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112 Cards in this Set

  • Front
  • Back
Path of Meniere's Dz?
Classic presenation?
Exacerbating Factors?
Distention of endolymphatic comparment innner ear
-episodes vertigo (20min-24hr) w/ naus/vom, sensorineural low freq hearing loss, tinnitis
-Hi salt food, ETOH, Caffeine, nictotine (restirct thest)
-If restriction fails, diuretics, antihistamines, anticholinergics
When to use oral isoretinoin? (acutane)
Side effects?
Moderate-to-sever acne in nodulocystic (papules/pustules and nodules) form and pts w/ scars developing
-teratogenicity, decreased night vision, dry eyes (kerratoconjunctivitis sicca), stunted growth (early epiphyseal closure)
Describe tmt of acne at various severity?
-Topical retinoid: initial therapy, non-inflammatory comedomes
-Benzoyl peroxide or topical abx (erythromycin, tetracycline, clindamycin): mild inflammatory
-Oral abx (tetracycline): moderate-to-sever acne
Risk from abrupt cessation of lithium?
suicide and relapse
Pt in MVC hemorrhaging given 4U pRBCs, now w/ serum Ca 7.2, has tingling fingers/toes
ML Dx?
What other electroylte abn could happen
Hypocalcemia-causes parasthesia
-citrate in whole blood collections that can chelate w/ serum calcium and Mg
-Hyperkalemia from stored RBCs leaking K
Pt w/ 24hr urine ptn excretion 5g/day, U/A w/ 3+ptnuria, 5-10wbcs, serum albumin 2.3, facial puffiness and bilateral pitting edema, Cr 0.9
ML Dx?
Complications from this?
Nephrotic Syndrome (not yet acute renal failure since Cr normal)
-peripheral edema, hypoalbuminemia, urine ptn excretion >3g/day
-elevated LDL causing accelerated atherosclerosis, hypercoagulability (from decreased antithrombin III)->manage aggressively w/ statins to prevent stroke or MI
Pt w/ high grade squamous intraepithelial lesion (HSIL) on cytology.
Next steps?
What if pregnant?
Colpo and endocervical bx (curretage)
-undergo initial colpo and bx, if negative->rpt 6wks postpartum, if positive CIN 2/3->rpt q12 wks looking for invasion/worsening
Pt w/ LSIL on cytology
Next Steps?
What if pregnant?
Colpo and endocervical bx (curretage)
-defer colpo and bx until 6wks postpartum
Pt w/ ASCUS on cytology
Next Steps?
-HPV DNA testing
=if positive->colp
=if negative->rpt pap in 6mos
40yo asian american F w/ bloating flatulence, and abd cramps w/ explosive watery diarhea after dairy products.
ML Dx?
Dx Test?
Findings on others studies?
Lactose Intolerance (common in asian americans, due to deficiency/reduction in lactase brush border enzyme over time)
-Lactose hydrogen breath test (give lactose bolus and have rise breath hydrogen from bacterial carbohydrate metabolism
-negative steatorrhea, positive stool test for reducing substances, low stool pH (from fermentation product), increased stool osmotic gap (from unmetabolized lactose)=290-[2(stool Na + K)] >50
Recent military recruit w/ pain in R foot started weeks ago now w/ sweling, warmth, and point tenderness over 2nd metatarsal.
ML Dx?
Dx Test?
Metatarsal hairline (nondisplaced) stress fracture
-plain film (2nd metatarsal is most common)
-Rest and anlagesia or Hard-sole shoe w/ light activity immediately
Triad of gonoccocal Arthritis?
Dx Test and findings?
Hx suggestive of this?
-Polyarthralgias (multiple joint pains), Rash (vesiculopustular see 2-10 furuncles/pimples), Tenosynovitis (finger movement hurts from inflammed tendon sheath)
-Cx multiple areas (synovial fluid w/ 50000 or less wbc, gram stain only 25% sensitive, cx <50% sensitive-so do lots of cxs)
-occurs in hx STDs, new sex partner, young person menstruating
-Ceftriaxone, cefotaxime, ceftizoxime (only use quinolones if sensitivity confirmed since >5% organisms resistant)
Type of neuropathy in DM?
symmetrical distal polyneuropathy = "stocking glove" loss of sensation
What is borborygmi
stomach rumbling...haha
What vaccines not to give to HIV pt?
What to give at all CD4?
What to give if CD4>200?
NO Live vaccines: BCG, anthrax, po typhoid, intranasal influenza, po polia
-Inactive to all: TdaP once, pneumoco (revaccinate q5yrs if CD4<200), influenza, HepA and B (2 and 3 doses), Meningococcal, HPV, HiB (usually given in childhood)
-Live: MMR, Varicella, Zoster (if >60yo)
TMT for heat stroke?
Criteria heat stroke?
Other findings you may see?
evaporation cooling of pt (spray pt w/ lukewarm water and run fans to circulate air)
-bdoy temp >105F (40.5C), AMS, HA, dizzy, hypotension
-rhabdo, acute renal failure, DIC
How many standard deviations is 95% confidence interval?
What about 68%, 99.7%?
2 standard deviations
1 sd
3 sd
SE of methotrexate?
macrocytic anemia (folate def), stomatitis, hepatoxicity, interstitial lung dz, alopecia, rash
SE of hydroxychloroquine?
G6PD deficiency, visual disturbances, GI distress (its a DMARD)
Complications oof cyclosporine?
used for transplant pts to prevent organ rejection, predisposed to viral infxn, lymphoma
SE of azathioprine?
pancreatitis, liver tox, bone marrow suppression (duh!)
Pt w/ posterior cervical lymphadenopathy, fever, pharyngitis w/ tonsillar exudates was treated w/ abx, now w/ maculopapular rash all over body.
What happened?
Pt w/ EBV treated w/ ampicillin or amoxicillin always gets rash after (don't know why, but didn't even need to treat)
Immigrant w/ persistent cough and SOB for 3mos, normal vitals, CXR w/ large cardiac silhouette, elevated L main bronchus, EKG w/ irregularly irregular rhythm.
ML Dx?
Typical presentation?
Hx hints?
Exam findings?
Dx Tests
Mitral Stenosis from rheumatic heart dz
-dysphagia, hoarseness, afib, hemoptysis, SOB, CHF
-prenancy (increased plasma volume to squeeze thru), immigrants, excercise
-loud S1, opening snap after S2 w/ diastolic rumble, heard best at apex, worse on expiration, squatting and leg raising
-Dx w/ TTE initially (TEE is accurate, but cath is most accurate), CXR w/ elevated L main bronchus, large heart, 2nd "bubble" behind heart, EKG w/ biphasic p wave in V1/V2 (L atrial hypertrophy)
-Diuretics and Na restrict first, balloon valvuloplasty
Pt w/ renal colic w/ KUB XR showing nothing.
ML Dx? (3 possibilities)
Prevention in future?
1.Uric acid stone (radiolUcent)
2.calcium stone <1mm diameter
3.nonstone obstruction (clot or tumor)
-assume uric acid stone->need to alkalanize urine w/ potassium citrate or postassium bicarbonate to pH>6.5
-Low ptn diet (low protein) w/ allopurinol
What does HCTZ do to urine ca?
when is it used in stone dz?
-decreases Ca excretion
-for recurrent Ca stones
What does furosemide do to urine ca?
predispose to ca stone formation
Risk factors for gallstones?
native american, obese, rapid weight loss, OCPs, diabetes, Pt who is "fat, femal, fertile, forty"
Pt w/ peptic ulcers, fam hx ulcer dz, labs with hi Ca, lo PO4
ML Dx?
-Pituitary (prolactinoma, GH or ACTH secreting)
-Parathyroid (parathyroid hyperplasia)
-Pancreas (zollinger-ellison #1/gastrinoma, insulinoma, VIPoma, glucagonoma)
Preventatitve TMT for sickle cell?
What does it do?
What other tmt?
Hydroxyurea->increases fetal hemoglobin
O2, analgesia, hydration important initially
-if infxn, immediate tmt w/ cefrtriaxone or fluroquinolone
-pneumococcal vaccine (autosplenectomy)
-folate replacement (chronic deficiency)
Differentiate Pulm contusion from ARDS from fat embolus
Pulm contusion: 1st 24hrs, chest bruisng, hypoxia SOB, decreased breath sounds, CXR w/ patchy alveolar infiltrate
ARDS: after 24hrs-48hrs, bilateral lung involved w/ "white out"
Fat embolus: mental change, petechia, thrombocytopenia, long bone fracture
Tmt for sickle cell aplastic crisis?
Dx Test?
-reticulocyte count (will have dropped since bone marrow frozen, whereas usually very hi in sicklers), most accurate test is PCR for B19 DNA
-Parvovirus B19, pt w/ sickle cell and sudden drop in hct
Criteria for ARDS?
pO2 (from ABG as decimal)/FiO2 <300 and cardiac cath wedge pressure normal (<18)
-Low tidal vol mech ventilation (6ml/kg tidal volume), if FiO2 is hi, then lower PEEP so below 50% (above 50% is toxic to lungs)
40yo F w/ fatigue, itchiness, elevated cholesterol, yellowish nodules on eyelids.
ML Dx?
Dx Tests (and most accurate?)
Findings on Labs?
Risk of what?
Primary Biliary Cirrhosis
-Anti-mitochondrial Ab, most accurate=liver bx
-bili normal until later in dz, hi cholesterol, elevated IgM
-Hepatobiliary Ca, osteoporosis
-Ursodeoxycholic Acid (if progresses liver transplant)
Anti-smith ab=?
Anti-smooth muscle ab=?
-chronic active hepatitis
-Churg-strauss and microscopic polyangitis
HIV pt w/ pain on swallowing and substernal burning x3 days.
Workup and TMT steps?
-PO fluconazole empirically for candida esophagitis
-if fails after 3-5days->esophagoscopy w/ cytology/bx
-if HSV esophagitis->po acyclovir
-if CMV esophagitis->po gancylovir
TMT of myasthenia crisis?
1. W/drawal acetycholinesterase inhibitor drugs
3. IVIG and plasmapheresis
4. monitor PFTs and look for concurrent infxn
Other than GERD/PUD, when do you give PPIs?
Stress ulcers:
Head Trauma
ET intubation
Coagulopathy w/ resp failure
When do you do a biophysical profile on fetus?
How done?
What are 5 components?
hi risk pregnancy w/ decreased fetal movement or nonreactive NST (nonstress test)
-w/ ultrasound (each =2pts)
1.nonstress test (reactive)
2. fetal tone (flexion or extension any extremity)
3. movement ( at least 2 in 30min)
4. breathing (at least 20sec in 30min)
5. amniotic fluid volume (pocket >2cm in vertical axis)
-score 8-10=normal, unless decreased amniotic fluid and 8=fetal compromise, 6 w/out oligohydramnios >37wk=delivery, 6 w/out oligo <37wk=rpt in 24hr and deliver if no change, 6 w/ oligo>32wk=deliver, 6w/oligo <32=daily monitor, 4 or less=deliver if>26wk
Define NST for fetal testing?
detect 2 fetal movements
-detect fetal HR accel >15bpm for 15sec in 20min
=reactive->do nothing
=nonreassuring->could be sleeping do vibroacoustic stim or BPP
What drug prevents ventricular remodeling after an MI (ie prevents ventricle from dilated cardiomyopathy if dead anterior wall)?
What is normal amniotic fluid index?
>5 to <25
What is expected lecithin/sphingomyelin ratio desired for fetal lung maturity?
What TMT to do this and when is it effective?
-Betamethasone, 24-34wks gestation (especially if PPROM <34wga)
Pregnant 32wga complains of gush of fluid.
Dx test?
ML Dx?
Risks from this?
amniotic fluid analysis (amniotic fluid=present in posterior fornix, turns blue on nitrazine paper, ferning when dried under microscope)
-PPROM (preterm since 32wks, if >37 would just be PROM)
-betamethasone (to mature lungs), ampicillin and 1dose azithromycin (prevent choriioamniotitis)
-Risk of chorioamnionitis (if chorio->deliver immediately)
Pt w/ "pounding" heart for several months, worse when lying supine or on L side, BP 150/55, HR 73.
ML Dx?
Dx Test?
Aortic Regurg
-in USA: bicuspid aortic valve or aortic root dilation (marfans, syphilis, ankylosing spondylitis, reiter syndrome, HTN)
-Water hammer pulse (pounding heartbeat), wide pulse pressure (systolic-diastolic), quincke pulse (pulses in nailbed seen), Head bobbing (de musset sign), Hill sign (BP in legs >40mg than BP arms)
-murmur: diastolic decrescendo best at LLSB, worse w/ squating/leg raise/HANDGRIP, better on standing/vasalva,
TMT ACEi or ARBs, eventuall surgery when EF<55%
Amiodarone side effect/contraindication
Pulmonary toxicity->don't use in pts w/ any underlying lung dz
Pt w/ fever, swelling around eyes, double vision, muscle aches in neck and jaw, 1wk earlier w/ abd pain/naus/vomit/diarrhea spont remitted, exam w/ "splinter" hemorrhage, Labs show 21% eosinophils.
ML Dx?
Trichinellosis (trichinosis)
-from eating undercooked pork, 3 phases of infxn: invades intestine (gi sx), then systemic hypersensitivity to larval migration = splinter/conjunctiva/retinal hemorrhages, periorbital edema, chemosis, then larva into muscle=muscle pain/tender/weakness.
-Triad of myositis, periorbital edema, eosinophilia
Name 4 drugs to treat acute angle closure glaucoma
1. mannitol IV
2. IV acetazolamide (reduce production humor)
3. pilocarpine topical (opens canals schlemm for drainage of humor)
4. timolol topical (decrease intraoc pressure via decreased acqueous humor)
Presentation of e. nodosum?
Most common causes of erythema nodosum?
-painful, subcu, nodules on anterior surface lower legs
1. recent strep infxn
2. sarcoid (in AA female)
3. TB
4. Histo
5. IBD
When should pregnant women have oral glucose tolerance testing?
24 to 28wga
What should all pregnant women have tested?
cervcial cytology (if its that time), Rh and ab, HCT, Hgb, MCV, rubella/varicella immune status, UCx, Syphilis and chlamydia test, HepB antigen status, HIV, influenza vaccine given, offer genetic screen CF and Down
Best treatment for Hypersensitivity Pneumonitis?
Avoid antigen exposure
-bird fancier's lung, farmer's lung
Differentiate cavernous sinus thrombosis from orbital cellulitis.
Orbital Cellulitis: unilateral is key. Fever, proptosis, ophtalmoplegia, visual defitic
Thrombosis: bilateral findings, headache, bilateral edema and cranial nerve findings key. (MRI is dx of choice)
Pt returned from mexico 6mos ago, now w/ RUQ pain, leukocytosis, diarrhea, up Alk phosph, tender liver mass, CT shows large solitary liver lesion.
ML Dx?
Dx Test?
Amebic abscess (can also involve lungs, heart brain), RUQ pain mos after return from endemic area, jaundice only in 10% pts,
-CT scan shows lesion, serology test confirms amebiasis
-po Metronidazole for 1wk empirically (before test results), if negative, then perc drain for pyogenic abscess
Pt w/ renal colic, has had many stones since childhood. U/A w/ hexagonal crystals
ML Dx?
Confirm testing?
Cystinuria (heritable radiopaque stones hexagonal since childhood)
-impaired amino acid transport of cystine, lysine, arginine, orthinine by renal tubule brush border
-Urine cyanide nitroprusside test
Define normal parameters of cardiac cath (right atrial pressure, PCWP, cardiac index, SVR, mixed venous O2sat)
R atrial pressure (preload): 4
PCWP (preload): 9
Cardiac index (pump fxn): 2.8-4.2
SVR (afterload): 1150L/min/m2
Mixed venous O2sat: 60-80%
Describe hemodynamic changes septic shock
preload (r atrial pressure and PCWP) normal
Cardiac index (CO) up
SVR (vascular resistance) down
Mixed venous O2 sat: down
Appearance: warm and faint
Describe hemodynamic changes cardiogenic shock
preload (r atrial pressure and PCWP) up
Cardiac index (CO) down alot
SVR: up
Mixed venous O2sat: down
Appearance: pale and cool and clammy
Describe hemodynamic changes hypovolemic shock
preload (r atrial pressure and PCWP) down
Cardiac index (CO) down
SVR: up
Mixed venous O2sat: down
Appearance: pale and cool
Differentiate chronic pancreatitis from onset lactase deficiency
Main difference is steatorrhea present in chronic pancreatitis from malabsorption, but not lactase def
Dx tests chronic pancreatitis?
Most common cause?
CT shows pancreatic calcification
Most accurate is Secretin Stim test (place NG tube and give secretin, expect bicarb to be secreted by pancreas)
-Cause is alcohol abuse
-Enzyme replacement
Tests for celiac dz?
Anti-TTG (tissue tansgultaminase) #1
antiendomysial ab
IgA antigliadin ab

Most accurate: small bowel bx
What is found in celiac that is not in chronic pancreatits?
What is siimilar btwn two?
iron deficiency (need brush border intestine to absorb iron)
-fat malabsorb, and fat sol vitamins (ADEK) and B12 (need brush border and pancreatic enzymes)
What antibodies are seen in IBD types?
ASCA (anti-saccharmoyces cerevesiae) in chrons
Name 6 classical findings of osteoarthritis
What is seen on xray?
What is seen on labs?
2. no morning stiffnes
3. bony tenderness
4. bony enlargment
5. crepitus on active motion
6. no warmth
-joint space narrow, osteophytes, dense subchondral bone, bone cyst
-NO lab changes
Pt w/ low grade fever, dull facial pain, bloody nasal discharge, diplopia, HA. Exam shows R nasal turbinate necrosis, R eye has chemosis and proptosis. KOH stain from tubrinate w/ hyphae.
ML dx?
Mucormycosis (fungus rhizopus)-can lead to death fast!
-surgical debride and IV amphotericin B
What substances increase warfarin and INR?
Vit E
st. johns wart
Sx/signs prostatitis
Best dx test for prostatitis?
dysuria, urgency, +leuk esterase, tender boggy prostate and perineum
mid-stream urine sample
Define winter's formula
what is it used for?
pCO2=1.5(HCO3) +8
for calculating respiratory comp in met acidosis
30yo F has multiple small teardrop shaped growths on vestibule of vulva.
ML Dx?
Genital Warts (condyloma acuminata)
-HPV infxn
-if small: trichloroacetic acid or podophylin
-if large, cryotherapy w/ liq nitrogen or surgery w/ fulguration (laser)
White, thin, wrinkled skin over labia major in postmenopausal female w/ pruritis=?
Lichen scelorsis
40yo F w/ hyperkeratotic erosive sore itchy lesion on vulva w/ vaginal discharge.
ML Dx?
vulvar lichen planus
65yo male w/ "smudge cells" and variable lymphocytes on smear.
ML Dx?
Confirm test?
Expected labs?
exam findings?
Flow cytometry of peripheral blood for clonality of lympocytes
-WBC >20000 w/ >80% lymphocytes
-lymphadenopathy, spleen or liver enlarged, recurrent infxn
-early TMT (w/ HSM, anemia, or thrombocytopenia)-Fludarabine and rituximab
What is DVT tmt?
start heparin and coumadin, stop heparin in 5-6days
Kid w/ atopic dermatitis 1wk ago treated w/ steroids, now w/ numerous umbilicated vessels over red cheeks.
ML Dx?
Eczema Herpeticum (life-threatening in infants, herpes simplex infxn over healing atopic dermatitis)
-acyclovir immediately
burst fracture of vertebra w/ loss of motor function and pain/temp sensatin bilat below=?
Dx Test?
Anterior Cord Syndrome
Define gestational HTN?
HTN >140/90 after 20wk gest
-methyldopa, labetalol, nifedipine
Mild vs. severe preeclampsia?
Mild: BP >140/90, ptnuria dipstick +1 or +2 or 24hr urine >300mg, edema hand/feet/face

Severe: BP >160/110 and one of: ptnuria dipstick +3 or 24hr >5grams, general edema, altered mental stat, visual change, up LFTs (RUQ pain)
Steps in tmt severe preeclampsia?
1. Mg sulfate (seizure control)
2. Hydralazine (control BP)
3. if term->deliver, if preterm->betamethasone then deliver
Best test to Dx tendons, ligaments, meniscus knee?
TMT of MCL tear?
bracing and early ambulation
F pregnant 34wks gest w/ vertex at fundus of uterus.
ML Dx?
Next step?
What if 4wks later?
Breech presentation (occiput is at uterine fundus)
-do nothing, breech will self-correct by 37wks gest
-if after 36wks, external cephalic version should be attempted
What test can differentiate cirrhosis from heart dz?
positive hepato jugular reflex = cardiac
Pt w/ microcytic anemia nonresponsive to iron supplement, meditteranean
ML Dx?
Expected RDW, MCV?
Dx Test?
b-thalassemia (more common in mediterraneans)
-Normal RDW, low MCV <80
-Hgb electrophoresis
-if b-thal major, rpt tranfusions (will also need deferasirox/deferiprone for fe chelation from iron overload of transfusions), if minor->nothing
IV drug users get what type of endocarditis?
What organism?
Predisposed to what if pleuritic pain?
Findings on test
Tricuspid valve endocarditis
-Staph aureus
-septic embolus
-CT or CXR w/ cavitating lung nodules
Describe CMV retinitis
in AIDS w/ CD4<50
-yellowish-white patch of retinal opacification & retinal hemorrhages (eye is white & quiet initiallY0
-TMT w/ ganciclovir
in AIDS w/ CD4<50
-yellowish-white patch of retinal opacification & retinal hemorrhages (eye is white & quiet initiallY0
-TMT w/ ganciclovir
Describe ocular toxoplasmosis
immunocompromised pt w/ sever necrotizing retinochoroiditis w/ necrosis in retina, white fluffy lesions around retinal edema, usually w/ ENCEPHALITIS
immunocompromised pt w/ sever necrotizing retinochoroiditis w/ necrosis in retina, white fluffy lesions around retinal edema, usually w/ ENCEPHALITIS
Describe HIV retinopathy
HIV infected pts w/ benign cotton wool spots in retina
remit spontaneously
Describe Herpes Keratitis
presents w/ pain photophobia, decreased vision
-fluorescein stain w/ DENDRITIC pattern (don't give steroids->make worse)
presents w/ pain photophobia, decreased vision
-fluorescein stain w/ DENDRITIC pattern (don't give steroids->make worse)
Define findings ekg of afib
-origin of ectopic foci?
absent p waves w/ irregular R-R intervals w/ narrow QRS complex
-pulmonary veins since cardiac tissue extend into veins and function like sphincter during atrial systole, but are thus prone to ectopic electric foci
Pt w/ 6mm prolactinoma.
medical w/ dopaminergic agents (cabergoline or bromocriptine),
if don't respond to meds or visual sx, then surgery
Pt w/ dry mouth, difficulty swallowing foods, needs lots of sips of water, dry eyes also, dental caries.
ML dx?
Related Dz?
Dx Tests?
Risk of?
-autoantibodies to lacrimal and salivary glands, middle age women, dry mouth and eyes, "sand in eyes" w/ burning/itching=keratoconjunctivitis sicca, loss of saliva=dental caries, loss of vaginal secretions=dyspareunia, enlarged parotids/submandibular swelling
-Autoimmunes (SLE, RA, polymyositis, hashimoto)
-Best initial: Schirmer test (filter paper against eye) or for blood: ab againts Ro/SS-A or La/SS-B, most accurate=parotid/lip gland bx w/ lymphoid infiltration
-#1 water mouth/sugar-free gum/fluoride tmt/artifical tears, #2 pilocarpine/cevimeline increase ACh stimulate saliva
Most appropriate next step in person w/ swollen tender erythematous R knee?
Athrocentesis/Tap and synovial fluid analysis
Side effect of colchicine?
When is it used in gout?
diarrhea and bone marrow suppression (neutropenia)
-When cannot use NSAIDs (indomethican) or steroids (triamcinolone) and as long term ppx
Pt w/ GERD and recent dx Barrett's Esophagus, now w/ heartburn resolved but w/ dysphagia to solids.
ML Dx?
Dx Test?
Peptic stricture (common in GERD, can stop reflux but presents as dysphagia solids w/out anorexia/weight loss)
-Barium swallow or endoxcopy w/ SYMMETRIC circumferential narrowing
-Still have to bx barrett's to r/o adenoca
Describe HIV initial infxn presentation
Mono like syndrome (fever, night sweats, arthralgia, lymphadenopathy), may have oral ulcers or skin rash. Prolonged diarrhea and weigh loss is common (differentiate from celiac via adenopathy present), dry cough, HA
Most common pituitary tumor?
lactotroph adenoma (prolactinoma)
F Pt w/ hi prolactin suspected.
Steps of Dx?
1. pregnancy test
2. Thyroid test (hypothyroid->up TRH->stim prolactin rls)
3.BUN/Cr (kidney dz->up prolactin)
4.LFTs (cirrhosis->up prolactin)
Non healing burn wound now increasing in size w/ constant pain and drainage. nonresponsive to creams/abx
ML Dx?
Dx Test?
Marjolin Ulcer (squamous cell carinoma from burn wound)
Precursor lesion to squamous cell carcinoma?
Actinic keratosis
Pt premature atrial complexes on EKG, no sx, hx of smoking, ETOH, no dz
When treat PAC?
Stop ETOH and smoking (precipitating factors, also caffeine, should be avoided)
-Only when symptomatic causing distress of w/ SVTs
70yo pt w/ difficulty hearing in crowded places but able to hear fine when one on one at home.
ML Dx?
Presbycusis (hi freq sensorineural heearing loss of aging, symmetrical)
When describe a pt who had pna treated and then gets another case immediately who is older, ML Dx?
Post-influenza staph aureus pna (seen in hospitalized, nursing home, IV drug user, CF, pts w/ recent influenza)
When is the sugar water test used?
dx paroxysmal nocturnal hemoglobinuria.
When is bone marrow bx w/ prussian blue staining used?
Sideroblastic anemia
When does basophilic stippling occur?
lead poisoning AND macrocytic anemias AND lots of stuff (its nonspecific!)
What are up LDH levels, MMA levels, and achlorhydria =?
B12 deficiency
What should the initial setting be?
How to change PaCO2?
How to change pO2 (desired range)
set tidal volume (TV) to 6ml/kg pt & FiO2 80%
-PaCO2 affected by TV and respiratory rate
-pO2 (desire 50-60% or below, greater is toxic) affected by FiO2 (normal sea level is 21%) and PEEP. Change FiO2 first, then PEEP
How to tell bronchopleural fistula on CXR?
see air in pleural space! usually following a surgical procedure such as pneumonectomy
What is the underlying cause of lacunar stroke?
What will be seen in CT
small vessel hyalinosis (from HTN)
Pt w/ chronic liver dz.
What immunizations should he get and recs?
Td/Tdap: 1x Tdap and then Td q10yrs
HepA: 2x 6mos apart
HepB: 3x 0,1,4mos
PCP: 1dose, and again in 5yrs (even if under 65)
Influenza: yearly intramuscular
TB pt w/ Hgb 8, MCV 77, Fe hi.
ML Dx?
Findings on blood smear?
Dx tests?
Acquired sideroblastic Anemia
-INH (from RIPES), Alcohol, B6 def, lead poison
-dimorphic RBC pop (hypochromic and normochromic)
-Only microcytic anemia w/ High Fe, most accurate test is bone marrow bx w/ prussian blue stain for ringed sideroblasts (not necessary though)
-Pyrodoxine (B6) supplement
HIV pt w/ red, purple or dark plaques or nodules on skin and oral mucosa.
ML Dx?
Kaposi's Sarcoma