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303 Cards in this Set

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anti-fungal medications that include:




Drug of choice for neutropenic fever not responding to Abx

Small bowel obstruction

Always think in a pt with abdominal pain post abd surgery

Best initial step in management --> Xray

Gold standard for dx --> CT with contrast

Times to perform LP



Neck stiffness

any other sign of CNS infection


Pituitary apoplexy

Sudden hemorrhage into the pituitary gland

can lead to hypotension due to loss of ACTH and cortisol --> endocrine emergency!

Immediately need to give stress dose glucocorticoid (eg hydrocortisone)


drug induced (eg steroids, testosterone, anti-epileptic, cyclosporin) induced acne

characterized by sudden onset of papules and pustules resembling acne lesions particularily on arms and trunk

rx with tretinoin cream


retention of sweat due to occlusion of eccrine sweat ducts and pores that lead to eruptions

most common on back bc of prolonged bedrest

Rx following initial variceal bleeding

50-80% of re-bleeding within 1 yr

rx with b-blockers, sclerotherapy, or banding

surg options follow medical rx

Testicular torsion

unilateral sudden onset of pain with tenderness and swelling

on PE, testicle is elevated compared to other testicle & it is erythematous

testicular cord may not be palpable

Wound dehiscence

suspect in pt with new onset serous d/c 7-10 post-laparotomy

diabetics have poor wound healing

pt may need to be brought back in OR to explore wound

Wernicke encephalopathy triad

In an etohic:

1) confusion

2) ataxia

3) oculomotor dysfunction

dx is purely on clinical information

w/u of epigastric pain

< 45 yr old:

give PPI and scope if Sxs do not improve


H pylori stool Ag


breath test and scope if positive

> 55 yr old:

upper endoscopy

Benzodiazepine withdrawal

Can be potentially fatal

Psychomotor agitation


Autonomic instabillity


Osgood-Sclatter dz

overuse injury

typically affects physically active adolescent boys with pain and swelling over the tibial tuberosity

caused by apophysitis (inflammation of the tibial tuberosity) and cartilage detachment

dx is made by hx & tibial tuberosity tenderness

Legg-Calve-Perthes dz

avascular necrosis of femoral head that is characterized by hip and knee pain, a limp, and decreased range of motion

affects boys 4-8 yrs old

rx with casting and surg


most common bone tumor in children

occurs in metaphyses of long bones

p/w pain, swelling, and a palpable mass

XR shows a lytic lesion with "sunburst" pattern

rx is surg

Slipped capital femoral epiphysis (SCFE)

occurs in obese adolescent boys p/w knee, thigh, and limp

can find external hip rotation with hip flexion

XR findings include slippage of femoral epiphysis that can be compared to scoop of ice cream that has partially slipped from the cone

can also have a double density sign and a break in Klein's line on XR

Tx by internal fixation of epiphysis with screws and avoid weight bearing to protect from osteonecrosis (should do immediately)

Treatment of acute STEMI




tPA IF within 12 hrs of Sxs

Treatment of acute NSTEMI/unstable angina

1) dual anti-plt therapy: aspirin & P2Y12 receptor blockers (eg clopidogrel, prasugrel, ticagrelor)

2) nitrates

3) b-blockers

4) statins

5) anti-coagulation: unfractionated heparin, LMWH, bivalirudin, or fondaparinux

in NSTEMI next step is NOT cardiac cath

Classic Sxs of Temporal arteritis

In a pt >60 yr old:

1) new onset headache

2) jaw claudication

3) elevated ESR

progressive vision loss can occur due to effect on ophthalmic artery

dx with bx of artery that will show mononuclear and giant multinucleated cells in the intima and media of the vessel

Also assoc with polymyalgia rheumatica --> limb girdle pain and stiffness


sexually transmitted dz most commonly caused by N gonorrhea & Chlamydia trachomatis

p/w scrotal pain and swelling with testicles and epididymis being enlarged and tender

Prehn's sign --> scrotal elevation may relieve some pain

u/s will show increased blood flow distinguishing btwn torsion or varicocele

rx with PO dox (for Chlamydia) & IM ceftriaxone (for gonorrhea)

Herpes simplex virus keratitis

suspect in pts with recurrent sxs of unilateral pain, redness, and photophobia with an epithelial staining defect

under slit-lamp biomicroscopy can show "dendritic pattern"

Dumping syndrome

surgical complication of treating peptic ulcer dz

surg is usually done if ulcer is bleeding, perforated, causing obstruction, or refractive to treatment

thought to be secondary to dumping hyperosmolar chyme into small intestine with the fluid shifts causing painful bowel distension

Tx with eating smaller meals with fewer carbs and more protein and fats

Preventing bacterial peritonitis

1 yr recurrence rate is as high as 70%

Give fluoroquinolone (eg levofloxacin) prophylactically

Tx for various types of headaches

temporal arteritis --> IV glucocorticoids

migraines --> sumatriptan

cluster headaches --> verapimil initially then oxygen therapy

acute glaucoma --> optho emergency, dx with intraocular pressure & tx with acetazolamide, topical beta blockers, mannitol, and pilocarpine

Risk factors for CAD

Most common --> HTN bc of the incidence

Most significant --> DM

Otitis media unresponsive to amox

switch Abx to:







Dynamics of cardiac enzymes

CK-MB goes away by 3 days, whereas troponin is still elevated

CK-MB goes away by 3 days, whereas troponin is still elevated

SLE and pregnancy

pts with hx of anti-phospholipid Abs are given LMW heparin and aspirin during pregnancy

pts should also be screened for anti-Ro Abs bc of their association with congenital heart block

Abruptio placenta

separation of the placenta from the uterus leading to bleeding and possible fetal demise

most common in the setting of drug abuse (esp cocaine), smoking, or abdominal trauma

is very painful

Vasa previa

the blood vessels within the placenta or umbilical cord that are btwn the fetus and the internal cervical os

when ROM occurs, the umbilical cord may get severed resulting in fetal exsanguination

Placenta previa

placenta covers the internal cervical os

blood loss can be small amount or catastrophic

PAINLESS unlike abruptio placenta

HPV infected pap smear

sharply demarcated, large perinuclear vacuoles with alterations to the chromatin pattern

HPV type 6 and 11 are assoc with condyloma acuminata

Crohns and colon cancer

Colon ca risk isnt as high in crohn's vs UC

Risk increases in crohns when colon is involved and pt has been dx for >10 yrs

pts with colon involvement and having it for >10yrs should have yearly colonoscopy

Otitis externa

managed with topical Abx and steroids

Abx: polymyxin or neomycin or cipro or gentamicin or tobramycin or sulfisoxazole

Decompression sickness

aka the bends --> occurs when scuba divers ascend too fast such the body doesnt excrete nitrogen

Type I: less severe and leads to pain, fatigue, malaise, headache, anorexia, lymphatic and cutaneous manifestations --> tx with oxygenation and fluid intake

Type II: more severe and can affect the neurologic, CV, resp, and vestibular systems leading to shock --> tx with hyperbaric chamber

HIV and pregnancy

Babies are delivered via c-section unless viral load is <1,000 copies/ml


normally suppressed by dopamine released from hypothalamus

can be stimulated by TRH (which is increased in primary hypothyroid along with TSH)

someone with primary hypothyroid can mimic pituitary tumor and should be treated with levothyroxine

Anatomy of airway

Rt main stem bronchus has much steeper angle (closer to the trachea) than the left bronchus

nearly all upper airway aspirations of objects smaller than the airway will end up in that location

Inactivated/killed vs live/attenuated vaccines

Inactivated/killed (ok to give in pregnancy)

Hep A



Influenza (Have both inactivated & live versions)

Live/attenuated (not recommended during pregnancy)


Varicella & zoster

Influenza (Have both inactivated & live versions)


Yellow fever

Managment of non-hemorrhagic stroke

Pt should be minimally on aspirin

If on aspirin and has an event, then ADD dipyridamole OR SWITCH to clopidogrel

For cardiac you use aspirin + clopidogrel but for brain you use either aspirin or clopidogrel

Carotid endarterectomy is only for clot of 70-100%

Thrombolytics and chest pain

should administer within 12 hours of chest pain

if done within 2 hrs benefit is as much as 50%

if done within 12 hrs benefit is ~10%

should give thrombolytics within 30 mins of entering ED

Assessment of aortic dissection

can confirm dx with contrast chest CT

can also dx with transesophageal echo or conventional angiography

Six Ps of compartment syndrome




pulselessness (most ominous sign)



can lead to ARF bc of rhabdo secondary to muscle necrosis

Signs of pericarditis

pleuritic chest pain, leathery rub on systole and diastole, and newly enlarged heart

ST elevation in all leads

Tx with NSAIDS and if refractory tx with steroids

Abx for PID

Best initial therapy is cefoxitin or cefotetan AND dox

if anaphylactic reaction to penicillin --> clinda and gent

Nephrotic syndrome complications

assoc with increased chance of bacterial infections

mildy hypercoaguable state leading to thrombosis, DVT, and/or PE

pts are actually hypovolemic bc of 3rd spacing

Henoch-Schonlein Purpura

most common cause of vasculitis in children (mean age is 4-7)

IgA mediated vasculitis involving small blood vessels of skin, GI tract, kidneys, and joints

classic rash is palpable purpura concentrated on the buttocks and lower extremities but rarely on trunk

plt count has to be normal or elevated

Rocky Mountain spotted fever rash

maculopapular rash that begins on extremities and spreads inward to the trunk and includes the palms and soles

rash can become purpuric after several days

Erythema infectiosum (fifth disease)

caused by parvo B19 virus

p/w bright red raised erythema on the cheeks that has the appearance of a sunburn

can have fever, headache, and muscle asches

is only infectious BEFORE onset of rash

Zollinger-Ellison syndrome

normally, secretin inhibits gastrin secretion but with gastrinomas secretin actually stimulates secretion

if gastrin level is markedly elevated (>1,000) then this is sufficient to make dx

if gastrin level elevated (150-1000) then need to do secretin challenge test

after dx is made, then need to localize the tumor so need to perform imaging

Post thoracentesis pulmonary edema

after draining large volumes (>1 L), can have re-expansion pulmonary edema

risk depends on chronicity of the effusion, capillary permeability, and whether suction was used to drain effusion

bc of high mortality rates assoc with this, ppl tend to drain large volumes in stages or by slow gravity drainage

Chest pain secondary to ischemia

described as substernal and dull (or being punched)

positional pain is NOT ischemia

pain described as knife or point like pain, lasting a few seconds, sharp, or positional is NOT ischemia

Metformin and kidney function

contraindicated in pts with renal insufficiency bc it raises the possibility of metabolic lactic acidosis

Most common cause of epigastric discomfort

Non-ulcer dyspepsia (NUD) --> mid epigastric abdominal pain or fullness w/o a cause identified

2nd most common is GERD

Child abuse

any child not walking with a lower extremity fracture is a victim of child abuse until proven otherwise

EKG changes in hypothermia

hypothermia prolongs repolarization leading to upward deflection of S wave

Also see QT interval prolongation

Electrolyte abnormalities and EKG changes

hypokalemia --> diffuse broadening of T waves and prominent U waves

hyperkalemia --> peaked T waves

hypercalcemia --> QT interval shortening

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

relatively common & normally occurs in 3rd trimester in primigravidas

typically develops on the abdomen with umbilical sparing

1-2mm erythematous papules which coalesce to form urticarial plaques

responds to steroids but usually resolves w/o treatment after pregnancy

can re-occur with future pregnancies

Pustular psoriasis of pregnancy

marked by acute, febrile onset with development of grouped erythematous plaques that are rimmed with small sterile pustules

hypocalcemia can develop leading to delirium, seizures, and tetany

Tx with high dose steroids

fetus is at higher risk for stillbirths and placental insufficiency

Risk factors for osteoporosis

advanced age

decreased gonadal function

Caucasian ethnicity

corticosteroid use

low Ca intake

poor physical activity

Rheumatoid arthritis

symmetrical joints of hands with elevated ESR, RF, anti-CCP, and CRP

most common extra-articular manifestation is nodules

pleural effusion with very low glucose is characteristic of RA

OCPs contraindications

migraine with aura

smoking in a patient >35yo

BP >160/>100

Contraindications for thrombolytics

Hemorrhagic stroke at any time in the past

BP >180/110

intracranial malignancy

aortic dissection

any major bleeding

Ectopic pregnancy management

Give low dose methotrexate IM if:

hemodynamically stable

b-HCG <5,000

mass <3-4cm with no fetal activity

repeat b-HCG 4 days then 1 week & if it doesnt decrease by more than 15% then give another dose of methotrexate (can give total of 3 doses)

if methotrexate doesnt reduce b-HCG --> surgical resection


loss of melanocytes from the epidermis, mucous membranes, and other tissues

thyroid dz (hypo and hyper), DM, pernicious anemia, addison dz, multiglandular insufficiency syndrome, and alopecia areata are assoc with vitiligo

Tx with corticosteroids and phototherapy

Pacemaker and stress test

cannot do stress test when pacemaker is present

Relapsing polychondritis

recurrent inflammatory condition of the cartilage

aortic aneurysm maybe a complication

unique to RP is confinement to carilaginous organs such as ears and nose

tracheal narrowing is characteristic CXR finding

tx with high dose oral pred & IV steroids for acute airway obstruction

B12 deficiency

can lead to peripheral neuropathy

Linezolid side effects

bone marrow suppression --> thrombocytopenia

Cushings syndrome w/u

plasma cortisol at 8AM after 1mg dex the previous night or 24 hr urine cortisol -->

low dose dex suppression test, if no response --> plasma ACTH

Drug-induced vs spontaneous SLE

drug induced DOES NOT affect CNS or kidneys

nearly all cases of drug induced have anti-histone Abs

in both, first step is to look for ANA Abs

hydralizine, procainamide, minocycline, etanercept, & infliximab are common drugs that cause SLE

Febrile seizures

leads to generalized tonic clonic

occurs >24hrs after onset of fever & can last >15 mins

Ticlopidine side effects

ADP receptor inhibitor --> anti coagulant

assoc with neutropenia

Sjogren's syndrome & cancer

assoc with B-cell NHL (3-5%)

Sulfonylureas side effect

can lead to SIADH (hyponatremia with elevated urine Na and osmolality)

weight gain


eg chlorpropamide, glipizide, glyburide

Hydroxycholorquine side effect

reversible ocular or retinal toxicity

Post-strep glomerulonephritis

caused by group A beta-hemolytic streptococcus





1st step in management, get anti-DNase B and/or ASO titers

Transected urethra

blood at urethral meatus with high riding prostate

need to do urethrogram immediately

Maternal alpha fetal protein

most common cause of abnormal finding --> incorrect preg dating so perform u/s

if correct date & abnormal --> offer amnio

if correct date & high --> neural tube defect?

& low --> Downs

Dipeptidyl Peptidase 4 inhibitors

eg Sitagliptin, saxagliptin, linagliptin

increase insulin levels and decrease glucagon levels by inhibiting destruction of GLP

function w/o increasing weight as opposed to sulfonylureas

Lead poisoning

<10 --> acceptable

10-14 --> repeat in 3 months

15-19 --> repeat in 2 months (>15 need to get health dept notified)

20-44 --> repeat in 1 week

45-70 --> chelation therapy with succimer

>70 --> tx with 2 chelators, dimercaprol & EDTA

Metformin & B12

leads to malabsorption of B12 in gut, resulting in macrocytosis and peripheral neuropathy

Waterhouse-Friderichsen syndrome

caused by Neisseria sepsis

can lead to b/l adrenal hemorrhages

need to check random cortisol level to make dx of adrenal insuff

tx with steroids

Metronidazole & breast feeding

appears in breast milk but do not know effects

as a result, recommend to pump and discard the milk for 24 hrs and then resume breastfeeding

Bacterial vaginosis

caused by Gardnerella vagianalis

d/c has fishy odor

KOH prep will produce foul smell (amine odor) & will see clue cells on microscopic evaluation

vaginal pH is elevated (>4.5)

not STI so treat with metro for the pt & dont need to tx the partner

in preg --> higher risk of preterm labor, PROM, spont abortion & tx with oral metro or clinda


most common bacterial STI

p/w abd pain, intermenstrual vaginal bleeding, & acute PID

long term problems include pelvic adhesions and chronic pelvic pain

tx with either 1 dose of azithro or 7 day course of dox for both patient and partner

Trichomonas vaginitis

2nd most common STI

pear shaped flagellated protozoan

leads to frothy, green vaginal d/c w/ or w/o strawberry cervix

dx by seeing bugs on slide

tx with metro for both partner and patient

Tx of lyme

Early localized:

<8yo --> IV amox or IV ceftriaxone

>8yo --> PO dox, amox, or ceftriaxone

Late disease:

no neuro involvement --> PO dox or amox

neuro involvement --> IV ceftriaxone

in preg --> amox or cefuroxime

Brain death criteria

no spont movement

no response to painful stimuli

no seizure or decerebrate, decorticate, or dyskinetic movements

absence of central resp drive documented with an apnea test, a test that monitors the response of resp drive to the rising PaCO2

Wegener's granulomatosis

pauci immune vasculitis --> inflammation of the blood vessels with very little immune complex deposits in the active lesions

affects small & med sized arteries

ulcerating granulomas in upper and lower resp tract and cavitating pulm lesions are hallmarks of wegener's

nasal bx of lesion is diagnostic (if no nasal lesion --> lung or kidney bx)

Polymyalgia rheumatica

common in pts >50yo with mean onset of ~70yo

p/w aching and stiffness in the prox muscle groups & assoc with constitutional Sxs (malaise, fever, weight loss)

can be assoc with temporal arteritis

normally have normocytic anemia, elev ESR, elev ALK Phos

next step is to give steroids and temporal artery bx


episodic symptoms of:

very high sputum

minimal physical findings, with clubbing rare

marked improvement to simply a cough btwn episodes

can find "parallel lines" or "tram-tracking" on CXR

most accurate test is high resolution CT scan

DM medication side effects

metformin - lactic acidosis, contraindicated in renal insufficiency

sulfonylureas - weight gain & SIADH

acarbose and miglitol - flatulance, GI distress, diarrhea

rosiglitazone & pioglitazone - CHF and MI

COMT inhibitors

eg tolcapone and entacapone

extend the duration of effect of levodopa by blocking its metabolism


small vascular malformation of the gut

common cause of GI bleeding

assoc with ESRD, vWF dz, & aortic stenosis

Sjogren serologies

90-95% are ANA+

70% are RF+

50-65% are anti-Ro and anti-La +

Colon cancer screening

start at age 50-75

annual screening with high-sensitivity fecal occult blood testing (FOBT)


sigmoidoscopy q5yrs with high sensitivity FOBT q3yrs


colonoscopy q10yrs

Causes of seizures

hypernatremia and hyponatremia





liver or renal failure

intracranial anatomic defect


benzo or barbiturate w/d

Hyperkalemia and motor vehicle accident

after motor vehicle accident, can release large amt of K into blood (analogous to rhabdo)

can result in EKG abnormalities (peaked T-waves)

tx with calcium gluconate

Pill esophagitis

focal inflammatory lesion of distal esophagus

assoc with:

bisphosphonates (eg alendronate)

anti-inflammatory meds (eg aspirin)




potassium chloride pills

Rheumatoid factor

IgM Ab against Fc region of IgG

100% + in cryoglobulinemia

70-80% + in RA

70% + in Sjogren

30% + in SLE

Antipsychotics and Parkinsons

anti-psychotics lead to def of dopamine --> change to clozapine or quetiapine & give benztropine or trihexyphenidyl

PD drugs increase dopamine levels --> can lead to psychosis that should be treated with clozapine or quetiapine

Plummer Vinson syndrome

caused by iron def leading to a web in the prox esophagus due to fibrous/epithelial narrowing of a thin mucosal band

rare, but assoc with squamous cell carcinoma (barret's is adenocarcinoma)

Tx with iron supplementation, if doesnt improve then repair via endoscopic methods (eg bougie or pneumatic balloon)

Meniere's disease

distortion and distension of the membranous, endolymph-containing portions of the labyrinthine system

Tx with diuretics and H1 antagonists

Status epilepticus

order of drugs for treating seizures:

benzo (eg lorazepam) --> fosphenytoin --> phenobarbital --> midazolam/pentobarbital/thiopental/propofol

give fosphenytoin vs phenytoin bc if phenytoin given rapidly can lead to hypotension and AV block

earliest sign of phenytoin toxicity is nystagmus

Posterior urethral valves in a newborn

varying degrees of obstruction in the posterior urethra in males by cusps of tissue called valves

causes dilation of the bladder due to increased pressure which back ups to collecting systems of the kidney and can result in varying degrees of renal damage

dx with voiding cystourethrogram that will show a thickened and trabeculated bladder from muscular hypertrophy and dilated posterior urethra with narrowing

tx with surgery

Tx of carboxyhemoglobin

<10% --> administer 100% O2 for 3 hrs

10-15% --> admit and give 100% O2 for 24 hrs

>25% --> hyperbaric oxygen

USPTF recommendations for adults

all >18 yrs --> BP check at every visit

1st pap smear at age 21 regardless of when sexually active

21-29 yo a pap q3 yrs

30-65 yo q3 yrs OR pap + HPV co-testing q5 yrs

Magnesium sulfate side effect

give magnesium sulfate to any pregnant woman who has new onset hypertension to prevent seizures secondary to eclampsia

most common side effect is loss of deep tendon reflexes

can also lead to hypotension, complete heart block, muscle paralysis, resp paralysis, and possible cardiac arrest

Tx of OCD

SSRIs such as paroxetine, fluvoxamine, sertraline, citalopram, and fluoxetine

Anterior cerebral artery stroke

urinary incontinence

personality and psychiatric distrubance

unilateral leg weakness

Craniofacial zygomycosis

fungal infection that affects only immunocompromised ppl & diabetics

p/w fever, sinus pain, thin bloody nasal d/c, double vision w/reduced eye movement, & red or necrotic nasal turbinates

wet mount made from crushed tissue can show septated hypahe

Mallory Weiss tear

can inject epinephrine with persistent severe bleeding

if not actively bleeding, can just observe and supportive care

assoc with hiatal hernias

Essential tremors

isolated tremor that occurs at both rest and with exertion

has no rigidity assoc with it

tx with propranolol

Shy-Drager syndrome

variant of Parkinson that is characterized primiraliy by orthostasis and syncope

another name is multiple system atrophy

Initial tx for Parkinson's dz

mild to mod severe PD should be treated with dopamine agonist such as ropinirole, pramipexole, apomorphine, or bromocriptine

levodopa/carbidopa are second line bc long-term use can lead to destruction of substantia nigra & worsen sxs

ARDS criteria

acute onset

CXR appearance

PaO2/FiO2 <200

pulmonary cap wedge pressure <18 mm Hg -> most important distinguishing factor vs cardiogenic etiology

Sodium nitroprusside complication

can lead to cyanide toxicity

tx with sodium thiosulfate

Exercise stress tests

If patient is unable to exercise then:

Dipyridamole thallium stress test -> contraindicated in pts with asthma and/or reactive airway dz (eg COPD)

Dobutamine ECHO

Ankylosing spondylitis test

abnormal Schober test --> <5cm change in distance from top to bottom of lumbar spine on forward flexion

XR --> narrowing of sacroiliac joint

Assoc with restrictive lung dz so FVC, FEV1, and TLC decrease

Lowering serum glucose in DKA

want to decrease ~50-100mg/dL/hr

more aggressive decrease may lead to cerebral edema and herniation

Adrenal crisis

can be induced by pyelonephritis that leads to loss of glucocoritcoid and mineralocorticoid production

leads to:





metabolic acidosis



tx with IV steroids then the underlying infection

Organophosphate toxicity



blurred vision

urinary incontinence



severe changes include:

bradycardia, hypotension, respiratory paralysis, AMS

can have garlic-like odor on clothes

can test RBC cholinesterase activity to provide degree of toxicity

tx with atropine and pralidoxime

Interferon and ribavirin side effects


thrombocytopenia, neutropenia, depression, flu-like symptoms


hemolytic anemia

do not give ribavirin in pt with renal insufficiency

Psychiatric drug class side effects

SSRI: decreased libido

TCA: cardiac arrhythmia, decreased seizure threshold, orthostatic hypotension

MAOI: hypertensive crisis

Thioridazine: retinal pigmentation, prolonged QT

Clozapine: agranulocytosis

Olanzapine: increased weight gain, dyslipidemia, hyperglycemia

Metformin and contrast

should d/c metformin prior to any angiographic/radiologic procedure that uses contrast

contrast may lead to AKI & metformin can lead to lactic acidosis in pts with renal insufficiency

Diabetes screening

age >45, especially obese

family hx


vascular dz


MMR and varicella vaccines

both are live attenuated vaccines

should not give prior to age 1

after first shot, should get booster btwn age 4 and 6

HepA should also be given at age 1

Fitz-Hugh-Curtis syndrome

complication of PID

salpingitis that spreads to cause more peritonitis affecting anterior surface of liver resulting in localized fibrosis and scarring

tx underlying chlamydial/gonococcal infections but with adhesions, surgery maybe required

Carotid stenosis

indications for endarterectomy are TIA/symptomatic stroke AND >70-99% stenosis

carotid angioplasty and stenting is done in those who cannot undergo surgery or who recur after endarterectomy

if pt has stroke and <70% stenosis, just tx with aspirin. if stroke reoccurs, can change to clopidogrel

Acarbose side effect

alpha-glucosidase inhibitors that block absorption of glucose in brush border of small intestine


abdominal pain




synthetic somatostatin analog

used in acute management of variceal bleeding

Thrombolytics use in stroke

must use within 3 hrs of Sxs but get CT first to make sure there is no hemorrhage

older stroke pt should get ECHO, carotid duplex, telemetry, & MRI

should do neuro checks q1 hr for first 24hrs

giving anti-plt or anticoagulants are contraindicated within first 24 hrs

Hepatopulmonary syndrome

combination of liver dz, increased A-a gradient, and intrapulmonary vascular dilatations

platypnea- dyspnea caused by upright position and relieved by lying down

orthodeoxia- desaturation on assuming an upright position

dx via either:

contrast-enhanced ECHO

technetium-99m-labeled macroaggregated albumin scanning

pulm arteriography

Refeeding syndrome

severe malnutrition decreases metabolic rate of cells and lack of dietary phosphate leads to whole body phosphate depletion

when refeeding is initiated, there is a spike in insulin with glucose rapidly taken up by cells leading to glycolysis and usage of phosphate

this leads to hypophosphatemia that can cause lethargy, muscle weakness, resp failure, and rhabdo

TCA overdose

dry mouth

blurred vision


sinus tachy

memory dysfunction

urinary retention

Fetal fibronectin

fibronectin is glycoprotein found in amniotic fluid, parts of placental tissue, and thought to act as trophoblastic glue

test predicts likelihood of delivery in the next 14 days

should only be performed with gestational age of 22-34 and have intact membranes

Risk factors for ectopic pregnancy

high risk factors:

previous ectopic

previous tubal surg

tubal pathology

congenital anomolies

current IUD use

mod risk factors:


previous cervicitis

hx of PID and multiple sex partners


low risk factors:

previous abd & pelvic surg

vaginal douching


Different types of shock


low CO, high PAWP, and high SVR

hypovolemic shock:

low CO, low PAWP, and high SVR

neurogenic shock:

nl-low CO, nl-high PAWP, low SVR

septic shock:

variable CO, nl-high PAWP, low SVR

extracardiac obstructive shock:

low CO, nl-high PAWP, high SVR


abnormal dilation of the spermatic veins within the scrotum

can be assoc with infertility & testicular atrophy

on PE find bag or worms & u/s shows dilated veins that distend on Valsalva --> usually appears on left & if on right, should get CT of abdomen to look for IVC obstruction

Asymptomatic pts just need f/u

surg required if:

varicoceles are b/l

causing sxs

decreased testicular volume or infertility

Adolescent pregnancies

increased risk of:

perinatal mortality

preterm delivery

premature & low birth weight

Flexible bronchoscopy

primary diagnostic tool to evaluate pts with persistent or nonresolving pneumonia or pulm infiltrates

best diagnostic tool for endobronchial obstructive lesions but next step in management for these cases should be CT

Histrionic personality disorder

pattern of excessive emotionality & attention seeking behavior since early adulthood

inappropriate sexually seductive or provocative behavior

shallow, shifting, dramatic emotions

Borderline personality disorder

exhibit attention-seeking, manipulative behavior, & rapidly shifting emotions

Self-injurious & suicidal behavior

intense anger

chronic feelings of emptiness

identity disturbance

use defense mechanism of splitting (ppl are all bad or all good)


fungal infection of toenails caused by Trichophyton rubrum

thick, brittle, discolored nails

dx with KOH, PAS stain

tx with terbinafine or itraconazole

Hypertonic saline

used in severe & symptomatic hyponatremia (Na <115)

do not want to raise Na >12mEq/L in first 24 hrs

Complications of infective endocarditis


valvular insufficiency

perivalvular abcess

conduction abnormalities

mycotic aneurysm


embolic stroke

cerebral hemorrhage

brain abscess

acute encephalopathy


renal infarction


drug induced acute interstitial nephritis from therapy


vertebral osteomyelitis

septic arthritis

msk abcess

Subchorionic hematoma

bleeding btwn endometrium & gestational sac

appears as crescent shaped hypoechoic regions adjacent to gestational sac

increased risk of experiencing spontaneous abortion

next step is repeat u/s in 1 week

Multiple sclerosis

nearly 50% develop optic neuritis, which typically p/w monocular visual loss accompanied by eye pain

can develop transverse myelitis resulting in upper motor neuron signs & sensory loss below the level of spinal involvement

best test for dx is MRI that reveals ovoid-shaped periventricular white matter lesions

tx of acute flair is with steroids

long term tx is with b-interferon or glatiramer can decrease freq of exacerbations & reduce development of brain lesions

Symptomatic management of common MS findings

depression --> SSRI

spasticity --> PT & stretching, massage therapy, baclofen

fatigue --> sleep hygiene, regular exercise, amantadine, stimulants

neuropathic pain --> gabapentin or duloxetine

urinary incontinence --> timid voiding, fluid restriction, anticholinergics

Abs that cause C diff


enhanced spectrum penicillins



Tx of squamous cell carcinoma

first line is surgical excision

second line for low risk is cryotherapy, electrosurgery, or radiation therapy

Adult polycystic kidney disease extra-renal manifestations

hepatic, pancreatic, splenic, & pulm cysts

cerebral aneurysms

aortic aneurysms

colonic diverticula

mitral valve prolapse

inguinal and abd hernia

Actinic keratosis

pre-malignant condition caused by excessive sunlight exposure

small, rough, erythematous, and keratotic papules that are often easier to feel than they are to see

leads to increased risk of squamous cell carcinoma

individual lesions can be r...

pre-malignant condition caused by excessive sunlight exposure

small, rough, erythematous, and keratotic papules that are often easier to feel than they are to see

leads to increased risk of squamous cell carcinoma

individual lesions can be removed via liquid nitrogen cryosurgery or surgical excision but if numerous --> tx with 5-FU, topical diclofenac, imiquimod

Likelihood ratio

Positive LR = sens / (1-spec)

Negative LR = (1-sens) / spec

prob of given test result occurring in a pt with a disorder compared to the prob of the same result occurring in a pt w/o the disorder

not dependent on disease prevalence as PPV and NPV are

Verification bias

when study uses gold standard testing in order to confirm a positive or negative result of preliminary testing

this can over- or underestimate the sensitivity or specificity

Thyroid lymphoma

p/w rapid increase in size that causes difficulty in breathing

can be palpable on exam

assoc with Hashimoto's thyroiditis (high TSH, low T4) --> Hashimoto's is also assoc with anti-peroxidase Ab

dx via large-bore needle bx

Drug caused pancreatitis

thiazides, furosemide

sulfasalazine, 5-ASA

azathioprine, L-asparaginase

valproic acid

didanosine, pentamidine

metro, tetracycline

C diff colitis algorithm

Tx of C diff recurrence

Bronchopulmonary aspergillosis

hypersensitivity to Aspergillus in pts with asthma

p/w recurrent episodes of fever, malaise, cough, with brownish mucoid expectorian, wheezing, & sxs of bronchial obstruction

CXR b/l upper lobe parencymal infiltrates

best screening test --> skin prick test for aspergillus --> if positive, then serum IgE & aspergillus serologies

tx with oral steroids & itraconazole


Lithium and drug interactions

lithium toxicity includes:



neuromuscular excitability

lithium levels can be affected by thiazides, ACEI, & NSAIDS, SSRI

Heart sounds

Fahr's syndrome

effect of long-standing pseudohypothyroid

hypocalcemia with hyperphoshatemia leads to b/l cataracts & calcification of basal ganglia

Low Ca

Porphyria cutanea tarda

def of uroporphyrinogen decarboxylase --> enzyme involved in heme synthesis

can p/w painless blisters, hypertrichosis, & hyperpigmentation

assoc with Hep C infection & can be triggered by certain substances (eg etoh, estrogen)

dx with urinary uroporphyrins

tx with phlebotomy or hydroxychloroquine or if with Hep C --> IFN-a


rare pancreatic tumor

characteristic rash of "necrolytic migratory erythema" assoc with mild diabetes

when dx normally have mets to liver

also secrete VIP, calcitonin, or GLP1

dx with measuring glucagon levels

tx with surgery

Superior vena cava syndrome

usually secondary to lung malignancy (most likely bronchogenic carcinoma)

p/w dyspena, persistent cough, facial fullness and neck pain, & progresses into hoarseness, dysphagia, chest pain, & syncope

can find dilated veins of arms & neck

best way to dx is CT with contrast

Tx of kidney stones

if pt has urosepsis, ARF, or complete obstruction --> urology consult for surg

<10mm --> hydration, pain control, a-blockers, strain urine

>10mm --> urology consult for surg

Clinical features of melanoma (ABCDEs)


Border irregularities

Color variegation

Diameter >6mm

Evolving - lesions change in size, shape, or color

HIV lipodystrophy

fat deposition on the back of neck & abdomen with thin extremities & face --> Cushingoid pattern

pts also develop insulin resistance

tx with statins and if triglycerides >500 tx with fibrates (eg gemfibrozil)

Carpal tunnel risk factors







W/u of palpable breast mass

Bone anti-resorptive agents

eg bisphosphonates & raloxifene

use in post-menopausal woman <65 with high risk of osteoporesis/bone fracture:


chronic steroid use


malabsorptive dz

fam hx or personal hx of hip fracture

Opioid withdrawal

GI --> N/V, diarrhea, cramping

CV --> tachy, HTN, & diaphoresis

Psych --> insomnia, yawning, dysphoric mood

General --> myalgias, arthralgias, lacrimation, rhinorrhea, piloerection, mydriasis

tx with opioid agonist (eg methadone or buprenorphine) OR non-opioid (eg clonidine or benzo)

Tinea capitis

"ringworm of the scalp"

patches of scaling, slightly erythematous alopecia with cervical adenopathy

dx clinically but can also do KOH exam of epilated hair stubs or fungal cx

tx with oral griseofulvin or oral terbinafine

Ethylene glycol toxicity

rapid and deep breathing


slurred speech




bad toxicity can lead to confusion, flank pain, renal failure, pulm edema, AMS, & coma

first line tx is fomepizole & second line is etoh

Scombroid poisoning

ingesstion of improperly stored seafood

p/w flushing, throbbing headache, palpitations, abd cramps, diarrhea, & oral burning

occurs within 10-30 mins of ingesting fish

Herbal supplements & drug reactions

Licorice --> stomach ulcers

inhibits conversion of cortisol to cortisone & can aggravate HTN

Saw palmetto --> BPH

increased bleeding risk

St John's wort --> depression

HTN crisis & interacts with many drugs (SSRI, OCP, digoxin, anticoagulants)

Garlic preparations --> hypercholesterolemia

bleeding risk

Fish oil supplementation --> refractory hypertriglyceridemia

Ginkgo --> memory

can interact with aspirin or warfarin leading to spont bleeding

Kava --> anxiety & insomnia

use with etoh, benzos, & other sedatives can potentiate their effect & cause drowsiness or disorientation. Also leads to severe liver damage

Black cohosh --> PMS & menopausal sxs

can cause hypotension & bleeding risk

Horse chestnut --> used in venous insuff or chronic venous stasis

can cause bleeding in pts on aspirin or warfarin

Asymptomatic left sided heart failure

pts with decreased EF who are asymptomatic --> tx with ACEI

Different types of dementia

Pick's dz

slowly progressive frontal lobe dementia affecting speech, executive functioning, mood, & disinhibition

Lewy body dementia

affect cortex & brainstem & p/w gradually progressive dementia assoc with visual hallucinations & parkinsonism motor features leading to falls

Vascular dementia

diffuse white matter dementia & seen in pts with multiple strokes & presents acutely

Wernicke's encephalopathy

mental impairment, ophthalmoplegia, horizontal nystagmus, & ataxia

Huntington dz

slowly progressive characterized by chorea & behavioral disturbances

Rashes associated with dermatomyositis

Gottron's papules --> erythematous papules overlying the metacarpal and interphalangeal joints

Heliotrope rash --> violaceous eruption on the upper eyelids (& in rare cases of lower eyelid) with itching & swelling

this is assoc with proximal muscle weakness

first step is serology --> ANA+ (80% of pts)

MELD score

determines prognosis and liver transplant listing for chronic liver failure

depends on bilirubin, INR, creatinine so these 3 characteristics are the most important predictive factors for prognosis in liver failure

Emergency contraception

most effective is Cu IUD but contraindicated in active pelvic infection or cervicitis

most effective oral is Ulipristal

most effective is Cu IUD but contraindicated in active pelvic infection or cervicitis

most effective oral is Ulipristal

always do b-HCG before giving

Sexual assault ppx meds

HIV --> 3 drug regimen (eg tenofovir-emtricitabine with raltegravir)

Hep B --> Hep B vaccine +/- Hep B Ig

Chlamydia --> azithro

Gonorrhea --> ceftriaxone

Trichomonas vaginalis --> metro

Acute chest syndrome

new pulm infiltrate with 1 or more of:

incr work of breathing, cough, tachypnea, wheezing

temp >38.5 (101.3)


chest pain

tx with ceftriaxone + azithro & IV fluids & pain control

Premenstrual syndrome

occur in the second half of the menstrual cycle & resolve after menses

depression, anxiety, irritiability, bloating, & breast tenderness

Premenstrual dysphoric d/o is severe form with anger & irritability

up to 80% can develop primary psychiatric, mood, or anxiety d/o

tx with SSRIs & if one doesnt work try another (eg fluoxetine --> citalopram), if no desire to get pregnant, can also try OCPs

Management of cat & dog bites

Metoclopramide drug side effects

metoclopramide is a dopamine (D2) blocker used as an anti-emetic

can lead to extrapyramidal sxs such as akathisia, dystonia, & parkinsonian-like sxs

should use ondansetron (serotonin receptor antagonists) or aprepitant instead

VSD vs ASD murmur

VSD with left-right-shunting --> holosystolic murmur

ASD with left-right-shunting --> wide and fixed splitting of S2

TOF has VSD along with RV outflow obstruction, overriding aorta, & RV hypertrophy

Sodium-glucose cotransporter 2 (SGLT2) inhibitors

inhibits glucose reabsorption at the level of the

prox renal tubule so reduces serum glucose via inducing glucosuria

common side effect is vulvovaginal candidiasis, polyuria, & increased UTIs

Mentzer index

MCV / RBC count

helps distinguish btwn iron def & thalessemia

>13 --> iron def

<13 --> thalassemia

Black box for atypical antipsychotics

elderly pts with dementia-related psychosis, treated with antipsychotics are at an increased risk of death

risk of death is primarily via CV events or infectious causes

but still can be considered with risk/benefit ratio

Management of back pain

Hypokalemia and SBO

hypokalemia can lead to paralytic ileus

loop diuretics (eg furosemide) can lead to both hypokalemia & hyponatremia

tx SBO with oral or parenteral K+

Gestational DM w/u

done at 24-28 weeks gestation

50g oral glucose & measure glucose 1 hr after:

<140 --> no further testing

>140 --> do 100g oral glucose & test each hr for 3 hrs

fasting should be <105

1 hr should be <190

2 hr should be <165

3 hr should be <145

if 2 or more times are abnormal --> dx with gestational DM

tx gestational DM with dietary modification & if that doesnt work start insulin or oral agents (eg metformin or glyburide)

two most common fetal complications are macrosomia & shoulder dystocia

can also cause cardiomyopathy/CHF (hypertrophic interventricular septum leading to ventricular outflow obstruction) in fetus

Anatomic location of digit arteries, nerves, veins, & tendons

run on sides:




runs on anterior surface (palmar surface):


Catatonia syndrome

assoc with severe psychiatric illnesses that results in marked psychomotor disturbance

can range from stupor to marked agitation

first line tx is benzos (eg lorazepam), if this doesnt work can do ECT

Neuroleptic malignant syndrome

assoc with antipsychotic meds

muscle rigidity


autonomic instability


elevated CK

tx with dantrolene sodium for muscle rigidity, benzo for agitation, & can consider bromocriptine or amantidine to reverse dopaime blockade

Ddx for vaginitis

Isotretinoin toxicity

used for nodulocystic acne

side effects include:

metabolic effects (hypoglycemia & hypertrig --> can lead to acute pancreatitis)


mucocutaneous reactions

hematologic abnormalities

ocular toxicity

known teratogen & woman of child bearing age need 2 negative preg tests & use 2 methods of contraception 1 month before, during & after tx

Tx of clavicle fractures

Reactive arthritis

Metastatic bone lesions

osteoblastic: detect with radionucleotide bone scan followed by Xray


small cell lung

Hodgkin lymphoma

osteolytic: detect with Xray or PET


non-small cell lung


osteoblastic or osteolytic:


Oropharyngeal lesions in kids

anterior oral mucosa:

aphthous stomatitis (canker sore) --> no fever

herpes gingivostomatitis (HSV type 1)--> with fever

posterior oropharynx:

herpangina (caused by coxsackie group A)--> with fever

tonsillar exudates:

group A pharyngitis --> anterior cervical LAD

infectious mono --> diffuse LAD w/ +/- HSM

Calcium channel blocker side effect

peripheral edema particularly with amlodipine & nifedipine

when given with ACEI, can reduce CCB assoc peripheral edema

Rotator cuff tendonitis

p/w lateral shoulder or deltoid pain aggravated by reaching or lifting the arms up

frozen shoulder is seen in rotator cuff tendonitis & pain is accompanied by stiffness & decreased ROM in abduction & external rotation

rotator cuff tear is likely if there is accompanying weakness or loss of strength during external rotation or abduction of shoulder

Tx of bacterial conjunctivitis

erythromycin ointment


sulfa drops


polymyxin/trimethoprim drops

for contact lens wearers --> fluoroquinolone bc of pseudomonas coverage

Meckel's diverticulum

p/w painless hematochezia

rule of 2s:

2% prevalence

2:1 male:female ratio

2% are symptomatic at age 2

located within 2 feet of ileocecal valve

dx with technetium-99M scan

tx with surgery for symptomatic pts

PPx for neonatal GBS

do rectovaginal cx at 35-37 weeks

tx with penicillin if:

had prior birth to affected infant

GBS bacteriuria or GBS UTI at any point in pregnancy

GBS+ within 5 weeks of labor

unknown GBS status AND 1 of following:

<37 weeks gestation

intrapartum fever

ROM for >18hrs

Diffuse esophageal spasm

p/w dysphagia to solids & liquids usually w/o weight loss

manometric studies demonstrate high amplitude peristalic contractions

difference btwn this & achalasia is lower sphincter has normal relaxation response

tx with PPIs, antispasmodics (eg nitroglycerin, CCB, hydralazine), dietary modulation, & psychiatric counseling


pt complains of "food stuck in chest" and also has difficulty with liquids

p/w dysphagia to solids & liquids with weight loss

manometric studies show lower esophageal sphincter does not relax (has high tone)

Initial test --> barium swallow

Best test --> manometry

path shows muscle hypertrophy, inner circular muscle with absence or degeneration of ganglia in Auerbach's plexus

esophagogram can show dilated esophagus like a bird's beak

can be caused by T cruzi

tx with ballon dilation of narrowed esophagus or surgical myotomy

Zenker's diverticulum

p/w dysphagia to solids with description of food gets stuck but many are totally asymptomatic

d/o of prox esophagus generally seen in woman

dx via barium swallow

tx with surgery

Scleroderma and esophagus

loss of distal peristalsis due to complete atrophy of esophageal smooth muscle & fibrosis (this is opposite of achalasia)

lower esophageal sphincter becomes incompetent with time that can lead to reflux esophagitis & a stricture

progressive & difficult to treat

Antibodies and diseases

ant-dsDNA --> SLE & can be used to follow dz activity

anti-centromere --> CREST variant of scleroderma

anti-Scl70 (topoisomerase) --> systemic scleroderma

anti-Smith --> SLE but less sensitive than dsDNA

anti-Ro/La --> assoc with heart block in neonatal SLE but is more sensitive for Sjogren's

anti-Jo1 --> dermatomyositis & polymyositis

anti-mitochondrial --> primary biliary cholangitis

Tx of syphilis

Jarisch-Herxheimer reaction

occurs after tx for syphilis & subsequent spirochetal lysis

p/w fever, malaise, chills, headaches, & myalgias

no way to prevent

Tx UTI in pregnancy

TMP-SMX affects folic acid metabolism

Cipro causes fetal arthropathy

tx with either amox, cephalexin, or nitrofurantoin

Molluscum contagiosum

small skin colored papules with indented centers  accompanied by pruritus & surrounding dermatitis

caused by poxvirus

children most commonly affected but also immunocompromised (adult pt with it --> think HIV)

usually self-limited


small skin colored papules with indented centers accompanied by pruritus & surrounding dermatitis

caused by poxvirus

children most commonly affected but also immunocompromised (adult pt with it --> think HIV)

usually self-limited

transmission via skin to skin contact (can be transmitted sexually)

Meconium ileus

characterized by distal intestinal obstruction, wherein the terminal ileum is dilated and filled with thick, tar-like, inspissated meconium

pathognomic for CF

dx with abd XR

Metastatic brain tumor

in order of freq (most common to lesser): lung, breast, unknown, melanoma, colon cancer

next step is MRI with contrast

presence of multiple, well-circumscribed lesions & relatively large amt of vasogenic edema as compared to size of lesion favors mets

Tx with whole brain radiotherapy

Acute rheumatic fever

Ddx for neuromuscular weakness


toxin released by C botulinum

botulinum toxin inhibits release of Ach into the synaptic cleft in both autonomic & somatic nervous systems

p/w acute bulbar and descending limb weakness with absent reflexes & autonomic dysfunction

similar to MG but MG does not have autonomic dysfunction & reflexes are normal


p/w vertigo, tinnitus, nausea, & loss of balance

normally caused by viral illness (eg influenza)

usually self limiting

Hep B vaccine serology

Vaccine is against HBs so IgG against Hbs could be from vaccine

anti-HBc IgM is serology that will be + during window period of acute HBV infection when HbsAg goes down

Anti-histamine drugs

H1 blocker --> hydroxyzine

H2 blocker --> ranitidine

2nd generation --> loratadine & cetrizine

Rabies ppx

Salicylate toxicity




mild GI discomfort

metabolic acidosis



tx with gastric lavage, activated charcoal, & alkalinization of the urine

Cutaneous cryptococcosis

seen in immunocompromised ppl

disseminated cryptococcosis usually affects CNS (meningitis or encephalitis) but skin is also common non-neuronal site

skin lesions are usually multiple, discrete, red-colored papules of varying size with slight central umbilication resembling Molluscum contagiosum

dx with bx of lesion that will show granulomatous inflammatory reaction with multtinucleated giant cells, histiocytes, lymphocytes, neutrophils, & plasma cells with numerous yeast-like organisms

once dx is made, need to do CXR, blood & CSF cx

Levothyroxine absorption

should take on empty stomach bc many meds can affect absorption of drug

Ca and Fe tabs are 2 things that cause impaired absorption

levothyroxine should be started slowly in pts with CAD bc can increase myocardial O2 demand

Afebrile pneumonia syndrome

caused by C trachomatis, U urealyticum, Mycoplasma, CMV, RSV, Parainfluenza, Adenovirus, & Pneumocystis

young children p/w cough, tachypnea, irritability, & poor feeding

staccato cough --> C trachomatous --> look for conjuctivitis

can see eosinophilia

Aspiration pneumonia vs pneumonitis

pneumonia: commonly polymicrobial with gram +, gram -, & anaerobes

occurs 1-5 days after aspiration event

CXR will show infiltrate

tx with clinda & b-lactam

pneumonitis: chemical injury leading to inflammation of parenchyma secondary to gastric content --> Mendelson's syndrome

occurs 2-5 hrs after aspiration event

tx is supportive

Thiamine deficiency triad


oculomotor dysfunction


seen in alcoholics

no change in MCV like in B12 def

Ankylosing spondylitis extraarticular assocs

anterior uveitis

aortic regurg

IgA nephropathy

apical pulm fibrosis

restrictive lung dz

4 T's in HIT


timing --> 5-10 days after starting heparin


oTher causes

stop heparin & give direct thrombin inhibitor (eg argatroban or bivalirudin)

CF pneumonia

most commonly secondary to S aureus & Pseudomonas aeruginosa with Pseudomonas becoming more common as the pt ages

other pathogens include H influenza, Burkholderia cepacia, & gram - rods

Abx that cover Pseudomonas

cefepime or ceftazidime

amikacin (aminoglycoside)

imipenem or meropenem





think pseudomonas in CF pt & for malignant otitis externa

Diphtheria toxin

can lead to myocarditis, neuritis, & rarely, nephritis

tx with diphtheria antitoxin --> it is generated in horse serum so run risk of anaphylaxis --> administer with epi

Boerhaave's syndrome

p/w chest pain, dyspnea, epigastric pain, & shoulder pain after repeated episodes of vomiting leading to esophageal perforation

perforation normally occurs in distal third of esophagus

75% of cases will develop pulm effusion on left side

after few hours, can also lead to mediastinitis, which requires urgent management

best initial test is esophagogram w/water soluble contrast

Pressure ulcers

Stage 1- nonblanchable erythema of intact skin

stage 2- superficial ulcers causing a partial thickned loss of the epidermis, dermis, or both

stage 3- deeper ulcers causing a full thickness loss with damage to subq tissue that may extend to, but not through, any underlying fascia

stage 4- very deep ulcers causing full thickness loss with extensive tissue destruction that may damage adjacent muscle bone

Serotonin syndrome triad


autonomic dysfunction

neuromuscular hyperactivity (hyperreflexia, myoclonus, ocular clonus, tremor, etc)

normally occurs secondary to drug interactions (eg SSRIs + MAOI (eg phenelzine))

tx with d/c serotonergic drugs, supportive measuers, & sedation with benzos

in very severe cases, can think of serotonin antagonist (eg cyproheptadine)

Breast cancer screening

Condyloma acuminata

caused by HPV 6 & 11 described as flesh colored hyperkeratotic papules

if pt gets during pregnancy, can still deliver vaginally with only reason to do c-sect is when one suspects the lesion may start bleeding

Subclinical hypothyroid

mildly elevated TSH with normal free T4 & no sxs

does not need tx UNLESS:

presence of anti-peroxidase Abs

abnormal lipid profile

sxs of hypothyroid

ovulatory & menstrual dysfunction

Chronic methotrexate and anemia

leads to macrocytic anemia bc of inhibition of DHFR leading to folic acid deficiency

TMP & phenytoin also affect folate metabolism

tx with folinic acid (leucovorin) NOT folic acid


caused by Sarcoptes scabiei

p/w intensely pruritic rash (often worse at night) in the flexor surfaces of wrist, lateral surfaces of fingers, & finger webs

see excoriations with small, crusted, red papules scattered around the region, often with linear burrows

delayed type IV hypersensitivity

dx with skin scrapings from lesions revealing mites, ova, and feces under light microscope

tx with topical 5% permethrin cream or oral ivermectin

Cyclosporin side effect

increases serum uric acid levels --> can lead to gout

if cyclosporin is being given for renal transplant, tx gout with intra-articular glucocorticoid injection & NOT NSAIDs bc of contraindication of affecting kidney function along with cyclosporin

Erythromycin side effect

assoc with pyloric stenosis

Abx assoc with seizures






Caloric intake

30kcal/kg/day with 1g/kg of protein

can consider 15kcal/kg/day in pts with severe malnutrition to prevent refeeding syndrome

if possible, always prefer enteral feeds over parenteral

Hypothyroid & hyperlipidemia

>85% of pts with hypothyroid also have elevated LDL

can also have concamitant elevation of trigly

tx of hypothyroid may improve hyperchol in pts with TSH >10

INH side effects

most common side effect is hepatotoxicity

normally occurs within the first 2 months of tx & range from mild hepatotoxicity to hepatitis

should get baseline LFTs prior to starting INH

pts are usually asx & have self limited transaminitis & can cont tx with close monitoring

d/c if ALT or AST are >5x above normal limit OR >3 with sxs

if not given with vit B6 (pyridoxine), can cause ataxia, peripheral neuropathy, & paresthesias

Aortic stenosis findings

soft single S2

delayed and diminished carotid pulse --> parvus and tardus

loud & late-peaking systolic murmur

best heard at right upper sternal border

normal split S2 r/o aortic stenosis

Restless Leg Syndrome

maybe caused by Fe def so need to do iron studies

tx with dopamine agonists (eg pramipexole or ropinirole)

Contraindications for breast feeding

Herpes gestationis

believed to be an autoimmune condition & not thought to be caused by viral infection

occurs during 2nd, 3rd, or postpartum periods

normally starts as pruritis & then develops into a rash localized around the umbilicus

characterized by papules, urticarial plaques, & vesicles

different from PUPPP bc PUPPP spares the umbilical region

tx with topical corticosteroids & if severe use systemic steroids

Hemochromatosis & arthropathy

can p/w arthropathy in someone in 50s-60s

will find calcium pyrophosphate dihydrate (CPPD) crystals aka pseudogout --> positive birefringent rhomboid crystals

usually affects 2nd & 3rd MCP joints but can also affect knees, ankles, & shoulders

assoc with morning stiffness that lasts <30 mins

hemochromatosis can also p/w liver dysfunction, central hypogonadism, DM, & skin pigmentation ("bronze DM")

next step is Fe studies

Knee ligament injuries

ACL --> hyperextension of knee & hear a popping noise

can dx with knee flexed at 20 degrees, 1 hand on prox tibia, & other hand stabilizes femur (Lachman's test)

PCL --> posteriorly directed force is placed on anterior aspect of prox tibia with knee flexed (car accident with knee hitting dashboard)

MCL & LCL --> line of force strikes from the side of the joint

Medial menscus --> occur after twisting injury with 1 foot fixed to the ground & can also hear popping like in ACL

Stages of labor

Stage 1:

latent --> 0-6cm dilation

active --> 6-10cm cervical dilation

arrest of labor in active phase if >4 hrs despite adequate contractions OR >6 hrs with inadequate contractions

Stage 2 --> 10cm dilation to delivery

Stage 3 --> delivery of baby to expulsion of placenta

Tx of pulmonary arterial hypertension

after dx is made via ECHO, should do vasoreactivity test that looks at pulm arterial pressure response to vasodilator --> if there is good response, then tx with CCB

if no response --> tx with endothelin receptor antagonist (eg bosentan) OR phosphodiesterase-5 inhibitor (eg sildenafil) OR prostanoid medication (eg epoprostenol)

Primary biliary cirrhosis

chronic & progressive liver dz that is autoimmune

90% are F

find destruction of small & mid-sized bile ducts with progressive fibrosis

p/w with progressive jaundice, pruritis, steatorrhea, hyperlipidemia, with an elevated ALK Phos

also assoc with bone dz (osteomalacia & osteoporosis)

dx with anti-mitochondrial Abs (high sens & specificity)

tx with ursodeoxycholic acid but only curative tx is liver transplant

Hidradenitis suppurative

aka acne inversa

inflammatory dz characterized by occlusion of skin follicles most commonly affecting intertriginous areas (eg axilla, inguinal, genital)

mild cases can be tx with topical antibiotics (eg clinda)

mod cases with scar formation req oral antibiotics (tetracyclines)

severe cases with diffuse involvement may require TNF-a inhibitors (eg infliximab) & surgical excision

APACHE II scoring system

predicts severity of acute pancreatitis using 12 physiologic variables

score >8 predicts severe dz & should undergo CT scan at 72 hrs to assess pancreatic necrosis

Ecthyma gangrenosum

assoc with lesion of the skin or mucous membrane that rapidly worsens into nodular patches marked by hemorrhage, ulceration, & necrosis

normally caused by Pseudomonas (gram - rod) in immunocompromised person

tx with 2 IV Abx (aminoglycoside (eg tobramycin, amikacin) + extended spectrum penicillin (eg piperacillin) OR cephalosporin (eg ceftazidime, cefepime)

Neonatal sepsis

Urethral diverticula

3 Ds:




can be congenital or acquired with maternal birth trauma being common cause of acquired

next step is either u/s or MRI

Trastuzumab side effect

anti-HER2 monoclonal

reversible cardiotoxicity affect LVEF that could lead to clinical heart failure

cardiotoxicity is even worse when combined with anthracycline (eg doxorubicin) & cyclophosphamide

usually EF goes back to baseline after d/c

Amiodarone side effect

long-term use can lead to:

thyroid dysfunction


cardiac bradyarrhythmias

interstitial pneumonitis

neuro sxs (ataxia, peripheral neuropathy)

blue-gray skin discoloration

visual disturbances

Relative risk vs attributable risk

RR = risk of exposed / risk of unexposed

AR = (risk of exposed - risk in unexposed) / risk of exposed = (RR-1) / RR

Population AR percent (PARP) = (risk in total population -risk in unexposed) / risk in total population

Tx of peripheral arterial dz

Guidelines for management of CHF

Prenatal testing

first visit:



Rubella status

Screening for syphilis, chlamydia, & HIV

HepB sAg

UA & cx


routine subsequent visits:



uterine fundal height

fetal heart tones

fetal presentation & activity

urine glucose & protein

Meningococcal meningitis ppx

household members

roommates or intimate contacts

child care center workers

airline travelers seated next to an affected person for >8 hrs

tx with rifampin (600mg twice daily for 2 days) OR cipro (500mg single dose) OR ceftriaxone (250mg single dose)

do not give rifampin to someone taking OCPs

Postpartum endometritis

polymicrobial infection of the decidua characterized by fever, uterine tenderness, foul smelling vaginal d/c, & leukocytosis

most sig risk factor is c-section

tx with clinda & gent

do not give metro for breast feeding mother

Dengue fever

viral infection spread by Aedes mosquito

can lead to circulatory failure

viral infection spread by Aedes mosquito

can lead to circulatory failure

Diabetic neuropathy management

strict glycemic control is best thing

for pain:

duloxetine (SNRI)


tricyclic antidepressant




OCPs & hypothyroid

can lead to increase in total T4 BUT decrease in free T4

pts with hypothyroid will require higher dose of levothyroxine

TSH should be checked q3 months in pt with hypothyroid

Gerstmann syndrome

damage to dominant parietal lobe

difficulty performing simple arithmetic, inability to name individual fingers, impaired writing, right/left confusion

Epidural abscess triad


focal spinal tenderness/back pain

neurological dysfunction

Next step includes urgent MRI, blood cx, inflammatory markers, CT-guided aspiration & cx, & abx

Papillary muscle rupture vs chordae tendineae rupture

both can lead to acute onset of MR (systolic decresendo murmur)

papillary muscle rupture --> occurs 2-7 days after an MI

chordae tendineae rupture --> multiple causes including mitral valve prolapse (think Marfan or Ehlers-Danlos), infective endocarditis, rheumatic disease

Congenital adrenal hyperplasia

Steroid synthesis

Ramsay Hunt syndrome triad

1) ear pain

2) vesicles in external auditory canal

3) ipsilateral facial paralysis

aka herpes zoster oticus

caused by reactivation of varicella zoster virus

Smoking cessation meds

1) varenicline - partial agonist of nicotinic ACh receptor

avoid in pts with unstable psychiatric issues (eg depression/suicidal ideation)

2) Bupropion - norepinephrine-dopamine reuptake inhibitor

also functions as anti-depressant w/o weight gain or sexual dysfunction

but increases risk of seizures

Schizoaffective disorder

Nelson's syndrome

following b/l adrenalectomy for Cushing's dz:

pituitary enlargement


visual field defect

tumors are fast growing & should be tx with surgery (transsphenoidal) and/or pituitary radiation

Cocaine and HTN & cardiac spasms

tx with benzos, phentolamine (alpha blocker), and/or nitroprusside

phentolamine is also used in pheo

Helminth infection causing diarrhea

Ascaris lumbricoides --> roundworm

Trichuris trichiura --> whipworm

Necator americanus/Ancylostoma duodenale --> hookworm

will find eosinophilia on CBC

tx all with albendazole or mebendazole

Heberden nodule vs Bouchard's nodule

Heberden --> distal interphalangeal joint

Bouchard --> prox interphalangeal joint (be seen in RA)

both are seen in osteoarthritis

Kappa statistic

quantative measure of inter-rater reliability

also referred to as inter-rater concordance

-1 is perfect disagreement & 1 is perfect agreement

External vs internal validity

external validity - refers to generalizability of the study

internal validity - refers to whether the study is actually measuring/observing what they are intending (major worry is confounding factors)

Bicuspid aortic valve

Exogenous thyroid hormone intake

Will see:

TSH - very low

T4 - normal/high

RAUI - low

thyroglobulin - low

first step when you suspect is get 24 hr RAUI

exogenous intake is only scenario you get both thyroglobulin & RAUI to be low


most commonly caused by Candida albicans

affects intertriginous areas (areas with folds like inguinal, genital, axillary, perineal, etc)

obese, diabetics, tight clothing, all predispose

eryhtematous plaques and erosions with satellite papules c...

most commonly caused by Candida albicans

affects intertriginous areas (areas with folds like inguinal, genital, axillary, perineal, etc)

obese, diabetics, tight clothing, all predispose

eryhtematous plaques and erosions with satellite papules can be seen

Whipple's triad

1) sxs of hypoglycemia

2) low blood glucose

3) sx resolution after giving glucose

these pts should be suspected of taking hypoglycemic agents when C-peptide is normal or high (if they took exogenous insulin, C-peptide would be low)

Viral encephalitis/meningitis


arbovirus or enteroviruses (eastern equine encephalitis, western equine encephalitis, St. louis encephalitis, etc)

zoonotic transmission so occur in rural areas


most common cause is HSV



Birth trauma to head

Autoimmune metaplastic atrophic gastritis

gastritis that is assoc with pernicious anemia

autoimmune reaction against oxyntic cells & intrinsic factor (hence assoc with pernicious anemia)

affects mainly gastric body and fundus leading to:

1) glandular atrophy

2) intestinal metaplasia

3) inflammation

Juvenile myoclonic seizures

usually affects young adolescents

p/w myoclonic jerks in the upper extremities

progression leads to tonic-clonic seizures

50% can have psychiatric d/o like anxiety d/o

EEG shows bilateral polyspike and slow discharge

tx with valproic acid

Erythema multiforme

targetoid lesions distributed symmetrically on arms

assoc with herpes simplex virus infection, cancer, & collagen vascular dz

targetoid lesions distributed symmetrically on arms

assoc with herpes simplex virus infection, cancer, & collagen vascular dz

EKG Leads

II, III, and aVF --> inferior wall (RCA)

V1 --> septum (LAD)

V2, V3, V4 --> anterior part of heart (LAD)

V5, V6 --> lateral wall (Circumflex/LAD)