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100 Cards in this Set
- Front
- Back
drug of choice to control BP in DM
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ACE inhibitors
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trastuzumab (Herceptin)
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a HER2 monoclonal Ab used to treat HER2 positive breast CA
it is cardiotoxic, so an EKG is recommended prior to starting |
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medication that alleviates pulmonary HTN the fastest
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nitroglycerin, though not used for long term therapy
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drugs that can induce pancreatitis
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diuretics: thiazides, loops
IBS: 5-ASA, sulfasalazine seizure: valproic acid AIDS: didanosine, pentamidine antibiotics: metro, tetracycline |
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standing increases what murmur?
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stand for the MVP
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what do you do if suspecting squamous cell carcinoma lesion?
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punch biopsy for dx
if positive then wide surgical excision if surgery fails, then radio or chemo can be used |
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cat scratch disease
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caused by Bartonella henselae
s/s are local vescular red papular and or nodules with localized regional tender lymphadenopathy treat with oral azithromycin |
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sarcoidosis s/s
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hilar andenopathy and reticular opacities on CXR, erythema nodosum, anterior uveitis, arthritis
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allergic rhinitis vs infectious rhinitis
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nasal smear for eosinophils
eosinophilia seen in allergic rhinitis, nasal polyposis (with ASA sens) |
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a useful indicator of dehydration on lab tests
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a increased BUN/Cr ratio
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NASH
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non-alcoholic steatohepatitis ;risks are obesity, DM, HLD, TPN
due to impaired insulin response leading to fatty liver pathology is macrovescicular steatosis with PMN infiltrates and necrosis |
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Xray features of OA
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joint space narrowing, subchondral sclerosis, and osteophytes in the MCP and DIP
the PIP is often spared |
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contraction alkalosis
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seen with volume depletion, the RAAS system is upreg to conserve more water at the expense of H+ and K+, so you become alkalotic and hypokalemic
correct with IV NS and K supplimentation |
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HIV pt with painful swallowing
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MCC is candidial infx, so treat empirically with oral fluconazole
failure to respond in 3-5 warrants esophagoscopy with biopsy, cytology, and culture to see if it is HSV or CMV |
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s/s of viral arthritis
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symmetric arthritis
distinguish from RA because viral is acute, lacks iflammatory markers and s/s, and resolves in 2 months |
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pt with meningococcal meningitis
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if they refuse to hosp and isolated, they will be held against their will to prevent spread in the community
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use of 2-sample t test
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to compare the means of two groups
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use of ANOVA
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ANOVA is the analysis of variance
used to compare 3 or more means |
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use of chi-squared test
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to compare proportions of data to each other
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mgmt of diabetic gastroparesis
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improve glycemic control, small and freq meals, and promotility drugs, like metoclopramide, bethanechol, and erythromycin
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treatment of v-tach
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if stable, use IV amiodarone or lidocaine
if unstable use cardioversion |
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pain control in cancer pts
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start with non-narcotics, but if needed, use short acting morphine then titrate narcotics to contorl pain
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heterophile pos infectious mono
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EBV, but may be negative early in the illness
s/s are fatique, malaise, sore throat, mac/pap rash, and post cervical LN, splenomegaly is common |
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dx of DKA
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blood glucose > 250
pH < 7.3 serum bicarb < 15 |
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DEXA recommendations
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women > 65 or >60 with risk factors (poor Ca, smoking, steroid, alcohol, low BMI, post-menopause)
DEXA -1.5 to -2.5 is osteopenia DEXA < -2.5 is osteoporosis |
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DEXA of -1.5 to -2.5
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osteopenia
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DEXA < -2.5
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osteoporosis
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colonoscopy recommendations
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start at 50, then every 10 years unless polyps are seen
if polyps are seen, repeat every 3-5 years |
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amiodarone and lung disease
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amiodarone can cause pulmonary tox like interstitial pneumonitis, organizing pneumonia, and ARDS
so avoid in pts with preexisting lung disease |
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cauda equina syndrome (CES)
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acute compression with acute motor and sens loss, loss of rectal tone, and urinary retention
it is a surgical emergency does NOT have to be related to trauma, as it can occur in men with prostate cancer mets to vet column |
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HCM
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hypertrophic cardiomyopathy murmur is harsh systolic at left lower sternal border and decreases with valsalva
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MCC of hypercoag disorder
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Factor V Leiden
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treatment of cocaine induced cardiac ischemia
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benzos, nitrates, and aspirin
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AIDS HSV retinitis
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painful keratitis with peripheral pale lesions and central retinal necrosis
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AIDS CMV retinitis
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painless retinal vessel hemorrhages or fluffy granular lesions
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difference in AIDS retinitis by HSV and CMV
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HSV: painful keratitis with peripheral pale lesions and central retinal necrosis
CMV: painless retinal vessel hemorrhages or fluffy granular lesions, usually without keratitis or conjunctivitis |
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steps in mgmt of esophageal variceal bleeding
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1st establish 2 large bore IVs or central line ;control bleeding with endoscopic sclerotherapy or meds like octreotide or somatostatin
if ineffective, use balloon tamponade |
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recurrent pneumonia in same anatomic location
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red flag for cancer, do a chest CT
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treatment for adjustment disorder
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CBT or psychodynamic psychotherapy
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MCC of symptomatic PE
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proximal deep leg veins
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exam for newly dx cirrhosis
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screening endoscopy to detect esoph varices
if found, beta-blockers have been show to decrease risk of hemorrhage |
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what do do about small, rubbery LNs
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if pt is asymptomatic and LN is less than 2cm, just observe
if over 2 cm or pt is symptomatic, biopsy |
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susceptibility bias
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selection bias where disease severity is used to select the treatment regimen
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HIV prophylaxis
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if CD4 < 100, give TMP-SMX or pentamidine for PCP
if CD < 50, give azithro or clarithromycin for MAC prevention |
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beta blocker antidote
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atropine and IV fluids 1st, if no improvement in BP give glucagon
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classic radio findings in osteosarcoma
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Codman's triangle and a sunburst appearance
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disseminated histoplasmosis s/s and dx
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seen in HIV with CD < 100, s/s are fever, weight loss, N/V, cough, SOB, lymphadenopathy
dx with antigen in the urine or serum treat with itraconazole |
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treatment of disseminated histoplasmosis
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itraconazole
it is better than fluconazole which is only used if the pt can not tolerate itraconazole |
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nerve damage in diabetic neuropathy is caused by what?
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ischemic damage
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dx of urinary retention
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more than 50mL postvoid residual bladder volume
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meds that slow the decline in Alzheimers
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reversible anticholinesterase inhibitors like dozepezil, rivastigmine
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features, cause, tx of drug-induced interstitial nephritis
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fever, rash, arthralgias, hematuria, sterile pyuria, and eosinophiluria
caused by cephalosporins, PCNs, sulfonamides, NSAIDS, rifampin, phenytoin, allopurinol treatment is to stop the offending drug |
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Wegner's granulomatosis
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has airway and glomerular involvement, and systemic vasculitis that can show as tender nodules, palpable pupura, or ulcerations
dx with c-ANA and elevated CRP treat with cyclophosphamide |
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contraindications for bupropion
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seizure or eating disorder, or things that predispose to seizures like EtOH or benzo use
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malignant melanoma mets
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can go ANYWHERE
brain mets are notorious for intracranial bleeding |
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years for screening for HBV and HCV s/p transfusions
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screen for HCV if transfused prior to 1992
screen for HBV is transfused prior to 1986 |
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problem with heparin
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HIT (heparin induced thrombocytopenia)
it is a prothrombotic syndrome leading to arterial and venous clots treatment is d/c of heparin and start direct thrombin inhibitor like lepirudin or argatroban |
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invasive aspergillosis
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usually in immunocomp pts wtih fever, cough, dyspnea, or hemptysis
the cavitary lesion will show pulmonary lesions with a halo sign or air crecent on a chest CT |
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treatment of ascites
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1. Na and water restriction
2. spironolactone 3. loop diuretic 4. paracentesis of 2 to 4 L/day as long as renal function is perserved |
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known risk factors for pancreatic CA
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family Hx, chronic pancreatitis, smoking, DM, obesity, and a high fat diet
NOTE: alcohol is NOT a proven risk factor |
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HIV pt with bloody diarrhea, suspect what?
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CMV colitis
colonoscopy will show mulitple ulcers adn mucosal srosions treat with ganciclovir, 2nd line is foscarnet |
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how to dx OSA
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obstructive sleep apnea is charact by snoring, daytime sleepiness and apneic episodes
increases risk for HTN, heart disease, cor pulmonale ;;dx with nocturnal polysomnography |
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coag change in nephrotic syndrome
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become hypercoag due to urinary loss of ATIII, altered lvls of protein C and S
renel vein thrombosis is most freq manifestation |
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nephrotic syndrome charact
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proteinuria > 3.5g/day
hypoalbuminemia edema hyperlipidemia |
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meds that can shift K into cells
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insulin, glucose, Na bicarb, and beta 2 agonist
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TCA overdose
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CNS depression, hypotension, dilated pupils, hyperthermia, intestinal ileua, QRS elongation
treat by ABCs then administer NaBicarb |
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MEN 2a
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from the RET gene and is autosome dominatnt
has medullary thyroid CA, pheochromo, and primary parathyroid hyperplasia |
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MEN 2b
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from the RET gene and is autosom dominant
has medullary thyroid CA, pheochromo, and mucosal neuromas |
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SE of high dose Beta2 agonist in asthma treatment
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the beta2 can push K into cells, so high doses can lead to hypokalemia that manifest as muscle weakness, arrhythmias and EKG abnormalities
other SE of beta agonists include tremor, palpitations, and headache |
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MCC of cirrhosis
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chronic alcohol abuse and viral hepatits
suspect and question both in pt with new ascites and pedal edema |
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thrombocytopenia in HIV
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thrombocytopenia is the initial presentation of HIV in upto 10% of pts, so a generally healthy pt with no other findings except for thrombocytopenia should be screen for HIV first.
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heart sound heard in the setting of acute MI
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ischemic damage from MI can lead to diastolic dysfunction and a stiffened ventricle, leading to an atrial gallop heard as an S4
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SE to look for in beta blockers
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in susceptible people, like asthamics, beta blockers can cause bronchoconstriction and cause wheezing and dyspnea
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what to do with new diastolic and continuous murmurs
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investigate with echo ;also investigate loud systoloc murmrs
midsystolic murmurs in asymptomatic young pts need no further workup |
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aspirin sensitivity syndrome
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people with susceptibility have a psuedo-allergic rxn with aspirin and can present with bronchoconstriction and nasal polyps
this is due to accumulation of leukotrienes treat with avoidance of NAIDS and use leukotriene receptor antagonists |
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testing to be done in person with rapidly progressing virilization
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sugestive of hyperandrogenism, test serum testosterone and DHEAS
elevated testosterone with normal DHEAS indicates ovarian source elevated DHEAS with normal testosterone indicates adrenal source |
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desired pO2 in ARDS on vent
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50-60%
this is adjusted by adjusting the FiO2 |
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factorial study design
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study that randomizes different interventions by looking at least 2 variables
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Bartter's syndrome
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seen as hypokalemia, metabolic alkalosis, normal BP, and elevated urine chloride conc
caused by defect in Na reabsorption in the thick ascending loop |
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increased BP with renal bruit
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renal artery stenosis
in older pt it is due to athromatous plaque in younger pt it is caused by fibromuscular dysplais treatment is percutaneous angioplasty with stent placement |
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risk of IV acyclovir
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as used in HCV encephalitits, it can crystallize in the urine
treatment is aggressive IV hydration that will help increase the solubility |
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serous otitis media
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no infection present, due to middle ear effusion from obstructing lymphadenopathy
exam will show dull TM that is hypomobile |
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renal disorders
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x
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type 4 RTA
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x
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cerviofacial actinomycosis
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indurated mass with multiple abscesses and draining tracts with sulfur granules
treatment is high dose IV PCN for 6-12 weeks |
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tangential vs circumstantial thought process
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seen with disorganized schizos,
tangential will leave topic totally circumstantial will leave topic but eventually return |
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Osler-Weber-Rendu syndrome
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autosomal dominant disorder with diffuse telangiectasias, recurrent epistaxis, and AVMs
the AVMs lead to hemoptysis and increased HCT |
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what to do first with high suspicion of PE
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start heparin protocol 1st
imaging can wait |
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drug of choice for inpt CAP
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levoflozacin or moxifloxacin
cipro does not have that good coverage for inpt, use aithro or doxy |
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what can soften S1 s/p MI
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mitral regurg due to papillary muscle rupture
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cosyntropin
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an analog of ACTH used for stimulation screening test in suspected primary adrenal insufficiency (Addison's)
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s/s of cerebellar hemorrhage
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ataxia, n/v, occitpital HA, gaze palsy, and facial weakness
NOTE: there is NO hemiparesis |
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treatment of sarcoidosis
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if symptomatic, treat with glucocorticoids
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MCC of painless hematuria in adults
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bladder cancer
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indications for hypothyroid test on lab results
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HLD, hypoNa, and elevated serum muscle enzymes
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what happens to lipids in hypothyroid pts
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hyperlipidiemia, often increase in LDL but can also have an increase in tri's
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what to look for in pt with increased PaCO2
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alveolar hypoventilation
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viral arthritis
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symmetric small joint inflam arthritis that usually resolves in 2 months
note that RA can be pos and ANA can be weakly positive treat with NSAIDS |
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formula to correct Ca lvl with albumin values
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corrected Ca = 0.8(normal albumin - measured albumin) + measured Ca
4.0 is used for normal albumin, so formula is: Corr Ca = 0.8(4-albumin)+Ca |
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TCA overdose and the QRS
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TCAs can prolong the QRS and lead to arrythmia
giving NaBicarb will increase the extracellular Na conc leading to shortening of the QRS |