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303 Cards in this Set
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- Back
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Echinocandins |
anti-fungal medications that include: caspofungin micafungin anidulafungin Drug of choice for neutropenic fever not responding to Abx |
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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 |
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Times to perform LP |
Fever Photophobia Neck stiffness any other sign of CNS infection DO NOT NEED TO DO FOR SEIZURE |
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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) |
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Acneiform |
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 |
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Miliaria |
retention of sweat due to occlusion of eccrine sweat ducts and pores that lead to eruptions most common on back bc of prolonged bedrest |
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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 |
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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
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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 |
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Wernicke encephalopathy triad |
In an etohic: 1) confusion 2) ataxia 3) oculomotor dysfunction dx is purely on clinical information |
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w/u of epigastric pain |
< 45 yr old: give PPI and scope if Sxs do not improve OR H pylori stool Ag OR breath test and scope if positive
> 55 yr old: upper endoscopy |
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Benzodiazepine withdrawal |
Can be potentially fatal
Psychomotor agitation Delirium Autonomic instabillity Seizures
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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 |
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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 |
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Osteosarcoma |
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 |
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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) |
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Treatment of acute STEMI |
Aspirin Heparin b-blocker tPA IF within 12 hrs of Sxs |
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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 |
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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 |
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Epididymoorchitis |
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) |
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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" |
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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 |
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Preventing bacterial peritonitis |
1 yr recurrence rate is as high as 70% Give fluoroquinolone (eg levofloxacin) prophylactically |
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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 |
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Risk factors for CAD |
Most common --> HTN bc of the incidence Most significant --> DM |
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Otitis media unresponsive to amox |
switch Abx to: cefdinir ceftibuten cefuroxime cefpodoxime amox-clavulanate azithro |
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Dynamics of cardiac enzymes |
CK-MB goes away by 3 days, whereas troponin is still elevated |
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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 |
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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 |
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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 |
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Placenta previa |
placenta covers the internal cervical os
blood loss can be small amount or catastrophic
PAINLESS unlike abruptio placenta |
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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 |
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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 |
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Otitis externa |
managed with topical Abx and steroids Abx: polymyxin or neomycin or cipro or gentamicin or tobramycin or sulfisoxazole |
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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 |
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HIV and pregnancy |
Babies are delivered via c-section unless viral load is <1,000 copies/ml |
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Prolactin |
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 |
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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 |
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Inactivated/killed vs live/attenuated vaccines |
Inactivated/killed (ok to give in pregnancy) Hep A Rabies Polio Influenza (Have both inactivated & live versions)
Live/attenuated (not recommended during pregnancy) MMR Varicella & zoster Influenza (Have both inactivated & live versions) Rotavirus Yellow fever |
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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% |
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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 |
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Assessment of aortic dissection |
can confirm dx with contrast chest CT can also dx with transesophageal echo or conventional angiography |
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Six Ps of compartment syndrome |
pallor pain paraesthesia pulselessness (most ominous sign) poikilothermia paralysis can lead to ARF bc of rhabdo secondary to muscle necrosis |
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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 |
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Abx for PID |
Best initial therapy is cefoxitin or cefotetan AND dox
if anaphylactic reaction to penicillin --> clinda and gent |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Metformin and kidney function |
contraindicated in pts with renal insufficiency bc it raises the possibility of metabolic lactic acidosis |
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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 |
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Child abuse |
any child not walking with a lower extremity fracture is a victim of child abuse until proven otherwise |
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EKG changes in hypothermia |
hypothermia prolongs repolarization leading to upward deflection of S wave
Also see QT interval prolongation |
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Electrolyte abnormalities and EKG changes |
hypokalemia --> diffuse broadening of T waves and prominent U waves hyperkalemia --> peaked T waves hypercalcemia --> QT interval shortening |
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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 |
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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 |
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Risk factors for osteoporosis |
advanced age decreased gonadal function Caucasian ethnicity corticosteroid use low Ca intake poor physical activity |
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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 |
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OCPs contraindications |
migraine with aura
smoking in a patient >35yo
BP >160/>100 |
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Contraindications for thrombolytics |
Hemorrhagic stroke at any time in the past BP >180/110 intracranial malignancy aortic dissection any major bleeding |
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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 |
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Vitiligo |
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 |
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Pacemaker and stress test |
cannot do stress test when pacemaker is present |
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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 |
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B12 deficiency |
can lead to peripheral neuropathy |
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Linezolid side effects |
bone marrow suppression --> thrombocytopenia |
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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 |
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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 |
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Febrile seizures |
leads to generalized tonic clonic occurs >24hrs after onset of fever & can last >15 mins |
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Ticlopidine side effects |
ADP receptor inhibitor --> anti coagulant assoc with neutropenia |
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Sjogren's syndrome & cancer |
assoc with B-cell NHL (3-5%) |
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Sulfonylureas side effect |
can lead to SIADH (hyponatremia with elevated urine Na and osmolality)
weight gain hypoglycemia
eg chlorpropamide, glipizide, glyburide |
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Hydroxycholorquine side effect |
reversible ocular or retinal toxicity |
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Post-strep glomerulonephritis |
caused by group A beta-hemolytic streptococcus Triad: edema hematuria HTN 1st step in management, get anti-DNase B and/or ASO titers |
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Transected urethra |
blood at urethral meatus with high riding prostate
need to do urethrogram immediately |
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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 |
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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 |
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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 |
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Metformin & B12 |
leads to malabsorption of B12 in gut, resulting in macrocytosis and peripheral neuropathy |
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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 |
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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 |
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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 |
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Chlamydia |
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 |
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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 |
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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 |
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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 |
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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) |
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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 |
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Bronchiectasis |
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 |
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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 |
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COMT inhibitors |
eg tolcapone and entacapone extend the duration of effect of levodopa by blocking its metabolism |
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Angiodysplasia |
small vascular malformation of the gut common cause of GI bleeding
assoc with ESRD, vWF dz, & aortic stenosis |
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Sjogren serologies |
90-95% are ANA+ 70% are RF+ 50-65% are anti-Ro and anti-La + |
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Colon cancer screening |
start at age 50-75
annual screening with high-sensitivity fecal occult blood testing (FOBT)
OR
sigmoidoscopy q5yrs with high sensitivity FOBT q3yrs
OR
colonoscopy q10yrs |
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Causes of seizures |
hypernatremia and hyponatremia hypocalcemia hypomagnesemia hypoxia hypoglycemia liver or renal failure intracranial anatomic defect cocaine benzo or barbiturate w/d |
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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 |
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Pill esophagitis |
focal inflammatory lesion of distal esophagus
assoc with: bisphosphonates (eg alendronate) anti-inflammatory meds (eg aspirin) dox quinidine clinda potassium chloride pills |
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Rheumatoid factor |
IgM Ab against Fc region of IgG 100% + in cryoglobulinemia 70-80% + in RA 70% + in Sjogren 30% + in SLE |
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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 |
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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) |
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Meniere's disease |
distortion and distension of the membranous, endolymph-containing portions of the labyrinthine system Tx with diuretics and H1 antagonists |
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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 |
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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 |
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Tx of carboxyhemoglobin |
<10% --> administer 100% O2 for 3 hrs 10-15% --> admit and give 100% O2 for 24 hrs >25% --> hyperbaric oxygen |
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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 |
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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 |
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Tx of OCD |
SSRIs such as paroxetine, fluvoxamine, sertraline, citalopram, and fluoxetine |
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Anterior cerebral artery stroke |
urinary incontinence personality and psychiatric distrubance unilateral leg weakness |
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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 |
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Mallory Weiss tear |
can inject epinephrine with persistent severe bleeding if not actively bleeding, can just observe and supportive care assoc with hiatal hernias |
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Essential tremors |
isolated tremor that occurs at both rest and with exertion has no rigidity assoc with it tx with propranolol |
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Shy-Drager syndrome |
variant of Parkinson that is characterized primiraliy by orthostasis and syncope another name is multiple system atrophy |
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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 |
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ARDS criteria |
acute onset
CXR appearance
PaO2/FiO2 <200
pulmonary cap wedge pressure <18 mm Hg -> most important distinguishing factor vs cardiogenic etiology |
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Sodium nitroprusside complication |
can lead to cyanide toxicity
tx with sodium thiosulfate |
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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 |
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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 |
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Lowering serum glucose in DKA |
want to decrease ~50-100mg/dL/hr more aggressive decrease may lead to cerebral edema and herniation |
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Adrenal crisis |
can be induced by pyelonephritis that leads to loss of glucocoritcoid and mineralocorticoid production
leads to: hypotension hypovolemia hyponatremia hyperkalemia metabolic acidosis hypoglycemia eosinophila
tx with IV steroids then the underlying infection |
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Organophosphate toxicity |
lacrimation salivation blurred vision urinary incontinence diarrhea diaphoresis 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 |
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Interferon and ribavirin side effects |
Interferon: thrombocytopenia, neutropenia, depression, flu-like symptoms Ribavirin: hemolytic anemia do not give ribavirin in pt with renal insufficiency |
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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 |
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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 |
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Diabetes screening |
age >45, especially obese family hx hyperlipidemia vascular dz HTN |
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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 |
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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 |
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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 |
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Acarbose side effect |
alpha-glucosidase inhibitors that block absorption of glucose in brush border of small intestine diarrhea abdominal pain cramping gas |
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Octreotide |
synthetic somatostatin analog used in acute management of variceal bleeding |
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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 |
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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 |
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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 |
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TCA overdose |
dry mouth blurred vision constipation sinus tachy memory dysfunction urinary retention |
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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 |
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Risk factors for ectopic pregnancy |
high risk factors: previous ectopic previous tubal surg tubal pathology congenital anomolies current IUD use mod risk factors: infertility previous cervicitis hx of PID and multiple sex partners smoking low risk factors: previous abd & pelvic surg vaginal douching age |
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Different types of shock |
cardiogenic: 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 |
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Varicocele |
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 |
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Adolescent pregnancies |
increased risk of: perinatal mortality preterm delivery premature & low birth weight |
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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 |
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Histrionic personality disorder |
pattern of excessive emotionality & attention seeking behavior since early adulthood inappropriate sexually seductive or provocative behavior shallow, shifting, dramatic emotions |
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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) |
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Onychomycosis |
fungal infection of toenails caused by Trichophyton rubrum thick, brittle, discolored nails dx with KOH, PAS stain tx with terbinafine or itraconazole |
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Hypertonic saline |
used in severe & symptomatic hyponatremia (Na <115) do not want to raise Na >12mEq/L in first 24 hrs |
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Complications of infective endocarditis |
cardiac: valvular insufficiency perivalvular abcess conduction abnormalities mycotic aneurysm neurologic: embolic stroke cerebral hemorrhage brain abscess acute encephalopathy renal: renal infarction GN drug induced acute interstitial nephritis from therapy musculoskeletal: vertebral osteomyelitis septic arthritis msk abcess |
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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 |
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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 |
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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 |
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Abs that cause C diff |
fluoroquinolones enhanced spectrum penicillins cephalosporins clindamycin |
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Tx of squamous cell carcinoma |
first line is surgical excision second line for low risk is cryotherapy, electrosurgery, or radiation therapy |
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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 |
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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 removed via liquid nitrogen cryosurgery or surgical excision but if numerous --> tx with 5-FU, topical diclofenac, imiquimod |
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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 |
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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 |
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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 |
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Drug caused pancreatitis |
thiazides, furosemide sulfasalazine, 5-ASA azathioprine, L-asparaginase valproic acid didanosine, pentamidine metro, tetracycline |
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C diff colitis algorithm |
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Tx of C diff recurrence |
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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 |
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Intussusception |
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Lithium and drug interactions |
lithium toxicity includes: confusion ataxia neuromuscular excitability lithium levels can be affected by thiazides, ACEI, & NSAIDS, SSRI |
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Heart sounds |
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Fahr's syndrome |
effect of long-standing pseudohypothyroid hypocalcemia with hyperphoshatemia leads to b/l cataracts & calcification of basal ganglia |
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Low Ca |
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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 |
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Glucagonoma |
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 |
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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
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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 |
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Clinical features of melanoma (ABCDEs) |
Asymmetry Border irregularities Color variegation Diameter >6mm Evolving - lesions change in size, shape, or color |
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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) |
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Carpal tunnel risk factors |
Obesity/DM hypothyroid RA ESRD pregnancy TYPING IS NOT ASSOCIATED BUT CAN WORSEN |
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W/u of palpable breast mass |
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Bone anti-resorptive agents |
eg bisphosphonates & raloxifene use in post-menopausal woman <65 with high risk of osteoporesis/bone fracture: <58kg chronic steroid use smoking malabsorptive dz fam hx or personal hx of hip fracture |
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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) |
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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 |
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Ethylene glycol toxicity |
rapid and deep breathing N/V slurred speech ataxia nystagmus lethargy bad toxicity can lead to confusion, flank pain, renal failure, pulm edema, AMS, & coma first line tx is fomepizole & second line is etoh |
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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 |
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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 |
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Asymptomatic left sided heart failure |
pts with decreased EF who are asymptomatic --> tx with ACEI |
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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 |
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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) |
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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 |
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Emergency contraception |
most effective is Cu IUD but contraindicated in active pelvic infection or cervicitis
most effective oral is Ulipristal
always do b-HCG before giving
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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 |
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Acute chest syndrome |
new pulm infiltrate with 1 or more of: incr work of breathing, cough, tachypnea, wheezing temp >38.5 (101.3) hypoxemia chest pain tx with ceftriaxone + azithro & IV fluids & pain control |
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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 |
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Management of cat & dog bites |
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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 |
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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 |
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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 |
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Mentzer index |
MCV / RBC count helps distinguish btwn iron def & thalessemia >13 --> iron def <13 --> thalassemia |
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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 |
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Management of back pain |
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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+ |
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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 |
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Anatomic location of digit arteries, nerves, veins, & tendons |
run on sides: arteries nerves veins runs on anterior surface (palmar surface): tendons |
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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 |
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Neuroleptic malignant syndrome |
assoc with antipsychotic meds muscle rigidity fever autonomic instability delirium elevated CK tx with dantrolene sodium for muscle rigidity, benzo for agitation, & can consider bromocriptine or amantidine to reverse dopaime blockade |
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Ddx for vaginitis |
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Isotretinoin toxicity |
used for nodulocystic acne side effects include: metabolic effects (hypoglycemia & hypertrig --> can lead to acute pancreatitis) hepatotoxicity 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 |
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Tx of clavicle fractures |
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Reactive arthritis |
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Metastatic bone lesions |
osteoblastic: detect with radionucleotide bone scan followed by Xray prostate small cell lung Hodgkin lymphoma
osteolytic: detect with Xray or PET MM non-small cell lung non-Hodgkins
osteoblastic or osteolytic: breast |
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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 |
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Calcium channel blocker side effect |
peripheral edema particularly with amlodipine & nifedipine
when given with ACEI, can reduce CCB assoc peripheral edema |
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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 |
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Tx of bacterial conjunctivitis |
erythromycin ointment OR sulfa drops OR polymyxin/trimethoprim drops for contact lens wearers --> fluoroquinolone bc of pseudomonas coverage |
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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 |
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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 |
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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 |
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Achalasia |
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 |
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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 |
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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 |
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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 |
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Tx of syphilis |
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Jarisch-Herxheimer reaction |
occurs after tx for syphilis & subsequent spirochetal lysis p/w fever, malaise, chills, headaches, & myalgias no way to prevent |
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Tx UTI in pregnancy |
TMP-SMX affects folic acid metabolism Cipro causes fetal arthropathy tx with either amox, cephalexin, or nitrofurantoin |
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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 transmission via skin to skin contact (can be transmitted sexually) |
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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 |
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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 |
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Acute rheumatic fever |
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Ddx for neuromuscular weakness |
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Botulinum |
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 |
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Labyrinthitis |
p/w vertigo, tinnitus, nausea, & loss of balance normally caused by viral illness (eg influenza) usually self limiting |
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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 |
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Anti-histamine drugs |
H1 blocker --> hydroxyzine H2 blocker --> ranitidine 2nd generation --> loratadine & cetrizine |
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Rabies ppx |
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Salicylate toxicity |
tinnitus restlessness N/V mild GI discomfort metabolic acidosis ARF hepatotoxicity tx with gastric lavage, activated charcoal, & alkalinization of the urine |
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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 |
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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 |
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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 |
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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 |
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Thiamine deficiency triad |
encephalopathy oculomotor dysfunction ataxia seen in alcoholics no change in MCV like in B12 def |
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Ankylosing spondylitis extraarticular assocs |
anterior uveitis aortic regurg IgA nephropathy apical pulm fibrosis restrictive lung dz |
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4 T's in HIT |
thrombocytopenia timing --> 5-10 days after starting heparin thrombosis oTher causes stop heparin & give direct thrombin inhibitor (eg argatroban or bivalirudin) |
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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 |
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Abx that cover Pseudomonas |
cefepime or ceftazidime amikacin (aminoglycoside) imipenem or meropenem piperacillin-tazobactam aztreonam colistin cipro think pseudomonas in CF pt & for malignant otitis externa |
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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 |
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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
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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 |
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Serotonin syndrome triad |
AMS 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) |
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Breast cancer screening |
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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 |
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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 |
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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 |
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Scabies |
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 |
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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 |
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Erythromycin side effect |
assoc with pyloric stenosis |
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Abx assoc with seizures |
penicillins cephalosporins monobactams carbapenems fluoroquinolones |
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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 |
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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 |
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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 |
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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 |
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Restless Leg Syndrome |
maybe caused by Fe def so need to do iron studies tx with dopamine agonists (eg pramipexole or ropinirole) |
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Contraindications for breast feeding |
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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 |
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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 |
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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 |
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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 |
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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) |
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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 |
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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 |
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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 |
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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) |
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Neonatal sepsis |
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Urethral diverticula |
3 Ds: Dribbling Dysuria Dyspareunia can be congenital or acquired with maternal birth trauma being common cause of acquired next step is either u/s or MRI |
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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 |
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Amiodarone side effect |
long-term use can lead to: thyroid dysfunction hepatotoxicity cardiac bradyarrhythmias interstitial pneumonitis neuro sxs (ataxia, peripheral neuropathy) blue-gray skin discoloration visual disturbances |
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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 |
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Tx of peripheral arterial dz |
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Guidelines for management of CHF |
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Prenatal testing |
first visit: T&S CBC Rubella status Screening for syphilis, chlamydia, & HIV HepB sAg UA & cx Pap routine subsequent visits: BP weight uterine fundal height fetal heart tones fetal presentation & activity urine glucose & protein |
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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 |
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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 |
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Dengue fever |
viral infection spread by Aedes mosquito can lead to circulatory failure |
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Diabetic neuropathy management |
strict glycemic control is best thing
for pain: duloxetine (SNRI) pregabalin tricyclic antidepressant gabapentin lamotrigine carbamazepine |
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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 |
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Gerstmann syndrome |
damage to dominant parietal lobe difficulty performing simple arithmetic, inability to name individual fingers, impaired writing, right/left confusion |
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Epidural abscess triad |
fever focal spinal tenderness/back pain neurological dysfunction Next step includes urgent MRI, blood cx, inflammatory markers, CT-guided aspiration & cx, & abx |
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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 |
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Congenital adrenal hyperplasia |
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Steroid synthesis |
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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 |
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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 |
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Schizoaffective disorder |
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Nelson's syndrome |
following b/l adrenalectomy for Cushing's dz: pituitary enlargement hyperpigmentation visual field defect tumors are fast growing & should be tx with surgery (transsphenoidal) and/or pituitary radiation |
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Cocaine and HTN & cardiac spasms |
tx with benzos, phentolamine (alpha blocker), and/or nitroprusside phentolamine is also used in pheo |
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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 |
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Heberden nodule vs Bouchard's nodule |
Heberden --> distal interphalangeal joint Bouchard --> prox interphalangeal joint (be seen in RA) both are seen in osteoarthritis |
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Kappa statistic |
quantative measure of inter-rater reliability also referred to as inter-rater concordance -1 is perfect disagreement & 1 is perfect agreement |
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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) |
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Bicuspid aortic valve |
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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 |
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Intertrigo |
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 |
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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) |
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Viral encephalitis/meningitis |
peds: arbovirus or enteroviruses (eastern equine encephalitis, western equine encephalitis, St. louis encephalitis, etc) zoonotic transmission so occur in rural areas adults: most common cause is HSV Immunocompromised: CMV |
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Birth trauma to head
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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 |
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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 |
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Erythema multiforme |
targetoid lesions distributed symmetrically on arms assoc with herpes simplex virus infection, cancer, & collagen vascular dz |
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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) |
