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574 Cards in this Set
- Front
- Back
Vit K dependent coagulation factors
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Factors 2, 7, 9 and 10
Protein C and S |
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Causes of high reticulocyte anemia
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# acute blood loss (trauma, GIB)
# hemolysis (destruction) |
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Causes of low retic count anemia
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Mirocytic/low MCV
# Iron deficiency # thalassemia # Anemia of chronic disease # Sideroblastic Anemia (usually hereditary) |
|
Causes of macrocytic anemia
|
# B12 deficiency
# folate deficiency # EtOH abuse # Liver dz # Myelodysplastic syndrome # sever hypothyroidism # acquire sideroblastic anemia # Drug effects |
|
Causes of Normocytic Anemia
|
# anemia of chronic dz
# anemia of renal failure # aplastic anemia # multiple myeloma # myelophthisis # hypothyroidism |
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Causes of sideroblastic anemia
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# EtOH abuse
# lead poisening # INH use # pyrodoxine deficiency |
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Iron deficiency anemia in patients with no apparent source of blood loss
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Celiac Dz
|
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Causes of B12 Deficiency
|
# Atrophic gastris (usually in elderly)
# Pernicious Anemia (will have anti-IF Ab) # Chrohn's Dz (no absorption in terminal ileum) # Blind intestinal loop syndrome (as in bacterial overgrowth which decreases the amount of B12 available for absorption) |
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Schilling Test
|
# Step 1: load body with IM B12 shot and ingestion of radioactive B12. Failure to renally excrete radioactive B12 means the body lacks absorption capacity
# Step 2: administer B12-IF together. Renal excretion of B12 here confirms lack of IF (pernicious anemia). Failure to excrete here suggests malabsorption # Step 3: if malabsorption dorrects after antibiotics, blind loop syndrom |
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Factors tested in PT
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Extrinsic p'way
- factor 7 and tissue factor-dependent) |
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Factors tested in aPTT
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Intrinsic p'way
- factors 8, 9, 11 and 12 and high molecular weight kininogen and prekallikrein. |
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Quick reversal of Warfarin anticoagulation
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Vitamin K SC
For more rapid reversal: FFP (contains all needed factors) |
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Indications for platelet transfusions
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Thrombocytopenia and active bleeding present or if a procedure is planned
|
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Longterm treatment for ITP
|
1. Prednisone 1 mg/kg/day
2. IVIG (temporary solution in patients who do not respond to Prednisone) 3. Splenectomy if thrombocytopenia recurs after steroids are withdrawn) 4. Retuximab (+/- anti-CD20 monoclonal Ab) |
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Treatment for uremia-related thrombocytopenia
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dDAVP (only for several hours)
|
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Treatment for quantitative defect in vWD (type 1)
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Intranasal dDAVP
|
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Types of animals that warrant post-exposure rabies ppx
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1. Bats
2. wild carnivores (raccoons, skunks and foxes, etc.) 3. any animal suspected of being rabid |
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Example of dihydropyridine Ca-channel antagonists and common side effect and
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Amlodipine, peripheral edema
|
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Right sided holosystolic murmur that increases with inspiration
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Tricuspid regurg
|
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Common cause of endocarditis in IVDUs and tx
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Staph Aureus, including MRSA
Vancomycin |
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Tickborne illness w/o rash
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Ehrlichiosis
|
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Endemic area for ehrlichiosis
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Southeastern
South Central Upper Mid-West Mid-Atlantic California |
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Treatment for Ehrlichiosis
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Empiric Doxycycline
|
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Correlation coefficient
|
shows the strength and direction of linear assocciate b/w 2 variables, between -1 and 1.
Closer to either extreme is stronger association |
|
Renal insufficiency, microscopic hematuria and/or RBC casts
+ Upper and Lower respiratory tract disease |
Wegener's granulomatosis
|
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c-ANCA positivity
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Wegener's granulomatosis
|
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Sx of gout + pruritis a/w hot baths
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Myeloproliferative d/os cause gout b/c of elevated production of uric acid
Polycythemia vera causes itchiness with hot baths because of histamine released from an increased number of circulated basophils |
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Treatment for idiopathic benign intracranial hypertension
|
Acetazolamide
|
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Anorexia, fatigue, GI complaints, weight loss and hypotension
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Adrenal insufficiency
|
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Electrolyte disturbances commonly a/w adrenal insufficiency
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MC: hyponatremia followed by hyperkalemia
|
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Abrupt onset of fever + impaired mental status w/o meningeal signs
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HSV encephalitis
|
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Insensate, hypopigmented patch of skin a/w signs of peripheral nerve damage (muscle atrophy, e.g.)
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Leprosy (Mycobacterium leprae)
|
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First line DMARD in RA
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MTX
|
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Hemolytic anemia and thrombocytopenia and next diagnostic step
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TTP and Peripheral smear looking for schistocytes
|
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Palpable purpura in adults with HSM, proteinuria, hematuria and systemic symptoms
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cyoglobulinemia
|
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Indications for anticoagulation therapy in pts with atrial fibrillation
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Based on CHADS2 score:
# 0, just aspirin # > 2, warfarin # 1-2 asprin or warfarin |
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Most common cause of ring enhancing lesions on CT in an AIDS pt and treatment
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toxplasmosis
sulfadiazine and pyrimethamine |
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bilateral loss of central vision in pts over 50
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age-related macular degeneration
|
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HTN, bilateral palpable abdominal masses and microhematuria
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Autosomal Dominant Polycystic Kidney Dz (ADPKD)
|
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MC extrarenal manifestation of ADPKD
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Hepatic cysts, but watch out for berry aneurysms
|
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Pt with a pmh of joint pain/swelling, and DM who p/w low libido and lethargy and who has hepatomegaly and testicular atrophy on exam
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Hereditary hemochromatosis
Systemic dz that can cause cirrhosis, pancreatic fibrosis (DM) and increased skin pigmentation (bronze diabetes) |
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+ Pronator drift
|
UMN lesion, think stroke
|
|
Location of CNS lesion:
Unilateral motor hemiparesis of face, arm and leg without any higher cortical dysfunction and visual field abnormalities |
Posterior limb of internal capsule
|
|
Location of CNS lesion:
right-sided hemiplegia, leftward eye deviation, hemianesthesia, hononymous hemianopia and aphasia |
Left MCA occlusion
|
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Location of CNS lesion:
Left-sided hemiplegia, rightward eye deviation, hemianesthesia, hononymous hemianopia and hemineglect |
Right MCA occlusion
|
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UC or CD: anywhere from mouth to anus
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CD
|
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Location of CNS lesion:
unilateral weakness that predominantly affects the lower extremity, abulia, akinetic mutism, emotional disturbances, contralateral deviation of the head and eyes, sphincter incontinence |
ACA occulsion
|
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UC or CD: rectal sparing
|
CD
|
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Location of CNS lesion:
unilateral hemiplegia and contralateral cranial nerve involvement |
vertebrobasilar system
|
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Stepwise approach of the tx of ascites
|
1. Na and water restriction
2. Spironolactone 3. Furosemide 4. Paracentesis |
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UC or CD: perianal dz (skin tags, anal fissures, perirectal abscesses and anorectal fistulae)
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CD
|
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Neurological sx + Systemic systems + cardiac murmur and a mass on echo
|
Atrial Myxoma
|
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UC or CD: Skip lesions
|
CD
area of normal mucosa with focal ulcerations interspersed ("skip lesions") |
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Dimensions of postive PPD in HIV pt and management
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> 5 mm, required Tb ppx with INH and pyridoxine (for INH-induced neuropathy) for 9 months
|
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Type of Seizure:
# brief periods of impaired consciousness +/- automatisms # no post-ictal state # Hyperventilation produces EEG changes (slow spike-and-wave pattern) |
typical absence seizure
|
|
Type of Seizure:
# longer periods of impaired consciousness # no post-ictal state # hyperventilation produces EEG changes (faster spike-and-wave changes) |
atypical absence seizure
|
|
Type of Seizure:
# adolescent # unilateral or bilateral myoclonic jerks # usually in mornings and may be precipitated by sleep deprivation |
Juvenile myoclonic epilepsy
|
|
Type of Seizure:
# childhood seizures # impaired cognitive function # slow spike-and-wave activity on EEG |
Lennox-Gestaut syndrome
|
|
Type of Seizure:
# brief episodes of impaired consciousness # staring spells, automatisms # positive post-ictal state # no EEG changes |
Complex partial seizures
|
|
Absolute indications for dialysis
|
1. fluid overload refractory to medical management
2. hyperkalemia refractory to medical management 3. uremic pericarditis 4. refractory metabolic acidosis 5. Uremic encephalopathy or neuropathy 6. Coagulopathy due to renal failure |
|
Contraindications to hemodialysis
|
1. debilitating chronic disease
2. severe irreversible dementia |
|
Elderly person with uncontrolled DM who presents with ear pain and drainage with visible granulation tissue in the ear canal and treatment
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Malignant Otitis Media caused by Pseudomonas aeruginosa
Tx: Cipro |
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1st step in a work up of a thyroid nodule
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TSH, if low -> radioisotope scan; if normal or high -> diagnostic US
|
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HA, visual problems and sexual dysfunction
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Craniopharyngioma- the sexual dysfunction should be part of hypopituitarism
|
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Drug of choice in stable angina and HTN
|
Beta blocker
|
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Abs suggestive of celiac dz
|
1. IgA Ab to gliadin (ELISA
2. IgA Ab to endomysium (IF) 3. Ab to tissue transglutaminase |
|
Anti-Scl-70
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Scleroderma
|
|
Anti-centromeric Ab
|
Crest syndrome
|
|
Anti-mitochondrial Ab
|
PBC
|
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Testing for EBV
|
1. heterophile Ab test
2. anti-EBV Ab |
|
Anti-centromeric Ab
|
Crest syndrome
|
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Anti-mitochondrial Ab
|
PBC
|
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Malabsorption + Fe deficiency anemia
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Celiac Dz
|
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Testing for EBV
|
1. heterophile Ab test
2. anti-EBV Ab |
|
HA, vision changes, n/v, changes in awareness and/or focal neurologic deficits, HTN and bradycardia
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Intracranial HTN (ICH)
HTN + Bradycardia = Cushing's reflex |
|
Way to monitor recovery in DKA
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Arterial pH or anion gap
|
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Guidelines for screening for AAA
|
One-time abdominal US in male pts 65-75 who are former or active smokers
|
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pain and stiffness of the shoulders and pelvic girdle with an elevated ESR
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Polymyalgia Reumatica (PMR)
|
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UC or CD: nicotiene decreases risk
|
UC
|
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Symmetric proximal muscle weakness and mild pain with an elevated CK
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Plolymyositis
|
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UC or CD: bloody diarrhea more common
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UC
|
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Joint pain w/o swelling + fatigue + IBS and depression without radiographic or lab abnormalities
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Fibromyalgia
|
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UC or CD: inflammation of all layers of bowel
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CD
|
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Pathogenesis of hepatic encephalopathy
|
# Accumulation of ammonia in blood
# production of false neurotransmitters # increased sensitivity of the CNS to inhibitory NTs like GABA # Zinc deficiency |
|
Precipitating factors for hepatic encephalopathy
|
# high protein diet
# diuretic tx # extensive GIB # narcotis, hypnotics and sedatives # Extensive paracentesis # portocaval shunts |
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Condition to ppx against in HIV pt with CD4 count < 100 and ppx measure
|
Toxoplasmosis and PCP
Bactrim (Dapsone is an alternative agent for PCP PPX) |
|
Condition to ppx against in HIV pt with CD4 count < 50
|
MAC and CMV (if also have a positive CMV IgG or bx positive for CMV)
Azithromycin and Gancyclovir |
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Individuals for whom a PPD > 5 mm is positive
|
1. HIV + pts
2. recent contact with TB+ person 3. Individuals with signs of TB on CXR 4. Organ transplant pts or pts on immunosuppression |
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Individuals for whom a PPD > 10 mm is positive
|
1. pts who emigrated from endemic area for TB
2. IVDUs 3. Residents/employees in high-risk settings 4. Pts with DM, CKD, hematologic malignancy or fibrotic lung dz 5. Children < 4 yo or teens exposed to hi-risk adults |
|
Individuals for whom a PPD > 15 mm is positive
|
healthy ppl with no risk factors for TB
|
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Management for pt with + PPD, but no evidence of active TB on CXR
|
INH for 6 mo
INH + pyridoxine for 6 mo |
|
MC vaccine preventable disease among travelers
|
Hep A
|
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Tx for mild manifestation of a drug allergy
|
Anti-histamines and discontinuing the offending agent and
|
|
Appearance of elevated K on EKG
|
1. Peaked T waves
2. Lengthening of PR interval 3. Widening of QRS 4. Sine-wave |
|
Drugs that commonly cause hyerkalemia
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NSAIDS, ACEi, K-sparing diuretics (spironolactone or amiloride)
|
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Back pain, low-grade fever, elevated ESR +/- local tenderness on percussion over lower back and paravertebral muscle spasm
|
Vertebral Osteomyelitis
|
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Potential metabolic side effects of thiazide diuretics
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hyperglycemia, elevated LDL and TGs
|
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Potential electrolyte abnormalities caused by thiazide diuretics
|
hyponatremia, hypokalemia and hypercalcemia
|
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HSM, LAD, anemia, easy bruisability and an IgM spike on SPEP
|
Waldenstrom's Macroglobulinemia
|
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Signs of hyperthyroidism, low TSH, high T3 and T4, decreased iodine uptake on 24-hr uptake study and follicular atrophy on bx
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Factitious thyrotoxicosis
|
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Factors that increase cerebral blood flow and their mechanism
|
Hypercapnia, increased metabolic demand and hypoxia all work to increase intracranial vasodilation
|
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MC type of thyroid nodules
|
Benign colloid nodule
|
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Back pain + anemia + renal dysfunction + constipation + elevated ESR
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Multiple myeloma (the constipation is caused by hypercalcemia from bone lysis)
|
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Rhomboid shaped crystals
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Pseudogout
|
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Negatively birefringent crystals
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Gout
|
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Needle-shaped crystals
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Gout
|
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Positively birefringent crystals
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Pseudogout
|
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Radiographic evidence of chondrocalcinosis
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Pseudogout
|
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Material composing crystals in pseudogout
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Calcium pyrophosphate dehydrate (CPPD)
|
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Management of pts with BPH based on history and DRE
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Urinalysis and Serum creatinine to assess for UTI, obstruction and hematuria
|
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Mechanism of Action for metochlopramide and potential side effect
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Dopamine receptor antagonist and EPSs such as dystonia
|
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Gait in Parkinsonism: narrow-based or wide-based
|
narrow
|
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Exertional dyspnea, syncope and angina + systolic ejection murmur
|
Aortic Stenosis
|
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RBC casts
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Glomerular dz or vasculitis
|
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WBC casts
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Interstitial nephritis or pyelonephritis
|
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Muddy brown/granular casts
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ATN
|
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Fatty asts
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Nephrotic Syndrome
|
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Broad and waxy casts
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Chronic renal failure
|
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Young male with low back pain and restrictive pattern on PFTs
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Ankylosing Spondylitis
|
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FEV1/FVC ratio in restrictive dzs
|
> 80%
|
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Type of lung dz (restrictive or obstructive) and effect on FRC that may be seen in AS
|
Restrictive b/c of fusion of the costovertebral joints
FRC is usually normal or increased b/c the chest wall is fixed in an inspiratory position due to this fusion |
|
Classic tetrad of multiple myeloma
|
CRAB:
# Calcium (hypercalcemia-> constipation) # Renal impairment # Anemia # Bone (pain, lytic lesions, fxs) |
|
Findings on renal bx in pts with RA that have nephrotic syndrome
|
Apple Green birefringence 2/2 to amyloidosis
|
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Persistant cough, elevation of the left main-stem bronchus
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Mitral stenosis; think rheumatic fever
|
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PNA with weight loss and pleuritic chest pain +/- erythema multiforme, eythema nodosum and arthralgias after trip to Southwestern Us, Centra land South America
|
Coccidiodomycosis
|
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Acute pneumonia after trip to Southeastern, mid-Atlantic, and centrral US
|
Histoplasmosis
|
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PNA with hemoptysis, cavitary lesions on cxr, and lesions with halo sign on CT in an immunocompromised patient
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Invasive Aspergillosis
|
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Meningoencephalitis in HIV pts with CD4 count < 200
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Cryptococcus
|
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Lung, skin, bone, joints and prostate sx in an immunocompromised pt afte a trip to the south- central or north-central US
|
Blastomycosis
|
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When is the relative risk and the odds ratio approximately the same?
|
If the out-come is not common in the population
|
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Types of studies where it is possible to calculate Relative Risk
|
Case Series- where long-term follow up is conducted
|
|
Types of studies in which you can calculate an odds ratio
|
Case control studies
|
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Common complication of cardiac catheterization that causes elevated creatinine and discoloration of toes and abdominal tenderness
|
"Blue toe syndrome" caused by atheromatous emboli from dislodged cholesterol plaques
|
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Type of cancer a/w with pernicious anemia and amount of elevated risk
|
Gastric cancer; 2x relative risk of general pop
|
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Asx pt with microcytosis, mild anemia and target cells on peripheral smear
|
Alpha/Beta thalassemia minor
|
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Contraindication to succinylcholine use in rapid-sequence intubation and alternative induction agents
|
Pts at risks for hyperkalemia such as burn and crush injury patients and patients with prolonged demyelination like Guillain-Barre;
Vecuronium or rocuronium (non-depolarizing agents) |
|
Common risks of untreated hyperthyroidism
|
1. Bone loss (thyroid hormones increase osteoclastic activity)
2. Cardiac arrhythmias |
|
Bite cells and heinz bodies on peripheral smear
|
G6PD deficiency
|
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Spherocytes on peripheral smear and a positive Coombs test
|
Autoimmune hemolysis
|
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Hormone elevated specifically in adrenal tumor patienst
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Dihydroepiandrosterone-Sulfate (DHEA-S)
|
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AMS, focal neurological deficit, glucosuria, and dehydration: condition and pathogenesis of these sx
|
Non-Ketotic Hyperosmolar Syndrome (NKHS);
The glycosuria and dehydration is caused by severe hyperglycemia (> 600) and the AMS and focal neurological deficits are caused by hyperosmolality |
|
Neck pain, fever, limited neck mobility and inability to open the mouth normally (trismus) and treatment
|
Retropharyngeal Abscess treated with broad spectrum IV abx
|
|
Tense bullae with pruritus,and urticarial plaques and pathogenesis
|
Bullous pemphigoid
Autoimmune blistering caused by IgG against the hemidesmosome and activation of compliment cascade causing inflammation (IgG and C3 seen on IF) |
|
Way to decrease probability of developing a febrile, non-hemolytic transfustion reaction
|
Leukodepletion of the blood, such as by cell washing
|
|
Characterization of the bruit in RAS
|
systolic-diastolic abdominal bruit
|
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Attributable risk percent
|
ARP represents the excess risk in the exposed population that can be attributed to the risk factor
ARP = (RR-1)/RR |
|
HA, vision changes, n/v, changes in awareness and/or focal neurologic deficits, HTN and bradycardia
|
Intracranial HTN (ICH)
HTN + Bradycardia = Cushing's reflex |
|
Pruritic, elevated, serpiginous lesious on the skin often acquired after contact with sand
|
Cutaneous larva migrans
|
|
Lymphocytes with fine, hair-like irregular projections and a tartrate-resistant acid phosphatase (TRAP) stain with a dry BM bx and management
|
Hairy cell leukemia Cladribine (purine analog toxic to BM)
BM tap is dry because the the BM becomes fibrotic |
|
Varicoseles that fail to empty when the patient is recumbent
|
RCC
|
|
Polycythemia, thrombocytosis in a pt with hematuria and constitutional sx
|
RCC
|
|
Flank pain, hematuria and a palpable abdominal renal mass
|
RCC
|
|
Neurological deficits that can't be explained by a single lesion
|
Multiple sclerosis
|
|
Internuclear ophthalmoplegia
|
Think MS
|
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Fever, rash, acute renal dysfunction and eosinophiluria with WBC casts
|
Interstitial nephritis usually 2/2 drug reaction
|
|
PPX measures against Lyme disease
|
1. light colored clothing to be able to spot ticks on clothes before attaching
2. tucking pants into socks and long sleeve shirts 3. DEET and permethrin to clothes and DEET to exposed skin |
|
Acute, severe retroorbital pain that wakes the pat from sleep and may be a/w redness of the ipsilateral eye, tearing, stuffed or runny nose and ipsilateral Horner's and management
|
# cluster HA
# for acute attacke: 100% oxygen and SC sumatriptan # PPX: verapamil, lithium and ergotamine |
|
Approved Tx for ALS, MOA and benefit
|
Riluzole, glutamate inhibitor
may prolong survival and time to tracheostomy |
|
Acute severe anemia with absent reticulocytosis in sickle cell pts and offending agent
|
Aplastic crisis usually a/w infection the most common of which is Parvovirus B19
|
|
Mallory bodies on Liver bx
|
# alcohol liver injury
# Wilson's Dz |
|
Criteria for diagnosing ARDS
|
1. acute onset of respiratory distress in the setting of a predisposing condition (sepsis, PNA, aspiration, toxic ingestions, trauma and/or burns)
2. PaO2/FiO2 < 200 3. bilateral infiltrates on cxr 4. normal PCWP |
|
Predisposing conditions for ARDS
|
Sepsis
PNA aspiration toxic ingestions trauma burns |
|
Pulmonary renal syndrome for which emergent plasmapheresis is required
|
Goodpasture's syndrome
|
|
Regular, narrow QRS complex tachycardia w/o P waves, management
|
SVT, Adenosine is treatment of choice.
May also use carotid massage |
|
Wide QRS tachycardia
|
Amiodarone, lidocaine
|
|
Test that should be obtained before starting treatment with trastuzumab
|
Echo because of potential cardiotoxicity
|
|
Fever, hypotension and generalized erythema that desquemates
?? offending agent |
Toxic shock syndrome caused by exotoxin-producing strains of S. aureus sometimes a/w recent foreign body exposre such as nasal packing or tampon use
|
|
Location of stroke:
hemi-sensory loss with sever dysesthesia of the affected area |
Thalamic Stroke
This is called thalamic pain syndrome Eponym: Dejerine-Roussy syndrome |
|
Acute glaucoma: treatments, MOA and meds that should be avoided
|
1. Mannitol IV (first line, osmotic diuresis)
2. Acetazolamide (carbonic anhydrase inhibitor decreases aqueous humor production) 3. Pilocarpine topical (opens canals of Schlemm and allows drainage of acueous) 4. Timolol topical (decreases production of aqueous) AVID: mydriatics like atropine because it dilates the pupil and exacerbates glaucoma. |
|
Pt who presents with syncope and has elevated JVD, distant heart sounds and has enlargement of the cardiac silhouette in the setting of a recent URI
? Characteristic EKG findings and offending agent |
Pericardial effusion showing as electrical alternans on EKG caused by viral pericarditis
|
|
Managenet of febrile neutropenia
|
hosptial administration, blood samples for culture and IV ceftaz or cefepime for gram neg coverage particularly p. aeruginosa
|
|
Sudden loss of vision and onset of floaters and cause
|
Vitreous hemorrhage, MCC is diabetic retinopathy
|
|
Intensely pruritic and erythematous rash with vesicles at multiple areas of exposed skin
|
Contact dermatitis
|
|
Epidemiological parameter that is affected by disease prevalance
|
PPV and NPV. As the prevalence of the disease increases the PPV increases and the NPV decreases
|
|
Work-up for b/l brown nipple discharge that is guaiac negative
|
Galactorrhea
r/o pregnancy measure serum PRL and TSH +/- brain MRI to r/o prolactinoma |
|
Worrying conditions to monitor that are often a/w ADPCKD
|
Intracerebral aneurysms
|
|
# Skin lesion that evolves through vesicular, erythematous, and papular phases a/w localized and regional tender LAD
# offending agent # managmenet |
# cat scratch dz
# Bartonella henselae # 5d of azithromycin |
|
B/l gynecomastia and testicular nodule
|
Leydig cell tumor
|
|
Elevated serum levels in the following gonadal-associated tumors:
1. Choriocarcinoma 2. Seminoma 3. Yolk Sac tumor 4. Leydig cell tumor |
1. Estrogen
2. Beta-hCG 3. +/- beta-hCG 4. serum AFP |
|
Symmetric duskiness and coolness in all fingertips in ICU pt and other potential complications
|
# Vasospasm caused by pressors such as norepi in pts that already have reduced distal perfusion
# mesenteric ischemia, renal failure |
|
Epidemiological phenomenon when the effect of the main exposure on the outcome is modified by the level of another variable
|
Effect modification
|
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Firm, non-tender, solitary lymph node in head/neck area in an older person w/ significant smoking hx and managment
|
Likely SCC, needs prompt bx
|
|
Contraindications to AC tx in pts with a DVT
|
1. recent surgery
2. hemorrhagic stroke 3. bleeding diathesis 4. active bleeding |
|
Low back pain a/w leg pain that worsens with sitting and produces a positive straight leg raise test
|
Herniated disc
|
|
Low back pain a/w leg pain that improves with sitting or lying still and has a negative straight leg raise test
|
Lumbar spinal stenosis
|
|
Way to screen for and confirm the dx of Duchenne muscular dystropy
|
Screen: CK and aldolase are elevated
Confirm: muscle bx and genetic study (gold standard) |
|
Type of bilirubin that ends up in the urine
|
Conjugated
|
|
Syndrome in which an asymptomatic person p/w jaundice, scleral icterus and elevated urine bilirubin and management
|
Rotor syndrome- defect in hepatic storage of conjugated bili. Tx is unnecessary
|
|
Intermittent wide QRSs with bizarre morphology followed by a compensatory pause, management
|
1. PVCs
2. Even in a post-MT pt, no tx is necessary unless they are symptomatic -> beta blocker |
|
MOA of oseltamivir and indications for use
|
1. neuraminidase inhibitors
2. abrupt onset of fevers, chills, malaise, myalgias, cough and coryza last 48 hrs |
|
Areas of depigmentation in skin a/w no other sx, hypothesized pathagenesis, other associated condiations
|
1. Vitiligo
2. auto-immune attack against melanocytes 3. Other auto-immune dzs, particularly: pernicious anemia, auto-immune thyroid dz, DMI, primary adrenal insuff, hypopit, and allopecia areata |
|
Potential tx for fibromyalgia
|
TCAs (amitriptyline) or cyclobenzaprine
|
|
Wide based gait
|
Neurosyphilis or destruction of posterior columns
|
|
Festinating gait
|
Hurried, Parkinsonism
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Waddling gait
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Muscular dystrophy
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Ipsilateral ataxic gait
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Cerebellar tumor
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Gait in which one arm remains adducted and ipsilateral leg remains extended and is swung out in semi-circle
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Hemiparisis (stroke)
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EBV DNA in CSF
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Primary CNS lymphoma
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Solitary, weakly ring enhancing periventricular mass on MRI in HIV pt
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Primary CNS lymphoma
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Multiple ring-enhancing, spherical lesions on MRI in HIV pt
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Toxoplasmosis
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#Substance in stored RBCs that can cause e'lyte abnormalities
# abnormality it can cause # resulting sx # amount of RBCs needed to cause abnormality |
# citrate
# hypocalcemia and hypomagnesemia # paresthesias # > 1 blood volume in 24 hrs |
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Meaning of HbSAg
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indicated infectivity
|
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Meaning of HBsAb
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successful vaccination and indicates non-infectivitity/immunity
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Meaning of HBcAb
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Elevated IgM fraction is most specific marker for acute HBV
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Meaning of HBeAg
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If persistantly elevated for 3 months = chronic infection
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Sudden painless loss of monocular vision and management
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Central Retinal Artery Occlusions (CRAO) usually 2/2 embolism
# ocular massage and high-flow oxygen |
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Tx for kidney stones that are radiolucent in a pt with acidic urine
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Alkalinization wit potassium bicarb or potassium citrate
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Ppx and Treatment after a human bite wound and offending agents
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Amoxicillin-clavulinate for gram pos, gram neg and anaerobes
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Definition of saline responsive metabolic alkalosis
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Urine Cl < 20 mEq/L and hypovolemia or GI proton loss from vomiting
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Non-renal problems nephrotic syndrome puts people at higher risk for
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1. accelerated atherosclerosis
2. hypercoagulability Two together = increased risk for stroke and MI |
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Mechanism of dangerously high temp during exercise in extreme heat in a healthy individual
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Exertional heat stroke from failure of thermoregulation
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Middle ear effusion and a dull, hypomobile TM without signs of infection in an HIV pt
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Serous otitis media from a eustachian tube dysfunction 2/2 to HIV LAD or obstruction lymphoma
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MCC of traveler's diarrhea
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Enterotoxigenic E. coli
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Morning stiffness, dactylitis, deformity and nail involvement
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Psoriatic arthritis
|
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GI complaints followed by perioorbital edema, myositis and eosinophilia
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trichinosis
|
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Steps in management of non-ketotic hyperglycemic coma
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1. MOST IMPORTANT: NS replacement followed by 1/2 NS when euvolemic
2. Regular Insulin 3. 5% dextrose once glucose lowered to 250 4. potassium supplementation once potassium reaches normal range |
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Management of caustic ingestion
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ensurance of airway patency, followed by serial abdominal and CXRs to look for perforation. If none, then assessing the extent of the injury with upper endoscopy
DO NOT ATTEMPT TO NEURTRALIZE |
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Back pain, weakness, dizziness, tachycardia and evidence of anemia in a pt on warfarin
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Suspect retroperitoneal hematoma
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PNA in alcoholics that affects the upper lobes and grows mucoid colonies
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Klebsiella (encapsulated gram negative rod)
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Fever, chest pain, leukocytosis, wound drainange and mediastinal widening on CXR s/p cardiac surgery and management
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Mediastinitis
Immediate drainage, surgical debridement and prolonged Abx |
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Peripheral neuropathy that develops after folate supplementation for folate deficiency anemia
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B12 deficiency- if both folate and B12 are deficient, then just replacing folate will exacerbate the B12 deficiency and cause neuropathy
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Type of nephrotic syndrome associated with active HBV infection
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Membranous Glomerulonephritis (particularly with HBeAg)
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Syncope in a young pt with a crescendo-decrescendo murmur at the LLSB
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Hypertrophic Cardiomyopathy
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Cause of chronic rhinosinusitis, nasal discharge and anosmia in a pt with Aspirin or NSAID-induced bronchospasm
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Nasal polyps
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Antidote for TCA or aspirin OD
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Sodium Bicarb
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Treatment for Lithium toxicity
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Hemodialysis
|
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Treatment for lead poisoning
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Calcium EDTA for moderate to severe lead poisoning
Succimer for mild to moderate |
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Type of lung cancer a/w SIADH
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Small cell lung cancer
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Allopecia, skin lesions abnormal taste and impaired wound healing in a pt on TPN
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Zinc deficiency
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Sx of digoxin toxicity
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N/V/D, vision changes and arrhythmias
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How to calculate risk
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divide the number of diseased pts by the number at risk, or the number of those with the disease by the number who were exposed
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Encephalopathy, oculomotor dysfunction and gait ataxia in a person with long-term alcohol abuse and pathogenesis
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Wernicke's encephalopathy caused by thiamine (B1) deficiency
|
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Cause of iatrogenic Wernicke's encephalopathy
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administration of glucose without thiamine in a pt susceptible to thiamine deficiency
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MOA and use of chlorpheniramine
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H1 receptor blocker used for allergic rhinitis
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Polycythemia, nausea, dizziness and headaches
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Carbon Monoxide poisoning
|
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MCC of painless hematuria in adults in the US
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Bladder tumors
|
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Low calcium and elevated phosphorus in the presence of normal renal function
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hypoparathyroidism
|
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Fatigue, DOE, muscle wasting, elevated JVP, ascities with sharp x and y descents and a early heart sound after S2 and MCC in US and elsewhere
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Constrictive pericarditis
MCC in 3rd world countries: TB MCC in the US: idiopathic, virus, radiation |
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A pt with intermittant hemoptysis and a mobile cavitary mass in the lung
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Aspergilloma
|
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Treatment of heat stroke
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Evaporation colling: spraying the patient with water and blowing fans on him/her
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Lower abdominal pain, malaise, low-grade fever and a tender pelvic mass on rectal exam and potential cause
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Pelvic abscess from ruptured appendicitis in younger pts and diverticulitis or cancer in older pts
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MOA and main uses for ipratroptium and tiotropium
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inhaled anticholinergics for COPD
|
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Tx for early-disseminated or late Lyme disease
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IV ceftriaxone
|
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Causative agent and Tx for pt who p/w meningeal signs and encapsualted yeast on CSF cx
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Cryptococcus
IV Amphotericin B and oral flucytosine |
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Vaccination recommendations for adults with chronic liver dz
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Tdap
Influenza HAV HBV Pneumococcal vaccine |
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Pathophysiologic mechanism of Paget's dz
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Abnormal bone remodeling
|
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MC extraarticular manifestation of AS
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Anterior uveitis
|
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Short systolic murmur at the apex that decreases with squatting
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MVP
|
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Trihexyphenidyl
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Anti-cholinergic agent sometimes used in the tx of Parkinson's disease, especially in younger pts when tremor is the primary sx
|
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Ab found in pts with scleroderma
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Antinuclear Ab
Anti-topoisomerase I Ab |
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Young female w/ b/l trigeminal neuralgia
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MS
|
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Bright, red, firm, friable, exophytic nodules in an HIV pt
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bacillary angiomatosis
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Chronic neck pain, limited rotation and lateral bending, and bone spurs and sclerotic facet joints on xray
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Cervical Spondylosis
|
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Sudden onset of vertigo, vomiting and occipital headache in a hypertensive patient
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Cerebellar hemorrhage
|
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Major toxicity of azathioprine
|
Dose related diarrhea
leukopenia Hepatotoxicity |
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Major toxicity of mycophenolate
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Bone marrow suppression
|
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Major side effects of Cyclosporine
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1. nephrotoxicity
2. hyperkalemia 3. gum hypertropy 4. hirsutism 5. tremor 6. HTN |
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Major side effects of tacrolimus
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1. Hyperkalemia
2. tremor 3. HTN 4. nephrotoxicity |
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First step in the care of a patient with new onset SLE
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Renal bx
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Anti-dsDNA
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SLE
|
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Sudden onset of non-inflammatory edema of the face, acral extremities, genitals, trachea and abdominal organs
# pathogenesis |
Angioedema
# C1 inhibitor deficiency or dysfunction leading to build up of C2b and bradykinin |
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Paroxysmal, lightning-like pain on the face and management
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Trigeminal neuralgia and carbamazepine
|
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Clear lung fields, hypotention and JVD in the setting of an inferior wall MI and management
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RV infarct; fluid resuscitation and avoid nitrates
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Neck space that carries the highest risk of mediastinal involvement
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retropharyngeal space
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Non-anion gap acidosis, hyperkalemia and renal insufficiency in a diabetic
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RTA (type 4- Aldosterone insensitivity or tubular insensitivity)
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Dry cough and systemic sx lasting for mo with b/l ground glass opacities on cxr
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Cryptogenic organizing PNA
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Shoulder and arm pain in a pt w/ significant smoking hx
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"Pancoast syndrome" - apical lung neoplasm-
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Syncopal episode preceded by nausea, diaphoresis, tachycardia and pallor
? inciting incidents |
Neurocardiogenic syncope (AKA vasovagal)
# pain, stress, needles/blood and urination |
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Times when Metformin should be d/c'd and why
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Acute renal failure, hepatic failure or sepsis b/c they all increase the chance of developing lactic acidosis
|
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Tremor and muscle weakness in a pt being treated for acute asthma exacerbation
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Likely Hyopkalemia 2/2 to high dose beta-2 agonists
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Condition and management for an HIV pt and CD4 < 200 who p/w fever, dry cough, DOE, hypoxia and b/l interstitial infiltrates on cxr
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IV TMP-SMX and prednisolone
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Abrupt onset of palpitations w/ a HR of 160 in a person w/ no h/o of structural heart dz
# MOA # management |
PSVT is MCC of paroxysmal tachycardia in these cases
# AV nodal reentry # carotid massage, valsalva, immersion in cold water (or adenosine) |
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Hypokalemia, alkalosis and normotension
|
# if urine chloride is low, suspect surreptitious vomiting
# If urine chloride is high, suspect diuretic abuse, but could also be Bartter/Gitelman's syndrome (genetic defect in renal tubular function) |
|
Definition of Sepsis
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SIRS criteria with a known infection
Severe sepsis: + evidence of end-organ dysfunction, thrombocytopenia, metabolic acidosis, or hypoxemia |
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Course of action when a someone is exposed to HBV
|
# if vaccination hx is unknown: HBV vaccine and IVIG
# if vaccinated, only need reassurance |
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Approach to a pleural effusion
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If undiagnosed, must do thoracentesis. If clear-cut evidence of CHF, trial of diuretic is warranted
|
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First line intervention for newly diagnosed stage I HTN
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Lifestyle modifications:
1. if obese, then weightloss 2. if not obese, then DASH diet 3. low-salt diet |
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Location of the pathologic process in pt with lung cancer-assciated paraneoplastic syndrome causing a rash and decreased proximal muscle strength with intact sensation and reflexes
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Muscle fibers
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MCC of lactic acidosis in pts with atherosclerotic dz and afib
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Bowel Ischemia
|
|
RQ for main sources of fuel
|
CHO ~ 1.0
protein ~ 0.8 lipid ~ 0.7 |
|
Ring-shaped scaly patches with central clearing and distinct borders
# tx |
Tinea Corporis
# Oral griseofulvin, topical terbinafine |
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What else appears on the peripheral smear of sickle cell pts besides sickle cells?
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Reticulocytes
|
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Hemolytic anemia, venous thrombosis, diminished hematopoiesis
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Paroxysmal nocturnal hemoglobinuria
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Drug of choice for chemotherapy induced n/v and MOA
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Odansetron- 5HT3 blockers
|
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Positive straight leg raise
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Suggests herniated disk
|
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Red flags in a pt c/o back pain
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1. age greater than 50
2. pain for longer than 1 month 3. h/o cancer 4. unexplained weight loss 5. Neurological sx 6. no response to specific therapy 7. nighttime pain causing difficulty sleeping |
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High fever, chills, tenosynovitis, migratory polyarthralgiea and a small number of pustular lesion on the extremities in a sexually active person
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Disseminated Gonococcemia
|
|
When is it safe to start anticoagulation for DVT after surgery?
|
48-72 hours
|
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Cough productive of foul-smelling sputum and fever after an UGI or instrumentation of upper airway and tx
|
Anaerobic lung infection
Clindamycin |
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Crackles on pulmonary exam in a pt that presents with paroxysmal nocturnal dyspnea and has a h/o of uncontrolled HTN
# and Tx |
Cardiogenic pulmonary edema
# Nitroglycerin is the most rapid acting relief of sx |
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Asymptomatic elevation of conjugated (direct) bilirubin
|
Rotor and Dubin-Johnson's syndrome
If Jewish (Sephardic), likely Dubin-Johnson. If both direct and indirect elevated, likely Rotor |
|
Malabsorption a/w a h/o abdominal surgery
|
Bacterial overgrowth syndrome
|
|
Prominent pulmonary arteries and enlarged right heart on CXR and RAD on EKG in a pt that p/w DOE
|
Pulmonary HTN
|
|
Types of vaccines that induce a T-cell-independent B-cell response
|
Polysaccharide based vaccines
|
|
Type of immune cell response (T-cell-dependent/independent B-cell response) utilized in the Pneumonia vaccine and why
|
T-cell-independent because the Pneumococcal capsule is made out of polysaccharides
|
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Types of vaccines that induce a T-cell-dependent B-cell response
|
Protein based vaccines
|
|
Unilateral eye pain, redness and a dilated pupil that does not respond to light +/- n/v
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Acute angle closure glaucoma
|
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Treatment for cancer induced cachexia
|
Progestins are first line, but corticosteroids are another alternative
|
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Management of AF
|
# hemodynamically stable pt: Pharmacological tx- amiodarone, digoxin
# hemodynamically unstable pts: immediate cardioversion |
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Yellow-white patches of retinal opacification and hemorrhages in an HIV pt who p/w a CD4 < 50 and management
|
CMV retinitis; ganciclovir or foscarnet
|
|
Pt who p/w painful and itchy red streaks that are TTP, erythematous and cord-like on exam
|
Migratory thrombophlebitis (think occult malignancy)
|
|
Condition that causes easy bruising, excessive bleeding after tooth extraction and joint swelling and the pathogenesis of persistent joint pain
|
Hemophilia; deposit of hemosiderin and iron in the joint space causes cytokine-mediated synovial thickening with fibrosis and cartilage injury
|
|
Warty, stuck-on appearing skin lesion that enlarges slowly
|
Seborrheic keratosis
|
|
Fever, night sweats, LAD, arthralgias, and diarrhea
|
HIV
|
|
Initial evaluation of patients with elevated MCV, elevated MHC and normal MCHC
|
Measure B12 and Folate levels
|
|
Sudden onset of cardiac failure in a healthy person with a recent h/o a URI and echo findings
|
Viral myocarditis caused by Coxsackie B infection leading to dilated cardiomyoapathy. Echo will show dilated ventricles and diffuse hypokinesia
|
|
A pt from Africa or Asia with high-grade periodic fevers and chills who is anemic and has splenomegaly on exam
|
Malaria
|
|
Bad prognostic indicator for pts with heart failure
|
Hyponatremia- portends poor prognosis
|
|
Nerve the innervates the muscles of the anterior compartment of the thigh (knee extension and hip flexion) and sensation to the anterior thigh and medial leg
|
Femoral nerve for motor, sensation via the saphenous branch
|
|
Nerve that innervatees the muscles of the posterior compartment of the thigh, posterior compartment of hte leg and plantar muscles (knee flexion, digits and plantar flexion and sensation to the lateral leg and plantar foot
|
Tibial nerve
|
|
Nerve that innervates the muscles of the anterior leg and sensation to the anterolateral leg
|
Superficial nerve (branch of the common peroneal/fibular nerve
|
|
Nerve that innervates the muscles of the lateral leg and provides sensation to the dorsum of the foot
|
Deep peroneal nereve (branch of the common peroneal/fibular nerve)
|
|
Tx for urge incontinence
|
Oxybutynin
|
|
Tx for overflow incontinence
|
Bethanechol
|
|
Urethral discharge, right knee pain, right heel pain, low-back pain and mouth ulcers with a synovial tap showing WBC of 10 and many PMNs with a negative gram stain
|
Reactive Arthritis; NSAIDS
Not gonococcal because afebrial |
|
Sudden onset of target-shaped, mucocutaneous lesions adn system signs of toxicity and pathogenesis
|
Stevens Johnson syndrom; immune complex mediated HS rxn
|
|
MCC of ductopenia in adults
|
PBC
|
|
Sorte throat, hyperemic and edematous oropharyngeal mucous membranes, chilitis, stomatitis, glossitis, normocytic-normochromic anemia, seborrheic dermatitis and photophobia
|
Riboflavin (Vitamin B2 deficiency)
|
|
Type of BP readings seen in patients with thyrotoxicosis and MOA
|
Systolic hypertension with an increase in pulse pressure and caused by hyper dynamic circulation
|
|
Mass involving the mandible or abdominal viscera with a high mitotic index and a starry sky appearance on histologic exam
# Associated conditions # type of cells involved |
Burkitt Lymphoma
# a/w EBV infx # it is a neoplasm of mature B cells |
|
Child with infection, LAD, splenomegally with many blasts on differential with PAS positive material and positive immunostaining for TdT
# types of cells involved |
# Acute lymphoblastic leukemia
# TdT is expressed only by pre B and pre T cells |
|
Characteristics of basal cell carcinoma
|
1. open sore that bleeds, oozes or cursts and remains open for > 3 wks
2. Reddish patch or irritated area 3. Shiny bump or nodule that is pearly or translucent and often pink, red or white 4., Pink growth with slightly elevated rolled border and a crusted indentation in center 5. Scar-like area which is white, yellow or waxy and often has poorly defined borders |
|
Treatment for BCC
|
Cauterization, cryosurgery, radiation or surgical removal (Mohs with 1-2 mm margin)
|
|
Personality changes, memory loss and cortical atrophy on CT scan
|
Alzheimer's dementia
|
|
Ssteps in the management of symptomatic sinus bradycardia
|
1. IV atropine to increase HR by decreasing vagal output
2. If a med is a responsible, switch 3. Transcutaneous pacing 4. permanent pacemaker if necessary |
|
Nephrotic range proteinuria and hematuria with C3 deposits seen on IF of renal bx and pathogenesis
|
# Membranoproliferative glomerulonephritis, type 2 (AKA dense deposit disease)
# persistent activation of alternative complement pathway |
|
Unremitting epistaxis, ruby-colored, partially-blanching oral lesions with clubbing and polycythemia
|
Hereditary Telengiectasia (Osler-Weber-Rendu syndrome)
# clubbing and polycythemia likely from hypoxia 2/2 pulmonary AVMs causing a right to left shunt |
|
Insidious onset of dyspnea and dry cough in the absence of constitutional symptoms with a h/o of anterior uveitis
|
Sarcoidosis
|
|
Proximal muscle weakness and absent DTRs in a smoker and pathogensis
|
Lambert-Eaton syndrome as a paraneoplastic syndrome a/w small cell lung cancer
# autoantibodies againse pre-synaptic voltage gated Ca channels |
|
Low luekocyte alkaline phosphatase with leukocytosis
|
Chronic Myelogenous Leukemia
|
|
Auer Rods
|
Seen in Acute Myelogenous Leukemia
|
|
Imaging modality of choice to diagnose kidney stones
|
Spiral Ct without contrast
|
|
Young adult who p/w thrombocytopenia, microangiopathic hemolytic anemia, neuroloic disturbances, renal dysfunction and fever
|
Thrombotic thrombocytopenic purpura
|
|
Ototoxic drugs
|
1. Aminoglycosides
2. CTx drugs 3. Loop diuretics (furosemide) |
|
Cardiac causes of acute Afib
|
1. acute ischemia
2. heart failure 3. myopericardial inflammation 4. Valve disease 5. surgery |
|
Metabolic conditions that can cause acute afib
|
1. catecholamine surge
2. hypothyroidism |
|
Pulmonary causes of acute afib
|
1. acute lung dz (e.g. pneumonia)
2. pulmonary emboli 3. hypoxia |
|
Drugs that can cause acute afib
|
1. EtOH
2. cocaine 3. amphetamines 4. theophylline |
|
Affect of placing a consolidated lung segment in the dependent position and explanation
|
It would decrease the pt's oxygenation because the consolidated portion is now dependent and receiving more of the pulmonary blood flow thereby increasing right-to-left shunt
|
|
CHD risk-equivalents
|
1. DM
2. symptomatic carotid artery dz 3. AAA 4. PAD 5. 10 yr risk of CHD of > 20% |
|
Affect of placing a consolidated lung segment in the dependent position and explanation
|
It would decrease the pt's oxygenation because the consolidated portion is now dependent and receiving more of the pulmonary blood flow thereby increasing right-to-left shunt
|
|
CHD risk-equivalents
|
1. DM
2. symptomatic carotid artery dz 3. AAA 4. PAD 5. 10 yr risk of CHD of > 20% |
|
Acute massive increases in AST and ALT with milder associated increases in total bilirubin and alk phos in a recently hypotensive pt
|
Ischemic hepatic injury AKA "shock liver"
|
|
Sudden onset of sharply demarcated, erythematous, edematous, tender skin lesion with raised borders in a febrile pt
# causative agent |
Erysipelas
GAS/S. pyogenes |
|
Pulsatile, holocranial headaches that wake the pt from sleep a/w a "whooshing" sound, n/v, blurry vision, with papilledema, 6th nerve palsy, but not meningisumus or sinus tenderness
|
Idiopathic Intrcranial Hypertension/pseudotumor cerebri
|
|
Criteria for diagnosis of IIH/Pseudotumor cerebri
|
1. Signs of increased ICP in an alert patient
2. absence of any focal neurological signs except a 6th nerve palsy 3. Normal CSF exam except for elevated opening pressure (< 20 mm) 4. Absence of any ventricular abnormality other than reduction in size (slit-like ventricles) or other causes of increased ICP (masses, e.g.) |
|
The most common histologic lesion in diabetic nephropathy
|
Diffuse glomerulosclerosis
Nodular glomerulosclerosis (Kimmelstiel-Wilson nodules) is pathognomonic |
|
Rapid impairment of vision in on eye marked by a central scotoma, afferent pupillary defect, changes in color perception and decreased visual acuity and associated condition
|
Optic Neuritis; often a/w MS
|
|
Conditions pts with HIT need to be monitored for
|
Arterial and venous clots
|
|
CT scan showing Dilation of the entire ventricular system with distinct enlargement of hte subarachnoid space over the cerbral cortex
|
Communicating hydrocephalus most commonly caused by SAH
|
|
Management of a pt < 55 yo with new onset of dyspepsia w/o weight loss dysphagia or persistent vomiting
|
H. Pylori serology test OR empiric treatment with PPIs
|
|
Tx for moderate to severe acne that is predominantly nodulocystic form
|
Oral isotretinoin
|
|
Tx for acne in pts that have developed scars
|
Oral isotretinoin
|
|
Common skin findings in pts with PBC, pathogenesis and histological appearance
|
# Xanthelasma- cholesterol filled yellow plaques on the medial aspects of the eyelids bilaterally
# due a reduced ability to absorb and store fat-soluble vitamins. # lipid filled macrophages in the dermis |
|
Management of an alcoholic pt who p/w pain raidiating to his back, markedly elevated amylase and lipase after binge drinking
|
Analgesics, IVF and NPO
|
|
Pulmonary parameter that can be estimated in a ventilated pt by performing end-inpiratory hold maneuver
|
Lung compliance, b/c the end inspiratory pressure is the product of elastance and the gas delivered and since compliance is inversely related to compliance, a decrease in compliance would show up as an increase in elastic pressure
|
|
Pulmonary parameter that can be calculated by examining the peak airway pressures
|
Airway resistance
|
|
A pt that p/w skin necrosis several days after starting warfarin
|
Congenital Protein C deficiency
|
|
MCC of mesenteric ischemia is an embolus from the heart
|
Embolus from the heart
|
|
Swollen joint with a WBC of 2,000-50,000 in synovial fluid
|
Gout
|
|
Tense abscess and intense throbbing pain in the distal volar space.
# what is it called # who gets it # tx |
# Felon
# tailors (from needle punctures) # cephalosporins |
|
Throbbing pain in the distal pulp space, swelling, and tenderness with non-purulent vesicles
# what is it called # who gets it # tx |
# herpetic whitlow
# health care workers exposed to orotracheal secretions # no real tx, can you oral acyclovir or topical bacitracin to prevent secondary infx |
|
Lobe of the brain involved in a pt with hemineglect
|
Right (non-dominant) parietal lobe
|
|
Lobe of brain involved if a pt presents with a hemiparesis
|
non-dominant frontal lobe
|
|
Lobe of brain involved if a pt presents with a hemiparesis and misarticulated speech
|
Dominant frontal lobe
|
|
Increased RBC mass, mild granulocytosis, elevated platelet count, mild HTN, peptic ulceration, gouty arthritis, plethoric face and splenomegaly
|
Polycythemia Vera
|
|
MCC of pancreatitis
|
In men: alcohol abuse
In women: gallstones |
|
Location of lesion based on when hematuria happens
|
Beginning: urethra
End: prostate or bladder Entire: ureters or kidneys |
|
Painless terminal hematuria with clots
|
Bladder disease
|
|
Prevention of malignant melanoma
|
Protective clothing
|
|
Types of nerves involved in diabetic neuropathy and treatment
|
Small fiber neuropathy is suggested by pain.
# TCAs, but if urinary sx or orthostatic hypotension are a concern, then gabapentin |
|
Dull aching and swelling of the left side of scrotum that does not transilluminate and increases in size during valsalva
|
Varicocele
|
|
Rapid onset of wheezing then respiratory distress and LOC during a blood transfusion and suspected underlying condition
|
Anaphylactic reaction; suspect IgA deficiency
|
|
Urinary cyanide nitroprusside test
|
Looks for elevated cysteine levels
|
|
Pt p/w sx of a kidney stone, a pmh and fhx of stones, hexagonal crystals on urinalysis and pathogenesis, positive urinary cyanide nitroprusside test and pathogenesis
|
Cysteinuria 2/2 abnormality in amino acid transport
|
|
Potential complication of Hashimoto's thyroiditis
|
Lymphoma of the thyroid
|
|
UC or CD: non-caseating granulomas
|
CD
|
|
UC or CD: creeping fat
|
CD
|
|
Dry eyes, dry mouth, difficulty swallowing, dental caries and b/l firm submandibular swellings.
# tests to order to confirm dx # histologic appearance of swellings |
Sjogren syndrome
# antibodies to Ro/SSA or La/SSB # lymphocytic infiltrates of swollen salivary glands |
|
Occaisional episodes of nocturnal substernal CP a/w ST elevations in I, aVL, V4-V6 and normal BP
# pathogenesis # management # meds to avoid |
Prinzmetal's angina/variant angina caused by vasospasm
# non-dihydropyridine CCBs (Dilt or Verapamil) and/or nitrates # avoid non-selective BB and ASA |
|
Chemical agents used in perfusion scanning and their MOA
|
Dipyrimadole or adenosine.
# "Coronary Steal" they cause non-diseased coronary vessel dilation which steals blood from diseased vessels allowing the identification of the areas supplied by the diseased vesselss |
|
Sudden onset of ataxia, vomiting, occipital HA, gaze palsy and facial weakness in a hypertensive pt
|
Cerebellar hemorrhage
|
|
MC side effects of digoxin
|
GI (anorexia, nausea, vomiting)
|
|
Drugs that increase digoxin concentrations
|
Verapamil
|
|
Type of bone abnormality in Osteomalacia
|
defective bone mineralization 2/2 to decreased availability of Ca and Phos at mineralization sites
|
|
Type of bone abnormality in Rickets
|
Defective mineralization of bone and growth plate cartilatge
|
|
Type of bone abnormality in Paget's dz of the bone
|
Disordered skeletal remodeling in focal areas
|
|
Type of bone abnormality in osteoperosis
|
Low bone mass, but the bone that is there is normally mineralized
|
|
Painful ulcers in mouth and painful flaccid blisters on skin with skin layers that separate with slight pressure
# histological hallmark # pathogenesis |
# pemphigus vulgaris
# Intercellular IgG deposits in the epidermis # autoantibodies to desmoglein (adhesion molecule) |
|
Sudden cessation of mental activity that last 30 sec and have abrupt return to consciousness w/ no automatisms or post-ictal state and may also recur several times a day
# how to diagnose |
# Absense/Petit Mal seizures
# diagnose w/ characteristic EEG pattern after provocation (hyperventilation, photic stimulation, sleep) |
|
Pathogenesis of normal pressure hydrocephalus
|
Decreased CSF absorption
|
|
Acute renal failure a/w arthralgia, a maculopapular rash, and WBC casts made mostly of Eos w/ a h/o recent bactrim use
|
Drug induced interstitial nephritis
|
|
Definition of null hypothesis
|
a statement of "no relationship" b/w the exposure and the outcome
|
|
Medical intervention that has the greatest likelihood of slowing AAA progression
|
Smoking cessation
|
|
Management of a pt who presents more than 5 days after onset of sx of appendicitis and have RLQ findings
|
1. IV hydration
2. Bowel Rest 3. Abx with coverage for gram negatives and anaerobes- either a 3rd gen ceph (cefotetan) or a fluoroquinolone + metronidazole |
|
Fever, weight loss, and frequent diarrhea and bloody stools with evidence of colonic dilation on xray.
# management |
# UC with toxic megacolon
# IV fluids, bowel rest # IV steroids # +/- Abx |
|
The immune function that is impaired in asplenic patients
|
Phagocytosis: the processing of Ab covered capsulated organisms by opsonization takes place in the spleen
|
|
The immune function that is impaired in chronic ganulomatous dz
|
Intracellular killing (defect in NADPH oxidase)
|
|
The immune function that is impaired in SCID
|
Ab production b/c of decreased circulating lymphocytes
|
|
The immune function that is impaired in leukocyte adhesion defect
|
Chemotaxis (auto-recessive defect in integrin Beta2)
|
|
The immune function that is impaired in DiGeorge syndrome
|
Cell mediated immunity because of thymic aplasia caused by a deletion in chromosome 22
|
|
Pt who p/w 2 wk h/o f/c/generalized weakness and a pmh of pyelo, recent cystography for persistent dysuria, rheumatic fever. Exam: 2/6 systolic murmur and tender erythematous lesions on finger tips.
|
SBE caused by enterococci introduced by cysto
|
|
Pt w/ isolated asymptomatic thrombocytopenia
|
Think HIV b/c low platelets is the initial presentation of HIV in 10% of pts
|
|
Best cardiac biomarker to use to evaluate recurrent CP in the setting of recent tx for acute MI and why
|
CK-MB because it returns to normal w/i 1-2 days
|
|
Management of hyperthyroid
|
Radioactive iodine to destroy thyroid follicular cells; important to pretreat with methimazole b/c dying thyroid cells release thyroid hormone
|
|
Travel-associated PNA with high fever, cough, GI sx and confusion
# characteristic lab results # tx |
Legionella pneumophila
# Sputum gram stain shows many PMNs but no orgs b/c it is a poorly staining GNR (should order urinary Ag) # azith or levo |
|
Type of arrhythmias tx w/ procainamide and potential side effects
|
# atrial and ventricular arrhythmias
# Nausea, drug-induced-lupus, agranulocytosis, and QT prolongation |
|
Type of arrhythmia treated with lidocaine, class of anti-arrhythmic and potential side effects
|
# Ventricular arrhythmias
# Class IB anti-arrhythmic # confusion, seizures and respiratory depression |
|
Type of arrhythmia treated with quinidine, class of anti-arrhythmic and potential side effects
|
# atrial arrhythmias
# class IA anti-arrhythmic # diarrhea, tinnitus, QT prolongation, torsades de pointes, hemolytic anemia and thrombocytopenia |
|
Type of arrhythmias tx w/ digoxin and potential side effects
|
# atrial arrhythmias
# nausea, anorexia, AV block, and Ventricular and supraventricular arrhythmias |
|
Type of arrhythmia treated with Amiodarone, class of anti-arrhythmic and potential side effects
|
# ventricular arrhythmia
# class III anti-arrhythmia # Pulmonary fibrosis (**), hypo-and hyperthyroidism, hepatotoxicity, corneal deposits and skin discoloration |
|
Drugs shown to have proven mortality benefit in CHF
|
ACEi (dose dependent), ARBs, BB and spironolactone
|
|
Pt who p/w weakness and DOE who has muffled heart sounds, JVD, hypotension on exam
# pathophysiology for sx |
Beck's triad for cardiac tampenade
# sx caused by restriction in ventricular filling |
|
ABI values and their meanings
|
# 1-1.3: normal
# < 0.9 sensitive and specific for >50% occlusion # <0.4 c/w limb ischemia |
|
Management of overflow incontinence 2/2 epidural anesthesia
|
Intermittent catheterization
|
|
Mechanism of kidney damage in SLE patients
|
Immune complex deposition in the glomeruli leading to complement activiation. Will see a decrease C3 level.
# same mechanism as in post-streptococcal glomerulonephritis |
|
Approach to a person who p/w with likely organophosphate overdose with bradycardia, miosis, rhonchi, muscle fasciculations, lacrimation, urination, defecation and covered in his own vomit
|
Must give atropine immediately to counteract the cholinergic effects of the organophosphate, but must also remove clothing and scrub skin to prevent further transcutaneous exposure
|
|
Test of choice when a pt p/w an unprovoked new-onset seizures
|
CT of the head w/o contrast
|
|
Common side effects of cyclophosphamide and way to avoid some serious
|
1. Hemorrhagic cystitis
2. Bladder carcinoma 3. sterility 4. myelosuppression (cystitis and carcinoma are caused by the acrolein metabolite and can be prevented by hydration and MESNA) |
|
Side effects of platinum chemotherapeutic agents and cancers they are used for
|
Cochlear dysfunction
Testicular, ovarian and bladder |
|
Weight loss/f/ns/cough productive of purulent sputum that grows partially acid-fast gram-positive branching rods and a cavitary lesion on cxr in a pt on chronic steroid and tx
|
Nocardiosis (N. asteroides)
TMP-SMX |
|
Pt who develops jaundice on POD2/ s/p complicated CABG in which he required 10 units of PRBCs and his elevated bili, alp and mildly elevated AST/ALT
|
Post-operative cholestasis
May also p/w hypotenstion |
|
Maneuvers that will increase the intensity of a systolic ejection murmur in a pt with hypertrophic cardiomyopathy
|
Valsalva maneuver and standing- it is one of the only murmurs that increases with a decrease in preload, this is because the obstruction is greater with less preload
|
|
Effect on circulation of squatting
|
Increases Venous return because it shortens vertical height of the blood column and it increases SVR.
|
|
Effect on circulation of sustained handgrip
|
Increases SVR and hence afterload;
Used to differentiate b/w: Aortic stenosis: decreases Mitral regurg: increases |
|
Effect on circulation of recumbency
|
Increases venous return
|
|
Most common malignant tumor of the eyelid which is a slow growing papule with pearly, rolled borders and overlying telengiectasias.
# management |
BCC
Needs excision because it can spread locally |
|
An obese African American IVDU pt w/ peripheral edema, periorbital edema, ascites and probable right-sided pleural effusion
|
FSGS- more common cause of nephrotic syndrome in an AA adult, with obesity and heroin use
|
|
Hemiparesis and disturbances in speech, gait and vision in an HIV pt with mutiple, hypodense, non-enhansing lesions and no mass effect in the cerebral white matter
|
PML caused my JC virus (a human polyoma virus)
|
|
Arthralgias, weight loss, fever, diarrhea, abdominal pain, chronic cough and a diastolic murmur with a small intestine bx that shows PAS material in the lamina propria
|
Whipple's dz caused by Tropheryma whippelii
|
|
MCC of endocarditis after dental procedures
|
members of the S. Veridans group: S. mitis, S. sanguis, S. mutans, and S. Salivarius
|
|
Bacteria that commonly cause dental carries
|
S. mutans
|
|
Common cause of prosthetic valve endocarditis
|
S. epidermidis
|
|
Palatal ulcers, HSM and pancytopenia in an immunocompromised pt from Missouri
|
Histoplasmosis
|
|
Female who p/w dull aching pain in the RUQ who has been on OCPs for 10 yrs and has a bx that shows enlarged hepatocytes containing glycogen and lipid deposits
|
Hepatic adenoma
|
|
Pt w/ epigastric pain and a mass at the pylorus that is positive for infiltrating, low-grade, gastrica MALT lymphoma that hasn't metastasized
# management |
Most likely because of H. pylori infx and manegement consists of PPI, clarithromycin, and amoxacillin
|
|
Appropriate management in a female pt who p/w rapidly developing virilization
|
Serum tetstosterone and DHEAS. Normal testosterone and high DHEAS indicates adrenal source; elevated testosterone and normal DHEAS suggests ovarian source
|
|
Single round blue inclusions in RBCs on Wright stain.
|
Howell-Jolly bodies which are nuclear remnants and indicative of physical or functional asplenism b/c they are typically removed by the spleen
|
|
Test to confirm the diagnosis of polycythemia vera
|
JAK2 mutation testing
|
|
Test to order on a pt that p/w high fevers, confusion, productive cough who is found to have an extremely high WBC that is predominantly lymphocytes
|
Flow cytometry will prove or disprove clonality
|
|
Smudge cells on smear and an extremely high WBC in an individual > 70yo
|
CLL
|
|
Approach to a person with elevated direct bilirubin
|
# if predominantly elevated AST/ALT, look for hepatocellular/intrahepatic causes
# if ALP is predominant, do ERCP or PTC to look for extrahepatic obstruction |
|
Chronic diarrhea and oocytes visible on acid fast stain of stool specimen in HIV pt with CD4 count < 180
|
Cryptosporidium parvum
|
|
Microcytic hypochromic anemia with hypochromic and normochromic RBCs on smeer
|
Acquired sideroblastic anemia
|
|
Microcytic hypochromic anemia with elevated serum Fe and decreased TIBC
|
sideroblastic anemia
|
|
Elevated JVD, hypotension, RBBB on ECG, along with CNS sx
|
Suspect massive PE.
The PE causes RHF, then decreased CO leading the LHF -> bradycardia -> cardiogenic shock |
|
Red eye with lymphocytes in the anterior chamber in a pt with cough, SOB, fever
|
Description of anterior uveitis and sarcoidosis
|
|
Painful, swollen knee with a WBC count of 98,000 in a pt with a prosthetic joint and a fever of 104
|
Staphylococcal septic arthritis; the prosthetic joint increases the risk of septic arthritis and a WBC > 50,000 separates this from crystal-induced arthritis
|
|
AG acidosis in a homeless alcoholic with eye symptoms
|
Methanol poisoning
|
|
AG acidosis in a homeless alcoholic with evidence of renal injury
|
Ethylene glycol poisening
|
|
Approach to hypercalcemia in a pt that likely has MM who p/w abd pain and neuropsychiatric disturbances
|
NS infusion: this is symptomatic hypercalcemia and the IVF + loop diuretics should bring calcium down
|
|
Best test to order in a young person with hypertension, muscle weakness and numbness
|
Aldo/renin ratio
|
|
First step in the management of pt who presents with AKI with acute oliguria, azotemia and increased Cr level
|
Foley catheterization to relieve possible urinary retention.
|
|
Tx for ITP
|
systemic immunosuppression with steroids
|
|
Parameters to check for DIC
|
Platelet count: down
PT: elevated Fibrinogen: decreased |
|
Approach to a pt with detectable serum HBsAg, HBeAg, HBV DNA and anti- HBcAg IgG
|
This is chronic HBV, treatment is recommended if ALT is elevated -> interferon or lamivudine
|
|
Tx of an acute exacerbation of MS
|
Corticosteroids
|
|
Tx of MS to reduce frequency of exacerbations
|
Beta-interferon or glatiramer acetate
|
|
Common benign side effect of rifampin
|
Red to orange discoloration of urine
|
|
Type of liver injury caused by INH and features of injury
|
Idiosyncratic- not dose-dependent and has a variable latent period and looks a lot like viral hepatitis histologically
|
|
Anterior mediastinal mass
|
4 Ts: thymoma, teratoma, thyroid neoplasm, terrible lymphoma
|
|
Way to differentiate seminomatous tumors from non-seminomatous
|
Seminomatous: 1/3 will have elevated beta-hCG and normal AFP
Non-seminomatous: elevated AFP and beta-hCG |
|
Initial therapy for rosacea
|
Topical metronidazole
|
|
Long term management for pts with hereditary spherocytosis and eplanation
|
Folic acid supplementation. This is because they are more prone to deficiency and hence severe anemia as their erythopoiesis is ramped up
|
|
MCC of megaloblastic anemia in alcoholics
|
Folate deficiency- alcohol impairs its enterohepatic cycle and inhibiting its absorption
|
|
Initial management of a pt that presents with symptomatic hyperthyroidism (racing heart, tachy, tremor, seating, anxiety)
|
Propanolol until the underlying cause of the hyperthyroidism can be established and treated
|
|
Infection that pts with hereditary hemochromatosis are at increased risk for
|
Listeria monocytogenes because of impaired phagocytosis 2/2 to high iron overload in the reticuloendothelial cells and b/c Listeria love oxygen. Same goes for Yersinia septicimia and Vibrio vulnificus
|
|
Approach to pt with high serum calcium and normal (inappropriately high) PTH levels
|
Check urine calcium/creatinine ratio. Familial Hypocalciuric Hypercalcemia will have a low ratio while primary hyperparathyroidism has high urinary calcium excretion
|
|
Neurofibrillary tangles
|
Alzheimer's dementia
|
|
Difference b/w Lewy Body Dementia and Alzheimer's Dementia
|
Alzheimer's pts have more pronounced anterograde memory loss and lter hallucination and changes in alertness than LBD
|
|
Alterations in consciousness, disorganized speech, visual hallucinations, EPSs (rigidity, e.g.) and early compromise of executive functioning and pathalogical feature
|
Lewy Body Dementia; Lewy Bodies- eosinophilic intracytoplasmic inclusions representing accumulations of alpha-synuclin protein in the substantia nigra, locus ceruleus, dorsal raphe and substantia innominata
|
|
Purpose of administering NaHCO3 in a TCA overdose
|
Alleviate the cardio-depressant action on sodium channels
|
|
Morning facial puffiness and b/l LE edema in a pt w/ a h/o IVDU, recurrent pulmonary infx, psoriasis who has hepatomegaly, palpable kidneys, high BP and an S4 on exam with a negative HIV test
|
Amyloidosis: think Amyloidosis in a pt with multisystem complaints, especially neprhotic syndrome, who has a h/o of a chronic inflammatory dz or IVDU
|
|
1st line tx in uncomplicated and complicated UTI
|
# Uncomplicated: oral TMP-SMX, or nitrofurantoin
# Complicated: fluoroquinolone (Cipro or Levo) |
|
CSF findings: lymphocytic pleocytosis, increased number of erythrocytes, elevated protein in a pt that had a seizure and recent fevers and HA
|
HSV encephalitis
|
|
A post-BMT pt who p/w lung and intestinal problems
|
CMV pneumonitis
|
|
A person who prominently flexes his hip and knee and slaps that foot with each step
|
Steppage gait as compensation for foot drop. The foot drop is caused by peripheral neuropathy to the nerve roots contributing to the common peroneal nerve: L4-S2
|
|
Approach to cocaine-related cardiac ischemia
|
Benzos to allay the anxiety, HTN and tachycardia, and aspirin and nitrates to prevent thrombus formation and reduce cardiac O2 demand
|
|
Exact pathology of renal failure in a pt w/ chronic analgesic use and findings on urinalysis
|
papillary necrosis and chronic tubulointerstitial nephritis; May have sterile pyuria (WBC casts)
|
|
One exception to the rule that live viruses should not be given to HIV pts
|
MMR vaccine should be given to any HIV pt w/ a CD4 > 200 and w/o a h/o an AIDS-defining illness
|
|
Only to reverse heart failure in a person suffering from alcoholic dilated cardiomyopathy
|
abstinence from drinking
|
|
Type of lung cancer a/w hypercalcemia
|
Squamous Cell (remember sCa++mous)
|
|
Diastolic decrescendo murmur heard best at the 3rd left ICS that increases with hand grip and medical tx
|
Aortic regurgitation; Afterload reduction with an ACEi or nifedipine
|
|
Unexplained hemolytic anemia and thrombocytopenia in a pt with renal failure and neurologic sx and management
|
TTP-HUS syndrom
Needs plasmapheresis (plasma exchange) as soon as possible to remove the offending antibody |
|
Pancystolic murmur that radiates to the axilla
|
Mitral valve regurg
|
|
MCC of mitral valve regurgitation
|
Mitral valve prolapse
|
|
Bilaterally symmetrical maculopapular rash involving the entire trunk and extremities including the palms and soles along with Condyloma lata in the anogenital area
|
secondary syphillis
|
|
Painless blisters and hyperpigmentation a/w HCV infx and estrogen ingestion
|
Porphyria cutanea tarda
|
|
Hyperglycemia, erythematous, scaly plaques on multiple area and diarrhea
|
Suspect glucagonoma.
|
|
Bilaterally symmetrical maculopapular rash involving the entire trunk and extremities including the palms and soles along with Condyloma lata in the anogenital area
|
secondary syphillis
|
|
Painless blisters and hyperpigmentation a/w HCV infx and estrogen ingestion
|
Porphyria cutanea tarda
|
|
Hyperglycemia, erythematous, scaly plaques on multiple area and diarrhea
|
Suspect glucagonoma.
|
|
Immunocompromised pt who p/w dry cough, fever, dyspnea who is found to be tachypneic, tachy and cyonotic on exam and show b/l diffuse interstitial infiltrates beginning in the perihilar region
|
PCP pneumonia
|
|
Nausea, vomiting, abdominal pain, diarrhea, arthralgias and myalgias in a pt w/ a h/o substance abuse who is hospotalized for another issue
|
Opioid withdrawal. Can use methadone because the pt is being treated for a medical issue, not specifically for withdrawal
|
|
Useful test to differentiate b/w liver and heart-related causes of LE edema in a pt with both heart and lung dz.
|
Hepato-jugular reflex. IF positive, it suggests heart; if negative, it suggests liver
|
|
What other condition are pts with nephrotic syndrome susceptible to?
|
Hypercoagulability: arterial thrombosis and PE (Renal vein is most frequent)
|
|
Intense itching, hyperemia, tearing, conjunctival edeam and eyelid edema in a pt with a personal or family h/o asthma; pathogenesis; management
|
Allergic conjunctivitis; caused by exposure to allergens; it usually resolved in 24 hrs
|
|
A pt that p/w deep abdominal pain, fever and chills several weeks after sustaining upper abdominal trauma at which time abd CT was neg
|
Pancreatic laceration causing a retroperitoneal abscess
|
|
Tx for active HCV
|
interferon and ribavirin (HBV is lamivudine)
|
|
A pt who p/w 1 year h/o watery diarrhea, abdominal cramps and frequent episodes of dizziness, flushing, wheezing and a feeling of warmth and hepatomegaly and a murmur;
# what vitamin or mineral will they become deficient in |
# this is serotonin syndrome
# they will become deficient in niacin because their body uses all of the tryptophan to synthesize serotonin rather than niacin |
|
Diarrhea, dermitits and dementia
|
3 Ds of niacin deficiency
|
|
Symmetric polyarthritis of acute onset and short duration a/w low-grade fever with a positive RF and weekly positive ANA
|
Viral arthritis (not rheumatological) because it resolves quickly and b/c viruses such as hepatitis, HIV,mumps, rubella and parvovirus can have a positive RF
|
|
Tx for acute PCP
|
TMP-SMX and steroids
|
|
Dietary recommendations for patients with renal calcula
|
1. decreased dietary protein and oxalate
2. decreased sodium intake 3. increased fluid intake 4. INCREASE dietary calcim |
|
Approach to a pt with elevated transaminases in the setting of HCV infx, HBV immunity.
|
Vaccinate against Hep A b/c co-infection would cause acute hepatic failure
|
|
Approach to a pregnant pt who p/w sx of aortic dissection and elevated BP
|
Treat the BP first
|
|
A patient who presents with acute delirium or ataxia in malnourished pt
|
Suspect Wernicke's encephalopathy and give thimine
|
|
Pain and stiffness in the neck, shoulders and hips, an eleveted ESR and morning stiffness lasting over an hour and management
|
PMR low dose prednisone unless a/w GCA (then use high dose steroids and order temporal artery bx)
|
|
A patient who presents with acute delirium or ataxia in malnourished pt
|
Suspect Wernicke's encephalopathy and give thimine
|
|
Pain and stiffness in the neck, shoulders and hips, an elevated ESR and morning stiffness lasting over an hour and management
|
PMR low dose prednisone unless a/w GCA (then use high dose steroids and order temporal artery bx)
|
|
Tx of histoplasmosis in an HIV pt
|
IV amphotericin B and lifelong itraconazole
|
|
Bloody diarrhea with abdominal pain, lack of fever, no travel hx
|
EHEC O157:H7
|
|
JVP, hepatomegally, ascites, distant heart sounds and LE edema w/o evidence of pulmonary congestion in a smoker
|
Cor pulmonale 2/2 to COPD
|
|
Steps to breaking bad news
|
1. make sure pt is a quiet, comfortable and private environment
2. Ask the pt how much he knows or what he thinks he might have 3. Ask how much he wants toknow 4. Warn that the situation is more serious that I originally though 5. If he wants to know the dx, give him the dx, i.e. "advances lung ca."\ 6. Give the prognosis, but make sure to tell him that options are available to keep him as comfortable as possible 7. try to explain everything as simply as possible |
|
Bleeding test results in a pt with SLE and evidence of VTE disease (DVT and PE)
|
PTT will be spuriously prolonged b/c lupus anti-coagulant binds the phospholipids used in the assay.
|
|
Possible presentations of gonococcal septic arthritis in young sexually active individuals
|
1. Asymmetric polyarthritis with tenosynovitis and a skin rash
2. isolated purulent arthritis affecting one or a few joints |
|
Sudden onset of abdominal pain, fever and hematuria in a pt with improving nephrotic syndrome and likely pathophysiological process involved
|
Renal vein thrombosis 2/2 to loss of anti-thrombin III in the urine; the most common variety of nephrotic syndrome a/w renal vein thrombosis is membranous glomerulopathy
|
|
Diagnostic criteria of malignant HTN
|
1. Papilledema, retinal hemorrhages and exudates
2. Malignant nephrosclerosis (fibrinoid necrosis of the capillaries and arterioles 3. CNS involvement: hemorrhages, infarcts, encephalopathy |
|
Metabolic process that involves both Cobalamin and Folate such that an elevated level of a substrate for the process is suggestive;
# how do you differentiate b/w deficiencies in them |
They are necessary for the converion of homocysteine to methionine, so a deficiency in either one will cause an elevated homocysteine.
Cobalamin is needed for the conversion of methylmalonyl-CoA to succinyl-CoA, so an elevated level of methylmalonic acid means that Cobalamin is low |
|
Systemic condition involving the upper and lower respiratory tracts and kidneys which may also present with cutaneous ulceration;
# how to diagnose # treatment |
Wegener's; C-ANCA positive against proteinase-3
# cyclophosphamide |
|
Reason why lidocaine is not used prophylactically in pts with acute coronary syndrome
|
It increases the risk of asystole
|
|
Cervicofacial non-tener, indurated mass that slowly develops into multiple abscesses, that drains yellow fluid and grows gram positive branching bacteria and management
|
Actinomycosis
High dose PCN for 6-12 wks |
|
Common cause of refractory hypokalemia in alcoholics
|
hypomagnesemia
|
|
Monomorphous erythematous papules without comedones on face arms and trunk in a pt w/ SLE who is taking prednisone for a flare
|
Steroid acne
|
|
Pseudofractures, blurring of the spine
|
Osteomalachia: low/low normal Ca, low phosphate, elevated PTH
|
|
most serious side effect of Anti-thyroid drug therapy (examples of drugs)
|
Agranulocytosis
Methimazole, propylthiouracil |
|
Hepatic cyst following a bout of bloody diarrhea after a trip to Mexico
|
Amebic liver abscess caused by Entamoeba histolytica
|
|
MCC of pneumonia in nursing homes
|
S. Pneumo
|
|
A young person with a long h/o of headaches refractory to OTC analgesics and painless hematuria
# pathogenesis |
# analgesic nephropathy
# renal papillary necrosis caused by analgesic-induced vasoconstriction of the medullary blood vessels |
|
Differntiating b/w exudative and transudative pleural effusion
|
Lights' criteria. If 1 is satisfied, then exudative:
1. pleural/serum protein > 0.5 2. pleural LDH/serum LDH > 0.6 3. pleural LDH > 2/3 upper limit of normal for serum LDH |
|
Differentiating b/w complicated and uncomplicated pleural effusion
|
Complicated- needs chest tube if:
1. positive gram stain 2. positive culture 3. fluid pH < 7.2 4. glucose < 60 |
|
Criteria for qualifying for home O2
|
1. PaO2 < 55 or SaO2 < 88% on room air
2. Signs of cor pulmonale, pulm HTN or hct > 55% 3. hypoxia during exercise of sleep |
|
Goal of home O2 and suggested use
|
Maintain SaO2 > 90 % during sleep, normal waking and at rest; Significant benefit if used more than 15 hrs/day
|
|
Guidelines for initiating symptomaitc treatment for Parkinsonism
|
For pts < 65yo, dopamine agonists (bromocriptine, ropinirole)
For pts > 65you levodopa/carbidopa |
|
Only medicine that can slow progression of parkinsonism
|
Selegiline
|
|
Tx for MS
|
Glatiramer acetate
|
|
Pulsus paradoxus
|
Cardiac tamponade
|
|
New cardiac finding in an acute MI
|
S4 gallop because of diastolic dysfunction
|
|
Arrhythmia suggestive of digitalis toxicity
|
Atrial tachycardia with AV block
|
|
MEdication prescribed for essential tremor that may cause abdominal pain, neurologic and psychiatric abnormailities.
|
Primidone (can cause acute intermittent porphyria). Can be diagnosed by checking urine porphobilinogen
|
|
Medicines that commonly cause Folic Acid deficiency and hence megaloblastic anemia
|
Phenytoin, MTX, TMP-SMX
|
|
Medications that can cause pseudotumor cerebri
|
Isotretinoin
Vitamin A toxicity |
|
Cause of nephrotic range proteinuria, axotemia and normal sized kidneys in an HIV pt
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Focal segmental glomerulosclerosis
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Epidemiolog/biostatistical factor controlled for by matching
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Confounding
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Changes in memory a/w systemic changes such as weight gain, fatigue and constipation
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hypothyroidism
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Common CSF finding in pts with MS
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Oligoclonal bands- will have a normal protein level, but elevated immunoglobulins, particularly IgG
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High calcium and low phosphorus
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Hyperparathyroidism
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Monoarthritis in the setting of hypercalcemia
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Pseudogout caused by the deposition of Calcium Pyrophosphate Dihydrate crystals (CPPD)
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Synovial fluid analysis in a pt with hyperparathyroidism and monoarthritis
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Rhomboid shaped, positively birefringent
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Initial work-up in pts with HIV
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# VDRL
# PPD # Hep A and B serology # Toxo titer |
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Hypotenstion pansystolic murmur that radiates to the axilla in a pt that is 3d s/p acute anterior wall MI
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Papillary muscle rupture leading to mitral regurgitation
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Management of solitary brain metastasis
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Surgical resection followed by whole brain radiation if extracranial dz is stable and there are not multiple lesions
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Management of multiple brain metastasis
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palliative whole brain radiation
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Management of an acute MI with bibasilar crackles and hypoxia
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This is flash pulmonary edema; beta blockers are contraindicated here and a diuretic should be used, particularly furosemide
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Sudden loss of vision with optic disk swelling ,retinal hemorrhage, dilated veins and cotton wool spots on funduscopic exam
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Central retinal VEIN occlusion
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Sudden painless loss of monocular vision and pallor of the optic disk, cherry red fovea and boxcar segmentation of the blood in the retinal veins
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Central retinal ARTERY occlusion
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Bradycardia, hypotension and wheezing in a suicide attempt in a pt who has HTN
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Most likely OD on BB.
1. IVF and atropine 2. If that doesn't work, try glucagon |
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New onset CHF in a pt 1 mo s/p anterior wall MI who has a new apical pan-systolic murmur radiating to the axilla, persistant ST segment elevations and an echo that shows wall motion abnormality
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Ventricular aneurysm
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Normal skin at birth that gradually becomes more dry and scaley over the extensor surfaces and is worse in the winter
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Ichthyoisis
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Bacillary angiomatosis
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# caused by Bartonella spp in immunocompromised pt
# causes characteristic cutaneous and visceral angioma-like blood vessel growths that may hemorrhage on bx # Abx |
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Managment of hypercalcemia 2/2 to malignancy
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Bisphosphonates
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Diff b/w open angle glaucoma and angle closure glaucoma
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Open angle is insidious and p/w gradual loss of peripheral vision and cupping of the optic disk on funduscopic exam
# angle closure is sudden onset of blurred vision, eye pain, n/v with a red eye, hazy cornea and a fixed dilated pupil on exam |
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Mechanism of arrhythmias in pts who die 2/2 to acute MI
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Reentry, e.g. vfib
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Indications for tx of Paget's dz of the bone (6)
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1. bone pain
2. hypercalcemia of immobilization 3. neurological deficit 4. high output cardiac failure 5. preparation for orthopedic surgery 6. involvement of weight-bearing bones (to prevent deformities) |
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Pitting vs. non-Pitting edema
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# Pitting: caused by increased intravascular hydrostatic pressure, decreased plasma oncotic pressure, or increased capillary leak (burns, trauma, infx)
# non-Pitting: lymphatic obstruction (lymphedema) or the accumulation of albumin and other proteins w/ low or normal lymphatic flow (myxedema) |
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Indications for transfusion in a pt with CHF
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Hb/Hct < 10/30
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Sx of ethylene glycol poisoning
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# Hematuria and flank pain because it causes a renal tubular damage and calcium oxalate crystals
# metabolic acidosis |
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Sx of methanol poisoning
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# visual disturbances
# metabolic acidosis |
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Type of lung cancer that produces ectopic ACTH
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Small cell lung cancer
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Paraneoplastic syndromes of Small Cell lung cancer
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SIADH
ACTH/Cushing's |
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Bullous Pemphigoid vs. Pemphigus Vulgaris: Tense bullae
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BP
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Bullous Pemphigoid vs. Pemphigus Vulgaris: oral cavity involvement
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PV
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Bullous Pemphigoid vs. Pemphigus Vulgaris: intraepidermal blisters
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PV
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Bullous Pemphigoid vs. Pemphigus Vulgaris: linear Ig deposition along BM on IF
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BP
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