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255 Cards in this Set

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PNH
GPI anchor prot defic. = hemolytic anemia + pancytopenia + venous thrombosis (e.g. hepatic)
PNH Dx
flow cytometry, HAM test
PNH labs
increased LDH, reticulocyte, decreased or negative haptoglobin, hemosiderinuria, hemoglobinuria
PNH Rx
iron, folic acid, transfusion, corticoids, eculizumab
Erythema nodosum Rx
NSAIDs
Back pain MRI indications
spinal stenosis, osteomyelitis, epidural abscess, post trauma
Down syndrome
should NOt participate in contact sports
Fracture on landing on feet
calcaneum, spine, acetabulum, post. hip dislocation
Melanoma suspicion
excisional biopsy
Osgood-Schlatter dis.
apophysitis of tibial tuberosity; Rx = decrease physical activity
Rotator cuff tear
weakness, instability; Dx = MRI; Rx = arthroscopic repair
Slipped capital femoral epiphysis
Dx = X-ray; Rx = fixation of epiphysis with long screws
Iliotibial band syndr.
pain in lat. aspect of knee
Axillary adenopathy in woman
mammography
Supraclavicular lymph node
lymph node biopsy
Miliaria
heat rash
Erythema multiforme minor
bull's-eye on palms, herpes simplex; Rx = long-term use acyclovir
Pustular psoriasis
sterile, post steroids, fever, malaise, arthralgia, diarrhea; Rx = cyclosporine
Seborrheic keratitis
"stuck on", waxy grease scale
Dermatomyositis
often is paraneoplasic
Hypercalciuria (renal stones) Rx
hctz orally
Dye S.E.
ac. tubular necrosis = muddy granular casts
ATN
BUN/Cr < 20:1; cisplatin is one of the causes
Ac. interstitial nephritis (drugs)
rash, fever, hematuria, white cell casts, eosinophiluria
Increase in eosinophils
tumors, parasitic infectious, autoimmune diseases
Indinavir (HIV drug) S.E.
renal stone
Struvite stones
Mg ammonium phosphate, pH>7.2, presence of urea splitting bugs (Proteus, Pseudommonas, Klebsiella; Rx = removal
Uric acid stones
radiotranslucent
Asymptomatic bacteriuria in non-pregnant, healthy patient
no Rx is indicated
Doxorubicin (Adriamycin) S.E.
cardiac toxicity, myelosuppression
Vincristine S.E.
motor, sensory and autonomic neuropathy
Bleomycin S.E.
pulmonary fibrosis
Myelosuppressant drugs
methotrexate, vinblastine, doxorubicin
Polycystic kidney dis
colonic diverticular dis (with increased risk for perfuration), it may evolute to end stage renal dis, 10-15% of the patients have intracranial aneurysm
Chrug-Strauss dis
nephritic syndr + eosinophilia + asthma, p-anca +; Rx = steroids, cyclophosphamide, azathioprine
Goodpasture syndr
nephritic syndr + pulmonary hemorrhage; Abs to glomerular basement membrane
Wegener granulomatosis
nephritis + nasal/sinus problems, c-anca +; Rx = same as Chrug-Strauss
Berger's syndr
IgA nephropathy, no latent period post infection, nephrotic syndr
DMSA renal scan
radionucleotide study for renal function
IV pyelogram
C.I. in renal insufficiency
Kegel exercises
benefits within 6 weeks
Dribbling + dyspareunia + dysuria in woman
urethral diverticulum; Dx = transvaginal ultrasond or MRI
Nephrotic syndr
increased susceptibility to bact. infections, hyperlipidemia, mildly hypercoagulable state, hypovolemia
Renal cell ca suspicion
radical nephrectomy; Bx only for metastatic cases (when Sx is not indicated)
Rapidly progressive GN Rx
high dose IV methylprednisolone
Alport syndr
hematuria +/- blindness +/deafness; type IV collagen of GMB in abnormal
Membranous glomerulonephropathy
MCC of nephrotic syndr in adults; Rx = ACEi
Membranoprolipherative GN
nephrotic sundr; renal dis + decreased complement, realted to hepatitis C virus
Painless hematuria
CT urogram or IVP (check ureteres)
Pyelonephritis suspicion
blood + urine cultures, urinalysis
Immunotherapy
for asthmatics patients with a single allergen
Interstitial fibrosis
decerased FVC, FEV1, RV, TLC, diffusion; increased FEV1/FVC; no response to bronchodilator
Immunisuppressed pat + pulm. aspergilosis Rx
IV amphotericin B
Primary pulm. HTN Rx
inhaled nitrous oxide, Calcium channel blockers
ARDS Rx
limit tidal volume to 6 cc/kg or less
Lung nodule on X-ray
thorax CT scan with contrast
Appropriate tube placement
colorimetric detection of end-tidal carbon dioxide
Sarcoidosis Dx
skin, transbronchial lung biopsy
To decrease aspiration risk during entubation
cricoid pressure
After pulm HTN Dx
vasodilator response testing
Albuterol usage > twice a week
add triamcinolone MDI
Ipratropium bromide
takes about 45 minutes to make effect
Non-massive hemoptysis
CXR, then bronchoscopy, then high resolution CT scan to Dx; not all tests necessary every time, though
Croup (laryngotracheobronchitis)
subglotic swelling, steeple sign on XR, parainfluenza, barking cough; Rx = mist tent, racemic epinephrine, IV corticosteroid, diphenhydramine
TB confirmatory Dx test
sputum acid-fast stain
Ciprofloxacin
does NOT cover streptococcus
Community acquired pneumonia Rx
azithromycin, levofloxacin
Sup. vena cava syndr due to ca Rx
radiation therapy
Penicillin alergy
cephalosporin use is OK if penicillin skin test is
Heparin
given with warfarin untill 2 days after INR reaches desired level
Foreign body aspiration in children
rigid bronchoscopy, methylprednisolone, cefazolin
Gout Rx
for overproducers = allopurinol; for underexcreters = probenecid
Cauda equina syndr. suspicion
MRI; it's an emergency!
Gian cell arteritis Rx
Prednisone 40-60 md daily for 1-2 m., then taper down; if there is suspicion, treat immediately, even before biopsy, to avoid blindness as a complication!
Fight bite bug:
Eikenella
Thompson test
pressure on gastrocnemius does not cause foot flexion, + in Achilles tendon rupture
Fibromyalgia symptoms with less than 11 trigger points
myofascial pain syndr.
Gottron's paules
happen in dermatomyositis
Polymyosistis Dx
increased creatinine, aldolase, CPK; EMG; muscle Bx; Rx = high dose corticosteroids
Urobilinogen
increased in hemolysis, hepatocelular dis.; decreased in biliary obstruction
Lithium S.E.
nephrogenic diabetes insipidus, hypothyroidism
Symptomatic hyponatremia Rx
3% hypertonic saline to increase PNa by 3-5 mEq in 6 h, but no more than 12 mEq per day, because of the risk of central pontine myelinolisis
Central pontine myelinolisis
flacid paralysis, dysarthria, dysphagia
Osmotic diuresis
Uosm/Posm>0.7
Diabetes insipidus
Uosm/Posm<0.7
Hypernatremia Rx
correct < 12 mEq/d to prevent cerebral swelling
Symptomatic hypercalcemia or > 13.5 Rx
hydration + furosemide, then biphosphonate or calcitonin; hemodyalisis if necessary
Intraductal papilloma
bloody nipple discharge
Duct ectasia
fever, greenish cheesy discharge, pain, tenderness
Breast ca
single, hard, immobile, irregular borders, >2cm
Triple Dx
PE + mammogram + FNA citology/Bx
Around ____% of breast cancers have a false negative mammogram
15%
Breast lump in woman younger than 35 yo
if cystic = FNA; if nonbloody liquid = reassurance; if bloody = citology; if not = US and core Bx or excisional biopsy
MC sequelae of meningitis
hearing loss; rememeber to order audiometry in ccs once the meningitis is cured
Meningococcal meningitis prophylaxis
rifanpim or cipro for close contacts
Measles
high fever for 3 days, then Koplik, then 1 day after head-to-toe rash; pneumonia; O.M.; encephalitis (ac.), subac. sclerosing panencephalitis (even after years)
Roseola infantum (exanthema subitum)
high fever for 4 days, stop, then rash on trunk; human herpes virus 6
Erythema infectiosum (fifth disease)
slapped cheek rash; parvovirus B19; when the rash is there, it's not contagious anymore
Varicella Ig
for immunodebilitated, NB, within 4 days of exposure
Scarlet fever
sand paper rash, circumoral pallor, strawberry tongue; Rx = penicillin to prevent RF
Kawasaki syndr Rx
aspirin + IV Ig; f/u with echo
Rocky mountain spotted fever Rx
tetracycline + chloranfenicol OR doxycycline; it may cause DIC, delirium
Epiglottitis Rx
entubate ot tracheostomy, third generation cephalosporin; "thumb sign" on XR, child 2-5 yo, H. influenzae, S. aureus
RSV/bronchiolitis Rx
O2, mist tent, bronchodilators, IV fluids, ribavirin if severe, child <18 mo
Diphteria
grayish pseudomembranous + myocarditis; Rx = atbtc + antitoxin
Pertussis
paroxysmal coughing + whooping inspiratory noise; Rx = atbtc
Post-streptococcal GN
NOT prevented by atbtc
Congenital toxoplasmosis
IC calcifications, chorioretinitis
Congenital varicella-zoster
limb hypoplasia, scarring of the skin
Congenital CMV
deafness, cerebral calcifications, microphtalmia
Conjunctivitis in the first day of life
chemical reaction
Gonorrhea conjunctivitis Rx
erythromycin ointment for 2-5 days
Chlamydial conjunctivitis Rx
topical + oral erythromycin for 5-14 days; the intention is to avoid that it becomes a Chlamydial pneumonia
NB cataracts
TORCH, inherited metabolic dis (e.g. galactosemia)
Orbital cellulitis
ophtalmoplegia, ptosis, severe pain, decreased acuity, it's an emergency!; Rx = blood culture, inpatient IV atbtc
Uveitis in juvenile RA
Dx = slit-lamp exam; Rx = steroid drops
Orchiopexy
correction of cryptorchidism after 1 yo; does NOT affect risk of testicular ca, wich is increased in these cases
PDA
congenital rubella, high altitudes
T4F
VSD + RV hypertrophy + pulm. stenosis + overriding Ao
"Tet" spells
squatting after exertion; increases venous return and peripheric resistance, keeping more blood in lungs and improving oxygenation; very common in T4F, although not patognomonic
Coarctation of Ao
Turner syndr; mid upper back systolic murmur, BP difference between arms and legs
VSD
MC congenital cardiac defect; muscular type is the one that has the greater cahnce of closing by itself before 2 yo, but rarely after 4 yo; fetal alcohol syndr, TORCH, Down syndr
Necrotizing enterocolitis
premature, fever, rectal bleeding, air in bowel wall; Rx = NPO, gastric tube, IV fluids, atbtcs
Cystic fibrosis
meconium ileus, rectal prolapse
Kernicterus
increased unconjugated bilirubin, depoists into the basal ganglia, poor feeding, seizures, flaccidity, opisthotonus, apnea deficiency
Breast milk jaundice
peak at 2-3 w; Rx = temporary bottle feeding
Increased unconjugated bilirubin
Criggler-Najar dis., Gilbert dis.
Increased conjugated bilirubin
Rotor, Dubin-Johnson dis.
Sulfa in neonates
displace bilirubin from albumin, leads to kernicterus
Exchange transfusion
unconjugated bilirubin >20 mg/dl + failed phototherapy
MC primary immunodeficiency
Ig A deficiency: respiratory and GI infections; avoid giving Ig (anti IgA antibodies)
Bruton agammaglobulinemia
6 mo, lung + sinus infections; Streptococcus, Haemophilus
Wiskott-Aldrich syndr.
+ boy, eczema + thrombocytopenia + resp. infections
Chediak-Higashi syndr.
giant granules in neutrophils + oculocutaneous albinism
Complement defic. (C5-9)
recurrent Neisserial infections
Chr. mucocutaneous candidiasis
often associated with hypothyroidism
Osteosarcoma
10-20 yo, about the knee, "sunburst" on X-ray
Job-Buckley syndr
intense increase in IgE, recurrent Staph infections; fair skin, red hair, eczema
Unicameral bone cyst
expansile, lytic, prox. portion of humerus
Bitot spots (debris in conjunctiva)
vit A
Vit A toxicity
pseudotu cerebri, bone thickening, teratogenicity
Vit. E defic.
anemia, peripheral neuropathy, ataxia
Give vit. A for
patients with measles
Give vit. E for
Alzheimer's patients
Give vit C for
iron deficiency anemia (increases absorption of Fe; calcium decreases it)
Vit K toxicity
hemolysis (kernicterus)
Vit. B6 defic. and toxicity both manifest as
peripheral neuropathy
Vit. B12 (cobalamin) defic.
megaloblastic anemia + neurologic symptoms
Folic acid defic.
megaloblastic anemia
Bone pain in vit C defic
periosteal hemorrhages
Wernicke/Korsakoff syndr
vit B1 deficiency (thiamine); never give glucose before thiamine for an alcoholic in the ER
Manganese toxicity
"manganese madness"in miners of ore
Chromium deficiency
impaired glucose tolerance
Removal of the ileum, tapeworm Diphylobothrium latum
B12 defic.
MCC of vit. B12 defic.
pernicious anemia
Pernitious anemia association
vitiligo, hypothyroidism, hypoadrenalism
Liver failure + increase in PT Rx
fresh frozen plasma
Rubella vaccine
NOT for immunocompromised patients (except for HIV), if given to a woman and she gets pregnant in the first three months after, abortion is NOT indicated, chances are nothing bad will happen to the fetus
Mean
average value
Median
middle value
Mode
MC value
Brain death with confounding medical dis.
needs additional confirmatory test
Tardive dyskinesia Rx
switch anitipsychotic to clozapine
Ac. dystonia, parkinsonism as S.E. Rx
diphenhydramine, trihexyphenidyl, benztropine
Akathisia Rx
betablockers
Neuroleptic malignant syndrome, malignant hyperthermia Rx
dantrolene
Thioridazine S.E.
retinal pigment deposits
Chlorpromazine S.E.
jaundice, photosensitivity
P. aeruginosa bacteremia Rx
tobramycin or amikacin + piperacillin OR ceftazidime OR cefepime
Ecthyma gangrenosum Rx
IV atbtc (not debridement)
Cryptococcal meningitis Dx
+ india ink preparation; Rx = amphotericin B + flucytosine 10-14 d, then fluconasole prophylaxis forever (for HIV); may require repeated lumbar punctures to decrease the pressure
Phenytoin toxicity
nystagmus on far lateral gaze, neurotoxicity; remember that it decreases the OCP levels in the blood
Catheter-related syst. infection
removal + vancomycin + gentamycin
Vertebral osteomyelitis Dx
MRI is the most accurate, bone Bx is the gold standard
Meningococcal meningitis prophylaxis
oral rifampin OR S.D. oral ciprofloxacin OR S.D. IM veftriaxone
IV pentamidine S.E.
metabolic disturbances, such as hypoglycemia (always check in case of seizure)
Herpes zoster Rx
acyclovir within 48 h of onset of rash
Candida ophtalmitis with vitreal involvement Rx
vitrectomy + systemic antifungal
Hypothermia or shock post blood transfusion
think hypocalcemia!
HIV prophylaxis post exposure
zidovudine + lamivudine for 4 w
Lungs + sinuses infections post bone marrow transplant
invasive aspergillosis
Rhinocerebral mucormicosis Rx
surgical debridement + IV amphotericin B
MCC of FUO
infection (30-40%)
Progressive multifocal leucoencephalopathy (JC)
multiple focal neuro symptoms in HIV patient
Shoulder dystocia Rx
stop pushing, suprapubic pressure, McRobert's maneuver
McRobert's maneuver
two assistants flexing thighs back against abd.
Zavanelli maneuver
replace fetal head back into the pelvis, but then you have only 7 minutes to perform the c-section
ARDS
clear lungs + diffuse bilat. infiltrates on CXR; Rx = PEEP around 9, high O2 concentration, low tidal volume (<6 ml/kg)
Neonatal polycythemia Rx
hydration + partial exchange transfusion
Mendelson's syndrome
aspiration pneumonitis
Ac. tubular necrosis
after prerenal azotemia; muddy brown casts in urinalysis; increased BUN and creatinine, anion gap acidosis
Hemosiderin laden macrophages
Wegener's, Goodpasture's
Heparin induced thrombocytopenia Rx
suspend it, lepirudin or argatroban; prevention = use low molecular heparin instead, or limit the use to a maximum of 5 days
Ascities fluid analysis
serum-ascitic fluid albumin gradient (SAAG) - if >1.1 g/dl = cirrhosis, CHF; if <1.1 = ca, pancreatitis, nephrotic syndrome, tuberculosis
Ac. compartment syndr. complication
rhabdomyolisis that may lead to ARF; Dx = pressure > 30 mmHg; Rx = emergent fasciotomy
Mental status change in the elderly
meds, infection, metabolic, thyroid dis.
Metastasis prostate ca Rx
leuprolide (LHRH agonist) + flutamide (antiandrogen)
Octreotide
somatostin analog, for bleeding esophageal varices
Active lower GI bledding
STAT colonoscopy or radionuclide scan
Ac. hemolytic transfusion reaction Rx
stop it and hydrate!
Metronidazole
contraindicated for breastfeeding women
Postpartum endometritis Rx
clindamycin + gentamicin
Infant botulism Rx
supportive care, human derived botulin antitoxin; expect 1-3 m of hospitalization and full recovery
Febrile transfusion reaction avoidance
washed cells
Pre-angiography
discontinue metformin to avoid renal complications and acidosis
Hypocalcemia
hyperactive DTRs
Hypermagnesemia
loss of DTRs
Condyloma acuminata
vaginal delivery is OK!
Transurethral resection of the prostate S.E.
hyponatremia = twitching, seizures
Stress ulcer prevention
oral PPI suspension
Erb's palsy association
diaphragmatic paralysis
Torsades de points with instability
unsynchronized cardioversion, then, IV magnesium sulfate, then temporary transvenous overdrive pacemaker (in this orden, according to necessity)
MCC of CAH
21-hydrolase enzyme defic. (increased 17-alpha-hydroxyprogesterone)
11-hydroxilase defic.
HTN, hypernatremia, hypokalemia, due to the increase in 11deoxycorticosterone, which is a mineralocorticoid
Classic dashboard injury (car accident)
post. cruciate ligament lesion
Mechanical valves INR goal
2.5-3.5
Cimetidine, trimethoprim S.E.
decrease clearance of creatinine
ITP in adults Rx
corticosteroids, then IV Ig, then splenectomy (rarely needed)
Hyperhomocysteinemia Rx
folic acid
Borderline personality dis. Rx
dialectical behaviour therapy
RSV Dx
detection of RSV Ag in nasal/pulm secretions by ELISA
Sudden hyperglycemia + total parenteral nutrition
sepsis
Hashimoto's thyroiditis association
thyroid lymphoma
Chr. recurrent pancreatitis complication
isolated gastric varices
Doxorubicin use
serial radionuclide ventriculography or MUGA is used to evaluate cardiotoxicity
Hospice care
life expectancy < 6 m
DM screening
45 yo, q3y if no risk factor
Chlordiazepoxide
Rx of alcohol withdrawal
Ceftriaxone S.E.
increase in both types of bilirubin
CIN 1
repeat pap smear in 6 m
Wernicke's encephalopathy
confusion + ataxia + nystagmus (ophtalmoplegia)
Korsakoff's psychosis
may happen as a consequence of giving glucose before thiamine; confabulation (creating a story to fill the gap in memory); mamilory bodies changes
Multiple sclerosis suspicion
MRI brain and spine; Rx (acutely) = steroids; to prevent relapsing = interferon OR glatiramer (remember they are both teratogenic); repeat MRI in 3 months
Increased bleeding time Rx
IV desmopressin (e.g. renal failure)
Isotretinoin, minocycline S.E.
pseudotu cerebri
MC scaphoid fracture complication
nonunion
Orthostatic hypotension
decrease by 20 mmHg in syst BP OR 10 mmHg in dyast BP
Thiazides, amiodarone, sulfa S.E.
photosensitivity
Increase in fibrinogen happens with use of
lovastatin, atorvastatin, pravastatin, simvastatin
Ac. Ao dissection HTN Rx
IV betablockers + nitroprussiate
Dipyridamole, adenosyne
C.I. in asthma or COPD
Antenatal corticosteroid therapy
24-34 w = IM bethametasone, dexamethasone
50 mg oral glucose challenge >140
do a 100 mg OGTT with 3 h measurement
Glucose in pregnancy goals
fasting 60-90, postprandial < 120
TMP-SMX
NOT in first and third trimester
Pyelonephritis + pregnancy Rx
IV ceftriaxone OR ampicillin + gentamycin
Condyloma acuminata in mucosa or pregnancy Rx
trichloroacetic acid
Severe PID Rx
IV cefoxitin/ceftriaxone + IV doxycycline
Next day pill
levonorgestrel (up to 120 h after)
Cystic fibrosis infertility
95% for men, 20% for women
Hyperthyroidism + pregnancy Dx
free T4, total T4, TSH
Pap smear screening
3 y after first intercourse or 18 yo
Hypothyroidism in pregnincy
dose of L-thyroxine needs to be increased (increased thyroglobulin)
Pessaries (+ vaginal estrogen)
structures to support the vagina walls
ASCUS Dx next step
HPV DNA testing, then colposcopy if necessary