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septic shock management

- fluid resuscitation to CVP of 8-12
- vasopressors if MAP <65 after fluids


What is immune reconstitution inflammatory syndrome?

paradoxical worsening of pre-existing infections in HIV positive individuals days to week after starting HAART treatment.
- self limited


Secondary causes of restless leg syndrome?

- iron deficiency anemia
- diabetes
- uremia (ESRD, CKD)
- MS, parkinsons
- pregnancy
- drugs (antidepressants, metoclopramide)


features of lumbar spinal stenosis?

- worsens with extension, improves with flexion
- pain decreases with sitting down
- diagnosed with MRI


what is kappa statistic?

-inter rater reliability


what is validity?



long term management of chronic hypoparathyroidism

- add a thiazide to increase serum calcium and decrease urinary calcium
- PTH increases renal calcium absorption


PMDD/PMS treatment

- first line: SSRI
- 2nd line: another SSRI or estrogen-progesterone oral contraceptive
- benzo and other GnRH agonist may be effective but has SE


Management of GBS

- intubation and mechanical respiration due to respiratory failure
- plasmapheresis and/or IVIG therapy


criteria for ARDS

- new or worsening resp sx in past week or w/i 1 week of clinical insult
- b/l lung opacities consistent with pulm edema
- no signs of cardiac failure or fluid overload
- ECHo needed for definite exclusion
- PaO2/FiO2 ratio <300mmHg


Sx and treatment of RA

- symmetric polyarthritis (MCP, PIP) with morning stiffness >30 min
- First line tx: NSAIDS
- DMARDS: antimalarials, sulfasalazine, methotrexate, azathioprine to slow down bone erosion
- RF only positive in 70-80% of ppl, it's a CLINICAL ddx
- CCP another marker


Sx of SLE

- migratory morning stiffness that lasts minutes
- manifestation in skin and kidneys and msk
- anti ds DNA


Cardiogenic shock hemodynamic parameters

- low cardiac index (normal 2.8-4.2)
- elevated pulmonary capillary wedge pressure (normal 9)
- elevated SVR


Signs of pulmonary artery hypertension, and best ddx test

- loud S2
- enlarged pulmonary arteries
- right axis deviation EKG
- raynaud's phenomenon
- ECHO as initial test


tx of PAH

- bosentan (endothelin inhibitor)
- epoprostenol and treprostinil (prostacyclin analogs)
- sildenafil


Management of cocaine induced chest pain

- first line: benzo to help with anxiety
- second line: phentolamine if benzo fails
- alternatives: nitroprusside, nitroglycerin
- avoid bb to avoid coronary vasospasm


features and tx of primary dysmenorrhea

- presents in first 6-12 months of period, normal physical exam
- elevated levels of prostaglandin
- tx: first line is NSAIDs, then OCP


HPV vaccination timeline and contraindications?

- first dose at age 11-12, 3 doses in 6 month period
- hx of prior sexual activity, previous HPV infection, immunosuppression, abnormal pap smear are NOT contraindications
- hypersensitivity to yeast IS contraindication


features and treatment of primary billiary cirrhosis

- unexplained pruritis and elevated alk phos
- progressive cholestasis and liver failure
- HLD with xanthomas
- antimitochondrial antibodies
- tx: ursodeoxycholic acid and liver transplantation
- cx: osteoporosis, osteomalacia


symptoms of serotonin syndrome

- mental status changes
- autonomic dysregulation
- neuromuscular hyperactivity (hyperrflexia, myoclonus, ocular clonus)
- cause: combined use of SSRI and MAOI (eg phenelzine); need 5 week wait period


risk factors, sx and tx of candida endophthalmitis

- central venous catheter, TPN, broad spectrum abx, abd surgery, IV drug use, steroids, neutropenia
- ocular pain, scotomas, photophobia, fever
- vitrectomy and antifungal (amphotericin B or fluconazole)


treatment and cx of beta thalassemia major

- hypertransfusion regimen
- iron overload and resultant organ damage


Risk of hepatic adenoma with use of OCP in women

Stop OCP due to risks of sudden rupture with infra-abdominal bleeding and malignant transformation


Features of Rocky Mountain spotted fever and treatment

5-7 days after tick bite, low fever, lethargy, myalgia, petechial rash in ankles and wrists, spreads to palm soles and body.

TX: doxy is first line, chloramphenicol is alt option.

clinical diagnosis, no need to wait for confirmatory test


Treatment of salicylate overdose (metabolic acidosis)

Gastric lavage
Administration of activated charcoal
Alkalization of urine to enhance secretion


Management of dyspepsia in:
1. pt with GERD sx
2. NSAID/cox2 use
3. no meds use, no alarm sx and above 55
4. no meds use but alarm sx

1. empiric tx, acid suppression
2. empiric tx, acid suppression, d/c meds
3. endoscopy
4. endoscopy

test for h.pylori only in high risk population (asia, eastern Europe, latinos)


what is parinaud's syndrome, and what tumor is it associated with?

- loss of pupillary reaction, vertical gaze paralysis, loss of optokinetic nystagmus, ataxia
- pineal tumor- some are germinomas, can produce HCG


Side effects of amiodarone

- thyroid dysfunction--> thyrotoxicosis
- corneal deposits
- skin discolorations
- pulmonary fibrosis
- liver toxicity


How does glucagonoma present?

pancreatic tumor associated with mild diabetes and classic skin rash that clears in the center, "necrolytic migratory erythema"


Most common cause of hemoptysis?

Pulmonary infections
- bronchitis
- bronchiectasis (mucopurulent sputum production, recurrent infection)
- lung cancer
- PE