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0
Q

Infectious endocarditis treatment

A

Native: vanco+gentamicin+ceftriaxone

Prosthetic: vanco+gentamicin+rifampin

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1
Q

Koplik spots
Conjunctivitis
Coryza
Conjunctivitis

A

Measles

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2
Q

Bacterial endocarditis

A

Native valve: mitral, streptococcus
Prosthetic valve: S. Epidermidis
GI malignant: S. Bovis

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3
Q

Erythema multiforme MCC

A

HSV

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4
Q

Adrenal insufficiency

A 
Hyponatremia
Hyperkalemia 
Fatigue
Abd cramps, dizzy, weak
Hyper pigmentation
Metabolic acidosis
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5
Q

Status epilepticus

A

BENZOS>PHENYTOIN>PHENOBARB

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6
Q

Systolic murmurs

A

Aortic stenosis
Pulmonic stenosis
M/T regurgitate
VSD

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7
Q

Diastolic murmurs

A

ARMS
Aortic Regurgitation MCC!!
M/T Stenosis
Also…pulmonic regurgitation

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8
Q

Only true continuous murmur that occurs both systole and diastole

A

PDA

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9
Q

Erythema multiforme medications

A 
Sulfonamides 
PCN
Barbiturates 
Phenytoin 
NSAIDS
Oral hypoglycemic meds
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10
Q

Ejection click

Systolic

A

Aortic stenosis

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11
Q

Opening snap

A

Mitral stenosis

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12
Q

Mid systolic click

A

Mitral valve prolapse

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13
Q 
Tremor
Insomnia
N/V
Hallucinations 
Agitated 
Anxiety 
Seizure
A

Alcohol withdrawal
Treat with:
BENZOS
Or Barbiturates

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14
Q 
Philadelphia chromosome
50-55
Increased WBCs and leuk
Anemia
Splenomegaly
Fatigue
Weight loss
A

Chronic Myelogenous Leukemia

Treat with HSCT and Imatinib

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15
Q

Rose thorn infection
Red ulcers that skip
Lymphocutaneous spread

A

Sporotrichosis

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16
Q

Chronic stable angina management

A

Statin
Anti hypertension meds-BB Preferred
Antiplatelet -ASA
Nitrates

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17
Q

What electrolyte abnormality can cause ileus?

A

Hypokalemia

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18
Q

Treatment for intracranial abscesses

A

Ceftriaxone+ metro

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19
Q 
Sore throat 
Fever
Muffled voice
Leans forward 
Thumbprint sign on X-ray
A

Epiglottitis

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20
Q

Synovial fluid analysis:

Inflammation

A 
Opaque
Yellow
WBC 3,000-50,000
PMNs: 50%
Low glucose
High LDH
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21
Q

Synovial fluid

INFECTION!

A 
Opaque
Yellow
WBC > 50,000
PMNs >75%
Very low glucose 
High LDH
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22
Q

What type of crystals are present in gout?

A

Uric acid
Needle shaped
Negative birefringence

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23
Q

What type of crystals are present in pseudogout?

A

Calcium pyrophosphate
Prism shaped
POSITIVE birefringence

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24
What labs, signs, symptoms in RA?
``` Positive RF and CCP Symmetrical joints PIP/MCPs Ulnar deviation Boutonnière def. Swan neck deformities ```
25
``` Medication used in RA folate antagonist Side effects: Interstitial pneumonitis Gastritis Stomatitis ```
Methotrexate
26
Third line medications for RA
Etanercept- Embrel Infliximabe- Remicade Side effects leukopenia and reactivate TB!!!
27
What labs are positive in SLE?
``` ANA ANTI NATIVE DNA -60% Some: Anti-sm Anti-ssa/ssb Anticardiolipin Anti phospholipid False positive VDRL ```
28
Medications used to treat SLE
Hydroxychloroquine-plaquenil
29
What drugs can induce positive ANA?
Procainamide Hydralazine Isoniazid
30
Labs positive in Sjogrens?
ANA RF ANTI SSA/B
31
What does CREST syndrome stand for?
``` Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangectasias ```
32
What is the triad of Reiters syndrome?
Urethritis Conjunctivitis/ Uveitis Arthritis- knee/ankle, asymmetric Positive HLA B 27 Follows infection G.I. or chlamydia
33
What are the characteristics of temporal arteritis?
Over 60 years old Female more than make Jaw claudication, fever, scalp tenderness, headache In one half of patients, PMR exists
34
What are labs done in temporal arteritis?
ESR is usually over 100 Do temporal artery biopsy. Treat with prednisone 60 to 120 mg daily
35
What are the symptoms of Wegener's granulomatosis?
``` Necrotizing vasculitis Triad of: Upper respiratory symptoms Lower respiratory symptoms Focal segmental glomerular nephritis ```
36
What are the symptoms of polymyalgia rheumatica?
Over 50 years old, pain and stiffness of shoulder and pelvic girdle, Fever malaise and weight loss Associated with giant cell or temporal arteritis Have high ESR
37
What rash and symptoms is associated with polymyositis and dermatomyositis?
``` Heliotrope rash on EYELIDS Gottrons papules on HANDS Proximal muscle weakness Elevated CK/ANA/myoglobin Increased Risk of colorectal cancer ```
38
How many sites of muscular pain are indicated in fibromyalgia
11 of 18 sites
39
What are symptoms of polyarteritis nodosa?
``` Vasculitis of small to medium vessels, younger males, Proximal myalgia and weakness Arthralgias Palpable nodules Fever, weight loss, night sweats, ```
40
What pathogens commonly cause otitis externa?
Pseudomonas Enterobacter Proteus Staph aureus
41
What is the fun saying for Hypercalcemia?
Stones, bones, abdominal groans, psychic moans and fatigued overtones
42
What deficiency is commonly present in alcoholics?
Folic acid deficiency Patients typically present with megaloblastic anemia. Give them 1 mg of folic every day
43
What murmur is associated with hypertrophic cardiomyopathy ?
Harsh left sternal border systolic crescendo decrescendo murmur that worsens with Valsalva maneuver
44
What is treatment for PID?
OP: CEFTRIAXONE+DOXY+METRO IP: CEFOXITIN OR CEFOTETAN + DOXY or CLINDA + GENT
45
Definition of menopause
12 months amenorrhea | FSH OVER 40
46
PCOS FINDINGS
Normal estradiol LH/FSH 3:1 Free testosterone over 50 Insulin resistance
47
What Meds can cause galactorrhea?
Psychotropics Cimetidine TCAs OCPs and DEPO
48
What leads check for axis?
I AND AVF
49
Lead I positive | Lead AVF negative
Left axis deviation
50
Lead I negative | Lead AVF positive
Right axis deviation
51
What is normal Tono pen pressure
10 - 21.5 mm Hg
52
``` Sudden onset painless vision less Atrial fib Carotid disease Temporal arteritis CHERRY SPOT ON MACULA ```
Central retinal artery occlusion
53
``` Blurry vision upon weakening Worsens over hours Diabetics Diffuse hemorrhage Cotton wool spots ```
Central retinal vein occlusion
54
What are physical findings in acute angle closure glaucoma?
``` Sudden eye pain Blurriness Fixed dilated pupil Cloudy cornea IOP over 49 ```
55
When do you usually hear an S3 gallop and where is it heard best?
CHF and volume overload | Heard best in left lateral decubitus
56
When and where do you hear an S4 gallop?
Pressure overload | Heard best in left lateral decubitus
57
What murmur is heard in a young child/adult, has fixed split, at LL sternal border?
ASD
58
What murmur is loud and associated with a thrill?
Grade 4 out of 6
59
What murmurs increase with the Valsalva or abrupt standing?
Hypertrophic cardiomyopathy and mitral valve prolapse
60
What are three causes of aortic disease in adults?
1. Calcific disease 2. Bicuspid valve 3. Rheumatic disease- less developed countries
61
What factors are associated with aortic stenosis?
Diabetes, metabolic syndrome genetics hyperlipidemia, smoking and end-stage renal disease
62
What classic physical findings are present in aortic stenosis?
SAD- syncope, angina, dyspnea
63
What physical findings are present in aortic stenosis?
Congestive heart failure or in late findings Pulsus parvus and tardus- small, weak slow rising pulse Systolic ejection murmur
64
What are physical findings in aortic regurgitation?
WATER HAMMER aka Corrigan pulse = wide pulse pressure Exaggerated by raising arm Diastolic murmur LLSB
65
What is MCC of mitral stenosis?
Rheumatic fever
66
What is treatment for mitral stenosis?
Diuretics Beta blockers Digoxin
67
What are findings in central retinal vein occlusion?
Painless vision loss Hemorrhages Disk edema Blood and thunder!
68
What are components of CHADS2 score?
``` CHF HTN OVER 75 DM TIA/CVA (2) All others are 1 ```
69
What are anticoagulant guides for CHADS2 score?
``` 0= no anticoagulants 1= ASA or Warfarin 2= Warfarin ```
70
What infection is associated with rheumatic fever?
Group A strep
71
What are manifestations of rheumatic fever?
``` Arthritis Carditis Chorea Erythema marginatum Subq nodules ```
72
What lab and EKG findings in acute or rheumatic fever?
Increased ESR and CRP Prolonged PR interval Positive ASO tiger
73
Causes of dilated cardiomyopathy
``` Idiopathic ETOH Tachycardia Autoimmune Viral HIV Chemotherapy ```
74
What are symptoms of dilated cardiomyopathy?
``` GLOBULAR HEART AND Congestive heart failure!!!! Ejection fraction less than 40%!!! Arrhythmias Systemic emboli Crackles in lungs S3 ```
75
Causes of restrictive cardiomyopathy
``` Genetics is the number one cause Remember that your families restrict you! Also: Sarcoidosis scleroderma hemochromatosis ```
76
Causes of acute pericarditis
Most commonly idiopathic Coxsackievirus and tuberculosis! post MI lupus and rheumatoid arthritis
77
What are classic signs of acute pericarditis?
Chest pain - improved by leaning forward! Friction rub EKG changes of ST elevation and PR depression
78
What is treatment for acute pericarditis?
NSAIDs Colchicine Aspirin for post MI
79
What are signs and symptoms of constrictive pericarditis?
Most often follows cardiac surgery! Right-sided heart failure EKG shows low voltage CXR shows pericardial calcification echocardiogram with pericardial thickening cardiac catheterization Diagnostic!!!
80
What is treatment for constrictive pericarditis?
Diuretics and salt restriction definitive therapy with pericardectomy
81
What are the two types of pericardial effusion and what are the causes of each?
Transudative and exudative T- CHF E-Infection, malignancy, autoimmune or myocardial infarction
82
What are signs and symptoms of pericardial effusion ?
Right heart failure pericardial rub water bottle heart on chest x-ray diagnostic test of choice is echo
83
What is becks triad in cardiac tamponade?
Hypotension JVD Muffled heart sounds
84
What are 5 cyanosis congenital heart diseases! 5 TS Remember R to L
``` Truncus arteriosus TGA Tetralogy of Fallot Tricuspid atresia Total analomous pulmonary venous return ```
85
What are characteristics of tetralogy of Fallot?
1. Overriding aorta 2. Right ventricular outflow obstruction 3. Right ventricular hypertrophy 4. Ventricular septal defect
86
What are symptoms in child with tetralogy of Fallot?
Cyanosis crying with feeding | chest x-ray reveals boot shaped heart treatment is surgery
87
What is characteristic of long QT syndrome and how is it treated?
QT interval of greater than 440 to 460 ms which is often treated by using beta blockers. It can progress to torsades de pointed or sudden cardiac death
88
What drugs can prolong the QT interval?
``` Procainamide and quinidine Propafenone and flecanide Antidepressants Droperidol Erythromycin Methadone ```
89
What is the classic triad of AAA?
Abdominal or back pain, hypotension and a pulsatile abdominal mass
90
What are three MCC of SVT?
1. AV re-entrant 2. WPW 3. Dig toxicity
91
What is difference between Multifocal atrial tachycardia and wandering atrial pacemaker?
Rate less than 100 in WAP | Rate over 100 in MAT
92
What are 4 acyanotic congenital heart diseases?
ASD VSD PDA CoA
93
Increased CO2 = Increased acid = decreased pH
Respiratory acidosis
94
Decreased CO2 = decreased acid equals increased pH
Respiratory alkalosis
95
HCO3 acts as a base | HCO3 increase = increase base = increased pH
Metabolic alkalosis
96
HCO3 decreased = decreased base and also decreased pH
Metabolic acidosis
97
Causes of respiratory acidosis | ...any process that decreases ability to exchange CO2 for oxygen
COPD Asthma Congestive heart failure Pneumonia
98
Causes of respiratory alkalosis | Any process which increases respiratory rate
Anxiety Fever Overventilation
99
Causes of metabolic acidosis | Any process that decreases bicarbonate
Diabetic ketoacidosis | Renal failure
100
Causes of metabolic alkalosis or any process that decreases acid or increases by carbonate
Prolonged vomiting or nasogastric suction
101
Describe how to analyze ABGs
First analyze the pH ...if pH is low it is acidosis ...then look at carbon dioxide ...if CO2 is elevated it is respiratory acidosis ...if CO2 is normal or low it is metabolic acidosis
102
Stage two or moderate COPD features
FEV1 between 50 and 80% and chronic cough sputum production
103
Stage III or severe COPD features
FEV 1 between 30 and 50% with progressive airway limitation and exacerbations
104
What are characteristics of stage four or very severe COPD
FEV1 less than 30% or… | FEV1 less than 50% plus chronic respiratory failure
105
When should I inhaled corticosteroids be used in the treatment of COPD?
In stage 3 and 4 COPD with greater than three exacerbations per year
106
What are some characteristics manifestations of cystic fibrosis?
Sinusitis and nasal polyps in infancy with multiple respiratory infections
107
What test is screening test for cystic fibrosis?
Sweat test also known as quantitative pilocarpine iontophoresis which shows increased sodium and chloride levels
108
What are characteristics of Horner's Syndrome and what tumor can it represent?
Miosis Ptosis Anhidrosis ...Pancoast tumor
109
Which two types of lung cancers related to brain mets?
Adenocarcinoma | Small cell
110
Which bacteria that causes pneumonia is common in COPD pts?
Haemophilus influenza
111
What are characteristics of patients with legionella pneumonia?
High fever | hyponatremia and diarrhea with very ill appearance
112
What is inpatient treatment for community acquired pneumonia ?
Provide coverage of strep pneumonia and Legionella with ceftriaxone plus Z
113
What is Potts disease and how does it manifest?
Skeletal tuberculosis with thoracic and lumbar vertebral fractures
114
What TB readings are considered positive?
>5mm: immunosuppressed pts >10mm: recent immigrants, children, other risk factors >15mm: normal no risk factors
115
What is treatment of active TB?
``` INH RIF PZA EMB X 8 wks Then INH AND RIF X 16 wks ```
116
What are non pulmonary manifestations of sarcoidosis?
``` Erythema nodosum Cardiac conduction issues Uveitis Parotitis Hypercalcemia ```
117
What is easy difference to identify pleura fluid transudate vs exudate?
Transudate protein < 3 | Exudate protein > 3
118
What is gold standard test for PE?
Pulmonary angiography
119
Which antibiotic can cause permanent hearing loss?
Gentamicin and vancomycin which are part of the aminoglycosides group
120
Which anabiotic's are associated with nephrotoxicity?
Amphotericin Gentamicin Nafcillin
121
Which antibiotic is associated with red man syndrome?
Vancomycin
122
Which antibiotic can cause hyperkalemia , especially in older pts taking an ace inhibitors?
Bactrim
123
Which antibiotic has highest incidence of c. Diff?
Clindamycin then augmentin and keflex
124
Possible effect on cbc by heparin
Thrombocytopenia
125
What drug can cause blue skin discoloration and thyroid abnormalities with toxicity?
Amiodarone
126
What drug can cause yellow and green vision disturbance and PVCs?
DIGOXIN
127
Name three alpha blockers
Prazosin Terazosin Doxazosin
128
What medications can cause gingival hyperplasia?
Phenytoin > nifedipine > amlodipine
129
What condition warrants caution when using inhaled anticholinergics?
Glaucoma
130
What are possible neuropsych side effects of montelukast?
``` Insomnia Agitated Anxiety Depressing Suicide ```
131
What are possible side effects of theophylline?
``` GI se HA anxiety Seizures Arrhythmia ```
132
What gout medication should not be used in pts with history if Uric acid renal stones?
Probenecid
133
What serological tests should be done before using infliximab or etanercept in RA?
HBV HCV TB
134
Which H2 blocker has anti androgen effects...ED and gynecomastia?
Cimetidine
135
What is black box warning associated with metoclopramide? Used in diabetic gastroparesis?
Acute dystopia
136
Name significant interactions of promethazine?
Levodopa | Otc prolongation
137
Side effects of PTU and methimazole
Vasculitis Agranulocytosis Hepatic failure
138
Common side effects Phenytoin
Gingival hypertrophy Teratogenic Nystagmus Stevens Johnson
139
Which BP medicine interacts with Prozac and Paxil cyp2d6
Metoprolol
140
Name 3 MAOIs and their interactions
Isocarboxazid Tranylcypromine Phenelzine Interacts w sympatomimetics a do high tyranime foods
141
What drug is used to reverse BZD OD?
Flumazenil
142
What is a sign of lithium toxicity
Tremor | Also hypothyroidism
143
Side effects of accutane
``` Alopecia Pseudotumor Teratogenic Hepatitis and pancreatitis Photosensitive ? Psychosis ```
144
What is treatment for histoplasmosis and blastomycosis?
Itraconazole
145
What is treatment for PCP Pneumonia
Bactrim
146
What infection shows ring enhancing lesions on CT?
Toxoplasmosis
147
What virus causes kaposis sarcoma?
HHV8
148
What are symptoms of botulism? | Home canned food and honey babies
``` Diplopoda Dry mouth Dysphasia and dysphonia Respiratory paralysis Muscle weakness ```
149
What are tx options for Lyme disease
Doxycycline Amoxicillin CEFTRIAXONE
150
What organism causes cervix petechia like strawberry?
Trichomonas
151
What is initial tx for syphilis
Benzathine penicillin G or doxy x 14 days
152
Virus associated with Bell's palsy
HSV1
153
What is empiric tx for meningitis?
Vancomycin+CEFTRIAXONE +|~ ampicillin
154
What organism causes hot tub follicles
P. Aeruginosa
155
What diarrhea causes rice water stool
Cholera
156
Severe effect of E COLI
Hemolytic uremic syndrome | ARF + thrombocytopenia + anemia
157
Shigella | Daycare
Quinolone or Bactrian or Z
158
Campylobacter | Chicken
Quinolone
159
What is difference between colles and smith fracture of distal radius?
Colles fracture is displaced dorsal and smith is displaced volar
160
What is most common bone cancer in children?
Osteosarcoma
161
What tumor causes onion skin appearance on X-ray
Ewing sarcoma
162
What endocrine disorder caused bitemporal hemianopsia
Pituitary adenoma

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