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Treatment of nongonococcal urethritis (watery discharge, dysuria, absence of bacteria)

azithromycin or doxycycline if chlamydial
if these don't respond, then try metronidazole as it can be trichomonas
(**ceftriaxone for gonococcal urethritis)


Gold standard test for HIT, and when to start warfarin in HIT

- serotonin release assay
- after treatment with non-heparin anticoagulant and platelet counts improving upto >150,000


Treatment of HELLP (hemolytic anemia, elevated liver enzymes, low platelet count) syndrome in severe pre-eclampsia

magnesium sulfate infusion


Diagnostic test to confirm organophosphate poisoning

RBC cholinesterase activity test


Reactive arthritis (asymmetric oligoarthritis, uveitis, urethritis, keratoderma blenorrhagica), usually occurs after genitourinary/GI infection, diagnostic test?

- synovial fluid shows elevated WBC but no bacterial culture


Treatment of iodine induced thyrotoxicosis (extreme fatigue, weight loss, palpitations after imaging)

- usually self limiting
- beta blockers for mild symptoms
- antithyroid drugs for moderate to severe sx
- potassium perchlorate for refractory cases


Management of flail chest ( tachypnea, tachycardia, shallow breathing, inadequate ventilation, double rib fx in more than one site, paradoxical/segmental chest movement )

- oxygen
- pain control
- positive pressure ventilation
- surgical stabilization


Treatment of mild to moderate psoriasis? psoriatic arthritis (DIP involvement, presents a lot like RA otherwise)?

- topical glucocorticoids or vitamin D derivatives (calcipotrieine)
- if systemic, need methotrexate


when to give oral metronidazole vs oral vanc for c.diff. When do you give IV metronidazole?

- give oral vanc if WBC >15000, creatinine greater than 1.5x of baseline, or serum albumin <2.5 or temp >100.9
If there is ileus, then give IV metronidazole or rectal vanc


Centor criteria for streptococcal pharyngitis: strep testing recommended if two or more criteria met, but if one or no criteria met, then sx treatment and no test

1. tonsillar exudates
2. tender anterior cervical lymphadenopathy
3. fever
4. absence of cough


Treatment for toxic megacolon

- in presence of pneumoperitoneum: surgery
- in absence: steroids if negative for c.diff, and appropriate abx
- avoid 5 ASA and opioids


Asymmetry in a funnel plot suggests what kind of bias?

publication bias


Screening test for hemochromatosis ( central hypogonadism, liver dysfunction, DM, arthropathy, skin pigmentation, hook-like osteophytes on x-ray)? Gold standard?

- serum iron studies- transferrin saturation
- gold standard: liver biopsy


Managing sexual SE related to SSRI (decreased libido, delayed ejaculation etc)

- switch to mirtazapine or buproprion
- adjunctive therapy with sildenafil


Complications of MI

- acute pericarditis (1-4 days): pericardial friction rub, pain changes with position and deep inspiration
- chordae tendinae (2-7 days): acute hemodynamic instability, pulmonary edema
- dressler's syndrome (weeks to months): autoimmune mediated syndrome, fever, leukocytosis, pleuritic chest pain, pericardial rub


Treatment of acute pericarditis

high dose aspirin, close obs


Initial management of postpartum hemorrhage (mostly caused by uterine atony)

- fundal massage
- uterotonic medications-oxytocin
- fluid resuscitation
- transfusion
-- if none of these help, then US, etc


Best lab test to assess thyroid function after RAI treatment?

total T3 and T4 levels


Abnormal lab levels associated with TURP



Contraindications of vaccines in HIV patients

- live vaccines (MMR, zoster, varicella) are contraindicated if CD4 counts <200.


Clinical features of acute retroviral syndrome/ HIV infection

- thrombocytopenia, leukopenia
- low grade fever, fatigue, maculopapular rash on face, trunk, extremities
- headache, lymphadenopathy, pharyngitis
- myalgias, arthralgias
- GI sx, night sweats, oral ulcers/thrush


Clinical features of subacute thyroiditis (inflammatory damage to thyroid follicles lead to release of stored thyroid hormones) and diagnostic testing, treatment?

- fever, hyperthyroidism sx
- painful, tender goiter
- elevated ESR and CRP
- low radioiodine uptake
- treatment: supportive, NSAIDs and beta blocker


most common causes of fever of unknown origin

1. connective tissue disease
2. infectious disease
3. malignancy


Management of acute back pain

1. no red flags, sciatica or cord compression: conservative therapy
2. red flags or sciatica/no improvement from PT: x-ray and ESR
3. cord compression/abnormal x-ray and ESR: MRI


Clinical features of MS and diagnosis test?

- optic neuritis (monocular vision loss and pain)
- transverse myelitis (UMN signs below lesion)
- internuclear ophthalmoplegia, numbness, parthesia, heat sensitivity, motor paraparesis, bowel/bladder dysfx
- diagnostic test: MRI (periventricular white matter region), lumbar puncture (oligoclonal bands or increased IgG) if equivocal


Treatment of MS, in presence of optic neuritis? chronic management meds? MS related fatigue?

- IV corticosteroids, as oral can promote recurrent optic neuritis
- plasmapheresis if refractory to steroids
- chronic management: disease modifying drugs-- beta interferon, glatiramer acetate
- MS related fatigue: amantadine


Clinical features of Addison's disease/adrenal insufficiency, diagnostic test

- weight loss, abdominal pain, asthenia
- decreased axillary and pubic hair
- increased pigmentation
- muscle tenderness
- hyponatremia, hyperkalemia, hyperchloremic metabolic acidosis
- ddx test: cosyntropin (synthetic ACTH) test with cortisol and ACTH levels


Hyperaldosteronism (hypertension, hypokalemia, metabolic alkalosis) diagnostic test and treatment

- ddx: low renin, hypertension, elevated aldosterone level. Confirm with CT scan of adrenal glands
- treatment: solitary adenoma-- surgical resection
hyperplasia-- spironolactone


Congenital adrenal hyperplasia has what lab characteristics, treatment?

- elevated ACTH
- low aldosterone and cortisol levels
- tx: prednisone


Paget's bone disease (pain, stiffness, aching, fx, bowing of the tibias, osteolytic lesion, normal calcium and phosphate levels) treatment and diagnostic test

- tx: bisphosphonates (alendronate) and calcitonin
- best initial test: alkaline phosphatase level
- most accurate test: x-ray