MCC of pneumonia in someone >40 y/o?
strep pneumonia
MCC of pneumonia in adults <40 y/o?
mycoplasma pneumonia
currant jelly sputum
klebsiella
chronic alcoholism and pneumonai?
klebsiella
hemorrhagic necrotizing consodilation pneumonia or bulging pneumonia
klebsiella
cystic fibrosis, brocnhiectasisi, recent abx, malignancy- at risk what type pneumonia?
psedumonas aeruginosa
what is the first MC noscomial infection?
UTI
Most common noscomial pneumonia?
pseduomonas
MC bacteria in pneumonia in ICU patient on ventilator?
pseudomonas aeruginosa
rusty colored sputum
pneumococcal pneumonia
who gets pneumovax?
<65 y/o and <65 + cardio/pulm disease (including asthma), chronic liver disease, alcoholism, DM, CSF leaks, cigarette smokers, aspelnic patients, sickle cell anemia
TXN pneumococcal pneumonia?
PCN G first line
second: azithromycing or clarithromycin
Pneumonia in an elderly patient with COPD or HIV?
H influ
what bug is associated with H influ?
M catarrhalis (peak rate: 2 years old)
Txn of H influ?
ceftriazone or cefotxaime
COPD: 1st line: levaquin
prevention of pnuemonia?
PCV- 4 doses- 6 weeks to 15 mo's
PPV 2-5 y/o
>65 y/o: PPV
nosocomial vs community acquired?
nosocomial >48 hrs after admission
strep pneumo- describe the bacteria?
GP encapsulated diplococci
describe staph auerus?
GP cocci in clusters
pneumoia + pneumoatoceles, empyemas, pyopneumothroacic
staph aeurus
non-toxic neo-nate with staccato cough
chlamydophila
bullous myringitis
mycolasma
DX of mycoplasma pneumonia
PCR of sputum
pneumonia + birds, parrot
chlamyida psittaci
TXN mycoplasma pneumoia?
azithromycin, clarithromycin, erytrhomycin
MC serotype for legionnarie's disease?
serotype 1
CAP + relative brachycardia?
legionnaries dsiease
2 distinct clinical presentation of legionnarie's disease
prodromal- pontiac fever- viral like syndroe- malaise, fever, chills, myalgais, HA
Second- pneumonia- severe- mortality rate of 75-80 if not treated- septic
describe legionnarie's bacteria
GN bacillus on charcoal yeast agar
DX legionnarie's disease
IFA and ELISA or direct fluoescent antibody
tXN legionella?
azithromycin, clarithromycin
2nd levofloxacin
ABG in PCP?
low PO2, increase in A-a O2 gradient
DX PCP?
bronchial lavage, elevated LDH levels!
patchy areas of ground glass attenuation with background of interlobular septal thickeneing
HRCT of PCP
TXN PCP
TMP /SMX x 21 days
prophylaxis in AIDS for PCP begins?
<200 CD4 count- TMP-SMX
side effects pentamide?
pancreatitis, renal failure, hepatooxicty, leukopenia, rash,f ever, hypoglycemia
txn chlamydia penumoniae?
doxycycline
how to dx viral pneumoia?
PCR testing
how to dx RSV pneumonia?
nasal wash, nasal cultures
TXN RSV
ribavirin
rodent feces + pneumonia?
hantavirus
RSV expsoure- what is the child at increased risk for?
reactive airway disease, asthma
when to admit the patient for penumonia?
CURB 65
confusion
urea >7 mmo/l
RR >30
BP <90/60
Age >65
only need 1 to admit
what increases tactile fremitus?
pneumonia, ateletcasis, malignancy, PE
what decreases tactile fremitus?
pneumothorax, pleural effusion, pleural thickening, tumors in pleural space
asthma, COPD
what electrolyte abnormality is legionella associated with?
hypoNa
most common site for inhaled foreign objects?
right lung
3 ways to dx asthma?
increase FEV1 by 15% after quick acitng bronchodilator
PEFR increase by 20% after quick acting bronchodilator
histamine/methacholine challenge: decrease FEV1 by 20%
mild intermittent- asthma severity of symptoms, night time symptoms, FEV, txn?
sx <2x/week
night time: <2x/month
FEV: >80- no daily meds
TXN: no daily meds
mild persistent- asthma severity of symptoms, night time symptoms, FEV, txn?
sx >2x/week, but <1x week,
night time >2 x/ month
FEV: >80%
Txn: Low dose inhaled CS
Moderate persistent- asthma severity of symptoms, night time symptoms, FEV, txn?
sx: daily sx, daily use of beta 2 agonist
night time >1x/week
FEV: 60-80%
TXN: Low to medium dose inhaled CS + LABA
severe persistent-asthma severity of symptoms, night time symptoms, FEV, txn?
sx: continual, limit physical activity
Night time: freqeunt
FEV: <60%
TXN: High dose inhaled CS and LABA + oral CS (no more >60mg/day)
nicotine in CAD
vasoconstrictor (potent) = common cause of CAD
how does smoking cause COPD?
impairs ciliary action and macrophage function
smoking degrades matrix proteins in ariway epithelium by reactive oxidants and proteinase activity-->stimulates inflammatory response such as macrophage recruitment of neutrolphils-->narrowing of respiratory
hypertrophy of bronchial wall mucous glands
chronic bronchitis
alveolar wall destruction, loss of elastic pulmonary recoil, enlarged air space
Emphysema
obstructive vs restrictive airway disease
obstructive: decreased FEV1
restrictive: decreased FC
PFTs in COPD?
decreased VC, TV, maximal ventilatory volume
total lung capacity and residual volume increased
mainstay for treatment of long term COPD?
long acting anticholinergics- tiotropium
1st line therapy COPD?
Beta 2 agonist (albuterol) or anticholinergics (ipratropium)
metabolic abnormality in COPD?
respiratory acidosis
most common type of lung cancer?
adenocarcinoma
lung cancers in outer, peripheral regions
adencarcinoma, large cell
lung cancers in central regions
squamous cell and small cell
female, non smokers, develops at mutliple sites in the lungs- what type of lung cancer?
bronchiolalveolar cardcinoma- subtype of adenocx
type of lung cancer in nonsmokers
adenocarcinoma
hypercalcemia and lung cancer
squamoud cell
where does adenocarcinoma arise from?
mucus cells
which type of lung cancer has a positive CEA?
adenoCX
mesothelioma vs lung cancer
mesothelioma - negative CEA, long microvilli, not associated with smoking
adenoCX: short microvilli, normal CEA, smoker (most of the time)
msot common cause of lower respiratory tract infections in children worldwide?
RSV
most common pathogen in bronchiolitis?
RSV
dx RSV
viral nasal washings, nasopharyngeal secretions RSV antigen test
key symptom w/ RSV?
wheezing
treatment acute exacerbation of COPD?
2nd gen ceph (cefuroxime, cefoxitin, cefaclor
MCC of croup?
parainfluenza
barking cough, inspiroatory stridor
croup
steeple sign
croup
txn croup
mild- shower steam, cool mist, antipyretics, oral rehydration
more severe- humidified air/oxygen, nebulized epinephrine or dexamethasone
MCC Of epiglottitis?
h. influenza
drooling, sniffing position
epiglottitis
txn epiglottitis
intubation, 2nd gen ceph- ceftriaxone, cefuroxime, or erythromycin
thumbprint sign
epiglottitis
how would you describe brodetella pertussis bacteria?
GN coccobacillus
phases of pertussis?
short catarrhal, then paroxysma cough, convalscent
txn pertussis
erythromycin
inspiratory whoop, repeated coughing
pertussis `
grayish membrane
diptheria
txn diptheria
erythromycin
dx pertussis
nasopharyngeal culture- bardet gengou agar
#1 cause of CAD?
smoking
what affects stroke volume?
contractility, afterload, preload
Ca and contractility?
calcium increases contractility
what is preload?
ventricular end diastolic volume- depends on venous tone and circulating blood volume
how to approximate afterload?
approximated by MAP
what is afterload?
what heart must pump against (aotic pressure, systole), ventricular pressure at end of systole
what is starling's law?
force of contraction is proportional to end diastolic length of cardiac msk fiber (preload)
difference between ionotropic and conotropic?
iontropic- affects contractility, chronotropic- affects HR
starling law
force of contraction : end diastole length of a cardiac msk fiber
what does angiotensin 2 do?
angiotensin II causes vasonconstriction and secretion of aldosterone
how do ACE I and HCTZ work synergistically?
ACE I increase blood flow to the kidneys and HCTZ gets rid of it
TXN HELLP syndrome
FFP, blood transfusion, steroids, antiHTN agents
when to do oral glucose tolerance test?
24-48 weeks
LDL goals?
<160 in normal population, 1 RF
<130 if 2 risk factors
<100 if high risk population (DM, CAD)
<70: those with 10 year risk of a cardiac event of 20% or recnet MI, or CAD + DM or severely controlled RF (smoking), metabolic
txn elevated TG?
fibrates
metabolic syndrome
central obesity (>102 in men,> 88 cm in women), TG >150, Low HDL <40, HTN >130/85, FBS >100 or dx of DM
what diseases accelerate atherosclerosis/
lupus, RA, HIV, CKD
definitive dx in ischemic heart disease?
coronary angiography
stress test- positive for MI?
ST depression of 1 mm
how do nitrates work?
decrease preload
ischemic symptoms but no elevation of troponins, ST depression, elevation, new T wave inversion
unstable anginga
unstable angina + elevations of troponins, but no ST elevation
Non-STEMI
MCC Of death after MI?
v fib
MCC MI
thrombotic event at site of pre-existing plaque causing complete blockage of the artery
angingal equivalents?
dyspnea, diaphoresis, N/V, waekaness, syncope or pre-syncope
echo of MI?
wall motion abnormalities
subendocardial vs transmural MI
subendocardial: Mc in women, affects inner 1/3 of ventricle due to hypoperfusion
DO NOT form aneurysms, no epicarditis, multifocal and patchy
Transmural: full wall thickness, thrombotic type;
unifocal and solid
subendocardial: ST depression
Transmural: ST
progressive of MI on EKG
peaked T wave-->ST depression-->ST elevation (injury)-->Q wave (infarct)
or new LBBB
ST depression is what on EKG
ischemia
ST elevation is what on EKG
injury
Q wave is what on EKG
infarct
1st biomarker to rise in MI?
myoglobin
last biomarker to rise in MI?
troponin
most sensitive biomarker?
troponin
TXN MI?
PCI with in 90 minutes
T-PA with in 3 hours
MONA +/- BB
what are pathological Q waves?
>0.04s or >25% of R wave amplitude
lateral MI on EKG?
I, aVL, V5. V6
what coronary artery in lateral MI?
LCX
V5-6 also: LAD
inferior wall MI on EKG?
II, III, aVF
coronary artery in inferior wall MI
RCA
septal MI on eKG
V1-V2
Anterior MI on EKG?
V3-4
septal/anterior MI- what coronary artery?
LAD
#1 cause of cardiac related death and disability?
atherosclerosis
screening for cholesterol?
female- begin at 45
male- begin at 35
#1 cholesterol med in pregnancy
cholesyramine
what to give with niacin to prevent flushing
aspirin
How to monitor coumadin (warfarin)
PT (INR)
how to monitor heparin?
PTT
PT vs PTT
PT: how long for plasma to clot
PTT: how long for blood to clot
Virchow's triad?
venous stasis, vascular injury, hypercoagulability
where is superficial thrombophlebitis MC?
saphenous vein
dx of DVT?
u/s duplex doppler
what is d-dimer?
fibrin degradation prodcut
first time patient with DVT treatment?
enoxparin 2 mg/kg subQ + warfarin 5 mg PO
check INR in 5 days, continue x 6 mo's
MC coronary artery to be occluded?
LAD
complications in the first 24 hrs after MI?
arrhythmia, HF, cardiogenic shock, death
3-14 days after MI- complications?
free wall rupture--> tamponade
Papillary msk rupture--> MR
LV pseudoaneurysm (mural thrombus)
best dx tool for abdominal aneurysms?
U/S
best dx of thoracic aneurysms?
CT/MRI
stanford classification
type A: proximal/ascending aorta- txn: surgical
Type b: distal: medical - ICU for BP mgt
buttock claudicaiton + ED + atherosclerotic disease
leriche's syndrome
post pradial pain, weight loss, hypercoag state
mesenteric ischemia
ankle brachial index in PAD?
<0.8
most common valve affected in RHD?
mitral valve
TXN RHD?
bed rest, salicylates reduce fever/pain, CS for severe pain or pericarditis
IM penicillin if + strep infection
most important virulence factor for group A strep infections in humans?
m protein
peak incidence of RHD?
5-15 y/o
JONES criteria
RHD
major: carditis, polyarthritis, chorea, subQ nodules, erythema marginatum
minor: fever, arthrlagias, prolonged PR, elevate ESR, C reactive protein, WBC, ASO titer test
PEACE: (PR INTERVAL, ESR, Arhrlagias, C-REACTIVE PROTEIN, ELEVATED TEMP)
IVDU and infective endocarditis- MCC, MC valve?
MC: tricuspid valve
MCC: S aureus
Non-IVDU- infective endocarditis
MC: Mitral vavle
MCC: Strep viridans
roth spots
reitnal hemorrhages with white centers- endocarditis
janeway lesions
painless lesions on palms/soles- endocarditis
osler nodes
painful lesions on fingers/toes- endocarditis
TXN endocarditis
IV PCN, ceftriaxone
criteria to dx endocarditis
Duke
Major: 2 positive blood cultures
positive echo finding
new regurg murmur
minor:
RF, fever, embolic event (janeway, petechiae, splinter hemorrhage)
immunolgoical events (GN, osler nodes)
MCC of sudden death in athletes?
hypertrophic cardiomyopathy
systolic murmur in left sternal borde that increases with standing and valsalva and decreases with squatting
hypertrophic cardiomyopathy
best screening test for hypertrophic caridomyopathy?
EKG
txn hypertrophic caridomyopathy?
bb
MC location of hypertrophci cardiomyopathy?
interventricular septum
MC type of cardiomyopathy
dilated
MC symptom of dilated cardiomyopathy?
dyspnea
MCC restrictive caridomyopathy?
amyloidosis
DX restrictive cardiomyopathy?
square root sign on cath, but definitive? enodmyocardial bx
TXN dilated cardiomyopathy?
ACEi, diuretics, stop drinking, BB
txn restrictive cardiomyopathy?
ACE I, lasix, BB
MCC pericarditis
coxsackivirus B
pericardial friciton rub, sharp or stabing retrosternal chest pain that is worse with supinea nd better leaning forward
pericarditis
diffuse ST elevations
pericarditis
TXN Pericarditis?
NSAID (indomethacin, aspirin)
Apsirin = #1
2nd line: steroids
TXN dressler syndrome?
aspirin, colchine
MCC pericardial effusion
pericarditis
elecrtical alternans
pericardial effusion
water bottle heart
pericardial effusion
low QRS voltage, tachycardia, electrical alternans
TRIAD on ECG
Beck's triad
hypoTN, JVD, muffled heart-->tamponade
paradoxical pulse pressures
drop of more than 10 mmHg in systolic blood pressure during inspiration
what does myocarditis lead to?
dilated cardiomyopathy
MCC of myocarditis?
coxsackie-adenovirus
most common drugs that cause myocarditis?
penicillin, ampicillin, hydrochlorothiziade, methyldopa, sulfonmaide
lithium, cocaine, catecholamines, acetaminophen, zidovudine (AZT)
DOXORUBICIN
DX of myocarditis?
cardiac echocardiogram
connective tissue d/o of myocarditis?
SLE, RA, kawasaki disease, sarcoidosis, giant cell arteritis
Most commonly, colon cancer arises from?
adenomas
most sensitive and specific test to detect colorectal cancer?
colonoscopy
most common site of distant spread of colon cancer?
liver
MC symptom of colorectal cancer?
abd pain
MCC Of LBO in adults
CRC
highest malignant potential in adults?
villous
follow up after CRC?
stool occult blood, annual CT of abdomen/pelvis/CXR q 5 years, colonocoscopy at 1 year and q 3 years, CEA q 3-6 mo's
most common cause of massive lower GI bleeding?
diverticulitis
dx of diverticulosis
barium enema
dx of diverticulitis
CT scan w/ IV or oral contrast
MC locaiton diverticulitis?
sigmoid colon
thickened area on the bowel in large intesine and soft tissue thickening of pericoloic fat
diverticulitis- CT scan
abx for diverticulitis?
cipro or augmentin + flagyl
s/s of LBO, but no mechanical obstruction
oglive's syndrome
MCC of mesenteric ischemia, MC location
MCC: arterial embolism (cardiac- a fib)
MC locaiton: superior mesenteric ischemia
txn of mesenteric ischemia?
papaverine (vasodilator)
most common site for voluvlus?
sigmoid colon
best test for volvulus?
sigmoidoscopy
txn volvulus?
decompression w/ sigmoidoscopy
classification of cirrhosis?
child's class
MC lab in cirrhosis?
anemia
MC complication of cirrhosis?
ascites
MCC of cirrhosis
alcoholic cirrhosis
txn encephalopathy?
lactulose
noemycin (prevents production of ammonia by bacteria in GI)
Limit protein to 30-40 g/day
MCC of varices
portal HTN secondary to liver cirrhosis
most serious complication of varices?
bleeding- death in 20%
red wale sign on endoscopy
esophageal varices
patients with cirrhosis should have what screening?
EGD screening
gold standard to dx esophageal varices?
upper endoscopy
txn of esophageal varices- long term?
BB- prevent re-bleed
TXn of esophageal varices during acute episode of bleeding
endoscopic band ligation or sclerotherapy (high chance re-bleed) or octreotide bolus (decrease portal HTN)
PPI- bolus followed by drip to suppress acid and prevent re-bleed
txn of coagulopathy in cirrhosis?
FFP
kayser fleishcher rings
copper accumulation in the eyes- wilson disease
Mc initial mainfestation in wilson disease
liver disease
what is wilson disease inherited?
autosomal recessive- ATP 7B gene
decreased ceruloplasmin
wilson disease
txn of wilson disease
Penicillamine (chelation)
zinc (binds copper)
most common genetic disease in caucasian population?
hereditary hemochromatosis
hepatic cirrhosis, DM, cardiomyopathy, hyperpigmentation (bronzing of the skin)
hereditary hemochromatosis
dx of hemocrhomatosis?
high serum ferritin, and liver bx is required
cause of autoimmune hepatitis
high IgG elvels
dx of autoimmune hepatitis?
liver bx
txn of autoimmne hepatitis?
steroids
occlusion of the hepatic venous outflow that leads to hepatic congestion is called?
budd-chiari syndrome
triad of budd-chiari syndrome?
abd pain, ascites, hepatomegaly
primary cause of budd-chiari syndrome?
thrombosis of hte hepatic vein
DX of budd-chiari syndrome?
UTZ- compressed hepatic veins
txn budd-chiari syndrome?
sodium restriction, diuretics for ascites, coumadin, TIPS
most common cause liver cancer?
cirrhosis
Causes of C. dif:
clindalmycin, cephalosporins, FQs, ampicillin
txn C dif
metro
ALT and AST- which is more sensitive for liver disease?
ALT
ALT:AST in alch disease
AST-ALT >2:1
where is ALP found?
bone, gut, placenta, liver, increase w/ obstruciton
liver enzyme sensitive to confirm the elevation of ALP is due to liver?
GGT
50 y/o female who is asymptomatic with elevated ALP, AMA, and choelsterol?
primary biliary cirrhosis
familial adenmatous polyps- autosomal dominant pattern is a mutation in what gene?
APC gene
incidence of malignancy in familial adematous polyps?
100% of cancer by age 40
anti-HAV (IgM)
acute phase heptatitis A
Anti- HAV (IgG)
later in the illness- elevated throughout life- hepatitis A
how is hep A transmitted?
fecal-oral route
incubation period hep A?
2-6 weeks
incubation hep B
6 weeks- 6 mo's
transmission of hep B
blood, IVDU, sex
HBsAg
positive in acute phase- hepatitis B and chronically infected patients (persists indef in chronic carriers)
HBeAg
positive in acute phase = replication occurring- hepatitis B
Anti-HBc
window period of hepatitis B
indicates infection w/in past 6 mo's
Anit-HBs
immunity via vaccination
Anit-HBs and Anti-HBc
immunity via actually having hep B
TXN of hep B
recombinant DNA hep B vaccine
incubation hep C
2wks -6 mo's
MCC of liver transplant?
hep C
transmission of hep C
Renal dialysis, IVDU, transplant,
Anti-HCV antibodies
hepatitis C infection
MCC chronic hepatitis?
hep C
MCC of hep C?
transfusion
txn hep C?
interferon with ribavirin, give with hep A/B vaccine
Hep D
needs Hep B
delta virus and affect on hep B
increases severity of acute hep B and increases the risk of chronic hep and cirrhosis verses hep B alone
which hepatitis is associated with high risk of death in pregnancy?
hep E
incubation hep E
15-60 days
how to trasmit hep E?
fecal-oral
MCC liver abscess?
enatomeba histolytica
txn of acetaminophen overdose?
acetylcysteine
MCC of cholecystitis
gallstones in the gallbladder
most common type of gallstone?
cholesterol
Boas sign
referred right subscapular pain- cholelithiasis
best test in cholelithiasis?
abdominal u/s
best test for acute cholecystitis?
abodminal U/S, then HIDA
gold standard for dx in choledocholithaisis?
ERCP
TXN choledocholithaisis?
ERCP decompression
porcelain gallbladder?
gallbladder cx- adenocarcinoma
best etst in cholecystitis?
abdominal u/s
Charcto's triad?
RUQ pain, jaundice, fever- acute cholangititis
Renyolds pentad?
AMS, shock, RUQ pain, jaundice, fever- acute cholangititis
definititive dx of acute cholangitits?
IVF, abx, after afebrile x 48 hours- decompress- ERCP, PTC, or laproscopic
most common cause of chronic pancreatitis?
ETOH
most common cause of acute pancreatitis?
gallstones
MCC of pancreatitis in kids?
blunt trauma
MC complication acute pancreatitis?
pseudocyst
DX pseudocyst?
CT scan
grey turner sign
falnk ecchomysosis- hemorrhagic pancreatitis
cullen sign
periumbillical ecchymosis- hemorrhagic pancreatitis
fox sign
ecchomyosis of inguinal ligmanet- hemorrhagic pancreatitis
TXN acute pancreatitis?
IVF, NG tube, IV pain meds
DX of acute pancreatitis
abdominal CT scan
RF for pancreatitis cancer?
ETOH, smoking, age, men
MC location of pancreatitis cancer?
head of pancreas
Courvosier's sign
palpable gallbladder- pancreatic cancer
most sensitive test for head of pancreas cancer?
ERCP
preferred test for dx and looking for distant mets in pancreatic cancer?
CT
txn of pain in pancreatitis
merpedine
criteria for acute pancreatitis?
Ranson's
sister mary joseph nodule?
periumbillical node- pancreatitis cancer
triad chronic pancreatitis?
steatorrhea, DM, pancreas calcifications
DX for appendicitis?
CT scan
deep palpation of LLQ causes referred pain to RLQ
rovsings sign (appy)
RLQ pain when right htigh is extneded as patient lies on left side
psoas sign
pain in RLQ when flexed right thigh is internally rotated when patient is supine
obturator sign
MCC of prostatitis overall?
nonbacterial
TXN of prostatitis <35 adn >35
<35- ofloxacin or ceftriaxone 250 IM, doxycycline x 10 days
>35 y/o: cipro/bactrim
TXN nonbacterial prostatitis?
erythromycin 250 Mg QID
MCC Of prostatitis <35 adn >35
<35: chlamydia, gonorrhea
>35: GN rods
most common non cutatenous cancer among males?
prostate cancer
MC location of prostate cancer?
peripheral region
when to start PSA check?
age 50 for men, 40 for AA
MC type of prostate cancer/
adenocarcinoma
MC met site for prostate?
bone
MC type of bladder cancer?
transitional cell, urothelial carcinoma
SCC bladder cancer associated with
schistosom haematobium
painless heamturia
bladder cancer q
MC renal malignancy
renal cell carcinoma
hematuria, flnak pain, flank mass, weight loss, HTN, hyperCa
renal cell carcinoma
DX renal cell carcinoma?
CT scan
asymptomatic abdominal mass in a 3 year old?
wilms tumor- nephroblastoma
MC renal tumor in kids?
wilms tumor
initial test in wilms tumor?
U/S
study of cohice in wilms tumor?
CT
MUST DO CXR TO R/O METS
MC malignancy in young men?
testicular cancer
MC cause of testicular cancer?
germ cell tumors
painless, unilaterla testicular mass
testicular cancer
DX of testicular mass?
utz
How to stage testicular cancer?
CT, CXR
serum markers in testicular cancer?
HCG, AFP, LDH
nitric oxide in erections?
NO released from nerve endings relaxes vascular and corporal smooth msk cells of penile arteries and trabeculae
TXN erectile dysfunction
PDE-5 phostphatdiesterase inhibitors (fil)- sildenafil, vardenafil, tadalafil
MCC of ED?
pscyhogenic
what are PDE-5 phosphatediesterase inhibitors contraindicated in?
CAD, CVA
what is leydig cell hyperplasia?
pre-cancer cells- cryptorchdisim
most common abnormality of sexual development?
cryptorchidism
Cryptorchdisim puts the person at an increase risk for?
testicular malignancy
treatment urinary retention?
alpha blockers- azosins
MC benign tumor of men?
prostate (BPH)
TXN BPH?
alpha 1 blockers- "sins"
5 alpha reductase inhibitors: finasteride
if you can't given a sin, give a ride.
soft, non-tender mass of the scrotrum that transilluminates?
hydrocele
hydrocele forms due to a defect of?
tunica vaginalis
DX hydrocele?
U/S
bag of worms?
varicocele
dilatation of the internal spermatic vein
varicocele
varicocele is associated with what in males?
infertility
when is testicular torsion MC?
12-18 y/o
prehn sign
relief with elevation of the testes
bell clapper deformity?
Pt's with inapprorpriately high attachment of the tunica vaginalis, the testicle can rotate freely on the spermatic cord within the tunica vaginalis
negative prehn sign, abnormal transverse lie?
testicular torsion
when must you detorse a testicular torsion in order to salvage the testicle?
within 6 hours
bladder contractions that can't be controlled by the brain and the patient cna't delay peeing
urge
urine leaks with elevated intra-abdominal pressure
stress
detrusor underactivity causes what type of incontinence?
overflow
treatment incontinence?
antimuscarinic (oxybutin), botox to detrusor msk, estrogen, kegels, surgery
MCC cystitis
e. coli
txn cystitis?
Bactrim first line; 2nd: cipro
txn of cystitis in pregnancy?
macrodantin or nitrofuratonin
first line txn of pyelo?
FQ x 7-14 days
first line txn of pyelo in prego?
ampicillin, gentamicin
mumps and orchitis?
unialterally in 70% of patients
orchitis is most commonly associated with?
viral mumps
MCC of urethritis in men <35 y/o
chlamydia and gonorrhea
MCC of urethritis >35 y/o
e. coli, pseudomonas
MCC overall of urethritis?
chlamydia
txn men <35 y/o with urethritis?
doxy x 7 days
males >35- txn of urethritis?
cipro
txn of epipidmyitis in males <35 y/o
chlamydia, gonorrhea-
ceftriaxone 250 mg IM + doxycycline 100 mg BID x 10 days
txn of epididmyitis in males >35 y/o
e. coli and pseudomonas
cipro
what is the epididmyis?
it connects efferent ducts of testis to vas deferens; it allows for stoarge, maturation and transport of sperm
solid palpable lesion that is <10 mm in diameter?
papule
solid palpable lesion that is >10 mm in diameter?
nodule
flat, nonpalpable lesion <10 mm
macule
palpable flat lesion that is usually raised >10 mm
patch
flat, nonpalpable lesion with is >10 mm in diameter
plaque
blister filled with serous fluid or blood which is >5 mm
bulla
blister filled with serous fluid that is <5 mm
vesicle
vesicle or bulla with purulent material?
pustule
small hemorrhagic spots that do not blanch
petechiae
punctate bleeding after scale is removed?
ausptiz sign
urticarial flare produced by rubbing of the skin?
darier sign
rubbing of hte skin leads to a blister
nikolsky sign
blaching indicates what?
intact capillaries
minor trauma leads to new lesions at site of trauma?
koebner's phenoemenon
MCC cellulitis?
group A strep, staph
txn cellulitis?
dicloxacillin or cephalosporin
allergy: ertyrhomycin
txn abscess?
I and D then back, given ABX if surroudning area has cellulitis
MCC abscess
staph
MCC furuncles, carbuncles?
staph
cause of erysipleas?
strep pyogenes
sharp, demarcated borders, edematous inudrated, pruritic, painful, espands, high fevers?
erysipelas
TXN erysipelas?
dicloxacillin or first gen ceph
txn impetigo?
mupirocin ointment
MCC erythema multiforme?
HSV
target lesions, mucosal lesions, macular or papular rash with vesicles adn bullae, general malaise, weakness, negative nikolsky
erythema multiforme
EM major= mucosal lesions
TXN erythema multiforme?
acyclovir, valacyclovir, famcyclovir
medications associated with SJS, TEN?
antiepileptic, sulfas, PCNs, NSAIDS, FQs, PB, tetracyclines, phenytoin, allopurinol, cephalosporins, carbamazpeine, valproic acid, oxicam, allopurinol, CS
SJS vs TENS
SJS: <10% sloughing of the epidermis
TENS >30% extensive mucus membranes infovlved
MCC of acne vulgaris?
propinibacterium `
treatment of acne vulgaris?
retinoids, azelaic acid, salicyclic acid, benzyol peroxide, topical abx (tetracycline, erythromycin, clindamycin); oral abx if more severe: tetracyclines
OCPS (decreased androgen levels
large bulbous, red nose
rhinopyhma - acne rosacea
other enlarged things: phyma!
TXN acne rosacea?
avoid triggers, metro topical; hydrocortisone topical
severe; oral abx- tetracyclines
MCC folliculitis?
staph
palpable purura, well dermarcated petechaie on bilateral lower ext, abd pain, joint pain
Henoch scholein purpura
atopic dermatitis is what type of hypersensitivity reaction?
type I immunobloglobulin E mediated
what type of hypersensitivity reaction is allergic contact dermatitis?
type IV cell mediated
distinct lichenified skin, involving flexural surfaces, dry skin
atopic dermatitis
txn atopic dermatits?
steroids (topical)
hydration, topical emollients
txn diaper dermatitis?
nystatin, clotrimazole, ketoconazole
well demarcated areas of erythema w/ possible exudative lesions, vesicles, crusted lesions, pruritis, location is key
allergic contact dermatitis
txn allergic deramtitis?
topical steroid- control pruritis w/ calamine lotion, wet dressing w/ burrows solution
coin shaped lesions with erythematous base and clearly demarcated borders?
nummular deramtitis
scattered yellowish or grey scaly macules, papules, flakey, dry itchy skin, found on the scalp, behind the ears, in nasal folds, eye lids- greasy
seborrehic dermatitis
txn seborrheic dermaitits?
cradle cap: olive oil compresses, baby shampoo; dandruff: shampoos w/ selenium or zinc; ketoconazole for acute flareups
txn perioral dermatitis?
topical metro or erythromycin
papulopustules on erythematous base that because confulent w/ plaques and scales around the mouth, vermilion border is spared
perioral dermatitis
tapioca apperance, clear vesicles on hands/feet, pruritis
dyshidrosis
txn dyshidrosis?
steroids, wet dressing, avoid skin irritation
solid, firm, thick plaques with little scaling, lichenification, well defined, high pruritic, itch cycle; bx: hyperplasia and hyperkeratosis
lichen simplex chronicus
txn of lichen simplex chronicus?
stop itch-scratch cycle- antihistamines, topical steroids
lichen planus is associated with what?
hep C
purple, polygonal, pruritic, papule
lichen planus
flat topped, shiny violaceous papules with fine white lines (Wickham's straie), painful mucosal lesions, purple, polygonal pruritic papule
lichen planus
txn lichen planus?
topical steroids
herald patch
pityriasis rosea
oval, salmon or fawn colored macuopaular rash on the upper trunk in an christmas tree patern,
pityriasis rosea
txn pityriasis rosea
self-limiting ; last 3-8 weeks
extensor surfaces with chronic, inflammatory scaling red flaky conditions, salmon colored, well defined papules and plaques with distinct margins and loosely adherent, dry,itchy, raised and thickened
psoriasis
nail pits
psoratic arthritis
auspitz sign, koebner's phenomenon
psoriasis
where is psoriasis located?
extensor surfaces
txn psoriasis?
topical steroids, topical Vit D prepararations, coal tar or salicyclic acids
more severe: phototherapy
pustular psoriasis occurs when?
taper steroids too quickly- life threatening
MC type of psoriasis?
psoriasis vulgaris
psoriasis that occurs after a streptococal infection?
guttate psoriasis
autoimmune disorder against basement membrane of the epidermis
bullous pemphigoid
large, tense bullae, usually from a urticarial rash that months later turns into large tense bullae, more difficult to rupture
bullous pemphigoid
txn bullous pemphigoid?
topical steroid for minor; may need systemic
loss of cell to cell adhesion?
pemphigus vulgaris
acitinic keratosis goes to what type of skin cancer?
acitinic keratosis
sandpaper, macule/papule, hyperpigmented
acitinic keratosis
txn acitinic keratosis?
liquid nitrogen
beige, brown, black with velvety warty surface appears stuck on?
seborrheic keratosis
TXN of alopecia?
minoxidil, finasteride
distal separation of the nail plate from the nail bed
onycholysis
txn of onycomycosis
terbinafine, itraconazole
MCC paronychia?
staph
cause of lice
pediculosis
txn of lice?
permethrin, pyrethroids, malathoin, lindane
what is the animal that causes scabies?
sarcpotes scabiei, obligate human parasite
burrows in intertriginous areas, intense pruritis, excoriations
scabies
txn scabies?
permthrin 5% or lindane
apply on body before bed, wash off in the AM, repeat txn in 1 week
cause of bed bugs
parasitic athropods- cimicdae
multiple bites noted upon wakening, pruritic, blood stained bedding
bed bugs
txn bed bugs
supportive- antipyretics, abx, eradication with cleaning
pin prick followed by msk cramps, bull's eye, central blanchin, generalized diaphroesis, tahcycardia
black widow bite
txn black widow?
can give opioids for pain mgt, BZ/Ca gluconate for neuro manifestations, antivenom
may need to admit for pain mgt; monitor for 6 hours after givne antivenom
txn brown recluse?
suppotive, abx, wash out area, surgical excision if necessary
bright red, raspberry like nodules on exposed part of the body like arms, hands, fingers or legs; bleeds easily with little provocation
pygoenic granulomas (capillary hemangiomas)
TXN pyogenic granulomas?
electrodissection
most common skin cancer?
basal cell carcinoma
shiny, pearly, wzxy papule, easily bleeding, central crater with rolled border,
basal cell carcinoma
what is necrobiosis lipodica associated with?
DM- do GTT
smal, shiny skin colored dermal papules that enlarge over time with central clearing MC on shins
granulomas annulare
nonhealing, rough, bumpy, scaly patch, erythema, sharply demarcated, hyperkeratonic macule or papule
SCC
MC melanoma in elderly?
lentigo maligna melanoma
MC type of melanoma
superficial spreading malignant melanoma
worst prognosis melanoma?
nodular malignant melanoma
best prognosis melanoma
superficial spreading malignant melanoma
melanoma MC in AA, think palms, soles, nail beds
acral lengtiginous melanomous
most important aspect of melanoma that determines survival rates?
tumor thickness
what does gardasil protect against?
HPV 6, 11, 16, 18,
HPV that causes cervical cancer?
16, 18
condyloma acuminatum is caused by?
HPV 6, 11
painless, non-pruritic red or purple plaques on the skin and mucosal surafces
kaposi sarcoma
kaposi sarcoma is associated with?
HSV 8, HIV
ephelis
freckle- increased melanin pigment
necrotizing fasciitis caused by?
s pyogenes
creptius with deep tissue injury
necrotizing fasciitis
what is acanthosis nigricans associated with?
DM, obesity, cushing's syndrome, visceral obesity (gastric adenocx)
Antibiotics for open fractures?
IV 1st/2nd gen ceph + amninoglycosides
TETANUS!
txn of open fractures?
iV abx (ceph + aminoglycoside), debride and irrigate w/in 48 hours, immobilize and fixation
txn of intra-articular fracture?
open treatment
txn of fractures of tibia and fibula
simple
complicated
simple: closed reduction, cast placement
complicated, unstable: open reduction + ORIF
trauma to the ligament or joint capsule?
sprain
trauma to tendon or msk
strain
severe pain on the bottoms of the feet in the AM, subsides after amublation, pain over palpation of the medial heel
plantar fascitis
most common location for compartment syndrome?
anterior in the lower extremity
MC fracutre in adults to lead to compartment syndrome? in Peds?
Adults: tib-fib
peds: supracondylar humeral fracture
5 p's of compartment syndrome?
pain out of proportion, on passive movement, parasthenia, pallor, pulselessness, poikilothermia, paralysis
DX of compartment syndrome?
MAP > 30 mmHg
MC osteomyelitis?
hematogenous spread
ares of osteomyelitis in kids?
long bones
area of osteomyelitis in IVDU?
lumbar vertebrae
MC location for osteomyelitis in adults?
vertebrae
nonhealing ulcer, sinus tract drainage, chronic fatigue, low grade fever, bone pain, leukocytosis - what are you thinking?
chronic osteomyelitis
best test to dx osteomyelitis
MRI
study of choice in legg calve perthes disease?
MRI
what does a hip xray of legg calve perthes disease show?
necrosis effusion and joint space widening
painless limb in a 4-10 y/o
legg calve perthes disease
obese AA male, 11-13 y/o, painful limb
SCFE
DX of SCFE?
frog leg xray bilaterally
TXN of SCFE?
non-weight bearing, surgery
x-linked recessive disease with decreased dystopin?
Duchenee's disease
Gower's manuever?
duchennes disease
4 signs of kanaval
pain on passive movement, flexion of joint, symmetrical swelling of hte joint, TTP of the tendon sheath
tensosynovitis
ortlani
abduct the hip with anterior pressure
development dyplasia of the hip
barlow
adduct the hip, audible clunk
development dyplasia of the hip
galezaai
unequal knee heights
development dyplasia of the hip
DX of development dyplasia of the hip
U/S is best after 10 weeks, xrays no longer good after 4 mo's
TXN development dyplasia of the hip
<6 mo's: pavilk harness
6-15 mo's: spica case
15-20: open reduction
SALTR harris fractures
Type 1: physeal fracture
Type 2: physeal and metaphysis fracture
Type 3: physeal and epiphyseal fracture
Type 4: epiphyseal, physeal and metaphysis fracture
Type 5: completely crushed
most common saltr harris fracture
Type 2
degree of angulation in green stick fracture that requires a surgeon?
>15
MCC of facial pain?
TMJ
most common condition of cervical spine?
spondylosis
MC area affected by degenerative changes?
C5-6
msot mobile joint of hte body?
shoulder
most common tear in the rotator cuff?
supraspinatous
rotator cuff msks?
supraspinatous, infraspinatous, subscapularis, teres minor
most common injured msk in fracture clavicle?
supraspinatous
Most common location of fracture of clavicle?
middle 1/3
TXN of fractured clavicle?
figure 8 sling
complication of fractured clavicle?
ulnar nerve
first degree AC separation?
stretching of the joint, no physical seperation
2nd degree AC separation
complete separation of the AC joint, but the ligaments of shoulder blade and collarbone are intact
PE: end of collarbone sticks up
TXN 1st degree AC joint separation?
sling x 3-7 days
TXN 2nd degree AC separation?
Ice, sling, painkillers; 2-3 weeks to heal
TNX 3rd degree AC separation?
surgical repair
3rd degree AC separation?
AC joint torn awawy and ligament attaching shoulder blade to collarbone are ripped
XRAY: complete separation
xray showed complete separation
most common type of shoulder dislocation?
anterior
when is an anterior shoulder dislocatino painful?
externally rotated and internal rotation= painful
most common finding on PE of anterior shoulder dislocation?
anterior apprehension sign (placing shoulder in abduction and external rotation = patient is uneasy that it might pop out)
hill sachs lesion?
humeral head deformity due to recurrent dislocations
Bankhart lesion
tear of glenoid labrum
most common injured nerve in anterior shoulder dislocation?
axillary nerve-->deltoid numbness
most common cause of posterior shoulder dislocation?
50% due to seizures
DX posterior shoulder dislocation?
Y or axillary view xray
where does the humeral head lie in the anterior shoulder dislocation?
inferior and medial to glenoid
txn shoulder dislocation?
reduction, immobilization with velpau's sling
x 3 weeks if <40, x 1 week <40 y/o, then PT
txn bursitis
Rest, NSAIDs, steroid injections
humeral shaft fracture- what nerve?
radial
humeral head fracture- what nerve?
axillary
radial nerve injury results in what?
wrist drop
Yergason test?
biceps tendon instability - biceps tendonitis
pain over bicipital groove + yergason test, pain radiating to biceps, pain with internal rotation, pain with forward flexion of the shoulder
biceps tendonitis, not rotator cuff injury
most common nerve injured in supracondylar fracture?
median nerve
complication with supracondylar fractures?
volkmans contracture (brachial artery)
elbow dislocation?
ulnar nerve
most common elbow fracture?
supracondylar fracture
Most common elbow dislocation?
posterior
posterior fat bad?
radial head fracture
MC overuse injury of the elbow?
epicondylitis (lateral)
MSK involved in lateral epicondylitis?
extensor carpi radialis brevis
nursemaids elbow- how does the child hold it?
fully pronated, partially flexed
radisu jumps annular ligament
nursemaid's elbow
radius fracture with distal ulnar joint injury
galleazei
ulnar fracture with radial head dislcoation?
monteggia
crush injury to radial head with distal radius ulnar joint injury
essex-lopressti fracture
direct blow to mid shaft ulna--> mid shaft ulnar fracture
night stick fracture
most common injury of wrist?
colles fracture
silver fork deformity
colles fracture
distal radius fx with dorsal angulation
colles fracture
TXN colles
long arm cast for 6- 8 weeks
distal radius with volar angulation
smith fracture
TXN smiths fracture
long arm cast
txn scaphoid fracture
short arm spica for 8-12 weeks
complication of scaphoid fracture?
avascular necrosis
TTP of anatomical snuff box?
scaphoid fracture
carpal bones?
some lovers try positions that htey can't handle
scaphoid, lunate, triquetrum, pisiform, trapezium, trapeizoid, capitate, hamate
TXN monteggia, galeazzi?
ORIF
what is dupuytrens contracture associated with?
alcoholism DM
what is involved in Dequervains?
abductor pollicis lungus and extensor pollicis previs
pain and tenderness of base of thumb, radiation of pain up forearm Positive finklestines test?
DeQuervains
ulnar colalteral ligament injury
gamekeepers thumb
treatment of gamekeeprs thumb?
thumb spica or surgery
flexor digitorum profundus tendon rupture
jersey finger
inability to extend DIP joint fully, flexed dip at rest
mallet finger
inability to flex the dip joint, acute pain/swelling over DIP joint
jersey finger
inflammation of the flexor tendon sheath?
trigger finger
carpal tunnel affects what nerve
median nerve
tapping on the wrist produces pain in the median nerve
tinel's sign- carpal tunel
patient flexes both wrist and that elicits pain
phalen test- carpal tunnel
thenar musk atrophy
carpal tunnel
most common site of ulnar nerve entrapment?
elbow
giant cell tumor?
expansile lytic lesion that involves epiphysis and metaphysis, MC in men 20-50 y/o, can occur in distal radius
when does erbs palsy occur?
brachial plexus injury during difficult births with fractured clavicles
most common radiculopathy (nerve root compression) in brachial plexus?
C7
DX erbs palsy
MRI
arm hangs loosely at a child's side after a difficult delivery?
erbs palsy
paralysis of the 7-8th cervical and first throacic nervs causing al imp hand with no finger movement, claw hand
Klumpkes paralysis
constricted pupil, drooping eyeld, and loss of sweat formatoin on cheek or foreahd of affected eye?
horner syndrome
Pancoast tumors are most likely what time of tumor?
SCC or adenoCX
winged scapula? Mks and nerve involved
serratus anterior msk, long thoracic nerve
erbs palsy nerves?
C5-6
MC herniated disk?
L5/S1
MC location for cauda equina?
L4-5
MCC of cauda equina?
herinated disk
bamboo appearance
ankylsosis spondylitis
MC extramsk affect?
iritis
Most common first xray finding in ankylosing spondylitis?
bilateral sacroilitis
worse at night or after inactivity, limited motion in the lowe back, limited expansion of the chest, limited ROM of spine/hips, iritis
ankylosing spondylitis
1st line txn ankylosing spondylitis?
indomethacin
2nd: DMARDS, methotrexate
convex curvature of hte thoracic spine
kyphosis
etiology of kyphosis in adults?
osteoporotic fractures
PFT in kyphosis
restrictive airway
Potts disease
TB of the back
MC extrapulmonary location of TB
spine
burst fracture of C1
jefferson
fracture of C2
hangman fracture
treatment of kyphosis?
> 60 degrees: milwaukee brace
MC form of scolilosis?
idiopathic
txn scoliosis?
10-15% observe
15-20: follow up with AP exrays
20-40: brace
>40 surgeon
MCC of DUB?
fibroids
MCC of IDA in females?
DUB
MC GYN malignancy in the US?
endometrial cancer
how to dx endometrial cancer?
endometrial bx
MCC of endometrial cancer/
adenocarcinoma
MC site for endometriosis?
peritoneal (ovary, pelvis)
TXN leiomyoma?
GnRH agonist (Leuporlide), misfepristone (decrease tumor size), hysterectomy, D &C, myomectomy
Adenomyosis vs endometriosis?
young female, infertile with cyclical pelvis pain and deep thrust dyspareunia
adenomyosis: middle aged parous femael with severe dysmenorrhea and menorrhagia with symmetrically enlarged uterus
fever in the PP period?
metritis
how to prevent endometritis?
single dose of antibiotic at cord clampin
TXN of endometritis?
clindamycin + gentamicin add ampicilin if not response and metro if septic
who are at increased risk for ovarian torsion?
cysts that are >5 cm.
what is used to monitor treatment of ovarian cancer?
CA125
MC type of ovarian neoplasm?
epithelial
most common presentation of ovarian cancer?
ascites
what spreads to the ovarian (cancer wise)?
endometrium, breast, colon, stomach, cervix
txn of PCOS (stein-leventhal syndrome)?
wants prego? #1 is clomid +/- dexamethasone
no prego? OCPS, medroxyprogesterone
hirutism? spirolactone, finasteride
dosing of gardasi?
3 doses- 1/st dose, then 2nd dose 2 mon'ths later and 3rd dose 6 months after first dose (4 mo's after 1st)
what does gardasil protect against/
6, 11, 16, 18
6,11: warts
16, 18 : cancer
summary of PAP smear recommendations?
begin at age 21
21-30: PAP q 3-5 years with cytology screen
30-65: co-test cytology and HPV q 5 years
sexually active: q 1 year
final PAP: age 65 y/o if at least 3 normal results in preceding 10 years
who gets gardasil?
everyone aged 9-26 y/o
patient has HPV + but negative cytology what is the work up?
repeat PAP In 12 mo's- if HPV +or LSIL or above again do colpo ; if ASCUS but negative HPV, routine screening
patient is HPV + and ASCUS- work up?
colpo
Patient is HPV negative and ASCUS - work up?
routine
patient is HPV negative, and LSIL- work up?
colpo
TXN chlamydia?
azithormycin or doxy
txn gonorrhea?
ceftiraxone
txn trichomonas
metro
strawberry cervix with green frothy d/c?
trich
most common cause of cervical cancer?
HPV 16/18
fishy odor, clue cells?
bacterial vaginosis (gardnerella)
cottage cheese discharge, burning, pruritis
candidiasis
txn candidiasis
fluconazole PO or clotrimazole PV
DES is associated with what GYN cancer?
vaginal cancer
MC symptom in vaginal cancer?
chronic itching
Most common squamous cancer in females >50 y/o
vaginal Ca
hypomenorrhea?
light menses
oligiomenorrhea/
menses cycles >35 days
metrorrhagia?
intermenstrual bleeding
menorrhagia
cyclical bleeding > 7 days
menstrual cycle order
follicular (estrogen increase uterine lining to thicken it; increase FSH- then follicle becomes dominant
ovulation: LH surge= dominant follicle releases egg
Luteal: follicle changes into corpus luteum= secrete progesterone; no implantation,- drop in proge
primary dysmenorrhea is secondary to?
excessive PG E2 -->smooth msk contraction
what is sheenan syndrome
damage to pituitary after delivery-->amenorrhea
what is asherman syndrome?
intrautine adhesions and scarring leading to normal estrogen, but amenorrhea
MC symptoms in PMS?
pscyh- irritable, depression, etc
txn of extreme mood changes secondary to PMS?
fluoxetine on day 21-1 of the cycle
what is PMS?
mood irritaiblity, bloating, etc the 1-2 weeks before menses (luteal phase), and has a symptom free period
TXN PMS?
diet (no sugar, alch, coffee, salt, fat), exercise, NSAIDs
diuretics (spironlactone) for bloating during luteal phase)
Fluoxteine 21-1 of cycle
NSAIDs
primary estrogen in menopause?
estrone
MC symptom of menopause?
hot flashes
FSH >30
menopause
MC malignancy in female?
breast
Pagets disease
ductal carcinoma of hte nipple;
redness, falking of nipple skin, peau d'orange
paget's disease
MC type of breast cancer?
ductal
screening for breast caner
USPSTF: q 2 years 50-79
American cancer: q 1-2 years 40-50, q 1 year at 50
most effective method of reversible means of pregnancy prevention
OCPs
how long after depo may it take to return to normal fertility?
18 mo's
SE depo?
irregular bleeding, weight gain
at waht weight does the transdermal patch become less effective?
>200 lbs
most common STD?
chlamydia
txn PID?
ceftriaxone 250 mg IM and doxy 100 mg
N,V, yellow/green visual changes, EKG changes
digoxin toxicity
what makes dig toxicity worse?
hypoK
best anti-HTN med for post MI?
beta blocker
most common location for renal artery stenosis?
infrarenal artery
HTN that is non-responsive to meds?
secondary causes, MCC: renal artery stenosis
rapid, deep labored breathing
kussmaul's breathing
deep breahting alternating with apnea
cheyne stokes breathing
pleural thickening on CXR ?
mesothelioma
eggshell pattern on CXR?
cilicosis
groundglass appearnace on CxR/
asbestosis
isolated elevated indirect billirubin?
gilberts syndrome
travelers diarrhea treatment
cipro
EKG of hyperCa?
prolonged PR, decreased QT, heart blocks
MCC hyperPTH?
PTH adenoma
MCC of chronic kidney stones?
hyperPTH
abd pain, decreased DRTs, bone pain, stones, polyuria, constipation, depression
hyperPTH
txn hyperPTH?
parathyroidectomy
MCC of hypothyroid?
post thyroidectomy
What is DiGeorge's syndrome?
congential facies and cardiac anomalies, thymic aplasia, cleft palate, hypoCa, hypoPTH
Troussea sign, chvostek sign, tingling of circumoral area, premature cataracts, msk cramps, increased DTRs
hypoPTH- hyperCa
txn of hypoPTH- acutely
IV Ca gluconate
txn of hypoPTH- chronically?
PO Ca and vit D
EKG hypoPTH?
T wave changes, increased QT
MCC addisons disease?
autoimmune
primary vs secondary addisons disease
primary: increased ACTH (pituitary is functioning), but decreased cortisol-->abnormal skin pigmentation
secondary: decreased ACTH (pituitary not working)- no pigmentation
DX of cushings disease?
dexamethasone suppresison test
cushings disease vs syndrome
disease- pituitary adenoma secreting ACTH
MCC of cushings syndrome?
Iatrogenic steroids
MCC of acromegaly?
pituitary macroadenomas
DX of acromeagly?
MRI with pituitary adenoma or elevated IGF-1
txn acromegaly?
removal of tumor, then bromcriptine
what hormones are secreted by anterior pituitary?
ACTH, TSH, LH, FSH, HGH, prolactin
hormones secreted by posterior pituitary?
oxytocin, vasopressin
MC type of pituitary tumors?
prolactinomas
MCC of anterior pitutiary hormones?
tumor
polyuria, polydipsia, dehydration, increased thirst, low specific gravity urine
diabetes inspidus
DX DI?
water deprivation test
txn DI?
vasopressin if central
what does aldosterone do?
Na reabsorption and K excretion
what does Cortisol do?
stimulates gluconeogensis and increase protein breakdowna nd free acid mobilization, suppresses immune system
what does adrenal medulla secrete?
EPI and NE
hypoNa, very saturated urine
SIADH
txn SIADH?
fluid restriciton, IV hypertonic saline
txn pituitary adenoma?
#1- carbegoline (dopamine agonist)
#2: surgery
DX pituitary adenoma?
MRI
most common presentation of graves disease?
atrial fib
graves disease
IgG autoantibodies against TSH receptors in the thyroid cell
elevated T3, low TSH, autoantibodies against TSH receptor dx of?
graves disease
what is the MCC of hyperthyroid?
graves disease
first choice treatment of graves disease in pregnancy and children?
PTU
thyroid: diffusely enalrged, non-tender, w/ bruit
graves disease
exquistely tender thyroid, diffusely enlarged
subacute thyroiditis
bumpy, irregular asymmetric thyroid?
plummer disease- multinodular goiter
Treatment for multinodular goiter?
radioactive iodine
graves vs subacute thyroiditis with uptake scan
low uptake with subacute
high uptake with graves disease
txn subacute thyroiditis?
aspirin
fever, pain, fluctuant mass of thyroid
suppurative thyroid
thyrotoxicosis fascitta?
ingestion of thyroid hormone (beef)
what is monitored in thyroid cancer?
thyroglobulin - should be gone after removal of thyroid
method of cohice in thyroid nodules
FNA
TSH mimicking autoantibodies?
graves disease
antiobodies against enzyme that makes T4
hashimotos
TXN of non-prego young patinet with graves disease?
methimazole, BB
txn of non-prego older patient with graves disease
radioactive iodine ablation
MC therapy for graves
radioactive 131
how does PTU, methamizole work?
blocks synthesis of thyroid hormone
cretinism
thyroid deficiency that started at birth
most common cause of primary hypothyroidism?
hashimotos
most common type of thyroid cancer?
papillary carcinoma
elevated TSH, low thyroid levels
hypothyroidism
elevated TSH, low thyroid levels, anti-thyroidal
ANTI-peroxidase, thyroglobulin, TSH receptor IgG
hashimotos
diffusely enlarged , firm finely nodular thyroid, then may progress to a small gland
hashimotos
most aggressive thyroid cancer?
anaplastic
hx of hodgkin's disease and now thyroid nodule?
thyroid cancer
what does medullary cancer of thyroid cause?
calcintonin and cEA to be secreted from parafollicular cells (C cells)
non-progressive disorder of motor function that affects msk tone, strenght, coordination, seizures, strabismus, contracture, microcephaly, hyperreflexia, incontinence, dsyphagia
cerebral palsy
treatment cerebral palsy?
anticholinergics--> benztropine, trihexyphenidyl, procyclinidine hydrchloride
most common and serious complication of cerebral palsy?
contracture
layers of meninges?
dura, arachnoid, PIA
MCC Of meningitis overall
viral
MCC of meningitis in neonate?
GBS, E.coli, listeria
MCC of meningitis in 3 mo's - 50 y/o?
strep pneumo, h influ, n meningitis
MCC of meningitis in >50 y/o
strep pneumo, neisseria meningitis, L monocytogenes
TXN of neonate meningitis?
Ampicillin + cefotaxime + aminoglycoside if <4 weeks
Treatment of 2 mo- 50 y/o meningitits
Vancomycin + ceftriaxone or cefotaxime
Treatment of 50 y/o + meningitis?
Vancoymycin + ceftriaxone + ampicillin
macular papular rash with petechiae and a HA, fever?
n. meningitidis
What is the prophylaxis for close contacts?
ceftriaxone IM
MCC of viral meningitis?
enterovirus
txn of HSV meningitis?
acyclovir
MCC of encephalitis?
viruses
txn of CMV?
gangciclovir
imaging choice in encephalitis?
MRI
most specific/sensitive for dx encepahlitis?
PCR CSF
best dx for brain abscess?
MRI
bells palsy vs stroke
bells palsy can't raise eyebrows-->facial nerve not intact
txn bells palsy?
prednison 60 or 80 mg, eye patch
bells palsy affects what nerve?
FACIAL NERVE 7
numbness, pain, burning, paresthesis in lower extremities in a patient with hyperglycemia
DM peripheral neuropathy
saturday night palsy
radial nerve--extensor,forearm-->wrist drop
peroneal nerve palsy
fibular head= foot drop (weakness of tibialis anterior msk)
sciatc nerve palsy
weakness, dorsiflexion, eversion of the foot
MCC of sciatica nerve palsy?
deep IM injection
gradual loss of vibration, propriocetion and have pallor and demtnia
B12 deficiency
lambert eaton syndrome is associated wtih?
small cell lung cancer
power of msk increases with sustained contraction , proximal msk weakness,
lambert eaton syndrome
idiopathic polyneuroapathy followeing minor infection with cambylobacter jejuni or CMV that destroys the schwann cells
Guillian Barre syndrome
rapid onset of ascending paralysis/weakness, loss of reflexes, and autonomic dysfunction liek tachycardia, cardiac irregularities, labile BP, sweating, sphincter disturbacnes
Guillian Barre syndrome
DX Gillian barre
LP: elevated fluid protein
EMG: loss of reflexes will be demosntrated
performed with: nerve conduction velocity test: slowing of neural responses= more impt test
txn of Gillian barre syndrome
gamma globulin or IVIG and can givne prednisone
what viruses are GB associated wtih?
cambylobacter jejuni or CMV
what to avoid in myastenia gravis?
aminoglycosides
autoimmune disease against AcH receptors
myasthenia gravis
ptosis or diplopia that gets worse as the day goes on?
myasthenia gravis
test for myasthenia gravis?
IV edrophonium (Tensilon)
TXN for myasthenia gravis
Pyridostigmine, neostigmine= AchE inhibitors (retards breakdown of AcH in synapic area
what is myasthenia asosciated with in older men?
thymus tumor in men
atrophy in the caudate nucleus on CT
huntingonts disease
most common genetic cause of abnormal involuntary movements/chorea?
huntingtons chorea disease
involuntary movements, depression, psychosis, chorea, dementia, difficulty with speech, rigidity
huntingtons chorea
txn of huntingotons chorea?
genetic counseling, tetrabenazine (phenothiazines)
inheritance of huntingtons chorea
autosomal dominant
bilateral frontal HA that is "band like" pressure, non-pulsatile
tension HA
classic vs common migraine
classic: w/ aura,
common: w/o aura
middle aged man that wakes up with recurrentt periorbital unilateral pain with associated lacrimination, eye redness, rhinorrhea
cluster HA
abortive txn of cluster HA
abortive 100% O2 and sumatriptain
brief epsiode of stabbing facial pain, worse with triggers like touching, movement,e ating
trigmineal neuralgia
what is trigmineal neuralgia associated with?
MS
TXN trigmineal neuralgia?
oxcarbazepine, carbazepaine
jaw claudication, amaurosis fugax, TTP of temporal artery
temporal arteritis
DX of temporal arterities?
temporal artery bx
txn of temporal arteritis
steroids 60-80 mg
doctor projects feelings about formative or other important persons onto patient (Ex. Patient reminds doctor of younger sibling)
countertransference
patient projects feelings about formative or other impt person onto physician (see physician as parent)
transference
expressing unacceptable feelings and thoughts through actions (tantrums)
acting out
temporary drastic changes in personality, memory, etc to avoid emotional stress
dissociation
transferring avoided ideas and feelings to some neutral person or object (mother yells at her child because husband yelled at her)
displacement
partially remaining at more childish level of development
fixation
modeling behavior after another person who is more powerful (but not necessarily admired)- abuser for example
identification
separating feelings from ideas and events (Describing murder w/o no emotional response)
isolation
attributing an unacceptable internal impulse to an external source (man thinking about cheating, thinks his wife is cheating)
projection
proclaiming logical reasons for actions actually performed for other reasons to avoid self blame
rationalization
: replacing a warded off idea or feeling by an emphasis on the opposite
reaction formation
turning back the maturational clock and going back to earlier modes of dealing with the world
regression
involuntary withholding an idea or feeling form conscious awareness
repression
believing that people are either all good or all bad at different times due to intolerance of ambiguity (borderline)
splitting
what are mature defenses?
alturism, humor, sublimation, supperssion
who is typically the abuser in child abuse?
childs mother
most common form of child maltreatment?
child neglect
at least one month of sponatenous and unexpected occurence of attacks of palpitations, pounding heart, accelerated HR, smothering feeling of choking
panic disorder
treatment of acute panic disorer?
alprazolam, clonazepam
treatment of chronic panic disorder?
SSRI, paroxetine, sertraline, fluoxteine
TXN of benzo overdose?
flumozenil
withdrawl symptoms of BZ use?
insomnia, anxiety, nausea, vomiting, pscyhomotor agitation, autonomic hyperactivity
treatment of choice in acute GAD?
lorazepam
first line treatment in chronic GAD?
SSRI- paroxetine
major mediators in GAD?
NE, serotonin
MC mental disorder
specific phobia
anxiety toward places or situations in which escape may be difficult or embarassing
agoraphobia
uncontrolled anxiety for at least 6 mo's
generalized anxiety disorder
emotional symptoms following a psychosocial stressor lasting <6 mo's
adjustment disorder
recurring intrusive thoughts, feelings or sensations that cuase severe distress, relieved in part by performance of repetitive actions
obessisive compulsive disorder
preoccupation with minor or imagined defect in apperance?
body dysmorphic
hyperactivity, impulsivity, inattention in mutliple settings
ADHD
TXN ADHD?
amphetamines, methylphenidate, atomeoxetine
poor social interactions, communication deficits, repetitive/ritualized behaviors, restricted interests; must present in early childhood
autistic spectrum disorder
first screening for autistic disorder?
at 18 mo's, 2nd at 24-30 mo's
hostile, defiant behavior towards authority figures in the absence of serious violations of social norms
oppositional defiant disorder
Repetitive and pervasive behavior that violates basic rights of others, <18 y/o, associated with antisocial personality disorder
conduct disorder
TRIAD of ADHD?
hyperactivity, impulsivity, inattention
difficulites with language and failure to acquire or early loss of soical skills
pervasive devleopmental disorders
x linked disorder in females - regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, stereotyped hand wrining
rett syndrome
full development until 2, and then regression in 2/3: social, communication, behavior
childhood disintegrative disorder
order of loss of orientation
time place person
cardiac changes in anorexia?
prolonged QT, supraventricular and ventricular arrhythmias
labs in anorexia?
elevated BUN, edema, acidosis, dehydration, hypoK
hypochloremic acidosis with vomiting, hyperaldosteronism
Normal BMI
18.5-24.9
hypomanic and depressive episode
bipolar II
at least 1 manic episode with or w/o hypomanic or depressive episode
bipolar 1
dysthymia and hypomania lasting at least 2 years
cyclothymic
1st line treatment of bipolar?
Lithium,valproate, gabapentin, carbamazepine, topiramte
what to monitor with the patient on lithium?
TSH and monitor lithium level q 4- 8 weeks
less severe major depression x 2 years
dysthymic disorder
want to r/o with major depression
thyroid, addisons, cushings
patient being treated with depresison develops dizziness, tremors, lethargy, vivid dreams, concentration, depersonalization, crying spells, depressed mood, anxiety
SSRI discontinuation syndrome
mixture of words/phrases that are incoherent
word salad
shift between subjects that are totally unrelated
looseness of association
eventually gets to the point after delay in thought processes
circumstantiality
disturbance in thought causing people to get off topic, but never gets back to the point
unable to provide an answer related to the questions
tangentiability
delusions, hallucinations, loose associations (patient unable to stay on topic), tangential response (can't provide answer to question), inappropriate agitation, sexual behavior
schizophrenia
positive signs of schizophrenia
hallucinations/delusions, bizarre behavior
negative features of schizophrenia
blunted affect, isolation, anhdedonia, poor grooming, soical w/d, poor eye contact
fixed, persistent untrue belief system last >1 mo, funcitoning is not otherwise impaired
delusional disorder
SE CLONAZPINE:
agranulocytosis
RF for suicide
Male, teenager/elderly, depression, previous attempt, drug/alch use, loss of rational thinking, sickness, organized plan, no spouse, social support lacking
defensive, oversensitive, secretive, suspicious, hyperalert, limited emotional response, belief that spouse is cheating on them when they are not, no one is trustworthy
paranoid personality disorder
voluntary social w/d, limited emotional expression, content with social isolation
schizoid
eccentric apperance, odd bleiefs, or magical thinking, social withdrawl?
schizotypal
hallmark symptom of schizophrenia?
auditory hallucinations
1st line outpatient of schizophrenia?
olanzapine
1st line of agitation in schizophrenia?
haldol or chlopromazine
txn of NMS?
dantrolene
risperidone may cause what
prolactin
ziprasidone may doe what se?
prolong QT interval
treatment serotonin syndrome
Cyproheptadine
Treatment coacine overdose?
BZs
Treatment BZ overdose?
flumazeil
treatment opioids overdose?
naloxone
unstable mood and interpersonal relationships, impulsiviness, self mutilation, boredom, sense of empitness, splitting
borderline
treatment of hordeolum?
warm compresses, bactricacin or erythromcyin eye ointment
cyst clogging the meibomian gland
chalazion
txn chalazion?
warm compresses, surgery, steroid injection
txn blepharitis?
baby shampoo, topical abx (erythromcyin, bacitracin)
unilateral or bilateral conjunctiva erythema and copious watery discharge with preauricular lymph nodes
viral conjunctivitis
MCC of viral conjunctivitis?
adenovrius type 3, 8, 19
TXN viral conjunctivitis?
eye rinses (flushing eye- eye lavage), hoot or cool compresses, no school
vasoconstrictor- antihistamine drops
bilateral copious wpurulent discharge from boht eyes?
bacterial conjunctivitis
MCC of bacterial conjunctivitis in...
neonates
young, pre-school
adults
neonates- c. trachomatis
preschool: H influ
adults: staph, strep
clogged naslocariminal tear duct with bacterial super-infection
dacrocystitis
MCC of dacrocytitis?
staph aerus
conjunctivitsis in contact lense wearers and txn?
psedumonas
txn: fluoroquinolone
TXN overall for bacterial conjunctivitis
sodium sulfacetamine (bleph 10)
gentamicin/tobramycin
erythromycin ointment (chlamydia)
cipro
watery, itchy eyes, cehmosis, eyelid edema with a ropy mucous discharge
allergic conjunctivitis
TXN allergic conjunctivitis
epinastine, azelastine emedastine, levocabastine
rust ring on eye exam- treatment?
remove with rotating burr, refer to ophtlamologist, add polymoyxin bacitracin ointment
tear drop sign
blowout fracture
limited extraocular movement, diplopia, exophthalmos, empyshema, ecchymosis, swelling, subconjunctival hemorrhage, inability to look up (infraoritbal anesthesia)
blow out fracture
dx of blow out fracture?
orbital CT
txn of blowout fracture?
refer, prophylaxis abx, keep patient calm to avoid sneezing or anything that can icnrease pressure, nasal decongestants, ice packs, cold compresses
txn of dacrocystitis?
keflex or augmentin
most common etiologies of retinal detachment
proliferative DM retinoaphty, Sickle cell, advanced retinopathy of prematurity, penetrating trauma, retinal vein occlusion
flashing light, floaters, painless vision loss
retinal detachment
curtain coming down
retinal detachment
bleeding in the anterior chamber of the eye
hyphema
hyphema MCC?
blunt trauma
other: child abuse, malignancy, sickle cell disease
TXN hyphema
most reabosrb on their own, but head of bed at 45 degrees, don't want TV or read, eye patch
refer if severe, bed rest
opacificaiton of hte lense of hte eye?
cataract
gradual onset of blurry vision, difficulty seeing at night, translucent finding on slit lamp exam
cataract
cause of cataracts?
prolonged steorid use, statins, lack of sunglasses
leading cause of irreversible central vision loss?
macular degeneration
MCC of macular degeneration?
atrophic
eye in macular degeneration?
drusen spots, atophy, mottling, retinal hemorrhage
treatment of orbital cellulitis?
IV antibiotics- vancoymycin, clindamycin, doxycycline
MCC of orbital cellulitis
strep
inner turning of lower eyelid
entropion
outward turning of hte eyelid
ectropion
yellow deposition on the conjunctiva, does n't grow over
pinguecula
triangular fleshy vascular thickening of conjunctiva usually from nasal side
pterygium
#1 cause of ambylopia?
strabismus
blue or cyanotic sclera
osteonesis imperfecta
what is the most common fundoscopic finding in patients with AIDS?
cotton wool spots
hard exudates, macular edema, maicroaneurysms, wet swollen retina, cotton wool spots, soft exudates, end stage: neovasculartization
DM retinopathy
cooton wool spots, AV nicking, hemorrahges, silver wiring, copper wiring
HTN retinopathy
most specific retinal change due to HTN?
AV nicking
papilledema automatically means what type of HTN?
malignant HTN
rendess, photophobia, pain, blurred vision, no discharge, circumocrneal injection, pupil responds poorly to light
acute uevitis
drusen spots
macular degeneration
meds that cuase macular degeneration?
choloroquine, phenothiazines
increased cupping of optic disk, teary aching eyes, progressive loss of peripheral vision?
glaucoma
treatment of glaucoma
brinzolamide/dorzolamide (carbonic anhydrase inhibitors)
timolol (BB)
Miotic drop (pilocarpine)
1st line treatment acute closure narrow angle glaucoma
IV acetazolamide
intraocular pressure reading in acute narrow angle glaucoma
>30
pain with movement of the eye, vision loss
optic neuritis
what is optic neuritis associated with
MS
most common cardiac arrhythmia?
atrial fib
atrial fib ___ x higher risk of death from thrombembolic events?
1.5-1.9
where is the most frequent source of autonomic foci in a fib?
pulmonary vein
what is teh most potent hormone in the body?
thyroxine
causes of afib?
CAD, myocarditis, pericarditis, collagen vascular disease, viral/bacterial infections, cardiac, esophageal or thoracic surgery
holidary heart-->alcohol
cocaine, methamphetamines
hyperthyroidism, pheochromocytoma, CVA, SSAH
most common location for atrial throbmus in a fib?
left atrial appendage
rate control in A fib?
beta blocker, CCB, digoxin
1st line: cardizem (diltiazem)
rhythm control A Fib
Flecainide
amoidarone- what must you check?
TSH
Wollf parkinson white syndrome what is drug of choice
procainamide
delta wave
Wollf parkinson white syndrome
INR target for warfarin?
2-3
what does warfarin affect?
PT, INR
what does heparin affect
PTT
what are contraindicated in 1st degree block?
CCB
PSVT treatmetn
vagal, adenosine
atrial flutter treatment
Cardizem, diltiazem
treatment 1st degree HB
none
treatment 2nd degree HB type 1
none
if symptomatic- atropine or pacer
treatment 2nd degree HB type 2
pacemaker
treatment 3rd degree HB
pacemaker
stoke-adams attack
syncope with sinus sinus syndrome
txn V tach with a pulse
amiodarone
txn of V tach with no pulse
defbriliation + CPR, then epi/vasopressin, then amiodarone, then lidocaine
medication that has shown to improve lifespan in CHf/
aCE I
low sodium diet?
<2,000 mg
kerkley B lines
intersitital edema- CHF
BNP is released by?
ventricular tissue when ventricular pressure is increased
most subtle and common symptom in CHF?
chronic cough
beta blockers to be used in CHF?
bisorpolo, carvediolol, metoprolol sucicnate (q day)
what is the DASH diet?
low saturated fat, cholesterol, total fat; increased fresh fruits, veggies, low fat milk products, increased fiber, decreasef salt
what suppplies the AV node?
RCA
MCC Of shock?
sepsis
what is postural hypotension?
greater than 20 mmHg drop in systolic BP between supine and sitting
what to give after a SAH to prevent vasospasm?
Nimodipine
tram tracks
broncheictasis
TXN of bronchiectasis
AMox Amox-clav, TMP-SMX, tetracyclines
abnormal permanent dilation of the bronchi and destruction of the bronchial walls
broncheictasis
foul smelling purulent sputum
bronchiectasis
MCC of bronchiectasisi?
CF-pseudomonas
imaging modality of choice in bronchectasis?
thin slice CT scan
MC lethal, genetic dz affecitng caucasian population?
CF
autosommal recessive disorder of chloride channels in exocrine glands?
CF
MCC of infeciton in CF
pseudmonas
definitive study to dx CF?
thin slice chest CT
only txn in CF that restores lung function
ivacaftor - G551d mutation
bright red facial flushing, diarrhea, occassional wehezing
carcinoid syndrome
what to check when you suspect carcinoid syndrome?
5-HIAA serotonin levels in urine
other: serotonin levels in blood, chromaogranin in blood, tryptophan in blood
tryptophan is diverted to form serotnin instead of niacin in this disease
carcinoid syndrome
most common cause of transudative pleural effusion?
CHF
most common cause of exudative pleural effusion?
pneumonia
cancer cause what type of pleural effusion
exudative
cirrhosis causes what type of pleural effusion?
transudative
gold standard for dx pleural effusion
thoracentesis
blunting of costaphrenic angles, mediastinal shift away from fluid
pleural effusion
MCC of spontaneous pneumothorax?
rupture of a smal, air-filled sac in the lung (bleb)
chest tube insertion location?
5th ICS mid axillary line
needle decompresison insertion?
2nd ICS mid clavicular line on affected side
penetrating chest trauma followed by dullness adn decreased to absent breath sounds over the affected side, chest doesn't expand with the breathing
hemothorax
drug induced restrictive pattern of lung disease?
amiodarone, bleomyci
MCC Of intersitial lung disease?
idiopathic pulmonary fibrosis
eggshell calcificaiotns
upper lobes
which pneumoconiosis affects the upper lobes?
coal miners, silicosis
ivory white calcified pleural plaques
asbestosis
asbestosis affects which lobes?
lower lobes
MCC of ARDS
sepsis
diffuse lung injury secondary to systemic disease
ARDS
TXN of ARDS?
mechanical ventilation (PEEP)
frothy pink sputum
ARDs
generalized symptoms, fever, weight loss, fatigue, malaise, fever, erythema nodosum
sarcoidosis
MC site for sarcoidosis
pulmonary
tender, painful, poorly demarcated areas of eyrthema on pretibial area
erythema nodosum- sarcoidosis
noncaseating granulomas
sarcoidosis
hyperCa, elevated ESR, ACE I elevated
sarcoidosis
When does surfactant production begin
24th week
MC location of aspiration?
right middle lobe
definitive dx of aspiration?
bronchoscopy
Is d-dimer sensitive or specific for DVT, PE?
sensitive
large A-a 02 gradient?
pulmonary embolism
gold standard for PE?
arteriogram
DX of PE- best test?
spiral CT
what test to use when kidneys are compromised in a patient with a PE?
VQ scans
MCC of pulm HTN?
hypoxia
primary pulmonary HTN?
young, female, self perpetruating disease that is fatal
physical exam findings on pulmonary HTN?
splitting S2, systolic ejection
test of cohice in pulmonary HTN?
echo
gold standard in DX of pulm HTN?
R heart cath
jaundice, pruritis, fatigue, malaise, weight loss, associated with UC
Primary sclerosing cholangitis
new onset of DM in an elderly patient, what must you rule out?
DM
pancreatic cancer in the body or tail presents with?
weight loss
pancreatic cnacer in the head persents with
steatorrhea, weight loss, jaundice
DX of pancreatitic cancer?
CT scan w/ bx
what type of cancer is pancreatitic cancer?
adenocarcinoma
cancer marker for pancreatic cancer?
CA 19-9
MCC of upper GI bleeding?
PUD
MCC Lower GI bleed?
diverticulosis
causes of dark stool?
bismuth, iron, spinach, licorice, charcoal
sqamous cell carcioma of the esophagus is associated with what RF?
smoking, alch consumption, AA
Adenocarcinoma of the esophagus is associated with what RF?
barrett's esophagus, GERD, white, men
where is SCC of the esophagus located?
upper and middle of the esophagus
where is adenoCx located?
distal 1/3
MC symptom of esophageal cancer?
dysphagia
initial test for dysphagia?
barium swallow
acquired motor disorder of the LES where it completely fails to relax and there is apersistalsis of the esophagua
achalasia
MCC of achalasia world wide?
chagas
dysphagia to both solids and liquids and regurg
achalasia
birds beak on barium enema?
achalasia
how to confirm dx of achalasia?
manometry
best txn for achalasia?
dilation (pneumatic),
can also try botox q 2 years into the LES
dx diffuse esophageal spasm?
manometry
out pouching of posterior hypopharyynx leading to regurg?
zenkers diverituclum
Dysphagia, non-cardiac CP, no regurg?
DES
Progressive dysphagia to solids, then liquids
esohpageal stricture
forceful or prolonged vomiting or coughing followed by vomiting bright red blood
mallory weiss tears
DX mallory weiss tears
EGD (upper endoscopy)
mucosal tear at the gastroesophageal junciton
mallory weiss tear
eosphageal perforation associated with alch binges, blunt trauma, bulmia, forceful vomiting, medical tubes
boerhaave's syndrome
hamman's crunch
mediastinal crunch- boerhaave's syndrome
CXR: air in mediastium
boerhaave's syndrome
definitive dx of boerhaave's syndrome
contrast esophogram
which PUD ulcer has increased risk malignancy?
gastric
MCC of gastric ulcers
NSAIDs
eating makes this ulcer worse?
gastric ulcer
MCC of duodenal ulcers
H pylori
most common location of PUD?
duodenum
shallow ulcers found on esophagitits patient?
HSV
treatment CMV esophagitits
gangcilcovir
multiple deep ulcers found on esophagitits patient?
CMV
white yellow plaques found on esophagitits patient?
fluconazole
DX test for ZES?
somatostatin receptor scintogrpahy
PUD symptoms that don't respond to therapy
ZES
increaed fasting serum gastrin concentration
ZES
MCC of adenoCX?
gastric cancer
loss of appetite, weight loss, premature abdominal fullness after meals, abd pain
gastric cancer
MCC Chronic gastritis
H pylori
strongest RF for gastric Ca
h pylori
string sign on barium swallow
pyloric stenosis
olive mass
pyloric stenosis
electrolyte abnormality in pyloric stenosis
hypochloremic alkalosis
MCC of SBO in adults?
adhesions
MCC Of SOB in kids <2 y/o?
intussception
what electrolyte abnormality is common in SBO?
hypoK, hypochloremia
MC gi Emergency in <2 y/o?
intusucception
currant jelly stool
intusuccption
sausage like mass
intussception
dx intussception
barium enema
TXN of intussception
barium enema
skip lesions, transmural, cobblestoning
crohns disease
complications of cronhns disease
obstruciton, fistula, abscesses, perforation,
DX of choice in crohns disease
colonoscopy
which type of IBD has a greater risk for colon cancer?
UC
continous from rectum, ucosal surface only
UC
TXN IBD
sulfaslaszine or mesalamine, prednisone
antibiotics if necessary cipro or metro
TXN IBS?
SSRI
MC type of polyp?
non-neoplastic- hyperlastic
Adematous polyps
are benign polyps, but have malignant potential
MC type of adematous polyp?
tubular
most common polyp to turn malignant?
villous
RF for polyp to be cancer?
large, atypia, histological type, sessile
deep rectal abscess/fistual are associated with what diseases?
crohn's disease, diverticulitis, Cancer, rectal TB, lymphogranuloma veneum
painful fluctuant area at sacrococygeal cleft
pilonidal dimples
MC location for anal fissure?
posterior midline
if anal fissure is off midline- what is the cause?
crohn's disease, HIV, TB, syphilis, anal cx
MCC rectal cancer
SCC
Beriberi
thiamine B 1 deficiency
burning feet syndrome
beriberi
abnormal eye movements, stance and gait abnormalities, AMS, ocular disutranbaces, cerebellar ataxia, mental confusion in an alcholic?
thiamine B1 def, beriberi
beriberi symptoms-
wet: high COf failure, peripheral/pulm edema, cardiomegay
Dry: peripheral neuraopthy
Karsakoffs
irreversible short term memory loss and confabulation- due to vit B1 def
Pellagra
B3- niacin def
S/S of pellagra
4 D's: dermatitis, diarrhea, demetnia, death ,
bright red tongue, flushing, irritable, mouth soreness
when treating with isoniazid what must you alos given the patient?
B6
B2 deficiency
riboflavin
cracks on sores of the outside of the lips (cheilosis), corners on sore of mouth (angular stomatitis), inflammation and redness of hte tongue
Vit C deficiency s/ss
bleeding, bruising easily, hair and tooth loss, joint pain, swelling, easy infection
scurvy
vit C def
Vit A first sign?
night blindness
leading cuase of blindness worldwide?
vit A deficiency
vit A toxicity?
pseudomotor cerebri (increased ICP), HA
treatment warfarin overdose
vit K
what does vit K affect
PT and PTT
most common inborn erroro of protein metabolism?
PKU
txn PKU?
low protein foods (no meat, fish, poultry, cheese, eggs)
type of anemia seen in crohns' disease
macrocytic, hypochromic
type of anemia seen in UC?
microcytic hypochromic
pea soup
salmonella
staph vs salmonella food poisining
staph is faster onset- 2-4 hours later, salmonella 8 to 72 hours later
txn shigella
cipro
low volume, blood mucus stools
shigella
txn salmonella
cipro
type of diarrhea that develops from drinking contaminaed water
giardia
dx of giardia
trophozoites or cysts in stool/ova on O and P exam
txn giardia
metronidazole
MC type of kidney stone?
CA
radio-opaque sotones?
Calcium, struvite CAST
kidney stones associated with infeciton
struvite
radiolucent kideny stones
uric acid, cystine
what organisms are struvite sontes associated with/
urea-splitting sontes- proteus, klebsiella, pseudmonas, staphylococcus
MC spot for kidney stones to get stuck?
UVJ area
best test for kidney stones?
abd/pelvic US (helical ct)
surgical intervention for kidney stones at what point?
5-10 mm
txn of kidney stones <5 mm
toradol, morphine sulfate, opiates (dilaudid)
send home with alpha blocks, CCB
renal vascular disease is associated with what symptom?
flash pulmonary edema
dx of renal vascular disease
angiogram
paint brush appearance of papillae?
medullary sponge disease
how is PCKD inherited?
autosomal dominant
what genes are affected in PCKD?
4 or 16, 16 is the mroe common-->faster progression
most frequent cause of genetic renal failure?
PCKD
what disorders are associated with PCKD?
infected renal cysts/renal abscesses, nephrolithiasis, hepatic cyst, cardiac valvular disease, intracranial aneurysms
test of choice for PCKD?
abdominal utz
MCC of hydronephosis?
congential
MC cause of glomerulonephritis?
IgA nephropathy
MCC Of IgA nephropathy
group A beta hemolytic strep
what titer is posiitve in IgA nephropathy
ASO titer
hemoptysis + dyspena + glomerunlonephritis
good pastures
hematuria, proteinuria, red blood cell casts
GN
heavy proteinuria, hypoalbuminemia, edema, hypercholesterolemia, normal reanl function
nephrotic syndrome
what are patients with nephrotic syndrome at risk for?
DVT (hypercoag)
who is nephrotic syndrome MC in?
kids
excretion of more than 3.5 g/24 hr period of protein in the urine
nephrotic syndrome
MCC of nephrotic syndreom?
minimal change disease
or kids: post viral, adults: DM
fat oval bodies
nephrotic syndrome
foamy urine
nephrotic syndrome
MCC of acute renal failure?
decreased renal perfusion
acute tubular necrosis causes?
gentamycing (aminoclgyosides), NSAIDs, contrast)
how to prevent contrast induced acute renal failure?
bicarb, acetylcysteine, IVF
MCC of chronic renal failure?
diabetes
second most common cause of chronic renal failure?
HTN
broad waxy casts in U/A significies
chronic renal failure
what stage do patients become symptomatic in CKD?
stage 4
stage 1 CKD
> 90 + albuminuria
stage 2 CKD?
60-89
stage 3 CKD?
30-59
stage 4 CKD?
15-30
Stage 5 CKD?
<15
electrolytes in CKD?
acidosis, hyperK, hypoCa, hyperphosophate
multi nucleated giant cells
herpes simplex
koplik spots
rubeola (measles)
coryza, cough, conjuncitivitis, white spots on buccal mucosa
rubeola (measles)
Cause of rubeola (measles)
paramyxovirus)
rash: begins behind the ears and moves to the face and neck and then travels down, red blanching macule, pruritic, lesions darken to brown and fade
rubeola (measles)
painful sunburn rash with tiny bumps that blanch, sandpaper like, strawberry tongue
scarlet fever
rubella and pregnancy
if mom gets it- first 20 weeks- 20% chance for SAB
erythema infectiosum,fifths disease is caused by?
parovirus
slapped cheeks
erythema infecitosum
MCC of erythema infantum (roseola)
herpex virus 6, 7
high fever for several days then rash appears (maculopapular rash
erythema infantum
cause of molluscum contagiosum?
pox virus
flesh colored, waxy, dome shaped umbillicated papules, white curd like material may come out
molluscum contagiosum
number one cause of febrile seizures?
erythema infantum (roseola)
cause of chicken pox
varicella-zoster- HSV 3
txn of oral thrush
nystatin swish and swallow
what to monitor when treating with terbinafine or itracanzole?
LFTs
griseflulvin- what must you avoid?
avoid EtOH (antabuse- flushing, HA, N/V, sweating)
broken hair shafts
tinea captius
cause of tinea versicolor?
malassezia furfur
KOH prep shows spaghetti and meatball appearance
teina versicolor
txn tinea versicolor
selenium sulfide lotion
ketoconazole
what is melasma associated with?
pregnancy, OCPs
hyperpigmentation of the sun exposed areas?
melasma
most common cutaneous cyst
epidermal inclusion cyst
disease of apocrine sweat glands that leads to chronic cysts, not associated with hair follicles, open comedones and sinus tracts form and may drain purulent material
hidradentitis suppurative
where are pressure ulcers MC?
hip and sacrum
stage 1 pressure ulcer
non-blaching erythema, skin intact
stage II pressure ulcer
necrosis, superficial, partial thickness
stage III pressure ulcer
deep necrosis, crater ucler with full thickness and skin loss
stage IV pressure ulcer
full thickness ulceration including bone and msk
what is vtiligo associated with
thyroid disease, PA< DM, Addisons disease
depigmentation of the skin, hypopigmentation
vitiligo
txn of burns
1st degree: cool compresses
2nd/3rd: tetanus shot, silver sulfadiazine, fluid/electrolytes, debrideement if necessary
Parkland formula
IVF requirements for hte first 24 hours after burn
4 cc/kg x % BSA burned
1/2 over first 8 hours after injury and second half over next 16 hours
MC type of hip fracture?
intertronchanteric
MC type of hip dislocation?
posteiror
MC type of femur fracture?
mid shaft
internally rotated and flexed hip dislocation?
posterior
most sensitive test for ACL tear
lachman
MC ligament tear in ankle?
ATFL
positive thompson test
achilles rupture
MC primary bone cancer?
MM
hyperCa, renal failure, anemia, bone pain
MM
bence-jones proteins
MM
onion line appearance, MC on diaphysis- what type of bone cancer?
ewings
bone cancer: MC: metaphysis, codman triagnle, sunburst
osteosarcoma
MCC septic arthritis?
staph
IVDU and septic arthritits- what organism?
psedumonas
septic arthritis in a young adult
gonorrhoea
TXN septic arthritis caused by staph/
vanco/nafcillin
treatment of gonococcal arthritis?
ceftriaxone
txn of septic arthritis in an IVDU
cipro/levofloxacin
most common joint in septic arthritis?
knee, hip
MC joint disease?
osteoarthritis
loss of articular cartilage in the joints
osteoarthritis
herbeden nodes
DIP jionts- OA
bouchards nodes?
PIP joints- OA
DX of septic arthritis?
arthrocentesis
pain localized to the third web space of the foot with a palpable mass
mortron neuroma
toeing in for a child <2 y/o is cuased by?
>2 y/o
tibial torsion
femoral anteversion
primary vs secondary osteoporosis
primary can either be due to a postmenopauseal state (type 1)- trabecular bone
or age related (type 2- senile)- trabecular and cortical bone
and secondary is due to a genetic d/o or other disease process
most common locations for osteoporosis fractures?
vertebral fractures, distal radius, hip
DEXA scan screenings?
>65 y/o q 2 years
>65 y/o: if RF or fracture or medical issues
T score vs Z score
T-score: healthy, young individuals
Z score : number of standard deviations below or above whats normal for your sex, age, weight, race
<-2.5 is osteoporosis
1-2.5: osteopenia
first line therapy for osteoporosis?
bisphonsophonates - "ronate and zoledronic acid)
how do bisphonsates work?
by inhibiting osteoclastic activity
SE of bisphosonates?
ostenoecrosis of jaw and esophagitits and avascular necrosis
how to dx fibromyalgia?
11/18 tender points
three months of widespread body wide pain with defined tender points associated with depresison, anxiety
fibromyalgia
mCC of gout?
underexcretion of uric acid
needle shaped negatively birefringence crystals
gout
1st line treatment in acute gout?
indometacin
how does colchiicine work?
Inhibits neutrophil and motility action= antinflammatory
how does allopurinol work?
Inhibits xanthine oxidase?less allopurinol created
how does probenecid work?
Inhibits reabsorption of urice acid in PCT
MC location pseudogout?
knee, wrist
rhomboid weakly birefrigent positive
pseudogout
TXN pseudogout?
NSAIDs, steroid injections,
vasculitis of small and medium arteries
polyarteritis nodosa
DX of polyarteritis nodosa?
vessel bx, angiography
TXN polyarteritis nodosa?
high dose steroids
livedo reticularis
lacey rash over extremities- polyarteritis nodosa
inflammation of the straited msk
polymyositis
what is polymyositis associated with?
occult malignancy
insidious painless, proximal limb and neck weakness, malar or heliotrope, polyarthralgias?
polymyositis
TXN polymyositits?
steroids
msk weakness,f ever, abd pain, weight loss, arthrlagias, livedo reticularis
polyarteritis nodosa
pain, stiffness in shoulder and pelvic girlde, stiffness worse in the AM, no msk weakness
polymyaglia rheumatica
txn polymyalgia rheumatica?
CS
vasculitis in the kidneys and resp tract?
wegner's granulomatotisis
tetrad of reactive arthritis
conjunctivitis, arthritis, urethritis, mucosal ulcers
causes of reactive arthritis?
STI (Chlamydia- MC in males); or GI: shigella, salmonella, campylobacter
TXN of reactive arthritis?
NSAIDs (indomethacin)
doxy if chlamydia present
may try sulfasalazine or methotrexate
dactylitis (sausage appearnace of joints)
psoriatic arthritis
pencil in a cup
psoriatic arhtritis
TXN of psoriatic arthritis?
NSAIDS, DMARDS
what to avoid in psoriatic arthritis?
antimalarials, CS
MC joint location for RA?
PIP, CMP, wrist joint, knees, feet, ankles
where is RA never?
DIP joint!
swan neck defomirty
RA
boutonnier's defomirty
RA
ulnar deviation
RA
what is fetly syndrome?
deforming RA, splenomegaly, neutropenia
what heart comps occur in RA?
pericarditis, myocarditis, CHF
type of anemia in RA?
normochromic, normocytic anemia
1st line treatment RA?
DMARDS- methotrexate and NSAIDs
high spiking fevers in a child, with salmon pink macular rash on teh chest, and mayalgias?
systemic arhritits (still's disease)
symmetrical joint involvement of >5 joints, ANA positive, elevated ESR
polyarticular onset juvenile arthritis
girl that walks funny in the AM, but improves during the day, <4 arthritic joints?
pauciarticular juvenile arthritis
what is the most common complication in pauciarticular juvenile arthritis
uveitis- need yearly screenings
first line treatment of juvenile arthritis?
NSAIDs
deposition of collagen into skin and other organs that leads to thickened, hardened skin
scleroderma
calcinosis, Raynaud's, esophageal dysfunction, sclerodactylyl, telangiectasis
scleroderma- limited (CREST syndrome)
anticentromere antibody?
scleroderma
anti-SCL 70
diffuse scleroderma
TXN scleroderma
no cure, just symptoms
ACEI for renal crsisi
PPI for reflux
CCB for raynauds
most specific antibody for lupus?
anti-smith and anti- double stranded DNA (anti-dsDNAs
most common presentation of lupus?
fatigue
where is joint pain common in lupus?
hand, wrist
drugs that cause lupus like syndrome?
procainamide, isoniazid, hydralazine, quinidine, phenytoin, parovirus b19
autoimmune disease that destroys exocrine glands that produce tears/saliva?