Clerkships-MEDICINE Flashcards
(33 cards)
Which thrombolytic is bad to give repeatedly and why?
Streptokinase- immunogenic
Ddx for mid systolic murmur (“6”)
Aortic/Pulmonic Stenosis/Sclerosis Anemia Fever Thyrotoxicosis Pregnancy Hypertrophic Cardiomyopathy (younger)
What does valsalva do in a circulatory sense?
Decreases preload
What does valsalva do to AS and HOCM? Squatting? Why?
Valsalva decreases AS murmur and increases HOCM murmur because it reduces preload and therefore decreases the amount of blood going across the stenotic valve. Squatting increases AS and decreases HOCM because of increased venous return?
Louder with valsalva, click
MVP
Holosystolic w/ radiation to axilla
MR
Holosystolic murmur with with late diastolic rumble
Wide fixed and split S2
VSD
ASD
Close contact meningitis ppx?
Listeria - which two populations, and what tx?
If Instrumentation in the head?
Best first step in meningitis?
Lyme meningitis tx?
TB meningitis tx?
Most common organisms with meningitis? Tx?
- Rifampin
- Really young and old, ampicillin
- Staph, vanc
- CHECK FOR ICP, empiric tx!, then lumbar puncture to confirm
- ceftriaxone
- STEROIDS +ripe
-strep pneumo, n. gonnohrea, h. flu; ceftriaxone/vancomycin
Tularemia tx?
Birthed a cow dx tx?
HAP tx?
Old person with PNA, diarrhea, abdominal pain?
PNA after having the flu?
Young?
Streptomycin, Gentamycin q-fever from coxiella burnetti, tx. doxy MRSA, pseudomonas, klebsiella, ecoIi; Pip-tazo/imipenem+vanc Legionella MRSA, vanc atypical, mycoplasma, tx doxy, FQ, macro
Endocarditis MC bact for acute? MC bact for subacute? IVD? MC valves? Indication for colonoscopy screening?
Staph aureus (tx. PNC) Strep viridans (tx. nafcillin + gent/vanc), staph aureus Mitral, Tricuspid (IVD)
with strep BOVIS (colon cancer)
Threshold for treating HIV?
HAART Side effects, name the drug:
1) GI, leukopenia, MACROCYTIC anemia
2) Pancreatitis, Peripheral neuropathy
3) HSR, rash, n/v, muscle aches, SOB
4) nephrolithiasis, hyperbilirubinemia
5) psych and sleep disturbance
CD455000; pregnant - lower threshold (new guidelines?)
1) Zidovudine
2) Didanosine
3) Abacavir
4) indinavir (protease inhibitor)
5) efavirenz (non-nucleoside rev. transcriptase inhibitor)
Tx for post-needle stick HIV ppx?
triple therapy (“2+1”): lamivudine, nelfinavir, AZT (azidothymidine)
(2 reverse transcriptase inhibitors “-vudines?”+ N-NRTI/-navir (protease inhib) [+ritonavir]/entry inhibitor)
Suspicion for pna in AIDS?
BFS?
Tx 1st and 2nd lines?
When to ppx and with what? Other 2 ppx for the other 2 bugs
PCP
CXR, BALavage
TMP-SMX, TMP-Dapsone, (aerosolized) pentamadine, ATOVAQUONE (esp. in G6PD)
If CD4<50 MAC (mycobacterium avium complex), azithromycin
Ddx for ring enhancing lesion(s) on CT in AIDS?
Multiple: Toxoplasmosis (tx. pyrimethamine-sulfadiazine) for 6 weeks, if no improvement, consider CNS lymphoma. [EBV assoc.; tx w/ HAART]
Single: CNS lymphoma
De ja vu and 500 RBC in CSF in AIDS?
Meningitis in AIDS?
Hemisensory loss, visual impairment, babinski?
HSV temporal enephalitis (tx acyclovir asap)
Cryptococcal (tx. amphoterocin, flucytocine/fluconazole)
PML from JC polyomavirus, demyelination of the gray-white jxn, dx with brain bx
Rash at wrists/ankles/palms/soles, fever, headache.
cause? tx?
Rikettsiae, doxycycline
lyme disease signs (beyond targetoid rash)
tx? kids?
what about tick bite, no rash… myalgia, fever, headaches, thrombocytopenia, leukopenia, elevated ALT?
AV block, meningitis, facial nerve palsy
doxycycline, amoxicillin (peds), ceftriaxone (CNS)
erlichosis (dx. doxy)
aerobic, gram+, cavitary lung lesion, immunosuppressed, partially acid fast purulent sputum
neck/face infection, draining yellow material (sulfur granules), gram+ anaerobic
nocardia, tx. TMP-SMX
actinomyces (tx. high dose PCN)
When would you use a FEUrea instead of FENa
someone on diuretic. 35% is the new number
Definition of nephritic syndrome (4)
Definition of nephrotic syndrome
1) nephrItic range proteinuria (3.5g/day)
2) hyperlipidemia (waxy casts)
3) edema
4) hypoalbuminemia/hypoproteinemia
Differentiate berger’s IgA nephropathy and PSGN (and BFS) and HSP
IgA nephropathy 1-2 DAYS after a viral infection
PSGN 1-2 WEEKS after impetigo or pharyngitis (BFS ASO titer)
Kid s/p viral URI with purpura, arthralgia, RF, and abdominal pain (tx steroids/supportive)
Hematuria + Hemoptysis
Hematiura + Deafness
Pathophys?
Goodpasture’s
Alports
Both collagen IV def.
Painless hematuria?
Blood only at the end of the piss?
Bladder cancer
Bladder Cancer/Hemorrhagic cystitis (from cyclophosphamide?)
Cardiac patient s/p cath, was given TICLOPIDINE, now has thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, and RF. Dx/Tx?
Kid s/p hamburger, diarrhea, RF, petechiae, and MAHA. dx/tx?
TTP (thrombotic thrombocytopenic purpura); ticlopidine is the culprit. DO NOT GIVE MORE PLATELETS. treat with PLASMAPHERESIS.
HUS. Ecoli/Shigella. DON’T treat with abx.
