground beef undercoked
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E coli e 157.
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Contraindicatications for triptans
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1.hemiplegic migraines, uncontrolled hypertension, pregnancy, CAD, prinz angina, ischemic stroke, basilar migraine
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Dx patient with inflammatory changes in teh medial canthal region of the eye
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dacryocystitis. infection of lacrimal sac. has discharge.
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Risk factors for aspiration pneumonia
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altered conciousness, dysphagia, neurolgoic disorder, sedation
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Tx for patient with TIAs
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they should be on aspirin. If there was an embolus, then you can put them on warfarin therapy
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Zenkers mgmt
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need to get esophagram first, then surgery
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Dx patient with hematuria, deafness, and family hx of renal failure
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alports syndrome. Splitting of the GBM.
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Etiology of CHF post viral infection
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viral myocarditis leads to dilated ventricles w diffuse hypokinesia. Most often due to a coxsackie infection, direct viral damage.
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Mgmt of patient having an alcohol withdrawel
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Need to give them chlordiazepoxide, a common benzo.
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Tx of opiod withdrawl
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need to give them methadone. Patieints present with nausea vomiting abdominal pain diarrhea myalgias, increased bowel sounds, mydrias and piloerection. Does not cause seizures
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Dc patient with htn, tachycardia, agitation, hallucinations, fever,
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D. Tremens. Treat with benzos
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Dx patient with pseudomembranes
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Due to c diff infection, causes a pancolitis
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Dx patient wtih neutropilc crypts
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IBD. Remember IBD is bimodal, with one peak at 20 and the other at 60
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MOst important prognostic feature of breast cancer
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the TNM staing.
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CSF picture in viral meningitis
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high wbc, high protein, nl rbs, nl glucose
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CSF in bacteria
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high wbc, high protein, low glucose
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CSF in herp encephalitis
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elevated WBC/RBC, nl protein and glucose
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MOst common cause of osteomyeltisi in patients with sickle celll
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salmonella.
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PCP is what drug
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phencyclidine.
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Dx patient w new onset diabets, arthropathy, and hepatomegaly
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Hemochromatosis
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Dx patient w multiple non enhacing brain lesions and HIV
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multifocal leukoencephlopathy.
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Patient w weakly enhancing lesion on mri and EBV in CSF
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has a CNS lymphoma
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Dx patient with C3 deposits in the glomerulus
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This is membranoproliferative glomerulonephritis, caused by IgG antibodies, aka C3 phactor. This leads to persistent activation of the alt. complement system.
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Mgmt for patient with menieres disease
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Need to have a low salt diet. Also avoid alcohol, caffeine, nicotine, and diuretics are helpful
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Pathophys of diabeteic neuroptahy
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can cause nerve damage.
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Tx for symptomatic gallstones
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needs to get them out. ACute pancreatitis is often caused by gallstones, which would be an indication for surgery.
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Tx for syph with patients who are allergic to penicillin
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azithromycin or two week course of doxy. (same as chlamydia)
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Dx patient w cotton wool spots
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diabetic retinopathy
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Dx patient with proliferative retinopathy or newly formed vessels
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diabetic retinopathy
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Dx patient with microaneurysms, hemorrhage, exudates, and retinal edema
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diabetic retinopathy
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Tx of postprandial bloatin, early satiety, and diarrhea secondary to DM
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metoclopramide, for autonomic neuropathy of GI tract. Basically its a promotility agent
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Tx for alzheimers dementia
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one of them is donepezil.
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Common SE of ARBS
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hyperkalemia, hypotension, and renal failure
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Tests for the syph
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VDRL, FTA ABS
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Tx of septic shock
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hydration and abx.
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Dx patient who has better bone conduction than air conduction and low freq hearing loss
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this is classic for otoscleroris
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Mgmt of child with suspected pyelonephritis
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give them empric antibiotics. If they fail, then get teh CT.
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tx of parkinson tumor
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trihexyphenadyl
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Dx patient with atypical enlarged hepatocytes containing glycogen and lipid deposits.
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hepatic adenoma. Benign epithelial tumor of the liver in young and middle aged women who have long OCP history. Elevated alk phos, and elevated GGT
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Dx patient with sunusoids and kupffer cells on biopsy, with presence of anomalous arteries present in the centre of the nodule
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Focal nodular hyperplasia
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Dx patient with ear drainage and difficulty hearing, ear pain, fever, irritability, and diarrhea
|
Acute otitis media
|
|
|
Tx for post ictal lactic acidosis
|
is common, and you can just recheck labs in 2 hours and it should be normal.
|
|
|
Dx patient with two strong systolic peaks of the aortic pulse from left ventr. ejection separated by midsystolic dip
|
pulsus bisferiens, typical of aoirtic regurgitation and in HOCM
|
|
|
Dx patient w opening snap
|
chracteristic of mitral steoniss.
|
|
|
Dx patient with low 3 am sugar levels and hyperglycemia in teh morning
|
Somogyi effect, body produces EPi and norepi, and releases glucagon to increase the glucose levels. DC the insulin.
|
|
|
Most common cause of blindness in industrialized nations
|
macular degeneration. starts with percieving that straight grid lines look curved.
|
|
|
Dx patient with raised area of erythema, hot, and mass in her right groin
|
cellulitis, the groin mass is just lymphadenopathy
|
|
|
Dx patient with temporal and parietal lobe atrophy
|
Alzhiemers dementia
|
|
|
Which cardiac drugs can worsen cardiac ischemia
|
The dihydropyridine CCBs can worsen cardiac ischemia. They cause peripheral vasodilation and reflex tachycardia.
|
|
|
Dx older patient, with elevated alk phos, no pain, and elevated direct bilirubin,
|
Think malignancy. Need to get a CT>
|
|
|
What is the best imaging modality for MS
|
need to get an MRI, pathology is demyelination of focal regions of white matter
|
|
|
Dx patient with fluctuating cognitive impairment, recurrent visual hallucinations, and motor features of parkinsonism
|
lewy body with dementia.
|
|
|
Dx patient w personality change, compulsive behaviors, and impaired memory
|
Pick's disease, a fronto temporal dementia.
|
|
|
Dx patient with CT scan showing a pulmonary nodule with a halo sign or lesions w an air crescent
|
aspergillosis.
|
|
|
Tx strategy for toxo in AIDS patietns
|
Need to treat with sulfadiazine and pyrimethamine
|
|
|
These tumor never metastasize to the brain
|
non-melanomatous skin cancer, mouth cancer, esophageal cancer, prostate cancer
|
|
|
Brain cancer met
|
most often due to malignant melanoma.
|
|
|
What is the most common type of diabetic mononeuropathy
|
symmetrical distal polyneuropathy. Characterized by the stocking glove pattehr.
|
|
|
Electrolyte profile seen in a patient with aldosterone deficiency
|
They have a non gap metabolic acidosis, characterized by hyperkalemia, and hyponatremia
|
|
|
Common drug that causes nephrotoxicity
|
the aminoglycasides, like amikacin, tobra, etc.
|
|
|
Dx patient who has to hold books at an arms length to read
|
he has presbyopia, and its ccaused by a decrease in lens elasticity.
|
|
|
Indications for bacterial peritnonits
|
A positive ascities culture and a PMN level great than 250. Done before antibiotics, enteric like e coli and klebsielal are the most common. Treat w a third generation ceph.
|
|
|
Common causes of enthesitis
|
Common finding in ankylosing spondylitis .
|
|
|
Dx patient wtih trouble hearing and fluid draining form the ear, and dever diarrhea
|
Pt has acute otitis media.
|
|
|
Shoulder pain that does not improve with lidocaine
|
indicates some kind of tear. MRI is necessary for seeing the associated soft tissue structures.
|
|
|
Dx patient with personality changes, compulsive behavior, and impaired memory
|
frontotemporal dementia
|
|
|
Pt with asbestos expsure who has cancer
|
Its either mesothelioma or BAC, but BAC is more common. Also, if its in the lung field, you can safely say that its not pleural mesothelioma.
|
|
|
Dx patient who complains of pruritus after bathing, elavated HCT, and RBC mass, with a granulocytosis or thrombocytosisand splenomegaly. elevated leuk alk phos
|
Pvera. Low epo levels, since its a proliferation of the marrow, not of epo production.
|
|
|
Type of osteomyelitis you get from a puncture wound
|
usually do to pseudomonas
|
|
|
Mgmt of patient w suspected MGUS
|
need to get bon scan anyways to make sure.
|
|
|
Dx patient wtih follicular conjunctivis and pannus (neovascularization) in teh cornea
|
trachoma. Caused by chlamydia.
|
|
|
Lab findings in patient with IBD
|
they will have an elevated ESR, a thrombocytosis, weight loss, anemia, and postiive FOBT.
|
|
|
Dx patient with mallory bodies, infilgration by neurtophils, liver cell necrosis, and periventricular dist of inflmmation of the liver
|
alcoholic hepatitis.
|
|
|
First line treatment for patient with visual loss, increasd ICP, and female morbid obesity
|
treat with acetazolamide.
|
|
|
Tx of choice for patients with bright red blood in rectum who are less than 50 wo risk factors for colon cancer.
|
anoscopy/proctoscopy
|
|
|
Dx patient with bronchial breath sounds that have a full expiratory phase
|
lung oconsolidation
|
|
|
Vit def in patients with CF
|
they cant absorb fat soluble vitatimine, so ADEK is down. K causes a def. in factor VII.
|
|
|
Tx strategy for patients with TTP
|
they need plamsa exchange. Recovery is characterized by normalizatino of the plately count adn LDH levles. TTP is usualy do to def od ADAMTS13, leading to too much VWF multimers.
|
|
|
Damage of one eye after having trauma of teh other
|
sympathetic ophtalmia, releasing hidden antigens and starting autoantibodies against the otehr eye.
|
|
|
MGMT of patient w chronic pancreatitis who presents with epigastric pain
|
Think CANCER, need to get teh ctof the abdomen.
|
|
|
MOst common form of glomerulopathy associated wtih HIV
|
focal segmental, leading to proteinuria, azotemia, and normal sized kidneys, also prevalent among blacks.
|
|
|
MGMT of patient suspected of a pneumonia
|
need to get the xray first , then abx, then gram stain
|
|
|
Side effect of anti histamines
|
can cause eye and oropharangeal dryness and urinary retention. These are diphenhydramine, chlorpheniramine, doxepin, and hydroxyzine. IT presents the detrusser from contracting, leading to retention
|
|
|
Dx patient with elevated transaminases, increased serum iron and ferritin levels, and a history of non alcoholic cirrhosis, with increased skin pigmentation, diabetes, and arthralgias
|
this is hemocrhomatosis
|
|
|
Indications for carotid intervetion
|
if more than 79% stensosed, then you need to do a carotid endarterectomy. if less then manage symptoms. if less than 50, dont worry about it, follow w us. Asymptomatic patients from 60-99.
|
|
|
Dx patient presenting with photopsia *flashing lifhgts and floaters
|
retinal detachment.
|
|
|
Masses found in the anterior mediastunum
|
thyroid, teratoma, lymphoma,
|
|
|
Middle mediastinum masses
|
tracheal tumors, pericardial cysts, lymphoma, lymph node enlargment, and aortic aneurysms, bronchogenic cysts
|
|
|
Posterior mediastinum
|
meningocele, enteric cysts, lymphomas, diaphragmatic hernias, esophageal tumors and aortic aneurysms
|
|
|
Dx patient with rapidly progressive dementia, myoclonus, and periodic synchronus bi or triphasic waves on EEG
|
CJD
|
|
|
HOw do you treat SVT
|
adenosine.
|
|
|
How do you treat wide complex tachycardias
|
Amiodarone or lidocaine.
|
|
|
Dx patient with many stomach ulcers, test of the stool show fat
|
ZE syndrome, which can lead to malabsorption bc of acid inactivation of pancreatic enzymes.
|
|
|
MGMT of patient with stones due to hypercalciuria
|
Ironically, give them thiazide diuretics, as you dont want the urine to build up calcium. Lasix will lead to calciuria, which is bad.
|
|
|
CREST syndrome
|
esophageeal dysmotolity, telangectais, sclerodactyl, reynauds, calcinosis cutis
|
|
|
Dx patient with resp problems and new onset RBBB
|
think PE
|
|
|
Dx patient wtih facial rash, proteinuria, and decrease C3 levles.
|
lupus, leads to kidney damage through immune complex deposition.Too much complex activation .
|
|
|
What is the chloride concentration in vomiting
|
it is usually low, since youre trying to retain NACl.
|
|
|
Dx patient with hypokalemia, alkalosis and normotension with high urine concentrations
|
they have either bartter or gitelman syndrome.
|
|
|
Amiodarone side effects
|
pulmonary fibrosis, hepatoxicity, thyroid dysfunction
|
|
|
Dx patient with decreased CI, increased TPR, adn inreased LVEDV
|
Systolic heart failure. LVEDV will be elevated in systolic heart faiulre, Things that may reduce LVEDV would be low TPR thing or hypovelemia.
|
|
|
Tx for patient with history of rheumaitc fever
|
they need to get penicillin prophylaxis
|
|
|
Cause of rheumatic fever
|
due to strep pharyngitis, jones criteria is imp. Major criteria are carditis, polyarthritis, chorea, rash, sub cut nodules. Minor are arthralgia, fever, elevated phase reactiants, and prlonged PR interval.
|
|
|
Most common valvular problem in rheumatic fever
|
mitral stenosis
|
|
|
Dx patient with acute onset of severe eye pain and blurred bision w nausea and vomitting
|
Acute closure glaucoma. Red eye, steamy cornea, dilated pupil on reactive light
|
|
|
Mgmt of HIV patient with diarrhea
|
check the stool for ova and parasites.
|
|
|
Anemiai assocaited wtih non hodkins lymphoma or CLL
|
usually due to warm autoimminue hemolytic anemia. Treat wtih prednisone.
|
|
|
Treatment of PDE inhibitor and alpha blocker
|
need to give it at 4 hours apart, for risk of hypotension. Sildenafil is contraindicated in those with nitrates, priapism, things that will affect its half life, or using alpha blocker.
|
|
|
Mgmt of patien w new onset of seizures
|
need to get non contast head CT.
|
|
|
Mgmt of patient with acne
|
first line is topical retinoids, then topical antibiotics, then oral abx, then oral isotretinoin
|
|
|
Tx of patielt w chronic hep B and persitantly elevated ALT levels, detectable surface antigen, e antigen, or HBV dna
|
need to be treate with interferon or lamivudine.
|
|
|
How to treat HBV stick
|
vaccine and HBIG if not immune .
|
|
|
Next line for patient on albu. whos asthma isnt controlled
|
need to be on a corticosteroid, then a laba
|
|
|
Dx patient with hypotension, tachycardia, and heart failure
|
they have tamponade
|
|
|
Someone with vesicles,
|
almost always some kind of herpes.
|
|
|
Virux infection associated with atopic dermatitis
|
eczema herpeticum
|
|
|
How to differentiate between epiglottitis and and a retropharyngeal abscess
|
think time of onset.
|
|
|
3 year old with fever, irritiability, folowed by erythema, flaccid blisters, and a positive nikolsky sign
|
indicative of staph scalded skin syndrome.
|
|
|
Dx of depression
|
need 1 major and 5 minor
|
|
|
UC complications, which one requires surveillance
|
you can get toxic megacolon, PSC (if there is elevated alk phos), UC needs annual colonosocly.
|
|
|
How to dx celiac disease
|
Dx with a d xylose absoprtion test. If you have it, youll poop out d xylose, even after ABX (to rool our bacterial overgrowht). Pancreatic insuficiency would give you steathorrea, but would not impair the absorption of sugar.
|
|
|
Where are bile salts absorbed
|
in the terminal iluem.
|
|
|
Dx crooked, branching, beaded, gram positive and partiall aci fast filaents on micriscopy
|
nocardiosis, treat with bactrim. Empyemea is common with these patietns
|
|
|
Dx pateint wtih triad of encephalopathy, oculomotor dysfunction and gait ataxia
|
wernickes due to thiamin deficiency.
|
|
|
Dx patient w irreversible amnesia, confabulation, and apathy
|
Korsakoffs, due to thiamine deficiency
|
|
|
Cast differentials
|
Muddy brown casts: ATN
RBC casts: GMN WBC casts: Interestitial nephritis, and pyelo Fatty Casts: Nephrotic Syndrome Broad and waxy casts: Chronic renal failure |
|
|
indicators for hypovolemic ATN
|
urina Na great than 20, Fena greater than 2 %, urine osm greater than 300
|
|
|
Treatment for lyme
|
doxy, if allergic, then amox
|
|
|
Decrease in levels of LFTS with an increase in the levels of PT and PTT
|
indicates fulm. hepatic necrosis.
|
|
|
How to tell superinection of hep D
|
usually see an increase in LFTS
|
|
|
Difference between a follicular adenoma from a cancer
|
usually has to do with the involvement invasion to the tumor capsule and blood vessels. Follicular is encapsulating.
|
|
|
Best way to treat hypercalcemia of malignancy
|
bisphosphonates.
|
|
|
CSF picture of patient with MS
|
will have oligoclonal bands. Usually IGG.
|
|
|
CSF in GB
|
high protein. Called albumino cytologic disscoaition
|
|
|
Tx for acute central retinal oclusion
|
eyeball massage and O2
|
|
|
Dx patient with fever, rash, occipial or posterior lymph, and arthritis
|
Rubella
|
|
|
Koplik spots
|
measels. also thinka descending maculopapular rash, but think a viral rodrome. noarthritis usually.
|
|
|
Hematuria right after a strep infection
|
think an IgA neprhopathy. complement levels will be normal. Will also have hematuria.
|
|
|
How to treat an acute migraine
|
give prochlorperazinel, it is an antiemetic. or metaclopramide is an option as well.
|
|
|
Murmer that dissapear w squatting
|
HOCM and MVP
|
|
|
CA 19-9
|
pancreatic cancer. not good for screening, can be useful in monitoring after chemotherapy.
|
|
|
What is the prophylaxis of choice for malaria
|
Mefloquine. Chloroquine would be for places where its sensitive. Endemic areas are usually chloroquine resitant.
|
|
|
Dx patient with erythema migrans, a facial nerve palsy
|
Think lyme disease. The erytheam migrans rash usually doenst preset wtih pain, itching, or burning.
|
|
|
How to help a patient wtih diverticulosis
|
Advise patient to take in more fiber. Smoking or alcohol doesnt help really help.
|
|
|
Ot with chondrocalcinosis
|
this is pseudogout image.
|
|
|
DIP joint nodules
|
heberdens. Bouchards is the PIP jt.
|
|
|
Initial management of patient cf for back pain fora month
|
get an MRI to see if there are any fractures or lytic lesions
|
|
|
how do antihistmaines hep with cough
|
they reduce secretions
|
|
|
Mechanism of ACE inhibitor cough
|
it leads to the overproduction of kinins, activation of the arachidonic acid pathway
|
|
|
Tx strategy for patient with allergic rhinitis
|
Need to see if they have it. Get a nasal smear for eosinophils
|
|
|
Other causes for nasal eosinophilia
|
nasal polyposis, can lead non allergic rhinitis.
|
|
|
Bad Prognosti factors for patients with heart failure
|
Hyponatremia is a bad feeature, it indicates a high level of neurohumoral activation. Also present is hypo or hperkalemia
|
|
|
What is the mechanism of benefit form patient being given sodium bicarb
|
Bicarb can narrow teh QRS complex, preventing the develpment of arrhtymia in antidepressant toxicity (they affect teh action sodium channel). Important for TCA toxicity
|
|
|
First line therapy for a young person presenting with a new cardiac diastolic murmur
|
She needs an echo. Only midsystoloc soft murmurs who are asymptomatic should be left alone.
|
|
|
Side effect of trastuzumab therapy
|
It works in patients who are HER 2 positive. Also known as herceptin, risk of cardiotoxicity.
|
|
|
Inability to concentrate urine
|
referred as hyposthernuia, common in patients w sickle cell trait. Due to red blood sickling, impairs countercurrent exchagne and free water reabsorption .
|
|
|
Indicators of bells palsy
|
you wont have forehead furrows. If you have forehead furrows, then its mroe a central facial paresis.
|
|
|
Rejection hapening within a few minutes of a transfusion
|
Is common in anaphylactis reaction, common in patients with an IgA def. Also, there will be no fever, rapid onset, and bronchoconstriction.
|
|
|
Dx patient w trasfusion who has fever, flank pain, dark uring, and DIC
|
ABO mismatch.
|
|
|
Dx patient with bradycahrdia, miosis, rhonchi, muscle fasciluation, salivation, lacrimation, urination, defecation
|
Organophopshate poisoning, revers w atropine. You basically dont have acetylcholinestarase that is functioning. Need to remove clothing
|
|
|
What is the most likely cause of UTI in patient with alkaline urine
|
Proteus. Common in patients wtih alkalotic urine and chronic indwelling catheter.
|
|
|
Common causes of UTI in patients with chronic indwelling catheters who do not produce alkaline urine
|
Candida, pseudomonas, klebsiella
|
|
|
Does E coli produce urease
|
NO
|
|
|
Dx patient with chronic abdominal pain and diarrhea
|
think of chronic pancreatitis, as these patients have problems absorbing teh fats. Need to check for a stoll elastase, you souldnt have any?
|
|
|
Tx of choice for paient with a UTI, postoperative
|
Give bactrim
|
|
|
Dx patient with artharlgias, and intermitent elevations of AST and ALT
|
this is classic for hepatiis C. Also common is cryoglobulinemia, porphyria cutanea tarda, and glmorelunophretis
|
|
|
Characteristics of chronic hep. B
|
less likely to have waxing and waning levels or arthralgias
|
|
|
Rejection hapening within a few minutes of a transfusion
|
Is common in anaphylactis reaction, common in patients with an IgA def. Also, there will be no fever, rapid onset, and bronchoconstriction.
|
|
|
Dx patient w trasfusion who has fever, flank pain, dark uring, and DIC
|
ABO mismatch.
|
|
|
Dx patient with bradycahrdia, miosis, rhonchi, muscle fasciluation, salivation, lacrimation, urination, defecation
|
Organophopshate poisoning, revers w atropine. You basically dont have acetylcholinestarase that is functioning. Need to remove clothing
|
|
|
What is the most likely cause of UTI in patient with alkaline urine
|
Proteus. Common in patients wtih alkalotic urine and chronic indwelling catheter.
|
|
|
Common causes of UTI in patients with chronic indwelling catheters who do not produce alkaline urine
|
Candida, pseudomonas, klebsiella
|
|
|
Does E coli produce urease
|
NO
|
|
|
Dx patient with chronic abdominal pain and diarrhea
|
think of chronic pancreatitis, as these patients have problems absorbing teh fats. Need to check for a stoll elastase, you souldnt have any?
|
|
|
Tx of choice for paient with a UTI, postoperative
|
Give bactrim
|
|
|
Dx patient with artharlgias, and intermitent elevations of AST and ALT
|
this is classic for hepatiis C. Also common is cryoglobulinemia, porphyria cutanea tarda, and glmorelunophretis
|
|
|
Characteristics of chronic hep. B
|
less likely to have waxing and waning levels or arthralgias
|
|
|
Dx patient with jaundice in the third trimester, with pruritis and elevated total bile acids
|
intrahepatic cholestasis of pregnancy. Increased bile acid concentrations.
|
|
|
Tx of choice for patients with esophagitis in HIV
|
first treat them with flucanozole. If it doest work, then think CMVa nd you treat with ganciclovir. CMV esopahgitis will show large, shallow, and superficial
|
|
|
Dx patient with multiple small and well circumscribed, volcano like apearance
|
These patient have HSV esophagitis, treat with acyclovir
|
|
|
Common side effects of glucocorticoids
|
Increases the bone marrow and mobilization of the marginated neutrophil pool, thus giving you a netrophilia
|
|
|
Mgmt of rabies
|
If dog is not captured, give post rabies immunization. If it is captures and doesnt have symptoms, wait 10 days. ou uses AB analysis.
If there is any exposure of teh head or neck, start therapy immediately |
|
|
SHould patients chronic liver disease get pneumovax
|
yes
|
|
|
What type of def. is assicated with a tea and toast diet.
|
Commonly def. in folic acid. It is heat sensitve, and will cause a macrocytic anemia.
|
|
|
Dx patient with jaundice in the third trimester, with pruritis and elevated total bile acids
|
intrahepatic cholestasis of pregnancy. Increased bile acid concentrations.
|
|
|
Third trimester of prgnancy, elevation of transaminases, and on biopsy you see you microvesicular fat deposition in teh hepatocyte wo evidence of inflammation or necrosis.
|
fatty deposits of pregnancy t
|
|
|
Tx of choice for patients with esophagitis in HIV
|
first treat them with flucanozole. If it doest work, then think CMVa nd you treat with ganciclovir. CMV esopahgitis will show large, shallow, and superficial
|
|
|
Dx patient with multiple small and well circumscribed, volcano like apearance
|
These patient have HSV esophagitis, treat with acyclovir
|
|
|
Common side effects of glucocorticoids
|
Increases the bone marrow and mobilization of the marginated neutrophil pool, thus giving you a netrophilia
|
|
|
Mgmt of rabies
|
If dog is not captured, give post rabies immunization. If it is captures and doesnt have symptoms, wait 10 days. ou uses AB analysis.
If there is any exposure of teh head or neck, start therapy immediately |
|
|
SHould patients chronic liver disease get pneumovax
|
yes
|
|
|
What type of def. is assicated with a tea and toast diet.
|
Commonly def. in folic acid. It is heat sensitve, and will cause a macrocytic anemia.
|
|
|
Dx patient w perifolicular hemorrhage, swollen gums, and pour wound healing
|
Vit C def.
|
|
|
Proximal pain and weakness after steroid therapy
|
steroid induced cardiomyopathy.
|
|
|
levles of G6Pd during flares
|
are actually normal in many patients.
|
|
|
What are untreated hyperthyroid patients at risk for
|
bone loss from increased osteoclastic activity. Also arrhtymias.
|
|
|
Dx patient w trouble swalloing solid food, eye dryness, dental caries
|
This is sjogrens. Anti RO LA, SSA, also large submandibular swelling
|
|
|
Best way of preventing diabetic neuropahy
|
bp control
|
|
|
Drug used for rate control in Afib
|
diltiazem or beta blocker.
|
|
|
Which lung cancer hast the least association w smoking
|
adenocarcionoma. Usually located in the peripher.
|
|
|
Lab features of Pagets dIsease
|
Usually seen by an isolated high alk phos level.
|
|
|
patient presenting with symmetric swlling of the hand joints, rheumatoid factor is postive, and ANA is only wekalky positive goes away in 2 weeks
|
most likely a viral etiology
|
|
|
Patient who is thrombotic due to high homocysteine levels
|
need to treat with vit Bg, or pyridoxine
|
|
|
Pleural effusion that isnt draining, thick peel in place
|
need to get surgery. Decortication to remove the peel
|
|
|
Mechanism of anemia in SLE
|
formation of autoantibides leads to a pancytopenia, and a type 2 hypersenstiivyt reaction. Same mechanisms of ITP
|
|
|
Type of tremor associated with alcoholic abusers
|
Intention tremor, due to cereballar atrohy.
|
|
|
Dx patient w ataxia, broad based gait, dysmetria, intention tremor, problem with rapid movement, and nystagmus
|
Cerebellar dysfunction
|
|
|
Tx of choice for malignant otitis externa
|
Treat with cipro. Amp doesnt work for pseudomonas.
|
|
|
Danger of giving lidocaine prophylactically in ACS
|
can cause asystole
|
|
|
Dx patient with rickets w a normla calcium, normal serum alk phos, and normal 25 OH D
|
hypophosphatemic rickets. ALso see is rachitic roasary and harrisons groove.
|
|
|
Two sources of ascending paralysis
|
Ticks and GBS. GBS will show an abnormality on CSF.
|
|
|
Hyperplastic polyps
|
Normal, non neoplastic, arise from mucosal prolieation, benign adn no work up is needed.
|
|
|
Peutz jegher polyp
|
usually are hamartomatous, and are non malgnant
|
|
|
Most comomon form of poly in the colon
|
Adenoma, potentially premalignant. These are sessile or stalked,
|
|
|
Dx patient with problems with hand grip and elevated ESR that is 32
|
most likely RA. Look for problems with cervical spine. Theyu have C1 and C2 instability.
|
|
|
Dx patient w a non prouritic maculopapular rash involing the entire body with lmphadenopathy
|
think syphillis, secondary. Start wtih an RPR or VDRL then get an FTA AS. Worry about the jarisch herxheimer reaction after therapy. A febrile reaction with headaches and myalgias. Remember PALMS AND SOLES. w genearalized lymphadenopathy
|
|
|
CT changes in alzheimers
|
generalized cortical atrophy
|
|
|
Dx patient with depostits that show apple green birefringence on congo red stain
|
this is amyloidosis. They will have RA, enlarged kidneys, and hepatomegaly
|
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|
Dx patient with rash on the dorsum of the fingers
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This is chracteritis of dermatomyositis. Gottrons papules are the rash on teh dorsum of teh fingers
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Cardiac thickening and renal and liver involvement
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amyloidosis
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Most common side effect of steroid use
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Thrush
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Common causes of cholestasis, drugs
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chlorpromazine, nitrofurantoin, erythromycin, and anabolic steroids
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causes of fatty liver
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tetracycline, valproate, anti retrovirals
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causes of hepatitis
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halothane, phenytoin, isonizid, and alpha ethyl dopa
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causes of toxic or fulminant liver failure
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thetrachloride or acetaminphen
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causes of granulomatous liver
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allopurinol and phenybutazone
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INdications for dexa scan
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all women 65 and older
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dx patient with heterogenous and serspiginous contrast enhancement, with a butterfuly shape
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GBM. glioblastoma multiforme.
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Dx patient with anion gap with disc hyperemia and dry mucos
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think methanol posioning. vision!
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Dx patient w a gap acidosis with tinnitus, fever and hyperventilation
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aspirin
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Most common clotting disorder
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factor 5 leiden.
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Concave hemorrhage
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subdural
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a convex hemorrhage
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epidural hemorrhage
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Tx for open angle glaucoma
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treat with acetazolamide
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Tx for temporal arteritis
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steroids
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Side effect of didanosine
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pancreatitis
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SE of abacavir
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hypersensitivety syndrome
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SE of indinavir (a protease inhibitor)
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crystal induced nephropathy.
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SE of neripapine
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liver failuer
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problems with the NRTIs
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lactic acidosis
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problems with the NNRTIs
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stevens johnsons
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a convex hemorrhage
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epidural hemorrhage
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3 sign, notching of the ribs,
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coarctation of teh aorta
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Tx for open angle glaucoma
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treat with acetazolamide
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Tx for temporal arteritis
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steroids
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Side effect of didanosine
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pancreatitis
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SE of abacavir
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hypersensitivety syndrome
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SE of indinavir (a protease inhibitor)
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crystal induced nephropathy.
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SE of neripapine
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liver failuer
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problems with the NRTIs
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lactic acidosis
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problems with the NNRTIs
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stevens johnsons
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dx patient with tinnitus, fever, and tachycardia
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aspirin OD. Respiratory alkalosis (bc of tachypnea) and a metabolic acidosis.
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Patients w chronic hep c who hace elevated liver enzymes
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usually dont have histo abnormalitis, dont need to be treated with antivirals. They dont need biopsy
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Tx of choice for aortic regugication
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Want to reduce afterload, and thus use CCB or an ACE. BB can worse it.
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Most common pathogen in nursing home patients
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pneumococcus.
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Panacinar emphysema
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more typical in A1 def.
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Dx patient with chornic cough, prominent bronchovascular markins, nromal DLCO
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chornic bronchitis. Low o2 sat.
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DLCO in emphysema
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is LOW.
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Compliance of lungs in COPD
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are more compliant.
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MEchanism of of the contours in COPD
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due to work of breathing, leads to flattening, and vice versa
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HOw to treat acute hyponatremia that leads to seizures
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need to treat wtih 3% saline, if it happened fast. Always treat at the speed that it occured.
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MOst reliable indicator in patient recovering from DKA
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serum anion gap
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BNP level that indicates CHF
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greater than 100.
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Dx patient w chornic rhinosinusitis, asthma, asprin induced bronchospams
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they have polyps. aspirin induce respiratory disease, also bladn tasting food, glestiening mucoid masses in mucosa.
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Liver cyst after trip to mexico
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entamoeba histolytica. Will have a bloody diarrhea
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liver Cyst after hanging out with dogs
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hydatid cysts.
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Dx patient with sudden onset of vertigo, vomiting, and occipital headache
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think cerebellar hemorrhage. Also will have a 6th nerve palsy, conjugate deviation, blepharosopams and coma
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Tx for frostbite injury
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rewarm with warm water.
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Moist common pituitary tumor
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prolactinoma
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Physical exam findings with OA
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will have crepitus, bony enlargement, bony tenderness, and lack of warmth mornign sitffness. It is an on inflammatory disease, so no soft tissue swelling.
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Is sarcoid an interstitial disease
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No it is a disease of inflammatory granulomas.
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Treatment strategy for patient with fibromyalgia
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treat with amitriptyline, also cyclobenzaprine will work. increase restorative sleep.
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Surgery for skin lesion
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excision with 1-2 mm of clear margins. highest cure rate for basal cell cancer
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Tx of choice for OA, 1st line
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start with acetaminophen
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Dx patient with acute MI w papillary dysfunction, what murmur do they ahve
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they have mitra regurg leading to left atrial enlargment
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Treatment for PAB
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no treatment necessary.
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Electrolyte abnormality due to prolonged bed rest
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can lead to hypercalcemia. too much osteoclast activation.
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Patient wi afib who is pulseless
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need to start chest compressions. PEA. 6 hs and 6ts. You cant shock someone out of afib.
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Dx patient with back pain, with tenderness on eprcussion, and is not releived by lying down
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compression fracture, most likely due to vertebral body demineralization
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Mgmt of patient wtih recurrent pneumonias
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Red flag for cancer. Get a ct scan.
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anatomical Abnormalitis in HOCM
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septal hypertrophy adn systolic anterior motion of the mitral valve.
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MGMT of patient with met acidosis
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always get an anion gap
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Mechanism of CML
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Ty kinsase inhibitor,
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Huge increase in AST and ALT with modest increase in t billi and alk phos
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think ischemic hepaitis
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Dx patient who had megacolon and cardiac dysfunction
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Think chagas, a protozoan disease.
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Dx patient with pneumonia who has erythema multiforme
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mycoplasma pneumonia, doesnt have a cell wall and doest stain, but will ahve PMN.
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Mgmt of patient who is having hyperlipidemia, unexplained hyponatermia, and elevated serum muscle enzymes
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get a TSH. These patients have hypothyrodism. Not enough LDL receptors is teh problme.
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Migratory thrombophlebitis
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think cancer, get a CT. called trousseaous syndrome
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Infected sadal with vomitting and nausea
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think staph aureus
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Bad poultry
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think clostridium.
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Cause of travellers diarrhea
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ecoli, spec enterotoxigenic
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Dx patient wtih conjugaer bilirubinemia, normal lfts,
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Rotor syndrome
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Dx patient with conjugate hyperbilirubineami, w icterus, high bili, BLACK LIVER, dense pigments omposed of epinephrine metabolitses
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DUbin Johsnon. The urine will have high levels of coproporphyrin I, and a dark granula pigment is seen
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Dx patient with high levels of testosterron and estradio, with low levels of LH and FSH
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think a leydig cell tumor. Ladig to icreased estrogen levels.
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Lab findings in choriocarcinoma
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will have high b HCG
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lab findings in Patient with osteomalalcia
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Low serum calcium, low phosphate, and increased PTH
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Pt with low serum calcium, increased phosphate and low pTH
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hypoparathyroidism
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pt with increased serum calcium, low phosphate, and icnreased PTH
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hyperparathyroidism.
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What will happen to pateint who loses their bowel
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wont be able to absorb as well, Vit D def, lead to low calcium lead to osteomalacia. Will have low calcium, low phoshate, and high pth
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Dx patient w headache, nausea, and dizziness, and polycythemia
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think carboxyhemoglobinuria
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DPt with a high hydroxypyroline
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marker of bone degradation
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Dx patient wtih sores that have a sandpaper like texture
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actinic keratoses, can progress to squamous
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Mgmt of patient with pyelo
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get bcx first, then abx, if uncomplicated .Give a fluroquni or ceftriaone.
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What is complicated pyelo
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abscess, emphysematous pyelo, or necrossi
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Complication of long term spondy
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at risk for vertebral fractures, due to decreased mineral density.
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How to treat new onset a fib or unstable patients
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DC cardioversion. Drugs would amio or quinidine.
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Most common cause of death in acromegaly
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heart failure. Too much IGF 1 these guys.
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SE of amlodipine
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can cause angioedema. not an allergic reaction
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Dx patient wtih stabbing eye pain
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usually a cluster eye headache, they usually start at night, stuffy nose, or an ipsilateral horners syndrome.
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Ptosis and miosis
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a horners syndrome
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HIgh urine concentration in the setting of hih aldosterone activity and low K
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think a barter/gitelman syndrome picture. Also will have a high serum bicarb. Renin and aldosterone are both elevated . DIueretics looks similar but wont be as elevated.
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Tx of ascites
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1. sodium and water restriction
2. spironolactone 3. loop diuretic 4. abdominal paracentesis |
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Dx patient with flushing, diarrhea, and wheezing
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they have carcinoid syndrome.
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