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Treatment of syphilis in:
1. primary, secondary, early latent stage (<12 months)
2. late latent stage (>12 months), or unknown, cardiosyphillis
3. neurosyphillis
4. congenital syphillis

1. benzathine penicillin G IM in single dose
2. benzathine penicillin G IM weekly in 3 doses
3. aqeuous penicillin G IV 10-14 days
4. aqeuous penicillin G IV 10 days


What is Jarisch-Herxheimer reaction?

acute febrile reaction within 24 hours of spirochetes treatment -- chills, headaches, myalgia.
innate immunologic reaction to lysis of spirochetes


3 thyroid effects of amoidarone, and treatments related to conditions

- decreased peripheral T4-T3 conversion, clinically euthyroid, no treatment needed. normal to slightly elevated TSH.
- inhibits thyroid hormone synthesis--> hypothyroidism. Give levothyroxine. Increased TSH
- amiodarone induced thyrotoxicosis (AIT)-- depending on type 1 vs 2, antithyroid drugs vs steroids. Low TSH.


Treatment of painful vertebral metastasis in metastatic prostate cancer

- 1 week of antiandrogen (flutamide) followed by LH releasing hormone agonist (leuprolide) to reduce initial symptom flare


Treatment of tinea capitis, diagnosis test?

oral griseofulvin and terbinafine
KOH prep


Pt with HIV presents with fever, blurry vision, headaches, and signs of meningitis. What bug is it? Treatment?

Cryptococcus neoformans (yeast)
- amphotericin B and flucytosine. If improvement occurs, then consolidation and maintenance with fluconazole.
- if meds don't improve, then repeat lumbar puncture to decrease intracranial pressure
*** don't start HAART until 4-10 weeks later for paradoxical worsening of infection


Cryptococcus neoformans meningitis findings in CSF

- elevated opening pressure
- elevated protein, low glucose
- positive india ink presentation/cryptococcal antigen test


What screening tests are needed in patients with Turner's syndrome?

- Echo
- renal ultrasound
- TSH levels
- visual and hearing test


lead poisoning test, management based on levels of lead- mild, moderate, severe

- mild (5-44mcg): no meds, repeat level in 1 month
- moderate (45-69): DMSA
- severe (>70): DMSA+EDTA


Definition of pre-eclampsia

- new onset hypertension >140/90 after 20 weeks gestation AND
- proteinuria OR
- signs of organ damage


Severe features of pre-eclampsia

- creatinine >1.1 or doubling
- thrombocytopenia <100,000
- >160/110
- elevated transaminases
- pulmonary edema
- new onset visual/ cerebral symptoms


Management of pre-eclampsia

- IV mag for seizure ppx
- delivery for term patients
- if bp >160/110, then give IV labetalol, hydralazine or nifedipine PO


HPV indications

-female 9-26
- male 9-21 (upto 26 in MSM)
- immunocompromised individuals 9-26
- NOT indicated in pregnant women


Clinical manifestations of Henoch Schonlein purpura (IgA mediated leukocytoclastic vasculitis)

- palpable purpura, esp in legs and buttocks
- arthritis/ arthralgia
- abdominal pain/intussusceptions
- renal disease similar to IgA nephropathy


Lab findings and treatment of HSP

- normal to increased creatinine
- normal platelet count and coag studies
- hematuria +/- RBC casts +/- proteinuria
- supportive (hydration & NSAIDs) treatment, hospitalization and systemic glucocorticoids for severe sx


How long should varicella zoster virus patients be isolated?

isolate till lesions are crusted


Clinical features of lateral medullary syndrome (wallenburg syndrome)

- vestibulocerebellar: horizontal and vertical nystagmus, vertigo
- sensory: loss of pain and temperature in ipsilateral face and contralateral body
- ipsilateral bulbar muscle weakness
- ipsilateral horner's syndrome, hiccups


Best test to diagnose infantile hypertrophic pyloric stenosis, and what med usage is linked with this disease



Contraindications of MMR

- anaphylaxis to neomycin, gelatin
- severe immunodeficiency
- pregnancy
*** presence of fever after vaccine is ok


Diagnosing acute mesenteric ischemia

- metabolic acidosis
- marked leukocytosis
- hemoconcentration (high hematocrit)
- CT angiogram


harsh holosystolic murmur in 4th intercostal space, palpable thrill. Which cardiac defect causes this?



Which electrolyte imbalance can lead to rhabdomyolysis?



Gold standard for diagnosing nephrolithiasis

- non contrast helical CT scan
- in pregnant patients, u/s is good alternative


When is lung cancer screening recommended? Which test?

- pt age 55-80
- more than 30 years smoking history AND is current smoker or quit smoking in last 15 years
- CT scan of lung


latent TB infection treatment

isoniazid with B6 for 6-12 months


Clinical features of juvenile myoclonic epilepsy and treatment

- myoclonic jerks of upper extremity within first hour of waking
- generalized tonic clonic seizures usually occur in all patients, sometimes concomitant anxiety disorder
- EEG: bilateral polyspike and slow discharge
- tx: valproic acid


Actinic keratosis (usually from sun exposure) treatment, risk of progression to which cancer?

- cryosurgery or by surgical excision
- field therapy if area is large, like 5-fluorouracil cream, topical diclofenac, photodynamic therapy


Screening for gestational diabetes, and target glucose levels

- 2 step oral glucose test:
if 1 hour glucose test of oral glucose challenge of 50g is >140, then 3 hour glucose challenge of 100g
- target: fasting-- <95, 1 hour post prandial <140, 2 hour postprandial <120


what are heberden's nodules?

DIP joint nodules present in OA


Signs of progressive multifocal leukoencephalopathy (PML)? Treatment?

- rapidly progressive focal neurologic deficits (cognitive impairment, hemiparesis, aphasia, ataxia, visual defects)
- JC virus, in late AIDs
- HAART seems to help as treatment