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100 Cards in this Set
- Front
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manifestations of hypercalcemia
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severe constipation, anorexia, weakness, neuro abdnormalities
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manifestations of multiple myloma
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back pain, anemia, renal dysfunction, elevated ESR, hypercalcemia
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acid-base status and seizures
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pt following tonic cloinc seizures often have postictal lactic acidosis and is seen as a transient anion gap metabolic acidosis that will resolve in 60-90 minutes post seizure
repeat the labs in 2 hours to reassess acid base status |
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rotator cuff tendonitis vs tear
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tendonitis will resolve with injection of lidocaine into the joint
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lupus anticoag
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the antiphospholipid in lupus binds the phospholipids used in the PTT assay, so they have a prolonged PTT, though it is not a true reading of their coag status
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brain death
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absent CN reflexes, fixed/dilated pupils, no spont breaths
no medical causes that can mimic brain death, temp > 32C, and must be agreed upon by 2 docs |
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immunity needed to clear molluscum contagiosum
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cellular immunity
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pt with DVT and hx of recent surgery, hemorrhagic stroke, bleeding diathesis, or active bleeding
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placement of IVC filter, as they would have contra indications for anticoag therapy
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what does an ateriovenous fistula do to circulation
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as volume is moved from the arterial side to venous side via shunting, cardiac preload is increased
will lead to high outpt failure as oxygen demands can not be met |
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causes of AV fistula
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congenital: PDA, angoimas, pulmonary or CNS AVF
aquired: trauma, cancer, iatrogenic (as with femoral cath) |
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Charcot's joint
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damage to joints from repeated joint trauma, seen in diabetics due loss of nerve sensation
also called neurogenic arthopathy will occur in weight bearing joints and will show as deformity, DJD, loose bodies, and osteophytes on imaging |
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treatment of prolactinoma
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first line are DA agonists like bromocriptine or cabergoline
2nd line is surgery |
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Lights criteria for determination of pleural fluid as an exudate
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effusion/serum protein > 0.5
effusion/serum LDH > 0.6 complicated effusion listed as pH < 7.2, glucose < 60, or positive Gram stain or culture; complicated require chest tube and drainage |
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MCC of thyroid cancer
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papillary thyroid is 70%
follicular cancer is 20% anaplastic is 5% medullary is 2% lymphoma is < 2% |
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lithium metabolism
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through the kidneys, so if there is kidney dysfunction, you can not give lithium ;for bipolar then give valproic acid
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MCC of foot drop
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neuropathy, L5 radiculopathy, and traumatic damage
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pica for ice
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called pagophagia, and is often seen in pt with Fe def anemia
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possible consequence of chemo and radio therapy for Hogkins
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3.2% will develop secondary malignancy in 20 years, the most common sites being lung and breast
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treatment of enuresis
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enuresis is recurrent invol voiding into clothses/bed after 5 y/o
1st line behavioral techniques 2nd line is desmopressin 3rd line is TCA imipramine (it is last due to safety profile) |
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IBD
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UC vs Crohns
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treatment route for endocarditis
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must treat IV!!!
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kidney disease seen in pt with active HBV ifx
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PAN, membranoproliferative glomerulonephritis, and membranous glomerulonephritis
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lifestype modificiation to reduce BP
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reduce Na intake, weight loss, avoid excessive alcohol
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1st line treatment in OA
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acetaminphen
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charact of Waldenstrom's macrogloulinemia
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hyperviscosity do to excess IgM which will show as a spike on the SPE, increased spleen, liver, and LNs, tiredness, HA, neuropathies
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what to do with newly dx Lupus pt
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renal biopsy
note that SLE renal disease is one of the leading causes of mortality, up to 40-75% of pts |
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ways that cancer can cause hypercalcemia
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metastatic solid tumors via cytokines
Hodgkin's via calcitrol nonmetastatic tumors via PTHrP |
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drugs used in stress testing when exercise is not an option
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dobamine or dipyridamole
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Somogyi effect in diabetics
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when there is hyperglycemia in the early morning due to counerregulatory hormones like Epi, NE, adn glucagon due to too much insulin at bedtime ;when the extra insulin is given at bedtime, there is hypoglycemia at like 3am that causes these hormones to kick in and increase glucose, but they overshoot
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treatment of Tourettes
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typical antipsychotics like haldol or pimozide
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Hawthorne effect
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when the study pop changes outcomes since they know they are being studied
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treatment of Paget's disease of bone
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only treat if symptomatic with bone pain, neuro defect, high output heart failure, or involement of weightbearing joints
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how to treat acute renal transplant rejection
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high dose IV steroids
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hepatitis problem that has waxing and waning ALT/AST lvls
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HCV
it also has arthralgias and myalgias |
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triad of Meniere's disease
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dizziness, hearing loss, and tinnitus
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lung cancer with increased sercum Ca
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squamous cell that makes PTHrP
think aCa++mous note that small cell associated with ACTH production |
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trihexyphenidyl
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an anticholinergic used in Parkinson's, similar to benztropine
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Fe def anemia and arthritis
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if it is RA, this anemia of chronic disease
if it is OA, think NSAID use causing ulcers and GI bleeding |
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dx of vasovagal syncope
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upright tilt table test
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what electrolyte is bad prognostic factor in CHF
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hyponatremia, as it shows a high lvl of the RAAS system and water retention trying to keep up CO
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primary CNS lymphoma
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seen in HIV pt
can cause altered mental status and can have EBV DNA in the CSF, MRI can show solitary, weakly ring-enhancing periventricular mass |
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empyema
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infection of the pleural space
anything entering the pleural space can cause them, one common one is a hemothorax reatment is surgery to remove pus, clotted blood, and fibrinous peel |
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well known renal complication seen in Hodgkin's lymphoma
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minimal change disease
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s/s of glucagonma
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hyperglycemia, necrolytic migratory erythema, and diarrhea
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Gilbert's vs Crigler Najjar
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x
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treatment of cancer induced anorexia
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progestins like medasterol (megase)
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effect of current or previous dx of anorexia on preg
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increased risk for miscarriage, premie, small for gest age, hyperemesis gravidarum, postpartum depression
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trichinellosis
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suspect in pt with GI issues followed by triad of periorbital edema, myositis, and eosinophilia
can also have splinter and retinal hemorrhages |
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podophyllin
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an antimitotic agent leading to cell death, used in condylomata acumiata caused by HPV
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treatment of HPV warts
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chemical agents: 5-FU, podophyllin
immune therapy: imiquimod, interferon alpha surgery: cyro, laser, excisional |
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SAAG
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Serum ascites albumin gradient found by different in albumin conc in serum vs ascites fluid
SAAG of 1.1 or greater shows transudative process consistent with portal HTN |
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isoniazid and the liver
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isoniazid causes indosyncratic liver injury with histology that looks like viral hepatitis
this is NOT dose dependent |
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what causes anion gap metabolic acidosis with an osmolar gap
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ethylene glycol, methanol, and ethanol intox
osmlar gap = observed osm - calculated osm calculated = 2Na +Glu/18 + BUN/2.8 |
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how to calculate osmolar gap
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osmolar gap = observed osm - calc osm
calc osm = 2Na+ Glu/18 + BUN/2.8 |
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ethylene glycol poisoning
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will cause calcium oxalate crystals that are rectangular and envelope shaped
it causes anion gap met acidosis with osmolar gap they will be stuporous, agitated , and disoriented |
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Duke's criteria for infective endocarditis
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must have 2 major, one major and 3 minor, or 5 minor
major are: 2 positive blood cultures, endocardial involve on echo, new murmur minor are: predispising condition, fever > 38C, septic emboli, immunologic phenom, one pos blood culture |
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electrolyte changes in tumor lysis syndrome
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hyperkal and hyperphos from being released from intracell
excess phos binds Ca making hypocalcemia cellular protein breakdown leads to hyperuricemia |
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treatment of uncomplicated cystitis
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TMP-SMX or nitrofurantoin
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homocystenuria and pyridoxine
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x
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what causes the pain in a pulmonary embolism?
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associated minor to massive pulmonary infarctions
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colonoscopy recommendations in ulerative colitis pts
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start screen 8 years after the dx, then repeat every 1-2 years after
note: some say you can extend the 1st window if only the left colon is involved |
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treatment of herpes zoster
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valacyclovir or acyclovir
postherpetic neuralgia can be treated with TCAs like amitriptyline |
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UA results
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leukocyte esterase indicates pyuria
nitries indicate Enterobacteriaceae, like E. coli, the MCC of UTI |
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tick-borne paralysis
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rapid ascending paralysis (hours to days), absence of fever or sensory abnormalities and normal CSF, treatement is removal of the tick
NOTE: Guillian Barre is days to weeks with sensory defict |
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radiation therapy use in prostate CA
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radiation therapy is useful for managing bone pain in pts with prostate cancer s/p orchiectomy
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pt with organophosphate poisoning
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1st take off clothes and wash skin, as it is absorbed through the skin
treatment is then use atropine and pyridoxime |
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area of the brain damaged in hemi-neglect
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the right (non-domiant) parietal lobe
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1st step in pt on heparin with drop in platelets
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pt has heparin induced thrombocytopenia (HIT) due to Ab against heparin-platelet factor 4
1st thing to do is stop the heparin then start other form of anticoag like danaparoid or lepirudin |
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recommened screening mammograms
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every 2 years for women 50 and older
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DeQuervain tenosynovitis
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inflammation of abd pollicis and extensor pollicis when mothers hold newborns with their thumbs outstretched
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blastomycosis s/s
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pulmonary infection with fever, sweats, productive cough, and weight loss
if it becomes systemic it can lead to ulcerated skin lesions and bone lesions |
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accidental preg within 3 months of MMR vaccine
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you should wait 3 months to get preg after rubella vaccine, but if it happens, just reassure them, as there have been NO cases of congenital rebella syndrome from vaccinations
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osteomyelitis
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fever, chills, and elevated ESR
common in IVDA, and can include the spine |
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disseminated histoplasmosis s/s and dx
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palatal ulcers, hepatoslpenomegaly, and pancytopenia
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treatment of essential tremors
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1st line is propranolol, but can not be give if contra as in bradycardia or COPD
2nd line is primidone an antiseizure that is converted to phenobarbital, SE of primidone is acute intermittent porphyria with abd pain, neuro and psych abd |
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causes of acalculous cholecystitis
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extensive burns, severe trauma, prolonged TPN, prolonged fasting, mechanical ventilation
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cause of mortality in SAH
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vasospasm that induces infarction, occurs in 30% of pt s/p SAH
prevent with Ca channel blockers like nimodipine |
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treatment of uric acid renal stones
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uric acid renal stones are 10% of renal stones and do not show up on xray
treat by alkalinization of the urine to pH > 6.5 with oral potassium bicarb or potassium citrate |
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causes of renal colic that do not show on xray
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radiolucent stones like uric acid
Ca stones less than 3mm nonstone causes like obstuction via tumor or clot |
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potassium citrate
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used to alkalize the urine as it is metabolized into bicarb by the liver
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MCC of epiglottitis
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H. influ and strep pyogenes
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treatment of Lyme disease
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doxycycline, but if pt is preg it is contra so use amoxicillin
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Meniere's disease
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abnormal accumulation of endolymph in the inner ear
s/s are vertigo, tinnitus, hearing loss, or a sense of ear fullness |
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dx of ARDS
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acute onset resp distress in setting of predisposing condition
PaO2/FiO2 ratio < 200 bilateral infiltrates and a normal PCWP (<18) |
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electrolytes in OSA
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it can cause chronic hypercapnia and hypoxia causing resp acidosis
renal compensation increases bicarb and decreases chloride reabsorption |
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thalamic stroke
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a painful stoke due to damage of the VPL that routes sensory information from the contralateral side of the body
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role of digoixin and furosemide in CHF
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they reduce symptoms and hospitalizations, but do NOT improve survivial
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psoriatic arthritis
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usually involves the DIP of the hand, morning stiffness, dactylitis (sausage digit), and nail involvement
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treatment of Grave's diesease
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radioactive iodine therapy unless contra by preg or severe ophthalmopathy
2nd line is antithyroid drugs like propthyouricil or methimidizole (sp?) |
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SE of abrupt withdrawal for short acting benzos
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generalized seizures and confusion
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MCC of suspected brain abscess
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aerobic and anaerobic strep as well as Bacteroides (also anaerobic)
staph is only responsible for 15% |
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amnioglycosides and the renal system
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they are used to treat gram neg infections and can be nephrotoxic
examples are gentamicin, neomycin, strptomycin, tobramycin, and amikacin |
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soap bubble appearance in the epiphyseal of bones
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think giant cell tumor and needs referral to ortho surgeon
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electrolytes in Conn's
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primary hyperaldosteronsism leads to increased Na, decreased K, increased bicarb causing metaboic alkalosis
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what can cause S4 heart sound
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prolonged HTN causing left vent hypertrophy that causes decreased ventricular compliance
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risk of having bipolar disorder
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general population: 1%
if pt has 1st degree relative, risk is 5-10% if both parents are, child is 60% |
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ethylene glycol poisoning
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calcium oxalate in the kidneys, extra oxalate binds Ca, so hypocalcemia
treat with fomepizole or ethanol to reduce further metaboilsm of the ethylene glycol with alcohol dehydrogenase |
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indication for removal of pleual fluid
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if the pH < 7.2 or glucose < 60, it is suggestive of empyema and needs to be drained via thoracostomy
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lumbar spinal stenosis
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pain termed "neuropathic claudication" is seen in lumbar spinal stenosis. Similar to pain with PVD, but this pain is position dependent, worse with standing
pain reduced by sitting or walking uphill dx with MRI of the spine |
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next step in a newly dx 1st degree heart block
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just observation if they are asymptomatic
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