CK Flashcards
(265 cards)
1
Q
Alpha synuclein
A
Parkinson’s
2
Q
Thymus absence on X-ray
A
Di George syndrome or thymic hypoplasia
3
Q
Evaluation of Primary Amenorrhea
A
Pelvic exam or U/S uterus present (serum FSH)- increased karotype decreased cranial MRI
Uterus absent (karyotype, serum testosterone) 46xx normal female testosterone abnormal Mullerian development 46 xy normal male testosterone level androgen insensitivity syndrome
4
Q
Preseptal cellulitis
A
Eyelid erythema and swelling, chemosis txt: oral Abx
5
Q
Orbital cellulitis
A
symptoms of preseptal cellulitis plus PAIN w/ EOM, proptosis and/or opthalmoplegia w/diplopia txt: IV Abx and Surgery
6
Q
Cat scratch Dx
A
Etiology: Bartonella henselae, fastidious gram - bacteria
Clinical manifestation- papule at scratch/bite site, regional adenopathy, +/- fever of unknown origin (>14days)
Dx: clinical +-serology
Txt: azithromycin
7
Q
ALS
A
Loss of upper and lower motor neuron loss
High CPK levels
Riluzole, Baclofen, CPAP and Bipap, Tracheostomy
8
Q
Charcot Marie Tooth Dx
A
Lose both motor and sensory innervation (distal weakness and sensory loss, wasting in legs, decreased DTRs, tremor)
Foot deformity with high arch common (pea cavus) legs look like inverted champagne bottles
Most acc test EMG
9
Q
Peripheral Neuropathy
A
Best initial therapy- pregabilin gabapentin
10
Q
Facial Nerve (Bell Palsy)
A
Best initial therapy: Prednisone
Most common complication: corneal abrasion
11
Q
Guillain Barre
A
Bilateral Ascending weakness with loss of reflex, respiratory muscles weakness
Autonomic dysfunction
Most specific diagnostic test EMG/ nerve conduction studies
Decrease in FVC and peak
Inspirational
12
Q
Myasthenia Gravis
A
Muscular weakness from antibodies against ach receptors at the NMJ
Double vision, difficulty chewing, ptosis, weakness of limb muscles worse at end of day
best initial test: Ach receptor antibodies
Most acc test: EMG
Imaging- Chest X-ray, CT, MRI for thymoma
Best initial therapy: Neostigmine
13
Q
Acute myasthenic crisis
A
Severe, overwhelming dx, profound weakness, respiratory involvement
Txt: IVIG or plasmapheresis
14
Q
Kawasaki Dx
A
Epidemiology 90% age <5, Asian
Dx criteria (4 of the following plus >5 days of fever)
- conjunctivitis
- mucositis (injected, fissured lips or pharynx, strawberry tongue)
- cervical lymphadenopathy
- rash: erythematous, polymorphous, generalized, perineal erythema & desquamation, morbilliform-erythema
- edema of hands and feet
15
Q
Cat bites
A
Pasturella multiocida, anaerobic bacteria
MGMT: copious irrigation and cleaning, prophylactic amoxicillin/clavulanate, tetanus booster as indicated, avoid closure
16
Q
Key features of a craniopharyngioma
A
Low grade malignancy derived from remnants of rathke pouch, optic chiasm compression-bitemporal hemianopsia, pituitary stalk compression- endocrinopathies( GH, DI), suprasellar calcified mass on imaging
17
Q
Alzheimer’s Dx
A
MRI, VDRL or RPR B12, Thyroid
Txt: Donepezil, rivastigmine, galantamine, memantine
18
Q
Lewy Body Dementia
A
Ass w/Parkinson’s Txt w levodopa/carbidopa
19
Q
Creutzfeldt Jakob Dx
A
Rapidly progressive dementia w/myoclonic jerks, normal CT & MRI, CSF w/ 14-3-3 protein, biopsy is most accurate
20
Q
Chronic pancreatitis
A
Secretin stimulation is the most accurate test for chronic pancreatitis
Best initial test: X-ray and abdomnial CT
21
Q
Group B Strep pregnancy prophylaxis
A
Penicillin G 35 to 37 weeks
If severe allergy to PCN: vancomycin
Minor allergy: cefazolin
When sensitivity is available and PCN Allergy : clindamycin erythromycin
22
Q
Primary ciliary dyskinesia
A
Resp tract findings: chronic sinopulmonary infxn, nasal polyps, bronchiectasis, digital clubbing
Extrapulm findings: situs inversus, infertility due to immobile spermatozoa, NORMAL GROWTH
23
Q
Cystic Fibrosis
A
Resp tract findings: chronic sinopulmonary infxn, nasal polyps, bronchiectasis, digital clubbing
Extrapulm findings: pancreatic insufficiency, infertility due to absent vas deferens (azospermia), FAILURE TO THRIVE
24
Q
Ectopic pregnancy
A
Risk factors: previous ectopic, previous pelvic/tubal surgery, PID
Clinical FX: abdominal pain, amenorrhea, vaginal bleeding, hypovolemic shock in ruptured ectopic, cervical motion, adnexal + abdominal mass
Dx: +hCG, transvaginal U/S revealing adnexal mass, empty uterus
Stable: MTX, unstable SURG
25
Necrotizing Enterocolitis
Risk factors: prematurity, very low birth weight(<1.5 or 3.3ibs), enteral feeding (formula >breast milk)
Clinical Fx: vital sign instability, lethargy, bilious emesis, bloody stools, abdominal distension
X-ray: pneumatosis intestinalis, portal venous gas, pnemoperitoneum
Txt: bowel rest: parenteral nutrition, broad spectrum Abx, +/- surgery
26
Congenital hypothyroidism
Initially normal at birth, symptoms develop after maternal T4 wanes: lethargy, constipation, enlarged Fontanalle, protruding tongue, umbilical hernia, jaundice, dry skin
Dx: Elevated TSH low T4
Txt: Levothyroxine
27
Impetigo
Non bullous- staph aureus, group A Strep, bullous- S. Aureus
Limited skin involvement: mupirocin
extensive Skin involvement: oral Abx (cephalexin, dicloxacillin)
28
12 months
Infants weight triples, height doubles standing and learning to walk, uses a 2finger pincer grasp, says 1 word other than mama and dada and follows 1step command w/gesture
29
Prader Willi syndrome
Paternal 15q11-q13 deletion death by choking
30
Most common cause of pneumonia in CF children is
Staph Aureus
Txt: IV vancomycin
31
SCID (severe combined immunodeficiency
Failure of T cell development (adenosine deaminase) B cell dysfunction due to absent T cells
XLR, autosomal recessive
- recurrent severe viral, fungal or opportunistic infxn (pneumocystis)
- failure to thrive
- chronic diarrhea
Txt:?stem cell transplant
32
Bacterial Meningitis
Clinical features: fever, increased intracranial pressure (vomiting, AMS, headache), meningal irritation (nuchal rigidity)
complications: hearing loss (most common), intellectual disability, cerebral palsy, epilepsy
33
Achalisia
Best initial test: Barium swallow
Most accurate: Manometry
Txt: Heller myotomy
34
Most acc test for esophageal cancer
Endoscopy
35
Esophageal spasm
Esophageal best initial test
Manometry most acc test
Txt: nitrates, calcium channel blockers
36
Plummer Vinson syn
Dysphasia, Iron def anemia , glossitis
Txt: iron replacement
37
Best test for Zenker’s Diverticulum
Esophagram
38
Boerhaave’s Syndrome
Full thickness tear
Hamman’s sign- crepitus
Subcutaneous air
EMERGEnCY
39
Pancreatic cancer
Painless jaundice
40
Most accurate test Gastritis
EGD
| + h pylori
41
Stress Ulcer Prophylaxis
Mechanical ventilation
Burns-curling ulcer
Head trauma-cushing
Coagulopathy
42
Zillinger Ellison Syndrome
Diarrhea, abdominal pain, anemia and Heme positive stools
43
Carcinoid syndrome
Flushing, wheezing, CV murmur(tricuspid regurgitation), diarrhea.
Best initial test: 5HIAA (urinary 5-hydroxyindoleacetic acid)
Txt: Octreotide
44
Paracentesis is performed when
New onset ascites
Abdominal pain and tenderness
Fever
45
Symptomatic from anemia means
SOB, Lightheaded, confused and sometimes syncope, hypotension and tachycardia, and chest pain
46
TTP
```
Hemolysis
Low platelet
Renal insufficiency
Neurological disorder (confusion, seizure
Fever
Normal PT, PTT
```
Txt Plasmapharesis or FFP no platelets
47
Paroxysmal nocturnal hemoglobinuria
CD 55, CD 59 decay accelerating factor deficiency
Hemolysis n thrombosis
Episodic dark urine
Pancytopenia
Txt Prednisone, bone marrow transplant, eculizumab, folic acid
48
Smudge cell
CLL
49
Cord compression
History of Cancer
Vertebral tenderness, sensory level, hyperreflexia
50
Epidural Abscess
Fever, high ESR
Vertebral tenderness, sensory level, hyperreflexia
51
Cauda Equina
Bowel and bladder incontinence, erectile dysfunction
Bilateral leg weakness
Saddle area anesthesia
52
Disk herniation
Pain, numbness of medial calf or foot
Loss of knee and ankle reflexes, positive straight leg raise
53
Felty Syndrome
RA
Splenomegaly
Neutropenia
54
Caplan Syndrome
RA
Pneumoconiosis
Lung nodules
55
Hydroxychloroquine
Toxic to retina
56
Juvenile Rheumatoid Arthritis/ Still’s Dx
Often only with fever spikes, salmon colored rash, on chest and abdomen
Splenomegaly
Pericardial effusion
Mild joint symptoms
57
Lupus flare
Decrease in complement and raise in anti-DS DNA
58
What is the treatment to prevent recurrence of spontaneous abortion in Antiphospholipid Syndrome
Heparin and Aspirin
59
Anticardiolipin
Ass with spontaneous abortion in APL Syndrome
60
Anticentromere antibodies
CREST syndrome
61
CREST syndrome
```
Calcinosis
Raynaulds phenomenon
Esophageal dysmotility
Sclerodactyl
Telangiectasia
```
62
Polymyositis / Dermatomyositis
| Best initial test and most accurate test
Best initial CPK and Aldolase
Most accurate test: muscle biopsy
63
Keratoconjuctivitis sicca
Dental caries
Dyspareunia
Sjögren’s syndrome
64
Most dangerous complication of Sjogren’s
Lymphoma
65
Sjogren best initial test and most accurate test
Best initial Schirmer test
Most accurate test lip or parotid gland biopsy
Best initial test on blood RO AND LA (SS-A- SS-B)
66
Water mouth
| artificial tears
Best initial therapy for Sjogrens
67
Polyarteritis nodosa
Foot drop
Stroke in a young person
Hep B, C
Always spares lungs
68
Leukocytoclastic vasculitis
Henoch Schonlein purpura
69
Juvenile rheumatoid arthritis has an excellent prognosis with
Positive ANA
70
Best initial test in an acute asthma exacerbation
ABG or Peak Expiratory flow
Mild- resp alkalosis
Severe- resp acidosis
71
Most accurate diagnostic test in asthma
PFTs
72
Adverse effects of inhaled steroids
Dysphonia and oral candidiasis
73
Management of acute asthma exacerbation
Oxygen
Albuterol +\- inhaled anticholinergic (ipratropium)
Corticosteroids
74
If pt with acute asthma exacerbation has no response to oxygen, albuterol, and steroids or develops a respiratory acidosis what should you consider
Endotracheal intubation and mechanical ventilation
75
Chronic bronchitis
Productive cough for more than 3 months/year for 2 consecutive years
76
COPD exacerbation
Increase cough
Sputum
SOB
77
Best initial test COPD
Chest X Ray
Increased AP diameter
Air trapping flattened diaphragm
78
Most acc diagnostic test for COPD
PFT
Decreased FEV1/FVC
Increase TLC and RV
Decreased DLCO in emphysema
79
Acute exacerbation COPD
ABG - increase PCO2 and hypoxia
80
EKG COPD
A fib or multifocal atrial tachycardia (MAT)
RAH or RVH
Echo: RA or RV hypertrophy, Pulmonary HTN
81
Improved mortality COPD
```
Smoking cessation
Oxygen therapy (pao2 <55 or Sa02 < 90 or if pt has cor pulmonale pulmonary HTN or polycythemia PaO2 <60 or Sa02 <90
```
82
When do you prescribe antibiotics for COPD flare
Requiring hospitalization or having 2/3 cardinal symptoms
1. Dyspnea
2. Increased sputum production
3. Increased sputum purulence
Abx: s. Pnemo, h flu or moraxella
Macrolides (azithromycin, clarithromycin), cephalosporin (cefuroxime, cefixime), amoxicillin/clavulanic acid, quinolone: levofloxacin, moxifloxacin), doxycycline or Bactrim
83
Best initial test Bronchiectasis
Chest X Ray
84
Most accurate test Bronchiectasis
High Resolution CT
85
Community acquired pneumonia
Within 48 hours of hospitalization
| Pneumonia occurring before hospitalization
86
Recent viral infection pneumonia
Staph aureus
87
Anaerobic pneumonia
Poor dentition
| Aspiration
88
Hoarseness
Chlamydophilia pneumonia
89
Abdominal pain or diarrhea pneumonia
Lower lobe pneumonia irritating intestines through diaphragm
90
Outpatient treatment for CAP
1. Previously healthy or no antibiotics in past 3 months
Macrolide (Azithromycin/clarithromycin) or Doxycycline
2. comorbidities or Abx past 3 mo
Respiratory floroquinolone (Levofloxacin or Moxifloxacin)
91
Inpatient treatment for CAP
1. Resp fluoroquinolone: levofloxacin or moxifloxacin
| 2. Ceftriaxone and azithromycin
92
CURB 65
```
Confusion
Uremia (BUN>30)
Resp distress RR>30, pulse >125
BP low (systolic <90)
Age >65
```
Also:pO2 <60, pH <7.35, sodium <130, glucose >250, Temp >104 or comorbidities such as cancer, COPD, CHF, renal failure or liver dx
93
Healthcare associated Pneumonia
Pneumonia > 48 hrs after admission
Much higher incidence of Gram - bacteria such as E. Coli or Pseudomonas
94
HAP Treatment
Cefepime or Ceftazidime
Or Pip/Tazo
Or imipenem, meropenem or doripenem
95
Look for the following changes in VAP (ventilator associated pneumonia)
1. Fever and/or rising WBC count
2. New infiltrate on chest X-ray
3. Purulent secretions coming from endotracheal tube
96
Most acc diagnostic test of VAP
Open lung biopsy
97
VAP treatment
1. Anti-pseudomonal beta-lactam (cephalosporin- ceftazidime or cefepime or penicillin pip/tazo or carbapenem imipenem )
2. 2nd anti-pseudomonal agent (aminoglycoside gentamicin or amikacin)
3. MRSA agent (Vancomycin or Linezolid)
98
Lung Abscess best initial test
Chest Xray, CT more accurate best biopsy (sputum culture always wrong answer)
99
Best treatment for Lung abscess
Clindamycin
100
PCP best initial test
Chest X-ray showing bilateral interstitial infiltrates or ABG showing hypoxia or increased Aa gradient
LDH is always elevated
101
PCP most accurate test
Bronchoalveolar lavage
102
Sputum stain PCP
If positive no need for further testing
| If negative-bronchoscopy as the best diagnostic test
103
PCP treatment
Bactrim
Add steroids when PaO2 <70 or Aa gradient >35
If toxicity to Bactrim: Clindamycin and primaquine (contraindicated in G6PD) or Pentamidine
104
PCP prophylaxis
Bactrim
| If rash or neutropenia atovoquone or Dapsone (contraindicated in G6PD)
105
TB best initial test
Best initial test: Chest X Ray
Sputum stain and culture specifically for acid fast bacilli (mycobacterium) must be done 3x to fully exclude TB
If 3 negative acid fast but clinical suspicion is high: Bronchoscopy with BAL or pleural biopsy
106
TB treatment standard of care
```
RIPE
PE- May be stopped after 2 mo
RI for 4 months
Total of 6 mo
Txt is extended to 9 mo (osteomyelitis, miliary TB, meningitis, pregnancy)
```
107
Toxicity of TB Meds
All cause hepatotoxicity (don’t stop unless transaminases rise 3-5x upper limit of normal)
Rifampin- red color
Isoniazid- peripheral neuropathy (txt pyridoxine)
Pyrazinamide- hyperuricemia (txt allopurinol if symptomatic only)
Ethambutol- optic neuritis/color vision (txt decrease dose in renal failure)
108
In TB txt pregnant pts should not receive
Pyrazinamide
109
Glucocorticoids are used in TB
Decrease risk of constrictive pericarditis in those with pericardial involvement and decrease neurological complications in TB meningitis
110
Positive PPD > 5
```
HIV positive
Glucocorticoid users
Close contact with active TB pt
Abnormal calcification on Chest X-ray
Organ transplant recipients
```
111
Positive PPD >10
```
Recent immigrants
Prisoner
Healthcare workers
Close contact with TB
Hematologic malignancy, alcoholics, DM
```
112
Latent TB txt positive PPD
9mo Isoniazid
113
ILD best initial test
Best initial- Chest X-ray
More accurate: High resolution CT
Most accurate: Lung biopsy
114
Agents to decrease rate of progression to IPF
Pirfenidone and nintedanib
115
Best initial test in Sarcoidosis
Chest X-ray
116
Most accurate test for Sarcoidosis
```
Lymph node Biopsy- granulomas
Elevated ACE
Hypercalcemia
Granulomas in sarcoid make Vit D
PFTs-restrictive lung disease
```
117
Best initial test for PE/DVT
Chest X-ray
EKG
ABG
118
When are thrombolytics the right answer for DVT/PE
1. Hemodynamically unstable (hypotension, tachycardia)
2. acute RV dysfunction
Contraindicated in recent surgery or bleed
119
Direct acting thrombin inhibitors are the answer for DVT/PE when
HIT (fondaparinux), argatroban, lepirudin
120
ARDS
Pa02/FI02 <200
Normal findings on R heart Cath
Normal PCWP <18
121
LH/FSH deficiency presentation
Both genders decreased libido and decreased axillary, pubic abs body hair
Men- unable to produce testosterone or sperm, erectile dysfunction and decreased muscle mass
Women- unable to ovulate or menstruate normally and become amenorrheic
122
GH deficiency presentation
Adults -few symptoms
Child- dwarfism
123
Kallman Syndrome presentation
Decreased FSH and LH
Decreased GnRH
Anosmia
124
Panhypopituitarian diagnostic test
Hyponatremia from
Hypothyroidism
Glucocorticoid underproduction
Potassium level normal (Aldosterone is not affected)
```
MRI- detects compression
GH- IGF level
ACTH And Cortisol levels
LH, FSH, Testosterone
TSH
```
125
Treatment for panhypopituitarism
Thyroxine
Cortisol
Testosterone and Estrogen
126
Acromegaly best initial test
Insulin like growth factor (IGF)
127
Most accurate test for Acromegaly
Glucose suppression test
128
MRI for Acromegaly
Only after lab identification of acromegaly
129
Best initial therapy for Acromegaly
Surgery (Transphenoidal resection of pituitary)
130
Meds for Acromegaly used if surgery does not work
Cabergoline: Dopamine agonist inhibit GH release
Octreotide or lanreotide: Somatostatin inhibits GH release
Pegvisomant: GH receptor antagonist
131
Hyperprolactinemia Diagnostic Tests
Thyroid function test
Pregnancy test
BUN/Cr ( kidney Dx elevates prolactin)
Liver function test (cirrhosis elevates prolactin)
MRI is done after
High prolactin level is confirmed
Secondary causes like Meds are excluded
Patient is not pregnant
132
Treatment for Hyperprolactinemia
Dopamine agonist
Cabergoline
Transphenoidal surgery when NOT responding to meds
133
Pearls for hypothyroid treatment
High TSH (double normal) plus normal T4 =treatment
Anti thyroid peroxidase antibodies tell who needs thyroid replacement when T4 is normal and TSH is high
134
Best initial test for hypothyroidism
TSH, T4
135
Best initial test for hyperthyroidism
T4, TSH
136
Pituitary Adenoma
High TSH
137
Best initial therapy for Graves ophthalmopathy
Steroids
For those unresponsive to steroids
Radiation
138
Treatment for subacute thyroiditis
Aspirin
139
Treatment for pituitary adenoma
Surgery
140
Thyroid storm treatment
Propanolol (blocks conversion of T4 to T3)
Thiourea drugs(methimazole and propylthiouracil) block hormone production
Iodinated contrast material
Steroids
Radioactive iodine
141
Next step after normal TSH/T4 in found in a pt with a Thyroid nodule
FNA
142
Most common cause of asymptomatic hypercalcemia
Primary hyperparathyroidism
143
Short QT syndrome is seen in what electrolyte disorder
Hypercalcemia
144
Treat acute hypercalcemia with
Saline
Bisphosphonates
Calcitonin
145
Management of Hyperparathyroidism
DEXA
| Preop imaging of neck with sonography or nuclear scan prior to surgery
146
Treatment of Hyperparathyroidism
```
Surgery
When surgery is not possible cinacalcet
Indications for removal of parathyroids:
Bone disease (osteoporosis)
Renal involvement including stones
Age under 50
Calcium consistently 1 point above normal
```
147
What electrolyte abnormality causes a prolonged QT
Hypocalcemia
148
Best initial test for hypercortisolism
Low dose dexamethasone suppression test
149
Most accurate test for hypercortisolism
Cortisol testing
24 hr urine
Late night salivary
150
Best next test after Cortisol testing
Serum ACTH level
151
If serum ACTH is low what is the next best step
CT Adrenals in search of an adrenal mass
152
If serum ACTH is high what is the next best step
High dose dexamethasone test to distinguish Ectopic vs Pituitary
High ACTH and cortisol- ectopic (does not suppress)
Suppression of cortisol- pituitary adenoma Cushing disease
153
If a pt fails high dose dexamethasone test what is the best next step?
Chest CT in search of Ectopic ACTH secreting tumor
154
Best next step after suppression of high dose dexamethasone suppression test?
Pituitary MRI
155
What if the pituitary MRI shows no mass?
Petrosal sinus sampling for ACTH
156
If surgical removal of hypercortisolism is not successful what is the next best step in treatment?
Pasireotide (somatostatin analog)
157
How does an acute adrenal crisis present?
Hypotension
Fever
Confusion
Coma
158
Hypoadrenalism findings on lab
```
Hypoglycemia
Hyponatremia
Hyperkalemia
Met Acidosis
High BUN
Eosinophilia
```
159
Next best step in management of acute adrenal crisis
Replace steroids with hydrocortisone
| Fludocortisone
160
Primary hyperaldosteronism lab findings
High BP and low K
161
Best initial test for primary hyperaldosteronism
Plasma aldosterone to plasma renin ratio
162
A low plasma renin with high aldosterone
Primary Hyperaldosteronism
163
Most accurate test for primary hyperaldosteronism
Adrenal venous sampling- high aldosterone
164
Treatment for hyperaldosteronism
Unilateral-resection
| bilateral-eplerenone or spironolactone
165
Best initial test for pheochromocytoma
Plasma catecholamines
166
Confirmation of pheochromocytoma
24 hr urine metanephrine and catecholamines
167
What is the next best step in management for a pheochromocytoma that originates outside the adrenal gland
MIBG scanning
168
Best initial therapy of a pheochromocytoma
Phenoxybenzamine (IV alpha blocker)
169
Treatment of Pheochromocytoma
Pehnoxybenzamine
Propanolol
Calcium channel blocker
Laparoscopic removal
170
Irregular menstraution
Clinical hirtuism and or high testosterone/DHEA
10 cyst on pelvic ultrasound with enlarged ovary (>10 cm)
Criteria to diagnose PCOS
171
Primary Immunodeficiency Disorder Low B cell output Normal T cell
Common variable Immunodeficiency (CVID)
172
Primary Immunodeficiency Disorder Low B cells, normal T cells in young male children
X-linked (Bruton agammaglobulinemia)
173
Primary Immunodeficiency Disorder Low B cell And T cell analogous to HIV
Severe combined immunodeficiency (SCID)
174
Primary Immunodeficiency Disorder Atopic disorders, anaphylaxis
IgA deficiency
175
Primary Immunodeficiency Disorder Skin infection (eg Staph)
Hyper IgE syndrome
176
Primary Immunodeficiency Disorder normal T cell normal B cell Low platelets, eczema
Wiskott- Aldrich Syndrome
177
Primary Immunodeficiency Disorder infections combined with staph, burkholderia, nocardia, aspergillus
Lymph nodes with purulent material
178
Most accurate test for Coccidioidomycosis
Sputum culture, serology
179
Coccidioidomycosis clues to diagnosis
Joint pain
| Erythema nodosum
180
Coccidioidomycosis treatment if symptomatic
Fluconazole or itraconazole
| Severe: amphotericin
181
Histoplasmosis most likely diagnosis when pt presents with
Involvement of bone marrow (pancytopenia), spleen and lymph nodes, resembles TB with lung cavities
182
Histoplasmosis most acc test
Culture of sputum, blood or affected organs. Urine and serum antigen highly specific
183
Histoplasmosis treatment
Severe illness gets amphotericin followed by oral itraconazole
184
Blastomycosis most likely diagnosis when pt presents with
```
Bone
Skin
Lung
Prostate involvement
“Broad budding yeast”
```
185
Mucormycosis most likely diagnosis in
Immunocomoromised pts (diabetics in DKA)
Rapidly dissects nasal canals and eyes to brain
Deferoxamine increases risk of mucormycosis by mobilizing iron
186
Treatment for Mucormycosis
Surgical emergency
Amphotericin best initial therapy
Follow up therapy with posaconazole or isavuconazole
187
Best initial therapy for invasive aspergillosis
Voriconazole, isavuconazole or caspofungin
188
Best method for detection of Malaria
Thick smear
189
Best method for speciation of Malaria
Thin smear
190
Treatment for infection with plasmodium falciparum Malaria
Mefloquine or atovaquone/proguanil
191
Treatment for infection with non-falciparum infection
Chloroquine or primaquine (vivax and ovale only)
192
Tropical disease that presents with:
CNS abnormalities (confusion, seizure, coma)
Hypotension/shock or pulmonary edema
Renal injury, acidosis or hypoglycemia
Manifestations of severe malaria
193
Treatment of severe malaria
Artemisinins (artemether, artesunate)
194
Prophylaxis for malaria
Mefloquine, atovaquone/proguanil
(Avoid mefloquine with history of neuropsychiatric disease )
Doxycycline
195
What tropical Dx presents with Intense joint pain, periarticular edema and rash
Chicungunya
196
What tropical disease is characterized by bone pain, the 2nd episode is worse
Dengue
197
Tropical disease whose 2nd episode presents with thrombocytopenia, petechiae and GI bleeding leading to fatal hemorrhage and shock with low WBC count and high transaminases
Dengue
198
What tropical disease may cause microcephaly and is ass/ w Guillane Barre
Zika
199
Diagnosed with culture showing boxcar shaped encapsulated rods
Anthrax
200
Treatment for Anthrax
Quinolone or doxycycline
201
Treatment of Staph sensitive isolates first agents IV & oral
IV: oxacillin nafcillin cefazolin
Oral: dicloxacillin cephalexin cefadroxil
202
Treatment of Staph sensitive Isolates additional agents
IV cephalosporins, carbapenem, beta-lactam/ beta-lactamase combination
Oral: amoxicillin/clavulanate, any oral cephalosporin
203
Telavancin, dalbavancin, tedizolid, oritavancin, vancomycin, daptomycin, linezolid, ceftaroline
MRSA drugs
204
Treatment of Staph resistant isolates first agents
IV: vancomycin, linezolid, daptomycin, ceftaroline, oritavancin, telavancin, dalbavancin
205
Treatment of Staph resistant isolates additional agents
IV oritavancin, telavancin, dalbavancin
| Oral clindamycin tedizolid
206
Best initial test in Meningitis
LP
207
When is a head CT the best initial test for Meningitis?
If before LP there is
Papilledema
Seizures
FND
Confusion
208
If there is a contraindication to immediate LP what is the best initial step in manangement
Abx
209
Treatment for bacterial meningitis
Ceftriaxone, vancomycin and steroids
210
What is the most common neurological deficit of untreated bacterial meningitis?
Eighth cranial nerve deficit or deafness
211
Best initial test for Infectious diarrhea
Blood and/or fecal leukocytes
212
Greater sensitivity and specificity than stool leukocytes
Stool lactoferrin
213
Most accurate test for infectious diarrhea?
Stool culture
214
Best initial test for Endocarditis
Blood culture
215
If blood cultures are positive for endocarditis what is the next best step in management?
Echo TTE first followed by TEE
216
How to diagnose culture negative endocarditis
```
Oscillating vegetation on echo
Three minor criteria
-Fever
-Risk IDU or prosthetic valve
-Embolic phenomena
```
217
Treatment of Endocarditis once cultures are positive
Vancomycin + gentamicin
218
When is surgery the next best step in management for Endocarditis?
- CHF or ruptured valve or chordae tendineae
- Prosthetic valve
- Fungal Endocarditis
- Abscess
- AV block
- Recurrent emboli while on Abx
219
Most common cause of culture negative Endocarditis
Coxiella
220
When is prophylaxis for Endocarditis the next best step in management
```
Significant cardiac defect
-prosthetic valve
-previous Endocarditis
-cardiac transplant with valvulopathy
-unrepaired cyanotic Heart disease
AND
Risk of bacteremia
-dental work
-resp track surgery that produces bacteremia
```
221
Prosthetic valve prophylaxis for Endocarditis with Staph
Rifampin
222
Prophylaxis for Endocarditis
Amoxicillin
223
Prophylaxis for Endocarditis if PCN allergic
Clindamycin, Azithromycin or Clarithromycin
224
Most common presentation of Lyme disease occurs 5-14 days after bite fever often present
Rash
225
Next best step in management once Lyme rash appears?
Treatment Doxycycline unless preg or a child amoxicillin
226
When is serology in Lyme Dx the best next step in management?
Serological testing for Lyme
- joint
- neurologic
- cardiac manifestation
227
Lyme disease treatment for cardiac and neurological manifestations other than the seventh cranial nerve palsy
IV ceftriaxone
228
Best initial treatment for HIV
2 nucleoside reverse transcriptase inhibitors (NRTIs) and an integrase inhibitor
Integrase inhibitors: dolutegravir, elvitegravir and raltegravir
NRTI: tenofovir, alafenamide and emtricitabine, abacavir and lamivudine
229
This HIV Med is not used during pregnancy
Efavirenz
230
PrEP
Emtricitabin-Etenofovir
231
Dysuria with flank or CVA tenderness, high fever, occasional abdominal pain, UA with high WBCs
Pyelonephritis
232
Best initial test for cystitis
Urinalysis >10 WBC
233
Most accurate test for cystitis
Urine culture
234
Best initial therapy for UTI
Fluoroquinolones like ciprofloxacin
235
Best next step in management for tertiary syphillis
IV penicillin
| Desensitize to penicillin if allergic
236
Treatment of chronic Hep C
Genotype 1- ledipasvir and sofosbuvir orally for 12 weeks
Other genotypes
Sofosbuvir and ribavirin orally
237
Tooth discoloration, type 2 RTA, photosensitivity and esophagitis
Adverse effects of Doxycycline
238
Gram negative bacteria covered by amoxicillin
```
HELPS
H-h. Influenzae
E-coli
L-isteria
P-proteus
S-almonella
```
239
Best initial step in management for a pt who presents with chest pain
EKG
240
After performing an EKG in a pt with chest pain what is the next best step in management if the EKG shows abnormalities
Stress Echo or nuclear stress test
241
If a patient presents with chest pain but the EKG shows no abnormalities what is the next best step in management
If the pt can exercise: stress test
| If pt cannot exercise: chemical stress test (dipyridamole thallium or dobutamine echo)
242
If a pt presents with chest pain and stress test is positive what is the next best step in management?
Angiography
243
Angiography is performed 1 or 2 vessel disease is noted what is the next best step in management?
Stent placement
244
Angiography is performed 3 vessel disease, left main, or 2 vessel disease in a diabetic is noted what is the next best step in manangement?
CABG
245
Medications that Lower mortality in CAD
Aspirin
B blocker
Nitroglycerin
246
Treatment in CAD for pts with low EF/systolic dysfunction (best mortality benefit) and regurgitant valvular disease
ACEi
247
The most common effect of statin medications
Liver dysfunction
248
Fibrates plus statins
Increase myositis
249
Edema, constipation, heart block
Adverse effects of CCB
250
What is the best step in management for CAD when a pt has severe asthma precluding the use of BB, prinzmetal variant angina, cocaine induced chest pain
CCBs (verapamil/diltiazem)
251
Internal mammary artery grafts last how many years?
10
252
Saphenous vein grafts last how many years?
5
253
ACS best initial step in management?
EKG
254
ACS EKG shows ST elevation
STEMI
255
ACS EKG shows no ST elevation
Next get cardiac biomarkers
If + NSTEMI
If - Unstable Angina
256
Increased JVP on inhalation
Kussmaul sign- constrictive pericarditis
257
Triphasic scratchy sound
Pericardial friction rub
258
May present several days after MI
Dressler Syndrome
259
What is the best initial step in ACS management after performing an EKG?
Aspirin
260
After performing an EKG and giving pt aspirin what is the best next step in management ?
Angioplasty
261
Acute cholangitis
Fever, RUQ pain, jaundice (Charcot triad)
| + hypotension and AMS (Reynolds pentad)
262
Treatment for acute cholangitis
Antibiotic coverage ERCP within 24-48 hrs
263
Diagnosis of acute cholangitis
Increased direct bili, alk phos, mildly increased ast/alt
| Biliary dilation on abdominal U/S or CT scan
264
Autoimmune hepatitis txt and lab findings
Elevated ANA and ASMA (anti-smooth muscle antibodies), elevated transaminases Txt: oral glucocorticoids
265
Tumors of the head of the pancreas present with this on imaging
Intra and extrahepatic biliary tract dilation
