High Yield Flashcards
(582 cards)
1
Q
What is Pulmonary HTN
A
Increased pulmonary vascular resistant
Leads to RVH and eventual Right sided HF
2
Q
What causes Pulmonary HTN
A
Idiopathic - Usually middle age or young women
Secondary is COPD, sleep apnea
3
Q
Sx of Pulmonary HTN
A
Dyspnea, Chest Pain, Weakness, Fatigue, Cyanosis
Signs of Right sided HF
4
Q
Dx of Pulmonary HTN
A
Right sided Cath is definitive: Pulmonary Artery PRessure >25 mmHg at rest or >35 mmHg during exercise)
CXR see enlarged pulmonary arteries
EKG shows Cor Pulmonale (RVH, RAE, RAD, RBB)
5
Q
Tx of Pulmonary HTN
A
Vasodilators -CCB are 1st line -Phosphodiesterase-5-Inhibitors (Sildenafil) -Prostacyclins (Epoprostenol) -Endothelin Receptor Antagonists Oxygen
6
Q
What is Systolic HF
A
Most common form of CVF
Decreased EF associated with S3 gallop
7
Q
Sx of HF
A
Left Sided: Dyspnea, Pulmonary Congestion Rales, Rhonchi, HTN
Right Sided: Peripheral Edema, JVD, GI/Hepatic Congestion
8
Q
Dx of HF
A
Echo is #1: See Decreased EF, thin ventricular walls, dilated LV chamber with Systolic HF
See Normal EF, thick ventricular walls, small LV chamber with Diastolic HF
CXR: Cephalization, Kerley B lines, Cardiomegaly, Pleural Effusions
BNP
9
Q
Tx of HF
A
Ace-I are 1st line! They decrease Mortality, decrease preload/afterload
Beta-Blockers decreased mortality, Increased EF
Nitrates decrease mortality, decrease preload
Diuretics tx the symptoms (furosemide, spironolactone, HCTZ)
Digoxin tx the symtpoms
10
Q
What is Thrombophlebitis
A
Inflammation of superficial vein and or thrombus
11
Q
What causes Thrombophlebitis
A
Usually IV cath, trauma, pregnancy, varicose veins
12
Q
Sx of Thrombophlebitis
A
Tenderness, Pain, Induration, Edema, Erythema along course of superficial vein, Palpable Cord
13
Q
Dx of Thrombophlebitis
A
Venous Duplex Ultrasound: Noncompressible vein with clot
14
Q
Tx of Thrombophlebitis
A
Supportive: Extremity elevation, warm compress, increase activity, NSAIDS, Compression Stockings
Phelbectomy if extensive varicose veins
15
Q
What is Myocarditis
A
Inflammation of the heart muscle
16
Q
What causes Myocarditis
A
Viral: Entervorisus like Coxsackie B, Echovirus
SLE, Rheumatic Fever
17
Q
Sx of Myocarditis
A
Viral Prodrome (Fever, Myalgias, Malaise)
HF sx: Exercise Intolerance, Syncope, Tachypnea, Tachycardia, S3 gallop
Pericarditis
18
Q
Dx of Myocarditis
A
Endomycardial Biopsy is Gold Standard: Shows infiltrations of lypmhocytes with myocardial tissue necrosis CXR shows Cardiomegaly EKG: Sinus Tach Cardiac Enzymes: CK-MB and Troponin Echo shows ventricular dysfunction
19
Q
Tx of Myocarditis
A
Supportive with diuretics, Ace-I, Dopamine
IVIG
20
Q
What is Dilated Cardiomyopathy
A
Most common form of Cardiomyopathy
Systolic dysfunctions leads to ventricular dilation which leads to dilated weak heart
21
Q
What causes Dilated Cardiomyopathy
A
Idiopathic
Viral: Enterovirus (Coxsackie, Echo), Parvovirus
Alcohol Abuse
22
Q
Sx of Dilated Cardiomyopathy
A
Systolic HF sx (S3, Fatigue, Syncope, Dyspnea)
Arrhythmias, Chest Pain on Exertion
23
Q
Dx of Dilated Cardiomyopathy
A
Echo: LV dilation, Low EF, LV Hyopkinesis
DXR: Cardiomegaly, Pulmonary Edema, Pleural Effusion
EKG: Sinus Tach
24
Q
Tx of Dilated Cardiomyopathy
A
Ace-I Diuretics Digoxin Beta Blockers Implantable Defibrillator if Ef <30-35%
25
What is Restricted Cardiomyopathy
Impaired Diastolic function with preserved contractility
26
What causes Restricted Cardiomyopathy
Infiltrative Disease: Amyloidosis, Sarcoidosis
27
Sx of Restrictive Cardiomyopathy
Right Sided HF: Increased JVD, Kussmaul's sign,
28
Dx of Restrictive Cardiomypathy
Echo: Ventricles are non-dilated with normal wall thickness, Dilated atria
29
Tx of Restrictive Cardiomyopathy
Tx the sx: Diuresis, Vasodilators
30
What is Hypertrophic Cardiomyopathy
Inherited genetic disorder of inappropriate LV or RV Hypertrophy
31
What causes Hypertrophic Cardiomyopathy
Hypertrophied Septum with Systolic anterior motion
32
Sx of Hypertrophic Cardiomyopathy
Dyspnea, Fatigue, Angina, Syncope, Arrhythmias (AF, Palpitations), Sudden Cardiac Death
33
What Murmur do you hear with Hypertrophic Cardiomyopathy
| What maneuvers increase/decrease the murmur
Harsh systolic crescendo-decrescendo best heard at LUSB
Increase Murmur: Valsalva and Standing
Decrease Murmur: Squatting, Laying Down
34
Dx of Hypertrophic Cardiomyopathy
Echo: Asymmetrical wall thickness, SYstolic anterior motion of mitral valve
EKG: LVH, Atrial Enlargement
35
Tx of Hypertrophic Cardiomyopathy
Beta Blockers are 1st line!
CCB
Myomectomy
Alcohol Septal Ablation
36
What is Atrial Fibrillation
No P-waves
| Irregularly Irregular Rhythm
37
Tx of Atrial Fibrillation
Rate Control: Vagal Maneuvars, CCB, Beta-Blockers
| Rhythm: DC Cardioversion (3-4 weeks after anticoagulation)
38
What are the criteria for CHADS to prevent stroke and what does it mean
```
C: CHF 1 point
H: HTN 1 point
A: Age >75 years 1 point
D: DM 1 point
S: Stroke 2 points
```
Tx
- 0-1: No tx or ASA
- 1: Warfarin or ASA
2: Warfarin for sure but INR between 2-3
39
What is Sick Sinus Syndrome
Combination of sinus arrest with bradycardia and tachycardia
40
What causes Sick Sinus Syndrome
SA node Disease or corrective cardiac surgery
41
Tx of Sick Sinus Syndrome
Permanent Pacemaker if symptomatic
| If severe, permanent pacemaker with implantable cardioverter defibrillator
42
What is Sinus Bradycardia
Normal Sinus Rhythm with rate <60bpm
43
What causes Sinus Bradycardia and who is it seen in
Young athletes, Vasovagal Reaction, Increased Intracranial Pressure
BB, CCB, Digoxin, Carotid Massage
44
Tx of Sinus Bradycardia
Atropine is 1st line if symptomatic
Epinephrine Transcutaneous Pacing
Permanent Pacemaker is definitive
45
What is Paroxysmal Supraventricular Tachycardia
Sudden onset and termination of tachycardia
46
Tx of Paroxysmal Supraventricular Tachycardia
Vagal Maneuvers, Adenosine, BB or CCB, Cardioversion if unstable
47
What is Wolff-Parkinson White
An accessory pathway (Kent Bundle) that pre-excites the ventricle
48
What do you see on EKG for WPW
Delta Waves (Slurred QRS upstroke, wide QRS, and short PR interval)
49
Tx of WPW
Vagal Maneuvers
Antiarrhythmics like Procainamide, Amidoraone
Radiofrequency Ablation is definitive
50
What causes Aortic Stenosis
Degeneration
Congenital
Rheumatic Disease
51
Sx of Aortic Stenosis
Angina, Syncope, CHF
52
What type of murmur is heard with Aortic Stenosis
Systolic Ejection Crescendo-Decrescendo heard best at RUSB
53
Where does an Aortic Stenosis murmur radiate to
Carotid Arteries
54
What are features of Aortic Stenosis
Pulsus Parvus Et Tardus (weak, delayed pulse)
| Narrow Pulse Pressure
55
What is Mitral Regurgitation
Backflow from LV into LA that leads to volume overload
56
What causes Mitral Regurgitation
Mitral Valve Prolapse
RHD, Endocarditis
Ischemia, Papillary Muscle Rupture, Chordae Tendinate after MI
57
Sx of Mitral Regurgitation
Pulmonary Edema, Dyspnea
| A.Fib, CHF
58
What type of murmur is heard with Mitral Regurgitation
Blowing Holosystolic murmur heard best at the apex
59
Where does a Mitral Regurgitation murmur radiate to
Axilla
60
What is Aortic Regurgitation
Backflow from aorta to LV leads to LV volume overload
61
What causes Aortic Regurgitation
Rheumatic heart disease, HTN, Endocarditis, Marfans
62
Sx of Aortic Regurgitation
Right Sided HF
63
What type of murmur is heard with Aortic Regurgitation
Blowing, Diastolic Decrescendo heard best at LUSB
64
Where does an Aortic Regurgitation murmur radiate to
Left Sternal Border
65
What are other features of Aortic Regurgitation
Bounding Pulses
Wide Pulse Pressure
Pulse Bisferiens
66
What is Mitral Stenosis
Obstruction of flow from LA to LV leads to left atrial enlargement
67
What causes Mitral Stenosis
Rheumatic Heart Disease!!
68
Sx of Mitral Stenosis
Right sided HF
Pulmonary HTN
A.Fib
69
What type of murmur is heard with Mitral Stenosis
Diastolic Rumble hears best at apex
70
Where does Mitral Stenosis murmur radiate to
Nowhere
71
What are other features of Mitral Stenosis
Opening Snap
72
What is a 1st degree Heart Block
| Tx
Constant Prolonged PR interval (>0.20)
Every P-Wave is followed by QRS
Tx: None
73
What is a 2nd degree Heart Block Type I (Mobitz I: Wenckebach)
Progressive lengthening of PR interval with eventual dropped QRS
Tx: If no sx, just observe. If sx, Atropine, Epineprhine
74
What is a 2nd degree Heart Block Type II (Mobtiz II)
Constant PR Interval, eventual dropped QRS
| Tx: Permanent Pacemaker
75
What is a 3rd degree Heart Block
Complete AV dissociation: P-waves are not related to QRS
Results in decreased Cardiac Output
Tx: Permanent Pacemaker
76
What is HTN
Elevated BP reading on more than 2 occasions
| Systolic >140, Diastolic >90
77
What is secondary HTN
Usually due to renal artery stenosis, primary hyperaldosteronism, pheochromocytoma
78
What are complications of HTN
CAD, HF, MI, LVH, Renal Stenosis and Sclerosis
79
Sx of HTN
Papilledema is advanced stage
Retinopathy: Arterial Narrowing, AV Nicking, Soft Exudates
Striae, Carotid Bruits, JVD
80
Tx of HTN
```
Goal is to be <140/90
If DM: <130/80
Lifestyle Modification is 1st, DASH diet, stop smoking, Exercise, Stop Drinking
HCTZ is 1st line
Ace-I provides cardioprotection
CCB
Beta Blockers
```
81
What is Nursemaid's Elbow
Due to lifting/swinging/pulling a child
| The radial head wedges into stretched annular ligament
82
Sx of Nursemaid's Elbow
Child presents with arm slightly flexed, refuses to arm
| Tenderness to palpation
83
Tx of Nursemaid's Elbow
Reduction (pressure on radial head with supination and flexion)
84
What is Carpal Tunnel Syndrome
When the median nerve is entrapped or compressed
| Seen with DM
85
Sx of Carpal Tunnel Syndrome
Parasthesias and pain of palmar 1st 3 and digits, usually at night
Thenar Muscle Wasting, Weakness of Thumb
Worse pain at night
Shaking hands reduces pain
86
Dx of Carpal Tunnel Syundrome
PHalen's Sign: Flex both wrists for 30-60 seconds to reproduce pain
Tinel's Sign: Percuss median nerve reproduces pain
87
Tx of Carpal Tunnel Syndrome
Volar Splint
NSAIDS
Corticosteroids
88
What is Spinal Stenosis
Narrowing of the spinal canal with impingement of nerve roots
89
Sx of Spinal Stenosis
Back pain with parasthesias in one or both extremtiies
Worse with extension and prolonged standing/walking
Better with Flexion, sitting, and walkin uphill (flexion increases canal volume)
90
Tx of Spinal Stenosis
Lumbar epidural injection of steroids
| Decompression laminectomy
91
What is Dequervain's Tenosynovitis
Stenosing tenosynovitis of abductor pollicus longus and extensor pollicus brevus
Due to repetitive thumb movements like golfers, clerical workers
92
Sx of Dequervain's Tenosynovitis
Pain along radial aspect of wrist that radiates to forearm
93
Dx of Dequervain's Tenosynovitis
Finkelstein Test: Pain with ulnar deviation or thumb extension
94
Tx of Dequervain's Tenosynovitis
Thumb Spica Splint for 3 weeks
NSAIDS
Steroid Injections
95
What is Osgood Schlatter Disease
Osteochondritis of the patellar tendon at the tibial tuberosity from overuse
Usually seen in adolescent males with growth spurts
96
Sx of Osgood Schlatter Disease
Activity related knee pain with swelling
| Tenderness to anterior tibial tubercle
97
Dx of Osgood Schlatter Disease
Xray shows ossification at tibial tuberosity
98
Tx of Osgood Schlatter Disease
RICE
NSAIDS
Quadriceps Stretching
99
What is Osteoarthritis
Chronic disease due to articular cartilage damage and degeneration
Obesity is risk factor
Common in weight bearing joints
Narrowed joint space, sclerosis, and osteophyte formation
100
Sx of Osteoarthritis
Evening joint stiffness, decreases with rest, worsens as day progresses
Heberden's Nodes (Palpable Osteophytes at DIP)
Bouchard's Nodes (PIP osteophytes)
101
Dx of Osteoarthritis
Xray: Narrowed joint space, osteophyte formation, subchondral bone cysts/sclerosis
102
Tx of Osteoarthritis
Acetaminophen in elderly
NSAIDS in everybody else
Corticosteroid injections
103
What is Osteoporosis
Loss of bone density over time due to increased aborption of bone or decreased formation of new bone
Loss of both bone mineral and matrix
104
What are causes of Osteoporosis
Primary: Postmenopausal and Senile
Secondary: Following chronic disease or meds (corticosteroids)
105
Sx of Osteoporosis
Asymptoamtic
Pathologic Fractures
Spine Compression
Back Pain
106
Dx of Osteoporosis
Serum Calcium, Phosphate, PTH, ALP are usually normal
| DEXA Scan: Osteoporosis T Score
107
Tx of Osteoporosis
```
Bisphosphonates are 1st line
Vitamin D (Ergocalciferol)
Raloxifene (Selective Estrogen Receptor Modulator)
Estrogen in postmenopausal women
Calcitonin is last line
```
108
What is Rheumatoid Arthritis
Chronic inflammatory disease with persistent symmetic polyarthritis with bone erosion, cartilage destruction and joint structure loss
T-Cell Mediated
109
Sx of RA
Small joint stiffness (MCP, wirst, PIP, Knee< MTP, shoulder, ankle)
Worse with rest, morning joint stiffness > 60 minutes
Gets better with movement throughout the day
Symmetric arthritis, boggy joints
Boutonniere defomirty (flexion at PIP)
Swan Neck Deformity (flexion at DIP)
Ulnar Deviation at MCP joint
Rhemuatoid NOdules
110
Dx of RA
Positive RF
Positive Anti-CCP MOST SPECIFIC!
Xray: Narrowed joint space, subluxation, ulnar deviation
111
Tx of RA
DMARDS: Methotrexate, Hydroxychloroquine
| NSAIDS for pain, low does steroids
112
What is Gout
Uric Acid deposition in soft tissues, joints, and bone
| Due to purine rich foods (meats, chocolate, alcohol, yeasts), Diuretics, Ace-I
113
Sx of Gout
Joint erythema, swelling, stiffness
Podagra (1st MTP), Knees, feet, ankles
Tophi deposition
Uric acid nephrolithiasis and nephropathy
114
Dx of Gout
Arthrocentesis: Negatively Birefringent Needle Shaped Urate Crystals
Xray: Mouse/Rat Bite punched out erosions
115
Tx of Gout
NSAIDS (Indomethacin)
Colchicine is 2nd line
Allopurinol for Chronic management (Colchicine for chronic too)
116
What is Pseudogout
Calcium Pyrophopshate deposition in joints and soft tissue
Acute arthritis seen in knee
Red, swollen, tender joint
117
Dx of Pseudogout
Positively birefringent, Rhomboid-shaped CPP cyrstals
118
Tx of Pseudogout
Corticosteroids
NSAIDS
Colchcine
119
What is Ankylosing Spondylitis
Chronic inflammatory arthropathy of the axial skeleton and sacroiliac joints with progressive stiffness
120
Sx of Ankylosing Spondylitis
Chronic low back pain, morning stiffness with decreased ROM
Peripheral Arthritis, may develop sacroilitis
Pulmonary fibrosis
121
Dx of Ankylosing Spondylitis
Increased ESR
Positive HLA-B27
Bamboo Spine on xray (squaring of vertebral bodies)
122
Tx of Ankylosing Spondylitis
NSAIDS
Rest, Physical Therapy 1st line
TNF-Alpha Inhibitors
Steroids
123
What is an MCL and LCL Tear
MCL: Valgus stress with rotation
LCL: Varus stress with rotation
124
Sx of MCL/LCL Tear
Localized pain, swelling, ecchymosis, stiffness
125
What is an ACL Tear
Most common knee injury due to noncontact pivoting injury
126
Sx of ACL tear
Heard a pop and it swelled
Hemarthrosis
Knee buckling
127
Dx of ACL Tear
Lachman's Test
| Anterior Drawer Test
128
Tx of ACL Tear
Therapy
| NSAIDS
129
What is a Meniscal Tear
Degnerative squatting twisting compression with rotation and axial loading
130
Sx of Meniscal Tear
Locking, Popping, giving way, effusion after activities
131
Dx of Meniscal Tear
Mcmurray's sign (pop or click while tibia is externally and interanlly rotated
132
Tx of Meniscal Tear
NSAIDS
Partial weight bearing
Arthroscopy
133
What is Morton's Neuroma
Degeneration/Proliferation of plantar digital nerve producing painful mass near tarsal heads
Usually seen in women with tight shoes, high heels or flats
134
Sx of Morton's Neuroma
Lancinating pain with ambulation usually at 3rd metatarsal head
Reproducible pain on palpation
Palpable Mass
MRI may be used
135
Tx of Morton's Neuroma
Wide shoes
Steroid injections
Surgical resection
136
What is Septic Arthritis
Infection in the joint cavity
A medical emergency
Usually hematogenous spread, direct inoculation via trauma, or contiguous spread
137
What is the most common pathogen in Septic Arthritis
Staph Auerus
| Neisseria Gonorrhea in sexually active young adults
138
Sx of Septic Arthritis
Single, swollen, warm, painful joint, tender to palpation
| Fevers, chills, sweats, myalgias
139
Dx of Septic Arthritis
Arthrocentesis: Joint Fluid Aspirate with WBC >50k mainly PMNs
Gram stain and culture
Crystals
140
Tx of Septic Arthritis
Gram Positive Cocci: Nafcillin (vanco if MRSA)
Gram Negative Cocci: Ceftriaxone (Cipro if PCN allergy)
Gram Negative Rods: Ceftriaxone + Gentamicin
141
What is Giant Cell Arteritis
A vasculitis
Associated with Polymalgia Rheumatica
Usually seen in women >50yrs
Autoimmune
142
Sx of Giant Cell Arteritis
Headache, new onset and localized usually temporal
Jaw Claudication
Acute Vision Disturbances (Amaurosis Fugax: Monocular blindness), Anterior ischemic optic neuritis
Fatigue, weight loss, anorexia, fevers, night sweats
Tender scalp, decreases pulses
Aortic Aneurysm!
143
Dx of Giant Cell Arteritis
Increased ESR
Increased CRP
Temporal Artery Biopsy is definitive: See mononuclear lymphocyte infiltration, multinucleated gian cells, lamina cell degradation
144
Tx of Giant Cell Arteritis
High Dose Corticosteroids
| Methotrexate
145
What is Sarcoidosis
Chronic Multisystemic, Inflammatory granulomatous disorder of unknown etiology
Lung is most commonly affected
Lymph Nodes
African Americans, Nortern Europeans, Females
Exaggerated T-Cell REsponse leads to Granuloma Formation
146
Sx of Sarcoidosis
Dry nonproducitve cough, dyspnea, chest pain
Painless hilar nodes, lymphadenopathy
Erythema Nodosum (bilateral tender red nodules on anterior legs)
Lupus Pernio (Violaceous raised discoloration of nose, ear, cheeck) Looks like frostbite
Uveitis (inflammation of iris and ciliary body)
Conjunctivitis
Arrhythmia
Arthrlagias
Fever, Malaise, weight loss
CN 7 Palsies
147
Dx of Sarcoidosis
Tissue Biopsy: Noncaseating granulomas
CXR: Bilateral hilar lymphadenopathy, Interstitial lung disease
PFT: Restrictive (normal or increased FEV/FVC, Lung volumes are decreased)
CT Scan: Ground glass, Fibrosis
Eosinophilia, Hypercalciuria, Increased ACE
148
Tx of Sarcoidosis
Observation
Oral Corticosteroids
Methotrexate, Hydroxychloroquine
NSAIDS
149
What is Asthma
Reversible hyperirritability of tracheobronchial tree
Leads to bronchoconstriction and inflammation
ATOPY: Asthma, Nasal Polyps, ASA/NSAID allergy, Eczema
150
Sx of Asthma
Dyspnea, Wheezing, Cough (especially at night)
| Prolonged expiration with wheezing, Hyperresonance
151
Dx of Asthma
PFT is Gold Standard: Reversible (increased RV, TLC, RV/TLC)
Peak Flow Rate >15% from initial attempt (responds to tx)
Metacholine challenge test (Positive if >20% reduction in FEV1)
Bronchdilator Challenge test (Positive if >12% increase in FEV1 or >200cc)
152
What is Intermittent Asthma
| Tx
<2x/week
Night: <2x/month
Albuterol use <2x/day
Tx: SABA (Albuterol)
153
What is Mild Persistent Asthma
>2x/week
Night: 3-4x/month
Albuterol use >2days/week
Tx: SABA + low dose ICS (Beclomethasone, Flunisolide, Triamcinolone)
154
What is Moderate Persistent Asthma
Daily sx
Night: >1x/week but not nightly
Albuterol use daily
Tx: SABA + Medium ICS or LABA (Salmetrol, Fluticasone/Salmeterol)
155
What is Severe Persistent Asthma
Sx many times a day
Night: Nightly
Albuterol use many times a day
Tx: SABA + High ICS + LABA, possibly add Omalizumab (anti-IgE drug)
156
What is COPD
Progressive irreversible airflow obstruction
Due to loss of elastic recoid, increased airway resistance
Includes Chronic Bronchitis and Emphysema
157
What causes COPD
Smoking
| Alpha-1-Antitrypsin Deficiency (Alpha-1-Antitrypsin normally protects elastin in lungs)
158
What is Emphysema
Smoking leads to chronic inflammation and decreases protective enzymes, leads to increasing damaging enzymes, alveolar wall dstruction and loss of elastic recoid
159
Sx of Emphysema
Accessory muscle use, tachypnea, prolonged expiration
| Hyperinflation: Hyperresonance to percussion, decreased breath sounds, decreased fremitus, barrel chest, pursed lips
160
What is Chronic Bronchitis
Productive cough lasting more than 3 months for 2 consectuvei years
Inflammation leads to mucous hypersecrtion and airway narrowing which leads to increased airway resistanc eleadsing to airway obstruction and mucous plugging
161
Sx of Chronic Bronchitis
Productive cough
| Crackles, Rhoonchi, Wheezing, Signs of peripheral edema, Cyanosis
162
Dx of COPD
PFT is Gold Standard: Fev1/FVC <70% is dx (obstructive)
Hyperinflation: Increased lung volumes, increased RV, TLC
CXR: Hyperinflation, flat diaphragam, decreased vascular markings
163
Tx of COPD
Oxygen is only therapy to decreased mortality
Bronchodilators
-Anticholinergics (Tiotropium, Ipratropium)
-Beta-2 Agonists (Albuterol, Terbutaline, Salmeterol)
-Theophylline
Corticosteroids
Smoking cessation
Vaccinations: Pneumococcal and Influanza
164
What is the most common pathogen with Community Acquired Pneumonia and what does it look like
Strep Pneumoniae
| Gram positive cocci
165
What is the 2nd most common cause of Community Acquired Pneumonia and what does it look like
H. Influenza
| Gram Negative Rods
166
What is the most common pathogen with Atypical (Walking) Pneumonia and what does it look like
Mycoplasma Pneumoniae
| No Cell Wall - doesn't respond to beta-lactams
167
What pneumonia pathogen is associated with outbreaks related to cooling towards, A/C vents, and contaminated water supplies and what does it look like
Legionella
| Gram Negative Rods
168
What pneumonia pathogen is associated with Alcoholics and what does it look like
Klebsiella
| Gram Negative Rods
169
Name some Community Acquired Pneumonia pathogens
```
S. Pneumonia
Mcoplasma
Chlamydia
H.Influenza
M.Catarrhalis
Legionella
Klebsiella
S. Aureus
```
170
Name some Hospital Acquired Pneumonia pathogens
Gram Negative Rods like Pseudomonas, Klebsiella
171
What are pathogens associated with Typical Pneumona vs. Atypical Pneumonia
Typical: Strep Pneumo, H. Influenza, Klebsiella, S. Aureus
Atypical: Mycoplasma, Chlamydia, Legionella, Viruses
172
What do you see on CXR with Typical vs. Atypical Pneumonia
Typical: Lobular
Atypical: Diffuse, patchy infiltrates
173
What are sx with Typical vs. Atypical Pneumonia
Typical: Sudden onset of fever, productive cough with sputum, pleuritic chest pain, Rigors, Tachycardia, Tachypnea. Bronchial breath sounds, dull to percussion, increased fremitus, egophony
Atypical: Low grade fever, dry, non-productive cough, myalgias, malaise, sore throat
174
```
What does the sputum tell you about the organism involved in pneumonia
Rusty
Currant Jelly
Green
Fout Smelling
```
Rusty: Strep Pneumonia
Currant Jelly: Klebsiella
Green: H.Flu, Pseudomonas
Foul Smelling: Anaerobes
175
What is the treatment for Community Acquired Pneumonia in outpatient setting
Macrolide like Clarithromycin, Azithromycin
or
Doxycycline
176
What is the treatment for Community Acquired Pneumonia in inpatient setting
Beta-Lacta + Macrolide
Beta Lactams: Ceftriaxone, Defotaxime, Ampicilin Sulbactam (Unasyn)
Marolides: Clarithromycin, Azithromycin
OR
Broad spectrum Fluoroquinolones: Levafloxin, Gatifloxacin, Moxifloaxacin, Gemifloxacin
177
What is the treatment for Community Acquired Pneumonia in IUC setting
Beta-Lactam + Macrolide
OR
Beta-Lactam + Fluoroquinolones
Beta-Lactams: Ceftriaxone, Cefotaxime, Unasyn
Macrolides: Clarithromycin, Azithromycin
FQ: Levafloxacin, Moxifloxacin, Gemifloxacin
178
What are vaccines that can be given to people to prevent pneumonia
PCV13: Childhood vaccine at 2, 4, 6 months and last dose after 4 yrs
PPV23: Polyvalent Pneumococcal Vaccine in adults
-If >65 yrs revaccinate very 5 years
-If age 2-64 with chronic disease (DM, Alcoholic, liver disease, cardiac, pulmonary, immunocompromised)
179
What is the treatment for Atypical Pneumonia
Same as CAP Outpatient: Macrolide or Doxy
180
What is the treatment for a person with HIV and Pneumonia
Bactrim (TMP-SMX)
181
What is TB
Caused by Mycobacterium Tuberculosis that leads to granuloma formation
182
What is Primary TB
Initial infection, usually self-limited
| Very Contagious
183
What is Chronic/Latent TB
A controlled TB infection
PPD will test positive in about 2-4 weeks after infection
Not Contagious
184
What is Secondary TB
Reactivation of latent TB with waning immune defnse
| Very Contagious
185
Sx of TB
Chronic, Productive Cough, Chest Pain
Hemoptysis
Constitutional Sx: Night sweats, fevers/cills, fatigue, anorexia, weight loss
Rales or Rhonchi, Dull to percussion
186
What is considered a positive TB skin test in a person of the general population, a person with high risk exposure like healthcare worker, and a person with a known risk exposure or HIV+/Immunocompromised
Regular Population: >15
Healthcare Workers: >10
Known exposure/HIV: >5
187
Dx of TB
Acid-Fast Smear and Sputum culture for 3 days is definitive
| CXR: Used for screening in patients with known positive PPD
188
Tx of TB
If active TB: RIPE with RIPE for 2 months, then RI for 4 more months
If latent TB: Isoniazi
R: Rifampin: SE is Orange secretions, Thrombocytopenia
I: Isoniozide: SE is Hepatitis, Peripheral Neuropathy
P: Pyrazinamide: SE is Hepatitis and Hyperuricemia, Photosensitivity
E: Ethambutol: SE is Optic Neuritis, red/green vision changes
189
What are the types of lung cancers
Non-Small Cell (most common)
| Small-Cell: Metastasize early
190
What are the subtypes of Non-Small Cell Lung CA
Adenocarcinoma: Peripheral, Most common in everyone (smokers and non-smokers)
Squamous: Central, Hypercalcemia and Pancoast Syndrome
Large Cell: Peripheral, Aggressive
191
Sx of Lung CA
Constitutional Sx
Small Cell: SVC Syndrome, SIADH/Hyponatremia, Cushings Syndrome
Squamous: Hypercalcemia, Pancoast Syndrome (Shoulder pain, Horner's Syndrome, Atrophy of hand/arm muscles)
192
Dx of Lung CA
Screening with Helical CT in smokers
CXR and CT show abnormalities
Sputum samples provide definitive
Bronchoscopy with biopsy
193
Tx of Lung CA
Non-Small Cell: Surgery
| Small Cell: Surgery + Chemo
194
What is a Pulmonary Noudle
If greater than 3cm it's a mass
| Nodule is usually a granuloma from TB, fungal or foreign body
195
Sx of Pulmonary Nodule
Usually non, usually incidental finding
196
Dx of Pulmonary Nodule
CT finds nodule
Biopsy is defintiive but only done if nodule changes size
Lesion not enlarged in more than 2 years is usually benign, usually infectious granulomas
Malignant lesions are usually greater than 2 cm in size and cause sx
197
Tx of Pulmonary Nodules
Observation with CT every 3 months for an entire year, if stable, repeat every 6 months for next 2 years
If malignant/rapid changes, resection, if slow changes then biopsy
198
What is a Carcinoid Tumor
Usually neuroendocrine tumor
199
Sx of Carcinoid Tumors
Asymptomatic but hemoptysis, cough focal wheezing
| Carcinoid Syndrome: Flushing, diarrhea, wheezing, hypotension
200
Dx of Carcinoid Tumor
Bronchoscopy
| CT
201
Tx of Carcinoid Tumors
Surgery
| Octreotide for sx
202
What is the transmission of Hepatitis B
Blood, Sex, Drugs
203
```
What do the following tests tell you about Hepatitis B and its course/infectivity
HBsAg
HBsAb
HBcAb (IgM, IgG)
HBeAg
HBeAb
```
HBsAg: Surface Antigen: First evidence of infection before sx occur
HBsAb: Resolved infection or vaccination hx
HBcAb (You only see this if they've had the infection, not been immunized)
-IgM: Acute Infection
-IgG: Chronic Infection
HBeAg: Increased viral replication and increased infectivity
HBeAb: Waning viral replication and infectivity
204
What do you see during the window period of a Hepatitis B infection
Positive HBcAb: IgM
| Everything else is negative
205
What do you see during an Acute Hepatitis B infection
HBsAg: Positive
HbsAb: Negative
HBcAb: IgM
May or may not see HB envelope
206
What do you see in an immunized person against Hepatitis B
HBsAg: Negative
HBsAb: Positive
HBcAb: Negative
All HBenvelopes negative
207
What do you see in someone who is recovering from a Hepatitis B infection
HBsAg: Negative
HBsAb: Positive
HBcAb: IgG
208
Tx of Hepatitis B
Acute: Supportive
Chronic: Alpha-Interferon 2b, Lamivudine, Adefovir
209
What is a contraindication to Hepatitis B vaccine
Allergies to Bakers Yeast
210
What is an Anal Fissure
A painful linear tear/crack in the distal anal canal
| It usually only involves epithelium
211
Where is the most common site for an Anal Fissure
Posterior midline
212
What causes Anal Fissures
Low Fiber diet
Passage of large hard stools
Anal Trauma
213
Sx of Anal Fissures
```
Severe painful bowel movements
Patients may not want to have BM
Constipation
Bright red blood per rectum
Rectal Pain
Skin tags
```
214
Tx of Anal Fissures
Sitz bath, analgesics, stool softeners, high fiber diet, laxatives
215
What is Achalasia
Loss of Auerbach's Pleuxus which leads to increased LES pressure
Failure of LES to relax which leads to obstruction and lack of peristalsis
216
Sx of Achalasia
Dysphagia to both liquids and solids
| Malnutrition, weight loss, dehydration, regurgitation, cough
217
Dx of Achalasia
Esophageal Manometry is gold standard, shows increased LES pressure and decreased peristalsis
Contrast Esophagram shows bird's beak (LES narrowing)
218
Tx of Achalasia
Decrease LES pressure via botulinum toxin injection, nitrates, CCB, dilation of LES, Esophagomyomectomy
219
What is the most common form of Esophageal Cancer
Squamous Cell
| Usually associated with Smoking and Alcohol use
220
What area of the esophagus is Squamous Cell Esophageal CA found
Proximal 1/3
221
What is another form of Esophageal CA (not Squamous), where is it found, and what is it a complication of
Adenocarcinoma
Distal 2/3
Complication of GERD, Barrett's
222
Sx of Esophageal CA
Dysphagia with solids, Odynophagia
Weight loss, chest pain, anorexia, cough
Hypercalcemia
223
Dx of Esophageal CA
Upper Endoscopy with biopsy
| Double contrast barium esophogram
224
Tx of Esophageal CA
Resection
| Chemo
225
Where do you get Giardia from
Contaminated water from remote streams/wells
226
Sx of Giardia
Frothy, Greasy, Foul Diarrhea
No Blood or Pus
Cramping
227
Dx of Giardia
Trophozites/Cysts in stool
228
Tx of Giardia
Metronidazole
229
What is Peptic Ulcer Disease
Usually due to decreased mucosal protective factors and increased damagin factors
230
What are the 2 types of PUD and how can you tell them apart
Gastric Ulcers: Pain right after you eat
| Duodenal Ulcers: Pain a few hours after eating, More common
231
What are causes of PUD
H.Pylori
NSAID use
Zollinger Ellison Syndrome (gastrinoma)
232
Sx of PUD
Dyspepsia, Epigastric pain, burning, gnawing
Gastric Ulcer: Pain 1-2 hours after meals and weight loss
Duodenal Ulcer: Pain Pain 2-5 hours after a meal, nocutral sx, relief with food
233
Dx of PUD
Endoscopy is gold standard
| Upper GI Series
234
How do you test for H.Pylori
Rapid Urease Test (direct staining of biopsy) is gold standard
H.Pylori Stool Antigen
Serologic Antibodies
235
What test is used to to see if H.Pylori has been eradicated
Urea Breath Test, H.Pylori Stool Antigen
236
Tx of H.Pylori
Triple Therapy: Clarithromycin + Amoxicillin + PPI
| If allergic to PCN, give Metronidazole
237
Tx of PUD with negative H.Pylori
PPI, H2 blocker, Atnacids, Bismuth
238
What is Hemochromocytosis
Excess iron deposition in parenchymal cells of heart, liver, pancreas, and endocrine organs
Usually genetic
239
Sx of Hemochromocytosis
Liver dysfunction, Cirrhosis, fatigue, weakness
Cardiomyopathy, Arrhythmias
Metallic or Bronze Skin
240
Dx of Hemochromocytosis
Liver biopsy is gold standard: Increased Hemosiderin (iron storage)
Increased serum iron
Increased serum transferrin
Increased Ferritin
241
Tx of Hemochromocytosis
Phlebotomy
| If unable to do phlebotomy then cheleation
242
What are the categories of Inflammatory Bowel Disease
Ulcerative Colitis and Crohn's Disease
243
What are the features of Ulcerative Colitis for area affected, depth, sx, dx, and tx
Limited to colon, starts in rectum and moves up
Mucosa and Submucosa ONLY
LLQ pain, Bloody Diarrhea
Uniform Inflammation, Sandpaper Appearance, Pseudo Polyps
+ P-ANCA
Surgery is Curative
244
What are the features of Crohn's Disease for area affected, depth, sx, dx, and tx
Any segment of GI from mouth to anus can be affected
Transmural
RLQ pain, weight Loss, No blood
See Skip Lesions and Cobblestone Appearance
+ASCA
Surgery is not curative
245
What tests do you use for Ulcerative Colitis and Crohn's if there is an acute attack
UC: Flex Sigmoidoscopy
| Crohn's: Upper GI series with small bowel follow through
246
Tx of Inflammatory Bowel Disease
5-Aminosalicylic Acids: Oral Mesalamine, Topical Mesalamine, Sulfasalazine
Corticosteroids (for acute flares only)
Immune Modifying Agents: 6-Mercaptopurine, Azathioprine, Methotrexate
Anti-TNF Agents (Adalimumab, Infliximab, Certolizumab)
247
What are features of Bacterial Vaginosis
- How do you get it
- Sx
- Microscope
- Tx
Decrease in lactobacilli leads to overgrowth of normal vaginal flora
Sx: Thin, Homogenous watery grey-white "fish rotten" smell, Pruritis
pH >5 (normal is 3.8-4.2)
Positive Whiff Test: Fishy Odor
KOH Prep shows Clue Cells, Few WBC
Tx: Metronidazole for 7 days, safe in pregnancy, Clindamycin
248
What are features of Candida Vulvovaginitis
- How do you get it
- Sx
- Microscope
- Tx
Candida Albicans overgrowth (part of normal flora), usually use of antibiotics causes this
Vaginal erythema, swelling, burning, itching
Thick Curd-like/Cottage Cheese Dischrage
Normal pH
See Budding Yeast, Hyphae on KOH prep
Tx: Fluconazole oral one dose, or Intravaginal antifungals (Nystatin, Miconazole)
249
What are features of Trichomoniasis
- How do you get it
- Sx
- Microscope
- Tx
Trichomonas Vaginalis, sexually transmitted
Vulvar pruritis, erythema, dysuria
Frothy green-yellow dischrage, Strawberry Cervix
pH>5
See Mobile Protozoa on wet mount and WBC
Tx: Metronidazole 2g oral one dose or 500mg bid oral for 7 days
Must treat partner
250
What are features of Chlamydia
- How do you get it
- Sx
- Microscope
- Tx
Chlamydia Trahcomatis, causes cervicitis, sexually transmitted
Sx: Mucopurulent cervicitis, increased frequency, dysuria, abdominal pain
Dx: LCR, Cultures, DNA prope
Tx: Azithromycin 1g oral one dose or Doxy 100mg id for 10 days
Treat for Gonorrhea too (Ceftriaxone)
251
What are features of Gonorrhea
- How do you get it
- Sx
- Microscope
- Tx
```
Neisseria Gonorrhea
Sx: Vaginal discharge, cervicitis, increased frequency, dysuria
Dx: Culture, DNA
Tx: Ceftriaxone IM or Cefixime
Treat for Chlamydia too (Azithromycin)
```
252
What are features of Chancroid
- How do you get it
- Sx
- Microscope
- Tx
Haemophilus Ducreyi (gram-negative Bacillus)
Sx: Genital PAINFUL ulcer, Painful inguinal LAD
Dx: Clinical or cultures
Tx: Azithromycin is 1st line, Ceftriaxone IM
253
What are features of HPV
- How do you get it
- Sx
- Microscope
- Tx
Genital warts are 6 and 11
Cancer causing are 16 and 18
Sx: Flat, Pauplar, pedunculated or flesh colored growths, cauliflower like lesion
Dx: Whitening with acetic acid
Tx: Trichloracetic acid, Podophyllin wash, Cryotherapy
254
What is Syphilis
Caused by Treponema Pallidum
255
Sx of Syphilis
| -primary, secondary, tertiary
Primary: Chancre (painless genital ulcer) lasts 3-4 weeks
Secondary: Maculopapular Rash usually on palms and soles, Condyloma Lata (Wart-like genital lesion)
Tertiary: Gumma (noncancerous granulomas on skin and body), Neurosyphilis (headache, eningitis, dementia, vision/earing loss), Aortic Regurgitation, Aortitis
256
Dx of Syphilis
Darkfield Microscopy, VDRL/RPR
257
Tx of Syphilis
Penicillin G
| Tetracyclines, macrolides, ceftriaxone if PCN allergy
258
What is Macular Degeneration
Most common cause of permanent blindness and visual loss in the elderly
Macula is responsible for central vision (detail and color)
259
What is Dry Macular Degeneration and Wet Macular Degeneration
Dry: Gradual breakdown of macula. See Dursen (small, round, yellow-white spots on outer retina)
Wet: Neovascular or exudative, new abnormal vessels grow under central retina which leak blood
260
Dx of Wet macular degeneration
Fluorescein Angiography
261
Sx of Macular Degeneration
Bilateral blurred vision or loss of central vision
Scotomas (blind spots, shadows)
Metamorphopsia
Micropsia
262
Tx of Macular Degeneration
Dry: Amsler Grid
Wet: Anti-Angiogenics (bevacizumab)
263
What is Diabetic Retinopathy
Most common cause of new permanent vision loss/blindness in 25-74 year olds
264
Sx of Diabetic Retinopathy
Microaneurysms, blot and dot hemorrhages, cotton wool spots, hard exudates
Neovascularization (treat with VEGF like Bevacizumab)
Macular edema or exudates blurred vision, central vision loss
265
What is Hypertensive Retinopathy
Damage to retinal blood vessles from longstanding high blood pressure
266
Sx of HTN Retinopathy
Arterial narrowing, AV nicking, Flame shaped hemorrhages, Cotton Wool Spots, Papilledema (bad)
267
What is Retinal Detachment
Retinal tear leads to detachment from choroid plexus
268
Sx of Retinal Detachment
Photopsia (flashing lights)
Floaters, Progressive unilateral vision loss
Shadow/Curtain in peripheral with eventual central vision loss
No Pain, No Redness
269
Tx of Retinal Detachment
Emergency, Lacer, Cryotherapy Ocular Surgery
270
What is Acute Narrow-Angle Closure Glaucoma
Glaucoma is increased intraocular pressure that leads to optic nerve damage
Acute narrow is decreased drainiage of aqueous humor
271
Sx of Acute Narrow-Angle Closure Glaucoma
Severe unilateral ocular pain
N/V, headache intermittent blurry vision
Halos around lights
Peripheral loss of vision (Tunnel Vision)
Steamy Cornea, Eye feels hard to palpation
272
Dx of Acute Narrow-Angle Closure Glaucoma
Tonometry measures intraocular pressure
| Cupping of optic nerve
273
Tx of Acute Narrow-Angle Closure Glaucoma
Acetazolamide IV is 1st line which decreased IOP and decreases aqueous humor production
Topical Beta-Blocker (Timolol)
Miotics/Cholingerics
274
What is Otitis Externa
Swimmers ear
| Pseudomonas
275
Sx of Otitis Externa
Ear pain, pruritis, Auricular dischrage
| Pain on traction of ear canal/tragus
276
Tx of Otitis Externa
Dry ear with isopropyl alcohol and aceitic acid
Cipro/dexamethasone (Ofloxacin)
Neomycin
Amphotericin B if fungal
277
What is Acute Otitis Media
Infection of the middle ear, temporal bone and mastoid air cells
Usually preceeded by URI
Strep. Pneumo, H. Influenza, Moraxella Catarrhalis, Strep Pyogens (same organisms as Bronchitis and Sinusitis)
278
Sx of Acute Otitis Media
Fevers, Otalgia, Ear tugging in infants
| Bulging, Erythematous TM with effusion and decreased TM mobility
279
Tx of Acute Otitis Media
Amoxicillin for 10-14 days
| Erythromycin-Sulfisoxazole if PCN allergy
280
What is Acute Sinusitis
Strep Pneumo, H. Influenza, GABHS, M. Catarrhalis
| URI leads to edema which leads to fluid buildup and bacterial colonization
281
Sx of Acute Sinusitis
Sinus pain/pressure, Headache, purulent sputum or nasal drainage
Maxialllary pressure
Sinus tenderness on palpation, opacification with trans illumination
282
Dx of Acute Sinusitis
CT is test of choice
| Xray: See Water's View
283
Tx of Acute Sinusitis
Amoxicillin 10-14 days
Doxycycline
Bactrim
284
What are Cataracts
Lens Opacification due to protein preceipitation in the lens
| Smoking and steroid use are risk factors
285
Sx of Cataracts
Blurred/loss of vision over months
Halos around lights
Absent red reflex, Opaque lens
286
Tx of Cataracts
Remove via surgery
287
What is Labyrinthitis
Vestibular Neuritis (inflammation of CN 8) and hearing loss/tinnitus
288
Sx of Labyrinthitis
Peripheral vertigo, dizziness, N/V, gain distrubances, hearing loss
289
TX of Labyrinthitis
Corticosteroids
| Antihistamines (meclizine)
290
What is Meniere's Disease
Idiopathic distention of endolympahatic compartment of inner ear by excess fluid
291
Sx of Meniere's Disease
Episodic peripheral vertigo lasting 1-8 hours with horizatonal nystagmus, N/V
292
Dx of Meniere's Diseae
Dix-Hallpike Positional Test
293
Tx of Meniere's Disease
Antiemetics (Meclizine)
Diuretics for prevention (HCTZ)
Avoid salt, caffeine, chocolate, and alcohol
294
What is Cholesteatoma
Abnormal growth of squamous epithelium which leads to mastoid bony erosion
Over time it erodes ossicles and leads to CONDUCTIVE hearing loss
295
Sx of Cholestetoma
Painless otorrhea (brown/yellow discharge with strong odor), peripheral vertigo, conductive hearing loss
296
Dx of Cholesteatoma
Granulation tissue seen with otoscope
297
Tx of Cholesteatoma
Surgical excision and reconstruction of ossicles
298
What is the most common site for anterior vs. posterior nosebleed
Anterior: Kiesselbach's Plexus (more common)
Posterior: Palatine Artery (usually associated with HTN or atherosclerosis)
299
Tx of Epistaxis
Direct Pressure usually seated or leaning forward
Short acting topical decongestants (cocaine, phenylephrine, Afrin)
Cauterization if area of bleeding can be visualized or nasal packing if all else fails
Posterior bleeds are serious and need hsopitalization and specialization
300
What is Chronic Sinusitis
Sinusitis for more than 8 weeks
| Usually due to Staph. Aureus or Pseudomonas, Aspergillus, Wegner's
301
What is Guillain Barre Syndrome
Demyelinating disease with Ascending WEAKNESS
| Usually preceeded by viral infection like Campylobacter or other GI bug, CMV, EBV
302
Sx of Guillain Barre Syndrome
Weakness and Parasthesias, usually symmetric
Decreased DTR
Autonomic dysfunction: Tachycardia, Hypotension, Breathing issues
303
Dx of Guillain Barre Syndrome
CSF: High protein with normal WBC
304
TX of Guillan Barre Syndrome
Plasmapheresis to remove harmful circulating antibodies
| IVIG to suppress inflammation
305
What is Myasthenia Gravis
Autoimmune disorder of peripheral nerves
Common in young women
Progressive weakness with repeated muscle use and recovery with periods of rest
306
Sx of Myasthenia Gravis
Ocular weakness: Extraocular muscle weakness leads to diplopia, Ptosis
Generalized muscle weakness
307
Dx of Myasthenia Gravis
Tensilon Test Edrophonium: rapid response to short acting IV edrophonium
Positive Ach-Receptor Antibodies
Ice pack test (improves ptosis)
308
Tx of Myasthenia Gravis
Ach-ase inhibitors: allows ach to stay in synapse longer by preventing the breakdown via enzyme ach-ase
Pyridostigmine, Neostigmine
Immunosuppression
309
What is Multiple Sclerosis
Autoimmune inflammatory demyelinating disease of the CNS
Axon degeneration fo whtie matter of brain, otpic nerve, and spinal cord
Found in young adults and usually women
310
Sx of MS
Optic Neuritis: Unilateral eye pain worse with eye movement, diplopia, scotoma/vision loss
Sensory deficits: Weakness, Parasthesias, Fatigue
-Lhermitte's Sign: Neck flexion causes lightning shock pain radiating from spine down the leg
-Uhthoff's Phenomenon: Worsening of sx with heat (exercise, fever, hot tubs)
Spinal Cord: Nystagmus, stacatto speech, and intentional tremor, Spacity and psotiive upward Babinski
311
Dx of MS
MRI with Gadolinium shows white matter plaques
| CSF: See increased IgG
312
TX of MS
Acute: Steroids
| Relapse-Remitting/Progressive: Beta-Interferon, Amantadine for fatigue
313
What are features of Cluster Headaches
Unilateral periorbital/temporal pain
Sharp, Lancinating
Usually lasts less than 2 hours
Nasal congestion/rhinorrhea, conjunctivitis and lacrimation
314
Tx of Cluster Headaches
Oxygen is 1st line
Anti-migraine meds (subq sumatriptan or dihydroergotamine)
Verapamil for prophylaxis, steroids, ergotamine
315
What is a Migraine Headache Common vs. Classic
Common: Without Aura
Classic: With Aura
Lateralize pulsatile/throbbing headache associated with N/V, Phtophobia and Phonophobia for 4-72 hours
316
Tx of Migraine Headaches
Abortive: Triptans, IV Dihydroergotamine (Triptans and Ergots). Dopamine Blockers for N/V (IV Phenothiazines, Metoclopramide)
Prophylactic: Beta Blockers, CCB, TCA's
317
What are freatures of a Tension Headache
Bilateral, tight band-like, vise-like constant daily headache worse with stress
No N/V or focal neurologic deficits
318
Tx of Tension Headaches
Same as Migraines
| NSAIDS, TCA, Beta Blockers
319
What is Trigeminal Nueralgia
Compression of trigeminal nerve root
320
Sx of Trigeminal Neuralgia
Brief, Episodic, Stabbing/Lancinating pain in the 2nd or 3rd division of CN V worse with touch, drafts of wind and movements
Pain starts near mouth and shoots to eye, ear, nostrile
321
Tx of Trigeminal Neuroalgia
Carbamazepine is 1st line
| Gapaentin
322
What are features of an Ischemic Stroke
Due to Thrombotic or Embolic event
Most common is Middle Cerebral Artery
-Contralteral sensory/motor loss/hemiparesis greater in face/arms than legs/foot
323
Sx of Middle Cerebral Artery Ischemic Stroke
Contralateral sensory/motor loss/hemiparesis greater in face/arms than leg/foot
Preferential gaze towards side of lesion
Left side Dominant: Aphasia, Wernicke, Math comprehension
Right side Dominant: Spatial deficits, Dysarthria, L side neglect
324
Dx of Ischemic Stroke
CT without contrast to rule out Hemorrhage
325
Tx of Ischemic Stroke
After you've ruled out hemorrhagic stroke
| If within 3 hours of onset of sx then initiate rTPA (Alteplase)
326
Sx of Posterior Circulation Ischemic Stroke
Visual Hallucinations, Contralteral homonymous hemianopsia
Cerebellar dysfunction, CN palsies
Vertigo, N/V, Nystagmus
327
What are features of an Epidural Hematoma
Arterial bleed between skull and dura
Due to skull fracture
Middle Meningeal Artery affected
CT shows convex bleed (doesn't cross sutures)
328
What are features of a subdural Hematoma
```
Venous bleed (tearing of bridging veins) between dura and arachnoid
Due to blunt trauma
CT shows concave (crescent shaped, does cross sutures)
```
329
What are features of subarachnoid hemorrhage
Arterial bleed between arachnoid and pia
Due to berry aneurysm rupture, AVM
Sx: Thunderclap, sudden headache of my life, STiff neck, photophobia
CT scan is 1st line
330
What is a TIA
Transient episode of neurological deficits caused by focal brain, spinal cord, or retinal ischemia without acute infarction
Lasts less than 24 hours
331
Sx of TIA
Monocular vision loss, lamp shade down one eye, weakness contrlateral hand, HEadache, speech changes, confusion
332
Dx of TIA
CT to rule out hemorrhage
Assess CVA risk (Age, BP, Clinical features, Duration of sx, DM)
Carotid Doppler to look for stenosis
CT Angiography
333
Tx of TIA
ASA and Clopidogrel (Plavix)
NO Thrombolytics
Place supine
334
What is Bell's Palsy
Idiopathic unilateral facial Nerve (CN 7) palsy
| Thought to be due to HSV reactivation or VZV or Lyme Disease
335
Sx of Bell's Palsy
Sudden onset of ipsilateral ear pain
Unilateral facial paralysis: unable to lift affected eyebrow, can't wrinkle forehead, smile, corner of mouth troops, taste distrubance
336
Dx of Bell's Palsy
Diagnosis of exclusion
337
Tx of Bell's Palsy
Prednisone
Artificial Tears
Acyclovir in severe cases
338
Name the Cranial Nerves and what they're responsible for
CN 1: Olfactory
CN 2: Vision
CN 3: Motor to Upper eyelid, and SR, IR, IO, MR
CN 4: Motor to Superior Oblique Eye
CN 5: Trigeminal, motor to muscles of mastication
-V1: sensory to forehead
-V2: sensory to cheeks
-V3: sensory to jaw and taste
CN 6: Motor to Lateral Rectus Eye
CN 7: Motor to facial expression, Taste anterior 2/3
CN 8: Vestibular, balance and hearing
CN 9: Glossopharyngeal, Motor to swallowing and gag, Taste posterior 1/3
CN 10: Vagus, Motor to voice, soft palate, gag, Sensory to organs
CN 11: Spinal Accessory, Motor to shrug, turn head, SCM
CN 12: Hypoglossal, Motor to Tongue
339
What are the most common types of pathogens by age group for Meningitis
- Infant
- 1 month to 18 years
- Adults
- Geriatrics
Infant: Group B Strep (Strep Streptococus Agalactiae), Listeria, E.Coli
1 month to 18 years: N. Meningitidis, Strep. Pneuo, H. Influenza
Adults: Strep. Pneumo, N. Meningitidis, H. INfluenza, Listeria
Geriatrics: Strep Pneumo, Listeria, Gram Negative Rods
340
What is the most common pathogen in a kid
N. Meningitidis
341
What is the most common pathogen in adults
Strep. Pneumoniae
342
Sx of Bacterial Meningitis
Fevers, chills, headache/nuchal rigidity, photosensivity, N/V, Seizures
Kernig's Sign, Brudzinski Sign
343
Dx of Bacterial Meningitis
Lumbar Puncture is Definitive
- Bacteria: High protein, Low Glucose, PMN's
- Viral: Normal protein, Normal Glucose, Lymphocytes
344
Tx of Bacterial Meningitis
Infants: Ampicillin + Cefotraxime
Kids and Adults: Ceftriaxone + Vancomycin
Geriatrics: Ampicillin + Cefotraxime
345
What is a Simple Partial Seizure
Confined to a small part of brain
Consciousness maintained
May have focal sensory, automonic, motor sx
346
What is a Complex Partial Seizure
Confined to a small part of the brain
Consciousness Impaired
Auras associated
347
What is an Absence Seizure
Diffuse brain involvement
Brief impairment of consciousness
Brief staring episodes, Eyelid twitching
348
What is a Tonic Clonic (Grand Mal) Seizure
Diffuse brain involvement
Loss of consciousness with rigidity followed by repetitive rhythmic jerking then flaccid coma/sleep
Auras may occur
349
What is a Myoclonus Seizure
Sudden brief sporadic involuntary twitching
| No Loss of Consciousness
350
What is an Atonic Seizure
Drop attacks
| Sudden loss of postural tone
351
Tx of Seizures
Absence: Ethosuximide
Grand Mal: Valproic Acid, Phenytoin, Carbamazepine
Status Epilepticus: Lorazepam
Myoclonus: Valproic Acid
352
What is Graves Disease
Autoimmune: TSH autoantibodies circulate and cause thyroid to release T3/T4
Leads to Hyperthyroidism
353
Sx of Graves Disease
Hyperthyroidism: Health Intolerance, Weight Loss, Goiter, Anxiety, Tremors, Tachycardia, Palpitations, Diarrhea, Hyperglycemia
Exophthalmos is unique to Graves: Lid lag and Proptosis
354
Dx of Graves
Positive Thyroid Stimulating antibodies
Low TSH, High T3/T4
RAIU: Diffuse Uptake
355
Tx of Graves
Radioactive Iodine
Methimazole or PropylThioUracil (PTU safe in pregnancy)
Beta Blockers
Thyroidectomy
356
What is Toxic Multinodular Goiter
Autonomous functioning nodules
357
Sx of Toxic Multinodular Goiter
Hyperthyroidism
| Palpable nodule
358
Dx of Toxic Multinodular Goiter
Low TSH, High T3/T4
| RAIU: Patchy areas of uptake
359
Tx of Toxic Multinodular Goiter
Radioactive Iodine
Methimazole/PTU
Beta Blockers
360
What is Hashimotos
Autoimmune that leads to Hypothyroidism
| Most common form of Hypothyroidism in US
361
Sx of Hashimotos
Hypothyroidism: Cold Intolerance, Weight Gain, Goiter, Fatigue, Memory Loss, Depression, Constipation, Bradycardia, Decreased CO, Menorrhagia, Hypoglycemia
362
Dx of Hashimotos
Positive Thyroid antibodies present
| TFT's
363
Tx of Hashimotos
Levothyroxine
364
What is De Quervain's
Usually post-viral
| Clinically looks like Hyperthyroidism but eventually leads to Hypothyroidism
365
Sx of De Quervain's
Painful neck/thyroid
366
What is a Thyroid Storm
Rare potentially fatal complication of untreated thyrotoxicosis
Hypermetabolic State
367
Sx of Thyroid Storm
Hypermetabolic State: Palpitations, A. Fib, Tachycardia, High fevers, N/V, Psychosis, Delirium, Tremors
368
Dx of Thyroid Storm
Low TSH, High T3/T4
| EKG shows sinus tachy, A.Fib, A. Flutter
369
Tx of Thyroid Storm
Methimazole, PTU, Beta Blockers for sx
Supportive: IV Fluids
Glucocorticoids
370
What is a Myxedema Crisis
Extreme form of hypothyroidism
| Seen in elderly women with long standing hypothyroidism in cold weather
371
Sx of Myxedema Crisis
Bradycardia, CNS depression, Respiratory depression, Hypothermia, Hypotension
372
Dx of Myxedema Crisis
Increased TSH, Low T3/T4
373
Tx of Myxedema Crisis
Levothyroxine, Supportive (ICU, fluids, Abx, Steroids)
| Passive Warming
374
What are the types of Thyroid Cancers
Papillary: Most Common, Least Aggressive
Follicular: More Aggressive
Medullary: Associated with MEN 2
Anaplastic: Least common, Most aggressive
375
What does Parathyroid Hormone do
High PTH increases calcium
| Low PTH decreases calcium
376
What is Primary Hyperparathyroidism
Inappropriate PTH production
| Parathyroid Adenoma is most common cause
377
What is Secondary Hyperparathyroidism
Increased PTH in response to low calcium or Vitamin D deficiency
378
Sx of Primary Hyperparathyroidism
Stones, Bones, Abdominal Groans, Psychic Moans
| Decreased DTR
379
Dx of Primary Hyperparathyroidism
Hypercalcemia, High PTH, Low Phosphate
24 hour urine calcium exretion
Osteopenia/bone scan
380
Tx of Primary Hyperparathyroidism
Surgery, Parathyroidectomy
| Secondary tx with Vitamin D and Calcium Supplement
381
What is Hypoparathyroidism
Low PTH or Insensitive to its action
| Usually due to damage to Parathyroid glands post-surgical or autoimmune
382
Sx of Hypoparathyroidism
Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign
| Increased DTR
383
Dx of Hypoparathyroidism
Hypocalcemia, Low PTH, High Phosphate
384
Tx of Hypoparathyroidism
Calcium Supplement and Vitamin D: Ergocalciferol or Calcitriol
385
What is Chronic Adrenocortical Insufficiency
Primary is Addisons: Adrenal gland destruction due to autoimmune or infection (TB)
Secondary is pituitary failure of ACTH secretion
386
Sx of Primary Adrenocortical Insufficiency
Nothing in Adrenal Gland Works
No Aldosterone, No Sex Hormones
Increased ACTH production causes Hyperpigmentation
No Aldosterone leads to orthostatic hypotension, Hyponatremia, HYPERKALEMIA, Metabolic Acidosis
387
Sx of Secondary Adrenocortical Insufficiency
```
No Cortisol (no ACTH production)
Weakness, muscle ache, myalgias, fatigue, headache, sweating, abnormal menstruation, hypoglycemia
```
388
Dx of Adrenocortical Insufficiency
1. Get baseline ACTH, Cortisol, and Renin
2. High does ACTH Stimulation Test
- Normal response is rise in cortisol after ACTH given
- If little or no increase, Adrenal Insufficiency
3. CRH Stimulation Test
- High ACTH but low cortisol is Addisons
- Low ACTH and low cortisol is Secondary (pituitary)
389
Tx of Adrenocortical Insufficieny
Addisons: Mineralocorticoid and Glucocorticoid
Secondary: Glucocorticoid Only
Mineralocorticoid: Fludrocortison
Glucocorticoid: Hydrocortison
390
What is Adrenal (Addisonian) Crisis
Sudden worsening of adrenal insufficiency due to a stressful event like surgery, trauma
Caused by abrupt withdrawal of glucocorticoids, someone undiagnosed with Addisons
391
Sx of Addisonian Crisis
Shock, decreased BP, Hypotension, Hypovolemia
392
Dx of Addisonian Crisis
BMP: Hyponatremia, Hyperkalemia, Hypoglycemia
393
Tx of Addisonian Crisis
IV Fluids: Normal saline to correct hypotension and hypovolemia
Glucocorticoids: Dexamethasone
Reverse electrolyte abnormalities
Fludrocortisone
394
What is Cushing's Syndrome
Hypercortisolism
395
What is Cushing's Disease
Cushing's Syndrome (Hyerpcrotisolsim) caused by pitutairy increase in ACTH secretion
396
Sx of Cushing's
Central Trunk Obseity, Moon Facies, Buffalo Hump, Supraclavicular Fat Pads, Wasting of extremtiies, Striae, Skin Atrophy, Weight gain, osteoporosis, Hypokalemia, Acanthosis Nigricans, Depression, Mania, Psychosis
397
Dx of Cushing's
1. Low does Dexamethasone Suppression Test
- Normal response is cortical suppression
- No suppression is Cushing's Syndrome
2. Increased 24 hour Urinary free cortisol
- If elevated in urine is Cushing's Syndrome
3. Increased Salivary Cortisol Levels
- Increased in Cushing's
4. High Dose Dexamethasone Suppression
- If suppressed: Cushing's Disease
- If not suppressed: Adrenal or Ectopic ACTH producing tumor
5. ACTH Levels
- Decreased ACTH is Adrenal Tumor
- NOrmal/Increased ACTH is Cushin's disease or ACTH producing tumor
398
Tx of Cushing's
Cushing's Disease: Pituitary Tumor, Transsphenoidal Surgery
Ectopic or Adrenal Tumors: Tumor Removal, Ketoconazole
Iatrogenic Steroid Therapy
399
What is a Pheochromocytoma
Catecholamine-Secreting Adrenal Tumor
| Secretes Norepinephrine and Epinephrine
400
Sx of Pheochromocytoma
Hypertension, Palpitations, Headaches, Excessive Sweating
401
Dx of Pheochromocytoma
Increased 24 hour urine catecholamines including Metanephrine and Vanillylmadelic Acid
402
Tx of Pheochromocytoma
Complete Adrenalectomy
| Prior to surgery needs to have Alpha-Blockade (Phenoxybenzamine or Phetolamine) followed by beta-blockers
403
What is Diabetes Insipidus
Problem with ADH
Central DI: No ADH production
Nephrogenic: Problem with response to ADH by the kidneys
404
Sx of Diabetes Insipidus
Polyuria, Polydipsia, Nocturia
Hypernatremia if severe
Low water intake
405
Dx of Diabetes Insipidus
Fluid Deprivation Test
-Normal response is urine becomes concentrated
-DI: Continued dilute urine
Desmopressin Stimulation Test
-Normal response is like ADH, so will concentrate urine
-If Urine becomes concentrated then it's an issue with the release of ADH from the pituitary, so Central
-If urine continues to be dilute, it's a problem with the kidneys not responding to ADH/Desmopressin, so Nephrogenic
406
Tx of Diabetes Insipidus
Centra: Desmopressin/DDAVP
Nephrogenic: Na/Protein restriction, Indomethacin
If sx: Hypotonic fluid (pure water orally is preferred, D5W, 1/2 normal saline)
407
What is Diabetes Mellitus
Hyperglycemia due to inability produce insulin or insulin resistance or both
408
What is DM I
Pancreatic beta cells are destroyed so no insulin production
409
What is DM II
Insulin resistance and impariment to insulin secretion
410
What are risk factors for DM
FAmily hx, Hispanic/AA, HTN, Hyperlipidemia
411
Sx of DM
Polyuria, Polydipsia, Polyphagia, Weight Loss
| DKA
412
What are complications of DM
Neuropathy: Stocking glove pattern of decreased proprioception, decreased DTR, Orthostatic hypotension
Retinopathy: Microaneurysms, hard exudates, flame shaped hemorrhages, cotton wool spots, Neovascularization, central vision loss
Nephropathy: Microalbuminuria
Hypoglycemia: Sweating, tremors, palpitations
413
Dx of DM
Fasting Plasma Glucose >126 on 2 occasions at least 8 hours apart (gold standard)
HgA1c >6.5%
2 hour plasma glucose >200
Plasma glucose >220
414
Who gets screened for DM
Patients >45 yrs, BP>138/80, BMI >25, low HDL, family hx
415
Tx of DM
Lifestyle changes first
DM I: Insulin
DMII
-Metformin first
416
What is DKA
REsults from insulin deficiency and counter-regulatory hormonal excess in response to stressful triggers
Hyperglycemia, Dehydration, Ketonemia, Potassium Deficit
417
Sx of DKA
Thirst, polyuria, polydipsia, weakness, fatigue, abdominal pain, Ketotic breath, Kussmaul's Respiration (deep continuous respirations to blow off CO2 excess)
418
Dx of DKA
```
Glucose >250
Arterial pH <7.30
Serum Bicarbonate 15-18
Ketones: Positive
Serum Osmolarity: Variable
```
419
Tx of DKA
ABC, Mental status, vital signs, volume status
IV Fluids are 1st!! Isotonic 0.9% NS then 0.45% NS
Insulin (Regular)
Potassium
Bicarbonate in severe acidosis
420
What is Crytptococcosis
Cryptococcus Neoformans
| Bird droppings
421
Sx of Cryptococcosis
Headache, Meningeal Signs, Penumonia
422
Dx of Cryptococcosis
Antigen in CSF (seen with india ink stain)
| Positive blood ultures
423
Tx of Cryptococcosis
Amphotericin B + Flucytosine for 2 weeks followed by Fluconazole
424
What is Histoplasmosis
Yeast
| Bird/Bat Droppings in Mississippi and Ohio River Valleys
425
Sx of Histoplasmosis
Penumonia, Disseminated in immunocompromised (hepatosplenomegaly, fevers, ulcers, bloody diarrhea)
426
Dx of Histoplasmosis
Increased ALP, Increased LDH
427
Tx of Histoplasmosis
Itraconazole
| Amphotericin B
428
What is Aspergillosis
Fungus characterized by Large Septate Hypae
| Found in garden and houseplant soil and compost
429
Sx of Aspergillosis
Allergic Bronchopulmonary Aspergillosis
Hemoptysis, Fungal Ball on CXR
Invasive Chronic Sinusitis
430
Dx of Aspergillosis
Dusky, Necrotic Tissue on biopsy and seen in tissues
431
Tx of Aspergillosis
Allergic: Tapered Steroids, Itraconazole
Severe: Voriconazole
Aspergilloma: Surgical resetion if sx
432
What is Coccidiomycosis
Grows in soil in Southwestern US and MExico
433
Sx of Coccidiomycosis
Mild flu-like illness, fever, chills, nasopharyngitis, headache, cough
Valley Fever: Fever, Arthralgias, Erythema Nodosum or Erythema Multiforme
434
Dx of Coccidiomycosis
Early: IgM
| Cultures are definitive
435
Tx of Coccidiomycosis
Most are asympomatic and self-limiting
| Fluconazole for CNS disease
436
What is Impetigo
Caused by Group A Beta Hemolytic Strep (Strep Pyogens)
437
Sx of Impetigo
Honey colored yellow crusts on arms, legs, face
438
TX of Impetigo
Topical Mupirocin
| Oral Keflex, Erytrhomycin, Clindamycin
439
What is Cellulutis
Caused by S. Auerus or GABHS
440
Sx of Cellulitis
Red, swollen, tender, hot, fevers, chills
441
Tx of Cellulitis
Cephalexin, Dicloxacillin, Clindamycin or Erythromcyin if PCN allergy
MRSA: Bactrim
442
How do you treat a cat bite
Augment
| Caused by Pateurella Multocida
443
How do you treat a dog bite
Augmentin
444
What is Osteomyleitis
Caused by S. Auerus or Group B Strep
445
Sx of Osteomyelitis
Local signs of inflammation/infection, pain over bone
446
Dx of Osteomyelitis
MRI
Xray: See periosteal reaction
Bone biopsy is gold standard
447
Tx of Osteomyeltiis
Nafcillin or Oxacillin
448
What is Tetanus
Clostridum Tetani, Grame Positive Rod
| Creates neurotoxin that blocks neuron inhibition leads to severe muscle spasms
449
Sx of Tetanus
Pain/Tingling and inoculation site
Local muscle spasms, neck/jaw stiffness, dysphagia
Trismus (Lock jaw), Drooling, Risus Sardonicus, Muscle Rigidity in descending fashion
450
Tx of Tetanus
Metronidazole or PCN G + Tetanus Immune Globuin
Prophylaxis: Tdap, Td vaccine every 10 years
If never immunzed give Tetanus Immune Globulin with initation of tetanus toxoid vaccine
451
What is Botulism
Clostridum Botulinum
Produces neurotoxin that inhibits acetylcholine release at neuromuscular junction
Found in canned/smoked/vacuum packed foods
Infants if ingest honey will get it
Sx occur 6-8 hours after ingestion
452
Sx of Botulism
Diplopia, Dry Mouth, Dysphagia, Dysarthria, Dysphonia, Decreased muscle streght, Dilated fixed pupils, Paralysis
Floppy Baby Syndrome: Newborn Botulism after ingestion of honey containing spores
453
Tx of Botulism
Antitoxins
| Respiratory support like intubation if respiratory failure
454
What is Pertussis (Whooping Cough)
Bordetella Pertussis
| Highly contageous
455
Sx of Pertussis
Catarrhal Phase: URI symptoms
Paroxysmal Phase: Severe paroxysmal coughing fits with post vomiting emesis
Convalescent Phase: Resolving sx, cough may last up to 2 months
456
TX of Pertussis
Erythromycin, helps prevent spread, does nothing to treat the actual disease
457
What is Lyme Disease
Borrelia Burgdorferi, a Gram Negative Spirochete
| Spread via Ixodes (deer) tick in spring and summer in Northeast, Midwest, Mid-Atlantic
458
Sx of Lyme Disease
Early: Erythema Migrans (expanding, warm annular erythematous rash with central bullseye) usually a month after bite
Disseminated: Rheumatologic arthrlagias, meningitis, weakness, CN 7 palsy, AV blocks
Late: Persistent synovitis, Arthritis
459
Dx of Lyme Disease
Clinical
| ELISA (Serologic)
460
Tx of Lyme Disease
Doxycycline
| If kids <8yrs, use Amoxicillin
461
What is Rocky Mountain Spotted Fever
Tick Disease, Rickettsia Rickettsii
| Spread by Ticks in South/South Atlantic States in spring and summer
462
Sx of Rocky Mountain Spotted Fever
Fevers, chills, myalgias, Headache
Red maculopapular rash first on wrists and ankles and then spreads centrally (palms and soles are characteristic), Petechia
463
Dx of Rocky Mountain Spotted Fever
Clinical
| Immunofluorescent assay for antibodies
464
Tx of Rocky Mountain Spotted Fever
Doxycycline even in young children
465
What is Coxsackie Virus
Part of Enterovirus family
Most common in kids 5 years or younger
Spread via fecal-oral route
466
What are illnesses caused by Coxsackie
Hand, Foot, Mouth: Mild fever, URI, vesicular lesions on a reddended base in oral cavity
Herpangina: sudden onset high fever, stomatitis
Pericarditis and Myocarditis
467
Tx of Coxsackie
Supportive
468
What is HIV
Retrovirus with Reverse Transcripate
| Transmitted via sex and IV drug use
469
Sx of HIV
Acute seroconversion: Flu-like illness, fever, malaise, generalized rash
AIDS: CD4 <200, recurrent severe and life threatening opportunistic infection, neurologic changes (encephalopathy or dementia, chronic diarrhea, weight loss)
470
Dx of HIV
Antibody Testing: ELISA. If positive confirm with Western Blot. Rapid testing blood or saliva
Western Blot Confirms
HIV RNA Viral Load: Can be positive in window period, used to monitor infectivity and tx effectiveness
471
TX for HIV
HAART used when CD4<350 OR Viral load >55,000 by RNA
NNRTI + 2 NRTI
PI + 2 NRTI
INSTI + 2 NRTI
NRTI: Zidovudine, Emtricitabine, ABacavir
NNRTI: Efavirenz, Delavirdine, Etravirine
Protease Inhibitors: Atazanavir, Darunavir, Indinavir
INTI: Raltegravir, Dolutegravir
472
What is Toxoplasmosis
Protozoan transmitted by cats (including cat litter)
473
Sx of Toxoplasmosis
Encephalitis and Chorioretinitis in immunocompromised patients
Blueberry muffin rash (TTP), Hepatosplenomegaly, hearing loss, mental retardation if congenital
474
Dx of Toxoplasmosis
PCR
| CT shows ring-enhancing lesions
475
Tx of Toxoplasmosis
Sulfadiazene or Clindamycin + Pyrimethamine
| Prophylaxis: Pyrimethamine, Sulfadiazene, Bactrim
476
What is Atopic Dermatitis (Eczema)
Atopy: Allergic Rhinitis, Asthma, Hay Fever
| Due to altered immune reaction and increased IgE production
477
Sx of Atopic Dermatitis
Pruritis, itch-scratch cycle
Small erythematous edematous ill-defined blisters, usually flexor creases
Nummular Exzema is sharply defined coin shaped lesions
478
Tx of Atopic Dermatitis
Topical Steroids and Antihistamine for itching
479
What is Pityriasis Rosea
Herald Patch on trunk with general exanthem 1-2 weeks later, smaller round/oval salmon colored papules with white circular scaling along cleavage lines
Christmas Tree Pattern
480
Tx of Pityriasis Rosea
None needed
Topical Steroids for itching
Oral Antihistamines
481
What is Psoriasis
Chronic multisystemic inflammatory immune disorder
| T-Cell activation and cytokine release
482
Sx of Psoriasis
Plaque: Raised, dark-red plaques/papules with thick silver/white scales on extensor surfaces
Guttate: Small erythematous papules with fine scale
Psoriatic Arthritis: inflammatory arthritis associated with psoriasis, Sausage digits, Xray shows pencil in cup
483
Tx of Psoriasis
Topical steroids
| UVB light therapy
484
What is Tinea Versicolor
Caused by a yeast, Malassezia Furfur
485
Sx of Tinea Versicolor
Well demarcated round/oval macules with fine scaling
486
Dx of Tinea Versicolor
KOH prep see hyphae and spores, Spaghetti and Meatballs
| Woods lap see yellow-green fluorescence
487
Tx of Tinea Versicolor
Selenium Sulfide, Sodium Sulfacetamide, Azole antifungals
488
What is Seborrheic Dermatitis
Occurs in areas of high sebaceous glands over secretions like scalp, face, eyebrows, body folds
489
Sx of Seborrheic Dermatitis
Cradle cap in infants
| Erythematous plaques with fine white scales (dandruff)
490
Tx of Seborrheic Dermatitis
Selenium sulfide, sodium sulfacetamide, Ketoconazole, STeroids
491
What is Erythema Multiforme
Target lesions, usually due to drugs like sulfonamides, penicillins, Dilatin
492
What is Urticaria/Angioedema
```
Type I (IgE) Hypersensitivity reaction
Triggers are foods, meds, infection, insect bites
```
493
Sx of Urticaria/Angioedema
Urticaria: Blanchable, edematous pink papules, wheals or plaques
Angioedema: painless, deeper form of urticaria affecting lips, tongue, eyelids, hands and feet
494
Tx of Urticaria/Angioedema
Oral antihistamines
Eliminate precipitants
H2 blockers
495
What is Erythema Multiforme
Type 4 Hypersensitivity reaction
| Associated with Herepes, Mycoplasma and meds
496
Sx of Erythema Multiforme
Target lesion, dusty-violet red purpruic macule
497
Tx of Erythema Multiofrme
Sx, antihistamines, analgesics
498
What is Basal Cell Carcinoma
Most common skin cancer
Fair-skinned with prolonged sun exposure
Slow growing
499
Sx of Basal Cell Carcinoma
Flat firm area with small raised translucent/pearly/waxy papule with central ulceration
Telengiectatic
500
Dx of BCC
Punch or shave biopsy
501
Tx of BCC
Electric desiccation/curettage
502
What is Squamous Cell Carcinoma
Often preceeded by Actinic Keratosis, HPV infection
503
Sx of Squamous Cell Carcinoma
Red, Eelvated nodule with adherent white scaly or crusted bloody margins
504
Dx of Squamous Cell Carcnioma
Biopsy: Epidermal and dermal cells with large, pleomorphic, hyperchromatic nuclei
505
Tx of Squamous Cell Carcinoma
Excision
506
What is Malignant Melanoma
UV radiation causes it
| Aggressive and high METS
507
Sx of Malignant Melanoma
ABCDE
Asymmetry, Borders are irregular, Colors are dark or variable, Diamater >6mm, Evoluation
Thickness is most important for prognosis
508
Dx of Melanoma
Full thickness wide excisional biopsy with lymph node biopsy
509
Tx of Melanoma
Excision with lymph node biopsy or dissection
510
What is Molluscum Contagiosum
Benign viral infection by Poxviridae
511
Sx of Molluscum Contagiosum
Single or multiple dome shaped, flesh colored pearly white, waxy papules with CENTRAL UMBILICATION
512
Tx of Molluscum Contagiosum
Usually resolve on their own in 3-6 months
Cryosrugery
Imiquimod or Podophyllin`
513
What is Lice
Pediculosis
514
Sx of Lice
Intense itching, papular uritcaria near lice bites
| See nits in hair
515
Tx of Lice
Permetrhin
| Bedding and clothes should be washed in hot water with detergent and dried in hot drier for 20 minutes
516
What is Scabies
Sarcoptes Scabiei
| Spread via feces
517
Sx of Scabies
Intesnely pruritic lesions, linear burrows usually in web spaces between fingers/toes, scalp
Itching is worse at night when females lay eggs
518
Dx of Scabies
Skin scraping shows mites or eggs
519
Tx of Scabies
Permetrin, may need reapplication after 1 week
| Bedding and clothes washed in hot water and dried in hot dryer
520
What are Dermatophytes
Fungal skin infections
521
Dx of Dermatophytes
KOH smear
| Woods Lamp
522
Tx of Dermatophytes
Tinea Pedis, Cruris, Corporis with topical antifungals
Tinea Capitus with Griseofulvin
Onychomycosis with Griseofulvin
523
What is Epididymitis
Usually due to Chlamydia in men <35 yrs or N. Gonorrhea
| E.Coli or Klebsiella >35yrs
524
Sx of Epididymitis
Gradual onset of scrotal pain, erythema, and swelling
Usually unilateral
Positive Prehn's Sign (Relief of pain with elevation of testicle)
Positive Cremasteric Reflex
525
Dx of Epididymitis
Scrotal Ultrasound: Increased testicular blood flow
| UA: Increased WBC
526
Tx of Epididymitis
BEd rest, scrotal elevation, cool compress, NSAIDS
If Gonorrhea and Chlamydia: Azithromycin and Ceftriaxone
If E.Coli: Fluoroquinolones
527
What is a spermatocele
Epididymal cystic scrotal mass containing sperm
528
Sx of Spermatocele
Painless, cystic mass in head of epididymis
| Transilluminates easily
529
Tx of Spermatocele
None
530
What is Testicular Torsion
Spermatic cord twists and cuts off testicular blood supply
531
Sx of Testicular Torsion
Abrupt onset of scrotal, inguinal or lower abdominal pain
N/V
Swollen, tender, retracted testicle
Negative Prehn's Sign (no relief of pain with elevation)
Negative Cremasteric Reflex
Blue dot sign at upper pole
532
Dx of TEsticular Torsion
Doppler Ultrasound: Avascular testcile
| Radionuclide Scan is Gold STandard
533
Tx of Testicular Torsion
Detorsion and Orchiopexy within 6 hours
534
What is a Hydrocele
Cystic collection of fluid in testicle
| Most common cause of painless scrotal swelling
535
Sx of Hydrocele
Painless scrotal swelling, dull ache, or heaviness
| Transillumiation
536
Dx of Hydrocele
None
| Aspiration of fluid if compressive
537
What is a Varicocele
Cystic testicular mass of varicose veins
Usually found on left side
Surgically correctable
538
Sx of Varicocele
Bag of worms superior to testicle
| Dull ache or heavy sensation
539
Tx of Varicocele
Surgery
| If sudden onset in older male may be renal cell carcinoma
540
What is Cryptorchidism
Undescended testicle
| Increased risk in premature infant and low birth weight
541
Sx of Cryptorhchidism
Emtpy, small scrotum with inguinal fullness
| Complications are testicular cancer or infertility
542
Tx of Cryptorchidism
Orchiopexy: as early as 6 months of age and before 1 year
Observation if less than 6 months
HCG or gonadotropin releasing hormone
543
Sx of TEsticular Cancer
Painless testicular nodule, solid mass or enlargement
| Gyncecomastia may be present
544
Dx of Testicular Cancer
Scrotal US and Serum STudies
Seminomous: Radiosensitive and NO tumor markers
Non-seminomas: Radioresistant, Increased alpha-fetoprotein and Beta-HCG
545
TX of Testicular CA
Low grade nonseminoma: Orchiectomy with retroperitoneal lymph node dissection
Low grade Seminom: Orchiectomy followed by radiation
High grade Seminoma: Debulking chemo then orchiectomy and radiation
546
What is the most common pathogen in Cystitis
E. Coli
547
Sx of Acute Cystitis
Dysuria, Increased Frequency, Urgency, Hematuria, Suprapubic discomfort
548
Sx of Pyelonephritis
Fever and Tachycardia
Back/flank pain
Positive CVA tenderness
N/V
549
Dx of Acute Cystitis/Pyelonephritis
UA: Pyuria, Positive leukocyte esterase, Positive Nitrities, Hematuria
Dipstick: Positive leukocyte esterase, nitrities, hematuria
IF you see WBC casts in UA it's Pyelonephritis
Definitive is Urine culture
550
Tx of Uncomplicated Cystitis
Fluoroquinolones: Cipro
Bactrim
Nitrofurantoin (Macrobid)
551
Tx of Complicated Cystitis
Oral Fluoroquinolone or IV
Aminoglycosides
If pregnant: Amoxicillin, Nitrofurantoin
552
Tx of Pyelonephritis
Fluoroquinolone or Aminoglycoside
553
What is Paraphimosis
Foreskin becomes trapped behind corona of gland forms tight band
Constricts penis
554
Sx of Paraphimosis
Enlarged, painful glans with constricting band of foreskin behind glans
555
Tx of Paraphimosis
Manual reduction
| Injection of Hyaluronidase
556
What is Benign Prostatic Hypertrophy
Prostate Hyperplasia that leads to bladder outlet obstruction
557
Sx of BPH
Frequency, Urgency, nocturia, hestitancy, weak/intermittent stream force, incomplete emptying and incontinence
558
Dx of BPH
DRE: Uniformly enlarged, firm, rubbery prostate
UA: Normal
Increased PSA
559
Tx of BPH
Observation
5-Alpha Reductase Inhibitors (Finasteride and Dutasteride) (affects clinical course)
Alpha-1 Blockers: Tamsulosin, Alfuzosin, Doxazosin (provides sx relief)
TUPR: trans urethral resection of prostate
560
What is Bladder Cancer
Most are Transitional Cell
| RF are smoking, occupational exposures
561
Sx of Bladder Cancer
Painless microscopic or gross hematuria
| Dysuria, urgency, frequency
562
Dx of Bladder Cancer
Cystoscopy with biopsy
563
Tx of Bladder Cancer
Localized or superficial: Transurethral resection
Invasive (involving muscle layer): Cystectomy
Recurrent: BCG Immune Therapy
564
What is Renal Cell Carcinoma
Tumor of proximal convulted renal tubule cell
| Smoking, Dialysis, HTN, and obesity are RF
565
Sx of Renal Cell Carcinoma
Hematuria, Flank/ABdominal pain, Palpable mass
| Varicocele
566
Dx of Renal Cell Carcinoma
CT Scan
567
Tx of Renal Cell Carcinoma
Localized: Radical nephrectomy, Immune therapy
| Bilateral invovlement or with one kidenY; Partial nephrectomy
568
What is the most common type of Kidney Stone
Calcium (Calcium Oxolate)
569
Sx of Kidney Stones
Sudden onset of constant upper/lateral back pain over costovertebral angle
Radiates to groin/anterior
N/V
Positive CVA tenderness
570
Dx of Kidney Stone
Noncontrast CT is 1st choice
IV Pyelography is gold standard
UA: Microscopic hematuria
571
Tx of Kidney Stone
If <5mm: Spontaenous passage, fluids, analgesics
If >7mm: Shock wave lithotripsy, Uretoscopy with stent
Percutaneous Nephrolithotomy if large stones
572
What is Prostatitis
Prostate gland ifnlammation due to secondary infection
| Usually due to E.Coli, Pseudomonas, Chlamydia/Gonorrhea
573
Sx of Prostatitis
Fever, Chills
Frequency, urgency, dysuria
Hestiancy, poor or interrupted stream
Tender, normal or hot boggy prostate
574
Dx of Prostatitis
UA or culture
Don't do prostatic massage in acute
Prostatic massage ok in chronic for culture
575
Tx of Prostatitis
Acute: Fluoroquinolones, Bactrim
Crhonic: FQ, Bactrim, TURP for refractory
576
What is Salmonellosis
Caused by Salmonella Enterica transmitted via food and water
577
Sx of Salmonellosis
3 types: Enteric (typhoid fever), gastroenteritis, bacteremia
Enteric: 5-14 day incubation, malaise, headache, cough, sore throat, splenomegaly, person looks ill, pea soup diarrhea
Gasteroenteritis: 848 hour incubation, fever, N/V, crampy abdominal pain, bloody diarrhea
Bacteremia: Prolonged recurrent fevers, local infection in bone, joints, pleura, pericardium
578
Tx of Salmonellosis
Tyhpoid: Ampicillin, Bactrim, but if resistant Ceftriaxone or FQ
Gastroenteritis: Self limited, but Bactrim, Ampicilin, Cipro work
BActeremia: Same as typhoid
579
What is Shigellosis
Caused by Shigella Sonnei, Flexneri, Dystenteriae
580
Sx of Shigellosis
ABrupt diarrhea, lower abdominal cramps, tenesmus, fever, chills, anorexia, headaches, malaise
Loose stools with blood and mucus
Tender abdomen
581
Dx of Shigellosis
Stool positive for leukocytes and RBC
| Cultures
582
Tx of Shigellosis
Fluid replacement
| Bactrim is 1st line, but Cipro and FQ work
