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Features of tabes dorsalis

- neurodegenerative condition that interferes with posterior spinal column and nerve roots
- treponema pallidum infx
- argyll robertson pupils (normal pupillary constriction w/ accomodation but not w/ light)
- sensory ataxia
- lancinating pain
- neurogenic urinary incontinence


late dementia is associated with what dz

alzheimers and vascular dementia


budd chiari syndrome signs sx tx

- ascites on imaging
- severe abdominal pain
- hepatic vein obstruction usually from thrombosis
- young and middle aged women


acute hep b treatment

- supportive measures, unless infected with concurrent hep c, immunosuppression, or severe disease
- then, requires antiviral therapy
-hep b ig and hep b vaccine usually given within 24 hours postexposure


acute to chronic hepatitis progression rates

- if perinatally acquired, then 90%
- for hep b, 5% of adults get chronic
- for hep c, 50%
- infected at age 1-5, 20-50% rate


Causes of long QT syndrome

- meds (diuretics, anti-emetics, anti-psychotics, TCA, SSRI, antiarrthymics, antianginal drugs, anti-infective drugs)
- metabolic disorders (electrolytes, hypothyroidism)
- bradyarrhythmias (SA node dysfx, AV node)
- Others (infection, hypothermia, MI)


torsades de pointes treatment

1. IV mag
2. temporary transvenous pacing


Acute mitral regurgitation causes, sx, heart sound, diagnostic test

causes: mitral valve prolapse, IE, trauma, rheumatic heart dz
- sx: pulmonary edema, cardiogenic shock, pulm HTN--> right heart failure
- descrescendo systolic murmur, silent murmur 50% of the time
- need ECHO


Ehlers Danlos syndrome

- joint hypermobility
- velvety hyperextensible skin
- atrophic scars
- AD


Marfan's syndrome

- pectus carinatum
- increased arm span to height
- aortic root dilation, MVP
- lens dislocation
- spontaneous pneumothorax
- AD


Refeeding syndrome clinical fx

- arrhythmia
- CHF (pulmonary edema, peripheral edema)
- seizures
- wernicke's encephalopathy
- decreased phos, potassium, mg, thiamine, increase in sodium, water retention


hyperthyroidism treatment

- beta blockers if symptomatic
- methimazole, PTU if thyroid storm (fever, AMS, CHF, liver disease)
- surgery/RAI if oral drug therapy fails


thyrotoxicosis in elderly

- neuro: apathy, confusion, tremor, proximal muscle wasting
- CV: afib, tachycardia, HF
- endocrine: proptosis, lid lag, thyromegaly (often absent)
- GI: decreased appetite, constipation


suicide assessment

ideation, intent, plan


when to start antivirals for flu (ostelmavir)

- hospitalization
- less than 48 hours of sx onset
- age over 65 or pregnant
- other high risk medical condition; pulmonary, cardiac


Indications for stress ulcer prophylaxis (PPI)

any 1 factor:
- coagulopathy (low platelets, high INR etc)
- mech vent > 48 hours
- GI bleeding/ulceration in the past year

any 2 factors:
- sepsis
- 1 week ICU stay
- glucocorticoid therapy
- occult GI bleeding > 6 days


presentation of acute ischemic colitis

- pt usually has atherosclerotic disease
- abdominal pain followed by bloody diarrhea (splenic flexure or rectosigmoid jx)
- x-ray/sigmoidoscopy show mucosal edema or mucosal ulceration


How to assess HIV progression

- CD4 count: damage that has already occurred
- viral load: disease activity/ damage that is about to occur


when to start statin therapy

- atherosclerotic disease
- LDL >190
- age 40-45 w/ diabetes
- estimated 10 year ASCVD risk >7.5%


management of symptomatic PAD

1. risk factor management: start statin, antiplatelet therapy, bp, diabetes, smoking cessation
2. exercise program
3. meds: cilostazol
4. revascularization (stents, surgery)


management and treatment of familial adenomatous polyposis (FAP)

- colectomy
- need upper GI endoscopy to see if gastric and duodenal adenomas/carcinomas exist
- nearly all patients get Colon CA by age 45


management and treatment of acute pancreatitis

- check amylase and lipase levels
- look for etiology: lipid test, US for gallstones, calcium levels
- treat with IV fluids (third spacing), pain control
- acute pancreatitis with deterioration after 72 hours needs CT SCAN


when should wounds be left open?

- puncture wounds
- dog bite, cat bite, human bite hand injury


neonatal jaundice presentation normal vs abnormal

- physiologic jaundice presents 24 hours after birth
- coombs negative unconjugated hyperbili in first 24 hours represents hemolysis (G6PD in Af. Am, Mediterranean, Asian male infants as it is X-linked)


HIV treatment in 6 months in treatment naive pt makes how many viral load?

<50 copies


best test for subphrenic abscess?

abdominal ultrasound

- presents with swinging fever, leukocytosis and follows abdominal surgery


Characteristics of porphyria cutanea tarda

- associated with Hep C infx
- painless blisters
- hypertrichosis
- hyperpigmentation


most effective oral contraceptive?

- ulipristal- upto 5 days after unprotected sex
- copper IUD is most effective but contraindicated in acute cervictitis/pelvic infx/ wilson's disease


empiric abx treatment for sexual assault

ceftriaxone (gonorrhea)
azithromycin (chlamydia)
tenofovir-emtricitabine with raltegravir (HIV)
metronidazole (trichomonas vaginalis)


How does fat embolism present?

- 24-72 hours after severe trauma
- triad of respiratory insufficiency, neurologic impairment, petechial rash
- early immobilization and operative fixation of fx reduces its occurrence