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100 Cards in this Set

  • Front
  • Back
drug of choice to control BP in DM
ACE inhibitors
trastuzumab (Herceptin)
a HER2 monoclonal Ab used to treat HER2 positive breast CA

it is cardiotoxic, so an EKG is recommended prior to starting
medication that alleviates pulmonary HTN the fastest
nitroglycerin, though not used for long term therapy
drugs that can induce pancreatitis
diuretics: thiazides, loops

IBS: 5-ASA, sulfasalazine

seizure: valproic acid

AIDS: didanosine, pentamidine

antibiotics: metro, tetracycline
standing increases what murmur?
stand for the MVP
what do you do if suspecting squamous cell carcinoma lesion?
punch biopsy for dx

if positive then wide surgical excision

if surgery fails, then radio or chemo can be used
cat scratch disease
caused by Bartonella henselae
s/s are local vescular red papular and or nodules with localized regional tender lymphadenopathy

treat with oral azithromycin
sarcoidosis s/s
hilar andenopathy and reticular opacities on CXR, erythema nodosum, anterior uveitis, arthritis
allergic rhinitis vs infectious rhinitis
nasal smear for eosinophils

eosinophilia seen in allergic rhinitis, nasal polyposis (with ASA sens)
a useful indicator of dehydration on lab tests
a increased BUN/Cr ratio
NASH
non-alcoholic steatohepatitis ;risks are obesity, DM, HLD, TPN
due to impaired insulin response leading to fatty liver

pathology is macrovescicular steatosis with PMN infiltrates and necrosis
Xray features of OA
joint space narrowing, subchondral sclerosis, and osteophytes in the MCP and DIP

the PIP is often spared
contraction alkalosis
seen with volume depletion, the RAAS system is upreg to conserve more water at the expense of H+ and K+, so you become alkalotic and hypokalemic

correct with IV NS and K supplimentation
HIV pt with painful swallowing
MCC is candidial infx, so treat empirically with oral fluconazole

failure to respond in 3-5 warrants esophagoscopy with biopsy, cytology, and culture to see if it is HSV or CMV
s/s of viral arthritis
symmetric arthritis

distinguish from RA because viral is acute, lacks iflammatory markers and s/s, and resolves in 2 months
pt with meningococcal meningitis
if they refuse to hosp and isolated, they will be held against their will to prevent spread in the community
use of 2-sample t test
to compare the means of two groups
use of ANOVA
ANOVA is the analysis of variance

used to compare 3 or more means
use of chi-squared test
to compare proportions of data to each other
mgmt of diabetic gastroparesis
improve glycemic control, small and freq meals, and promotility drugs, like metoclopramide, bethanechol, and erythromycin
treatment of v-tach
if stable, use IV amiodarone or lidocaine

if unstable use cardioversion
pain control in cancer pts
start with non-narcotics, but if needed, use short acting morphine then titrate narcotics to contorl pain
heterophile pos infectious mono
EBV, but may be negative early in the illness

s/s are fatique, malaise, sore throat, mac/pap rash, and post cervical LN, splenomegaly is common
dx of DKA
blood glucose > 250

pH < 7.3

serum bicarb < 15
DEXA recommendations
women > 65 or >60 with risk factors (poor Ca, smoking, steroid, alcohol, low BMI, post-menopause)

DEXA -1.5 to -2.5 is osteopenia

DEXA < -2.5 is osteoporosis
DEXA of -1.5 to -2.5
osteopenia
DEXA < -2.5
osteoporosis
colonoscopy recommendations
start at 50, then every 10 years unless polyps are seen

if polyps are seen, repeat every 3-5 years
amiodarone and lung disease
amiodarone can cause pulmonary tox like interstitial pneumonitis, organizing pneumonia, and ARDS

so avoid in pts with preexisting lung disease
cauda equina syndrome (CES)
acute compression with acute motor and sens loss, loss of rectal tone, and urinary retention

it is a surgical emergency

does NOT have to be related to trauma, as it can occur in men with prostate cancer mets to vet column
HCM
hypertrophic cardiomyopathy murmur is harsh systolic at left lower sternal border and decreases with valsalva
MCC of hypercoag disorder
Factor V Leiden
treatment of cocaine induced cardiac ischemia
benzos, nitrates, and aspirin
AIDS HSV retinitis
painful keratitis with peripheral pale lesions and central retinal necrosis
AIDS CMV retinitis
painless retinal vessel hemorrhages or fluffy granular lesions
difference in AIDS retinitis by HSV and CMV
HSV: painful keratitis with peripheral pale lesions and central retinal necrosis

CMV: painless retinal vessel hemorrhages or fluffy granular lesions, usually without keratitis or conjunctivitis
steps in mgmt of esophageal variceal bleeding
1st establish 2 large bore IVs or central line ;control bleeding with endoscopic sclerotherapy or meds like octreotide or somatostatin

if ineffective, use balloon tamponade
recurrent pneumonia in same anatomic location
red flag for cancer, do a chest CT
treatment for adjustment disorder
CBT or psychodynamic psychotherapy
MCC of symptomatic PE
proximal deep leg veins
exam for newly dx cirrhosis
screening endoscopy to detect esoph varices

if found, beta-blockers have been show to decrease risk of hemorrhage
what do do about small, rubbery LNs
if pt is asymptomatic and LN is less than 2cm, just observe

if over 2 cm or pt is symptomatic, biopsy
susceptibility bias
selection bias where disease severity is used to select the treatment regimen
HIV prophylaxis
if CD4 < 100, give TMP-SMX or pentamidine for PCP

if CD < 50, give azithro or clarithromycin for MAC prevention
beta blocker antidote
atropine and IV fluids 1st, if no improvement in BP give glucagon
classic radio findings in osteosarcoma
Codman's triangle and a sunburst appearance
disseminated histoplasmosis s/s and dx
seen in HIV with CD < 100, s/s are fever, weight loss, N/V, cough, SOB, lymphadenopathy

dx with antigen in the urine or serum

treat with itraconazole
treatment of disseminated histoplasmosis
itraconazole

it is better than fluconazole which is only used if the pt can not tolerate itraconazole
nerve damage in diabetic neuropathy is caused by what?
ischemic damage
dx of urinary retention
more than 50mL postvoid residual bladder volume
meds that slow the decline in Alzheimers
reversible anticholinesterase inhibitors like dozepezil, rivastigmine
features, cause, tx of drug-induced interstitial nephritis
fever, rash, arthralgias, hematuria, sterile pyuria, and eosinophiluria

caused by cephalosporins, PCNs, sulfonamides, NSAIDS, rifampin, phenytoin, allopurinol

treatment is to stop the offending drug
Wegner's granulomatosis
has airway and glomerular involvement, and systemic vasculitis that can show as tender nodules, palpable pupura, or ulcerations

dx with c-ANA and elevated CRP

treat with cyclophosphamide
contraindications for bupropion
seizure or eating disorder, or things that predispose to seizures like EtOH or benzo use
malignant melanoma mets
can go ANYWHERE

brain mets are notorious for intracranial bleeding
years for screening for HBV and HCV s/p transfusions
screen for HCV if transfused prior to 1992

screen for HBV is transfused prior to 1986
problem with heparin
HIT (heparin induced thrombocytopenia)

it is a prothrombotic syndrome leading to arterial and venous clots

treatment is d/c of heparin and start direct thrombin inhibitor like lepirudin or argatroban
invasive aspergillosis
usually in immunocomp pts wtih fever, cough, dyspnea, or hemptysis

the cavitary lesion will show pulmonary lesions with a halo sign or air crecent on a chest CT
treatment of ascites
1. Na and water restriction
2. spironolactone
3. loop diuretic
4. paracentesis of 2 to 4 L/day as long as renal function is perserved
known risk factors for pancreatic CA
family Hx, chronic pancreatitis, smoking, DM, obesity, and a high fat diet

NOTE: alcohol is NOT a proven risk factor
HIV pt with bloody diarrhea, suspect what?
CMV colitis

colonoscopy will show mulitple ulcers adn mucosal srosions

treat with ganciclovir, 2nd line is foscarnet
how to dx OSA
obstructive sleep apnea is charact by snoring, daytime sleepiness and apneic episodes

increases risk for HTN, heart disease, cor pulmonale ;;dx with nocturnal polysomnography
coag change in nephrotic syndrome
become hypercoag due to urinary loss of ATIII, altered lvls of protein C and S

renel vein thrombosis is most freq manifestation
nephrotic syndrome charact
proteinuria > 3.5g/day

hypoalbuminemia

edema

hyperlipidemia
meds that can shift K into cells
insulin, glucose, Na bicarb, and beta 2 agonist
TCA overdose
CNS depression, hypotension, dilated pupils, hyperthermia, intestinal ileua, QRS elongation

treat by ABCs then administer NaBicarb
MEN 2a
from the RET gene and is autosome dominatnt

has medullary thyroid CA, pheochromo, and primary parathyroid hyperplasia
MEN 2b
from the RET gene and is autosom dominant

has medullary thyroid CA, pheochromo, and mucosal neuromas
SE of high dose Beta2 agonist in asthma treatment
the beta2 can push K into cells, so high doses can lead to hypokalemia that manifest as muscle weakness, arrhythmias and EKG abnormalities

other SE of beta agonists include tremor, palpitations, and headache
MCC of cirrhosis
chronic alcohol abuse and viral hepatits

suspect and question both in pt with new ascites and pedal edema
thrombocytopenia in HIV
thrombocytopenia is the initial presentation of HIV in upto 10% of pts, so a generally healthy pt with no other findings except for thrombocytopenia should be screen for HIV first.
heart sound heard in the setting of acute MI
ischemic damage from MI can lead to diastolic dysfunction and a stiffened ventricle, leading to an atrial gallop heard as an S4
SE to look for in beta blockers
in susceptible people, like asthamics, beta blockers can cause bronchoconstriction and cause wheezing and dyspnea
what to do with new diastolic and continuous murmurs
investigate with echo ;also investigate loud systoloc murmrs

midsystolic murmurs in asymptomatic young pts need no further workup
aspirin sensitivity syndrome
people with susceptibility have a psuedo-allergic rxn with aspirin and can present with bronchoconstriction and nasal polyps

this is due to accumulation of leukotrienes

treat with avoidance of NAIDS and use leukotriene receptor antagonists
testing to be done in person with rapidly progressing virilization
sugestive of hyperandrogenism, test serum testosterone and DHEAS

elevated testosterone with normal DHEAS indicates ovarian source

elevated DHEAS with normal testosterone indicates adrenal source
desired pO2 in ARDS on vent
50-60%

this is adjusted by adjusting the FiO2
factorial study design
study that randomizes different interventions by looking at least 2 variables
Bartter's syndrome
seen as hypokalemia, metabolic alkalosis, normal BP, and elevated urine chloride conc

caused by defect in Na reabsorption in the thick ascending loop
increased BP with renal bruit
renal artery stenosis
in older pt it is due to athromatous plaque
in younger pt it is caused by fibromuscular dysplais

treatment is percutaneous angioplasty with stent placement
risk of IV acyclovir
as used in HCV encephalitits, it can crystallize in the urine

treatment is aggressive IV hydration that will help increase the solubility
serous otitis media
no infection present, due to middle ear effusion from obstructing lymphadenopathy

exam will show dull TM that is hypomobile
renal disorders
x
type 4 RTA
x
cerviofacial actinomycosis
indurated mass with multiple abscesses and draining tracts with sulfur granules

treatment is high dose IV PCN for 6-12 weeks
tangential vs circumstantial thought process
seen with disorganized schizos,

tangential will leave topic totally

circumstantial will leave topic but eventually return
Osler-Weber-Rendu syndrome
autosomal dominant disorder with diffuse telangiectasias, recurrent epistaxis, and AVMs

the AVMs lead to hemoptysis and increased HCT
what to do first with high suspicion of PE
start heparin protocol 1st

imaging can wait
drug of choice for inpt CAP
levoflozacin or moxifloxacin

cipro does not have that good coverage

for inpt, use aithro or doxy
what can soften S1 s/p MI
mitral regurg due to papillary muscle rupture
cosyntropin
an analog of ACTH used for stimulation screening test in suspected primary adrenal insufficiency (Addison's)
s/s of cerebellar hemorrhage
ataxia, n/v, occitpital HA, gaze palsy, and facial weakness

NOTE: there is NO hemiparesis
treatment of sarcoidosis
if symptomatic, treat with glucocorticoids
MCC of painless hematuria in adults
bladder cancer
indications for hypothyroid test on lab results
HLD, hypoNa, and elevated serum muscle enzymes
what happens to lipids in hypothyroid pts
hyperlipidiemia, often increase in LDL but can also have an increase in tri's
what to look for in pt with increased PaCO2
alveolar hypoventilation
viral arthritis
symmetric small joint inflam arthritis that usually resolves in 2 months

note that RA can be pos and ANA can be weakly positive

treat with NSAIDS
formula to correct Ca lvl with albumin values
corrected Ca = 0.8(normal albumin - measured albumin) + measured Ca

4.0 is used for normal albumin, so formula is:

Corr Ca = 0.8(4-albumin)+Ca
TCA overdose and the QRS
TCAs can prolong the QRS and lead to arrythmia

giving NaBicarb will increase the extracellular Na conc leading to shortening of the QRS