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345 Cards in this Set

  • Front
  • Back
Possible complication of blood transfusion in patients with shock, hypothermia, renal failure, hepatic failure
Hypocalcemia due to impaired ability to metabolize citrate into lactate
Splenic vein thrombosis can be a complication of ___ and causes ___
- Chronic recurrent pancreatitis
- Isolated gastric varices (not esophageal), portal hypertension, ascites, splenomegaly with pancytopenia
Test for meniscal injury in knee
McMurray maneuver: knee flexed, tibia externally rotated and knee slowly extedned. Positive it there is a click or pop.
Presentation of fat embolism
Respiratory insufficiency, neurological impairment, petechial rash
Treatment for pregnant woman with active TB
Only add pyrazinamide if concern for MDR-TB because unclear data on safety in pregnancy
Do not use streptomycin (fetal ototoxicity)
- Drug that increases risk of gout
- Mechanism
- Cyclosporine
- Decreasing renal urate excretion
Type of crystals in pseudo-gout
Most commonly affected joint
Other name
Positively birefringent, rhomboid
Calcium pyrophosphate dihydrate deposition dz (CPPD)
Type of crystals in oxalate-induced arthritis
Patients at risk
Calcium oxalate crystals - bipyramidal, variable birefringence
Patients with ESRD
When to treat subclinical hypothyroidism
- Presence of antithyroid antibodies
- Abnormal lipid profile
- Symptoms of hypothyroidism
- Ovulatory and menstrual dysfunction
Common anticholinergic toxic agents
- Tricyclic antidepressants
- Plants including Datura stramonium
- Mushrooms
Skin finding in anticholinergic toxicity
Dry skin
Toxic agents causing excessive salivation
Pesticides/insecticides (Organophosphates, carbamates)
Treatment for UTI in pregnant women
Cephalexin, amox or nitrofurantoin
Management of pyelo in pregnancy
Hosp, IV abx (eg CTX or amp+gent) until afebrile x24-48 hours, then continue PO course x total 10-14 days
MRI findings of PML
Non-enhancing, demyleninating lesions with no mass effect
Anti-pseudomonal antibiotics (8)
- Cefepime
- Ceftaz
- Amikacin
- Imipenem/meropenem
- Cipro
- Zosyn
- Aztreonam
- Colistin
Valve problem in Marfan syndrome
Mitral insufficiency
When to treat post-AOM effusion
- Bilateral
- Persistent symptoms
- Lasts >3 months
2nd line abx for AOM (3)
- Augmentin
- Cefuroxime
Management of epidural spinal cord compression
High-dose corticosteroids
MRI followed by radiation or surgery
Presentation of scleroderma renal crisis
Severe hypertension and renal failure in pt with evidence of underlying scleroderma (e.g. Raynaud phenomenon, GERD)
Treatment of hypertension in scleroderma renal crisis
ACE inhibitors (esp captopril)
+IV nitroprusside if CNS manifestations are present
Normal distribution:
% within 1 SD
% within 2 SDs
% within 3 SDs
Post-exposure prophylaxis for HIV:
- Low viral load
- High viral load
- Two nucleoside reverse transcriptase inhibitors x4 weeks
- " " plus a protease inhibitor
Antihypertensives that are safe to take with lithium
Beta blockers
Calcium channel blockers
- Goal blood pressure after tPA for ischemic stroke
- Meds to achieve this
- 180/105
- IV labetalol, nitroprusside, nicardipine
- Electrolyte derangement associated with surgery, esp major surgery with extensive transfusions
- Manifestations
- Hypocalcemia
- Hyperactive DTRs, muscle cramps, convulsions
Drugs that can exacerbate psoriasis (5)
Beta blockers
ACE inhibitors
Evaluation of pancreatic cyst
Endoscopic ultrasound with aspiration
Therapy for chronic prostatitis
Quinolone or Bactrim x6-12 weeks
High-grade squamous intraepithelial lesions of cervix include
Moderate and severe dysplasia
Carcinoma in situ
- Drugs that cause an isolated increase in serum Cr (3)
- Mechanism
- Cimetidine, probenecid, trimethoprim
- Decreased tubular secretion of creatinine
Adrenal incidentaloma:
- Initial evaluation
- Which to excise
- Lytes, dexamethasone suppression test, 24-hr urine catecholamine, metanephrine, VMA and 17-ketosteroids
- Functional tumors, malignant tumors, tumors >4cm
Test for CAD in patient unable to exercise
Adenosine myocardial perfusion test
Testing of children with family history of hypercholesterolemia or premature CAD
Begin testing at 2 years.
- If relative has TChol >240, get random chol. If <170, repeat in 5 years. If >200, order FLP
- If relative has h/o premature CAD, order FLP.
Thyroglossal duct cyst:
- Presentation
- Management
- Midline neck mass that moves with protrusion of tongue
- Pre-op imaging (ideally CT) as this may be the only functional thyroid tissue
- Danger with metformin
- Conditions in which metformin should be avoided (5)
- Situation in which to hold metformin
- Lactic acidosis
- Renal failure, hepatic dysfunction, alcoholism, sepsis, CHF
- Administration of IV contrast (or other situation with risk of renal failure)
When to perform correction of cleft lip
- 10 lbs
- 10 weeks
- 10g Hgb
PE finding suggestive of thyroid as source of esophageal obstructive symptoms
Pemberton's sign: facial plethora or neck vein distention when arms raised
Criteria for resolution of DKA (4)
- Glucose <200
- Gap <12
- Bicarb >17
- Ability to eat
Lab/electrolyte findings in adrenal insufficiency
- Hyponatremia
- Hyperkalemia
- Hyperchloremic metabolic acidosis
What to rule out first (and how) with concern for diabetic gastroparesis
Gastric outlet obstruction, with endoscopy or upper GI (then can do scintigraphic gastric emptying study)
Raloxifene: periop management
Stop 4 weeks pre-op, restart post-op once stable with decreased risk of thromboembolism
Patients with hyperparathryoidism in whom to do parathyroidectomy (5)
- Symptomatic
- Ca >1 mg/dL above normal
- CrCl <60 mL/min
- T-score < -2.5 on densitometry or previous fragility fracture
- Age <50
Initial management of pheochromocytoma
Alpha blockade to control HTN and restore intravascular volume x10-14 days before surgery
*Alpha blockade BEFORE beta blockade
Management of intraop hypotension in patient with pheochromocytoma
Normal saline bolus
Use of phentolamine IV bolus
HYPERtension during surgery
Which neonatal head swelling crosses suture lines?
Caput succedaneum
Characteristics of androgen insensitivity (5)
- Primary amenorrhea
- Bilateral inguinal masses
- Breast development without pubic/axillary hair
- Blind vaginal pouch
- 46 XY
- LES tone
- Histopath
- Peristalsis
- Esophagogram
- Therapy
- High tone of LES
- Hypertrophied inner circular muscle; absence/degeneration of ganglia in Auerbach's plexus
- Absence of peristalsis
- Dilated esophagus with bird's beak narrowing distally
- Balloon dilation or surgery
Diffuse esophageal spasm:
- Peristalsis
- LES tone
- Esophagogram
- Treatment
- High amplitude peristaltic contractions (may be intermittent)
- LES tone normal
- Corkscrew esophagogram
- Antispasmodics, dietary modulation, psych counseling
Condition with high LES tone
Condition with low LES tone
Scleroderma in esophagus:
- Peristalsis
- LES tone
- Esophageal smooth muscle
- Symptoms
- Loss of distal peristalsis
- Low LES tone
- Atrophy of esophageal smooth muscle and fibrosis
- Reflux esophagitis, stricture
Condition with corkscrew esophagus
Diffuse esophageal spasm
NF1: Diagnostic criteria (7)
2+ of:
- First degree relative
- >6 CALMs (5mm in children, 15mm in adults)
- >2 neurofibromas
- Lisch nodule
- Optic glioma
- Bone dysplasia
- Axillary freckling
Management after removal of a large (>2cm) sessile polyp or if there is concern that a large adenoma has not been completely removed
Follow-up colonoscopy in 3-4 months
Time interval for surveillance colonoscopy for most patients after removal of adenomatous polyp
3 years
HIV prophylaxis after sex with an infected person
- Within 72 hours
- Two nucleoside reverse transcriptase inhibitors x4 weeks
Nucleoside reverse transcriptase inhibitors for HIV (4)
- Zidovudine
- Lamivudine
- Tenofovir
- Emtricitabine
Side effect of licorice
Hypercortisolism (HTN, hypokalemia, metabolic alkalosis)
Risk with ginkgo
Interaction with aspirin or warfarin --> spontaneous bleeding
Risks with kava
- Increased sedation with EtOH/benzos/etc
- Hepatotoxicity
Risk with black cohosh
Risk with horse chestnut
Increased risk of bleeding in patients on ASA or warfarin
Findings in sarcoidosis (5)
- Peripheral nerve disease
- Erythema nodosum
- Hepatic compromise
- Hilar node enlargement
- Hypercalcemia
EKG findings in multifocal atrial tachycardia
- Narrow QRS
- 3+ morphologies of P waves
- Variable PR segments and RR intervals
Causes of multifocal atrial tachycardia (6)
- Hypoxia
- Hypomag
- Hypokalemia
- Heart disease
- Aminophylline, theophylline, isoproterenol
- When to treat MAT with drugs
- Which drugs
- Once correctable underlying causes have been addressed
- Beta blockers (or verapamil in pts with asthma/COPD)
Nelson's syndrome:
- Patients
- Presentation
- Treatment
- Post-bilateral adrenalectomy
- Pituitary enlargement, hyperpigmentation, visual field defect
- Surgery and/or radiation
Management of acute arterial occlusion
Immediate IV heparin therapy
Type of inguinal hernia in pediatric patients
Indirect, due to failure of processus vaginalis to obliterate
Meralgia paresthetica
- What is?
- Symptoms
- Treatment
- Entrapment of lateral femoral cutaneous nerve
- Area of decreased sensation over anterolateral thigh without weakness or DTR changes
- Weight loss, avoid tight-fitting garments
PE findings in obturator nerve lesion
- Sensory loss over medial thigh
- Weakness in leg adduction
Typical symptoms in myasthenia gravis
Weakness in ocular and bulbar muscles (double vision, ptosis, dysphagia, dysarthria) worsening over the day
Concern in refractory or rapidly progressive osteoporosis
Multiple myeloma
Skin problem with thiazides
Photosensitivity (because are sulfonamides)
Neuro sx of lithium toxicity
Slurred speech
Medications that can increase serum lithium levels
- Diuretics (incl thiazides)
Management of biopsy-proven CIN 1 with satisfactory coloposcopic exam
- Repeat cytology at 6 & 12 months
- HPV DNA at 12 months
Typical presentation of invasive aspergillosis
- Fever
- Pulmonary sx
- Sinus sx (incl HA and nasal bleeding)
Treat asx carriers of Giardia?
Only in outbreak control and for prevention of household transmission by toddlers to pregant women and pts with hypogammaglobulinemia or CF
Patello-femoral pain syndrome:
- Presentation
- Exam findings
- Anterior knee pain provoked by climbing stairs or prolonged sitting
- Retropatellar pain, crepitation on vigorous patellar compression
Patellar tendonitis
- Other name
- Affected patients
- Exam finding
- Jumper's knee
- Volleyball and basketball players
- Local infra-patellar tenderness
Symptoms of prepatellar bursitis
Anterior knee pain and swelling
Pathophys of Osgood-Schlatter
Epiphysitis of tibial tuberosity
Symptoms of anserine bursitis
Medial knee pain and local tenderness
Subacute thyroiditis
- Presentation
- Pathophys
- Thyrotoxicosis with low radioactive iodine uptake
- Release of stored thyroid hormone
Treatment of subacute thyroiditis
NSAID + beta-blocker
Management of thyroid nodule
Obtain TSH
- If TSH is normal, do a FNAC
- If TSH is decreased, do a radioisotope scan. If hot nodule, observation.
Management of papillary thyroid cancer
- Near total thyroidectomy
- Then radioactive iodine
Treatments for postherpetic neuralgia
- Tricyclic antidepressants (e.g. amitriptyline)
- Topical capsaicin
- Gabapentin
- Long-acting oxycodone
When to check serologies in baby born to mother with HBV
3-4 months after third vaccination dose (or 9-15 months of age)
Symptoms of Candida endophthalmitis (4)
Ocular pain
Treatment of candida endophthalmitis with vitreal involvement
Vitrectomy and systemic antifungal tx (amphotericin B and/or fluconazole)
Setting for IgA nephropathy
Urine finding
- Often follows URI
- Gross hematuria, flank pain
- Dysmorphic RBCs in urine
Post-strep GN
- Delay between infection and onset
- Symptom
- Lab findings (2)
- 10 days
- Urine RBCs/RBC casts, low complement levels
Metabolic/electrolyte abnormalities with IV pentamidine (5)
- Hyperkalemia
- Hypokalemia
- Hyperglycemia
- Hypoglycemia
- Hypocalcemia
Lab tests helpful in diagnosis of RA
Anti-cyclic citrullinated peptide (CCP)
Which antibody is specific for SLE?
Anti-ds DNA
DMARDs for RA, incl first choice (6)
TNF inhibitors (etanercept and infliximab)
CSF findings in MS
Elevated IGs, with IGg disproportionately elevated (oligoclonal band)
Treatment of acute MS exacerbation
IV steroids
Treatment of relapsing or secondary progressive MS, and safety in pregnancy
Interferon or glatiramer acetate
Teratogenic, but therapeutic abortion not indicated
Positive prognostic indicators for MS
- Early age of onset
- Female gender
- Relapsing disease
- Sensory or cranial nerve sx (esp optic neuritis) as first presentation
Autoimmune hepatitis:
- LFT results
- Antibodies
- Elevated AST/ALT, normal alk phos and bili
- ANA and anti-SM
Condition with elevated ANA and anti-SM antibodies
Autoimmune hepatitis
Antibodies in PBC
Condition with antimitochondrial antibodies
LFT result in PBC
Elevated alk phos
T-score cutoffs for
- osteopenia
- osteoporosis
-1.0 to -2.5
< -2.5
Hemosiderin-laden macrophages seen in
Diffuse alveolar hemorrhage syndromes (Wegener's, Goodpasture's, other systemic vaculitides)
Treatment of PE
- Unstable
- Heparin
- IV fibrinolysis
Concern with unilateral headache and Horner's syndrome
Carotid dissection
Initial evaluation for carotid dissection
In which cardiac patients should beta blockers be started?
- Stable angina
- Prior ACS
- LV dysfunction
Rx to maintain NSR in pt with paroxysmal afib and structural heart disease
Treatment of uncomplicated cystitis in healthy nonpregnant woman
Bactrim x3 days
If Bactrim allergic: quinolone x3 days
Criteria for complicated cystitis (7)
-Anatomic abnormality
-Indwelling catheter
-Sx >7 days
Treatment of complicated cystitis
Bactrim x7 days
Treatment of cystitis in pregnancy
- Nitrofurantoin x7 days
-If allergic, Augmentin x7 days
*Avoid Bactrim (folate antagonist) and quinolones
Initial therapy for UC with mild proctitis
Topical 5-ASA (mesalamine suppository)
Initial therapy for UC with moderate proctitis in order of initiation
1) Oral 5-ASA compounds (sulfasalazine, mesalamine)
2) Steroids
3) Immunomodulators (azathioprine, 6-MP)
How long to continue antidepressants in pt with first episode of depression
6 months
Common meds for meningococcal ppx in contacts of pt with meningitis (5)
- Oral rifampin*
- Cipro*
- CTX*
- Sulfonamides
- Minocycline
Poor prognostic indicators in PE (2)
- Elevated troponin
- Hypotension
First-line tx for conjunctivitis in non-contact lens wearers (3)
- Erythromycin ointment
- Sulfa drops
- Polymyxin/trimethoprim drops
Treatment for roundworm, hookworm, whipworm, pinworms
Albendazole or mebendazole
Helminths (4)
- Ascaris lumbricoides (roundworm)
- Trichuris trichiura (whipworm)
- Necator americanus
- Ancylostoma duodenale (hookworm)
Rx for pt with asx LV dysfunction to prevent progression to heart failure
ACE inhibitor
Type of cancer associated with Sjogren's syndrome
B-cell lymphoma
Most sensitive test for Vitamin D
25,hydroxyvitamin D
When to give anti-D immune globulin in pregnancy
28 weeks
Tinel's sign
- What?
- Seen in?
- Worsening of median nerve paresthesia with tapping of palmar aspect of wrist
- Carpal tunnel syndrome
Chvostek's sign
- What is?
- Seen in?
- Contraction of facial muscles with tapping of facial nerve
- Hypocalcemia
Treatment of ecthyma gangrenosum
IV abx (no surgical debridement)
Typical regimens for PsA bacteremia
Aminoglycoside (tobramycin, amikacin)
piperacillin or ceftaz/cefepime
TCA overdose: presentation (4)
- Hypotension
- Anticholinergic sx
- CNS manifestations
- Cardiac arrhythmias
TCA toxicity:
- Treatment of cardiotoxic effects
- Treatment of ventricular dysrhythmias
- Sodium bicarb
- Lidocaine
First step in management of septic shock
Fluid resuscitation to CVP of 8-12 mmHg
Findings in femoral nerve injury (3)
- Inability to extend knee against resistance
- Loss of knee jerk reflex
- Sensory loss over anterior and medial thigh, medial shin, arch of foot
Nerve injury causing sensory loss over anterior and medial thigh
Femoral nerve injury
Symptoms of sciatic nerve injury (2)
- Sensory loss in lower leg
- Loss of ankle jerk
Presentation of common peroneal nerve injury
- Acute foot drop
- Weakness in dorsiflexion and inversion
- Sensory changes over dorsum of foot and lateral shin
Normal thyroid hormone change in pregnancy
Elevated TBG --> elevated total T3 and T4
Initial labs in pt with c/f lead poisoning
CBC, retic, iron, ferritin
Test for monitoring cardiotoxicity of anthracycline chemo
Radionuclide ventriculography (MUGA scan)
When can a noncontact athlete return to sports after a clavicle fracture?
4-6 weeks
MAOIs (2)
Meds (2) for hypertensive crisis complicated by acute pulmonary edema
IV nitroglycerine
IV nitroprusside
Typical finding in patient with posterior communicating artery aneurysm
Cranial nerve III palsy
Symptoms with PICA aneurysm
Bulbar dysfunction
Typical symptoms of subarachnoid hemorrhage
- Sudden onset headache
- Nausea
- Nuchal rigidity
Cluster headache prevention: 1st line and two 2nd line meds
1st: Verapamil
2nd: Lithium, pred
Acute management of cluster headache
100% O2.
Can also try sumatriptan, ergots, or NSAIDs
Paraneoplastic syndrome with small cell lung cancer
Paraneoplastic syndrome with squamous cell lung cancer
Parathyroid-like hormone production --> hypercalcemia
Medications for severe refractory SIADH
Then demeclocycline or lithium
Indications for tx of Paget's (6)
- Bone pain
- Involvement of weight-bearing bones
- Neuro compromise
- Hypercalcemia
- Hypercalciuria
Rx for HTN in pt with BPH
Alpha-1-block (prazosin, terazosin)
Positive side effects of alpha-1-blockers
Increase insulin sensitivity
Decrease LDL
Increase HDL
CSF findings in cryptococcal meningitis (4)
- Elevated opening pressures (often >200)
- WBC <50 with mononulear/lymphocyte predominance
- Elevated protein
- Low glucose
Initial treatment of cryptococcal meningitis
Amphotericin B + flucytosine
Maintenance therapy for cryptococcal meningitis after induction
Dangerous side effect of nitroprusside
Cyanide toxicity
Presentation of cyanide toxicity (3)
- Tachycardia
- Lactic acidosis
- Change in mental status, coma, sz
Treatment for cyanide toxicity
Sodium thiosulfate
Effect of OCPs on pt with hypothyroidism
- Increased TBG --> increased total T4, decreased free T4.
- May need to increase dose of levothyroxine
Management of intraocular melanoma
Surgical enucleation or radiotherapy
S/S of PBC (6)
- Jaundice
- Steathorrhea
- Fatigue
- Hyperlipidemia withxanthomas
- Osteoporosis/osteomalacia
- Hyperpigmentation
Medical tx for PBC
Ursodeoxycholic acid
Next step in woman >21 with ASCUS
HPV testing; if positive colpo, if negative repeat Pap in one year
Next step in woman >21 with ASC-H
- Pts at high risk for colorectal cancer
- When to do first colonoscopy
- First degree relative with colorectal cancer or advanced adenoma before age 60
- 10 years before relative's dx or age 40 (whichever earlier)
Drugs (2) used for prevention of esocophageal variceal hemorrhage
- Nonselective beta blockers (nadolol, propranolol)
- Oral nitrates
Findings in pseudohypoparathyroidism
B cataracts
Calcificiation of basal ganglia
Elevated PTH
Low Ca
High phos (5)
- Mechanism
- Use
- Partial agonist at a subunit of nicotinic acetylcholine receptor
- Smoking cessation
Patients in whom to avoid verenicline
Unstable psych sx or h/o SI
Contraindication to bupropion
Strongest known risk factor for male breast cancer
Klinefelter's (47 XXY)
Evaluation of testicular swelling
If suspicious: CT abd/pelvis, AFP, beta hCG
If still suspicious: Radical orchiectomy (risk of iatrogenic local spread with testicular biopsy)
Initial treatment of hyperthyroidism with afib
Symptom of hyperthyroidism in elderly patients
Most common ophthalmic manifestation of sarcoidosis
Anterior uveitis (acute onset of red eye, photophobia, blurred vision, pain)
Rx for carotic stenosis (2)
- Clopidogrel
Tx of chlamydia during pregnancy (2)
- Erythromycin base (not erythryomycin estolate)
- Azithromycin 1gm
Tx of chlamydia (not in pregnancy)
Azithromycin 1gm
Doxycycline 100mg PO BID x7d
Symptoms of refeeding syndrome
Heart failure
Echo finding in cardiac tamponade
Collapse of RA and RV during diastole
Normal change in systolic BP during inspiration
Drop of 10-12 mmHg
Blood pressure finding in inspiration in cardiac tamponade
Drop of >20 mmHg
EKG finding in pericarditis
Diffuse ST segment elevations in all leads
Beck's triad
- Seen in what?
- What is?
- Cardiac tamponade
- Hypotension, distant heart sounds, elevated JVP
Factors incorporated in MELD score
Treatment of sulfonylurea poisoning
1) Dextrose
2) Octreotide (somatostatin analog) if severe
- Class
- Mechanism
- Sulfonylurea
- Increases insulin production
PPX for meningococcal meningitis exposure
- Rifampin x4 doses
- Cipro x1 dose if cannot tolerate rifampin (eg on OCPs)
Lab test in Wegener's
Dz in which C-ANCA is positive
Other name for Wegener's
Granulomatosis with polyangiitis
Most common cause of acquired essential mixed cryoglobulinemia
Hepatitis C
Presentation of mixed cryoglobulinemia (7)
- Nonspecific systemic symptoms
- Arthralgias
- Palpable purpura
- Peripheral neuropathy
- Renal disease
Tx of Hep C-associated cryoglobulinemia
Anti-viral tx for HCV
Associated problems in Turner's syndrome (4)
- Cardiac defects (coarct, biscupid aortic valve, MVP, hypoplastic heart)
- Visual and hearing impairment
- Hypothyroidism
- Renal malformations (horseshoe kidney)
Rash in RMSF and when it appears
- Petechial rash on ankles/wrists --> palms, soles, central body
- 3rd-5th day of illness
Arthropathy of hemochromatosis:
- Joints affected
- XR findings
- Clinical findings
- Fluid examination
- 2nd and 3rd MCPs
- Osteoarthritic changes
- Morning stiffness for <30 min
- CPPD crystals
Tx for mucormycosis
Debridement & amphotericin B
- Class
- Mechanism
- Thiazolidinedione
- Increases insulin sensitivity
Goal of intention-to-treat analysis
Preserve randomization
Rx for narcolepsy
Distinction between Trichophyton tonsurans and Microsporum canis
Microsporum canis fluoresces bright green under Wood's lamp
Presentation of transverse myelitis (4)
Usually after a URI
Rapidly progressive paraplegia
Sensory loss
Pelvic organ dysfunction
First test in evaluation of transverse myelitis
Biopsy finding in celiac
Villus blunting with lymphocytic and plasma cell infiltration
Biopsy finding in Crohn's
Transmural inflammation of mucosa
Biopsy finding in UC
Superficial mucosal inflammation with infiltration of plasma cells
PE findings of cutaneous cryptococcosis
Multiple discrete reddish papules with central umbilication
Diagnosis of cutaneous cryptococcosis
Histopath of biopsy
Symptom of duodenal ulcer
Pain on an empty stomach
Antipsychotics available in long-acting injectable form (3)
- Haloperidol decanoate
- Risperidone
- Fluphenazine
Presentation of rupture of chordae tendineae
Flash pulmonary edema a/w acute mitral regurg
Characteristics of acute MR murmur (5)
- Systolic murmur in apex, radiating to axilla
- Increased with grip
- Decreased with Valsalva
- Decreased 1st heart sound
- Fourth heart sound
Treatment of acute gout (3)
- NSAIDs (1st line)
- Colchicine
- Glucocorticoids
Chronic gout treatment
Sources of septic pulmonary emboli (2)
- Septic thrombophlebitis
- Tricuspid endocarditis
Medical management of acute aortic dissection
- IV propranolol or labetalol
- Can add sodium nitroprusside (never use alone 2/2 reflex sympathetic activation)
Levels in hemolysis of
- Haptoglobin
- LDH increased
- Haptoglobin decreased
Treatment of lead poisoning:
- Mild
- Moderate
- Severe
- Mild: oral DMSA or d-penicillamine (or no tx)
- Moderate (45-70): oral DMSA or IV EDTA
- Severe (l>70 and/or acute encephalopathy): IV dimercaprol and EDTA
Does likelihood ratio change with prevalence?
Prophyria cutanea tarda
- Presentation
- Associations
- Diagnosis
- Manageent
- Painless blisters, fragile skin on dorsum of hands, facial hypertrichosis and hyperpigmentation
- Ethanol, estrogens, Hep C
- Elevated urinary uroporphyrins
- Phlebotomy, hydroxychloroquine, interferon-alpha for HCV
Skin condition a/w gluten-sensitive enteropathy
Dermatitis herpetiformis
For which mechanical valve pts is the INR goal
- 2-3
- 2.5-3.5
- 2.5-3.5 with low-dose ASA
- 2-3: AVR with normal rhythm
- 2.5-3.5: MVR, AVR with aFib
- 2.5-3.5+ASA: Mechanical valve and systemic embolism despite anticoagulation
MI pts who are candidates for thrombolytic tx
- Present within 12 hrs of sx onset
- ST elevations >1mm in two contiguous leads or new LBBB
Medication used in cocaine chest pain
Medication to avoid in cocaine chest pain
Management of HTN in cocaine chest pain
1) Benzo
2) (if needed) Phentolamine (1st choice), nitroprusside, nitroglycerine
Murmur in mitral stenosis
Low-pitched rumbling diastolic murmur at apex
Valvular lesion that can cause hemoptysis
Mitral stenosis
Crescendo-decrescendo murmur
Aortic stenosis
Indications for surgery in AAA (3)
- Diameter >5cm
- Symptoms
- Rapid enlargement
Post-MI acute pericarditis:
- Time frame
- Management
- 1-4 days post-MI
- Pain control with ASA (usually transient)
Time frame for post-MI chordae tendineae or papillary muscle rupture
2-8 days post-MI
Dressler's syndrome
- Time frame
- Mechanism
- Presentation (4)
- Weeks-months after MI
- Autoimmune
- Fever, leukocytosis, pleuritic CP, pericardial rub
Acne medication that can cause hypertrigyceridemia and pancreatitis
Most deadly toxicity of amiodarone
Pulmonary toxicity
Shampoo ingredients for seborrheic dermatitis (4)
- Ketoconazole
- Tar
- Zinc pyrithione
- Selenium sulfide
Side effects of lindane
- Seizures
- Aplastic anemia
Acute treatment of symptomatic tachycardia in hyperthyroidism
Beta blocker
Medical tx of hyperthyroidism (2)
Propylthiouracil (PTU)
Max length to use glucocorticoids without having to taper
3 weeks
How long to continue warfarin after 1st episode of DVT
3-6 months
Start ___ before ___ in alcoholics to prevent ___
Start thiamine before glucose to prevent Wernicke's encephalopathy from thiamine deficiency
Electrolyte derangement that can cause paralytic ileus
Manifestations of glucagonoma
- Mild diabetes
- Painful, itchy erythematous rash with central clearing
- Deficiency of
- Manifestations
- Niacin
- Dementia, diarrhea, dermatitis, stomatitis, cheilosis
Ca/D/PTH in sarcoidosis
Incr 1,25-OH D --> incr GI absorption of Ca --> hypercalcemia --> decr PTH, incr urinary calcium excretion
Treatment of hypoparathyroidism
- Ca and 25-OH D
- If low serum Ca and high urine Ca, add thiazide diuretic
Most common cause of nonsustained VTach
Structural heart disease
Valve disease with midsystolic click
MV prolapse
Thyroid condition with elevated serum alpha subunits
TSH-secreting pituitary adenoma
Single most important predictor of adverse cardiovascular outcomes
Test of choice for diverticulitis
Tx of mild diverticulitis
Cipro + Flagyl
Effect of amiodarone on TFTs
Decreased conversion of T4 --> T3
Increased T4; decreased T3
Meds used for diabetic neuropathy (3)
- Tricyclic antidepressants
- Duloxetine
- Gabapentin and other anticonvulsants
Next evaluation after diagnosis of familial adenomatous polyposis
Endoscopy to look for gastric/duodenol adenomas/carcinomas
Risks with ginseng
- Psychosis
Treatment C. diff relapses after metronidazole tx:
- First
- Second
- Metronidazole again
- Oral vanco
Tx of acute Hep B
Supportive measures
Marker of high HBV infectivity
HB eAg
Rate of chronic Hep B in
- Infants with acute Hep B
- Adults with acute Hep B
- 90%
- 5%
Management of 3-vessel or left main CAD in diabetic patient
Biggest risk with compartment syndrome
Rhabdo and renal failure
Management of salicylate overdose
Alkalinization of urine
Gastric lavage/charcoal
Management of hyponatremia in advanced CHF
Water restriction
Bile-salt induced diarrhea:
- Seen in (2)
- Tx
- Short gut, s/p cholecystectomy
- Cholestyramine (bile-acid binding resin)
Diagnosis of brain death (correct)
- CNS catastrophe
- No confounding factors
- Absent cortical and brainstem function
--> Then, apnea test
Presentation of acute ischemic colitis
Acute abdominal pain followed by bloody diarrhea
Analgesic nephropathy
- Pathophys
- UA findings
- Papillary damage
- Hematuria, pyuria, proteinuria
Type of endocarditis that can cause conduction system abnormalities
Aortic valve
Management of acute hemolytic transfusion reaction
Stop transfusion and hydrate with NORMAL SALINE only
- Presentation
- Lab findings (2)
- Oliguria after a hypotensive episode
- Muddy brown casts, high FENa
FENa in prerenal azotemia
Fluid for oliguric, hyperkalemic, acidotic patient
D5W with bicarb at slow rate (e.g. 50 mL/hr)
Diagnosis of severe C diff colitis
Limited sigmoidoscopy of unprepared bowel with minimal air inflation
Med for tx of SVT
Abx associated with infantile hypertrophic pyloric stenosis
LDL level at which to start a statin in diabetic pts
When can Pap interval be decreased from every 2 to every 2-3 years?
3 consecutive negatives or after age 30
Rx for early localized Lyme
Tx for H pylori
Two weeks of:
- Clarithromycin
- Amoxicillin (metronidazole if allergic)
H. pylori treatment after failure of initial triple therapy
Two weeks of:
- Bismuth
- Tetracycline
- Metronidazole
FEV1, FVC and FEV1/FVC in asthma
FEV1: decreased (more)
FVC: decreased (less)
FEV1/FVC: decreased
First-line tx for RLS
Dopamine agonists (pramipexole or ropinirole)
Anti-centromere antibodies seen in?
CREST (scleroderma)
Anti-smith antibodies seen in?
SLE (but less sensitive than anti-dsDNA)
Use of hydroxychloroquine in SLE
Pts with arthralgias, serositis, cutaneous manifestations
Antihypertensive used in opiate withdrawal
Tx of Graves' dz with ophthalmopathy
Radioiodine ablation + steroids
Drug for management of thyroid storm
Mammography guidelines
Every two years for women 50-74
Calculation of plasma osmolality
(2 x Na) + (glucose/18) + (BUN/2.8)
Next step if Pap shows HSIL
LEEP or colpo
Test to confirm suspected 21-hydroxylase deficiency
Elevated 17 alpha-hydroxyprogesterone
Findings in CAH caused by 11-hydroxylase deficiency
Window for fibrinolytic therapy after ischemic stroke
3-4.5 hours
Febrile transfusion reaction:
- Cause
- Prevention
- Distinction from hemolytic reaction
- Recipient antibodies to donor leukocytes
- Washing cells
- Absence of hemodynamic abnormalities and renal dysfunction
CXR finding in pulmonary contusion
Homogenous opacification of lung fields not conforming to a specific anatomic segment of the lung
Most common cause of diverticular bleeding
Erosion of the artery
VZV vaccination of household contact of transplant patient
Give vaccine and monitor for rash; isolate if rash appears
Osteonecrosis of femoral head
- Other names (2)
- Patients at highest risk
- Avscular necrosis, osteochondritis dissecans
- SLE patients on chronic high-dose steroids
Mangement of AVN (osteonecrosis of femoral head)
- Stage 1-2
- Stage 4
- Core decompression
- Total hip replacement
Indinavir: class
Protease inhibitor
Side effect of indinavir
Crystal-induced nephropathy
HIV drug that can cause crystal-induced nephropathy
Risk with didanosine
HIV med with risk of pancreatitis
Risk with abacavir
Hypersensitivity syndrome
HIV drug with risk of hypersensitivity syndrome
HIV drug class that can cause lactic acidosis
HIV drugs that can cause SJS
RIsk with nevirapine
Liver failure
HIV drug with risk of liver failure
Percentage of HbA in:
- Sickle trait
- HgbS beta 0
- HgbS beta +
- 60%
- 0%
- 3-25%
Meds that can impair levothyroxine absorption
Meds for hyperthyroidism in pregnancy
Propylthiouracil during 1st trimester (methimazole teratogen)
Can switch back to methimazole during 2nd and 3rd trimesters
Evaluation in patient with B varicocele, R varicocele, or varicocele that does not disappear when supine
CT to look for process causing IVF obstruction (e.g. clot, tumor)
Treatment of symptomatic proximal ureteral calculi:
<10 mm
>10 mm
- Shockwave lithotripsy
- Ureteroscopic removal
Initial evaluation of patient with suspected ankylosing spondylitis
X-ray of sacroiliac joint for evidence of sacroiliitis
Extraarticular manifestations of ankylosing spondylitis (5)
- Acute anterior uveitis
- Aortic regurgitation
- Apical pulmonary fibrosis
- Restrictive lung disease
- IgA nephropathy
Lichen planus:
- Lesions
- Locations
- Diagnosis
- Pruritic polygonal violaceous papules/plaques
- Flexural surfaces, esp wrists
- Skin biopsy
Infectious associated with lichen planus
HCV with advanced liver disease
ART drugs to avoid in pregnancy (2)
- Efavirenz
- Delaviridine
HAART regimen
- Two NRTIs
- One protease inhibitor or NNRTI
Tx for catatonia in schizophrenia
- Benzos
- ECT if benzos fail
Post-exposure rabies ppx for people who have previously been vaccinated
Vaccine (no Ig)
Esophageal adenocarcinoma: location and risk factors
Esophageal squamous cell carcinoma: location and RF
- Distal, GERD
- Proximal, smoking/alcohol
Drug that must be administered at a 4 hour interval from sildenafil
Alpha-blockers (e.g. doxazosin)
Rx for ALS and class
Riluzole (glutamate inhibitor)
HBV serology in window period
Anti-HBc Ab only
Presentation of Meniere's disease
- Periodic vertigo
- Unilateral hearing loss
- Tinnitus
Subphrenic abscess: findings
- 2-3 weeks after abdominal surgery
- Swinging fever
- Leukocytosis
- Cough
- Shoulder-tip pain
Cancer with increased risk in celiac disease
Intestinal T-cell lymphoma
AK can develop into ___
SCC of skin
Management of venous sinus thrombosis
Anticoagulation with heparin, even if an area of hemorrhagic infarction is seen on CT (b/c hemorrhagic foci are 2/2 venous hypertension)