Medicine Qbank Flashcards
(471 cards)
1
Q
A1c in diabetes
A
> 6.5
2
Q
A1c prediabetes
A
5.7-6.4
3
Q
give in ischemic strokes
A
fibrinolytics (tPA) within 3-4.5 hours
4
Q
treat acute limb ischemia
A
direct arterialial fibrinolytics or emboletomy
5
Q
confidence interval 95%
A
p-value >.05
6
Q
confidenceinterval 99%
A
p>.01
7
Q
wider confidence intervals
A
more likely the null is in it, smaller sample sizes
8
Q
positive anti HBsAg
A
immune to hep B
9
Q
negative HBSAg
A
Hep B negative
10
Q
fever, leukoctosis, n/v, murphy’s sign, RUQ pain radiates to right shoulder
A
acute cholestystis (leads to acute gallbladder infxn in 50-70% of cases)
11
Q
onset over 40, assymetrical
A
secondary raynaud’s (vascular or autoimmune, check ANA, Rh factor)
12
Q
gout prevention
A
indomethacin, decrease alcohol, decrease purines
13
Q
warm water pruritis, headache, dizziness, splenomegaly
A
polycythemia vera (low EPO, hyper viscocity)
14
Q
to increase appetite in cancer pts
A
progesterone analogs
15
Q
tx atypical bipolar and trigeminal neuralgia
A
carbamazamine
16
Q
compare likelihood of adverse events in 2 drugs
A
compare hazard ratios
17
Q
treatment for restless legs
A
dopamine agonists: pramipexole, ropinorole
18
Q
restless legs plus insomnia, pain, anxiety
A
gabapentin (alpha2delta calcium channel ligand)
19
Q
pulsus paradoxus, hypotension, distended neck veins
A
tamponade
20
Q
pleuritic chest pain, friction rub, diffuse ST elevation
A
pericarditis
21
Q
pleuritic chest pain, friction rub, no ST elevation
A
uremic pericarditis, tx: dialysis
22
Q
HIV initial test
A
anyone 16-65, anyone positive for TB, STI
23
Q
HIV test annually
A
IVDU, MSM, prostitution, HIV positive partner, more that 1 partner since last test, homeless shelter, prison
24
Q
over 40, indolent progressive anterior hip pain, worse w/exercise, relieved by rest
A
osteoarthritis
25
food poisoning: vomitting only
staph aureus, bacillus cereus, norovirus
26
food poisoning: watery diarrhea
c. perfringens, eneterotoxin e.coli, enteric viruses, crytposporidium, cyclospora, tapeworms
27
bloody diarrhea
salmonella, campylobacter, shiga-toxic e.coli, enterobacter, vibrio, yersinia
28
food poisoning: descending paralysis
botulism
29
food poisoning: parasthesias
ciguatera
30
food poisoning: flushing, urticaria
scrombroid
31
food poisoning: meningitis
listeria
32
cellulitis, sepsis
vibrio vulnifaesus
33
food poisoning: jaundice
hepA
34
fever, arthralgia
brucellosis
35
low-risk lung nodule
rounded, opacity,
36
high risk nodule
>60y, irregular margins,
37
nontender firm hyperpigmented nodule, less than 1 cm, dimples when pinched
dermatofibroma
38
pearly nodule in sunexposed area w/small telangiectasias
bal cell carcinoma
39
multicentric red, purple, brown nodules, macules, papules
karposi sarcoma (HHV8)
40
high output heart failure
anemia, hyperthyroidism, beriberi, paget's, AV fistula
41
rheumatoid arthritis preserves
dips
42
rheumatiod arthritis tests
antiCCP, IgM RhF, high CSR, ESR
43
rheumatoid arthrihritis and surgery
cervical xray befor intubation (osteoporosis, subluxation)
44
postop pneumonaia
VAP! gram stain, culture, aempiric abx
45
lupus limited to skin, joints tx
hydroxychlorquine
| may cause retinopathy
46
fatigue in TB tx
isoniazid, sideroblastic anemia
| also in B6 deficiency! give pyridoxine
47
tx megaloblastic anemia
folate and B12
48
bone deformity, hearing loss, increase alk pkos, lytic/sclerotic bone lesions
paget's
49
pagets tx
bisphosphonates
50
excess mineralization of periosteum
excess vit A
51
excess deposition of poorly mineralized ostium
low vit D
52
androgen excess, oligo or anovulation, cysts on ovaries, no other endocrine explanation
polycystic ovarian syndrome. dx with two criteria (hyperadnrogenism, irregular menses, pelvic US)
53
steriod infertility
low GnRH, LH, FSH
54
tx polycystic ovarian syndrome
wt loss, OTCs (for hyperandrogenism, mentrual dysfucntion) metformin for DMII (fasting over 140, oral >200), clomiphene to induce ovulation
55
skin blisters enlarge and rupture
impetigo
56
normal skin turns into lizard
ichthyosis
57
silver scales on elbows, knees, scalp, trunk
psoriasis
58
most syphilis tx
penicillin
| doxycyclin if allergic
59
tertiary syphilis tx
penicillin for two weeks
| ceftriaxone if allergic
60
syphilis in pregnancy
penicillin, desensitive if allergic
61
increased pth, low normal Ca
seconday hyperparathyroidism, as in ckd
62
most common hyperparathyroidism, low or normal PTH
primary hyperparathyroidism
63
hypercalcemia with suprreessed PTH, 2/2 extrarenal vitamin D conversion
sarcoid
64
weight loss, chronic abdominal pain, food aversion, bruit fifty percent
mesenteric ischemia
65
hearts in marfan's
aortic dilitation, regurg (early diastolic decrescendo murmur),dissection
66
fever, leukocytosis, LUQ abdominal pain, hx of mitral prolapse, +/- splenomegaly
infective endocarditis (staph, strep, salmonella)
67
painless, white-yellow retinal patches, hemorrhages, CD
CMV retinitis, tx genciclovir, foscarnet
68
fluffy white necrosis in retina
ocular toxoplasmosis
69
dendritic ulcer in eye (acute painful necrosis)
herpes simplex keratinitis
70
benigh cotton wool spots on retina
HIV retinopathy
71
burning pain in eyes, fever, malaise, vesiculr rash in V1 distribution
herpes zoster opthamicus
72
post seizure BMP
anion gap acidosis (lactic acidosis), resolves in 60-90 min
73
tx MALT lymphoma, no mets
omeprazole, clarithromycin, amoxicillin (for h. pylori!)
74
proton pump inhibitor for heartburn, ulcers, GERD
omeprazole
75
women >50, widespread pain, weakness, elevated ESR, creatine kinase and other muscle enzymes
fibromyalgia
76
symmetrical proximal weakness sparing hips, shoulders
polymyositis
77
myalgia associated w/temporal artertis
polymyalgia rheumatica
78
no goiter or exopthalmos, low TSH, high T3, T4, low thyroglobulin
exogenous thyrotoxicosis
79
leads to Barrett's esophagus, adenocarinoma of esophagus
GERD
80
reticular nodular opacites on CXR, fibrosisor honeycomb on CT
interstitial lung dz
81
PFTs in interstitial lung dz
increased FEV1/FEC, decreased TLC, impaired gas exchange, high alveolor/arterial gradient
82
fremitus in lobar pneomonia
increased over consolidation
83
renal failure w/o response to fluid
hepatorenal syndrome, need liver xplant
84
ascites w/PMN>250, SAAG>1.1
bacterial perotinitis (gram neg: e.coli, klebsiella)
85
tx bacterial perotinitis
empiric w/cephalosporins, fluoroquinolones for weekly prophylaxis
86
mild asthma:
albuterol only
87
moderate asthma: weekly >2, monthly
add inhaled steriods (AE: thrush!)
88
severe asthma: daily symptoms, frequent awakenings
add long acting b2 blockers
89
leukocytosis w/elevated alk phos
leukemoid reaction (infection, inflammation)
90
leuocytosis w/o elevated alk phos
CML
91
sudden SOB in COPD
spontaneuos pneumothorax (dilated alveolar blebs)
92
eggshell cysts in dog owner
hydatid cysts, echinococcus granulosus
93
tx symptomatic idiopathic pulmonary hypertension
bosetan, sildenafil, prostanoids
94
class I antiarrhythmics
block Ca channels
95
antiarrhythmics causing wide QRS w/exertion
class 1C: flecainide, propafenone
96
new onset afib, most common cause
hyperthyroidism
97
inhibits Na/K ATPase, causes bradyarrhythmia in young, ventricular ectopy and tachyarrhythmia in old
digoxin
98
middle age woman, OCP hx, benign hepatic mass (rare)
benign epithelial adenoma
99
most common hepatic tumor
mets! multiple masses, atypical cells
100
exopthalmos in Graves
antithyrotropin Abs lead to tissue expansion, worsens with radioactve iodine
101
thyroidectomy risk
recurrent laryngeal nerve damage
102
adverse effects of hyperthyroid drugs
thionamides. agranulocytosis; tertagen, cholectasis (methimazole); hepatic failure, ANCA vasculitis (propylthiourcil)
103
antihistamines and heat stroke
anticholinergics decrease heat dissipation
104
P-ANCA, ankylosing spondyitis-type arthritis, diarrhea
IBS/UC
105
diarrhea, wt loss, migratory arthritis
t. whippelii
106
frothy foul-smelling steatorrhea
giardia
107
exertional syncope associated murmur
aortic stenosis: systolic ejection
108
capillary pulsations in fingers and lips
aortic regurg
109
late diastolic murmur, opening snap
mitral stenosis (pulmonary edema, a.fib)
110
holosystolic, apical, radiates to axilla
mitral regurg
111
aneorbic, gram +, filamentous branching bacteria that colonized the mouth
actinomyces
112
actinomyces tx
high dose penicillin
113
aneorobic gram +, partially acid fast filamentous rod that infecs brain, soft tissue, skin and lungs in immunocompromised pt
nocardia. cavity lesions!
114
nocardia tx
trimethoprim-sulfamethoxazole
115
serum alpha-fetoprotein elevatin
hepatocellular carcinoma
116
looks like mono, no lyphadenopathy, negative heterophile antibody, large basophils with vacuolated appearance
CMV mononucleosis
117
leukocytosis, splenoegaly, smudge cells in pt over 60
CLL
118
"succussion splash"
gastric outlet obstruction
119
pneumonia, CXR shows solid mass w/radiolucent crescent (Monod's sign)
aspergillosis (immuncomprise)
120
atypical pneumonia, bilateral diffuse interstitial infiltrates beginning perihilar
pneumocystis jiroveci
121
painful ulcer with purulent base, violaceus border, in pt with systemic illness such as IBS, rheumatoid arthritis, hematologic conditions
pyroderma gangrenosum
122
multiple tender nodes or plaques on lower extremeties, do not ulcerate, resolve w/out scarring. associated w/meds, infections, or autoimmune dz
erythema nodosum
123
inflammatory scarring nodules at axilla, groin, or scalp
hidradentis suppurativa (acne inversa)
124
fungal infection from breaks in skin, from rose bushes or plant material
sporotrichosis
| fungus spreads along lymphatics, forming subcutaneous nodules and ulcers
125
maculopapular rashes on palms and soles, ulcers on mucous membranes
secondary syphilis
126
ring-shaped scaly patches with central clearing and distint borders
tenea corporis, treat w/antifungal lotions (2% terbinafine) or systemic antifungal (griseofluvin)
127
treat diabetic neuropathy
gabapentin, TCAs (amitriptyline, desipramine, nortriptyline), or NSAIDs
128
resistant HTN, abdominal bruit
renal artery stenosis (also assymetric kidneys, increased creatinine)
129
resistant HTN, high plasma adosterone renin level, hypokalemia
primary aldosteronism
130
resistant HTN, increased 24hr free cortisol
Cushings, usually other symptoms (central obesity, facial plethora, muscle wasting, hirsutism)
131
resistant HTN, headaches, palpitations, diaphoresis, urinary vanillylmandelic acid
pheochromocytoma
132
resistan HTN (usually in child), continuous machinary murmur, rib notching on CXR
coarctation of aorta
133
ecchymosis w/leukopenia and anemia
bone marrow failure (thrombocytopenia)
134
mild DM, necrolytic migratory erythema, weight loss, diarrhea, anemia
glucagonoma
135
chronic hypercapnia (leading to respiratory acidosis, compensatory renal bicarb retention and chloride loss), hypoxia, respiratory failure, secondary erythorcytosis, PHTN, and cor pulmonale
obesity hypoventilation syndrome
136
pain with active shoulder motion, tender in passive internal rotation, forward flexion
subacromial bursitis
137
lateral epicondyle pain
tennis elbow
138
inflammatory mediators damage alveoli. dyspnea, tachypnea, hypoxemia, bilateral alveolar infiltrates
ARDS (setting of sepsis, severe bleeding or infection, toxic ingestion or burns)
139
ARDS tx
low tidal volumes, PEEP, FiO2 at nontoxic levels (
140
indication for packed RBCs
never if hgb>10, always if hgb
141
PEEP complications
barotrauma, tension pneumothorax
142
exertional dyspnea, elevated JVP, pulsatile hepatomegaly, signs of fluid overload
constrictive pericarditis
143
most common cause of tricuspid stenosis
rheumatic heart dz
| aortic stenosis is most commonly senile calcific or bicupid aortic valve
144
painful abcess associated with hair follicle
furunculosis
145
acute well-defined erythematous plaques with satellite vesicles in axilla, groin, skin folds
intertrigo
146
elevated BNP and S3 signal
increased cardia filling pressures. cough, SOB, CHF
147
risky polyps
villous adenoma, sessile adenoma, siza>2.5
| less than 5% of adenomas become malignant
148
white granular patch on buccal mucosa
leukoplakia (reactive precancerous squamous epithelium)
149
steatorrhea and vit. D deficiency
vitamin deficiency from malabsorption (as in celiac)
| hypocalcemia, low phosphorous, eleated PTH
150
CHF 2/2 to alcoholism tx
no more EtOH
151
hallmark: intestinal villous atrophy
```
celiac dz
(also minor abdominal pains, Fe anemia, increased transaminases, arthritis, neuro symptoms)
```
152
hallmark: anal fistula
Crohn's
| also arthritis, skin disorders, nephrolithiasis
153
abdominal symptoms >3 days/month, >3 months, plus feeling better after BM
IBS
154
rectal bleeding, awakening for BM, wt loss, abnormal labs
not IBS
155
most likely to be hypothyroid after radioactive iodine test
Graves
156
common causes of priapism
sickle cell or leukemia (kids)
trauma (laceration of cavernous artery)
neuro (spinal cord injury, cauda equina)
meds: trazadone, prazosin
157
deep linear ulcers in esophagus
CMV esophagitis
158
candida esophagitis tx
fluconazole
159
progressive bilateral loss of central vision, straight lines appear wavy
macular degeneration
160
markers of resolving DKA
anion gap, beta-hydroxybutyrate levels
161
splenic rupture risk in mono
avoid sports for >3 weeks (can't feel spleen in athletes)
162
induced hypokalemia after starting thiazide diuretic
primary hyperaldosteronism (may also have spontaneous hypokalemia)
163
biopsy a lymph node when
>2cm (firm, nonmobile too)
164
AE: hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression
cyclophosphomide (2nd line SLE, vasculitis, cancers)
165
AE: cochlear dysfuntion
cisplatin, carboplatin (testicular, ovarian and bladder cancer), aminoglycosides (gram neg antinbacterial agent Gentamycin)
166
AE: optic neuritis
hydroxychoroquine (SLE, malaria, arthritis), ethambutol (TB)
167
AE: peripheral neuropathy
phenytoin, isoniazid, vincristine (leukemia), heavy metals, alcoholism
168
AE: Raynaud's
beta-blockers, ergotamine (migraines)
169
AE: thyroid dysfunction
amiodarone(III antiarrhythmic, prolonges phase 3 of repolarization), lithium
170
AE: gout
cyclosporine (immune suppressant, xplant)
171
common cause of lower GI hemorrhage in elderly
diverticulosis
172
cardiac cath indications
STEMI (thrombolytics if not available), unresolving severe chest pain
173
tx cocaine induced chest pain
IV benzos, aspirin, nitroglycerin, Ca channel blockers (not beta-blockers!)
174
PE in renal insufficiency
unfractionated heparin!
| warfarin takes 5-7 days to level, low-molecular weight heparin, fondaparinux, and rivoxaban are contraindicated
175
recurrent genital ulcers, oral ulcers, eye lesions, and skin lesions
behcet's syndrome
| turkish, asian, middle eastern
176
bilateral ankle arthritis plus bilateral hilar adenopathy, anterior or posterior uveitis
sarcoidosis. also skin lesions (erythema nodosum), cough, dyspnea, chest pain in Africa-American women in 20s-30s
177
urethritis, conjuctivitis, arthritis and mucocutanous lesions, can follow STIs
reactive arthritis
178
cyanide (fires!) causes lactic acidosis by, and tx
blocking oxphos by binding iron on cytochrome oxidase 3, promoting anearobic metabolism. tx: sodium thiosulfate!
179
live vaccines in HIV
contraindicated in CD4
180
hemorrhagic pustules evolving into necrotic ulcers in the setting of neutropenia
```
ecthyma gangrenosum
(pseudomonas aeruginosa)
```
181
multisystem involvement post-cath: renal failure, livedo reticularis, blue toe, cerebral or intestinal ischemia, Hollenhorst plaques
cholesterol embolization
182
muddy brown granular/epithelial casts, resolves w/in 3-5 days
contrast induced nephropathy
183
active urinary sediment w/hematuria and red cell casts; rapid onset renal failure
cresentic glomerulonephritis
184
endocarditis after dental procedures
viridans group strep: s. mitis, s. sanguis, s. salivarius, s. mutans (most common, also causes dental caries)
185
endocarditis in DM, carcinoma, alcoholism, liver failure, and IV drug use
group B strep
186
bacteremia associated w/colon cancer
S. bovis (normal GI inhabitant)
187
Prosthetic valve or umbilical venous catheter endocarditis
S.epidermidis
188
old men after genitourinary procedures, young women after obstetric procedures endocarditis
enterococci
189
weakness and small cell carinoma of lung
lambert-eaton syndrome: autoantibodies against voltage-gated Ca channels in presynaptic motor terminal
190
pneumonia plus erythema multiform (dusky red target-shaped lesions)
mycoplasma pneumoniae
| most common atypical pneumonia
191
diffuse ST elevations, esp. w/PR depressions, 3-7 days after MI
acute pericarditis
192
AE: edema in face, mouth, lips, tongue, glottis, larynx
ACE inhibitors (enalapril, captopril, lisinopril)
193
AE: thrombotic thrombocytopenic purpura
clopidogrel (blood thinner)
194
AE: hepatoxicity, myopathy
statins
195
Tdap indications
in adults with HIV (and Td booster every 10 years), in every pregnancy. (Everyone gets Tdap as children, then Td booster every 10)
196
Rule out PE
D-dimer
197
Wells criteria immobility
3 days, or surgery w/in 4 weeks. long flights don't count for wells but are a risk factor
198
chest and neck pain, mediastinal widening
aortic dissection (dx: transesophageal echo)
199
DIP involvement, nail involvement, morning stiffness, sausage fingers
psoriatic arthritis
200
gottron's papules (scaley violaceous plaques) on MCPs
dermatomyositis
201
DIP involvement, worse with activity, improves with rest
osteoarthritis
202
mismatched perfusion/ventilation defect
diagnostic of PE, present only 50%
203
mixing the effect of an exposure with the effect of an extraneous factor
confounding (related to exposure and outcome of interest)
204
treatment for necrotizing otitis externa
```
IV ciprofloxacin
(pseudomonas)
```
205
presents as insensate hypopigmented plaque
leprosy. dx with acid-fast bacilli on biopsy
206
causes dry cough due to decreased degradation of bradykinin and substance P
ACE inhibitors
207
recommended in pts with microalbuminuria, even if BP is normal
ACE inhibitors. reduce urinary albumin secretion, slows progression of renal damage
208
hyperpigmentation, DM, arthralgias, cardiomyopathy, conduction abnormalities, hypogandism, cirrhosis, pseudo-gout
hereditary hemochromatosis
(abnormal Fe deposition; also susceptible to listeria, vibrio vulnificus, yersinia) tx is phebotomy (can lead to hepatocellular carcinoma 20-200x normal rates)
209
most common causes of acute pancreatitis
gallstones, alcohol, hypertriglyceridemia, recent ERCP. use ultrasuond to detect gallstones
210
cholinomimetic agent that stimulates contraction of the bowels
carbachol (treats ileus)
211
low PTH, severe hypercalcemia (>13)
hypercalcemia of malignancy
212
new mother, inflammation of abductor pollicus longus, extensor pollicus brevis
de quervian tenosynovitis (pain when squeezing thumb in fingers, "finkelstein test")
213
pain over palmar aspect of first metacarpophalangeal joint, locking of thumb in flexion
trigger thumb
214
pain localized to anatomical snuffbox
scaphoid fracture, often from fall
215
pain with radial flexion of wrist, point tenderness over trapezium
flexor carpi radialis tensynovitis
216
tx uncomplicated cystitis
nitrofurantoin for 5 days (avoid in pyelo, Cr clearance20%)
217
tx complicated cystitis (DM, renal failure, obstruction, indwelling catheter, immunosuppression, hospital aquired)
fluoroquinolones (ciprofloxacin, levofloxacin), 5-14 days, ampicillin/gentamicin if severe. obtain culutre
218
tx complicated cystitis (pregnant)
NOT fluorquinolone (ciprofloxacin, levofloxacin). Consider nitrofurantoim, amoxicillin, cephalexin
219
tx pyelonephritis
fluoroquinolone (cipro, levofloxacin) in outpatient, IV fluorquinolones, aminoglycosides, +/- ampicillin if inpatient
220
hypotension, new onset JVP and RBBB
indicate right heart strain, seen in massive PE
221
hypokalemia, alkalosis and normotension
vomitting, diuretic abuse, Bartter syndrome (thick ascedning limb of loop of henley(like loop diuretics), Gitelman' syndrome (like thiazide diuretics)
222
overproliferation of plasma cells in bone marrow
multiple myeloma. (Bence Jones proteins in urine, rouleaux RBCs. Often presents with lytic lesions, hypercalemia, and renal failure in 50%.)
223
increased bone marrow cellularity with megakaryocytic hyperplasia
essential thrombocytosis
224
hypoplastic fat-filled marrow with no abnormal cells
aplastic anemia
225
incidentally isolated elevated alkphos in elderly patient
paget's dz
226
life threating cause of severe mitral regurg 2-5 days after MI
papillary muscle rupture. does not cause persistent ST elevation
227
low voltage QRS, electrical alternans on EKG
pericardial effusion (early after MI)
228
persistent ST elevation with deep Q waves in same lead
ventricular aneurysm (5 days to 3months post-MI)
229
hemolytic anemia following oxidative stress (infections, sulpha drugs, fava beans
G-6-P dehydrogenase deficiency.
| X-linked, asain, african or middle eastern men, bite cells with Heinz bodies, negative Coombs. tx is supportive
230
p-ANCA in ulcerative colitis
positive
231
hot potato voice, deviated uvula
peritonsillar abscess. tx: aspirate IV antibiotics
232
sudden elevated HR (160-220) relieved by vagal maneuvers
paroxysmal supraventricular tachycardia. healthy hearts. results from accessort conduction pathways through the AV node
233
best evaluation of undiagnosed plural effusion
thoracentesis, except in patients with clear evidence of CHF
234
unexplained hemolytic anemia in patient with renal failure and neurological symptoms, fragmented cells in smear
TTP-HUS. plasmaphoresis is tx.
235
AE: subclinical hepatic injury
isoniazid (TB). Usually self-limiting
236
decreased esophageal peristalsis, poor relaxation of LES, "bird's beak" on barium
achalasia. mostly primary, sometimes secondary to Chagas, esophageal cancer
237
popping sensation, rapid swelling (effusion, hemarthrosis)
ACL injury. knee is lax to pulling tibia forward relative to femur (Lachman test, anterior drawer sign)
238
twisting injury, little swelling, laxity when foot is abducted with the knee stationary (valgus stress test)
MCL tears
239
swelling in posterior knee and calf in older people, associated with osteoarthritis
rupture of popliteal (baker's) cyst
240
megacolon/mega-esophagus, heart disease (CHF)
Chagas. protozoal disease in Latin America cuased by Trypanosoma cruzi.
241
frostbite tx
rewarming with water, no initial attempts to debride tissue
242
retrosternal pain and crepitus in suprasternal notch
pneumomediastinum from esophageal rupture, seen in chronic alcoholics, or after esophageal instrumentation
243
source of 90% of acute PE
proximal deep veins (iliac, femoral, popliteal veins)
244
patients at increased risk of upper extremity venous thromboemboli
patients with indwelling catheters
245
renal vein thrombi in patients with
nephrotc syndrome. (PE in nephrotic syndrome 10-30%)
246
bronchial lavage most useful in
suspected malignancy and opprotunistic infection
247
dx interstitial pulmonary fibrosis and interstitial lung disease caused by rheumatoid arthritis
lung biospy
248
high-pitched diastolic decresendo murmur, wide pulse pressure, uncomfortable awareness of heartbeat lying on left side
aortic regurg. increased left ventricular end diastolic volume leads to hypertropy and ventricular enlargement
249
"water hammer" pulSE
aortic regurg. rapid upstroke followed by rapid collapse of peripheral pulse
250
chemicals in eye
immeadiately wash with copious amounts of water
251
mucolytic used in cystic fibrosis
acetylcysteine
252
tx COPD exacerbation
supplemental O2 (to 88-92%), inhaled bronchodilators (B2 agonists and anticholinergics), antibiotics and ssytemic glucocorticoids
253
absent P waves, narrow QRS, irregularly irregular
afib (originates in ectopic foci from myocardial sleeves on pulmonary veins)
254
afib, low bp, crackles in both lungs
DC cardioversion
255
tx symptomatic bradycardia
transcutaneous pacing
256
rate control in hemodynamically stable afib
amiodarone, quinidine, digoxin
257
tx ventricular arrhythmias
lidocaine
258
murmurs to always explore with transthoracic ehco
diastolic and continuous murmurs, loud systolic murmurs
259
midsystolic soft murmurs in asymptomatic patients
no further workup
260
dysphagia, coughing, regurgitation, halitosis and a neck mass
zenker (pharyngoesophageal) diverticulum. cricopharyngeal hernia caused by esophageal sphincter dysfunction, esophageal dysmotility. dx with barium swallow (contrast esophagram), tx with surgery
261
dysphagia, stomatitis, metabolic abnormalities (Fe deficiency)
upper esophageal webs (Plummer vinson syndrome)
262
reciprocal translocation on chromosomes 9 and 22
form the philedephia chrmosome containing BCR/ABL fusion gene, found in chronic myloid leukemia
263
tx CML
tyrosine kinase inhibitors, with inhibit BCR/ABL
264
headaches, jaw claudication, amaurosis fugax
giant cell arteritis
265
tx GCA and acute vision loss
high-dose IV corticosteroids
266
treats open angle glaucoma and benign intracranial hypertension
acetazolamide
267
tx polymyalgia rheumatica without evidence of GCA
low-dose prednisone (10-20mg daily)
268
steriod-sparing second-line tx for temporal arteritis
methotrexate (anti-rheumatic drug, AE include macrocytic anemia)
269
human herpesvirus 8
karposi's sarcoma. asympotomatic, elliptical, linear arrangment. Legs, face, oral cavity and gentials.
270
asymptomatic, centraly-umbilicated papules on the face, neck, and anogenital areas
molluscum contagiosum (poxvirus)
271
obtunded, decreased bowel sounds, hypotension, hypothermia, bradypnea
opioid intox, even with normal pupils. Give naloxone.
272
intoxication presenting with bradycardia and hypotension, possibly wheeze
beta-blockers. reverse with glucagon
273
30s, hemoglobinuria, fatigue and dyspnea from anemia, hypercoaguable state (including portal vein thrombosis)
paroxysmalnoctural hemoglobinura, dx with flow cyotometry (CD55 and CD59 absent from RBCs)
274
multi-system illness: arthralgias, wt loss, fever, diarrhea, abdominal pain
whipple's disease (bacillus Tropheryma whippelii)
275
PAS-positive material in the lamina propria of the small intestine
whipple's disease
276
performed on active genital lesions to diagnose HSV
Tzanck smear
277
intracellular gram negative diplococci on pelvic
gonorrhea
278
tx gonorrhea
ceftriaxone for gonorrhea, aslo azithromycin for chlamydia!
279
test patients with pelvic inflammatory disease
HIV, RPR for syphilis, pap smear and hep B surface antigen, hep C serology if IV drug user
280
recent onset confusion, fever, muscle rigidity, diaphoresis, elevated CK
NMS, tx dantrolene (muscle relxant), bromocriptine (a dopamine agonist), and amantadine (antiviral drug with dopaminergic properties)
281
rash, high fever (>104), cranial-caudal spread of rash over a few days
measles
282
tenosynovitis, dermatitis, and migratory asymmetric polyarthralgias. Rash is vesiculopustular, few in number, and rarely involves the face
desseminated gonococcal infection
283
febrile prodrome followed by erythematous macular rash that starts over wrists and ankles, involves palms and soles, and spreads centrally
rocky mountain spotted fever
284
fever and maculopapular rash involving entire trunk and extremities, including palms ans soles
secondary syphilis
285
fevere, lymphadenopathy, followed by cranial to caudal rash sparing palms and soles
rubella. in adult women can lead to a month of postdromal arthritis.
286
rubella in pregnancy
active infection can cause dangerous and permanent birth defects
287
cavitary lesions in HIV pts in southwestern USA
coccidioidomycosis
288
increases with increasing severity of hypovolemia
BUN/serum Cr (sensitive, not specific)
289
pulsatile abdominal mass, sometimes a systolic bruit
abdominal aortic aneurysm
290
systolic-diastolic abdominal bruit
renal artery stenosis
291
varied blood pressure in each arm accompanied by tearing chest pain
aortic dissection
292
pt with chronic afib presents with diarrhea, nausea and fatigue
digoxin toxicity. also change in vision, scotomata, blindness. sometimes incited by volume depletion.
293
variceal bleeding prophylaxis
beta-blockers
294
variceal bleeding tx
octrotide (long-acting somatostatin analog that causes splanchnic vasoconstriction and reduces portal blood flow by inhibiting release of glucagon
295
wedged-shaped pleural-based opacification
pulmonary embolism (v. nonwedge consolidations in bacterial pneumonia, round or spiculated in cancer). embolism is more frequent in dehydrated state. hemoptysis.
296
notorious for causing refractory hypokalemia in alcoholics, folks on diuretics
hypomagnesemia. Alcoholics also have hypoalbuminemia, which may cause spurious hypocalcemia)
297
nagging epigastric pain worse at night, food intolerance, weight loss, enlarged nontender gallbladder
biliary obstruction (intra- and extrahepatic duct dilation) consistent w/pancreatic cancer
298
initially unilateral, watery discharge, scant stringy mucus, burning, follicular or bumpy injection
viral conjunctivits
299
initially unilateral, purulent unremitting discharge, diffuse injection, fever
bacterial conjunctivitis
300
bilateral, water mucus, itching, diffuse injection, conjunctiva edema
allergic conjunctivitis
301
severe eye allergy, prolonged course, potential corneal damage
atopic keratoconjunctivitis
302
invasive globe infection 2/2 trauma, purulent haziness
endophthalmitis
303
vasculitis of medium sized arteries in young children. conjunctivitis, fever, lymphadenopathy and mucocutaneous inflammation, general rash
kawasaki disease
304
slurred upsloping R waves, atrioventricular reentrant tachycardia
wolff-parkinson-white (accessory Av bypass tract)
305
sudden onset and termination, rapid rate (140-250), regular rhythm, narrow QRS, absent P waves
AV nodal reentry tachycardia
306
rapid sawtooth flutter waves
atrial flutter (most commonly from reentry circuit around tricuspid annulus)
307
multiple rib fractures, respiratory distress
flail chest (tx pain control, supplemental oxygen, positive pressure ventilation)
308
abdominal pain, nausea, diarrhea, followed in a few weeks by fever, myositis, subungual, retinal and conjunctival hemorrhages, periorbital edema and chemosis
trichinellosis, roundworm in undercooked pork. Also look for eosinophilia!
309
intestinal symptoms, eosinophilia, + nonproductive cough
ascaris
310
4-5 days to develop fever, headache, retroorbital pain, myalgias, arthralgias
dengue fever. may also be hemorrhagic in skin, nose.
311
progressive fever, abdominal pain and salmon rash, to hepatosplenomegaly with intestinal bleeding, perforation
typhoid
312
Light's criteria for exudate
fluid/serum protein ratio>.5, LDH ratio>.6, or fluid LDH >2/3 normal limit of normal
313
cause exudative plural effusion
infection, autoimmune, neoplasm (all via increased capillary permeability)
314
transudative pleural effusions, as in liver failure
decreased plasma oncotic pressure
315
transudative pleural effusions, as in CHF
elevated hydrostatic pressure
316
attributable risk percent (ARP)
(risk in exposed-risk in unexposed)/risk in exposed. So if a factor causes a 4x risk, then ARP is (4-1)/4=75%
317
epithelial necrosis in colon
ischemic colitis (acute presentation, mild elevation in inflammatory markers)
318
pancolitis with fibrinous pseudomembranes
c.diff colitis (recent antibiotic use)
319
neutrophilic cryptosis, erthymous friable mucosa, inflammation marker elevation, subacute abdominal pain with bloody stool.
inflammatory bowel disease. presents in 20s, second peak in 60s.
320
intense pruritis, esp. at night, hepatosplenomegaly and xanthomatous lesions. middle aged-women, insidious onset.
primary biliary cirrhosis. autoimmune destruction of intrahepatic ducts and cholestatis. confirm with anti-mitochondrial antibody test!
321
primary biliary cirrhosis tx
ursodeoxycholic acid first line (relieves symptoms and lengthens survival. methotraxate, colchincine some evidence as secondline), transplant required in 7-10years
322
second-line drug to control symptoms of primary biliary cirrhosis
cholestyramine (forms nonabsorbable complex with bile acids in small intestine, increasing loss of cholesterol and bile acids)
323
respiratory support in AECOPD
noninvasive positive-pressure ventilation. reduced work of breathing, improves alveolar ventilation, dereases mortality and nosocomial infections. (intubation required if failed for two hours)
324
melena + nocturnal pain relieved by eating
duodenal ulcer disease (90% have h. pylori!)
325
women under 50 w/early severe hypertension, resistant to treatment, w/symptoms of carotid or vertebral artery involvement, or abdominal bruit
fibromuscular dysplasia! look for family hx of strokes, increased Cr on ACE inhibitor, secondary hyperaldosteronism (from decreased perfusion to kidneys), aldosterone to renin ration is
326
hypertension, hypokalemia, plasma aldosterone >15, renin suppressed (aldo:renin >20)
primary hyperaldosteronism
327
soft left-sided scrotal mass that worsens with standing and valsalva, does not transilluminate
varicoclele (dilated pampiniform plexus). much more common than femoral hernias (older women)
328
hypertension and hypokalemia: high renin, high aldosterone
secondary hyperaldo: renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretics
329
hypertension and hypokalemia: low renin, high aldosterone
primary hyperaldo: aldo producing tumor, bilateral adrenal hyperplasia
330
hypertension and hypokalemia: low renin, low aldosterone
non-aldosterone causes: congenital adrenal hyperplasia, deoxycorticosterone-producing adrenal tumor, cushing syndrome, exogenous mineralcorticoids
331
aldosterone effects
saves sodium, loses potassium and H+, leading to metabolic alkalosis (low K also causes increased bicarb reabsorption, whih leads to alkalosis too)
332
hyperkalemia in DKA
parodoxical: body has depleted K 2/2 osmotic diuresis and increased GI losses, but K shifts extracellularly in exchange for iron, and isulin-dependent K entry into cells is impaired. SO replace K (
333
painful hyperkeratotic papules on sole of foot
plantar warts (HPV)
334
constipation, fatigue, excess urinary, abdominal pain, urinary stones, mental status changes.
and osteoporosis! it's hypercalcemia. hyperparathyroidism increases Ca and decreases phosphorus. Can lead to pseudogout
335
rhomboid crystals with positive birefringence
pseudogout. acute onset, painful monoarthopathy affecting knee. caused by calcium pyrophosphate dihydrate deposition
336
crystals in the shape of coffin-lids
struvite crystals, from nephrolithiasis caused by chronic UTIs caused by ureases producing organisms
337
needle-shaped crystals w/negative birefringence
gout
338
polymorphonuclear cells with gram positive cocci in joint aspirate
septic arthritis
339
lymphocytes and budding yeast in joint aspirate
fungal arthritis, rare, slowly progressive monoarthritis in knee
340
fever, chills, malaise, dyspnea, fine diffuse crackles, diffuse reticular or ground glass opacities on x-ray
hypersensitivity pneumonitis
341
cardiomegaly, cephalization of pulmary vessels, kerley B lines and pleural effusions on XR
pulmonary venous congestion (CHF)
342
headache, nausea, eye pain, and nonreactive mid-dilated pupil
acute angle-closure glaucoma
| dx w/optho consult for tonometry
343
exudative effusions with low glucose content
empyema, due to high metabolic activity of leukocytes and bacteria within the pleural fluid (transudative)
344
cause of hypocalcemia in malnutrition
hypomagnesemia, leads to decreases PTH and PTH resistance
345
serum Ca and albumin
serum calcium falls .8 for every 1gm/L decrease in albumin
346
chronic cough, hemoptysis, intermittent fevers +/- weight loss, upper lobe cavitary lesion
TB
347
tx CMV infections
ganicyclovir
348
tx influenza (within 48 hrs)
oseltamivir, zanamir (neuroamidase inhibitors); rimanatdine, amantadine (influenza A only)
349
nucleotide analog used to treat HIV
tenofovir
350
protease inhibitor used to treat HI
Ritonivir
351
tx herpes simplex and varicella zoster
valacyclovir (acyclovir is cheaper, also effective)
352
nonnucleoside reverse transcriptase inhibitor used to treat HIV
nevirapine
353
most common cause of hemoptysis in patients who have smoked
pulmonary airway dz (chronic bronchitis, bronchogenic carcinoma, bronchiectasis)
354
common cause of aseptic menningitis
coxsackie or echovirus
355
20% of cocaine overdoses are complicated by
rhabdomyolysis
356
main danger of CPK>20,000
acute tubular necrosis
357
great lakes, Mississippi and Ohio river basins, Wisconsin most of all
blastomycosis
358
months of low-grade fever, night sweat, productive cough, ulcerated skin lesions, bone lesions
blastomycosis, fungal infection with CXR resembling TB, histoplasmosis (great lakes, Mississippi and Ohio river basins, Wisconsin most of all). broad-based budding yeasts grow from sputum
359
fever, cough and night sweats in the southwestern US
coccidiomycosis
360
blastomycosis tx:
Itraconazole or Ampho
361
sensitivity equation
true positives / (true positives+false negatives)
362
specificity equation
true negatives / (true negatives+false positives)
363
mean corpusular volume over 100
macrocytic anemia
364
progressive symmetric polyneuropathy great in legs than arms
subacute combined degeneration (vitamin B12 deficiency! also see peripheral neuropathy, memory loss and dementia)
365
increased methylmalonic acid
decreased vitamin D! think malnutrition, malabsorption, neuro deficits
366
D-lactic acidosis
pts with short-bowel syndrome. often asymptomatic, sometimes confusion, atxia and dysarthria durning carbo-loading.
367
macrocytic anemia, polyneuropathy (reduced deep-tendon reflexes, delayed relaxation phase)
hypothyroidism
368
microcytic anemia with reduced transferrin saturation
iron deficiency anemia (as in GI malabsorption)
369
flank pain, hematuria, AKI, calcium oxolate crystals
ethylene glycol poisoning
370
tx anti-freeze intoxication
fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol; sodium bicarb for acidosis, hemodialysis if needed
371
tx dapsone, anesthetic OD (cyanosis, respiratory depression)
methylene blue
372
tx tylenol overdose
N-acetylcysteine
373
geneti syndromes associated with pancreatic cancer
Peutz-Jeghers, Lynch syndrome
374
first line tx for stable patients with torsades
IV magnesium
375
all pts with tachycardia causing hemodynami instability or poor perfusion
immeadiate synchronized DC cardioversion
376
stable SVT tx
vagal maneuvers, or IV adensoine, or Ca channel blockers (verapamil)
377
don't use amiodarone, procainamide, or other IV antiarrhymthics
in unstable or narrow-complexed tachycardia
378
hypochromic/microcytic anemia w/depressed iron and ferritin
check for bleeding! GI blood loss is the most common cause of Fe-deficiency anemia in men and postmenopausal women
379
classic manifestation of malaria
headaches, cyclic fevers, chills, diaphoresis, anemia, thrombocytopenia (most common cause of fever in returning traveler)
380
looks like malaria in traveler to northeastern or midwester US
babesiosis (ticks)
381
East African travel, fevers, chancre, myocarditis, CNS effects
trypanosomiasis (sleeping sickness, from tsetse fly)
382
fever, facial pain, necrosis in nasal passage, chemosis, proptosis in eye
mucormycosis. most often fungal (rhizopus). Tx: debridement, amphotercin B
383
positive predictive value equation
true positives/positive calls
384
tx digoxin toxicity (disturbed color perception, arrhythmias, fatigue, anorexia, nausea, blurred vision)
digoxin-specific antibody
385
bone conduction>air conduction in Rinne
conductive hearing loss. common cause in young adults is otosclerosis
386
dx bronchiectasis (cough, mucopurulent sputum, hemoptysis that responds to abx)
CT chest! CXR is not sufficient
387
most common lung cancer (in smokers and non)
adenocarcinoma (peripheral, associated with clubbing, hypertrophic osteoarthropathy)
388
lung cancer associated with central local, necrosis and cavitiation, hypercalcemia
squamous cell carcinoma (second most common)
389
lung cancer associated with central locale, cushings, SIADH, lambert-eaton
small cell carcinoma
390
lung cancer associated withperipheral locale, gynecomastia, galactorrhea
large cell carcinoma
391
marked severe hypertension associated with malignant hypertension or hypertensive encephalopathy
hypertensive emergency
392
severe hypertension (usuallyt >180/120) associated with retinal hemorrhages, exudates, or pailledema
malignant hypertension
393
nodular pulmonary infiltrate with cavitation in IV drug user
staph aureus endocarditis embolized to lungs
394
pain with abdominal palpitation with legs raised from table
Carnett's sign: source of pain is in abdominal wall (hematoma)
395
tx papulopustular roscacea
topical: azeliac acid, oral: low dose doxycyline
396
uric acid levels to prevent joint damage in gout
397
normal aA gradient, normal PaCO2, corrects with O2
reduced inspired O2 tension (high altitude)
398
normal Aa gradient, increased PaCO2, corrects with O2
hypoventilation (CNS depression)
399
increased Aa gradient, normal PaCO2, corrects with O2
diffusion limitation (interstitial lung dz)
400
increased Aa gradient, normal PaCO2, does not correct with oxygen
shunt (intercardiac, extensive ARDS)
401
increased Aa gradient, normal or high PaCO2, corrects with O2
V/Q mismatch (obstruction, atelectasis, pulmonary edema and pneumonia)
402
bacille Calmette-Guerin
live TB vaccine (adverse effects in advanced HIV)
403
dropped QRS
Mobitz I heart block. Constant P-P interval, increasing PR interval. Impaired AV nodal conduction.
404
impaired SA conduction
sick sinus syndrome. sinus pause/arrest, alternating brady/tachycardia
405
RUQ radiating to right shoulder
acute cholecystitis
406
complications of acute pancreatitis
pleural effusions, ARDS, ileus, renal failure
407
fever, arthralgia, sore throat, lymphadenopathy, mucocutaneous lesions, diarrhea, wt. loss
acute HIV
408
eyes in sarcoidosis
red, with chamber leukocytosis (uveitis)
409
CNS depression, hypotension, hypothermia, bradycardia
myxedema coma, sever hypothyroidism
410
hyperkalemia on EKG, + tx
peaked T waves, then lengthened PR, QRS, then sine wave. tx: calcium gluconate.
411
clarithromycin and amlodipine
clarithromycin inhibits 3A4, increases amlopdipine levels
412
azythromycin AE
long QT, fatal arrhythmias
413
repeat colonoscopy after 8mm hyperplastic polyp
10y! If pt has one to two tubular adenomas, repeat in 5-10 years, if more, repeat in 3 years
414
possible tx for Raynaud's
nifedipine
415
risk factors for long concussion recovery
60hr HA, or three lasting symptoms
416
lower BP in legs than arms
ankle-branchial index, PAD
417
pain in calf on abrupt dorsoflexion of foot with knee extended
Homan's sign, DVT
418
thickened skin on hands and feet, obliterated har follicles and glands, flexion contractures, Raynaud's, mask-like faces, HTN (renal), PHTN, GERD
systemic sclerosis. cutaneous scleroderma (anti-nuclear antibodies), anti-neutrophil cytoplasmic antibodies
419
Rh factor
rheumatoid arthritis, sjogrens, dermomyocytis, HCV
420
c-ANCA
granulomatosis w/polyangitis
421
p-ANCA
microscopic polyangitis nodosa, churg-strauss
422
episodic flushing, wheezing, diarrhea, tricuspid regurg, telengectasias
carcinoid. slow-growing neuroendocrine tumor (distal small intestine, proximal colon, lung). Secrete serotonin, histamine, vasoactive intestinal peptide
423
deficiency in carcinoid tumor
niacin (needs tryphophan, which is used for serotonin in carcinoid)
424
low FEC1/FEV
obstructive lung dz
425
low FEC1/FEV, increased FEV with bronchodilators
asthma
426
low FEC1/FEV, no change in FEV with bronchodilators
COPD
427
normal or high FEC1/FEV
restrictive lung dz
428
normal or high FEC1/FEV, normal DLCO
chest wall weakness
429
normal or high FEC1/FEV, low DLCO
interstitial lung disease
430
initial tx afib
BBs, Ca channel blockers (adenosine), digoxin if in HF
431
aortic stenosis in young
congential bicuspid aortic valve
432
angina in aortic stenosis
LVH leads to increased myocardial oxygen demand
433
acute toxic mucocutaneous disorder after new medication (antibiotics, tylenol, ibuprofen, sitiglipin, carbamazepine, lamotrogine, many others)
if 30%, toxic epidermal necrosis (TEN)
434
sudden rash w/target lesions after infections (herpes simplex), drugs, other diseases (heme onc, collagen diseases)
erythema multiform. self-limiting
435
warm sandpapery skin, diffuse rash, bullae, nikolsky's sign, facial edema, perioral crusting
in kids
436
pseudogout associated conditions
hemochromotosis, hyperPTH, hypothyroid, hypophosphotemia, Wilson's, osteoarthritis
437
next of kin consent to unplug brain-dead patient
no
438
both SLE and steroid use
accelerate coronary atherosclerosis. Stress test if normal EKG
439
JVC + Kussmaul's sign + clear lungs
R. ventricular infarct. (fluids, avoid nitro, diuretics)
| Kussmaul's: JVD increases with inspiration
440
PE on EKG
sinus tach, new onset RBBB, S1Q3T3
441
variant angina EKG
transient ST elevations
442
rare, incidentally found in southwestern native american women with hx of gallstones
gallbladder carcinoma. track remission w/CA9-19
443
45* branching septated hyphae, rare budding bodies
aspergillus
444
yeast with wide capsular halo, narrow-based unequal budding
cryptococcus
445
empty-looking nonseptate hyphae with wide-angle branches
mucor
446
saucer-shaped yeast forms
pneumocystis
447
cigar-shaped yeast with unequal budding
sporothrix
448
treat most yeasts
fluconazole/ketoconazole for superficial infection, ampho B if systemic
449
gram positive cocci in chains
strep
450
gram positive cocci in clusters
staph
451
gram positve bacilli (thick)
clostridium
452
gram positive bacilli (thin)
listeria)
453
gram + bacilli (branched)
actinomyces, nocardia
454
some appear as poor-staining gram positive rods (beaded)
mycobacteria
455
gram - diplococci
neiseria meningitidis
456
thin gram - rods
e. coli
457
gram - coccobacilli
haemophilus
458
gram - curved
vibrio, campylobacter
459
PEEP levels in ARDS
up to 15, w/tidal volume ~6
460
increased plasma free metaphendrines
pheochromocytoma (triad: HA, sweating, palpitations with tachycardia)
461
acute arthritis is MCP, PIP and wrists
viral arthritis (usually parvo: shows slapped-cheek rash in kids)
462
recent strep, lower limb polyarthritis, erythema marginatum, subcutaneous nodules
acute rheumatic fever
463
duration for rheumatoid arthritis
>6 weeks
464
tx viral conjunctivitis
hot or cold compress, +/- antihistamines, decongestants (adenovirus)
465
olopatadine, azelastine
mast cell stabilizing agents for allergic conjunctivitis
466
who needs Td/Tdap
all adults. Tdap once, Td every ten
467
PPSV23, 19-64y
chronic heart, lung or liver dz, DM, smokers alcoholics.
468
PCV13, then PPSV23, 19-64y
CSF leak, cochlear implant, sickle cell, asplenia, HIV, malignancy, CKD
469
PCV13, then PPSV23, >65y
all of 'em. (6-12 months apart)
470
HIV exposure
4 weeks of 3 drug PEP (tenofovir-emtricitabine + raltegravir), test for baseline status
471
most common cause of myocarditis in the young
viral: coxsackie B
