IM Flashcards
(302 cards)
1
Q
anaphylaxis sx
A
rash
hTN
tachycardia
SOB/wheezing/stridor
2
Q
anaphylaxis tx
A
epic
antihistamines
glucocorticoids
airway protection
3
Q
angioedema management
A
- airway
- FFP or ecallantide
- long term: danazole and stanazole
4
Q
angioedema dx
A
decreased C2 and C4
C1 esterase inhibitor
5
Q
non- chemical causes of uticaria
A
pressure
cold
vibration
6
Q
how long is the acute phase of HIV
A
first 4 weeks
7
Q
sudden SOB, hTN, tachycardia, new blowing diastolic murmur
A
aortic regurg
8
Q
eyelid erythema/edema, eye pain, opthalmoplegia, proptosis
A
orbital cellulitis
9
Q
polymyositis vs dermatomyositis
A
skin involvement (duh): butterfly/scaly knuckles/V/shawl/telangiectasias
10
Q
if you dx dermatomyositis, what do you check for
A
malignancy
11
Q
joints affected in polymyositis/dermatomyositis
A
hips, shoulders, neck
12
Q
direct vs indirect hernias
A
direct: medial to inf epigastric art, not external inguinal ring
indirect: lateral to inf epigastric art, through ring
13
Q
BUN/Cr ratios and etiologies
A
< 15: think intrinsic causes
>15: think postrenal
>20: think prerenal
14
Q
prerenal causes
A
hypovolemia shock sepsis anaphylaxis hepatorenal syndrome renal artery stenosis fibromuscular dysplasia NSAIDs/ACE-Is
15
Q
postrenal causes
A
nephrolithiasis
prostate probs
congenital
bladder/pelvic masses
16
Q
what kind of renal dz –> increased urine osm (>500) + why
A
prerenal (decreased renal blood flow –> decreased GFR –> attempt to conserve vol –> retain Na and water/concentrate urine –> increase BUN and Cr)
17
Q
young, HTN female w/ abdominal bruit
A
fibromuscular dysplasia is most likely
18
Q
vessels affected by fibromuscular dysplasia
A
renal and carotid arteries
19
Q
renal mass found on ultrasound workup
A
Sx: refer to urology
no sx: get a CT w/ contrast if there are some signs of septa, calcifications or other masses
20
Q
renal mass found on CT: workup criteria
A
Bosniak’s Classification of Cystic Renal Masses
21
Q
Bosniak’s Classification
A
(for cystic renal masses)
Class I: benign –> no actions till there are sx
Class II: probable benign (have septation, minimal calcification, or are high density) –> serial CTs every 6 - 12 mo
Class III: some malignant signs (thick/irregular borders, irregular calc, loculated, enhance w/ contrast) –> MRI then bx/ablation/excision
Class IV: clearly malignant (enhancing, heterogenous, “shaggy”) –> surgical excision
22
Q
when would a positive renal bx result in ablation rather than excision
A
high risk pts
unwilling to have surgery
23
Q
brocas aphasia: which vessel is occluded
A
middle cerebral artery (superior branch) of dominant side (L for right handed)
24
Q
wernicke’s aphasia: which vessel occluded
A
middle cerebral artery (inferior branch) of dominant side (L for right handed)
25
brain infection w/ CD4 < 100
toxoplasmosis encephalitis
26
brain infection w/ CD4 count < 50
CMV
27
brain lesions in HIV pts
ring enhancing: toxoplasmosis (MC, multiple), primary CNS lymphoma (solitary, well-defined)
non-enhancing: progressive multifocal leukoencephalopathy (+demyelination); HIV dementia (more symmetric, less well demarcated)
28
acute hemolytic blood transfusion reaction possible sx
fever, flushing, rigors, dyspnea, chest pain, abd pain, n/v, hTN, hematuria
29
type II DM dx criteria
random gluc > 200
fasting > 126
A1C > 7
30
what to worry about with a fam history of medullary thyroid cancer
MEN 2A/B
| check for pheo
31
all the weird details about multiple myeloma
```
elevated IgG (--> renmal problems)
lytic lesions (esp in skull)
hypercalcemia
fried egg plasma cells with "clock face" chromatin (tons of them on marrow bx = plasmacytosis)
rouleaux formations of RBCs
Bence Jones (Ab light chains) in urine
```
32
all the weird details about Waldenstrom's macroglobulinemia
```
elevated IgM
rouleaux formations of RBCs
hyperviscocity
cryoglobulinemia
cold agglutinins
NO bone lesions/hyperCa
```
33
all the weird details about Langerhan's Histiocytosis
Birbeck granules (tennis racket)
lytic bone lesions
eosinophilic granulomas
brown-purple skin lesions
34
transfusion rxns by time frame
minutes: allergic (uticaria, pruritis, anaphylaxis)
1st few hours: febrile nonhemolytic rxns
1st 24 hrs: acute hemolytic rxns
days after: delayed hemolytic rxns
35
what to bx in suspected Wegners (granulomatosis w/ polyangiitis)
lung
| can do kidney, but lots of false negatives
36
polyarteritis nodosa vs granulomatosis w/ polyangiitis
PN spares the lungs
| PN has transmural vascular necrosis where GWP has granulomas
37
definitive tx for achalasia
myotomy of LES
38
TRAP+ cell leukemia
hairy cell leukemia
39
t(9; 22)
CML (usually) (middle age)
| can be ALL (teen)
40
smudge cells
CLL
41
auer rods
AML/APL
42
treated with all-trans-retinoic acid
APL (of AML)
43
dx of BPHG
pelvic U/S w/ post void residual
44
dx of vesiculoureteral reflux
voiding cystourethrogram
45
neurogenic bladder dx
urodynamic testing
46
poison ivy hypersensitivity type
type IV (delayed, T)
47
ABO transfusion rxns hypersensitivity type
type II (IgG)
48
TSH/thyroxine levels in primary vs secondary hypothyroidism
primary: increased TSH, decreased thyroxine
secondary: decreased both
49
causes of secondary hypothyroidism
pit tumors, brain surgery, cranial radiation
50
what causes hyperpigmentation in adrenal insufficiency
increased levels of ACTH
51
painless, unilateral scrotal swelling that transilluminates
hydrocele
52
when to fix a hydrocele
if pt has pain or pressure
53
DM, hyperpigmentation and cirrhosis
hereditary hemochromatosis
54
iron study results for hemochromatosis
increased ferritin and transferrin saturation
| transferrin is more sensitive
55
hypertrophic CM heart description
asymmetric hypertrophied non-dilated L ventricl
56
amyloid CM heart description
concentrically thickened ventricles w/ diffuse fibrin deposits
57
systolic murmur worse w/ valsalva, better w/ squatting
hypertrophic CM
58
valsalva does what to preload
decreases
59
squatting does what to preload
increases
60
young smoker with hand/feet ischemia
thromboangiitis obliterans (Buerger dz)
61
conditions that can have erythema nodosum
post-strep infection
sarcoidosis
IBD
TB
62
tx for erythema nodosum
treat underlying if can
| NSAIDs, oral steroids, potassium iodide
63
people at increased risk of renal cell carcinoma
von Hippel-Lindau, tuberous sclerosis
64
cancers people w/ tuberous sclerosis are at risk for
cardiac rhabdomyomas
astrocytomas
renal cell cancer
65
intellectual disability, seizures, hamartomas, renal failure
tuberous sclerosis
66
pernicious anemia at risk for what
gastric adenocarcinoma
67
myesthenia gravis pts at risk for what cancer
malignant thymomas
68
paget dz risk of what cancer
fibrosarcoma of bone
69
sx of HCa
weakened bones, lethargy, depression, nausea/vom/constipation, kidney stones
(bones, stones, abdominal groans and psychiatric moans)
70
HCa EKG
shortened QT
| arrhythmias
71
hypercalcemia/hyperPTH ddx
lithium (Ca + PTH)
thiazide diuretics (Ca)
parathyroid adenoma (Ca + PTH)
familial hypocalciuric hypercalcemia (Ca + PTH)
malignancy (Ca)
vit D def (PTH) usually from kidney failure
72
hypercalcemia, metabolic alkalosis and renal insufficiency
milk-alkali syndrome
73
CXR in bleomycin toxicity
interstitial pneumonitis w/ honeycombing
74
positive obstructive atelectasis cause
mucus plug
75
signs/sx of ventilator-associated pneumonia
new fevers, purulent tracheobronchial secretions, leukocytosis
CXR: focal lung consolidation
76
pemphigus vulgaris
flaccid blisters that start in MM, tear easily, IgG/C3 in epidermis
77
bullous pemphigoid
tight blisters that spare MM, often post uticaria/pruritic rash, don't tear easily, IgG/C3 in subepidural BM
78
IgA deposits in papillary dermis
dermatitis herpetiformis
79
IgA deposits in BM of skin
linear IgA dermatosis
80
spontaneous pneumothorax risk factors
male 10 - 30, tall and thin
81
ABCDE of melanoma
```
asymmetry
border
color
diameter (>6mm)
evolving
```
82
ruptured esophageal varices: Tx
immediate EGD w/ banding
83
other dz a/w celiacs
dermatitis herpetiformis
type 1 DM
selective IgA deficiency
84
oculomasticatory myorhythmia
rhythmic movements of eye convergence w/ masticatory muscle contractions
seen in whipples
85
whipples tx
ceftriaxone then TMP-SMX
86
hemophilia coag
aPTT
87
von willebrand coag
bleeding time, aPTT
| ristocetin cofactor assay
88
which vessel?: vertigo, horners, nystagmus, face sensation down, opposite body sensation down
(same side as face)
posterior inferior cerebellar artery
Wallenberg's syndrome
89
which vessel?: return of primative reflexes (rooting, grasping, suckling)
anterior cerebral artery
90
which vessel?: vertigo, vertical nystagmus, dysarthria, ataxia, face sensory changes, "drop attacks" or labile BP
vertebrobasilar artery
91
fever, new/severe unilateral HA, acute onset focal deficit
brain abscess (usually hx of chronic sinusitis, otitis media, mastoiditis, dental cavity, etc)
92
sinusitis -- when to give Abx
Abx: > 10 days, complications like facial swelling or tooth pain (give amoxicillin)
No Abx: everything else (give nasal saline and decongestants)
93
sinusitis -- when to get a CT
chronic (ongoing for > 12 weeks)
| do nasal culture too
94
cancers at high risk for brain mets
lung, breast, melanoma
95
MC brain tumor in adults
mets
96
MC primary brain tumor in adults
glioblastoma multiforme
97
HA worse in the AM w/ nausea/vomiting is a sign of?
increased ICP
98
constant HA worse in the am w/ n/v and ring enhancing mass on CT
glioblastoma multiforme
99
HIV pt w/ HA, personality changes, neuro deficits, seizures
primary CNS lymphoma
100
primary CNS lymphoma tx
high dose methotrexate then radiation
101
organism in neurocysticercosis
taenia solium
102
risk of crazy high sugar in DM
hyperglycemic hyperosmolar state
103
tx for hyperglycemic hyperosmolar state
fluid replacement and insulin drip
104
spontaneous DVT or PE with hx of miscarriages
factor V leiden mutation
105
double layer basement membrane
membranoproliferative GN
106
RF for membranoproliferative GN
hep C
107
what does amiodarone pulm-tox look like?
dyspnea, cough, fever
CXR: ground glass
BAL: PMNs, T-cells, "foamy" macs
108
severe diarrhea --> what kind of electrolyte imbalance?
non-anion gap metabolic acidosis
| decreased potassium, increased Cl
109
how to calculate anion gap
sodium - chloride - bicarb
< 12 = non anion gap
> 12 = anion gap
110
anion gap dx
```
Methanol, metformin
Uremia
DKA
Propylene glycol
Iron, INH
Lactic acidosis
Ethylene glycol
Salicylates, starvation
```
111
1st line tx CAP
azithromycin
112
stevens johnsons vs toxic epidermal necrolysis
> 30% of total body surface --> toxic epidermal necrolysis
113
causes of toxic epidermal necrolysis
meds: sulfonamides, allopurinol, carbamazepine, lamotrigine, phenobarbital and piroxicam
infections: viral, mycoplasma pneumonia
114
angiofibroma, ash-leaf spots, shagreen patch, intellectual disability, epilepsy
tuberous sclerosis
115
treatment for ventricular fibrillation
```
...defibrillation
then epi (or vasopressin) if didn't work (while doing cpr)
```
116
tx for ventricular tachycardia w/ pulse
lidocaine
117
cherry red macular spot
central retinal artery occlusion (caused by carotid atherosclerosis or cardiogenic emboli)
118
yellow deposits (drusen) around macula
dry age related macular degeneration
119
night blindness --> dry eyes
vit A def
120
blood/vessels in subretinal space
wet age related macular degeneration
121
old, acute abd pain, bloody diarrhea, leukocytosis (hx of atherosclerosis)
acute mesenteric ischemia
122
1st line tx acute cluster headache
high flow 100% O2
123
suspect acute bacterial meningitis: management
1. non-contrast head CT to r/o mass lesions, strokes, hematoma
2. LP
(if can't LP/delay --> start Abx)
124
abx for acute bacterial meningitis
1 mo - 65: vanco, ceftriaxone
| baby or old: vanco, ceftriaxone +ampicillin
125
+ PPD size in HIV +
> 5 mm
126
vaccinations for HIV +
```
hep A
hep B
pneumococcal
HPV
annual flu
```
127
prophylactic abx for HIV (<200)
TMP-SMX against pneumocystis jiroveci
128
prophylactic abx for HIV (<50)
azithromycin (or clarithromycin) against mycobacterium avian
129
prophylactic abx for HIV w/ thrush
TMP-SMX against pneumocystis jiroveci
130
pathophys of hepatic encephalopathy
bacteria in gut make ammonia, can't be taken out by damaged liver
131
serum-ascites albumin gradient(whats the over under)
> 1.1 = transudative
| < 1.1 = exudative
132
transudative causes of ascites
cirrhosis, CHF
133
exudative causes of ascites
malignancy, infection, pancreatitis, nephrotic syndrome
134
light's criteria
```
for pleural effusions
transudative if:
effusion to serum protein > 0.5
effusion to serum LDH > 0.6
effusion LDH > 2/3 normal
```
135
transudative causes of pleural effusions
cirrhosis, CHF, nephrotic syndrome
136
MC kidney stone
Ca oxalate
137
when to work up back pain presenting normally
```
> 6 wk duration
(+) straight leg raise
red flags (suspect tumor, infection, or cauda equina)
```
138
when to get an MRI for back pain
hx cancer or weight loss
fever, chills
incontinence, bilateral leg weakness, saddle anesthesia
139
when to get an xray for back pain
suspect fractures: trauma or osteoporosis
| > 6 wk pain with conservative management
140
heart thing a/w diff BP in arms than legs
coartaction of aorta
141
heart thing a/w forceful arterial pulse with rapid collapse
aortic regurg
142
initial tx for pylonephritis
cipro
143
sickle cell w/ acute chest pain, dyspnea
acute chest syndrome
144
wolf parkinson white ecg changes
short pr
wide qrs
delta wave
145
hyperkalemia ecg
peaked T waves
| widened qrs
146
when do you see u waves
hypokalemia
147
kidney problems a/w Crohns
CaOxylate stones (fat malabsorption --> ca not absorbed --> hyperoxaluria)
148
thrombocytopenia management
Asx, > 30000 --> nothing
Sx, > 30000 --> glucocorticoids (or IgG if cant); then splenectomy if need or rituximab
Asx, < 30000 --> tx as above
149
when to give oseltamivir
flu for 2 or fewer days
150
Hep B markers: vaccine vs. natural immunity
vaccine: (+) Anti-HBs (surface)
| from infection: (+) Anti-HBs and (+) Anti-HBc
151
Hep B markers: acute vs chronic infection
both (+) HbsAg and (+) Anti-HBc
| Acute also has (+) IgM Anti-HBc
152
best initial screening for cushings
low dose dexamethasone suppression test
153
epigastric pain -- awakens pt from sleep
duodenal ulcers apparently
154
cause of anion gap acidosis in septic shock
decreased organ perfusion --> lactic acidosis
155
well differentiated papillary thyroid cancer tx
1. surgery
2. radioactive iodine ablation
3. T4 (levo)
156
Graves tx
radioactive iodine ablation + levo
157
what else to consider w/ achalasia
```
SCCAN
Sarcoidosis
Chagas
CA (esp gastric)
Amyloidosis
Neurofibromatosis
```
158
kidney stones dx
helical CT w/o contrast
159
hypercalcemia workup
1. serum parathyroid
2. check for cancers
3. bone density (not for dx)
160
hyperkalemia tx
calcium gluconate (stabilize <3)
insulin/glucose
albuterol
keyexolate (Na polystyrene sulfonate)
161
time frame: chronic sinusitis
> 12 wks (3 mo)
162
non hemolytic febrile transfusion rxn tx
tylenol (+ stop transfusion)
163
uticarial allergic transfusion rxn tx
diphenhydramine (+ stop transfusion)
164
inflammatory bowel dz dx
fecal lactoferrin
165
pheochromocytoma tx
1. alpha blockers
2. beta blockers
3. surgery
166
large bowel vs small bowel ischemia
large: low grade pain + hematochezia
small: severe pain OOP, vomiting
167
cause of pigmented (black) gallstones
chronic hemolysis
cirrhosis
Asian...?
168
cholesterol gallstone RFs
fat, female, forty, fertile (birth control)
| + estrogen replacement therapy
169
paraneoplastic Abs
Anti-Hu (small cell lung)
| Anti-Yo (breast/gyn)
170
brain complication of autosomal dom polycystic kidney dz
cerebral aneurysms --> subarachnoid hemorrhages
171
subarachnoid hemorrhage dx
non contrast CT
172
why does that smoker have cough + low sodium
SIADH from small cell carcinoma
173
polycythemia ddx
high altitude life
obstructive sleep apnea
carbon monoxide
sports cheating (exogenous EPO, steroids)
paraneoplastic (renal cell, hepatic, pheo, fibroids)
polycythemia vera (LOW EPO)
174
polycythemia vera dx
JAK-2 mutation
175
polycythemia vera tx
ASA, phlebotomy
176
abdominal pain, psych stuff, red/pink urine
acute intermittent porphyria
177
triggers for acute intermittent porphyria flares
alcohol
barbiturates
OCPs
hep C
178
chemo drug that --> hemolytic uremic syndrome
mitomycin
179
aortic dissection tx
1. beta-blocker or nitroprusside
| 2. surg: graft/ or endovascular stent/graft
180
why do you get increased Ca in lung cancer
paraneoplastic -- release parathyroid hormone-RELATED protein
181
tx primary pulmonary HTN
sildenafil
182
PE Dx
D-dimer to r/o PE in low risk
high risk get a CTA
V/Q scan for those who can't CTA
183
metastatic prostate Ca tx
less androgens:
GnRH agonists (leuprolide, goserelin)
adrenal inhibitor (ketoconazole)
or @ receptors (flutamide)
184
diff btwn asthma and COPD
1. asthma is reversible
| 2. diffusion capacity for CO (normal for asthma, down in COPD)
185
recurrent oral/genital ulcers in young person (not herpes)
Behcet's
186
lewy body dementia tx
```
levodopa (parkinson sx)
acetylcholinesterase inhibitors (behavioral/hallucinations)
clonazepam (sleeping crap)
```
187
acute urinary retention management
try to pass a foley
suprapubic if can't
then surg consult
188
supplement to give w/ isoniazid (and why)
B6, avoid neuropathy
189
electrolyte weirdness in kidney failure
down phosphorus
up potassium
down calcium
190
MCC osteomyelitis
staph aureus (even in DM pts)
191
when can you give anti-motility in diarrhea
non-invasive, non-bloody
192
erythematous, scaly plaques on the face w/ remission and relapse
seborrheic dermatitis
193
benign esophageal strictures tx
endoscopic dilation
194
drugs causing aplastic anemia
chloramphenicol
| valproate, carbamazapine, phenytoin
195
phenytoin toxicity sx
```
vertical nystagmus
sedation,
hTN
arrhythmias
GI distress
```
196
hemolytic anemia ddx
```
autoimmune
paroxysmal noctural hemoglobinuria
sickle cell
malaria/babesia
hereditary spherocytosis
G6PD deficiency
microangiopathic (DIC, TTP, HUS)
mechanical (heart valve)
```
197
dx paroxysmal nocturnal hemoglobinuria
flow cytometry
198
dx sickle cell
hb electrophoresis
199
dx autoimmune hemolytic anemia
Coombs
200
dx hereditary spherocytosis
osmotic fragility test
201
hemolysis, thrombosis, pancytopenia
paroxysmal nocturnal hemoglobinuria
202
psychomotor slowing w/o aphasia
NPH (part of whacky)
203
pts > 50 w/ bilateral shoulder and hip pain/stiffness
polymyalgia rheumatica
204
labs for polymyalgia rheumatica
ESR > 50
205
what else to check for with polymyalgia rheumatica
temporal arteritis
206
tx for secondary lymphedema (ex: post lymph node bx)
compression + skin care
207
thyroid enlargement weeks after infection
subacute thyroiditis
208
when to bx prostate
abnormal DRE
| PSA > 4
209
gradual bilateral loss of central vision
age related macular degeneration (dry?)
210
cupping of optic disc
open-angle glaucoma
211
kid with edema and heavy proteinuria -- most likely cause
minimal change disease
212
dx minimal change disease
renal bx and electron microscopy
213
cause of shock liver
not adequate liver perfusion --> ischemic hepatitis
214
chemo pt w/ fever and decreased WBCs
neutropenic fever
215
tx for neutropenic fever
start broad spectrum abx, and get blood/urine cultures
216
dx Conn's syndrome (also, wut is it)
aldosterone secreting tumor
| measure aldosterone-renin ratio (+ is > 20)
217
palpably enlarged but non-tender gallbladder
sign of extrahepatic biliary obstruction (courvoisier's sign)
218
tx: ball cancer
1. inguinal orchiectomy (not simple -- leads to seeding)
2. retroperitoneal lymph node dissection
3. radiation/chemo
219
management: guillain barre
1. hospitalize + get serial PFTs
| 2. IgG (non-ambulatory only) or plasma exchange for tx (combo not better)
220
dx: guillain barre
Clinical but may see
| LP: up protein, normal WBC
221
PPD (+) for close contacts
> 5 mm
222
shiny, umbilicated, dome-shaped papules
molluscum contagiosum
223
how does Mg affect K?
hypomagnesemia --> renal potassium wasting
| so if Mg is low you can't fix the K no matter what
224
1st line tx for severe acne
oral isotretinoin
225
viral diarrhea time limit
14 days
226
tx: uncomplicated pylonephritis
cipro/levofloxacin
227
unilateral joint pain/stiffness (better in first 30 min) w/ crepitus or effusion
osteoarthritis
228
osteoarthritis tx
PT
weight loss
NSAIDs
229
fever, leuks, LLQ pain
diverticulitis
230
diverticulitis dx
CT
231
diverticulitis tx
bowel rest
broad-spec Abx
IV fluids
232
HTN and hK
think excess aldosterone
233
bilateral sacroiliitis in teen
ankylosing spondylitis
234
weird ankylosing spondylitis things
HLA-B27 +
elevated ESR
bamboo spine
pain improved w/ moving/hot showers
235
confluent hyperpigmented or hypopigmented macules on upper torso and arms
tinea versicolor
236
healthy-ish old person w/ 2+ cytopenias on peripheral smear
myelodysplastic syndrome
237
myeloid cell lines
```
granulocytes (neutrophils, eos, basophils)
erythrocytes
megakaryocytes/platelets
monocytes
mast cells
```
238
dx: sarcoidosis
biopsy (lung usually)
| non-caseating granulomatous infiltration (w/o orgs)
239
ddx: hypernatremia
```
6 Ds:
diuretics
dehydration
diabetes insipidus
docs (iatrogenic)
diarrhea
dz of kidney
```
240
hypernatremia workup
1. check urine osms
2. high = dehydration
low = diabetes insipidus
3. water deprivation/desmopressin
241
#1 RF for ischemic and hemorrhagic strokes
HTN
242
central DI tx
desmopressin
243
CML treatment
imatinib
| stem cell transplant if fail and young
244
skin findings in hypercholesterolemia
xanthomas:
lipid deposits (yellow pustules)
tuberous masses on tendons
xanthelasma (eyelids)
245
OCPs up risk of what in RUQ
`hepatic adenoma
246
NASH puts you at risk for what
hepatocellular carcinoma
247
MS exacerbation Tx
steroids
248
thyroid nodule, no problems -- next step?
fine needle aspiration
249
blood smear for mono
large, dark lymphocytes
250
HTN med for pts w/ CKD
ace inhibitors
251
hyperthyroid treatment for preggers
propylthiouracil 1st trimester
| methimazole 2nd, 3rd
252
tx tension pneumo
needle thoracostomy
253
contact dermatitis hypersensitivity type
type IV
254
pseudotumor cerebri
idiopathic intracranial HTN
255
management for pseudotumor cerebri
1. MRI/CT
| 2. LP
256
MEN 1
pit adenomas
parathyroid hyperplasia
panc tumors
257
MEN 2A
parathyroid hyperplasia
medullary thyroid carcinoma
pheo
258
MEN 2B
mucosal neuromas
marfanoid
medullary thyroid carcinoma
pheo
259
gas gangrene tx
1. surgical debridement
| 2. hyperbaric/Abx
260
generalized maculopapular rash days to weeks after starting bactrim (and what to do)
drug eruption
| stop drug, give antihistamines
261
1st MI blood level to rise (and how fast)
myoglobin (1st 2 hours)
262
when does troponin increase/peak (hours)
up at 3-12
| peak @ 24
263
dull flank pain, hematuria, bilateral kidney masses
ADPKD
| autosomal dominant polycystic kidney dz
264
tx kawasaki
IVIG and hi dose ASA
265
right ventricular heave, loud P2 and tricuspid regurg
primary pulmonary HTN
266
tests for primary pulmonary HTN
CXR, EKG, Echo
| R heart cath is most definitive
267
when do you get the shingles vaccine?
60
268
when do old people get the pneumonia vaccine? (and which one?)
old folks get the 23 polysaccharide vaccine @ 65
269
peripheral lung lesion in young non-smoking female
adenocarcinoma
270
clotting factors affected by warfarin
```
II
VII
IX
X
(1972)
```
271
what needs to change if postprandial and fasting glucose levels are high
increase basal insulin
272
levels in tumor lysis syndrome
sudden increase in K, phos (which can --> hypocalcemia), and uric acid from dying cancer cells
273
prevention of tumor lysis syndrome
allopurinol and IV bicarb (+ aggressive hydration)
274
cancers to look out for tumor lysis syndrome
ALL
Burkitt's lymphoma
other high grade lymphomas
275
dx testicular torsion
doppler u/s
276
what do you worry about w/ strep bovis infxn?
colon cancer
277
causes of eosinophilia
```
NAACP
neoplasm
asthma/allergy
addisons
collagen vascular d/os
parasites
```
278
tx for polyarteritis nodosa complicated by hep B/C
1. corticosteroids
| 2. plasma exchange
279
spontaneous bacterial peritonitis (SBP) dx
paracentesis:
| neuts > 250 or + fluid culture
280
asthma drug sequence
```
SABA (albuterol)
ICS qD (fluticasone or budesonide)
LABA qD (salmeterol or formoterol)
hi dose ICS
oral corticosteroid (prednisone)
```
281
MC EKG finding in PE
sinus tach
282
how do you know if its chronic vs acute pancreatitis
amylase/lipase: way high in acute
| x-ray: calcifications in chronic
283
dermatomyositis dx
muscle biopsy: pathology only in one portion of muscle fascicle
284
lead poisoning tx
adults: Ca-EDTA (dimercaprol is old)
kids: succimer
285
T scores mean...
-1 to -2.4 = osteopenia
| < -2.5 = osteoporosis
286
when do you get a dexa scan?
65
hx trauma
hx glucocorticoid use
287
which vessel: oculomotor palsy (ptosis, diplopia, down+out, non-reactive mydriasis)
posterior communicating artery (--> subarachnoid hemorrhage)
288
arteries that can -->. subarachnoid hemorrhage (SAH)
```
circle of willis:
internal carotids
ant cerebral
ant communicating
post cerebral
post communicating
basilar
```
289
unequal pulses or unilateral claudication
takayasu disease
| granulomatous thickening/stenosis of aortic arch
290
fund: retinal microaneurysms, blot hemorrhages and cotton wool spots
diabetic retinopathy
291
GERD tx
1. lifestyle
| 2. antacids, H2 blockers, or PPIs
292
when can you get sheehan syndrome
right after childbirth or even months/years later
293
tx for acute sheenhan syndrome
IV dexamethasone
| then MRI the head to r/o other crap
294
MCCs of otitis externa
pseudomonas
| staph aureus
295
NF1 vs NF2
1 has axillary freckling and ocular findings (optic gliomas or iris hamartomas)
296
work up for neurofibromatosis
```
slit lamp (gliomas/iris hamartomas) (1 only)
plain films (bony lesions)
head imaging (gliomas)
auditory (b/l vestibular schwannomas) (2 only)
```
297
bone lesions in NF-1
x-ray: done dysplasia, vertebral defects, sphenoid wing dysplasia, fibromas
298
cafe-au-lait spots, fibrous skeletal dysplasia, precocious puberty
McCune Albright (not NF-1)
299
tx for lyme
No CNS/cardiac involvement: doxy
preg/breastfeed/kids < 8: amoxicillin
CNS/cardiac: ceftriaxone
300
IBD + jaundice
primary sclerosing cholangitis (a/w UC)
301
dx malaria
thick and thin blood smear
302
tx thyroid storm
beta blocker (propranolol)
PTU
hydrocortisone
stable iodine (1 hr post PTU)
