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145 Cards in this Set
- Front
- Back
Mucormycosis
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fever, sinus pain, thin bloody nasal discharge, double-vision, red or necrotic nasal turbinates.
DM predisposes confirm with biopsy before treating |
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VUR
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grade 1&2 -> 80% resolve spontaneously. Therefore, prophylactic Abx only.
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1. CF Lung infx organism
2. How treat? |
1. Pseudomonas
2. Inhaled Tobramycin |
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Thoracic aneurysm types and how treat
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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 |
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Which diabetes medication class increases insulin production?
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sulfonylureas (e.g. glipizide, glyburide)
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How detect exogenous insulin?
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absence of c-peptide, which is present with endogenous insulin production
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APGAR review
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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) |
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Hyperkalemia tx
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("See Big K Drop")
Calcium - works immediately, emergency Bicarb 30-60min Insulin and Glucose 30-60min Kaexylate Dialysis |
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Pulmonary Alveolar Proteinosis
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positive PAS (periodic acid-schiff)
- cough, dyspnea, weight loss - treat with whole lung lavage - "bat wing" config on x-ray - CT ground glass |
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Muscle weakness diseases
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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. |
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MTX protocol for ectopic pregnancy
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- 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 |
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Testosterone treatment. What labs check?
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Hg/HCT and PSA in 3 months
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Trazadone side-effect
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priapism
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Hypothyroidism. What effect on CBC?
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Macrocytic anemia
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Renal Stone types
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Calcium Oxalate (60%) radio-opaque
Uric Acid (10%) radio-luscent |
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nail in foot through shoe. What bacteria?
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Pseudomonas
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Cluster HA treatment
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oxygen
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Conn's disease
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Hyperaldosteronism
causes hypertension and hypokalemia |
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testicular CA types and cancer markers
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germ cell types
- seminoma (increased HCG) - non-seminoma (increased HCG and increased AFP) |
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Cancer Markers:
1. colon CA 2. pancreatic gastric CA 3. GT dz or testicular CA |
1. CEA
2. CA-19-9 3. B-hcg |
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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 |
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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 |
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Bacterial Meningitis tx by age rage
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1mo -> 50yo CTX (S. pneumo and N. mening.)
50yo+ CTX and amp (to cover listeria) |
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Treatment for Neuroleptic Malignant Syndrome (and what is it)
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mental status change / rigidity / fever / dysautonomia
Dantrolene (skeletal muscle relaxant) Bromocriptine (dopamine agonist) Tylenol Lorazepam caused by: Haldol fluphenazine Phenergan etc. |
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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 |
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Gastroenteritis treatment:
1. E. Coli 2. Salmonella 3. Shigella 4. Campylobacter |
1&2. normally nothing, but Bactrim if used
3. Bactrim 4. Azithro |
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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 |
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nephritic vs. nephrotic
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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) |
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HUS cause
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E. Coli O157:H7
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descending paralysis
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Botulism
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pulsus alternans cause
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cardiac tamponade
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Giardia latency
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about 1 week
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Entamoeba Histolytica (Amebiasis) tx
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Flagyl
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Biggest cause of liver dz
1. worldwide 2. in US |
1. Schistosomiasis
2. Viral hepatitis and Etoh |
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1. common cause diarrhea in AIDS patients
2. how treat that organism |
1. CMV
2. Ganciclovir |
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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" |
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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 |
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Ribavirin mechanism of action, indication and major side-effect
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1. Antiviral guanosine analogue
2. Hep C 3. Hemolytic Anemia |
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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 |
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Compare and contrast Crohn's disease to UC
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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. UC: - mainly large colon - presents with tenesmus, urgency, and bloody diarrhea |
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Prinzmetal angina:
1. treatment 2. What avoid? |
1. CCB
2. avoid ASA and non-selective BB |
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Antibiotic given when involving a human or when involving a dog bite on the face, joints, or that looks infected
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IV Unasyn
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SCC
face vs. oral |
face - good pronosis with about 80% cure
oral - bad prognosis, occurs mainly from smoking |
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B12 deficiency signs
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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 |
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slowed relaxation phase of DTR in elderly
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hypothyroidism
|
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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 |
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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) |
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how check for gallbladder rupture?
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ex lap
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side of lungs where aspiration normally occurs
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right
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Hepatopulmonary sx and tx
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sx -> platypnea, orthodeoxia, A/a gradient (all caused by intrapulmonary vascular dilatations, i.e. shunting)
tx -> liver transplant |
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trich vs. BV
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trich:
often asx frothy, green-yellow d/c fishy odor abd tenderness just before or after period vaginal mucosa inflamed "strawberry cervix" pH>4.5 treat with Flagyl BV: vaginal d/c that adheres to vaginal walls fluid pH > 4.5 treat with Flagyl |
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Gilbert's Syndrome
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7% prevalence!
transient increase in unconjugated bilirubin during times of stress |
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pain out of proportion to abdominal exam
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mesenteric ischemia
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AOM strains
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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 |
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1. Gram negative diplococci
2. Gram negative coccobacilli |
1. Neisseria, Moraxella
2. H. flu |
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aspergillus tx
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amphoterecin B
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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. 2.Kawasaki: 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. |
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Tzanck smear
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checks for Varicella. Looks for Multi-nucleated Giant Cells.
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Immunization schedule
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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 |
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plantinum based chemotherapeutic regimen (e.g. MVAC) main side-effect
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nephrotoxicity
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mutiple bilateral lung nodules with surrounding hemorrhage
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Aspergillosis
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thiazide diuretics
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increase Calcium, decrease phosphate
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what effect Hyperthyroidism have on Calcium?
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Increases
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maculopapular rash on hands and feet in sexually active young person. What is it and how treat?
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1. secondary syphilis
2. PCN |
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xanthochromia
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yellow supernatant seen in CSF about 2-4 hours after a SAH bleed
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Beck's triad
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for acute tamponade
1. falling BP 2. rising JVP 3. small, quiet hard |
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Wernicke's encepholopathy
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from thiamine deficiency:
1. encepholapthy 2. ataxia 3. ocular motor disturbance |
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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. |
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Charcot triad
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for ascending cholangitis
1. fever 2. RUQ pain 3. Jaundice |
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TTP vs. ITP
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TTP (pentad)
1. Microangiopathic hemolytic anemia 2. Thrombocytopenia 3. Neurologica abnormalities (waxing and waning) 4. fevers 5. Renal abnormalities ITP Thrombocytopenia only |
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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 |
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malignant otitis media
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IV PCN and aminoglycoside
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postviral pericardidits tx
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NSAIDS
|
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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. |
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sarcoidosis
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cough, dyspnea, chest pain
bilateral hilar adenopathy pulmonary infiltrate |
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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. |
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sarcoidosis
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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 |
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What med give to selectively decrease pulmonary artery pressure?
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Nitric Oxide
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MEN types
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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 |
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pain made worse by eating
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dumping syndrome
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painless hematuria workup
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CT urogram (IVP)
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how stopping smoking change risk of MI, dying?
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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 |
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Goodpastures
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nephritic syndrome
pulmonary hemorrhage (anti-GBM Ab dz) |
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Vasculitis types by vessel size
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large - giant cell arteritis
medium - Polyarteritis nodosa - kawasaki Small vessel - Churg Strauss (pANCA eosinophilia, asthma, nephritic syndrome) - Wegener's (cANCA, resp. mainly, eye, skin, nerve, upper resp. tract, kidneys) - HSP |
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Chaga's dz
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achalasia, cardiomyopathy, megacolon
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PCP treatment
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1. high-dose Bactrim
2. IV Pentamadine Prophylaxis - Bactrim PO or aerosolized Pentamadine increased LDH leads to increased mortality therefore IV steroids |
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types colon polyps
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non-neoplastic - most common hyperplasia
adenomatous - tubular (best) - tubulovillous - villous (worst) |
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Bacterial endocarditis
- how tx - what sx? |
- vanc/gent
sx - Janeway Lesion - Osler's Nodes - Roth spots - Staph aureus (most common) |
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a-fib indication
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CHADS
- CHF - HTN - Age - Diabetes - Stroke |
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elevated bilirubin values
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24hrs 5mg/dl
72hrs 15mg/dl >25mg/dl exchange transfusion |
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pericarditis
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- worse supine, better standing up
- diffuse ST elevation |
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SAH - what medicine use to tx?
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vasospasm complication - treat with CCB
|
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hypercalcuria
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treat with HCTZ (to prevent recurrent stones)
|
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HSV encephalitis
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causes mass lesion!
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congenital infections
1. Rubella 2. CMV |
1. "Blueberry rash", heart defects, cataracts
|
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anticholinergic overdose
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hyperventilate to increase pH, since this
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RA tx
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methotrexate
|
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erythema nodosum
- treatment - associated diseases |
- tx with NSAIDs
- Histoplasmosis (Mississippi Valley) - Sarcoidosis - Coccidiomycosis (SW) - drugs (OC, sulfa) |
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RA tx
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methotrexate
|
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clozapine monitoring
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CBC, b/c causes agranulocytosis
|
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post-streptococcal GN
1. clinic sx 2. lab abnormality |
1. nephritic syndrome (HTN, edema, proteinuria)
2. low complement! |
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SBP prophylaxis Abx
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Levaquin
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Neutropenic fever Abx
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ceftaz
|
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thyroid CA types
1. most common 2. familial |
1. papillary
2. Medullary (part of MEN 2a) |
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what do about asymptomatic bacteruria in an otherwise normal patient?
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Nothing, ignore. Don't even need to re-check.
|
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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 |
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postherpetic neuralgia tx
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TCA (amitriptyline)
|
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Lithium level > 4. How tx?
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dialysis!
|
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MR referral to a cardiac surgeon
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end-systolic size > 55mm or LVEF < 55%
|
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side-effects of Ritalin
|
It is a psychostimulant
1. insomnia 2. loss of appetite 3. abdominal pain |
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how treat dystonic reaction? Name two drugs.
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1. diphenhydramine orally
2. benztropine PO or IM |
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bilateral adrenal hemorrhage cause
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Waterhouse-Friderichsen syndrome, caused by disseminated Neisseria sepsis. Check random cortisol, not cort-stim test (1 hour) or ACTH stim test (24 hours)!
|
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herpes zoster in eye
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oral acyclovir, not topical!
|
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b-HCG value at which a yolk sak will be visible on u/s
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1500. Otherwise it can only be a "r/o ectopic" and need to be followed
|
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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 |
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PCP characteristics
|
methenamine silver stain
patchy bilateral infiltrates on CXR retrosternal CP dyspnea tx with Bactrim |
|
EKG criteria for thrombolytics
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1. ST elevation >1mm in 2 contiguous leads
2. ST depression >2mm in anterior leads (v1-v2) 3. new LBBB |
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length of time for fluoxetine to achieve steady-state
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at least 5 weeks, up to 6-8 weeks in many people
|
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erythema multiforme minor
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caused by herpes. Occurs a couple of weeks after outbreak. Suppress with acyclovir.
|
|
how slow HIV-associated dementia?
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HAART (two nucleoside reverse transcriptase inhibors, and one protease inhibitor)
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gingko balboa - bad interaction with what med?
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Warfarin - potentiates action
|
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pseudotumor cerebri - what is it, and how treat?
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idiopathic intracranial hypertension. Tx with acetazolamide. Common in young, obese women.
|
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Pheochromocytoma
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. |
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cushing triad
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1. elevated bp
2. irregular breathing (Cheynes-Stokes) 3. bradycardia |
|
PCP
|
- 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 |
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how treat Paget's disease?
|
alendronate (Fosamax)
|
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target for lowering BG in diabetic ketoacidosis
|
50-100 per hour
|
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correction of Na for hyperglycemia
|
1.6 for every 100 above 100
|
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ocp's affect on STD's
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increases risk of chlamydial infection, decreases gonorrheal infection
|
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uncal herniation on right side, what eye exam look like?
|
fixed and constricted on left
|
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positive birefringent crystals
|
Calcium Pyrophosphate deposition (not gout, which is negatively birefringent)
|
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Lupus screening tests
|
ANA - 95% sensitive but not specific
dsDNA - 50% sensitive, but very specific |
|
DES
|
- stopped in 1971
- offspring have clear cell vaginal adenoCA |
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priapism
|
trazadone, SCD, crack, perineal trauma
|
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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 |
|
bulumia
|
prolonged QT
fluoxetine 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)
|
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Mastitis Abx tx
|
dicloxacillin
|
|
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 |