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145 Cards in this Set

  • Front
  • Back
fever, sinus pain, thin bloody nasal discharge, double-vision, red or necrotic nasal turbinates.

DM predisposes

confirm with biopsy before treating
grade 1&2 -> 80% resolve spontaneously. Therefore, prophylactic Abx only.
1. CF Lung infx organism
2. How treat?
1. Pseudomonas
2. Inhaled Tobramycin
Thoracic aneurysm types and how treat
1. Type A - ascending
B-blockers only
surgery if 5-6 cm

2. Type B - descending.
Surgery if 6-7 cm?
these ones grow faster
Which diabetes medication class increases insulin production?
sulfonylureas (e.g. glipizide, glyburide)
How detect exogenous insulin?
absence of c-peptide, which is present with endogenous insulin production
APGAR review
Appearance (0-blue, 1-blue extrem, 2-pink)
Pulse (0-absent, 1-<100, 2->100)
Grimace (0-absent, 1-grimace,2-cough/sneeze)
Activity (0-limp, 1-some flexion, 2-active motion)
Respirations(0-absent, 1-slow and irreg, 2-good,crying)
Hyperkalemia tx
("See Big K Drop")
Calcium - works immediately, emergency
Bicarb 30-60min
Insulin and
Glucose 30-60min
Pulmonary Alveolar Proteinosis
positive PAS (periodic acid-schiff)
- cough, dyspnea, weight loss
- treat with whole lung lavage
- "bat wing" config on x-ray
- CT ground glass
Muscle weakness diseases
1. Dermatomyositis. Symmetric and proximal. (anti-Jo Ab, heliotrope rash, do CT scans for CA screen!)

2. MG. Intermittent. Ptosis, bulbar muscles, coulg be anywhere - no pattern! Caused by Ab against Acetylcholine receptor. (opposite of organophosphate poisoning)Check CT scan for thymoma! Lambert-Eaton is a variation.

3. GB - tingling starts in toes and feet. Then ascending paralysis.
MTX protocol for ectopic pregnancy
- give MTX PO or IV
- check B-HCG at days 4&7
- if not fall > 15% from day 4 to 7, then repeat MTX
- follow weekly B-HCG until falls to zero
Testosterone treatment. What labs check?
Hg/HCT and PSA in 3 months
Trazadone side-effect
Hypothyroidism. What effect on CBC?
Macrocytic anemia
Renal Stone types
Calcium Oxalate (60%) radio-opaque
Uric Acid (10%) radio-luscent
nail in foot through shoe. What bacteria?
Cluster HA treatment
Conn's disease
causes hypertension and hypokalemia
testicular CA types and cancer markers
germ cell types
- seminoma (increased HCG)
- non-seminoma (increased HCG and increased AFP)
Cancer Markers:
1. colon CA
2. pancreatic gastric CA
3. GT dz or testicular CA
1. CEA
2. CA-19-9
3. B-hcg
Food poisoning sources and characteristics of each of these:
1. E. Coli 0157:H7
2. Clostridium perfinges
3. Vibrio
4. Campylobacter jejuni
5. B. cereus
6. S. aureus
1. undercooked hamburger, 24-72 hours after exposure, bloody diarrhea, abdominal pain
2. caused by toxin, only 8-16 hours after exposure, more abdominal pain, cramping
3. seafood
4. diarrhea and fever
5. rice/no fever
6. 1-8 hours after eating dairy
Immune Defic. types:
1. Fungal, PCP infections
2. Neisseria (pyogenic)
3. granulmoatous
4. enteric and sinopulmonary
1. T-cell, delayed hypersensitivity
2. complement
3. Nitroblue tetrazolium test
4. Quant Immg G
Bacterial Meningitis tx by age rage
1mo -> 50yo CTX (S. pneumo and N. mening.)
50yo+ CTX and amp (to cover listeria)
Treatment for Neuroleptic Malignant Syndrome (and what is it)
mental status change / rigidity / fever / dysautonomia

Dantrolene (skeletal muscle relaxant)
Bromocriptine (dopamine agonist)

caused by:
treatments for overdoses of:
1. INH
2. Cyanide
3. Methanol
4. Copper
1. Pyridoxine (Vit B-6)
2. Amyl Nitrate and Sodium Thiosulfate
3. Ethanol
4. Penicillamine
Gastroenteritis treatment:
1. E. Coli
2. Salmonella
3. Shigella
4. Campylobacter
1&2. normally nothing, but Bactrim if used
3. Bactrim
4. Azithro
organophosphate poisoning
1. mechanism of action
2. treatment
1 cause parasympathetic stimulation by binding to and inactivating Acetyl cholinesterase enzyme.
2. atropine, which blocks acetylcholine receptor site. Pralidoxime, which removes phosphoryl group which had inactivated acetlycholinesterase enzyme, thereby reactivating it
nephritic vs. nephrotic
nephritic - blood, RBC casts, proteinuria < 3.5g per 24 hours

nephrotic - > 3.5g/24 hours, decreased blood relative to nephritic syndrome
- caused by tumor, drugs, infection
- increased bacterial infxns (reason not clear)
HUS cause
E. Coli O157:H7
descending paralysis
pulsus alternans cause
cardiac tamponade
Giardia latency
about 1 week
Entamoeba Histolytica (Amebiasis) tx
Biggest cause of liver dz
1. worldwide
2. in US
1. Schistosomiasis
2. Viral hepatitis and Etoh
1. common cause diarrhea in AIDS patients
2. how treat that organism
1. CMV
2. Ganciclovir
3rd nerve palsy
1. direction eye will point and why
2. pupil dilated as well?
1. "down and out" because of unrestrained action of CN 4 and 6
2. yes, mydriasis because etiology is usually from aneurysm compressing outside fibers of 3rd nerve, where pupil fibers run.
When diabetic etiology, then from microvascular infarction, which spares outer fibers, therefore "pupil-sparing"
dialysis disequilibrium syndrome
1. what causes?
2. What are sx?
3. how treat?
1. CNS disorder following (usually the first) HD
2. HA, nausea, and disorientation
2. IV Mannitol
Ribavirin mechanism of action, indication and major side-effect
1. Antiviral guanosine analogue
2. Hep C
3. Hemolytic Anemia
Meniere's disease
1. symptoms
2. treatment
1. intermittent vertigo lasting 1-8 hours with associated hearing loss, aural pressure, and tinnitus.
2. stop smoking, stop caffeine, low-salt diet, HCTZ
Compare and contrast Crohn's disease to UC
Crohn's dz:
- mouth to anus
- transmural with skipped areas
- "cobblestoning" of small intestine
- 2/3 will need surgery at some point
- relapsing, intermittent course common
- presents with RLQ pain and diarrhea
- often diagnosed with UGI series that shows "skip lesions" in small bowel.

- mainly large colon
- presents with tenesmus, urgency, and bloody diarrhea
Prinzmetal angina:
1. treatment
2. What avoid?
1. CCB
2. avoid ASA and non-selective BB
Antibiotic given when involving a human or when involving a dog bite on the face, joints, or that looks infected
IV Unasyn
face vs. oral
face - good pronosis with about 80% cure

oral - bad prognosis, occurs mainly from smoking
B12 deficiency signs
5 P's
Pancytopenia (macrocytic anemia, hypersegmented neutrophils!)
Peripheral neuropathy
Posterior Spinal Column Neuropathy (decrease proprioception, vibration, hyporeflexia)
Pyramidal tract signs
Papillary atrophy of tongue

also depressed mood, memory impairment, peronality change
slowed relaxation phase of DTR in elderly
1. 3rd heart sound
2. 4th heart sound
1. volume overload
normal in < 40yo, 3rd trimester pregnancy

2. stiff left ventricle
normal in athletes, elderly
Hyponatremia tx by total body fluid status
1. Hypovolemic
2. Euvolemic
3. Hypervolemic
1. IV 0.9% saline, 3% if sx's (or < 120)
2. fluid restrict (often seen in SIADH, COPD)
3. lasix, salt-restriction (often seen in CHF, hepatitis)
how check for gallbladder rupture?
ex lap
side of lungs where aspiration normally occurs
Hepatopulmonary sx and tx
sx -> platypnea, orthodeoxia, A/a gradient (all caused by intrapulmonary vascular dilatations, i.e. shunting)

tx ->
liver transplant
trich vs. BV
often asx
frothy, green-yellow d/c
fishy odor
abd tenderness just before or after period
vaginal mucosa inflamed
"strawberry cervix"
treat with Flagyl

vaginal d/c that adheres to vaginal walls
fluid pH > 4.5
treat with Flagyl
Gilbert's Syndrome
7% prevalence!
transient increase in unconjugated bilirubin during times of stress
pain out of proportion to abdominal exam
mesenteric ischemia
AOM strains
1. S. pneumo 60-70%
2. H. flu 10-20% (2/3 are B-lactamase resistant!)
3. Moraxella Ca 2-15% (90% are B-lactamase resistant!)

Moraxella (and Neisseria) are GN diplococci
1. Gram negative diplococci
2. Gram negative coccobacilli
1. Neisseria, Moraxella
2. H. flu
aspergillus tx
amphoterecin B
Childhood rashes:
1. Roseola
2. Kawasaki
3. Mono
4. Hand-Foot-Mouth
5. Fifth disease
1. Roseola:
3-5 days of high fever followed by rash (rose-pink macules). Ages 6mo-3yrs.

fever > 5 days. Edema hands, conjunctivitis, cervical LA, morbilliform (like measles) exanthem with desquamation.

3. Mono
EBV. Pharyngitis, fever, LA, fatigue, malaise, generalized morbilliform rash. After 2 weeks, possibly splenomegaly (therefore thrombocytopenia). Avoid physical contact!

4. HFM disease:
low fever, anorexia, sore mouth, malaise, abdominal pain precedes rash by 1-2 days

5. Fifth disease (erythema infectiosum):
parvovirus B19
nonspecific febrile illness followed by diffuse lace-like rash. Only infectious before the rash. Can cause hydrops in pregnant women. Can cause severe illness in patients with SCD.
Tzanck smear
checks for Varicella. Looks for Multi-nucleated Giant Cells.
Immunization schedule
0-2wks HepB #1
6-8 wks Hep B#2
2,4,6 mo DTP, HIB, IPV, PCV7
10mo HepB#3
15mo DTP#4, HIB#4, PCV7#4, MMR#1, Varicella
2yrs HepA#1, MMR#2
3.5yrs HepA#2
5yrs DTP#5, IPV#4
11-12yrs Td, Menactra
plantinum based chemotherapeutic regimen (e.g. MVAC) main side-effect
mutiple bilateral lung nodules with surrounding hemorrhage
thiazide diuretics
increase Calcium, decrease phosphate
what effect Hyperthyroidism have on Calcium?
maculopapular rash on hands and feet in sexually active young person. What is it and how treat?
1. secondary syphilis
2. PCN
yellow supernatant seen in CSF about 2-4 hours after a SAH bleed
Beck's triad
for acute tamponade
1. falling BP
2. rising JVP
3. small, quiet hard
Wernicke's encepholopathy
from thiamine deficiency:
1. encepholapthy
2. ataxia
3. ocular motor disturbance
Broca's aphasia
Wernicke's aphasia
Broca's - expressive aphasia. Intactive receptive aphasia. Substituion of words like "cat" for "dog". Non-melodic speaking. Often with right-sided hemiparesis.

Wernicke's - receptive aphasia. Also, "word salad" with non-sensical speech. Normal speech pattern.
Charcot triad
for ascending cholangitis
1. fever
2. RUQ pain
3. Jaundice
TTP (pentad)
1. Microangiopathic hemolytic anemia
2. Thrombocytopenia
3. Neurologica abnormalities (waxing and waning)
4. fevers
5. Renal abnormalities

Thrombocytopenia only
1. IgA Nephropathy (Berger's dz)

2. Focal segmental glomerulosclerosis -

3. Membranoproliferative glomerulonephritis

4. Rapidly Progressive glomerulonephritis
1. recurrent hematuria. Nephrotic syndrome overall, with hyperlipidemia, proteinuria, and hypoalbuminemia.

2. rare - HTN, hematuria, RI, and nephrosis

3. asx to full nephrotic syndrome. Renal dz with low complement level. Normally caused by Hep C

4. declining renal fxn, RBC casts, anuria or oliguria
malignant otitis media
IV PCN and aminoglycoside
postviral pericardidits tx
1. pemphigus
2. Toxic epidermal Necrolysis
1. bullous disorder starting at mouth, then moving to intertriginous zones like axilla and groin. Ab against desmosomes. Tx with steroids.

2. TEN. Usually caused by anticonvulsants, allopurinol, and sulfa drugs. Bullae involve trunk and extrem. instead of intergrinous areas.
cough, dyspnea, chest pain
bilateral hilar adenopathy
pulmonary infiltrate
1. pemphigus
2. Toxic epidermal Necrolysis
1. bullous disorder starting at mouth, then moving to intertriginous zones like axilla and groin. Ab against desmosomes. Tx with steroids.

2. TEN. Usually caused by anticonvulsants, allopurinol, and sulfa drugs. Bullae involve trunk and extrem. instead of intergrinous areas.
1. bilateral hilar adenopathy
2. pulmonary infiltrates
3. skin and/or eye lesions

causes cough, dyspnea, chest pain

work-up with serum ACE and calcium
What med give to selectively decrease pulmonary artery pressure?
Nitric Oxide
MEN types
Type I
- Primary hyperparathyroidism
- Pancreatic tumors (60-70%)
- Gastrinoma (Z. Ellison)
- Pituitary tumors (10-20%)

Type IIa (Autosomal Dominant)
- Medully thyroid CA (>90%)
- Pheochromoctyoma (40-50%)
- Hyperparathyroidism
pain made worse by eating
dumping syndrome
painless hematuria workup
CT urogram (IVP)
how stopping smoking change risk of MI, dying?
chance of MI:
- after 1 yr, 50% decrease
- after 15 yrs, approaches non-smokers

chances of dying
- quite before 50, 1/2 risk in next 15 years
nephritic syndrome
pulmonary hemorrhage
(anti-GBM Ab dz)
Vasculitis types by vessel size
large - giant cell arteritis
- Polyarteritis nodosa
- kawasaki

Small vessel
- Churg Strauss (pANCA eosinophilia, asthma, nephritic syndrome)
- Wegener's (cANCA, resp. mainly, eye, skin, nerve, upper resp. tract, kidneys)
Chaga's dz
achalasia, cardiomyopathy, megacolon
PCP treatment
1. high-dose Bactrim
2. IV Pentamadine

Prophylaxis - Bactrim PO or aerosolized Pentamadine

increased LDH leads to increased mortality therefore IV steroids
types colon polyps
non-neoplastic - most common hyperplasia

- tubular (best)
- tubulovillous
- villous (worst)
Bacterial endocarditis
- how tx
- what sx?
- vanc/gent
- Janeway Lesion
- Osler's Nodes
- Roth spots
- Staph aureus (most common)
a-fib indication
- Age
- Diabetes
- Stroke
elevated bilirubin values
24hrs 5mg/dl
72hrs 15mg/dl
>25mg/dl exchange transfusion
- worse supine, better standing up
- diffuse ST elevation
SAH - what medicine use to tx?
vasospasm complication - treat with CCB
treat with HCTZ (to prevent recurrent stones)
HSV encephalitis
causes mass lesion!
congenital infections
1. Rubella
2. CMV
1. "Blueberry rash", heart defects, cataracts
anticholinergic overdose
hyperventilate to increase pH, since this
RA tx
erythema nodosum
- treatment
- associated diseases
- tx with NSAIDs

- Histoplasmosis (Mississippi Valley)
- Sarcoidosis
- Coccidiomycosis (SW)
- drugs (OC, sulfa)
RA tx
clozapine monitoring
CBC, b/c causes agranulocytosis
post-streptococcal GN
1. clinic sx
2. lab abnormality
1. nephritic syndrome (HTN, edema, proteinuria)
2. low complement!
SBP prophylaxis Abx
Neutropenic fever Abx
thyroid CA types
1. most common
2. familial
1. papillary
2. Medullary (part of MEN 2a)
what do about asymptomatic bacteruria in an otherwise normal patient?
Nothing, ignore. Don't even need to re-check.
RTA types
1. type 1
2. type 2
3. type 4
Type 1 - <distal>
- can't concentrate H+ in lumen
- if also lose ability to re-absorb Phosphate, glucose and amino acids, then called Fanconi syndrome
- low or normal K, pH > 5.5
- rare in both children and adults
- Bicarb often below 10

Type 2 - <proximal>
- low or normal K, pH > or < 5.5
- can't reabsorb bicarb
- most common RTA in children
- bicarb 15-20

Type 4 - <hyperkalemic RTA>
- caused by hypoaldosteronism
- most common RTA in adults
- bicarb 15-20
- treat with fludrocortisone
postherpetic neuralgia tx
TCA (amitriptyline)
Lithium level > 4. How tx?
MR referral to a cardiac surgeon
end-systolic size > 55mm or LVEF < 55%
side-effects of Ritalin
It is a psychostimulant
1. insomnia
2. loss of appetite
3. abdominal pain
how treat dystonic reaction? Name two drugs.
1. diphenhydramine orally
2. benztropine PO or IM
bilateral adrenal hemorrhage cause
Waterhouse-Friderichsen syndrome, caused by disseminated Neisseria sepsis. Check random cortisol, not cort-stim test (1 hour) or ACTH stim test (24 hours)!
herpes zoster in eye
oral acyclovir, not topical!
b-HCG value at which a yolk sak will be visible on u/s
1500. Otherwise it can only be a "r/o ectopic" and need to be followed
How treat methylene chloride exposure?
Methylene chloride converts to CO by liver, so:

1. If carboxyhemoglobin < 25%, stick with 100% NR

2. If > 25%, angina, pH<7.2, unconscious > 20min, needs hyperbaric oxygen tx. Also if pregnant and carboxyhemoglobin > 15, since fetal Hg about 10% higher affinity than adult
PCP characteristics
methenamine silver stain
patchy bilateral infiltrates on CXR
retrosternal CP
tx with Bactrim
EKG criteria for thrombolytics
1. ST elevation >1mm in 2 contiguous leads
2. ST depression >2mm in anterior leads (v1-v2)
3. new LBBB
length of time for fluoxetine to achieve steady-state
at least 5 weeks, up to 6-8 weeks in many people
erythema multiforme minor
caused by herpes. Occurs a couple of weeks after outbreak. Suppress with acyclovir.
how slow HIV-associated dementia?
HAART (two nucleoside reverse transcriptase inhibors, and one protease inhibitor)
gingko balboa - bad interaction with what med?
Warfarin - potentiates action
pseudotumor cerebri - what is it, and how treat?
idiopathic intracranial hypertension. Tx with acetazolamide. Common in young, obese women.
1. triad of sx
2. how tx
1. headache, palpitations, diaphoresis. Elevated bp during these episodes of course.
2. adrenalectomy, but first give alpha-blocker (phenoxybenzamine) to prevent hypertensive crisis in surgery.
cushing triad
1. elevated bp
2. irregular breathing (Cheynes-Stokes)
3. bradycardia
- induced sputum is as specific, but much less sensitive, than BAL
- colonization is common, but test is still highly specific for actual infxn.
- helmet shaped
- for AID patients, Bactrim proph if CD4<200
how treat Paget's disease?
alendronate (Fosamax)
target for lowering BG in diabetic ketoacidosis
50-100 per hour
correction of Na for hyperglycemia
1.6 for every 100 above 100
ocp's affect on STD's
increases risk of chlamydial infection, decreases gonorrheal infection
uncal herniation on right side, what eye exam look like?
fixed and constricted on left
positive birefringent crystals
Calcium Pyrophosphate deposition (not gout, which is negatively birefringent)
Lupus screening tests
ANA - 95% sensitive but not specific
dsDNA - 50% sensitive, but very specific
- stopped in 1971
- offspring have clear cell vaginal adenoCA
trazadone, SCD, crack, perineal trauma
Rickettsia Mountain Spotted Fever
fever, HA, malaise, maculopapular rash spread inwards from palms and soles
Wiskott-Aldrich syndrome
x-linked recessive syndrome.
eczema, low plats, petechia, recurrent infxns
prolonged QT
increased risk osteoporosis
prostate CA pharmacotherapy
ketoconazole - blocks p450, causing castration levels of testosterone in 8 hours

LHRH - initial flare of testosterone, but then castration levels in 30 days
WPW drugs to avoid
anything that slows AVN conduction. (verapamil, dilt, digitalis) can increase vent rate by facilitating conduction throu access pathway
drug eruption rash characteristics
start proximal, move distal
no arthralgias, fever
Rat Bite Fever
caused by Streptobacillus or spirilum
- tx with PCN or TCN
osteoporosis - when use calcitonin?
can give if woman > 5 years after menopause (because not effective during times of rapid bone loss)
Mastitis Abx tx
pupil size is overdose:
1. narcotics
2. cocaine
3. benzos
1. small
2. large (and dry mouth)
3. small then large (and dry mouth)
how treat Alz Dementia?
mild - Donepezil
Mod - Memantine