IM Flashcards
(406 cards)
1
Q
Waterhouse Friderichsen syndrome
A
Meningococcemia patients suddenly developed hypotension, shock– most likely diagnosis adrenal
hemorrhage.IV Corticosteroid + treat meningococcal infection
2
Q
Endocarditis: Native or culture negative: RX
empiric
A
Vancomycin and gentamycin
add rifampin for prosthetic valve. Vancomycin alone for culture MRSA only
3
Q
eoshinophilic pneumonia
A
rare can cause severe respiratory failure, acute hypersensitivity reaction to unidentifed
Ag in otherwise healthy individula. dx criteria:
acute febrile illness of short duration 25%
Lung biopsy: eosinophilic infiltrates
treat: admin steroids. if not respiratory fialure, po prednison; if failure exists, methylprednisolone.
corticosteroids are given until respiratory syptoms resovle take 1-3 days.
4
Q
aortic dissection dx
A
sudden onset of chest pain radiating to back.
• Signs: Asymmetrical pulse, BP eg Right 180/100, left 130/70.
New murmur of aortic regurgitation (In Type A)
Widening of mediastinum in x-ray.(not always as blood accumulate in flap)
contrast enhanced chest CT: demonstrate a dissection flap in thoracic aorta.
5
Q
guillain-barre syn
A
polyradiculoneuropathy: 3 As
acute, areflexic, ascending paralysis.Rx: plasma exchange, iv IVIG
6
Q
gonorrhea infect Rx
A
ciftriaxone IM +doxy 100mgcontinuous bid po*7(preg: azithromycin 1gm one time)
7
Q
primary syphilis/secodnary syphillis Rx
A
Benzathine 2.4 million IM *1 dose or doxycycline po *2 week
8
Q
condyloma accuminata Dx
A
dx is clinical ,ddx from condyloma lata, application of acetic acid turn white, biopsy if dx is in doubt.
9
Q
Jarisch Heerxheimer reaction Rx
A
bed rest, ASA
10
Q
latent syphilis have CSF exam criteria
A
ophthalmic signs of it, other evidence of tertiary , treatement failure, HIV coninfection not known duration or more than one year
11
Q
false positive serologic test for syphilis
A
shit:SLE, iv drug abuse, liver chronic (Transmase)disease, HIV
12
Q
chancroid
A
painful genital ulcer with necrotic base and painful lymphadenopathy
13
Q
lympho-granuloma venerum LGV
A
baseline ingunial lymph node present, not genital lesion, bilateral inguinal lymph node(big lymph node as name) cause chalmydia trachomatis
14
Q
Granuloma inguinale
A
painless large ulcerated lesion in genital area with beffy red friable base of granulation tissue. tissue secretion or scraping contian Donovan bodies. (granuloma: large difference)
15
Q
needle stick transmission
A
HIV 0.3%, Hep C 3%:c is 3; Hep B 6-30%.
16
Q
prphylactis HIV
A
tripel therapy AZT+3TC+indinarvir for 4 weeks.
17
Q
HIV acquire infeciton rate
A
blood transfusion: 1;100,000, needle 0.3%, preinatal 13-40%
18
Q
GRED endoscopy indication
A
PPI increase dose to twice a day doesn’t relieve symtom or alarming symptom, need endoscopy evaluation
19
Q
risk of rebleeding for varices
A
=5mm 15-20% per yr.
20
Q
prophylactic of rebleeding of varices
A
b-blocker for lighter; banding for severe >3 degree
21
Q
immunization contraindication
A
small disease is not contraindicate, even with live vaccine
22
Q
isotrenitin Rx
A
need 2 contraception method 1 month before , during and after one month of treatment
23
Q
unstable angina
A
iv b-blocker, Heparine(decrease propogation), GP IIb/IIIa(decrease clot formation)
24
Q
Henosh purpura
A
IgA vasculities,cause tissue damage,may kidney:permanent sequela,
25
ulcerative colitis think of
toxic megacolon prediposition, c.difficile, abdomen distention and bowel motility disturbance, x ray shows distended large bowel. 40% mortality and it is leading cause of death of uc
26
zepam(clonazepam)
benzodiazepine. zepine-zepam
27
SSRI
sertraline,paroxetine,citolapram(pram:pray for mood) fluoxetine: alter P450, be cautious
28
unstable suprventricular arrhthymia Rx
synchronized cardioversion
29
echocardiogram in evaluate pulmonary HTN
can measure pressure through assessing velocity to calculate the pressure, LV/RV function and valve
30
pulmonary HTN Dx
pressure > 25 at rest ; > 30 at exercise
31
pulmonary HTN mechanism
decreased exogenous vasodilator:NO, Prostacyclin
32
pulmonary HTN Rx
prostacyclin analog, Phosphodiesteras inhibitor sildenafil, endothelin receptor blocker bosentan.are first line
33
axillary lymph node in wm
mammograph and biopsy of lesion if found and then biopsy of lymph node
if breast lesion is excluded out
34
supraventricular lymph node
biopsy the node
35
HIV drug teratogenic
efavirenz:enfant avoid.
36
HIV drug review
check
37
HIV prophylactic by cell value
<150 endemic for histoplasm
38
Vac contraindicate in HIV
psy:polio,po, shingle, yellow fever, MMR & varicella if CD4<200
39
health mainten of HIV
Influenze, pneumo every 5 yr, HepA, B, PPD annually, Pap every 6 month first year and annually. so two PP, MMR , Varicella if CD4>200
40
HIV therapy NRTIs(nucleoside and nucleotide reverse transcriptase inhibitor
zidovudine,AZT didanosine DDI Zalcitabine DDC stavudine d4T, lamivudine 3TC all abberviations
41
NNRTIs non-NRTIs
**-vira/i-** nevirapine,Delaviridine, Efavirenz
42
Protease Inhibitor
inhibitor:Na vir, not vir: Indinavir, nelfinavir, Atazanavir
43
HIV lipdystorphy
elevated cholesterol, TAG, insulin resistance, DB, change in body fat composition abdomen fat with skeletal wasting. Nucleoside +Protease inhibitors usage link to lipodystrophy. don't use Lovastatin, simvastatin. when TAG >500 treat with Gemfibrozil.
44
Protese inhibitor metablized by
P450, Lovastatin: sensitive to CYP3A4 inhibitors and casue exposrue 20 times, cause rhadomyolysis, "LOV" not use for HIV with protease inhibitor to treat LDL.
45
two HIV drug can't use together
zidovudine and stavudine AZT d4T, antagonist; stavudine+didanosine in pregnant pt, increase lactic acidosis, AZT+Ganciclovir-->severe bone marrow suppression
46
cyrptococcal meningitis Rx, prophylaxis
amphotericin B+Flucytosine, life long fluconazole, continue for CD4<200.
47
CMV retinitis
blurring vision, increase floater, ophthalmoscopy:perivascualr hemorrhage and fluffy exudates, ganciclovir iv(avoid with AZT, nerutopenia) for sight thereatening:ganciclovir intraocular implant,life long prophylaxis: ganciclovir. if CD4<100
48
disseminated cyrptococcosis
HIV with umblicated lesion on skin
49
HIV with papular reddish vascualr lesion
ddx: bacillary angiomatosis:with fever; Kaposi sarcoma: not fever. confirm by biopsy
50
HIV with dysphagia
if with oral thrush, empiricall with po fluconazole for 2 weeks, if not improve, endoscopy: if candidiasis:diffuse white lesion; Herpes simplex: deep small multiple lesion:acyclovir; CMV:superficial large lesion, Ganciclovir; if giant ulcer no virus: aphthous ulcer:steroid.
51
HIV with diarrhea
stool workup, if negative, colonscopy show ulcers or erosions in colon, biopsy: large cells contianing basophilic intranuclear inclusion which sometimes surrounded by a clear halo, like owl's eye, CMV colitis.
52
HIV headache or weak of EXT or change mental status
CT: ring enhancign lesions.toxo usu multiple, treat empriically reevaluate after 2 weeks. sulfadiazien+pyrimethamine+leucovorin if sulfa allergic:clindamycin
53
AS heart sound
systolic and S4: stiff ventricular. atrial to push
54
Inguinal hernia repair
shouldn't delay, contralateral surgical exploration is done for high risk groups: female <2 with left side hernia, with ventricular peritoneal shunt.
55
child abuse management stepwise
admit, neurosurgical evaluation, notification child protection service, full skeletal survey
56
DB retinopathy care
yearly visit ophthalmologist
57
HTN Rx
multiple recordings >140/90 one; >160/100 two drugs
58
aspiration pneumonia
moxifloxacin, G- is predominant in oral flora; clindamycin is used with evidence of anaerobic infection like abscess,necrolizing, putrid sputum,servere peridontal disease
59
sigmoid volvulus
x ray shows distended colonic loop in right upper quadrat,tip point toward lower left quadrat, if diverticulitis: uniformly and mildly distended. volvulus: twist.
60
seizure status
iv lorazepam or other benzodiazepine with reassessment after 1min, if still seizing, repeat and then loading lose of either phenytoin or fosphenytoin with second iv line if still seizing and airway compromise possible, intubate.propofol is for refractory cases
61
shock
cardiogenic shock: co low, PAWP High, SVR High
Hypovolemic shock: co low, PAWP low, SVR High
Septic shock: CO high-normal-low, PAWP normal/high, SVR low
Extracardiac obstructive shock: CO low, PAWP normal or High, SVR High
62
extra cardiac obstructive shock
tamponade, PE, pneumothorax
63
coccidioidomycosis
erythema nodosum, M/C: fever, penumonia, x-ray: mutliple nodule with cavity.
64
cryptococcosis
C?F:headache, change in mental status. mcc of fungal meningitis
65
Histoplasmosis
bird dropping, bat exposure. panctyopenia, increased liver enzymes and LDH level. Hepatosplenomegaly,lymphadenopathy.
66
thrombocytopenia in HIV
occurs in all stages, Rx AZT
67
HAART viral load reduction
4weeks <50
68
disease transmitted by ticks
berl:babesiosis, Ehrlichiosis, Rocky mountain , lyme
69
lyme dx. Rx, prophylactic
early by clinically. first erythema migrans
70
who with cardio problem needs prophylactic
prosthetic heart valve, unrepaired cyanotic, repaired with residual defects, cardiac valvulpathy in transplanted heart, previous IE
71
DB po medication strategy when to change to insuline
p80 when metformin doesn't control glucose, add second oral agent , don't switch to insulin until fail at least 2-3 po medications.
72
hyperosmolar hyperglycemia cause hypoNatremia
elevated glucose levels pull water out of cells. this in turn lowers serum sodium level. correct glucos and serum electrolytes will improve. for every 100mg/dl glucose above normal, there is 1.6mEq/L decrease in sodium level. p82
73
stress test is abnormal, what is next step
first one is med, then angiography
74
Thyroid nodule
TSH,if normal or hypo, do FNA; if high, uptake test
75
ARDS tidal vol number
limit to 6cc/kg to avoid barotrauma
76
pregnant with seizure which drug is most dangerous
all are not safe but worse is valproate. stop and change to others. make sure high dose folate as all seizure drug cause folate def
77
Tinear versicolor
ketoconazole shampoo
78
imipenem SAE
seizure esp in renal dysfunction
79
Thalassemia trait
Normal Hemoglobin A contains 2 alpha and 2 beta. if insufficient beta chains are produced
body switches production to gamma chains(HgF) and delta chains(HgA2).
Thalassemai trait only 10-15% of normal HgA is lost. some only an elevated HgA2.p143-144
80
Hemoglobin profile for normal and thalassemia major
normal hemoglobin with 96%HgA and only 3% HgA2 and 1% HgF. It is also found with minor alpha thalassemia.
Beta thalassemia major: no normal HgA. since no beta chains produced, alpha chains only have gamma chains(HgF) and delta chains(HgA2) match up .
81
CREST syn
GERD symptoms and abnormalities of hands.
82
scleroderma vs CREST:
scleroderma Involve heart, lung and kidney
83
acute pancreatitis maintain treatment NPO?
Acute pancreatitis: early feeding of ICU is with less sepsis and mortality. jejunal tube.PPN and
TPN are inferior as expensive and associated with lots of metabolic abnormalites
84
Lynch syndrome
AD, mutation in mismatch repair genes and leads to predisposition to endometrial, ovarian, breast and GI cancer. screening for malignancy start early annual colonscopy at 25.
85
confirmation of endotracheal tube placement
1.ausculation of both lung and stomach is needed to check for breath sounds. 2.measuring end tidal carbon dioxide 3. chest x ray
86
Zenker diverticulum
pharyngoesophageal pulsion deverticulum due to hypertrophied cricopharyngeus muscle. appears as an indentatin in upper third of esophagus on a barium esophagram. It represnets a contraindication to NG tube palcement and endoscopy.
87
DB with BP control
goal is <130/80. use ACE or ARBs individually but not in combination
88
RTA
type I/distal: serum K low/normal. urine ph >5.5; defect of H secretion, po bicarbonate 4 supplement. low serum K; type IV/aldosteron def. urine PH<4. serumK is high.
89
MM relate to which RTA
type II proximal one. treat bicarbonate, potassium and thiazide
90
manage hyperK induced arrhthmia
calcium gluconate, insuline, glucose, remove exess k by diuretics, kayexelate and dialysis.(note if using diuretics, make sure bp is normal)
91
Erythema multiforme minor
recurrent episodes of targetoid, bull's eye or iris lesions. usually located in palms. associated with herpes simplex virus. long term suppression with acyclovir
92
ARDS low tidal vol
6ml/kg is better.
93
most benefit in case of acute ST elevation MI
agnioplasty with drug-eluting stent
94
pyogenic granuloma
exuberant granulation tissue following minor trauma. biopsy must be doen for histologic confirmation for ddx from amelanotic melanoma.
95
Diabetic nephropathy
urine microablumin first, 24 hr urine protein.
96
mc form of anemia of SLE
anemia of chronic disease, more common than autoimmune IgG hemolysis
97
Mallet finger
extended finger forcibly flexed, treat extensor slpintign for 4-5 weeks.
98
Ribavirin SAE
Hemolysis, usually mild but pronounced in pts with pre-existing anemia such as HIV or chronic renal insufficiency.
99
DKA is best assessed with
low serum bicarbonate.low PH and increased anion gap.
100
DKA most important step in management
correct volume depletion with saline and insulin
101
sickle cell with parvovirus B19 management
severe RBC aplasia with IVIG and transfusion
102
msot severe risk factor for coronary artery disease
diabetes is strongest.
103
psoriatic arthritis specific form
cause nail pitting. only this one causes.
104
otitis media if amoxicillin fails
if fail, try cefdinir, cefditoren, cefixime, cefuroxime. Tympanocentesis only done after 2-3 trials failed antibiotics. Ab first 2-3 days have response if it works.
105
Hypothermia EKG
upward deflection following s wave, osborn wave
106
drug-induced parkinson managemenet
first switch to clozapine or quetiapine. if persists, try anti-cholinergic such as benztropine or trihexyphenidyl. unknown reason why levodopan,dopamine agonist doesn't work.
107
Porphyria cutanea tarda
PCT with pseudo-PCT are similar, pseudo-PCT can mimic PCT excetp wtih normal level of porphyrins in urine, plasma and stool. The conditin is precipitated by certain drugs, tetracycline, nalidixic acid, naproxen, furosemide, dapsone, pyridoxine. present as blistering in sun exposed area, skin fragility, scarring with milia formation and hypertrichosis. In sporadic PCT or acquired PCT, association with exposrue to hepatitis B or C or HIV as well as alcohol intake, E therapy and dialysis treatment is recognized.
108
recurrent SBP prophylactic
fluoroquinolone: Levofloxacin
109
spontaneous pneumonthorax recurrence
can recur esp with bulla. Airline plots and ppl with far away from hospital facility should get bulla resection.after bulla, recurrence wont' and don't need to change career.
110
severe Parkinson disease treatment
first step is to replenish dopamine with levodopa/carbidopa. COMT inhibitors are used as adjunct
111
severe Parkinson disease with psychosis
some ppl with severe Parkinson needs so much levodopa/carbiodpa that cuases psychiatric symtpoms. if drug is stopped, pts become forzen. use quetiapine so you can continue using PD meds needed. Efficacy is more important than adverse effects. (Quiet!)
112
Aspergillus
Voriconazole is single most effective agent against Aspergillus. caspofungin is for those not responding to voriconazole alone. Caspofungin is slavage treatment for Aspergillus
113
exophthalmos mcc of unilateral
grave's , cigartte smoke is connected with increasing severe disease
114
treatment failure of H.pylori
is managed first with retreat with new antibiotics and PPI.
115
alcohol reaction with metronidazole
disulfiram like reaction
116
Sideroblastic anemia
from alcohol abuse. casue high serum iron level with low MCV. only microcytic anemia with high circulating iron level. Iron accumulates in mitochondria of RBC while prussian blue stain detects it.
117
PID treatment
cefoxitin(or cefotetan) and doxycycline, cephalosporins are safet to use in those with rash to panicillin.
118
SIADH diagnosed
by high urine osmolality and high urine sodium in presence of hypoNa and lwo serum osmolality.
119
Non-hemorrhagic stroke
if on ASA, can either switch to clopidogrel ro add dipyridamole, don't add clopidogrel to ASA for stroke or TIA. In brain, combination clopidogrel to ASA brings no benefit but increase bleeding. In heart, it is routine to use combination. Note stroke is not coronary equivalent for using statin when LDL >100 due to many strokes originate from vavles of heart. The equivalent coronary diseases are DB, peripheral arterial disease, aortic disease
120
Acute MI medication management
all(doesn't matter of angioplasty) with ASA and clopidogrel or prasugrel(more efficacy but higher risk of bleeding) no benefit to add dipyridamole.
121
Nephrotic syn
susceptible to infections, cardiovascular complications 2nd to hyperlipidemia and hypercoagulable state, protein malnutrition and renal failure.
122
temporal ateritis with visual changes management
immediate iv steroids and hospital admission with high risk of blindness or stroke.
123
T score
between 1-2.5 osteopenia; below 2.5 osteoporosis. treat with bisphosphonates for T below 2.5 SD or between 1-2.5, also smoke, use corticosteroids, low body wt. excessive alcoho.
124
Reactive arthritis treat
usually resolves on its own. NSAIDS are used to relieve pain which waiting for disease resolve.
125
post viral pericarditis
mcc form pericarditis. inspiratory chest pain, leathery rub on systole and diastole, new enlarged heart. treat nonsteroidal med and in refractory cases, steroids.
126
Rheumatoid arthritis extra joint manisfestation
skin nodules
127
VitB12 def characterized by
increased LDH, increased indirect bilirubin, decreased reticulocyte, hypercellular bone marrow: bone marrow produces cells but they die rapidly when released from the marrow. this is why decreased reticulocyte count with increase LDH and bilirubin which looks like hemolysis. You must check and replace postassium levels when replacing B12 in pts with profoundly anemic or pancytopenic. treatment can induce hypokalemia by using it all up to put inside the cells.
128
B12 treatment who is back normal first
first reticulocyte count,3-4days then disappear of hypersegment neutrophils 10-14 days and rise in Hct begin in 10 days come to normal in 8 weeks. MCV will not normalize unitl Hct starts to rise. the last thing is neurological abnormal: 3 month.
129
sickle cell disease fever or wbc higher or lower
due to no functional spleen, start antibiotics before die of sepsis.
130
tigecycline
only antibiotic in its class(clycylcyclines). combine vancomycin with aztreonam. cover both MRSA AND MOST g- BACILLI WITH exception o fpseudomonas. (tigar is pseudomonas can't)
131
cephalosporine with penicillin allergy
cephalosporine can't use when anaphylaxis to penicilline.
132
basilar artery stroke:
weakenss can start unilaterally and become bilateral
cranial nerve abnormalities, loss or alteration in consciousness, Gaze palsies: diplopia, internuclear ophthalmoplegia, in severe cases, it causes locked-in wtih 4-limb weakness.
133
Anterior cerebral artery stoke:
leg weakness, persoanlity and psychiatric disturbance(apathy), urinary incontinence
134
Middle cerbral stroke and carotid disease:
exclusively unilateral disorders.
135
PICA
is lateral medullary syn. affects braisntem and has severl similarities to basilar artery stroke. both cause vertigo, nausea, vomiting, dysphagia and dyarthria, diplopia and ataxia. PICA cause limited motor manifestations, horner syndrome while basilar artery stroke casues limited sensor manifstations, internuclear ophthalmoplegia
136
Basilar a stroke diagnose/brainstem
MRI
137
worsen ascites despite compliance with med result in
unrestricted dietary sodium intake. in fact, water consumption, unless truly excessive, is irrelevant to total body fluid balance. the key determinant of sodium excretion adn thus fluid excretion by the kidney is sodium intake. Sodium is the key.
138
Barrett esophagus management
PPIs and surveillance endoscopy for biopsy every 3 years. don't treat or test H. pylori. it is not related unless ulcer, MALT.
139
Endoscopy indication with epigastric pain
age, >45-55,scope no wait. >55 definetely scoop.<45, 2 optiosn: treat with PPI and scope if symptoms persists. or H. pylori positive.
140
post MI exercise and sex
low risk: 1 week, high risk 6 weeks. moderate exercise several weeks after and it is necessary to check exercise tolerance a couple week after MI.
141
cardiac tamponade:dx mode
echo to dx
142
Interstitial lung disease which is treatable with steroid
Berylliosis, computer and electronics, is granulomatous.
143
metastatic Non-Hodgkins management
immediately iv steroid to reduce inflammation
144
smoke cessation
varenicline is best superior to bupropion
145
AFib treatment
CHADS score 0-1 ASA; warfarin or dabigatran for 2 or greater
146
non STEMI management
chest pain and ST depression or T wave inversion, ASA, clopidogrel, low molecular weight hepain.
147
GRED H2 blocker and antacid don't work,next
PPI for acid suppression
148
non-hemorrhagic stroke therapy
ASA first line. clopidogrel or ASA/dipyridamole is acceptable.if it is clear that recurrent stroke while on ASA, switch to clopidogrel or have dipridamole added
149
indications for endarterectomy
TIA or symptomatic stroke +70-99% stenosis
150
polymyalgia rheumatic
aching and stiffing of proximal muscle groups. associated with malaise, low grade fever and weight loss. ESR is most sensitive test for this pathology.treat with low doses of oral steroids for several weeks.
151
Sjogren syn what is abnormal
ANA 95%, anti-Ro and anti-La are more specific and only in 50%-65% pts.
152
otitis external what bring more rapid resolution
Acetic acid locally.
153
Relapsing polychondritis
a recurrent inflammatory condition of cartilage. more prominent in joints, nose, ears, costal cartilage, larynx and airways. aoritc aneurysm can be complications.the characteristic feature ddx from other rheumatologic conditionsis inflammation confined to crtilaginous organs such as ears and nose. Tracheal narrowing is characteristic radiographic finding.cortiocsteroids are treatment .
154
fastest way to stop autoimmune hemolysis
IVIG.plasmapheresis is not effective in controlling autoimmune Hemolysis ever the disorder is based on antibody attacking RBC. It just doesn't work.
155
MSSA(methicilin sensitive)
when organism sensitive to beta-lactam antibiotic(penicillin, cephalosporin, carbapenem),it is always use beta-lactam. use oxacillin or cefazolin for senstive staphylococcus. MSSA: methicillinis not manufactured. so if methicillin sensitive, use oxacilli, nafcillin or cefazolin.
156
which med worsen memory
anticholinergic. like benztropine cause worsen
157
Nucleic acid amplification test NAAT
standard care in Dx of chalmydial and gonorrheal infections urethritis, cervicitis and PID. The accuracy of NAAT is greater than of culture, faster to obtain.
158
Alpha thalassemia with 2 of 4 gene deletion
mild to moderate anemia normal electrophoresis,normal iron study and RDW
159
Alpha thalassemia, 1 gene deletion
carrier, CBC completely normal or slight microcytosis.
160
pt with inflammatory bowel disease such as Crohn : Vitb12 def
due to physical b12 absorption.
161
bronchiolitis obliterans organzing penumonia
unknow etiology. inflammation of small airways(bronchiolitis) and organizing penumonia. biopsy to dx.
162
temporal arteritis is suspected
corticosteroids given immediately.
163
patent foramen ovale indication of closure
if an embolus gone through it.
164
pt with cirrhosis and upper GI bleed prophylactic
antibiotic:ciprofloxacin. Ballon tamponade is temproizing maneuver and not be in place for more than 24 hrs. Sclerotherapy and band ligation are equally efficacious and superior to balloon tamponade alone.
165
Hypogonadism treat with testosterone need to check what
SAE: exacerbation of BPH, sleep apnea and erythrocytosis. all pt need Hb and/or Hct and PSA check after 3 month treat
166
acute coronary syndrome
when need coronary agiogram.
167
single most important risk factor for stroke, CAD
HTN for stroke, DB for CAD
168
onchomycosis Rx
Terbinafine(nail fine)
169
Hep C antibody
until 18 weeks
170
anuric ppl schedule dialysis
most at least 3 times/week
171
IVIG usage
parvovirus 19, hemolysis acute
172
Hypothermia EKG
prolong repolarization cause upward deflection following s wave(distinctive convex elevation of J point)
173
antipsychotic drug cause Parkinson management
first switch to clozapine, quietapine, if stillpersists, try benztropine or triphexyphenidyl. other PD drugs don't work here for unknown reasons.
174
allergic contact dermatitis
stop defending med and apply topic steroids.
| neomycin oinment: 5% have allergy.
175
Conn syn
HTN, hyperNa, hypoK. abdominal CT scan to ddx adrenal adenoma and bilateral hyperplasia and identify a surgically curable disease
176
DTH test
Delayed type hypersensitivity test. to see if there is immunity.for example in HIV pt. DTH positive means have immunity. it is different from PPD test
177
sjogren syn treatment
cevimeline(see meiling to dry solved):acetylcholine agoinst, direct stimulate saliva and tears
178
most sensetive to test if endotrachea tube is right
colormetric detection of end-tidal carbon dioxide
179
TIPS contraindications
transjugular intrahepatic portosystemic shunt. major drawback is portal venous blood dumps directly into systemic circulation without being processed by liver. Toxins from being metabolized and can greatly worsend hepatic encephalopathy.
180
Hyperbaric oxygen
CO>25%, or 20% preg due to fetal CO higher than mother. or other symptoms.
181
Recurrent infection of gonorrhea, management
culture and sensitivity test first before going complement deficiency test.
182
increased diffuse CO
blood in alevolar, which increase diffuse CO
183
impetigo and folliculitis difference
impetigo sometimes caused by streptococci and lead to post strepto GN. the treatment is identical.
184
seizure from brain tumor
caused by pressure on nearby structures. use steroids to decrease pressue.
185
seizure management
no difference in anti-epileptic drugs in terms of efficacy in suppressing seizure. Many AECs cause osteoporosis. Levetiracetam has few adverse effects.
186
sickle cell trait
hematuria, urinary concentration defects, increased frequency of urinary tract infection. Renal tubular concentration dysfun leads to isosthenuria, difficulty either concentrating or diluting urine. Urine from these pts comes out in the same concentration as blood.
187
Rapid progressive GN management
high dose methy-predinisone
188
pituitary apoplexy management
endocrine emergency. first step to stabilize the patient and give stress doses of glucocotiocosteroid then mineralocorticoids. most cases of middle ear barotrauma occur at relatively shallow depths(15-20 feet).
189
middle ear barotraumas
Reassurance and prescription of decongestants.
190
COPD management medication
inhaled muscarinic receptor agents ipratropium or tiotropium have better efficacy than long acting beta agonists like salmeterol, inhaled steroids.
191
COPD decrease mortality
stop smoking. use low flow home oxygen in those who are hypoxic: po2<88% on room air.
192
Tetanus vaccine
1.receive 3 doses in the last 5 yrs, no need any further for both contaminated and clean wound. 2.receive tetanus toxoid bt 5-10yr,if contaminated: need booster toxoid, if clean, no further therapy. 3. if more than 10 yrs, both clean and dirty wounds need toxoid booster. A dirty wound also needs tetanus immunoglobin.
193
initial therapy for purulent sinusitis
amoxicillin, if dx is clear, an imaging study is not necessary. If treatment fails, use any of followings: cefuroxime, cefpodoxime, amoxicillin-clavulanate, azithromycin, levofloxacin, gemifloxacin
194
Sitagliptin
sitaGLiPtin is inhibitor of GLP.
195
Nateglinide
has same mechanism as sulfonylurea, adds nothing in combination with sulfonylurea.
196
transfusion indication of elderly
especially increase risk of highly symptomatic anemia. transfusion takes priority over all other treatment and goal is to maintain Hb above 10mg/dl
197
how to triage pt with DB
send home if only hyperglycemia, admit to ward if signs of volume depletion, metabolic acidosis, K elevation, admit to ICU with altered mental status, severe acidosis PH<3.7 and respiratory distress
198
Metformin vs sulfonylurea
Metformin doesn't cause hypoglycemia, use it when glucose levels are borderline. Sulfonylureas take several weeks to reach their maximum effect and can cause hypoglycemia
199
first long term controller med to use in asthma
inhaled steroid, all drugs in this class are equally effective.
200
Hypertension dx
three separate readings > 140/90. after first elevated reading, reevaluated within 2months.
201
Ertapenem
only carbapenem doesn't cover Pseudomonas. otherwise cover other G- equally. (Error target in Psuedo)
202
Genital herpes
HSV-1. transmission is possible during asymptomatic periods.many pts with frequent reactivation of HSV2 need chronic daily suppressive therapy with acyclovir. It is lifelong latent infection in sensory ganglion cells.
203
GERD and Helicobacter pylori
GRED IS NOT caused by Helicobacter pylori, no need to treat Helicobacter to treat GRED.
204
Helicobacter pylori management
don't need to treat if found with GERD, is not cause of GERD. large portion of general population is colonized with Helicobacter pylori, it requires treatment if there is ulcer, gastritis, MALT.
205
ARDS management
goak is 6ml/kg to achieve plateau pressure <30cm H2O.
206
Aspiration
typically causes two stage disease process. in the immediate stage, cause chemical pneumonitis which cna present with consolidationon chest x ray, fever,and.or leukodytosis. the pneumonitis can resovle without medical intervention. support and monitor development. aspiration pneumonia typiclaly presents as delayed complicaiton.
207
Thiazolidinediones(rosiglitzaone and pioglitazone) SAE
assoicated with fluid retention with CHF and MI.
208
Ischemic bowel
precipitated by dehydration and hypotension.Initially put on bowel rest and enough hydration
209
can't use EKG for stress test, use nuclear
LBBB, digoxin, left ventricular hypertrophy, packemaker , any major baseline abnormality of ST segment
210
Ticlopidine SAE
associated with neutropenia. has equal efficacy to clopidogrel, use clopidogrel first.
211
Gastrinoma
look for it when ulcers are unusual. use endoscopic u/s and nuclear somatostin scan to determine if this is solitary lesion could be resected or metastatic disease should be treated with PPI lifelong as too widespread to be cured.
212
EN
Ibuprofen is treatement of choice for erythema nodosum. EN is common
inflammatoy panniculitis which occurs in two forms: acute and chronic. Acute most occur in young adult wn with bilateral, symmetrical, deep tender nodules 1-10cm in diameter. Usually there are up to 10 lesions but many more may be found. the most common location is pretibial area. The onset is acute, frequently assoicated with malaise, leg edema, and arthritis or arthralgias. Over a few days lesions flatten, leaving purple or blue-green color resemblign a deep bruise.Acute EN is associated with stretptococcal infection. Drugs may also induce EN, includign bromides, iodides, and sulfonamides. The mcc to induce EN is oral contracetpives.
213
mitral valve repair indication
End-systolic LV dimenstion of greater than 45-55mm. LV ejection fraction is less than 55%
214
Difference between CREST(limited) vs diffuse systemic sclerosis
anti-cnetromere antibody present in CREST
215
Pathognomonic for RA
anti-CCP antibody is 95-98% specific for RA.
216
which drug cause SIADH
Sulfonylureas most often chlorpropamide is associated with SIADH
217
Negative ANA excludes out which
drug-induced SLE. negative ANA is very sensitive in excluding a number of diseases. most sensitive is drug-induced SLE.
218
Voriconazole SAE
associated with transient visual distrubance. Vori-vision
219
most common extra skeletal abnormality of ankylosing spondylitis
Uveitis: photophobia and blurry vision.
220
most common extra skeletal abnormality of ankylosing spondylitis
Uveitis: photophobia and blurry vision.
221
which med cause SIADH
sulfonylureas occasionally cause and is idiosyncratic effect. Chlorpropamide.
222
allergic rhinitis treatment
topical intranasal steroids are superior to antihistamines and first line.like mometasone
223
Pulmonary HTN
sob, weakness, PE shows right heart failure, increased pulmonary component and wide splitting S2. pulmonary function test: normal ventilatory pattern with decreased DLco
224
pt with gastric ulcer recheck
after treatment, must re-scoped to confirm that lesion is resolved and no cancer in the lesion. ulcer can resolve and leave cancer behind.
225
Hydroxychloroquine SAE
retinal toxicity
226
when pt discontinue a medication due to SAE
offer alternative med
227
whipple disease
chief coplain is joint pain which is non-deforming polyarthritis that is asymmetric and associated with diarrhea and fat malabsorption, weight loss and CNS abnormalities. whipple ddx from other malaborpotion like Celiac, tropic sprue and chronic pancreatitis is joint pain is unique to whipple.
228
prenatal risk of SLE :which marker
anti-Ro anti-La
229
cryptococcus which antifungal doesn't cover
Echinocandins (caspofungin, micafungin, anidulafungin)
230
best initial test to dx hemochromatosis
transferrin saturation more sensitive than ferritin level
231
CT scan don't adequatly look at brainstem and cerebellum
MRI and MRA look brainstem and posterior fossa where cerebellum is.
232
lumbar puncture HD
within 24 hr of procedure, positional in nature, worse when sitting upright and relieved by lying down. believe to be due to loss of CSF and decrease cushioning brain.
233
osteoporosis RF
female is most important RF, when man, is caucasian race.
234
Diverticulitis acute symptom with imagine
pneumaturia is sign of colovesical fistual, need surgery. a Barium emema can be done for 2-3 wks after acute episode not 3-4 days--which will cause perforation.
235
most appropriate reason to screen db
HTN due to ACE benefit. screen must be meaningful.
236
Exenatide
GIP, slow gastric motility. power for wt loss.can't ddx from gasteroparesis from db. so stop the drug to see
237
increase HDL
niacin is most effective , followed by gemfibrozil, then statin
238
tenderness with epigastric pain
only pancreatitis.
239
polymyositis/dermatomyositis associated with interstitial lung disease presnce which marker
anti-jo
240
non STEMI management
ASA, heparin, Glycoprotein IIB/IIIa , beta blocker to limit myocardial damage.
241
Linezolid SAE
thromobocytopenia. Line-one line platelet
242
most common symptom in SLE
fatigure.if no fatigue with joint problem is not SLE
243
Rib fracture complication
due to pain and rapid breathing, predispose to profound atelectasis and infection due to residual secretions. nerve block and chest physiotherapy
244
RF is 100% in which patient
cryoglobulinema.
245
dipyridamole thallium contraindication
asthma and severe reactive airway disease. increase cyclic AMP and provoking bronchospasm.
246
stress test for pt can't exercise
either dobutamine with echo or dipyridamole with thallium--avoid in asthma and with theophylline use.
247
achalasia
dysphagia for both solids and liquid at same time. Ring and webs are exclusively for solid food not liquid. cancer: first solid for a long time and then progress to liquid.
248
myoglobin
normal at 1-4 hr exclude MI
249
vibrio vulnificus
combine of 3rd cephalosporin and tetracycline.
250
Hypophosphatemia
refeedign syndrome. increae glycolyiss deplete phophate leel and present with lethargy and muscle weakness
251
first time seizure management
majority don't need treat, need treat: abnormal EEG, family strong hx, non resolvable source:tumor cause, status
252
linezoid SAE
thrombocytopenia
253
Daptomycin
myopathy and increase CPK
254
Dermatomyositis association
malignancy: ovarian, lung, pancreatic, stomach, colon, non-hodgkin
255
Vancomycin SAE
Red man syndrome, but it not allergy, slow the rate of admin and problem is eliminated.
256
Medication for MRSA
dlt:delete; vancomycin, linezolid, Ceftaroline, Televancin, Daptomycin, Tigecycline(not achieve high blood levels and not first choice for bacteremia). all agents are equla for cellulitis from MRSA, but not clear that tigecyclien and linezolid are equal to vancomycin for bacteremia. Daptomycin not for pneumonia or bacteremia 2nd to pneumonia. it is neutralized by surfactant as it binds to lung surfactant.
257
Daptomycin
can't use for pneumonia as it binds surfacant. Died for pneumonia
258
PV syndrome
cause mild dysphagia of unknown etiology form upper esophageal web, more frequent found in Caucasian woman. associated with iron-def anemia.Etiology is unclear. Anemia fromPV is not from blood loss into stool.
259
Schatzki ring
lower esophageal narrowing caused by submucosal fibrosis of esophagus. Dx by barium and Rx with penumatic dilation or bougie. not associated with iron def. is on the end of esophagus
260
Hepatopulmonary syn
liver disease, increased alveolar-arterial gradient , evidence of intrapulmonary vascular abnormality known as intrapulmonary vascualr dilation. common symptoms: sob, platypnea, orthodeoxia.
261
osteomyelitis management
bone biopsy is indispensible to confirm specific organism to cause osteomyelitis. It is impossible to construct empiric regimen of antibiotics to cover all roganisms.
262
dog bite management
depends on severity
263
Schkiatz ring
dysphagia intermittently(for unknown reason), no pain, no bleeding
264
Negative strept test management
generally, it is no treatment but if it meets several criteria, it needs culture and treat until culture is proved to be negative to stop meds.
265
if penicilline allergy not amoxicilline
yes
266
Barrette esophagus
every 2-3 yr scoop, if low grade, every 6month scoop, if high grade, resection
267
cellulitis not MRSA
cefazolin is excellent (not recurrent hospitalization) if skin reaction after penicilline, still can use cephalosporine. cefazoline(surface zol)
268
DKA blood sample analysis
Paco2 and PH determines whether condition is acute or chronic. DKA is metabolic acidosis which cause him to hyperventilate to compensate. His oxygen will essentially normal as he has no pulmonary pathology.
269
blood sample analysis
1.PH. 2. HCO3 and H2CO2 decide which is chronic and acute. PO2 reflexes hypoxia or not
270
PD management
milde to moderately severe PD need dopamine such as ropinirole, pramipexole, apomorphine or bromocriptine. Dopamine agonsit is effective and don't have severe on-off lfuctuations which characterize levodopa/carbidopa.
271
Respirator setting for asthma exacerbation
low tidal volume, low rate and high flow
272
syncope by stroke
brain stem is only site that stroke can cause syncope as it control wake and sleep . Head CT won't find any focal. carotid artery cause TIA but not syncope. MRA need to evaluate it
273
syncope by stroke
brain stem is only site that stroke can cause syncope as it control wake and sleep . Head CT won't find any focal. carotid artery cause TIA but not syncope.
274
acute influenza should be treated within 48 hrs of symptoms. neucleotidas.
use neucleotidase within 48hr, common wrong answer is supportive care.
275
DDx ARDS vs cardiogenic pulmonary edema
pulmonary wedge pressure. low or normal in ARDS, .18 cardiogenic edema
276
COPD oxygen therapy indication
Pao2<88%
277
Inhale steroid for COPD Indication
Fev1< 50%, exacerbation >3 /yr
278
Fraction excretion of sodium
1% renal
279
reduce coronary a disease RF ;
smoking cessation more than lipid control
280
anterior cerebral stroke
psychiatric or personality abnormalities, leg weakness and urinary incontinence. treat same way as stroke of MCA. thrombolytics are benefit for pt presents within 3hrs of onset of symptoms.
281
Anterior cerebral a stroke vs NPH
urinary incontinence, ACA: personality and psychiatric disturbance; NPH: dementia
ACA: unilateral leg weak NPH bilateral gait disturbance and ataxia
282
which reduce intubation
Non invasive postiive pressrue ventilation show to decrease mortality and need fo rendotracheal intubation in pts with COPD in acute exacerbation
283
Wegner granulomatosis
pauci-immune vasculitis: few immune complex in active lesion. affect small and medium sized a. ulcerating granulomatous lesions of upper and lower respiratory tract are hallmarks of wegener granulomatosis as caviating pulmoanry lesions. biopsy of nasal mucosal lesions shows necrotizing granulomas which Dx.
284
Tolcapone and entacapone are COMT
extend duration of levodopa. best threapy of treating on/off phenomenon.
285
thrombolytic usage for MI hrs
up to 12 hrs of pain
286
neutropenia
without fever receive po antifungal and quinolone. no need iv antibiotics.
287
Neutropenia with fever
Neutropenia ANC <1500. if develop fever, empiric antibiotic treat start. 3 acceptable empiric :
1.carbapenems:imipenem, meropenem, doripenem, 2.cefepime, 3 piperacillin/tazobactam. Ertapenem is carbapenem not against pseudomonas. antifungal is not in the first set of antibiotics.
288
crohn with colonscopy schedule
every yr in the first 8-10 yrs.
289
crohn with colonscopy schedule
every yr in the first 8-10 yrs.
290
DB with HTN management
make sure 130/80, use ACE if doesn't work, add CCB.
291
cross covering
always discuss with other team before makign major decision
292
psoriatic arthritis dx
no specific dx method
293
psrosis arthritis unique finding
nail is the only one.
294
osler-weber-rendu:hereditary hemorrhagic telangiectasia
AD, telangictasia in skin, muucous membranes, internal organs often complicated with epistaxis or GI bleeding. two common complications: melena and anemia evaluated by CBC and stool hemoccult.
295
pregnancy DB screening test
OGTT , very sensetive. can't use H1AC as it takes several month for abnormality. can't wait, damage fetus
296
SODIUM POLYtyrene sulfonate
resin binds cations in the gut
297
Evaluate renal failure: urine ?
sodium
298
adrenal crisis
triggered by minor infection with long standing adrenal insufficiency. iv saline, steroid and antibiotics
299
how to recognize adrenal insufficiency
sudden hypotension, low Na, high K. trigger by minor infection.
300
Routine evaluation of embolic stroke
echo, carotid duplex us, telmetry monitor arrhythmia, MRI routine to document location and extent of stroke
301
HIV+odynphagia
esophageal candidas, fluconazole
302
osteomyelitis dx test
MRI , if pacemaker: nuclear bone scan
303
asthma exacerbation management
inhaled steroid at begining, it takes 5-10 days to reach its effect, can't wait until u tape off systemic steroid. no need antibiotics for asthma exacerbation
304
mucormycosis Rx
amphotericin is best.it is surgical ER,need resection
305
psoratic arthritis management
NSAID if doesn't work, methotrexate or anti-TNF
306
lowering glucose in DB
50-100mg/dl, if does too quick, serum glucose is low and CSF reacts slower and glucose is higher in CSF, cause edema
307
alveolar proteinosis
alveolar filled with floocular material PAS+
308
alpha-antitypsin def
COPD pattern in pulmonary function
309
ATN
muddy, granula cast
310
Ankylosing spondylitis
no specific test, schober test to see decrease the mobility
311
PICA syn
1.vertigo, nystagmus, vomiting, 2.facial anesthesia ipsilateral 3, body anesthesia contralateral 4.Horner
312
Anterior crebral a
psychiatric and personality abnormalities, urinary incontinence, lower extremity weakness greater than upper stremity weakness.
313
Basilar a stroke
similar to those for PICA stroke such as vertigo,nystagmus and speech defects. they differ from PICA by having: motor symptoms, including "locked" in syndrome with quadriparesis.
diplopia from conjugate gaze palsy and damage to pons. altered consciousness and occasional respiratory involvement. absence of sensory findings.
314
posterior stroke management
same as ACA
315
stroke and facial palsy
both facial weakness, stroke spare the upper part of face due to dual innervation
316
GERD with PPI doesn't work what next
24hr PH. if no alarming sign
317
proteinuria in urinary tract infection management
protein/creatine excretion assay as proteinuria is not from UTI, accidental finding, need investigation
318
disseminated gonorrhea culture
hard to capture, need multiple places
319
disseminated gonorrhea prediposition
complement def and SLE
320
up to ?hrs for MI
12hr
321
? reduce mortality in sickle cell disease
hydroxyurea
322
celiac and chronic pancratic insufficiency
are associated with malaborption of fat and vitA, D, E, K
and VitB12 malabsroption. Celiac destroy terminal ileum,can't absorp vitb12; pancreatic enzymes need to absorb b12. Iron def or microcytis anemia is not seen in chronic pancreatitis.
323
fosphenytoin
faster, can give fater than phenytoin. phenytoin can give fater will casue heart block and hyptension
324
fosphenytoin
faster, can give fater than phenytoin. phenytoin can give fater will casue heart block and hyptension
325
status epilepticus
benzodiazepien such as lrazepam or diazepam->fosphenytoin or phenytoin->phenobarbital->general anesthesia: midazolam, pentobarbital or propofol
326
PET scan
malignant tumor cells absorp more sugar as metabolic rate is high. PET use glucose analoge. so check serum glucose level before PET scan as it will alter absorption: reduce absorption and cause false negative
327
MI contraindication of thrombolytic
1.non-hemorrhagic stroke within 3 months.2.HTN >180/110 3. other bleeding. so nee transfer to outside for angioplasty and it is true even outside 90 min window.
328
cyanide poison
sodium thiosulfate binds to cyanide liberated from sodium nitroprusside, leading to thiocynate which can be excreted by kidneys.
329
methylene blue
methemoglobinemia:methy
330
acute rescue med for asthma
albuterol, systemic steroid, ipratropium, manesium.
systemic steroid take 4-6 hrs to start to work , route of admin can be po or iv and no clear benefit which one is better. Inhaled steroid are less effective in acute exacerbation and restart on admission so they take effect by time pt is discharged.
331
PID specific sign
cervical motion tenderness
332
most accurate test for PID
laparoscopy
333
stress test
if can't exercise or severe bradycardia, use diprydimole or adenosin
334
CO posion
CO oximetry. it is normal in pulse oximetry, Sao2 and venous O2
335
antidiabetic loos weight most
GLP like exenatide(exe: exercise no to reduce wt). decrease gut motility. loose wt better than metformin. metformin:wt stablize or modest wt loss
336
COPD exacerbation management
same as asthma except adding antibiotics
337
Klebsiella pneumonia producing extended spectrum beta lactamases
treat with carbapenems:imipenem, meropenem. ESBL areenzyems confer resistance to most beat lactam antibiotics including penicillin, cephalosporins, monobactam aztreonam
338
urethritis best initial test
grain stain esp in symptomatic pt
339
stress ulcer prophylaxis
head trauma, spind trauma, major burn, endotracheal intubation
340
RA initial treatment
methotrexate. don't need to wait x-ray become abnormal.
341
Eosinophilic pneumonia
fever, nonproductive cough,larvag show >25% eosinophils. acute <1 week. treat with steroids, usually 1-3 days.
342
Ankylosing spondylitis
MRI finds ealier than x ray
343
ankylosing spondylitis treatment
Etanercept, adalimumab, infliximab and golimumab, are tumor necrosis factor TNF inhibitors. approve for ankylosign spondylitis. methotrexate no benefit for AS.
344
Sogreen syndrome Dx
most accurate is salivary gland biopsy, it is gold standard
345
candida systemic infection
capofugin
346
Daptomycin
use when can't tolerate beta-lactamase like oxiclline , cephalosporin, vancomycin
347
Daptomycin
use when oxacycline is allergic
348
Wernicke encephalopathy
clinical dx. presence 3 findings;confusion, ataxia and ophthalmoplegia. treat iv thiamine
349
Giant papillary conjunctitis
bilateral related to contact lens. complete not use contact lens
350
churg-strauss syndrome
vasculitis associated with nephritic syn, eosinophilia, asthma. p-ANCA
351
Wegner granulomatosis
similar to chug-struss but respiratory involvement such as nasal septal perforation or sinus problem is typical sign. c-ANCA
352
Berger's disease
IgA nephropathy, similar to post infectious GN but no latent period bt infection and kidney involvement. pt has gross hematuria after viral illness. 50% have elevated IgA
353
pulmonary involvement in CREST vs diffuse systemic sclerosis
primary pulmonary HTn alone without lung disease is key difference in limited disease CREST from diffuse disease. Diffuse disese can produce pulmoanry fibrosis in 50% cases and then cause pulmonary htn. primary, isolated pulmonary HTN is not frequent feature.
354
sitagliptin
inhibitor of DPP-4, DPP-4 metabolize and inactivate incretin:GLP. this agent don't increase weight.
355
Baker's cyst
outpocketing of synovium of knee in those with increased intra-articular pressure esp RA. It simulates DVT with pain and tenderness of back of knee and upper calf. most cysts resolve spontaenously but some need steroid injections or surgical removal.
356
miliaria
heat rash, common in prolonged bedrest. keep cool and avoid occlusive clothing
357
Decompression sickness
type I decompression sickness includes pain, sonstitutioanl symptoms, lymphatic and cutaneous manifestation which managed with 100% oxygen inhalation. Hyperbaric chamber is reserved for worsenign conditions.
type II Is more serious that affect neurologic, cardiovascular, respiratory and vestibular systems. always treat in hperbaric chamber.
358
empirical coverage for neutropenia
Empiric coverage for fungi must start when there is persistent fever and neutropenia even after use of iv antibiotics for several days. don't wait for culture. caspofungin is doc due it is best drug for all forms of candida and very effective for aspergillus as well. echinocandins don't produce same visula disturbance as does voriconazole.
359
CCB proven mortality
only HTN
360
Biphasic P wave in v1
left atrial hypertrophy
361
Right hypertrophy in Ekg
tall p wave in v1 is right atrial hypertrophy, tall R wave in V1 and v2 is right ventricular hypertrophy.
362
Home oxygen therapy indication
no symptom: po2<90%
363
Brock's aphasia
Bring problem. no comprehension problem. impairment of fluency, naming repetition and writing. like substitution of words dog for cat
364
Wernicke aphasia
fluent speech iwth impaired name and repttion. word salad but devoid of meaning. comprehension is impaired. wernick: word problem to say
365
Tilt test
for recurrent and unexplained. if clear reason , no need tilt test
366
ICP lower down
hyperventilation (reduce pco2 and shrink vessel) is quickest way to lower down ICP, endotrcheal intubation and hyperventilaton on ventilator.
367
xanthochromia in CSF
more specific than RBC in SAH. it is not in traumatic tap
368
pseudotumor cerebri management
normal CT or MRI with papilledema, acetazolamide. diuretics has no role here.
369
Fitz-Hgh_Curtis syndrome/perihepatitis
complacation of ascending infection from pelvic inflammatory disease caused by both Neisseria and Chalmydia.
370
any new headache associated with nausea and vomitting and exacerbated by exertion or positional changes
associated with increase ICP and likely due to cerebral tumor. MRI or CT to dx.
371
venous sinus thrombosis
preg and post partum. MRI/MRV
372
traumatic lumbar puncture
supernatant of centrifuged CSF is clear(red cells have not a chance to lyse, need 2-4 hr. ) SAH: xanthoma.
373
spinal cord infarction
complication of abdominal aortic aneurysm. can leave pt paraplegic. need neurologic consult immediately
374
AF with age >65 stroke risk
high and warrant therapy. RHD AF 17 folds, non-RHD AF 5 folds.
375
alcohol withdraw seizure
24-48 hr after last drink, admission to hospital
376
olanzapine SAE
weight gain
377
clozapine SAE
check CBC, agranulocytosis
378
citalopram
SSRI, excited pray for it, bring excited.
379
Fluoxetine
SSRI but alter p450, flu: influence. less SAE SSRI is citalopram, excitalopram, setraline have fewer interactions with hepatic enzymes.
380
NMS contraindication meds
benzotropine:cause heat retention. bromocriptine sometimes used for regualtion dopamine
381
long term usage lithium
thyroid function disturb
382
domestic violence
use simple direct language
383
detoxification of alcohol
Lorazepam is short acign with no active metabolites. metabolized by kidney.safe in liver damage.chlordiazepoxide is long term but has metabolic is long acting and not good for liver damage.
384
Hemodialysis for lithium toxic
>4, or any symptoms seizure or mental status change regardless of lithium level.
385
ETC indications
1.high risk of immediate suicide 2. MDS not responds to meds. 3.antidepressant contraindications. 4.previous ETC with good response.
386
panic attack med
SSRI
387
Biopolar in first trimester management
stop lithium and use ETC
388
metastatic lung cancer
first step is to discuss the goal of treatment
389
urethra stone dx
CT, u/s of kidney is not right as it can't see urethra stone.
390
Right bronchus
closer to trachea and it is foreign body located place.
391
dumpling syndrome
post ulcer treatment, vasomotor and GI disturbance
392
exam acute abdomen evaluation
must check groin for hernia
393
pulmonary edema test
echocardiogram to sort out systolic vs diastolic dysfunction
394
beta blocers with evidece fro lowering mortality
two: metoprolol and carvedilol.
395
pulmonary edema treatment
oxygen, furosemide, nitrates and morphine
396
CHF abs for systolic dysfunction mortality reduce
ACE, beta blocker, spironolactone.
397
CHF for diastolic dysfun(for systolic)
beta blocker, duretic(systolic add ACE and spironolactone)
398
most common cause of death of CHF
arrhythmia
399
dilated cardiomyopathy should get
implantable cardioverter/defibrillator
400
biventricular pacemaker
severe CHF and qrs > 130 msec
401
absolute contraindication of beta blocker
symptomatic bradycardia
402
handgrip effect
still (hocm and mvp) are different from other valve but only exception is AS(which is go with HOCM as gradient reason. memorize AS, shake hand are with HOCM) MS no effect
403
MS when it is worsen, open snap move close to
s2
404
surgery indication for asympotmatic pt in AR vs MR
AR EF 55mm; MR: 45% more serious.
405
PAD therapy
ASA, cilostazol:phosphoditerase inhibitor, cAMP.
406
pulmonary edema with arrhthymia
consider as hemodynamic instable, give defibrillation
