9 ⼀RENAL/UROLOGY/ID II Flashcards

Question

Dx for Rhabdomyolysis (2)

Answer 1

[⊕gross blood on UA]^{*(2/2 [hgb lab test's] cross reactivity with myoglobin)*} *but* [**⊝RBC** actually seen on **Umicro**]^{*(indicates ⊕UA likely from presence of myoglobin^{which → rhabdomyolysis dx})*} | rhabdoM dx= {[⊕blood_UA] but [⊝RBC_UMicro]}

Answer 2

[(most common: chronic HepC) vasculitis] that involves [polyclonal IgG and (Rheumatoid Factor IgM)] depositing in vascular walls of small & medium vessels ➜ [**P**AW-**C**^PR-**G**^NC] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dx = ⇪ serum cryoglobulins *MIXED **PCG**!*

Answer 3

[(most common: chronic HepC) vasculitis] that involves [polyclonal IgG and (Rheumatoid Factor IgM)] depositing in vascular walls of small & medium vessels ➜ [**P**AW-**C**^PR-**G**^NC] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *MIXED **PCG**!* Tx = [Immunosuppressants (CTS/rituximab)] ➜ [treat underlying cause (common HepC]

Answer 4

*Mixed* = *[Type 2 vs Type 3]* = [(**chronic HepC** > chronic HBV|autoiummune) ] --> [B cell hyperactivation] --> {*mixed* [polyclonal IgG and (Rheumatoid Factor IgM)] Immune Complex} depositing in small & medium vasc walls ➜ [**P**AW-**C**^PR-**G**^NC] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ sx: MIXED **PCG**!

Answer 5

MIXED **PCG**! **PAW C**PR **G**NC ***P**alpable purpura \*\** ***A**rthralgias \*\** ***W**eakness Fatigue \*\** **C**omplement is low **P**eripheral neuropathy [**R**heumatoid factor IgM elevated] [**G**lomerulonephritis (RBC cast, RBC, prOteinuria)] **N**ausea **C**hronic H*C*V

Answer 6

[Renal parenchymal disease] ; Glomerulonephritis (nephritic or nephrOtic) can ➜ secondary HTN because of INC renal Na+ reabsorption

Answer 7

[**⊕gross blood** *on UA*] but also has [**⊝/min actual RBC** *on UMicro*] = (indicates *myoglobinuria* instead of *hgburia*) | rhabdoM dx= {[⊕*gross*🩸_*UA*] but [⊝RBC_*UMicro*]}

Answer 8

MUSCLE INJURY ➜ release of intracell components of muscle cell ([CPK \> 10K] & [myoglobin ➜ AKI]) *tx = aggressive IVF to prevent intratubular cast formation* | rhabdoM dx= {[⊕blood_UA] but [⊝RBC_UMicro]}

Answer 9

* [OAIP- Orthostatic adolescent isolated prOteinuria] = most common cause of teenage prOteinuria * exaggerated [angiotensin II] response to upright posture (especially during day when pt stands more) ➜ ⇪ GFR ➜ prOteinuria \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Split 24H urine collection (12H Day + 12H Night)] ⼀*demonstrating elevated prOteinuria during Day but normal at night* ]

Answer 10

NOTHING! *self limited with age*

Answer 11

▶poor volume regulation ➜ pressure overload ➜ Chronic Systemic HTN ➜ concentric LVH ▶CKD ➜ anemia ➜ myocardial hypoxia/necrosis/fibrosis ➜ compensatory remodeling ➜ Eccentric LVH

Answer 12

Epoetin | darbEpoetin ; [CKD's severe anemia hgb\<10] ▶ hgb\<10

Answer 13

Epoetin | darbEpoetin ; [CKD's severe anemia hgb\<10] ▶ hgb\>13

Answer 14

Epoetin | darbEpoetin ; [CKD's severe anemia hgb\<10] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 15

1. Neuro (*stroke, hemorrhage, trauma*) 2. Lung (*PNA, SOLC*) 3. Somatic (*Pain, Nausea*) 4. Meds (*SSRI, Carbamazepine, Valproate, NSAIDs*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = [fluid restriction +/- salt tablets]*

Answer 16

*ACUTE* SEVERE PROTEINURIA on AiN_AKI \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *NSAIDs inhibit prostaglandin production (prostaglandins preferentially vasoDilate Afferent arteriole ➜ ⇪ GFR) = [NSAIDs ultimately➜ DEC GFR] and NSAIDs directly cause AiN*

Answer 17

*ACUTE* SEVERE PROTEINURIA on AKI \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶NSAIDs inhibit prostaglandin production (prostaglandins preferentially vasoDilate Afferent arteriole ➜ ⇪ GFR) = [NSAIDs DEC GFR]👎🏾 ▶▶NSAIDs also directly cause AiN

Answer 18

**CLag** 1. ⬆︎**C**oagulation^{from loss of AT3 (MOST COMMON WITH MEMBRANOUS NEPHROPATHY)} 2. ⬆︎**L**ipidemia ^{-->loss of lipoproteins = [Fat oval body Maltese crosses] in urine} 3. ⬇︎**a**lbumin 4. ⬇︎**g**ammaglobins ^{--> infection}

Answer 19

**CLag** ⬆︎**L**ipidemia from loss of lipoproteins

Answer 20

1. ⬆︎ K+ 2. ⬆︎Mg 3. ⬆︎H+ 4. ⬆︎ Phosphate \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 5. DEC Ca+

Answer 21

**NARCO** ## Footnote 1. **N**SAIDs 2. **A**mphotericin B 3. **R**adiocontrast (*also causes oxidant injury*) 4. **C**yclosporine 5. tacr**O**limus

Answer 22

[muddy Brown Granular Cast] = **A**cute **T**ubular **N**ecrosis

Answer 23

RBC Cast = [Acute Glomerulonephritis_*nephritic*]

Answer 24

WBC Cast = **AiN** (Acute _*allergic* **i**nterstitial nephritis) or Pyelonephritis

Answer 25

1. [mBGC^{muddy Brown Granular Cast}] 2. [RTEC/C ^{(Renal Tubular epithelial cells/cast)}] 3. Hematuria

Answer 26

[Sterile _**WBC** Pyuria] *plus* [^{*Eosinophilic*}**WBC Cast**]

Answer 27

1. [Hematuria *dysmorphic RBCs*] 2. Proteinuria 3. **[RBC Cast]** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *These pts will also have HTN*

Answer 28

1. [Hematuria *dysmorphic RBCs*] 2. Proteinuria 3. **[Fatty *O*val*B*ody cast]**

Answer 29

Waxy broad cast

Answer 30

1. **DEC renal EPO** 2. **[IDA_fn2/2 ACD]** ⼀ [*Chronic Disease (CKD)]➜ inflammation ➜ INC hepcidin ➜ prevents macrophages from releasing iron into plasma ➜ iron sequestration = [inadequate iron stores (low ferriTin)]due to ACD* 3. **[IDA_fn 2/2 ESA mismatch]** ***⼀**occurs when, despite nml iron stores, there's still not enough iron to keep up with the accelerated erythropoiesis from ESA* 4. **Uremia** ⼀➜ DEC RBC lifespan \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [IDA_functional(nml ferriTin)] / [IDA_ABSOLUTE (low ferriTin)] / ESA=Erythropoietin Stimulating Agent

Answer 31

Gestational complications \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(preeclampsia, gestational DM, gestational HTN) = women should complete child bearing prior to donating kidney*

Answer 32

1-2 weeks after [Strep _{or Staph} infection] immune complex deposit in the [glomerular Basement Membrane _{*subepithelium*}] ➜ permitting protein and RBC to cross into urine^{*= [AGN _nephritic_]*} ➜ prOteinuria^{*→ edema, HTN*} and hematuria^{***→ RBC cast***}

Answer 33

glomerular hyperfiltration \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ DM-related hormonal mediators cause renal afferent vasoDilation and efferent vasoconstriction ➜ [⇪ GFR^{(glomerular hyperfiltration)}] --(over time)--\> glomerular sclerosis = Diabetic Kidney Disease *ACEk2 inhibitors and ARBS ⬇︎Angiotensin (which normally vasoconstricts efferent arteriole) ➜ efferent arteriole vasoDilation ➜ ⬇︎ GFR and prevents DKD*

Answer 34

**DECOMPRESS UPPER URINARY TRACT** BY **DRAINING THE HYDRONEPHROSIS** (proximal to the ureteral stone ) *via Percutaneous Nephrostomy* *\> retrograde ureteral stent* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *any [complicated ureterolithiasis] = a/w infxn, AKI, severe pain, hydronephrosis or failed initial tx] ➜ [Proximal Ureteral Decompression by PQ Nephrostomy]*

Answer 35

1. indicated for **UNCOMPLICATED** proximal ureteral stones 2. does not immediately relieve obstruction 3. = *complicated* ureterolithiasis (unstable/infection/AKI) must first have [Proximal Ureteral Decompression via PQ nephrostomy] before having Shock wave Lithotripsy

Answer 36

[ α1🟥 ] ; [small \< 10 umm]

Answer 37

*(see image)* ## Footnote **C**_{lostridioides} **D**_ifficile **I**_nfection *GRADE 1 = initial presentation = CDI^Tx_A* 1. [**C**diff ⊕stool test ^{*+/- RF*}] 2. [ **D**iarrhea WATERY x ≥3 per day] 3. [ **I**ntestinal abdP] *GRADE 2 = severe CDI^Tx_A* *GRADE 3 = Fulminant CDI^Tx_A* *GRADE 4 = REFRACTORY CDI^Tx_B* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{Tx_A = {[(fidaXomicin PO^10d) or (Vancomycin PO^10d)] --*if fail*--> (PO metro)}
Tx_B: [fecal microbiota transplant | Surgery]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *🔎abdP = abdominal Pain*

Answer 38

-watery diarrhea -[weight loss (2/2 malabsorption)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tinidazole (or nitaZoxanide) *non-inflammatory diarrhea = negative fecal leukocytes*

Answer 39

***C**ellulitis **C**an **B**e **D**ecreased **V**ia **P**ipTazo* ## Footnote 1. **C**lindamycin \*\* 2. **C**ephalexin 3. **B**actrim 4. **D**oxy 5. **V**ancomycin 6. [**P**iperacillin/Tazobactam (PipTazo)]

Answer 40

1. **CLINDAMYCIN** 2. [amox/clav] 3. [amox/metronidazole]

Answer 41

[ROC mucormycosis] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *ROC: Rhino-Orbital-Cerebral*

Answer 42

DKA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [(Amphotericin B_{Liposomal IV}) + surgical debridement]

Answer 43

cryptococcus neoformans *cutaneous* *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* USUALLY IN CD4 \< 100 AND IS MARKER OF DISSEMINATED DISEASE

Answer 44

[widespread papules containing central umbilication & central hemorrhagic necrosis] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**BIOPSY** of lesion revealing hyperplasia of dermis overlying granulomas with encapsulated yeast]

Answer 45

[Chagas Heart Disease] ; [Trypanosoma Cruzi *protozoa*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **[L Vt apical aneurysm]** ***in the absence of coronary disease*** 2) [HF (R\>L)] 3) Mural thrombosis 4) [Conduction ∆ 2/2 fibrosis (*complete heart block/VT*)] 5) Dilation of Esophagus 6) Dilation of Colon

Answer 46

1. [Active TB infection] can transmit Mycobacterium Tuberculosis to close contacts starting 3 mo **before** sx onset = Healthcare Personnel are at risk! 2. exposed HCP should receive [TST or IGA] screening 3. --(if negative)--\> Repeat [TST or IGA] in 8 weeks 4. --(if positive)--\> [CXR and Sx review] to determine ATBI or LTBI. 5.- ATBI = confirm with sputum mycobacterial *acid-fast* if + ➜ ATBI tx if *neg ➜ LTBI tx

Answer 47

[⊕ TST/IGA] [NO sx^{(cough>3mo, wt loss, night sweats, fever)}] [NO CXR findings^{(cavitation/infiltrate)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *determine LTBI tx using susceptibility from the initial TB source*

Answer 48

[⊕ TST/IGA] PLUS [⊕TBSx (cough\>3 mo, wt loss, night sweats, fever)] and/or [⊕ CXR (cavitation/infiltrate)]

Answer 49

[RIPE]² ➜ [RI]⁴ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *RIPE = Rifampin/Isoniazid/Pyrazinamide/Ethambutol*

Answer 50

***1st line:*** **[( Ri ) qd]³** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * 3 LTBI tx Alternatives: (see image)* * determine LTBI tx using susceptibility from the initial TB source*

Answer 51

( [RIE² ➜ RI⁷] + [Pyridoxine B6] ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3-DRUG THERAPY (**RI**P**E**) * [2 mo RIE"Ree2"] ➜ [7 mo RI"Ry7"]* * pregnant women with ACTIVE TB should be treated*

Answer 52

> *\>15 mm* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote *pts below only require > 5 mm induration:* 1. HIV⊕ 2. Transplant recipient⊕ 3. Immunocompro 4. [⊕ Recent TB exposure] 5. [⊕CXR ^{*showing fibrotic ∆ c/f TB*}]

Answer 53

> *\>15 mm* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote _{*pts below only require > 10mm induration:*} 1. [kids < 4 yo] 2. [_{*HIGH RISK*}personnel ^{*healthcare|jail|homeless shelter*}] 3. [recent immigrant from TB_country] 4. IVDA

Answer 54

*\>15 mm ; 48h* *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* ⊕LTBI *⊕[Latent TB infection] = pt has been exposed to TB sometime in the past and was never treated ➜ (non-infectious) [Latent "dormant" TB infection]*

Answer 55

HIV \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[HIV p24 antigen] and [HIV-1 / 2 Ab screen]*

Answer 56

**REC** the MAC **R**ifambutin **E**thambutol **C**larithromycin

Answer 57

**KEEP** away, UTI! **K**lebsiella **E**.Coli **E**nteroCoCCus **P**roteus

Answer 58

**Droplet** precaution \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ UNTIL NEISSERIA MENINGITIDIS IS RULED OUT! ## Footnote _{“**BANGIR** needs to *drop* what he's doing and don a *basic facemask*, right now!”}

Answer 59

**B**-**E**-**L*****^ag*****^|*****^a🅇*** ***^{_________________}*** [Amp/Gent*_{(any aminoglycoside)}*] or [Amp/cefoTA🅇ime]

Answer 60

**B**-**E**-**L** _ag|a🅇 ## Footnote _{[Amp/Gent*_{(any aminoglycoside)}*] or
[Amp/cefoTA🅇ime]}

Answer 61

**B**-**E**-**H**-**N**-**S*****^VX*** ***^{_________________}*** [**V**anc + (CefTria**X**one | cefoTa**X**ime)]

Answer 62

**B**-**E**-**H**_flu-**N**-**S***^VX*

Answer 63

**H**-**N**-**S*****^VX*** ***^{_________________}*** [**V**anc + (CefTria**X**one | cefoTa**X**ime)]

Answer 64

**H**_SV-**N**-**S***^VX*

Answer 65

**A**-**N**-**S**-**L*****^VAXS*** ***^{_________________}*** **V**anc + **A**mpicillin + [(CefTria**X**one | cefoTa**X**ime))] + [**S**teroids CTS]*^{(Dexamethasone) ⬇︎ hearing loss and death a/w Strep Pneumo}*

Answer 66

**A**-**N**-**S**-**L***^VAXS*

Answer 67

[year ([DM1: starts 5y after dx] / [DM2: starts 1y after dx])] [Urine a/c ratio] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [\<30 mg/day] ; * * * [30-300 mg/day] ; [\>300 mg/day] *a/c: albumin/creatinine*

Answer 68

> *a.* Morphine undergoes 2-step metabolism-- > > 1st: catabolism into {*m3G* and [*m6G(MORE POTENT)]}* > > 2nd: both kidney excretion b. Kidney dysfunction→ DEC kidney excretion → accumulated ***m******6******G*****→** [INC risk OPIOID TOXICITY/OD (especially if postop)] * * * * m6G: [morphine-6-glucuronide]*

Answer 69

INC; [urine recombinant EPO]; 1. Hyperviscosity (HA, visual ∆ ) 2. Thrombosis (MI, CVA/TIA)

Answer 70

▶[Proteus mirabilis and Klebsiella Pneumoniae] produce Urease which hydrolyzes [urea → Ammonia] ▶▶[Ammonia alkalinizes urine pH\>8] → precipitates crystallized [MAPS *kidney stones*] ▶▶▶ MAPS exposed to lrge amounts urea rapidly expand → [STAGHORN CALCULUS (*also seen with uric acid & cysteine *kidney stones*)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *MAPS: Magnesium Ammonium Phosphate Struvite*

Answer 71

**[*****MAPS*****LARGE KIDNEY STONE****]** that fills entire renal pelvis → unable to pass in ureter = [severe colicky flank pain + fever + dysuria] ## Footnote * * * COMPLETE REMOVAL + abx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *MAPS: Magnesium Ammonium Phosphate Struvite*

Answer 72

[**spontaneous _←_** *4*_mm--**(R_x*****PASS*****)**--*10*_mm _→_**Surgical**] R_{x =}[**P**ain control, {**A**lpha R blockers}^4w, **S**train urine, **S**olvent(IV Hydration)]

Answer 73

a. ≥10mm b. uncontrolled pain c. ⊕AKI d. ⊕UTI e. [no stone passage in 4-6 wks]

Answer 74

▶Acute Urinary Retention 2/2 [bladder outlet obstruction (INC Risk with [Rx: baclofen/anticholinergics], GU trauma, UTI)]⁽*^{dx confirmed via bladder US > 300cc}*⁾ * * * ▶Bladder decompression [Catheterization (**URETHRAL**_{(if no GU trauma)} → suprapubic*_{(if urethral unsuccessful)}*)]

Answer 75

[**DKA**^{*(likely 2/2 poorly controlled DM)*}] ; *rapid…* 1. nasal necrosis 2. facial swelling 3. fever 4. HA 5. sinusitis *rhino-orbital-cerebral*

Answer 76

[**ALBUMIN**-Ca+]^45% \> [**FREE ionized** Ca+]^40% \> [**anion*****_(O&iO)-***Ca+]^15% \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ serum Ca+ concentration DEC by 0.8 for every DEC of 1 by Albumin = {[Albumin ⬇︎ 1] = [Ca+ ⬇︎0.8]} * * * * [O&iO: Organic&inOrganic] | [Albumin]g/dL | [Calcium]mg/dL*

Answer 77

“⇪^{**F**luids **P**lus **C**itrate}|⼀**C**an⼀ | ⬇︎_{**O**verall **A**gonizing **S**tones*|} _{*💊r Take Pills*}” _🍴(^{⇪ FPC}🄲 _⬇︎OAS)^{🆚 _💊TP} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ⇪ [**F**luids > 2L urine/day]^{(INC urine flow/DEC urine concentration)} ⇪ [**P**otassium_citrate^{*available via🍌and💊*!}]^{(INC urinary Citrate → binds urinary Ca+ → DEC Ca⁺ kidney stone formation)} ⇪ [**C**itrate fruits/vegetables]^{(binds urinary Ca+ → DEC Ca⁺ kidney stone formation)} \_\_ \_\_ \_\_ _(maintain)⼀ [^dietary**C**alcium intake 1200 mg/day]^{([GI dietary Ca+] binds [GI dietary Oxalate] → DEC reabsorption of [GI dietary Oxalate] → [DEC renal Oxalate] available → {[DECREASED [_Ca⁺**♉XALATE**_{^{(*only!*)] kidney stone formation} )}

\_\_ \_\_ \_\_

⬇︎ [^{dietary *(Spinach)*}**O**xalate]^{DEC reabsorption of [GI dietary Oxalate] → [DEC renal Oxalate] available → {[DECREASED [_Ca⁺**♉XALATE**_{^{(*only!*)] kidney stone formation} )}}}

⬇︎[**A**nimal protein]^{(DEC _*renal*Ca⁺ excretion)}

⬇︎[**S**odium < 2300 mg/day]^{(→ INC _renalCa⁺ reabsorption → DEC _urinaryCa⁺ available → DEC Ca⁺ kidney stone formation)}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## Footnote

*♉= DEC [_Ca⁺**♉XALATE**] _{*kidney stone formation*} only!*

*^{All other methods apply to both [Ca+_Phosphate and Ca+_Oxalate stones]}*}}

Answer 78

1. [**T**hiazide^{*INC renal Ca+ reabsorption → DEC urinary Ca⁺ available →DEC Ca+ kidney stone formation*}] 2. [**P**otassium_citrate^{*available via🍌and💊*!}]^{(INC urinary Citrate → binds urinary Ca+ → DEC Ca⁺ kidney stone formation)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ “⇪^{**F**luids **P**lus **C**itrate}|⼀**C**an⼀ | ⬇︎_{**O**verall **A**gonizing **S**tones*}| _💊r**T**ake **P**ills*” ( ^⇪FPC 🄲 _⬇︎OAS)^{🆚 TP}

Answer 79

[GASP > Staph infxn]; nephriiiitic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *UA🟡:* 🔬 prOteinuria 🔬[RBC dysmorphic]_hematuriiia, 🔬[RBC cast]_hematuriiiia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Serum🔴:* 🔬⇪Creatinine 🔬⬇︎C3 complement 🔬[↧C4 complement^{*normal or low*}] 🔬⬇︎CH50 complement 🔬[⊕STREPTOZYME₄^{*= (∀streptolysinO 🆚 ∀DNAseB 🆚 ∀hyaluronidase 🆚 ∀streptokinase)*}] | *🔎 ∀= [Anti_\_\_]* ## Footnote 🧠PSGN-PiG etx: 1-4 weeks s/p [GASP_>Staph] immune complex^{*(Ig+antigen+[C3, C4, CH50])*} deposit in GBM_*subEpi*] ^{*( with pgn inverse to age)*}➜ 1. [AGN AKI_*nephritic*]^{→ 🔬⇪ Creatinine, [🔬⬇︎C3, 🔬↧C4, 🔬⬇︎CH50 ], 🔬⊕STREPTOZYME4} = [**💊Hemodialysis prn refractory**, [**💊supportive**] 2. [🔬prOteinuria *UA*]^{*→ edema, volume overload, HTN*} = [**💊diuretics**], [**💊antiHTN**] 3. [hematuriiia *cola-urine*^{🔬RBC dysmorphic *UA* and 🔬RBC Cast *UA*}

Answer 80

## Footnote 🧠PSGN-PiG etx: 1-4 weeks s/p [GASP_>Staph] immune complex^{*(Ig+antigen+[C3, C4, CH50])*} deposit in GBM_*subEpi*] ^{*( with pgn inverse to age)*}➜ 1. [AGN AKI_*nephritic*]^{→ 🔬⇪ Creatinine, [🔬⬇︎C3, 🔬↧C4, 🔬⬇︎CH50 ], 🔬⊕STREPTOZYME4} = [**💊Hemodialysis prn refractory**, [**💊supportive**] 2. [🔬prOteinuria *UA*]^{*→ edema, volume overload, HTN*} = [**💊diuretics**], [**💊antiHTN**] 3. [hematuriiia *cola-urine*^{🔬RBC dysmorphic *UA* and 🔬RBC Cast *UA*}

Answer 81

^initial[GASP infection]; [nephritic ^{*(AKI, prOteinuria/edema/volumeOverload/HTN, hematuriiia/RBC/RBC cast/cola urine)*}] ## Footnote 1. 40% Adults in general 2. CKD Adults 3. [Metabolic Syndrome X] Adults 4. DM Adults

Answer 82

diagnosis of exclusion; *[hematuria after exercise] DDx:* 1. [**Exercise**_{Contact&NonContact}**-induced hematuria**] = A. [*bladder jarring:* *repetitive up/down mvmt or trauma to bladder* *+ B. [*kidney shunting:* exercise shunting of blood away from visceral organs like kidney**]→ hematuria* * = \*\*1 week follow up to confirm [self-limited spontaneous hematuria resolution] on repeat UA* * * * 2. [**myoglobinuria 2/2 rhabdomyolysis**] 3. [**March hgburia 2/2 RBC trauma**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *C & NC: Contact & NonContact*

Answer 83

**ASYMPTOMATIC** 2. malaise 3. nausea 4. [RUQ pain with transaminitis] * * * * acute HCV:* [**⊕HCV_{RNA PCR}**→ ⊕antiHCV ab within 12w]

Answer 84

**ASYMPTOMATIC** 2. malaise 3. nausea 4. [RUQ pain with transaminitis] * * * * CHRONIC RESOLVED HCV:* [⊕_antiHCV ab] [**NEG** HCV_{RNA PCR}] [**NEG** transaminase]

Answer 85

fatal virus ; [rabid animal's bite/scratch's *saliva*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ TRUE [*viP(O)RIC*] can prevent development of Rabies infection * * * \*\*[*V-i*-P-(O)-RIC] [(VARID/ipris) Prophylaxis pOst-exposure Rhabdovirus Immunization Course)]

Answer 86

fatal virus ; [rabid animal's bite/scratch's *saliva*] * * * [viP(e)RIC] = [V_ARID]⁴^X * * * \*\*[*V-i*-P-(e)-RIC] [(VARID/ipris) Prophylaxis prE-exposure Rhabdovirus Immunization Course)] [(**V^ARID**) Vaccine ⼀ACTIVE RABIES IMMUNIZATION (Delayed-Ab)] → virus-neutralizing Ab Delayed available within 10d *K^4X = 4 doses of*

Answer 87

fatal virus ; [rabid animal's bite/scratch's *saliva*] * * * [viP(O)RIC] can prevent development of Rabies infection = {[**V**_ARID⁴^X + **i**_pris¹^X] \<-*N*- **[*****PREVIOUS RABIES VACCINE*****?]** -*Y*-\> [**V**_ARID²^X]} * * * \*\*[*v-i*-P-(O)-RIC] [(VARID/ipris) Prophylaxis pOst-exposure Rhabdovirus Immunization Course)] [(**V^ARID**) Vaccine ⼀ACTIVE RABIES IMMUNIZATION (Delayed-Ab)] → virus-neutralizing Ab Delayed available within 10d [(**i^pris**) Ig ⼀*passive rabies immunization (STAT-Ab )*] → virus-neutralizing Ab STAT IMMEDIATELY AVAILABLE *K^4X = 4 doses of*

Answer 88

RPP [povidone⼀iodine] * * * RCP [(**_V_^ARID**)] ; [(**i^pris**)] * * * regimens: viP(e)RIC ; viP(O)RIC

Answer 89

fatal virus ; [rabid animal's bite/scratch's *saliva*] * * * [povidone⼀iodine] * * * [(**V^ARID**) **V**accine ⼀ACTIVE RABIES IMMUNIZATION (Delayed\_Ab)] → virus-neutralizing Ab Delayed available within 10d [(**i^pris**) **I**g ⼀*passive rabies immunization (STAT\_Ab )*] → virus-neutralizing Ab STAT IMMEDIATELY AVAILABLE

Answer 90

EBV; [degree of immunosuppression (CD4 count)]

Answer 91

TRUE ## Footnote _{*“Got HIV? get the **TIMP APB** *Vaccine!*”}

Answer 92

*“Got HIV? get the **TIMP APB** *Vaccine!*” 1. **T**DaP 2. **I**nfluenza 3. **M**eningococcus 4. **P**neumococcus 5. H**A**V 6. H**P**V 7. H**B**V *note: any Live Vaccines^{(MMR,Varicella)} are c❌d if CD4\<200*

Answer 93

Fluoroquinolone^6w vs TMpSMx^6w ## Footnote _{*"CBP=PENIS PAIN! PP: when you Pee! when you Cum! on paper! & just to be!"*}

Answer 94

*"CBP=PENIS PAIN! PP: when you Pee! when you Cum! on paper! & just to be!"* 1. [\> 3 mo UTI]^{*...PP when you Pee!*} 2. [\> 3 mo pain with ejaculation]^{*...PP when you Cum!*} 3. [UA^{pyuria+bacteriuria} & Prostate XM^{nml|hypertrophy|TTP|edema}]^{*PP...on Paper!*} 4. [\> 3 mo GU pain]^{*... & PP just to be!*} | "CBP=PENIS PAIN! PP: when you Pee! when you Cum! on paper! & just to be! ## Footnote _Tx[Fluoroquinolone^6w vs tMpSMX^6w]

Answer 95

parasitic fluke worm infxn; [sub-Saharan Africa] * * * 1. **terminal hematuria** 2. dysuria 3. urinary freq 4. peripheral eosinophilia

Answer 96

^urinarySchistosomiasis ; [identification of eggs on **urine sediment microscopy**] ; praziquantel

Answer 97

Onset & [Labs^{C3 complement}] ## Footnote P: [**O**: 1-4*WEEKS* after infxn] [**L**: C3**^DECREASED**] * * * B: [**o**: 1-4*days* after infxn] [**L**: C3^normal] ⼀*C3 normal* *due to weak complement fixing by IgA*

Answer 98

🩻*phenomena in which _R_adiocontrast^*(NA_R_CO)* (1-2d after exposure) induces vasoconstriction of the afferent arteriole → ⬇︎GFR → [AKI^{7 days}]* 🩻*preexisting renal dysfxn and/or preexisting renal hypOperfusion = CIN risk factors* 🩻*give high risk CIN pts [aggressive IVF^{NaCl or NaHCO3}] before and after radiocontrast*

Answer 99

1. fever 2. HA 3. myalgia 4. rigor 5. diaphoresis 6. hypOtension 7. [rash progression *^{(if 2º syphilis)}*] ▶[6-48h]; ▶[infection from ANY spirochete (Treponema Syphilis , Borrelia Lyme, Leptospirosis)] ▶[**widespread bacterial lysis** → massive release of bacterial degradation lipoproteins → transient inflammatory response] ▶[supportive (JHR is self limited to 48h)]

Answer 100

[evaluate Upper _and_ Lower urinary tract] ## Footnote Upper: CT urogram \> [US_{(alt for CKD)}] * * * Lower: Cystoscopy \> [urine cytology_{(low risk pts)}]

Answer 101

1. 40+ yo 2. male 3. smoking 4. pelvic radiation 5. aniline dyes

Answer 102

SOLELY SUPPORTIVE CARE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. immunoCompromised 2. \< 12 yo

Answer 103

[Nondialytic Conservative CKD Management] * * * - [severe CKD + poor functional status + low QOL] → [Nondialytic Conservative CKD Management (focus on *palliative, uremia, mineral-bone disease, electrolyte ∆, bp*] - HD can actually worsen QOL in these pts

Answer 104

FALSE * * * Pts with preexisting poor functional status and low QOLS are **UNLIKELY** to get improved sx and/or improved survival with HD = [Nondialytic Conservative CKD mgmt] instead

Answer 105

"histo**PLAS**ma spreads to **PLAS**" 1. [**P**ulmonary^{*→Granulomas with Hilar calcification!*}] 2. [**L**ymphatic RES involvement^{*(LymphNodes/Spleen/Liver)*}] 3. [**A**plastic Anemia pancytopenia^{*2/2 histoPLASma bone marrow infiltration*}] 4. [**S**kin (Mucocutaneous papules/nodules)] | *Dx =[serum histoPLASma Ag] | [urine histoPLASma Ag] immunoassay*

Answer 106

apply **compressive elastic dressing** (direct pressure) to bleeding surgical site, BUT ONLY FOR SHORT TIME (to avoid necrosis) and then remove [compressive elastic dressing] after hemostasis ... and prior to discharge

Answer 107

DM \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *INC insulin excretion and gluconeogenesis by healthy transplanted kidney*

Answer 108

candida Intertrigo *(occurs in inguinal/perineal/genital/intergluteal/inframammary)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Topical Antifungals

Answer 109

candida Intertrigo ; KOH exam \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ obestiy / DM / immunosuppresion

Answer 110

Prerenal failure FENa \< 1% \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Prerenal failure ➜ Na+ conservation

Answer 111

ATN Intrinsic renal failure FENa \> 2% \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ATN impairs Na+ reabsorption ➜ more Na+ in urine

Answer 112

intrinsic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *ATN* comes from **SIN** **S**epsis **I**schemia **N**ephrotoxic meds

Answer 113

[Prerenal failure]

Answer 114

Acute Tubular Necrosis ## Footnote * look for muddy brown cast & FENa\>2%* * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* 1. Maintain Euvolemia 2. Maintain Electrolytes 3. Maintain Nephrotoxin avoidance (*ACE inhibitors/ARBS/NSAIDs*) 4. Hemodialysis if AEIOU (*ph\<7.1/hyperK/intoxication/overload-Fluid/uremia*)

Answer 115

1. eye❌ 2. hearing❌ 3. heart❌

Answer 116

public crowding * * * [Tinidazole or NiTazoxanide] ➜ [metronidazole _{(2nd line/kids)}] [*p*aromomycin _{(1st trimester}*_p*_regnancy)]

Answer 117

Fecal-Oral or ingestion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Contaminated food/water] [Fecal incontinence with crowding (day care/nursing home/Norris' apt)] Immunodeficiency *⬇︎ with hand sanitizer*

Answer 118

[Tinea capitis *ring worm*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [PO griseofulvin] or [PO terbinafine] *cp = scaly pruritic erythematous patches of hair loss*

Answer 119

[clean catch urine \> 100,000 CFU/mL of ≥1 organism] + [No UTI sx(*SUD)*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Pregnant / [urologic procedures] / [within 3 mo kidney transplant] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *SUD: Suprapubic TTP/Urinary Freq-Urgency/Dysuria*

Answer 120

[PO Cipro]^7d \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *DW SLUFF: dysuria/WBC Pyuria/suprapubic pain/Leukocytosis/Urinary sx/Flank Pain/Fever*

Answer 121

[4-7d incubation by Aedes mosquito] ➜ SEVERE [break bone *MARF*] + [hemorrhagic sx (tourniquet petechiae)] -----(POSSIBLY)----\> [DENGUE SHOCK = LIFE THREATENING CAPILLARY LEAKAGE ➜ CIRCULATORY COLLAPSE, 3RD SPACING, END ORGAN DAMAGE] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[break bone MARF =**M**yalgia/**A**rthralgia/**R**etroorbital Pain/**F**EVER]*

Answer 122

Streptococcus PeptoStreptococcus

Answer 123

GASP; fever + [acute rapid spreading erythema with ***raised, well demarcated borders** +/- external ear involvement*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PCN

Answer 124

M**s**SA M**R**SA

Answer 125

**TECH** bites are [*left open to heal by _secondary intention_* *with* ***_AMOX\_CLAV_** _px_]* 1. [**T**ime of bite \> 12 hours old] 2. [**E**xtremity (hand or foot) bite] 3. [**C**AT bites (except if on face\*\*)] 4. [**H**UMAN bites (except if on face\*\*)] * \*1° \< [CAT/HUMAN Face bite 24h old] \< 2°* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ These bite wounds are high risk for subsequent infection

Answer 126

1. **Painless Hematuria 2/2 papillary necrosis** 2. Inability to concentrate urine (due to vasa recta damage) 3. Distal Renal Tubular Acidosis 4. UTI 5. Renal Medullary CA ## Footnote *Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis*

Answer 127

[**AiN** (Acute *Allergic* interstitial Nephritis)] which → [***chronic*** **renal papilla necrosis**]

Answer 128

**POSTCARDS** 1. **P**yelonephritis 2. **O**bstruction of urogenital tract 3. **S**ickle Cell 4. **T**uberculosis 5. **C**hronic Liver disease 6. **A**AAA ^{(Analgesic NSAIDs/ASA/APAP/Alcohol)} 7. **R**enal transplant rejection/Renal vein thrombosis 8. **D**M 9. **S**ystemic Vasculitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = correct underlying etx* ## Footnote _{***POSTCARDS***➜ ischemia_^{(i.e. BL AiN)}➜ [*chronic* renal papilla necrosis] ➜ [papilla sloughing] ➜ {[gross hematuria]/ [prOteinuria] / [pyuria with WBC cast] / [neg urine cx] + [renal colic]}}

Answer 129

***POSTCARDS***➜ _impaired renal perfusion → ischemia_^{(i.e. BL AiN)}➜ [*chronic* renal papilla necrosis] ➜ [papilla sloughing] ➜ gross hematuria/ proteinuria / [pyuria with WBC cast] / [neg urine cx] + renal colic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = correct underlying etx*

Answer 130

Acute Rheumatic Fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**DANCING:** ***MIND**(emotionally labile) / **FACE** / **HANDS** / **FEET** (rapid jerky movements)*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**PCN** until adulthood] (to prevent recurrent rheumatic fever)

Answer 131

*late sequelae =* Mitral regurgitation/stenosis

Answer 132

[Lyme Arthritis (synovial fluid WBC 20-50K)]; [serum ELISA + Western blot] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *septic arthritis = synovial fluid WBC \> 50K*

Answer 133

[Lyme Arthritis (synovial fluid WBC 20-50K)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**DOXY** (or Amoxicillin) PO x 28 days] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *septic arthritis = synovial fluid WBC \> 50K*

Answer 134

CefTriaxone + Doxy^{(or Azithromycin if Pregnant)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - NAAT - Wet Mount

Answer 135

*FeNa* preRenal \< 1% \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Intrinsic \> 2%

Answer 136

1. Travelers going to countries where HepA is present 2. Gay Men 3. Chronic Liver Disease Hepatitis A can cause **SIGNIFICANT but benign TRANSAMINITIS** so do not be alarmed by this self limited to 1 month

Answer 137

[S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb] | *CSAB = RESOLVED HBV* ## Footnote _{*unvaccinated pts acutely exposed to HBV should STILL get vaccinated in addition to the immunoglobulin*}

Answer 138

[S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb] [**S**Ag and **C**ore\_IgM]

Answer 139

[repeat HBV serologies] --\> [obtain [Core\_Ig**m**] and obtain LFT] to delineate acuity ^{([acute HBV window (Core m|mg)] vs [Chronic HBV post resolution (only Core g)]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote [S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb]

Answer 140

* isolated [⇪ Core\_TOTAL] = 2 possibilities:* 1a. [acute HBV *window*] = [⇪Core\_Ig**m**] 1b. [acute HBV window _with subclinical hepatitis_] = ([⇪Core\_Ig**m**] _with [⇪ LFT]_) \_\_\_\_\_\_\_\_\_or\_\_\_\_\_\_\_\_\_ 2.[chronic HBV *postwane*]: = [only Core\_Ig**G** present] = Years after acute HBV, once SAb has waned from CSAb = ([*no* Core\_Ig**M**] [SAb wanes → *no* SAb) = only [Core\_Ig**G**^{which will keep [Core_TOTAL] elevated}] * * * ## Footnote [S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb]

Answer 141

[VZV IG (or antiviral tx if IG not available)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *IG = ImmunoGlobulin*

Answer 142

[Varicella Vaccine within 5d of exposure]

Answer 143

NOTHING \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ([hx of Varicella infection] or [hx of 2-dose Varicella Vaccine])

Answer 144

persistent allodynia and pain **\> 4 months** after resolution of acute [herpes Zoster shingles] rash \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Gabapentin vs Pregablin vs TCA] --(if fail)--\> Opioids

Answer 145

from the onset of lesions **UNTIL LESIONS HAVE COMPLETELY CRUSTED OVER** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ DIRECT CONTACT \>\> [active lesion aerosolization] * * * * In Hospital: Contact and Airborne precautions.* * At Home: keep lesions covered _until completely crusted over!_*

Answer 146

DIRECT CONTACT \>\> [active lesion aerosolization] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [localized single Dermatome Zoster] = [lesion coverage + standard precautions] [DISSEMINATED ZOSTER \> 1 DERMATOME] = [lesion coverage + CONTACT + AIRBORNE + standard precautions] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *apply this until lesions are completely crusted over*

Answer 147

[SEVERE hypOnatremia → SEIZURES / COMA] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [3% Hypertonic Saline]

Answer 148

mild hypOnatremia → nausea / forgetful \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Fluid restriction +/- salt tablets]

Answer 149

1. CNS ❌ 2. Lung ❌ 3. Meds^{(Carbamazepine|SSRI|NSAIDs)} 4. Ectopic ADH^(SOLC) 5. Pain 6. Nausea * * * ❌=disturbance

Answer 150

_C_ancel _C_ LABI with **CCC** 1. **C**lean site with Chlorhexadine *before insertion* 2. **C**over w MAX BARRIER PRECAUTION ^{(large sterile drape, mask)} *during insertion* 3. **C**atheter removed as soon as no longer needed *after insertion*

Answer 151

*"**DIAPERS** gave him reversible urinary incontinence"* 1. [**D**elirium|Depression (psych)] 2. [**I**nfection (UTI)] 3. **A**trophic urethritis/vaginitis 4. **P**harm^{(α🟥 | diuretics)} 5. **E**xcess urine output^{(CHF, DM)} 6. **R**estricted mobility 7. **S**tool impaction

Answer 152

**ADPKD** **A**neurysm (Berry) **D**oomed [HTN*-(treat w ACEk2 inhibitor)* and MVP] {[**P**rOteinuria with Hematuria] & [Polycystic BL kidneys with flank fullness]} **K**idney Failure ^{*CKD → ESRD, early/late onset, hepatomegaly if cystic involvement*} **D**ifferentiation problem = Etx (may be asx) *Image: Renal Ultrasound which = Dx*

Answer 153

★ CKD [⬇︎1αHydroxylase] → [⬇conversion of 25-hydroxyvitD to 1-25DihydroxyVitD] ➜ {[⇪ Phosphate retention] ➜ [bind free Ca+]} + (also ⬇︎ renal Ca+ absorption)] ➜ [**⬇︎free Ca+**] ➜ [( ⇪ PTH secretion) = compensatory 2º hyperparathyroidism] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ★ EVENTUALLY.... [2º HPTH] may progress to [3° HyperParathyroidism AUTONOMOUS PTH SECRETION]➜ [HIGH PTH AND EVENTUALLY HIGH CA+] ➜ [high bone turnover = (⇪ *BONE* ALP)] ➜ ★ [***PTH*** _sx**=** parathyroidectomy] - **P**ersistently elevated [Ca+\> 10.5] , [(P )because of CKD] and [PTH\>800] - **T**issue calcification /[calciphylaxis (vascular calcification)] - **H**eavy intractable bone pain

Answer 154

GASP \> MssA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *cellulitis: poorly demarcated confluent erythema and/or induration involving deep dermis, SQ fat +/- fever*

Answer 155

tx = [(fidaXomicin PO) or (Vancomycin PO)]^10d ^{*"**M**icrobial **F**ighters **C**an **C**ause **C**razy **C**Diff*_{(**a**nd **t**aking **m**acrolides, **t**oo)}"} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 7.**a**minoglycoside 8.**t**MP-SMX 9.**m**acrolides 10.**t**etracycline | Reinfections are from persistent spores of the initial strain ## Footnote _{^{*"**M**icrobial **F**ighters **C**an **C**ause **C**razy **C**Diff*_{(**a**nd **t**aking **m**acrolides, **t**oo)}"}
1. **M**onobactams
2. **F**luoroquinolones
3. **C**arbapenems
4. **C**lindamycin
5. [**C**ephalosporin^3G]
6. [**C**ephalosporin^4G]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
7.**a**minoglycoside
8.**t**MP-SMX
9.**m**acrolides
10.**t**etracycline}

Answer 156

tx = [(PO fidaXomicin) or (PO Vancomycin)]^10d * * * ^{*"**M**icrobial **F**ighters **C**an **C**ause **C**razy **C**Diff"* _{(**a**nd **t**aking **m**acrolides, **t**oo)}"} 1. **M**onobactams 2. **F**luoroquinolones 3. **C**arbapenems 4. **C**lindamycin 5. [**C**ephalosporin^3G] 6. [**C**ephalosporin^4G] | Reinfections are from persistent spores of the initial strain ## Footnote _{^{*"**M**icrobial **F**ighters **C**an **C**ause **C**razy **C**Diff*_{(**a**nd **t**aking **m**acrolides, **t**oo)}"}
1. **M**onobactams
2. **F**luoroquinolones
3. **C**arbapenems
4. **C**lindamycin
5. [**C**ephalosporin^3G]
6. [**C**ephalosporin^4G]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
7.**a**minoglycoside
8.**t**MP-SMX
9.**m**acrolides
10.**t**etracycline}

Answer 157

histoPLASmosis ## Footnote *Mississippi and Ohio River basins*

Answer 158

Trichomonas vaginalis ; Trichomoniasis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Trichomonads ⇪ rates of HIV transmission

Answer 159

[infection / inflammation of **glans penis** *(common in uncircumcised infants)*] ➜ THICK WHITE DISCHARGE +/- [concurrent Candida Diaper Dermatitis] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ topical antifungal *Balanoposthitis = inflammation of glans penis AND foreskin*

Answer 160

Ingested spores (transmitted by fecal-oral route) germinate in COLON = become fully functional bacilli ➜ proliferate unchecked **when COLON FLORA IS DISRUPTED** ➜ [⇪ release of exoToxin A and B] ➜ mucosal inflammation ➜ [PROFUSE WATERY DIARRHEA ≥ 3 LOOSE STOOLS daily]

Answer 161

MeningoEncephalitis ; mosquito \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Summer \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Fever / AMS / HA / Nuchal rigidity / Vomiting*

Answer 162

1. [***E**levating testicle alleviates pain* = ***E**pididymitis*] 2. Edema of Epididymis 3. uL POST testicle pain 4. [(if E.Coli BOO) SUD urinary sx] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [STI (Chlamydia/Gonorrhea)] \< [*Age 35*] \< [Bladder outlet obstruction (E.Coli)]

Answer 163

[HIV test *window period*]= first 4 weeks of infection after initial exposure \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ during first 4 weeks of infection after initial exposure, low titers of antigen and antibody may ➜ **FALSE NEGATIVE**. So if suspicious for HIV infection, retest ≥4 weeks after initial exposure \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *HIV test = p24 antigen + HIV1 ab + HIV2 Ab*

Answer 164

Hepatitis **B** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Some antiretrovirals have DUAL activity against HIV and H**B**V

Answer 165

VOLUME RESUSCITATION \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [*once stable (SBP\>90) obtain CT abd to assess severity] or [XLAP if pt remains HDUS despite volume resuscitation]*

Answer 166

[infective suppurative portal vein thrombosis] ; intraabdominal infections

Answer 167

1. Chlamydia = doxy 2. Gonorrhea = Ceftriaxone 3. Trichomoniasis = Metronidazole 4. [H**I**V _{(if within 3 days of exposure)}] = ^{*("P.T.S.D.")*}triple drug regimen 5. [H**B**V^{[*HBV-Vaccine*_if not immune ➕ *HBV-Ig*_if sexual partner HBV+]}

Answer 168

1. **TESTICULAR CANCER** (orchiopexy enables increased detection and ⬇︎ testicular CA but it will still remain higher than gen pop) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2. Testicular Torsion (orchiopexy ⬇︎) 3. Inguinal hernia (orchiopexy ⬇︎) 4. Subfertility (orchiopexy ⬇︎)

Answer 169

| ***VINCOS***_ddx

Answer 170

Retractile Testes; 1. RT (caused by hyperactive cremasteric reflex) **R**e**T**ains ability to manually manipulate testicle into the scrotal base *(In cryptorchidism, testicles can not be manipulated back down)* 2. RT **R**e**T**ains scrotal rugae \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Monitor annually

Answer 171

3 * * * 1._{1 of 2}[tuberculin skin test or interferon gamma assay] screening *if ...* * * * 2A.[#1 is NEGATIVE] = _{2 of 2}[tuberculin skin test or interferon gamma assay] screening 8-10 wks later \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2B. [#1 or #2A is POSITIVE] = CXR + [acid fast sputum testing]--\> if BOTH negative --\> [latent TB tx], othwise → [ACTIVE TB tx]

Answer 172

**STD** 1. **S**everal migratory arthralgias 2. **T**enosynovitis pain along tendon sheaths 3. **D**ermatitis pustular rash *pts may NOT have urinary or pelvic sx with Disseminated Gonococcal infection!*

Answer 173

[aPG **4**MU q**4**H] x **14**d

Answer 174

1. Pregnancy (No DOXY for POXY) 2. 3° CNS syphilis 3. refractory to initial tx

Answer 175

There is a possible [false negative RPR result] early in infection - follow with FTA

Answer 176

Must be [4-fold FTA titer DEC] by 12 month mark

Answer 177

1. Cellulitis extensively 2. Immunosuppression (DM, HIV, CA) 3. Valvular Heart Disease | *50% of Anal Abscesses --\> Fistula!! Tx = I & D that mofo!*

Answer 178

[**HAPPY** *RABIES Sx*] ## Footnote **H**YDROPHOBIA (fear of water triggering Pharyngeal spasms) = PATHOGNOMONIC FOR RABIES! **A**erophobia **P**haryngeal spasms [**P**aralysis (Spastic --\> Ascending flaccid)] -\> respiratory failure within wks **Y**ankin' Agitation

Answer 179

VERY POOR ONCE [**HAPPY** *RABIES Sx*] START! = Die within weeks *Remember! Post-Exposure Px IgG and Vaccine CANONLY HELP TO PREVENT ONSET OF SX. Once* [**HAPPY** *RABIES Sx*] *starts....it's Over*

Answer 180

Hep C\_Advance Liver Disease

Answer 181

1. {Break Bone **MARF**^{[^**M**^yalgia/^**A**^rthralgia/^**R**^{etroorbital Pain/}^**F**^EVER]*}
2. **[Thrombocytopenia w POSITIVE TOURNIQUET TEST^{*⊕petechiae with 5 min BP cuff inflation*}]**
3. [_{*"white on red"*}Rash]}

Answer 182

1. TB 2. [Tertiary syphilis gummas] 3. Blastomycosis 4. histoPLASma 5. Sarcoidosis 6. [CEGP -Churg Strauss Eosinophilic Granulomatosis with Polyangiitis]

Answer 183

[S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb] ## Footnote 1. OUTPATIENT FOLLOW UP! (most HepB resolves spontaneously! . Only < 5% → Chronic HBV infxn) 2. Admit IF SERIOUS DECOMPENSATION ONLY

Answer 184

\< 5% * * * [S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb]

Answer 185

Trichomoniasis | *tx = [metronidazole 2 gm PO x 1] and treat partner*

Answer 186

[Metronidazole 2 grams **PO** x 1] + treat sexual partner

Answer 187

NO TX! *(Supportive^{[self limited to 48h]})*

Answer 188

CD4\<100 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Fluconazole PO 2. Esophagoscopy with bx/cx if refractory to rx

Answer 189

1. [**HAMS** (**H**eterophile **A**b **M**ono**S**pot)] test (only accurate first 2 weeks from Sx onset\*\* 2. Anti-EBV test *No sports for ≥3weeks because of splenomegaly!*

Answer 190

grayish vesicles on the tonsillar pillars and **posterior** oropharynx that --\> fibrin-coated ulcerations ## Footnote *doesn't have to have hand or foot involvement*

Answer 191

CMV will have a [⊝**HAMS** (**H**eterophile **A**b **M**ono**S**pot)]

Answer 192

Erysipelas from GASP \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [acute rapid spreading erythema with ***raised, well demarcated borders** +/- external ear involvement*]

Answer 193

FALSE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *+ Strep RADT ➜ Abx*

Answer 194

**Reactivation** TB ## Footnote (cavitary UPPER lung lesion) *This is different from Aspiration PNA since Aspiration PNA occurs in LOWER lobes*

Answer 195

*"before giving ATBI abx ...confirm ATBI dx with a good **sCAN**"* **3 SPUTUM SAMPLES** sent for ***s**putum mycobacterial*: 1. [**CX (GOLD STANDARD)** ⼀*CONFIRMATORY*] 2. [**A**cid Fast Bacillus Smear^{*(_A_ids ATBI dx confirmation)*}] 3. [**N**ucleic Acid Amplification Test ⼀*CONFIRMATORY*]

Answer 196

stroking upper inner thigh ➜ testicle elevation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ABSENT CREMASTERIC REFLEX = TESTICULAR TORSION *(6 HOURS UNTIL IRREVERSIBLE DAMAGE)*

Answer 197

[ACEk2 inhibitors ^{(⬇︎GFR → prevents CKD)}]

Answer 198

*[Mantoux TST( **_T_**uberculin**_S_**kin**_T_**est)]* 0.1 cc intradermal forearm injection of TB [**_P_**urified **_P_**rotein **_D_**erivative (PPD)] ➜ diameter of [swollen indurated area] measured perpendicularly 48-72H later

Answer 199

**RMSF** ▶[**R**ickettsia Rickettsii^{*overlaps🔗🇪hrlichiosis*}] / ▶[**M**ental AMS❌^{(a/b _HA_)}]/ ▶[**S**potted^{(🆚 macular)} RASH_{@Wrist & Ankles}^{*(2/2 thrombocytopenia petechiae)*} in Summer after Tick Bite]/ ▶**F**ile❌^{(fever, [thrombocytopenia w petechiae])} | Rocky Mountain Spotted Fever ## Footnote 🇪hrlichiosis = Ehrlichiosis = Rocky Mountain Spotted Fever... *without the "Spotted^Rash"* = RMF

Answer 200

[**10-20 cc/kg** Fluid Resuscitation (NS vs LR) over 30 min]

Answer 201

FBLA ## Footnote 1st: Fluid Resuscitation 2nd: Blood Cx 3rd: **Lumbar puncture BEFORE ABX** (unless pt requires Head CT 1st or is critically ill and can't receive lumbar puncture) \*\*4th\*\*: Abx Empirically

Answer 202

[lymphoma B symptoms] or [TB] FML "fuck my life": Fever/Mnight sweats/Loss wt

Answer 203

“**BANGIR** needs to *drop* what he's doing and don a *basic facemask*, right now!” 1. **B**ordatella 2. **A**denovirus 3. **N**eisseria Meningiditis 4. **G**ASP 5. **I**nfluenzae 6. **R**hinovirus

Answer 204

“**C**age^{(N95 + Negative pressure room)}**T**hese **V**ery **S**mall **M**icrobes” 1. [**C**oronavirus (SARS/MERS/COVID19)] 2. **T**B 3. [**V**ZV Varicella Zoster] 4. **S**mallpox 5. [**M**easles RubeOla] *Airborne= Negative Pressure Room + N95 mask*

Answer 205

Infection--\>Cytokines--\>influences hypothalamus to ⬆︎ body temp set point--\> 1. Muscles repetively contract (shivering) 2. Peripheral vasoconstriction--\> "cold" sensation

Answer 206

1. **Flu**: Risk= less effective in elderly / Benefit= ⬇︎mortality & occurrence 2. **Pneumococcal**: Risk=does NOT ⬇︎ occurrence / Benefit= does ⬇︎ invasive dz from S.Pneumo

Answer 207

[staphA] vs [Strep Viridans] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CT-guided aspiration for cx | *Toxo and Nocardia would occur in immunocomp pts*

Answer 208

PML (Progressive Multifocal Leukoencephalopathy) 2/2 [John Cunningham Polyoma Virus]

Answer 209

Rheumatic Fever and [Infective Endocarditis]

Answer 210

Echinococcus granulosus ## Footnote **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** **DOGS**

Answer 211

[Appendicitis (GI infection)] Surgery

Answer 212

1. [Sensorineural Hearing loss] 2. [BL Cataracts] 3. PDA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Live Rubella vaccine **prior to conception** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** Dx = Rubella IgM vs PCR (Transmission occurs 1st trimester)

Answer 213

[well circumscribed raised violaceous (wart like) nodules --\> microabscess] ## Footnote *Blastomycosis causes Skin, Pulmonary and Bone findings*

Answer 214

1. Giardia 2. Crypto*SPO*ridium^{(parasite) - can still occur in immunocompetent pts!} 3. Cyclospora 4. ETEC ## Footnote *Profuse watery diarrhea after traveling*

Answer 215

1. Echovirus 2. Coxsackie

Answer 216

1. **INCESSANT DRY COUGH** in teen/young adult/military 2. nonexudative pharyngitis 3. [Fever w/malaise] ## Footnote *CXR = ⬆︎interstitial infiltrates +/- pleural effusion*

Answer 217

If sx are improved at the **48 hour mark** pts can be transitioned to PO (i.e. TMP-SMX or Levofloxacin) abx

Answer 218

1. **INFECTIVE ENDOCARDITIS** 2. IVDA 3. Immunosuppression 4. Trauma 5. Hemoglobinopathy

Answer 219

droplet; Macrolides \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ YES. ALL CLOSE CONTACTS should receive Macrolide px ## Footnote _{“**BANGIR** needs to *drop* what he's doing and don a *basic facemask*, right now!”}

Answer 220

[NeuroCystiCercosis from *Taenia Cestode Helminths*]

Answer 221

*Echinococcus Granulosus* [EH] reside in sheep(intermediate host) Dogs eat Sheep ➜ Dog poop now contains [E**e**]. → Dog poop contaminates [Human water/food] with [E**e**]. Humans consume water/food contaminated with Dog poop⼀[Ee]. [Ee] hatch in human small intestine into 🅴, 🅴 penetrate [human small intestinal wall] and travel to Liver to form a [EH] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Dx = US / Tx = [Cyst\<5cm=Albendazole] ## Footnote *🔎EH = Echinococcus Granulosus Hydatid Cyst* *🔎Ee = Echinococcus Granulosus eggs* *🔎 🅴 = [Echinococcus Granulosus (the actual mature adult parasite)]*

Answer 222

Candida; pts with **sole odynophagia** who have no thrush nor difficulty swallowing = viral (HSV, CMV) esophagitis

Answer 223

*PCV-13* ▶{[Adults ≥65 yo] = [(PCV13 x 1) → (PCV23 x 1 ^{6 mo later})]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶{[Adults \<65 yo^{with PCV13_RF}]= [PCV13 x 1]} * * * * [PCV13\_RF^-*]*: (SickleCell/CochlearImplant/ESRD/HIV)*

Answer 224

* (SickleCell/* * CochlearImplant/* * ESRD/* * HIV)*

Answer 225

* (Heart/* * Lung/* * Liver/* * DM/* * Smoker)*

Answer 226

*PPSV23* ▶{[age ≥65 yo] = [(P13 x 1) → (P23 x 1 ^{6 mo later})]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ▶{[age \<65 yo^{with P23_RF}]= [P23 x 1]} *P23RF = heart/lung/liver/DM/smoker/[peds with sickle|heart|ear]*

Answer 227

1. Mouth 2. Face 3. Genitals 4. Legs *papules --\> violaceous plaques or nodules*

Answer 228

**SH**i**N** = encapsulated organisms 1. **S**trep Pneumo = MOST COMMON even despite immunization because of non-vaccine serotypes! 2. **H**Flu B 3. **N**eisseria Meningitidis *these happen to asplenic pts because they have ⬇︎antibody mediated phagocytosis and complement activation*

Answer 229

1. CMV^{*(ganciclovir/ValGanciclovir px)*} 2. PCP^{*(Bactrim px)*}

Answer 230

*In the absence of a Source patient, assume Source patient is ⊕* = [Source patient ⊕] + [unvaccinated HealthCareWorker] = 1. Hep B Immunoglobulin 2. Hep B **VACCINE** still * * * ## Footnote _{[S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb]}

Answer 231

[Source patient ⊝] + [unvaccinated HealthCareWorker] Hep B **VACCINE** ## Footnote _{[S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb]}

Answer 232

[Source patient HBV ⊝/⊕] + [_any_ *vaccinated* HealthCareWorker] = NOTHING! ## Footnote _{[S - **S**E**C** - SCEb - core_*m* - CEbSAb - CSAb - core_*G* - SAb]}

Answer 233

EBV^*(⊕HAMS)* ## Footnote **P**latelet thrombocytopenia **A**nemia from autoimmune hemolytic anemia **N**eutrophil/WBC ⬇︎ with atypical lymphocyte on blood smear due to viral suppression

Answer 234

1. Eye❌^{PeriPOrbital edema + [Retinal/conjunctival hemorrhaging]} 2. Myositis (⬆︎CK) 3. Eosinophilia 4. GI❌^{onsets early on} 5. [nailbed subungual splinter hemorrhages]

Answer 235

⭐(irrigation ⭐➜ [amox\_clav]) ⭐ ^{**TECH** bites are}[*left open to heal by _secondary intention_ with _amox\_clav px_]* ## Footnote *Cat bites are **DEEP PUNCTURE WOUNDS** AT RISK for Pasteurella and oral anaerobes*

Answer 236

1. [EBV^{*(⊕HAMS, ⊕PANcytopenia)*}] 2. CMV

Answer 237

Legionella

Answer 238

1. Homelessness 2. Alcoholism 3. Immunosuppression 4. Healthcare worker *Disseminated TB affects peritoneum, cervical lymph nodes, eyes, bones and skin*

Answer 239

1. Animal is unavailable 2. Animal is symptomatic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Pet Observation x 10 days or Test Wild Animals to determine need for Rabies px

Answer 240

≥48 hrs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1st: lower respiratory tract Gram stain and culture 2nd: Empiric abx

Answer 241

1. Hepatosplenomegaly 2. Blueberry muffin spot rash 3. Jaundice

Answer 242

**T**oxoplasmosis **O**thers^{(VZV|Parvovirus|Syphilis)} **R**ubella **C**MV **h**epatitis **H**IV **H**SV

Answer 243

**LEP**rosy 1. [**L**AD painful] 2. [**E**M-*LIKE* ANESTHETIC mascular rash^📖] 3. [**P**oorly functional nerves w ⬇︎s/m] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Dx = FULL THICKNESS Skin bx of lesion] | [Tx = Rifampin WITH Dapsone] || [hypOfunctional n with ⬇︎sensory/motor] ## Footnote _{📖**Anesthetic** *EM-LIKE* mascular Rash^{hypOpigmented with raised borders - similar to Erythema Multiforme but more irregular}}

Answer 244

1. Rifampin _**WITH** 2. Dapsone | *{[**L**AD] [**E**M-like rash] [**P**oor nerves] ⼀rosy}*

Answer 245

1. Albendazole 2. Pyrantel Pamoate

Answer 246

🇪Ehrlichiosis = Rocky Mountain Spotted Fever... *without the "Spotted^Rash"* = **RMF** 🇪**RMF** ▶eh**R**lichiosis^{*overlaps🔗Rickettsia Rickettsii*} but has NO RASH / ▶**M**ental AMS❌^{(a/b _MALAISE_)}/ ▶**F**ile❌^{(Low platelet, Leukopenia, LFTitis)} | *🔎LFTitis = transaminitis*

Answer 247

Staph Aureus

Answer 248

Vibrio Vulnificus ## Footnote also causes food borne illness

Answer 249

{**[HOOKWORM Ancylostoma Duodenale]** [Cutaneous larvae migrans]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ walking barefoot in contaminated sand or soil | *Tx = Ivermectin* ## Footnote _{"ROUND, HOOK, WHIP ... intestinal Helminths"
- [ROUNDWORM ascaris Lumbricoides]
- [HOOKWORM ancylostoma Duodenale]
- [WHIPWORM trichuris Trichiura]}

Answer 250

{**[HOOKWORM Ancylostoma Duodenale]** [Cutaneous larvae migrans]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Ivermectin | *acquired by walking barefoot in contaminated soil|sand* ## Footnote _{"ROUND, HOOK, WHIP ... intestinal Helminths"
- [ROUNDWORM ascaris Lumbricoides]
- [HOOKWORM ancylostoma Duodenale]
- [WHIPWORM trichuris Trichiura]}

Answer 251

dimorphic ; decaying plant and soil papule at inoculation site ulcerates and drains odorless nonpurulent fluid. This then spread proximally along lines of lymphatic drainage Tx = PO itraconazole

Answer 252

Diffuse Maculopapular rash **starting at trunk and spreading to extremities TO INCLUDE PALMS AND SOLES**

Answer 253

FUNGUS (it's apart of their cell wall) - and this is nonspecific

Answer 254

[JC polyoma virus] reactivation in HIV pts --\> ASYMMETRIC focal **nonenhancing white matter brain lesions WITH NO EDEMA** ## Footnote *HIV neurocognitive disorder will have DIFFUSE enhancement*

Answer 255

Staph Aureus

Answer 256

the Strep Viridan **MOMS** **M**utans/**O**ralis/**M**itis/**S**anguinis * * * tx = CefTriaxone _or[aq PCN G IV]

Answer 257

EColi if \>35yo (secondary to bladder outlet obstruction) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Chlamydia or Gonorrhea if under 35 yo (secondary to STI)]

Answer 258

sublingual and submandibular \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ infected mandibular **MOLAR**

Answer 259

{*[DEET]* + **C**_hloroquine_|**D**oxy|malaron**E**|me**F**loquine]} 1. Mefloquine 2. Doxycycline 3. Malarone *and of course DEET* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ px [≥2wks prior to travel], [during stay] and [stopped 4 weeks after returning] | {*[DEET]* + **C**_hloroquine_|**D**oxy|malaron**E**|me**F**loquine]}

Answer 260

**Gonorrhea** only

Answer 261

1. Pseudomonas 2. Serratia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ painful red eye and corneal opacification with corneal ulceration

Answer 262

*[external hordeolum stye]* an external hordeolum = a stye = inflammation of eyelash follicle or tear gland --\> tender nodule at lid margin \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = warm compresses

Answer 263

Hematogenous spread of TB (possibly from primary infection or reactivation) that --\> subacute sx +/- extrapulmonary^{*(CNS, Liver)*} involvement ; Millet seed diffuse reticulonodular pattern

Answer 264

1. Diffuse erythematous macular rash 2. hypOtension 3. fever \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tampons, nasal packing, post surgery

Answer 265

1. **b**12 deficiency^{(w subsequent Macrocytic Anemia)} 2. ⊕**b**reath LactuLOSE test] ## Footnote (**SI_bbbO**_*"SIBO"*) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **S**tinky flatulence / [**I**ntestinal lack of TTP OR Fever] / [**b**loating | **b**12 deficiency | ⊕**b**reath LactuLOSE test] / [**O**asis WATERY Diarrhea]

Answer 266

1. intraepithelial lymphocytic infiltrates 2. loss of villous architecture -\> villous atrophy 3. Crypt hyperplasia *bx from distal duodenum*

Answer 267

1:16 ## Footnote *anything where they had to dilute it MORE than 16 times is HIGH RPR Syphilis titer*

Answer 268

HIV (especially if facial MC)

Answer 269

[Abx (^{*"**M**icrobial **F**ighters **C**an **C**ause **C**razy **C**Diff*_{(**a**nd **t**aking **m**acrolides, **t**oo)}"} )] gastric acid suppression ≥65 yo \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *CDI ➜ Severe CDI ➜ FULMINANT CDI*

Answer 270

periods of [LIFE THREATENING APNEA] ; RSV \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Palivizumab px for \<29WG / Chronic lung disease of prematurity / HDUS CHD*

Answer 271

Answer 272

1. multiple sex partners 2. IVDA 3. Pregnant 4. Healthcare worker 5. Inmate

Answer 273

3 ; HIV infection \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote 1. [painful lesion] 2. [^palm/sole⊕rash] 3. constitutional

Answer 274

heart valves, lungs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ spine MRI ➜ spine biopsy

Answer 275

11-26 yo GIRLS AND BOYS \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote ⬇︎ risk for 1. GENITAL WARTS 2. cervical CA 3. anogenital CA 4. oropharyngeal CA

Answer 276

_{*"ROUND, HOOK, WHIP ... intestinal Helminths"*} - [ROUNDWORM ascaris Lumbricoides] - [HOOKWORM ancylostoma Duodenale] - [WHIPWORM trichuris Trichiura] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **PERIPHERAL EOSINOPHILIA** 2. [acute pulmonary sx ➜ chronic GI sx] 3. ⊕FOBT 4. microcytic anemia

Answer 277

⊕[helminth **eggs**] in stool Ova & Parasite \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ albendazole *sx: [acute pulm ➜ chronic GI] + peripheral eosinophilia + FOBT* ## Footnote _{"ROUND, HOOK, WHIP ... intestinal Helminths"
- [ROUNDWORM ascaris Lumbricoides]
- [HOOKWORM ancylostoma Duodenale]
- [WHIPWORM trichuris Trichiura]}

Answer 278

[HIV-associated **thrombocytopenia**] can occur at any stage of HIV and tx = treat the HIV \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *these pts rarely have INC bleeding*

Answer 279

3-6 months \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ failure to achieve [viral load \< 200 copies] within 6 months of starting triple-ARV \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ may indicate drug resistance or noncompliance * * * * (triple-ARV = 3 drug regimen Antiretroviral)*

Answer 280

Eikenella corrodens ; gram negative anAerobe \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote 1. TETANUS PX 2. [PO amox/Clav^{(or IV amp/Sulfa)}] 3. {_{**TECH** wounds}left open to heal by 2º intention^{*unless [(human|cat) to _face_]^⚠️*}} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{⚠️[(human|cat) _face_ wounds]: [1º healing < *24h old* < 2º healing ]}

Answer 281

1. TETANUS PX 2. [PO amox/Clav^{(or IV amp/Sulfa)}] 3. {_{**TECH** wounds}left open to heal by 2º intention^{*unless [(human|cat) to _face_]^⚠️*}} | *covers polymicrobial + Eikenella Corrodens* ## Footnote _{⚠️[(human|cat) _face_ wounds]: [1º healing < *24h old* < 2º healing ]}

Answer 282

pH \>4.5 *dx = Trichomonas vaginalis* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Trichomonas vaginalis in prepubescent child = sex abuse and **must** be reported*

Answer 283

Flu sx ➜ [slapped cheek malar erythema infectiosum rash (*kids*)] or [symmetrical joint stiffness/pain (*teens/adults)*] ➜ self limited to 3 weeks with no sequelae \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *tx = supportive/NSAID*

Answer 284

[HOOKWORM Ancylostoma Duodenale] **eggs** in Stool O&P \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *sx: peripheral eosinophilia/[Pulm ➜ GI sx]/+FOBT/microcytic anemia*

Answer 285

negative; marine; [ingestion or wound contamination] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ chronic illness = 1. [rapidly progressive {within hrs} cellulitis] -*image* 2. hemorrhagic bullae 3. septic shock * dx = blood/wound cx | tx = IVAbx STAT*

Answer 286

Corynebacterium diphtheriae \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [Pharyngitis **with grey exudates** that coalesce into a {pseudomembrane (*bleeds with scraping*)}] 2. Cervical LAD 3. TOXIN-MEDIATED SEQUELAE ⼀ MYOCARDITIS / NEURITIS / NE**P**HRITIS

Answer 287

▶[2 weeks low-fever prodrome] ➜ ▶[**Choroidal tubercles** (yellow/white nodules near optic disc)] ▶[basilar meningeal enhancement] ▶{TB CSF: [ADA ⇪ + ( G\<45 | P 100-500 | W^Lymphocyte 100-500⇪)]} | *ADA = Adenosine DeAminase* ## Footnote _{*Dx = {⊕_CSFAFB smear/culture via [serial LP CSF]}*}

Answer 288

{⊕_CSFAFB smear/culture via [serial LP CSF]} ## Footnote _{[serial LP CSF exams] looking for acid-fast bacilli using smear/culture}

Answer 289

[**CRiP** ₍**_A|F**₎]² ➜ [**Ri**]⁹ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**C**TS (prednisone|dexamethasone) / **R**ifampin / **i**NH / **P**yrazinamide (**A**minoglycoside IV *or* **F**luoroquinolone)]² ➜ [**R**ifampin / **i**NH]⁹

Answer 290

[**e**HEC STEC 0157 EColi]causes **NO HIGH FEVER** in patients ## Footnote *(likely because mechanism involves only STEC toxins causing local damage)*

Answer 291

azithromycin; ## Footnote 1. repeat urethral Gram stain 2. repeat urine NAAT

Answer 292

[72h (preferably within 3h if occupational)]; 28days \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PEP **PTSD** 1. **P**rimary labs [HIV test_exposed*(+ HIV test_SOURCE)*] 2. [**T**riple ARV ([**2** NRTI + (**1** [II or PI or nNRTI])_{within 72h}]^28d 3. **S**econdary labs (HIV test_exposed) at 6w 4. **D**elayed labs (HIV test_exposed) at 16w

Answer 293

[tick saliva neurotoxin] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [SKIN EXAM TO FIND AND REMOVE TICK] *SPONTANEOUS RECOVERY AFTER TICK IS REMOVED*

Answer 294

[tick saliva neurotoxin] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tick attachment --(4-7days)--\> [**afebrile** **rapid ascending paralysis + gait ataxia**] = [absent DTR and normal sensation]

Answer 295

1. Coxsackie A 2. **POSTERIOR** oropharyngeal vesicles 3. [self limited to 1 week (so tx = hydration/analgesics)]

Answer 296

- Pseudomonas skin lesion [≥1 erythematous macule ➜ blueish/green pustule/bullae ➜ nonpainful gangrenous ulcer] - immunocompromised pts

Answer 297

* STAT blood and wound cx ➜ * ([Pip/tazo *βL*] + [gentamicin *aminoglycoside*]) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *βL=βeta Lactam*

Answer 298

1. [Livingmate^{(Roommate/Housemate)}] 2. Day care workers 3. [direct exposure to oropulmonary secretions (i.e. MD that intubates/CPR/Spouse)] 4. [seated next to affected person ≥8h]

Answer 299

1. Tick attached \> 36h 2. Tick is ENGORGED upon removal \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Erythema migrans takes \> 3 DAYS to develop. do NOT confuse with cutaneous irritation from Tick Saliva presenting shortly after tick removal*

Answer 300

* Scabies* 1. [HIGHLY CONTAGIOUS (*via* *contact*) Mite infestation] ➜ 2. SEVERE pruritic excoriations with small red crusted papules and linear burrows on the 3. flexor wrist, lateral fingers, finger webs 4. dx by [skin scrapings demonstrating mites/ova/feces under light microscopy] 5. tx = [Permethrin 5% topical cream] (*apply everywhere except head*) * oral Ivermectin is alternative*

Answer 301

[white lesions on the oral mucosa that are **easily scraped off**] (+/- cervical LAD) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ HIV\*\* | abx | inhaled CTS | chemo

Answer 302

p24 antigen + HIV**1**Ab + HIV2Ab

Answer 303

FALSE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Fever and AMS* are usually **NOT** PRESENT in [clostridium Botulism]

Answer 304

[(spores = babies) | (NEUROTOXIN = ADULT)] ➜ inhibits **PRE**synaptic ACh release at neuromuscular junctions ➜ [descending flaccid paralysis] \_\_\_\_\_\_\_\_\_\_\_\_\_ *dx = + serum toxin*

Answer 305

[Vanc PO **and** Metronidazole IV] --(if refractory)--\> [fecal transplant 🆚 surgery] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 306

Rifampin PO \> [cipro PO = Ceftriaxone IM] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[cipro PO or Ceftriaxone IM] for any Rifampin ctd (ie on OCP)*

Answer 307

**1. BLOOD** **2. (any bodily fluid with visible BLOOD in it)** **3. RECTUM** **4. SEMEN** **5. Vagina** **6. Breast Milk** **7. Mucous membrane** **8. Non-intact skin/Percutaneous exposure** **9. eYE** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *HIV^hRC indicates [HIV PEP **PTSD**]*

Answer 308

[72h (preferably within 3h if occupational)]; 28days \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [(Tenofovir + Emtricitabine) + Raltegravir] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PEP **PTSD** [**T**riple ARV ([**2** NRTI + (**1** [II or PI or nNRTI])_{within 72h}]^28d

Answer 309

[Equine serum **7**valent boTulinum antiToxin] ## Footnote *dx = + serum toxin*

Answer 310

[ACE _{from Lungs}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ “*Angiotensin 2* **HAVDEN** way for more!” 8. **H**ypothalamus: stimulates Thirst at hypOthalamus 7. [**A**DH Vasopressin] secretion^{from POST Pit → INC principal cell H20 channels} 8. **V**asoconstriction^{(via smooth m AT1 R)} 4. al**D**osterone secretion from adrenal gland 5. **E**fferent arteriole constriction^{( ⇪ GFR to preserve renal function during low volume states
6. [**N**a+/H+ PCT pump] activity INC ^{→ INC PCT Na+ reAbsorption}

[AT₁R] = Angiotensin 1 Receptor}

9 ⼀RENAL/UROLOGY/ID II Flashcards

(344 cards)