Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
2.
3.
4.
5.
6.
DM
Hyperlipidemia
hypertension
cigarette smoking
Age >45 M, >55 F
family history of MI at young age
high LDL level
CAD prognostic
factors
LVF EF<50%
left main
two or three vessel diseases
1. clinical
presentation of
stable angina
2. dx:
3. what to do with
patients with
positive stress or
echo
what is the
advantage of stress
echo vs stress ECG
LV size/function
dx. valvular disease
identifies CAD
* if positive -->cardiac cath
what is a positive
stress test
metabolic syndrome
X
7.
8.
3
INSULIN RESISTANCE 2/2 OBESITY
-->
hypercholesterolemia/low HDL
hypertriglyceridemia - >150
impaired glucose tolerance >110
diabetes
hyperuricemia
HTN
syndrome X
indications for
stress ECG
confirm angina DX
evaluate therapy response in CAD pts
identify pts with CAD
9.
10.
11.
12.
13.
14.
15.
16.
how does
dipyridamole/adenosine
work for pharmacologic
stress test
holter monitor
1. use
Cardiac catheterization
1. info gathered
2. coronary
angiography/PCI/CABG
eval
3. indications for
cardiac cath
coronary angiography
1. info gathered
2. what can be done
>70% occlusion
stress echocardiography
+ follow up with positive
result
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
thallium 201
stress test
give thallium - no
uptake indicates
ischemia
...
secondary
hypertension
1. renal causes
2. endocrine
causes
3. medication
causes
- others include
coarctation,
cocaine, sleep
apnea
HTN effect on
heart
what other
conditions
comorbid with
HTN
general - 140/90
diabetics/renal disease - 130/80
36.
cardiac
complications of
HTN
37.
CNS
complications of
HTN
renal
complications of
HTN
arteriosclerosis of afferent/efferent
arterioles and glomerulus
(nephrosclerosis)
what labs to
evaluate target
organ damage in
HTN
urinalysis
BMP (K/BUN/Cr)
Fasting glucose
lipid panel
ECG
29.
30.
31.
32.
33.
34.
35.
38.
39.
40.
...
...
thiazides
beta blockers
ACE
ARB
CCB
alpha blockeres
vasodilators
(hydralazine/minoxidil)q
vasodilators
(hydralazine, minoxidil)
+ beta blockers +
diuretics
pregnancy test
contraindicatedthiazides, ACE, CCBs
Safe - Beta blockers,
hydralazine
41.
42.
43.
44.
45.
46.
47.
48.
49.
1. hypokalemia, hyperuricemia,
hyperglycemia,
hypertriglyceridemia, met.alk,
hypomagnesemia
2. bradycardia, bronchospasm,
insomnia, masked
hypoglycemia
3. dry cough, ARF,
hyperkalemia, rash, altered
taste
cardiovascular risk
factors
1. screening for
hyperlipidemia
2. effect of high dietary
sat.fat on lipid panel
3. effect of high calorie
on lipid panel
4. effect of alcohol on
lipid panel
1. age effect on
cholesterol
2. thiazides effect on
lipid panel
3. beta blockers ""
4. estrogens ""
5. corticosteroids and
HIV proteases ""
1. <200 cholesterol
<130 LDL
<125 triglycerides
2. <100
3. <70
4. >60, every inc. in 10 HDL
lowers CAD by 50%
physical symptoms of
hyperlipidemia
usually asymptomatic....
xanthelasma
xanthoma
pancreatitis
TSH - hypothyroidism
LFTs - chronic liver dz
BUN/Cr - nephrotic syndrome
glucose level - comorbid
diabetes
50.
51.
52.
53.
54.
55.
56.
57.
LFTs
58.
statins
1. effect on lipid panel
2. side effects
- only lipid drug that
reduces mortality,
first line**
1. lowers LDL
2. monitor LFTs, may be CPK
elevation
niacin
1. effect on lipid panel
2. what patients
should not use niacin
3.
cholestyrine/colestipol
1. effect on lipid panel
2. SE
fibrates
1. effect on lipid panel
2. SE
tension headache
1. clinical pres
2. tx
emergency headache
evaluation
cluster headaches
1. clinical pres
2. tx
migraine
1. clinical pres
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
migraine
2. tx
3. prophylaxis
1. DHE
contraindications
rebound analgesic
headaches
what does
migraine that
does not resolve
with medications
indicate
cough
1. acute cough
causes
2. chronic cough
causes
3. dx
4. tx
1. causes of cough
in patients with
normal CXR`
what features of
URI indicate
bacterial origin
yellow sputum*
fever and cough
NO headache, myalgias, or rhinorrhea
acute bronchitis
1. clinical pres
2. dx
3. tx
rhinosinusitis
1. patho
2. clinical pres
3. tx
what is
distinguishing
features between
rhinosinusitis vs.
influenza
69.
70.
71.
72.
73.
74.
75.
acute
sinusitis
1. clinical pres
acute
sinusitis
1.
pathogenesis
1. common cold/polyps/deviated
septum/foreign body --> inflammation of
paranasal sinuses, obstruction of sinus
ostia, trapping of secretions--> s.pneumo, h.
flu, moraxella, anerobes
acute
sinusitis
1. dx
2.
complications
3. tx
chronic
sinusitis
1.
pathogenesis
2. clinical
pres
laryngitis
1. patho +
clinical pres
2. treatment
sore throat
1. patho
2. which can
cause
exudative
tonsillitis
3. dx/tx
treatment for
EBV
pharyngitis
acetaminophen, ibuprofen
NOT amox
76.
77.
78.
dyspepsia
1. patho +
clinical pres
2. dx
3. when to do
endoscopy for
dyspepsia
dyspepsia
1. tx
peptic
stricture
clinical
presentation
GERD
1.
pathogenesis
2. clinical
pres
complications
of GERD
diagnosis of
GERD
84.
85.
79.
86.
80.
81.
82.
83.
when to
screen for
barrett's
esophagus
GERD
treatment
87.
88.
chronic diarrhea
1. patho
2. pathogens that can cause
chronic diarrhea
blood/melena
other assc. sx
sick contacts/travel
assc. with certain foods
other medical problems
(AIDS etc)
recent med changes
acute diarrhea
1. lab tests for suspicious
cases (chronic, severe
illness/fever, blood, IBD
suspicion, volume
depletion)
1. CBC
(anemia/leukocytosis)
stool sample - #1 fecal
leukocytes/culture
c.diff toxin (treat empirically
if suspicious),
ova/parasites, giardia
ELISA,
stool culture - very low
sensitivity dont order
routinely (only detect
shig/salm/camp)
flexible sigmoidoscopy with
bx
1. campylobacter,
salmonella, shigella, EIEC,
c.diff
2. hypokalemic met alk.
89.
90.
91.
92.
93.
94.
acute diarrhea
1. when to
hospitalize
2. tx
constipation
1. patho
2. what meds
cause
constipation
3. what
neuromuscular
causes ""
constipation
1. dx
2. complications
of chronic
constipation
3. tx
.............
irritable bowel
syndrome
1. patho +
clinical pres
2. dx
3. tx
nausea/vomiting
1. patho
2. bilious,
feculent,
undigested,
projectile
95.
96.
97.
98.
99.
100.
101.
nausea/vomiting
1. dx
2. tx.
hemorrhoids
1. external vs internal
2. causes
3. clinical pres
hemorrhoids
1. tx
1. what exacerbates
disc herniation pain
2. what exacerbates
spinal stenosis pain
1. coughing/sneezing increase
intraspinal pressure
forward flexion, sitting, driving,
lifting
2. standing, walking, relieved by
bending or sitting (walking on a
shopping cart)
cauda equina
syndrome
1. patho
2. clinical pres
3. treatment
1. spondylolisthesis
2. lumbar herniation
clinical pres.
3. lumbar disc
herniation treatment
102.
103.
104.
105.
106.
107.
108.
109.
spinal stenosis
1. patho
2. clinical pres
3. dx/tx
**differentiate from
arterial claudication
by checking pulses
musculoligamentous
back strain
1. patho
vertebral
compression
fracture
1. patho
2. tx
spine pain
1. when to get
imaging/MRI
1. AVOID PROLONGED
INACTIVITY, ATTEMPT WALKING
ROUTINE
NSAIDS, acetaminophen, activity
modification, slow return to
activities
PT if above fails
surgery if >1 year of failed
conservative tx
1. clinical
presentation of
cervical spondylosis
2. MCC acute neck
pain
110.
111.
112.
113.
114.
115.
116.
cervical
radiculopathy
1. patho +
clinical pres
2. dx/tx
cervical
myelopathy
1. patho +
clinical pres
evaluation of
gait
unsteadiness in
an elderly
patient
how to
differentiate
shoulder
impingement
(C5
radiculopathy)
from cervical
stenosis
causes of
arthritis
osteoarthritis,
systemic autoimmune disease - RA, SLE,
IBD, psoriatic arthritis
crystal arthropathies
infectious - septic arthritis/lymes disease
trauam
chargot joint
congenital - hip dysplasia, legg-calve
perthe, SCFE
sickle cell, hemophilia (recurrent
hemarthrosis)
wilsons, hemochromotosis
patellofemoral
pain
1. clinical
presentation
2. tx
meniscal tears
1. dx
2. tx
osteochondritis
dissecans
1. patho +
clinical pres
2. tx
118.
119.
120.
121.
122.
123.
124.
125.
126.
causes of
acute
monoarticular
arthritis
septic
disseminated gonorrhea
gout/pseudogout
rheumatic fever
lymes disease
seronegative spondyloarthropathy
bakers cyst
1. patho
patellar
tendinitis
1. patho
2. tx
plica
syndrome
1. patho
diagnosis of
knee pain
ligaments on
the lateral
aspect of the
ankle
ligaments on
the medial
aspect of the
grade 1,2,3
ankle sprains
dx of ankle
sprains
treatment of
ankle sprains
1.
supraspinatus
tendinitis + tx
2. rotator cuff
tear + dx
127.
128.
129.
130.
131.
132.
133.
134.
135.
lateral
epicondylitis
1. patho
2. tx
1. inflammation/degeneration of forearm
extensor tendons from excessive
supination/pronation
2. PT, splinting, injections
medial
epicondylitis
1. patho
de quervain's
tenosynovitis
1. patho
2. dx
3. tx
olecranon
bursitis
1. patho
2. tx
trochanteric
bursitis
1. patho
2. tx
carpal tunnel
syndrome
1. patho
2. dx
3. tx
hip
osteoarthritis
clinical pres
osteoarthritis
1. patho
2. clinical
pres
3. dx
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
osteoarthritis
1. tx
heberden's
nodes
bouchard's
nodes
bouchard's
nodes - """ at
PIP
...
osteoporosis
1. patho
Type 1
Type 2
146.
147.
secondary
osteoporosis
osteoporosis
1. risk factors
2. tx
osteoporosis
1. dx
2. secondary
osteoporosis
dx
osteoporosis
tx
ARMD
1. patho
2. risk factors
3. tx
MCC of vision
loss in
developed
countries
diabetic retinopathy
ARMD (age > 65)
cataracts
glaucoma
148.
149.
150.
151.
glaucoma
1. patho
2. open angle
3. closed angle glaucoma
4. dx
1. OA glaucoma clinical
pres
2. CA """
1. OA glaucoma tx
2. CA """"""
1. beta blockers,alpha
agonists, CA inhibitors,
prostaglandin analogs,
laser/surgery
2. immediate referral,
pilocarpine drops, IV
acetazolamide, oral glycerin,
laser/surgery
red eye
1. MCC
- refer if FFF, recent eye
surgery, corneal
opacification/ulcer/foreign
body, chemical exposure,
2. subconjunctival
hemorrhage
3. keratoconjunctivitis
sicca
4. blepharitis
1. conjunctivitis
2. focal, unilateral rupture of
small conjunctival vessels by
valsalva, trauma, HTN
3. autoimmune, meds,
CNV/VII, foreign body
sensation
4. inflammation of eyelid,
staph aureus
red eye
1. episcleritis
2. scleritis
3. anterior uveits
1. inflammation of episclera,
autoimmune, include dull
ache/discharge, self limited
NSAIDs
2. pain with palpation of the
eyeball
3. iris/ciliary body inflamm,
circumcorneal injection,
blurred vision,
pain/photophobia,
ipsilateral constrictionassc. with sarcoid, ank
spondy, reiters, IBD
152.
153.
154.
155.
156.
157.
158.
159.
HSV keratitis
1. clinical pres
2. tx
viral conjunctivitis
1. patho + clinical
pres
bacterial
conjunctivitis
1. patho
2. tx
- chlamydial = MCC
blindness
worldwide (tx =
tetra,doxy,erythro)
allergic
conjunctivitis
1. patho
2. tx
amaurosis fugax
1. patho
2. dx
OSA
1. patho
2. dx
3. tx
160.
161.
162.
complications of
OSA
narcolepsy
1. clinical pres
2. tx
163.
164.
165.
Insomnia
1. transient
insomnia
2. secondary
insomnia
3. definition
of insomnia
4. tx
treatment for
obesity
incontinence
(urge, stress,
overflow,
functional)
1. usual
causes in
males
2.. usual
causes in
females
3. risk factors
1. causes of
conductive
hearing loss
2.
sensorineural
hearing loss
3.. treatment
for cerumen
impaction
menieres
disease
1. clinical
pres
2. patho
2. tx
urge
incontinence
1. patho
2. clinical
pres
3. dx
4. tx
166.
167.
168.
169.
170.
171.
172.
173.
stress
incontinence
1. patho
2. clinical
pres
3. tx
overflow
incontinence
1. patho
2. clinical
pres
reflex
incontinence
1. patho
incontinence
dx
fatigue
1. causes
fatigue lab
workup
CFS
1. patho
2. tx
erectile
dysfunction
1. patho
2. dx
3. tx
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
alcoholism
1.
complications
alcoholism
1. treatment
most
important
causes of
mortality with
smoking
alcohol
withdrawal
1. symptoms
2. DT
health risks
assc. with
smoking
smoking
cessation aids
1. HTN
screening
2. womens
breast
screening
1. cervical
cancer
screening
1. STD
screening
1. eye
screening
2. ear
screening
1.
osteoporosis
screening
2. AAA
1. DEXA at age 65
2. ultrasound at age 65 with history of
smoking
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
.....
HPV vaccine
reccomendation
contraindications of to
vaccination
positioning for
1. ET tube
2. central line
3. swan ganz
4. NG tube
abdominal images
1. standard abdominal
film
2. obstruction series
ileus vs mechanical
obstruction on
obstruction series xrays
ECG
1. detemrine rate
2. determining axis
3. LAD axis
4. RAD axis
1. # of large boxes/300=
1/#BPM
2. I and aVF should be positive
(= normal axis)
3. I positive, aVF negative
4. I negative, aVF positive
I negative, aVF negative extreme LAD
1. PR>0.2
2. progressive PR lengthening
and then dropped QRS
no , because it is caused by
NTHI
3 doses, 0,1-2,4-6
196.
197.
198.
199.
200.
201.
202.
203.
204.
205.
risk factor
modification for
CAD
smoking cessation
HTN - <130/80 for diabetics
HLD - statins and diet
DM - strict glycemic control
obestity
exercise
Diet
medical
treatment for
CAD
what drugs
decrease
mortality in CHF
beta blockers
ace inhibitor
hydralazine + isosorbide dinitrate
spironolactone (blocks aldosterone)
treatment for
stable angina
side effects of
nitrates
headache
orthostasis
tolerance
syncope
indications for
CABG or
coronary
angioplasty
...
acute coronary
syndrome
unstable angina
1. pathogenesis
2. clinical history
of unstable
angina
3. how to
differentiate
between unstable
angina and
NSTEMI
4. managment
treatment of
unstable angina
206.
207.
208.
209.
beta blockers
LMWH (enoxaparin) 2-2.5
INR
clopidogrel - reduces MI in
USA
gpIIb/IIIa inhibitors abciximab, tirofiban
K+ and Mg+ replacement
...
risk of death/ischemia in
patients with unstable
angina/NSTEMI
Age>65
>3 CAD risk factors
known CAD >50% stenosis
2 episodes of angina in last
24 hours
aspirin use in last 7 days
elevated cardiac enzymes
ST change >0.5mm
0-1 point = 5%
2 points = 8%
3 points = 13%
4 points = 20%
5 points = 26%
6-7 points = 41%
when to proceed to
cath/revascularization in a
patient with unstable
angina
1. transient coronary
vasospasm associated with
atherosclerosis, smokers
2. angina pain, ventricular
dysrhythmias, night time
onset*
3. transient ST elevation
during chest pain
coronary angiographyadminister ergonovine
shows coronary vasospasm
4. CCBs***, nitrates,
smoking cessation
avoid aspirin (prostacyclin
inhibitor)
avoid beta blockers
211.
212.
213.
214.
215.
216.
217.
218.
210.
myocardial infarction
1. patho
2. clinical pres
...
219.
post operative
diabetics
patients on beta blockers
women
myocardial infarction
3. diagnosis
3. ECG - ST elevation or
depression, peaked T waves
(earliest), Q waves (late), T wave
inversion
cardiac enzymes - inc. 3-5 hours
post MI, peak 24-48 hours,
measure q8hrs for 24 hours
right ventricular MI
clinical presentation
1. ST elevation V1-V4
2. large R wave V1-V2
ST depression V1-V2
prominent upright T waves V1V2
3. ST elevation/Q waves I, aVL
4. ST elevation/Q waves II, III,
aVF
hyper/hypotension
PVCs which predict Vfib or VT
auscultation for lung crackles,
S3/S4, friction rubs
in unstable patient
hemodynamic monitoring with
pulmonary artery catheter
what hemodynamic
information from a
pulmonary artery
catheter
NSTEMI
1. patho
2. ECG findings
1. subendocardial ischemia
2. non-ST elevation, ST
depression, T wave inversions,
no Q waves
220.
221.
222.
223.
224.
225.
226.
1. medical treatment
for acute MI
2. surgical treatment
for acute MI
1. IV access
supplemental oxygen - limits
myocardial damage
nitrates - dilate coronaries,
vasodilator, reduces preload
morphine - venodilator, analgesia
Aspirin - antiplatelet
LMWH
beta blockers - reduce MVO2,
reduce post-MI remodeling of
myocardium
ACE inhibitors
atorvastatin - stabilizes plaques,
lowers cholesterol
Stress EKG before leaving hospital
--> angiography --> possible PCI
or CABG
2. early thrombolysis, PCI or
CABG- within 90 minutes of
arrival improves outcome
troponin vs CKMB
...
complications of MI
1. pump failure
2. pump failure
treatment
complications of MI
pump failure
arrhythmias
asystole
AV block
recurrent infarction
interventricular septum rupture
papillary muscle rupture
ventricular pseudoaneurysm
ventricular aneurysm (persistent
ST elevation)
acute pericarditis
Dresslers syndrome
227.
228.
229.
230.
231.
232.
233.
complications of MI
1. arrhythmias +
(tx)
2. asystole tx
complications of MI
1. AV block
2. tx
complications of MI
1. recurrent
infarction dx
2. tx
1. when is
thrombolytic
therapy (alteplase)
prefered over PCI
2.contraindications
to thrombolytic
therapy
mechanical
complications of MI
1. free wall rupture
+ tx
2. interventricular
septum rupture +
tx
3. papillary muscle
rupture+ tx
4. ventricular
pseudoaneurysm +
tx
5. ventricular
aneurysm
complications of MI
1. acute pericarditis
2. tx
234.
235.
236.
237.
238.
239.
240.
241.
complications
of MI
1. dresslers
syndrome
chest pain
ddx
chest pain
workup
characteristic
of pleuritic
chest pain
high output
heart failure definition
and causes
CHF
1.
pathogenesis
2. what does
the frank
starling curve
describe
1. CHF clinical
presentation
left sided
heart failure
signs
displaced PMU
S3- rapid filling into non-compliant left
ventricle (@ apex with bell)
S4- atrial systole blood ejected into noncompliant left ventricle
crackles/rales - fluid in small airways
dullness to percussion of lung fields -pleural
effusion
strong P2 component of S2 - from pulm.
HTN
242.
243.
244.
245.
NYHA
classification of
CHF
BNP
1. when is it
released
BNP can help
differentiate
between CHF and
COPD causing
dyspnea
246.
247.
248.
249.
250.
251.
252.
253.
CHF treatment
1. MILD (I and II)
2. MILD-MODERATE (II
and III)
3. MODERATESEVERE(III and IV)
4. what drug for patients
who cannot tolerate ACE
inhibitors
spironolactone vs
eplerenone
beta blockers
spironolactone (stage II and
III)
ACE inhibitors
hydralazine + nitrate
digoxin toxicity
symptoms
ECG findings
ICD indications
254.
255.
beta blockers
diuretics
ACEs/ARBS
DO NOT USE digoxin +
spironolactone
oxygenation/ventilation
with non-rebreather,
NPPV, intubation
diuretics***
nitrates
inotropes - dobutamine
(faster onset than
digoxin)
...
http://meds.queensu.ca/central/assets/modules/ECG/Slide11.JPG
1. adrenergic excess,
drugs, alcohol, tobacco,
electrolyte, ischemia,
infection--> atria fire on
their own without SA
node
2. early P waves with
different morphology,
normal QRS
3. asymptomatic, beta
blockers if symptomatic
...
256.
257.
258.
259.
260.
261.
262.
263.
264.
http://meds.queensu.ca/central/assets/modules/ECG/premature_ventricular_complex.html
265. atrial fibrillation
1. heart disease -1.CAD,
structural
MI, HTN,
heartmitral
1. causes
valve disease, pericarditis,
dz, hypoxia,
pericardial
2. patho
trauma
electrolytes,
pulmonary disease
stimulants,
- PE
meds
hyper/hypothyroid
--> beat fires on
sepsis, malig, DM
its own from a
excessive alcoholventricular focus
sick sinus syndrome
2. wide QRS, lost
pheochromocytoma
P wave (hiding in
2. multiple atrial;QRS
focicomplex),
fire continuously
causing rapid irregular
compensatory
ventricular rate -> thromboembolism,
pause*hemodynamic
compromise
couplet - two
successive PVCs
266. atrial fibrillation
1. fatigue, exertional dyspnea,
bigeminy - sinus
1. clinical
palpitation, dizziness, angina, syncope
beat followed by
features
2. irregularly irregular rhythm, no
PVC
2. ECG
identifiable P waves
trigeminy - two
3. tx
3. RATE CONTROLLED - *Beta
sinus beats
blockers or CCB
followed by PVC
*immediate electrical cardioversion if
3. asymptomatic
unstable
no treamtent, beta
*digoxin or amiodarone if LV
blockers if
dysfunction
symptomatic
*anticoag - if >48 hours,
(palpitations,
anticoagulation 3 weeks before and 4
dizziness)
weeks after cardioversion (INR 2-3)
should post MI PVCs be suppressed with antiarrhythmics
TEE - to detect LA
NO
thrombus
NO NO *pharma cardioversion
increases
- ibutilide,
risk of
procainamide, flecainide,
death
sotalol,
amiodarone
management of patient with frequent PVCs
workup for
267. how does afib
under age 60, nostructural
other heart
heart
disease
treatment differ
do not need heparin/warfarin
disease
for patients with
if heart disease is
lone afib
found patient
should have
268. chronic afib
beta blockers/CCBs
electrophysiologic
treatment
warfarin
study and
269. 1. cardioversion
1. shock that is synchronous
possible ICDwith QRS
2. defibrillation
(NOT T-wave) - used
for afib, aflutter,
implantation
to
VT with pulse, SVT
prevent sudden
2. shock that is not
synchronous
cardiac
death with
QRS - Vfib, pulseless VT
causes of diastolic heart dysfunction
infiltrative
270. indications for
Vfib, or VT that is
not controlled by
cardiomyopathies
automatic
medical therapy (amyloid,
implantable
sarcoid),
defibrillator
hypertrophic
271.
atrial flutter
1. causes
2. patho
3. ECG
4. tx
cardiomyopathy,
1. heart failure, rheumatic
heart disease,
CAD, COPD, ASD
2. right atrial macro-reentry focus firse
250-350BPM
3. saw tooth baseline, with QRS every 23 atrial contractions (II, III, aVF)
4. same as for Afib
multifocal atrial
tachycardia
1. causes
2. ECG findings +
dx
3. wadering
atrial pacemaker
4. tx (w and w/o
LV dysfunction)
paroxysmal
supraventricular
tachycardia
1. AV nodal reentrant
tachycardia +
ECG
2. orthodromic
AV re-entrant
tachycardia +
ECG
3. causes
4. tx
274.
vagal maneuvers
275.
PSVT prevention
digoxin*
verapamil, beta blockers
radiofrequency catheter ablation
WPW syndrome
1. patho
2. dx
3. tx
272.
273.
276.
277.
ventricular
tachycardia
(sustained and
nonsustained)
1. patho
2. causes
3. ECG
278.
279.
280.
281.
282.
283.
284.
285.
ventricular
tachycardia
1. sustained
VT tx
2. nonsustained VT
tx
Ventricular
fibrillation
1. causes
2. patho
3. clinical
pres
4. ECG
5. tx
pulseless
electrical
activity
1. causes
2. clincial
findings
3. tx
sinus
bradycardia
1. causes
2. symptoms
3. tx
sick sinus
syndrome
1. patho
2. sx
first degree
AV block
second
degree AV
block
1. type 1
(wenckebach)
2. type 2
3. tx for type 1
vs 2
third degree
AV block + tx
286.
287.
288.
289.
290.
tx = atropine
acutely,
pacemaker
implantation**
****
...
dilated
cardiomyopathy
1. patho
2. clinical pres
3. dx
4. tx
HCM
(hypertrophic
cardiomyopathy)
1. patho
2. clinical pres
3. dx
1. AUTOSOMAL DOMINANT-->
diastolic dysfunction, worse with
exercise or valsalva + dynamic outflow
obstruction
2. angina, syncope, dyspnea (on
exertion or valsalva), arrythmias,
SUDDEN CARDIAC DEATH
3. loud S3, systolic ejection murmur @
LSB, rapidly increasing two upstroke
carotid pulse (bisferiens pulse)
Echocardiogram - shows left ventricular
hypertrophy esp. of septum
ECG, family history
HCM
1. treatment
HCM murmur
features
291.
292.
293.
294.
295.
restrictive
cardiomyopathy
1. patho
1a. clinical pres
2. dx
3. tx
1. amyloid, sarcoid,
hemochromatosis, scleroderma,
carcinoid, chemotherapy -->
impaired diastolic ventricular
filling
1a. absent pulses, absent
kussmaul's sign, prominent x
descent
2. echocardiogram - shows
enlarged RA/LA sizes, sparkled
appearance in amyloidosis
ECG - low voltage,bundle branch
blocks, LVH
endomyocardial biopsy
3. hemochromatosis phlebotomy,
deferoxamine
sarcoidosis glucocorticoids
amyloid - none
digoxin for systolic
failure
avoid
diruetics/vasodilators
...
myocaridtis
1. patho
2. clinical pres
3. dx/tx
acute pericarditis
1. causes (long list...)
1. idiopathic/infectious (cox*,
echo, adeno, ebv, flu, HIB,
hep A/B, TB*, fungal, toxo)
Acute MI (within 24 hrs)
uremia
collagen dz - SLE, scleroderma,
RA, sarcoid
hodgkins lymphoma, breast/lung
cancer
drug lupus: procainamide,
hydralazine
Dresslers syndrome- weeks to
months after MI
post pericardectomy sndrome
amyloid
radiation
trauma
acute pericarditis
1. treatment
2. complications
296.
297.
298.
299.
300.
301.
acute pericarditis
1. clinical pres
best positioning to
hear a pericardial
friction rub
acute pericarditis
1. dx
2. tx
constrictive
pericarditis
1. patho
2. clincal pres
3. dx
diagnostic
modality of choice
for pericardial
effusion and
cardiac tamponade
echocardiogram
constrictive
pericarditis
1. tx
1. underlying condition*
diuretics
monitor/treat for coagulopathy
302.
303.
304.
305.
306.
pericardial
effusion
1. pathogenesis
2. clinical pres
3. dx
pericardial
effusion
1. tx
cardiac
tamponade
1. patho
2. causes
- note also
interventricular
septum bows into
LV during
inspiration
further reducing
LV filling
cardiac
tamponade
1. clinical pres
2. dx
becks triad
cardiac tamponade:
hypotension, muffled heart sounds,
JVD
307.
308.
309.
310.
311.
cardiac
tamponade
1. tx
mitral stenosis
1. patho
2. clinical pres/PE
mitral stenosis
1. dx
2. tx
aortic stenosis
1. patho
2. clinical pres
25% 3 year survival
w/o treatment @
time of
presentation with
symptoms
aortic stenosis
1. dx
2. tx
312.
313.
314.
315.
aortic
regurgitation
1.
causes/patho
2. symptoms
aortic
regurgitation
1. clinical
presentation
aortic
regurgitation
1. dx
2. tx
mitral
regurgitation
1. patho
2. clinical
pres
3. dx
4. tx
316.
317.
318.
319.
320.
321.
tricuspid
regurgitation
1.causes
2. clinical pres
tricuspid
regurgitation
1. dx
2. tx
1. echocardiogram
2. diuretics for volume overload
treat underlying cause
valve repair, tricuspid ring
mitral valve
prolapse
1. patho
2. sx/clinical
pres
MVP
1. dx/tx
1. dx = echocardiogram
tx = reassurance, beta blockers
surgery rarely
rheumatic heart
disease
1. patho
2. clinical pres
3. tx
infective
endocarditis
1. acute
2. subacute
3. native valve
endocarditis
4. IVDU
5. prosthetic
valves
6. pathogenesis
7. recent bladder
instrumentation
8. colon cancer
322.
323.
324.
325.
326.
327.
328.
329.
330.
331.
332.
333.
MCC epiglottitis +
CXR finding
neisseria gram
stain
clinical
presentation of
mycoplasma
pneumonia + dx
methenamine silver
stain
pneumocystis
dx EBV
amoebic liver
abscess
1. dx/tx
2. clinical
presentation
Coxsackievirus can
produce a
morbilliform
vesiculopustular
rash, often with a
hemorrhagic
component and
with lesions of the
throat, palms, and
soles.
...
stages of lymes
disease
VDRL
treatment of
influenza outbreak
in a nursing home
334.
335.
336.
337.
338.
339.
340.
341.
342.
343.
causes of fever of
unknown origin
infections, malignancies,
collagen vascular disease,
granulomatous disease
2. elevated serum
ferritin**, RF is often
negative
...
acute hepatitis A
incubation period
features of chickenpox
rash
diabetics
ureaplasma urealyticum,
trichomonas vaginalis ,
chlamydia trachomatis
infectious endocarditis
1. clinical presentation
endocarditis
2. complications of
infective endocarditis
3. tx
dukes criteria
344.
345.
346.
347.
infective endocarditis
diagnostic criteria
Major - sustained bacteremia,
endocardial involvement by
echo, new valvular
regurgitation
Minor - predisposing condition,
fever,
septic or pulm emboli, mycotic
aneurysm, intracranial
hemorrhage, janeway lesions
immune phenomenon glomerulonephritis, osler's
nodes, roth spots, rheumatoid
factor
non major blood culture/echo
348.
349.
350.
351.
352.
endocarditis
prophylaxis
indications +
tx
nonthrombotic
marantic
endocarditis
1. patho
2.
complications
non-bacterial
verrucous
endocarditis
(libman
sacks)
1. patho
2.
complications
+ tx
ASD
1. patho
2. clinical
pres
3. dx physical,
Echo, CXR,
ECG
treatment of
refractory
c.difficile
treatment for
hospital
MRSA
HIV
treatment
1. raltegravir
2. maraviroc
3. basic
treatment of
HIV
1. integrase inhibitor
2. CCR5 antagonist
3. 2 NRTI + 1 NNRTI, or 2 NRTI + protease
inhibitor
prophylaxis
against
malaria
atovaquone-proguanil, mefloquine, or
primaquine, 2 days before trip starts based
upon CDC sensitivities
catheter
associated
UTI
353.
354.
355.
356.
357.
358.
359.
360.
361.
362.
363.
cervicofacial
actinomyces
blastomycosis clinical
presentation
aspergillus related
disease
disseminated in
immunocompromised
allergic bronchopulmonary young woman with asthma
aspergilloma - bronchial plugs
with hyphae
which diseases
associated with
peeling of the skin
meningococcus, gonococcemia,
rickettsia, infectious endocarditis,
atypical measles, DIC associated
with sepsis
causes of dysphagia in
HIV patients
candida***(empiric fluconazole),
HSV, cytomegalovirus
steroids
- Bipap is better because is
reduces CO2 retention,
- NOT OXYGEN THERAPY because of haldane effect and
hypoxia drives respiration in
COPD patients
causes of delirium
medications (anticholinergics,
antihistamines, TCAs),
postsurgical, infection,
electrolytes, benzos,
fluoroquinolones.
healthcare associated
pneumonia
1. associated settings
2. bacteria
3. tx
364.
365.
366.
367.
368.
369.
370.
complications
of ASD
2. when to treat
ASD
1. pulmonary hypertension
eisenmenger disease- irreversible
pulmonary hypertension leads to shung
reversal, heart failure, cyanosis
right heart failure
A.fib
stroke (PARADOXICAL EMBOLI), Afib
2. when pulm:systemic > 2:1 or if
symptoms
VSD
1. patho
2. clinical pres
3.
complications
4. dx/tx
coarctation of
the aorta
1. patho
2. clinical pres
3. dx/tx
coarctation of
the aorta
complications
clinical
associations
with PDA
PDA
1. clinical
presentation
2. tx
TOF
1. patho
2. tet spells
3. dx
371.
372.
373.
374.
375.
hypertensive
emergency
1. definition
2. clinical findings
hypertensive urgency
posterior reversible
encephalopathy
syndrome
1. patho
2. symptoms
3. dx
treatment for
hypertensive
emergency
aortic dissection
1. risk factors
2. type A vs type B
3. clinical pres
*****BE CAREFUL
AND DO NOT GIVE
THROMBOLYTIC IF
PRESENTATION IS
SIMILAR TO
MYOCARDIAL
INFARCTION
1. hypertension, smoking,
cocaine, trauma, marfans, ehler
danlos, bicuspid aortic valve,
coarctation, third trimester
pregnancy
2. type A includes the ascending
aorta
type B distal to the subclavian
artery
3. severe tearing, ripping
sensation anterior chest (type A),
or interscapular (type B),
diaphoresis, pulse asymmetry
between limbs, aortic regurg
murmur (A), neurologic
(obstruction of carotid)
376.
377.
378.
379.
380.
381.
382.
383.
aortic
dissection
1. dx / tx***
AAA
1. patho
2. clinical
pres
3. ruptured
AAA clinical
pres
4. dx/tx
AAA
1. tx
leriche
syndrome
PVD
1. associated
conditions
2. common
sites
3. risk factors
PVD
evaluation
PVD
1. intermittent
claudication
2. rest pain
3. clinical
findings
brodie
trendelenburg
test
...
384.
385.
386.
387.
388.
389.
PVD
diagnosis
PVD tx
acute
arterial
occlusion
1. patho
2. clinical
pres
3. dx/tx
cholesterol
embolization
syndrome
1. patho
2. clinical
presentation
3. dx/tx
mycotic
aneurysm
cause and
treatment
luetic heart
1. patho
DVT
1. pahto
2 risk
factors
3. clinical
pres
390.
391.
392.
393.
394.
395.
396.
DVT dx
tx
doppler analysis, doppler ultrasound good for proximal thrombi, not for distal
Venography - best for calf veins
impedance plethysmography
D-dimer testing - high sens
tx = if doppler is positive start
anticoagulation, if non-diagnostic
repeat every 2-3 days for up to 2 weeks
- heparin bolus titrate up to 1.5-2x
aPTT, start warfafarin for 3-6 months,
thrombolytic therapy (massive PE and
unstable)
IVC filter - prevents PE
complications of
DVT
PE
post thrombotic syndrome (chronic
venous insufficiency)
phlegmasia cerulea dolens - severe leg
edema that compromises arterial supply
results in impaired sensory/motor
function
how to prevent
post-op DVT
heparin or
LMWH +
pneumatic
compression =
BEST COMBO
...
chronic venous
insufficiency
1. pathogenesis
chronic venous
insufficiency
1. clinical
presentation
2. tx
superficial
thrombophlebitis
1. patho
2. clincal pres
397.
398.
399.
400.
401.
402.
403.
404.
septic phlebitis
tx
migratory
superficial
thrombophlebitis
1. most common
tumor of the
heart
2. atrial myxoma
3. atrial myxoma
clinical pres
shock
1. clinical
presentation
CO/SVR/PCWP
for
1. cardiogenic
shock
2. hypovolemic
3. neurogenic
4. septic
1. dec,inc, inc
2. dec, inc, dec
3. dec, dec, dec
4. inc, dec, dec
cardiogenic
shock
1. patho
2. clinical pres
3. dx
cardiogenic
shock
4. tx
4. NO IV FLUIDS IF LEFT
VENTRICULAR PRESSURES ARE
ELEVATED
ABCs,
identify cause, aspirin and heparin,
treat arrhythmias/tamponade
dopamine dobutamine norepinephrine, or phenylephrine
do not use nitroprusside/nitroglycerin
- diuretics
IABP
intra aortic
balloon pumps
effects
405.
406.
407.
hypovolemic shock
-page 66 good
classification of shock
chart
1. causes
2. dx/tx
- cool skin
****MONITOR URINE
OUTPUT AND
HEMODYNAMIC
MONITORING ARE
BEST INDICATORS OF
SHOCK STATUS
1. trauma, GI bleed,
retroperitoneal bleed
vomiting, severe diarrhea,
dehydration, burns, third
spacing
2. central venous line or
pulmonary arterial catheterdec. CVP/PCWP/dec. CO/inc.
SVR
tx = ABC, IV hydration (class
II,III,IV) with crystalloid if
non-hemorrhagic
septic shock
1. definition
2. patho
3. clinical pres
4. tx
1. SIRS
2. sepsis
2a. severe sepsis
3. septic shock
4. multiorgan
dysfunction
2 or more of
fever >38 or hypothermia <36
hyperventilation >20 bpm, or
PaCO2<32
Tachycardia >90
Inc. WBC >12000 or <4000 or
>10% bands
2. positive blood cultures (2
different sites) before abx
administration + SIRS
2a. sepsis with organ
dysfunction, hypoperfusion or
hypotension
3. hypotension induced by
sepsis despite adequate volume
resuscitation
4. altered organ function in
acutely ill patient leading to
death
408.
409.
410.
411.
412.
413.
414.
415.
416.
417.
neurogenic
shock
1. patho
2. clinical pres
3. tx
COPD
1. chronic
bronchitis
diagnostic
criteria
2. pathogenesis
diagnostic test
for sjogrens
DMARDs
other associated
conditions with
ank-spondy
gonorrhea,non-gonococcal urethritis,
GI infections - yersinia, campylobacter,
salmonella, shigella
2. oligoarticular arthritis, conjunctivitis,
urethritis, keratodermia
blennorrhagicum (looks like papular
psoriasis), spondylitis
3. HLA B27,
Scleroderma
systemic
sclerosis,
polymyalgia
rheumatic
1. patho +
clinical
association
radiological
finding of
psoriatic
arthritis
chondromalacia
patellae
418.
419.
420.
421.
422.
423.
424.
425.
426.
427.
dermatomyositis
vs. polymyositis
etiology
polymyositis is T
cell mediated
...
emphysema
1. patho
causes of COPD
tobacco smoke
alpha 1 antitrypsin
environment (2nd hand smoke)
chronic asthma
how does
tobacco smoke
cause
emphysema
centrilobular
emphysema
panlobular
emphysema
COPD
1. clinical
presentation
2. PFT findings
that defines
COPD
key history in
COPD patients
pink puffer
emphysema
thin (inc. work of breathing)
lean forward
barrel chested
tachypnea with prolonged expiration
through pursed lips
accessory muscles
428.
429.
430.
431.
432.
433.
434.
435.
436.
437.
blue bloater
chronic bronchitis
overweight and cyanotic
chronic cough with sputum
Obstructive/restrictive
lung dz
1. FEV
2. FEV1/FVC
3. peak expiratory flow
4. residual volume
5. TLC
6. VC
7. peak expiratory flow
COPD CXR
hyperinflation, flattened
diaphragm, enlarged retrosternal
space, dec. pulmonary vascular
markings
clinical monitoring of
COPD patients
functional residual
capacity
ERV + RV
treatment of COPD
1. smoking cessation
beta agonist - salmeterol
ipratropium - longer lasting
combo therapy
inhaled steroids- slow FEV1
decline minimally, use with
bronchodilators
exacerbations - steroids,
antibiotics
theophylline
oxygen therapy
vaccination - strep.pneumo every
5 years
pulmonary physiotherapy
BETA BLOCKERS
CONTRAINDICATED IN ACUTE
COPD AND ASTHMA
PaO2 55mmHg
O2 sat <88%
PaO2 55-59+ polycythemia
Hct>55 or cor pulmonale
hypoxia during exercise or sleep
(nocturnal)
**in the context of optimal
medical therapy
...
438.
439.
440.
441.
442.
1. acute COPD
exacerbation
2. tx
asthma
1. definition
2. extrinsic vs
intrinsic
3. clinical pres
1. signs of acute
severe asthma
attack (acute
asthma
exacerbation
2. treatment
asthma
CHF - 2/2 edema/congestion
COPD - inflamed narrow airways
cardiomyopathies - pericardial diseases
causing edema
Lung cancer- obstruction of the airways
asthma
4. dx
443.
444.
445.
446.
447.
448.
classification/treatment
asthma
1. mild intermittent
2. mild persistent
3. moderate persistent
what to order in a
suspected acute asthma
exacerbation
PEF - decreased
ABG - inc A-a gradient
CXR - rule out
pneumonia/pneumothorax
asthma complications
aspirin sensitive
asthma
bronchiectasis
1. patho
2. clinical pres
3. dx/tx
449.
450.
451.
452.
453.
cystic fibrosis
1. patho
2. clinical pres
3. tx
lung cancer
1. types
2. risks
3. clinical pres
- tends to
present late
4. sites of mets
lung cancer
clinical
syndromes
1. SVC syndrome
2. phrenic nerve
palsy
3. hoarseness
4. horners
syndrome
5. pancoast
tumor
1. which type of
lung cancer
associated with
airway
involvement
2. what kind of
lung cancer
associated with
pancoast tumor
3. which type of
lung cancer seen
in women, nonsmokers
1. SCC
2. SCC
3. bronchoalveolar
paraneoplastic
syndromes
1. small cell
2. squamous cell
3.
adenocarcinoma
454.
455.
456.
457.
458.
lung cancer
1. dx
lung cancer
1. tx
solitary pulmonary
nodule
1. possible causes
2. features favoring
benign
3. feature favoring
malignant
- page 80- algorithm
1. granuloma, hamartoma,
adenoma, carcinoma
2. age <50, non-smoker,
<1cm, smooth borders, central
calcification, no change in
size
3. age >50 (50%), smoker, size
> 2cm,
1. radiographic features
of SCC lung cancer
2. """"""
adenocarcinoma
3. """""" large cell
4. """""" small cell
1. serial CT scan
2. PET scan
459.
460.
461.
mediastinal mass
1. MCC in older
patients
2. ant. mediastinal
masses
3. middle
mediastinal
masses
4. posterior
mediastinal
masses
5. symptoms of
mediastinal
masses
6. dx
1. transudative vs
exudative pleural
effusions
2. causes of """"
1. what tests
should be
performed on an
exudative pleural
effusion
2. lab findings that
distinguish
exudative vs
transudative
effusion
462.
463.
464.
465.
466.
467.
pleural
effusion
1. dx
2. tx
special
pleural
effusions
1. elevated
amylase
2. milky
opalescent
3. frankly
purulent
4. bloody
5.
lymphocytic
6. pH <7.2
what does
low glucose
in a pleural
effusion
indicate
...
what does
low pH
pleural
effusion
indicate
empyema***
must place
chest tube
...
empyema
1. patho
2. tx
468.
469.
470.
471.
472.
473.
474.
pneumothorax
1. patho
2.secondary
pneumothorax
3. clinical pres
4. dx/tx
fibromyalgia
1. clinical pres
2. dx
tension
pneumothorax
1. patho
2. clinical pres
3. dx/tx
malignant
mesothelioma
clinical
association
asbestos exposure
define
interstitial
lung disease
chemotherapeutics, amiodarone,
penicillamine, nitrofurantoin, bleomycin,
phenytoin
end stage
interstitial
lung disease is
referred to as
honeycomb lung
475.
476.
477.
478.
479.
sarcoidosis
1. patho
2. clinical
pres
sarcoidosis
1. dx
2. PFTs
3. tx
classic
clinical
presentation
for
sarcoidosis
constitutional symptoms
respiratory complaints
erythema nodosum
blurred vision
bilateral hilar adenopathy
CXR staging
of
sarcoidosis
histiocytosis
x
1 patho
2. clinical
pres
3. dx/tx
480.
481.
482.
483.
484.
485.
486.
487.
488.
wegeners
granulomatosis
1. patho
2. clinical pres
3. dx/tx
1. necrotizing granulomatous
vasculitis affects lungs/upper
airway**, kidneys, and other organs
2. upper and lower respiratory
infections, glomerulonephritis,
pulmonary nodules, skin findings subQ nod, purpura, pyoderma
gangrenosum
3. tissue biopsy positive for CANCA*** ~ anti proteinase 3
tx = glucocorticoids +
cyclophosphamide
churg strauss
syndrome
1. patho
2. clinical pres
3. dx/tx
coal workers
pneumoconiosis
substances that
cause
pneumoconiosis
asbestosis
1. patho
2. complications
3. dx/tx
silicosis
1. patho
2. clinical pres
3. dx
diagnosis of
berylliosis
hypersensitivity
pneumonitis
1. patho
2. causes
3. clinical pres
4. dx / tx
489.
490.
491.
492.
493.
494.
495.
eosinophilic
pneumonia
1. dx
2. tx
goodpasture's
syndrome
1. patho
2. clinical pres
3. dx/tx
pulmonary
alveolar
proteinosis
1. patho
2. clinical pres
3. dx/tx
idiopathic
pulmonary
fibrosis
1. patho
2. dx
cryptogenic
organizing
pneumonitis
1. patho
2. dx
radiation
pneumonitis
1 patho
respiratory
failure
1. hypoxia
definition
2. hypoxemic
respiratory
failure
definition
3. causes of
hypoxemic
respiratory
failure
496.
497.
498.
499.
500.
501.
502.
ventilatory
respiratory
failure
1. definition
2. causes
how to change a
patient's
ventilation vs
oxygenation
two causes of
respiratory
failure
1. VQ mismatch
2.
intrapulmonary
shunting
clinical pres. of
respiratory
failure
evaluation of
hypoxemic
patient
Pg 96 - evaluation
of hypoxic
patient
get ABG
look at PaCO2 elevated or not
look at A-a gradient
look at response to oxygen
1. if PaCO2 is elevated and A-a is
normal = hypoventilation
2. if PaCO2 is elevated and A-a is
elevated = hypoventilation + another
factor
3. if PaCO2 is normal, and A-a is
normal = low inspired PAO2
4. if PaCO2 is normal, A-a increased,
and response to supp O2 = VQ
mismatch
5. if PaCO2 is normal, A-a increased,
no response to supp O2 = shunt
treatment for
respiratory
failure
503.
504.
505.
506.
507.
508.
509.
ways to
improve
tissue
oxygenation
NPPV
1. indications
2.
requirements
ARDS
1. patho
2. causes
ARDS
1. clinical pres
2. dx
3. tx
complications
of ARDS
mechanical
ventilation
1. indications
2. goals
ventilator
settings
1.assisted
controlled
2.
synchronous
intermittent
mandatory
ventilation
510.
511.
512.
513.
514.
515.
516.
ventilator settings
1. CPAP
2. pressure support
ventilation
ventilator
1. tidal volume
/minute ventilation
2. FiO2 setting
3. I:E ratio
4. PEEP settings
extubation criteria
drugs used to
diagnose pulmonary
hypertension
what ventilator
settings associated
with oxygen toxicity
pulmonary
hypertension
1. definition
2. passive type
3. hyperkinetic type
4. obliterative
517.
518.
519.
520.
pulmonary
hypertension
1. obstructive
type
2.
vasoconstrictive
type
3. increased
intrathoracic
pressure
- inc. blood
viscosity
*or classify by
post capillary,
complications of
mechanical
ventilation
pulmonary
hypertension
1. clinical pres
2. dx
PPH
1. patho
2. dx/tx
-exertional
syncope common
- presents late,
very poor
prognosis only 23 year survival
521.
522.
523.
524.
525.
526.
527.
cor
pulmonale
1. patho
2. clinical
pres
3. dx/tx
how does PE
cause death
pulmonary
emboli
sources
DVT
fat embolism
amniotic embolism
air embolism
septic embolism (IVDU)
schistosomiasis
PE
1. patho
2. DVT
sources
3.
complications
4. risk factors
two
important PE
studeies
clinical
presentation
of fat
embolism
PE clincal
pres
PE mortality
528.
529.
530.
531.
532.
533.
534.
535.
PE
1. dx
2. how to rule
out PE
3. what
patients
cannot have
spiral CT
PE
1. CXR findings
2. negative CTA but high
clinical
suspicion=
what prob of
PE
3. tx
complications
associated
with IVC filters
indications for
IVC filters
wells criteria
for acute PE
symptoms/signs of DVT - 3
alt diagnosis less likely than PE - 3
HR > 100 bpm - 1.5
immobilization >3 days or surgery in
previous 4 weeks - 1.5
previous DVT or PE - 1.5
hemoptysis - 1.0
malignancy - 1.0
...
pulmonary
aspiration
1. anatomic
location
2. clinical
presentation
3.
predisposing
factors
what is the
indication for
an INR 2.5-3.5
536.
537.
538.
539.
540.
541.
542.
543.
1. aspiration
pneumonia clinical
pres
2. dx
3. tx
how to prevent
aspiration pneumonia
dyspnea
1. key history
2. most common causes
dyspnea
1. cardiovascular
causes
2. respiratory causes
3. psychiatric causes
4. chest wall causes
5. neuromuscular
causes
6. systemic causes
1. CHF, ischemia,
pericarditis/tamponade,
arrhythmias, valve disease,
congenital
2. COPD, asthma, PE, ARDS,
pneumonia, TB, bronchitis,
pleural effusion, pulmonary
edema, PTX, airway obstruction,
ILD
3. GAD, panic attacks,
hyperventilation
4. kyphoscoliosis, rib fractures,
ank spondy
5. myasthenia , muscular
dystrophy
6. chronic anemia, sepsis, DKA,
GERD, narcotics
dyspnea
1. dx
lung aspiration/pneumonia
544.
545.
546.
547.
548.
549.
550.
551.
552.
hemoptysis
1. massive hemoptysis
definition + most
common causes
2. causes
3. dx
O2 saturation <88%
acidosis expected
changes for
respiratory/metabolic
on ABG
...
what is spirometry
useful to evaluate
what is DLCO useful
to evaluate
what conditions have
high vs low DLCO
asthma vs COPD,
monitoring of
sarcoidosis and
emphysema
...
High - asthma,
obesity, left to right
shunt, exercise,
pulmonary
hemorrhage
Low - emphysema,
sarcoid, fibrosis,
pulmonary vascular
disease, anemia
...
hemoptysis
evaluation
553.
554.
555.
556.
557.
558.
559.
560.
561.
colorectal
cancer
1. screening
2. staging
3.
recurrence
surveilance
4. methos of
spread of
CRC
colorectal
cancer risk
factors
age >50
adenomatous polyps
IBD - UC 20% at 30 years of age
family history (first degree relatives
CRC
1.
histological
classes
2.
morphology
types
FAP
gardners
syndrome
turoct's
syndrome
AUTOSOMAL RECESSIVE
colon polyps, cerebellar medulloblastoma,
GBM
peutz
jeghers
familial
juvenile
polyposis
coli
HNPCC
1. lynch 1
562.
563.
564.
565.
566.
567.
568.
569.
570.
CRC
1. clinical
presentation
2. right sided
clinical pres
3. left sided
clinical pres
4. rectal clinical
pres
what fraction of
CRC patients are
metastatic at
clinical
presentation
20%
CRC
1. tx
2. follow up
non-neoplastic
polyps
adenomatous
polyps
+ histology, size,
typia, and
morphology
Diverticulosis
1. patho
2. clinical pres
3. dx/tx
diverticulosis
1. complications
diverticulitis
1. patho
2. clinical pres
3. complications
4. recurrence rate
what is worse,
rectal cancer, or
colon cancer
571.
572.
573.
574.
575.
576.
what is the
indication for
radiation in CRC
diverticulitis
1. dx
2. tx
angiodysplasia
1. patho +
clinical pres
2. dx/tx
3. key clinical
association
(non-GI)
acute mesenteric
ischemia
1. patho (4)
2. mortality
acute mesenteric
ischemia
1. clinical pres
2. dx/tx
577.
578.
579.
580.
581.
582.
583.
584.
chronic
mesenteric
ischemia
1. patho
2. clinical pres
3. dx/tx
ogilvie's
syndrome
1. patho
2. causes
3 dx/tx
1. SIGNS/SYMPTOMS/RADIOGRAPH
of large bowel obstruction without
mechanical obstruction
2. recent surgery/trauma, serious
medical illness, meds (narcotics,
psychotropics, anticholinergics)
3. diagnosis of exclusion after
mechanical obstruction ruled out
tx = stop offending agents, IV fluids,
electrolyte, decompression with
enemas/NG suction, surgical
decompression (with
cecostomy/colostomy)
diagnostic test of
choice for
diverticulosis vs
diverticulitis
comorbid
condition with
AVM
aortic stenosis
comorbid
conditions with
acute mesenteric
ischemia
clinical
presentation of
acute mesenteric
ischemia
1. embolic
2. arterial
thrombosis
3. nonocclusive
ischemia
4. venous
thrombosis
signs of
intestinal
infarction
when should
colonic
distension be
immediately
decompressed
when the colon diameter exceeds 10cm - RISK FOR RUPTURE AND DEATH
585.
586.
587.
588.
589.
pseudomembranous
colitis (antibiotic
resistant colitis)
1. patho
2. most common abx
associated
3. clinical pres
4. compliations
pseudomembranous
colitis
1. dx/tx
colonic volvulus
1. patho
2. locations
3. risk factors
4. clinical pres
cecal volvulus
pathogenesis
colonic volvulus
1. dx
590.
591.
592.
593.
cirrhosis
1. patho
2. causes
Childs
classification
Childs 1
Childs 2
Childs 3
cirrhosis
1. portal
hypertension
bleeding
complications
+ tx
2. variceal
bleeding
clinical pres
3. variceal
bleeding tx
-rectal
hemorrhoids,
caput
medusae
ascites
1. patho
2. dx
3. tx
594.
595.
596.
597.
hepatic
encephalopathy
1. patho
2. clinical pres
3. tx
hepatorenal
syndrome
1. patho
2. clinical pres
3. tx
classic signs of
chronic liver
disease
treatment of
bleeding
esophageal
varices
variceal ligation/banding
endoscopic sclerotherapy
IV vasopressin
IV octreotide - causes splanchnic
vasoconstriction, reduces portal pressure
esophageal balloon tamponade
TIPS, shunts, liver transplant
598.
599.
600.
601.
602.
603.
ddx of ascites
laboratory
monitoring for
patient with
cirrhosis
compliations of
liver failure
AC9H
ascites, coagulopathy
hypoalbuminemia, hypoglycemia,
hyperammonemia, portal hypertension,
hyperestrinism, hyperbilirubinemia,
hepatic encephalopathy, hepatorenal
syndrome, HCC.
spontaneous
bacterial
peritonitis
1. patho
2. clinical pres
3. dx/tx
1.
hyperestrinism
in liver failure
clinical pres
2.coagulopathy
in liver failure
treatment of
cirrhosis
604.
605.
606.
607.
608.
609.
wilsons disease
1. patho
2. clinical pres
wilsons disease
1. dx/tx
hemochromatosis
1. patho
2. organs effected
3. clincal pres
4. complications
secondary
hemochromatosis
signs of acute
liver failure
coagulopathy
jaundice
hypoglycemia
hepatic encephalopathy
infection
elevated LFTs
hemochromatosis
1. dx/tx
610.
611.
612.
613.
614.
615.
616.
617.
hepatocellular
adenoma
1. patho
2. clinical pres
3. dx/tx
cavernous
hemangioma
1. patho
2. clinical pres
3. dx/tx
focal nodular
hyperplasia
HCC
1.two
pathological
types
2. risk factors
3. clinical pres
paraneoplastic
syndromes
associated
with RCC
erythrocytosis, thrombocytosis,
hypercalcemia, carcinoid syndrome,
hypertrophic pulmonary osteodystrophy,
hypoglycemia, high cholesterol
HCC
1. dx
2. tx
1. liver bx
hep B/C serology, LFTs, coagulation
studies
ultrasound, CT cx/ab/pelvis,
elevated AFP (40-70% of patients)
elevated alk phos
2. tx = liver resection, liver transplantation
most common
malignant liver
tumors
nonalcoholic
steatohepatitis
1. patho + risk
factors
2. dx
618.
619.
620.
621.
622.
623.
624.
gilberts
syndrome
1. patho
2. clinical
pres
3. dx/tx
hemobilia
1.
patho/clincal
pres
polycystic
liver cysts
1. patho
hydatid liver
cysts
1. patho
2. treatment
pyogenic
liver abscess
1. patho
2. clinical
pres
3. dx/tx
1. biliary
obstruction/appendicitis/diverticulitis -->
bacterial proliferation - ecoli, klebsiella,
proteus, enterococcus, anaerobes
2. fever, malaise, anorexia, weight loss,
nausea, vomiting, RUQ pain
3. CT scan, elevated LFTs
tx = IV abx, percutaneous drainage
amebic liver
abscess
1. patho
2. clinical
pres
3. dx/tx
budd chiari
syndrome
1. patho
2. clinical
pres
3. dx/tx
625.
626.
627.
628.
629.
630.
jaundice
1. what level is
clinical observable
2. clinical finding
unique to
conjugated
hyperbilirubinemia
3. sources of
bilirubin
4. clinical findings
unique to
unconjugated
bilirubin
causes of
conjugated
hyperbilirubinemia
1. dec intrahepatic
excretion of
bilirubin
2. extrahepatic
biliary obstruction
causes of
unconjugated
hyperbilirubinemia
1. excess
production of
bilirubin
2. reduced hepatic
uptake of bilirubin
or impaired
conjugation
1. hemolytic anemia
2. gilberts, crigler najjar,
sulfonamides, penicillin, rifampin,
radiocontrast agents, immature conj.
system (physiologic jaundice of
newborn), hepatitis, cirrhosis
clinical
presentation of
cholestasis
jaundice
gray stools, dark urine (conjugated)
pruritus
serum alk phos
elevated cholesterol
skin xanthomas
631.
632.
633.
634.
635.
636.
637.
638.
Aminotransferases
1. which is more
sensitive/specific for
liver damage
2. what condition
does ALT and AST
not rise at same rate
3. mildly elevated
LFTs
4. moderate elevated
LFTs (100s-1000s)
5. severely elevated
LFTs (>10,000)
1. ALT
2. alcoholic liver disease - AST:ALT
2:1
3. chronic viral hepatitis, acute
alcoholic hepatitis
4. acute viral
5. ischema, shock liver,
acetaminophen toxicity, viral
hepatitis
causes of elevated
LFTs in
asymptomatic
patients
alkaline phosphatase
1. what causes very
high elevation
2. if levels are mildly
elevated what should
be the next step
3. what is possibility
if ALP is elevated but
GGT is normal
where is
AST/ALT/ALP found
in the body
at what hemoglobin
level will central
cyanosis be present
tachybradycardia
syndrome
1. patho
2. tx
contraindications to
cardiac stress testing
+ what to do to test
them for CAD
639.
640.
641.
642.
643.
644.
645.
cholelithiasis
1. yellow/green stones\
2. black stones
3. brown stones
cholelithiasis
1. clinical pres
2. complications
3. dx
...
...
646.
647.
648.
649.
650.
651.
652.
acute cholecystitis
1. patho
2. clinical pres
3. dx/tx
signs of biliary
tract obstruction
acalculous
cholecystitis
1. patho
2. tx
complications of
cholecystitis
choledocholithiasis
1. patho
2. dx/tx
1. gallstone in CBD
2. elevated D-bili, ALP,
RUQ ultrasound (only 50% sensitive)
ERCP is gold standard - and
therapeutic
PTC
tx = ERCP with
sphincterotomy/extraction/stent, lapcholecoholithotomy
complications of
choledocholithiasis
cholangitis
1. patho
2. clinical pres
3. dx/tx
1. ERCP/PTC/choledochal
cyst/obstruction --> biliary
stasis/bacterial overgrowth
2. CHARCOT-TRIAD: RUQ pain,
jaundice, fever
REYNOLDS PENTAD - charcot +
septic shock, altered mental status
3. RUQ ultrasound,
hyperbilirubinemia, leukocytosis,
elevated LFTs
PTC (when duct dilated)/ERCP - NOT
DURING ACUTE PHASE
tx = IVF, ABX, monitoring UOP/BP,
after afebrile 48 hours --> ERCP/PRC
653.
654.
655.
656.
657.
658.
complication of
cholangitis
primary sclerosing
cholangitis
1. patho
2. clinical
associations
3. dx/tx
primary biliary
cirrhosis
1. patho
2. clinical pres
3. dx/tx
cholangiocarcinoma
1. patho
2. risk factors
1.adenocarcinoma of
intra/extrahepatic bile ducts -->
prox 1/3 = klatskin tumor, distal
extrahepatic, intrahepatic
2. PSC, UC, choledochal cysts,
clonorchis sinensis (hong kong)
causes of secondary
biliary cirrhosis
choledochal cysts
1. patho
2. clinical pres
3. dx/tx
4. complications
659.
660.
661.
662.
663.
664.
biliary
dyskinesia
1 patho
2. dx/tx
acute
appendicitis
1. patho
2. clinical
pres
3. DX
carcinoid
syndrome
1. patho
2. clincal pres
appendicitis
complications
acute
pancreatitis
1. patho
2. what
viruses
associated
with acute
panc
3. what drugs
associated
with acute
panc
acute
pancreatitis
1. clinical pres
2. dx
665.
666.
667.
668.
669.
670.
ranson's
criteria
1. admission
2. 48 hours
3. mortality %
acute
pancreatitis
1.
complications
2. tx
chronic
pancreatitis
1. patho
2. clinical
pres
3. dx/tx
chronic
pancreatitis
1. tx
complications
of chronic
pancreatitis
pancreatic
cancer
1. risk factors
2. clinical
pres
3. dx
4. tx
671.
672.
673.
674.
675.
676.
GI bleeding
1. upper GI
bleeding causes
2. lower GI
bleeding causes
GI bleeding
1. hematemesis
2. coffee ground
emesis
3. melena
4. hematochezia
- occult blood in
the stool
causes of dark
stools
GI bleeding
1. diagnostic test
for
hematemesis,
hematochezia,
melena, occult
blood
2. dx
3. tx
1. hematemesis/melena - upper GI
endoscopy
hematochezia/occult blood colonoscopy
2. BP, pulse rate, CBC with diff, BUN/Cr,
PT/PTT/INR stool guaiac,
hemoglobin/hematocrit, upper
endoscopy, NG tube (bile but no blood =
not upper GI), colonoscopy,
radionucleotide scan (tagged RBCs),
arteriography (must be during active
bleeding, therapeutic =
embolization/vasopressin)
3. ABCs- Oxygen, 2 large bore IVs, draw
blood hgb/hct/pt/ptt/platelet, monitor
hgb q4-8
type and cross
EGD with coagulation
colonoscopy
normal
hematocrit in
young adult vs.
elderly
indications for
surgery in
patient with GI
bleed
677.
678.
679.
680.
681.
esophageal
cancer
1. risk factors
for SCC
2. risk factors
for adeno
- 5-15% 5 year
prognosis
3. clinical pres
4. dx/tx
achalasia
1. patho
2. causes
3. clinical pres
achalasia
1. dx/tx
what cancer
are patients
with achalasia
at increased
risk for
diffuse
esophageal
spasm
1. patho
2. clinical pres
3. dx/tx
682.
683.
684.
685.
686.
687.
688.
esophageal
hiatal hernias
1. sliding (type
1)
2.
paraesophageal
(type 2)
3. dx/tx
4. type 3
1. gastroesophageal junction/stomach
herniate into thorax associated with
GERD
2. stomach herniates into the thorax, but
NOT GE junction- risk for strangulation
and should be repaired
3. barium upper GI series, upper
endoscopy
tx = type 1 = antacids, small meals,
nissen's fundoplication
type 2 = elective surgery
4. combination of type 1 and 2
mallory weiss
syndrome
1. patho
2. clinical pres
3. dx/tx
plummer
vinson
syndrome
1. patho
2.
complications
3. dx/tx
schatzki's ring
1. patho
2. clinical pres
3. tx
zenker's
diverticula + tx
traction
diverticulum
epiphrenic
diverticulum
689.
690.
691.
692.
693.
694.
boerhaave's
syndrome
1. patho
2. clinical
pres
3. dx/tx
peptic ulcer
disease
1. causes
2. clinical
pres
3. dx/tx
duodenal
ulcers
1. malignant
potential
2. location
3. age
4. associated
blood type
5. clinical
pres
1. low
2. 1-2 cm distal to pylorus (posterior wall)
3. <40
4. O
5. NSAID use, pain that is relieved by food,
nocturnal pain
gastric ulcers
1. malignant
potential
2. location
3. age
4. associated
blood type
5. clinical
pres
1. high - 5-10%
2. type 1 70% on lesser curvature,
type 2 - gastric AND duodenal
type 3 - pre-pyloric
type 4 - near GE junction
3. >40
4. A
5. smokers, eating does not relieve pain
lifestyle
modifications
for PUD
complications
of PUD (3) +
dx/tx
695.
696.
697.
698.
699.
700.
701.
*Gastric outlet
obstructionbarium swallow,
upper endoscopy,
saline load test
(750
injected, after 30
min aspirate
>400ml = + test)
tx = NG suction,
volume
replacement,
surgery
...
...
acute gastritis
1. patho
2. clinical pres
gastric cancer
1. morphologies
2. risk factors
3. clinical pres
1. krukenberg
tumor
2. blumers shelf
3. sister mary
joseph node
4. virchows node
5. irish's node
chronic gastritis
1. patho
2. dxt/tx
autoimmune
gastritis
702.
703.
704.
705.
706.
707.
gastric cancer
1. dx/tx
small bowel
obstruction
SBO
1. three ways
to
differentiate
small bowel
obstruction
2.
patho/clinical
pres
SBO
1. dx/tx
difference in
clinical pres
between
proximal vs
distal SBO
large bowel
obstruction
1. causes
paralytic
ileus
1. patho
2. causes
3. dx
708.
709.
710.
711.
712.
celiac sprue
1 patho
2. dx/tx
crohns disease
1. patho
2. clinical pres
3.
extraintestinal
manifestations
1. chronic flaring/remitting
TRANSMURAL inflammatory disease that
can affect any part of the GI tract, usually
includes terminal ileum, skip lesions,
FISTULAS, STRICTURES, NON
CASEATING GRANULOMAS*, mesenteric
fat wrapping
2. diarrhea, malabsorption/weight loss,
abdominal pain, n/v, fever, malaise
3. uveitis, arthritis, ank spondy (C<UC),
erythema nodosum (C>UC), pyoderma
gangrenosum (C<UC), aphthous oral
ulcers, cholelithiasis, nephrolithiasis
epidemiology
of IBD
crohns disease
1.
complications
2. dx/tx
ulcerative
colitis
1. patho
2. clinical pres
3. dx/tx
713.
714.
715.
716.
717.
718.
ulcerative
colitis
4. extra
intestinal
manifestations
/ complications
graves disease
1. dx
graves disease
(80% of
hyperthyroid)
1. patho
2. clinical pres
plummer's
disease (15% of
hyperthyroid)
1. patho
2. clinical pres
3. dx
toxic thyroid
adenoma
1. hashimotos
thyroiditis
2. de quervain's
(subacute,
granulomatous)
thyroiditis
1. transient hyperthyroid,
multinodularity,
2. exquisitely tender diffusely enlarged
gland after/during viral illness
719.
720.
721.
722.
723.
724.
postpartum
thyroiditis
iodine induced
hyperthyroidism
iatrogenic
hyperthyroidism
...
causes of
elevated TBG
hyperthyroidism
tx
thionamides - methimazole (men/nonchild age women), PTU (for pregnant dec. conversion of T4-T3) - SE =
agranulocytosis (MONITOR
LEUKOCYTES)
iopanoic acid - dec. thyroid hormone
release from thyroid gland
beta blockers - for symptoms (tachy,
sweating, weakness)
sodium ipodate - rapid improvement for
medically refractory hyperthyroidism
I-131 ablation of thyroid follicular cells repeat after 6-12 months if initially
unsuccessful- (can cause temporary
worsening)
subtotal thyroidectomy - SE- recur hyper,
hypothyroidsm
graves disease
treatment
graves treatment
in pregnant
women
thyroid storm
1. patho
2. tx
725.
726.
727.
728.
729.
730.
hypothyroidism
1. causes
2. clinical pres
1. hashimoto's (autoimmune),
iatrogenic- radioiodine, thyroidectomy,
mediations, secondary/tertiary
hypothyroidism (low T4/T3 and low
TSH)
2. fatigue, weakness, heavy menstrual
periods*, weight gain, cold intolerance,
dull expression, muscle
weakness/rhabdomyolysis, arthralgias,
depression, dry skin, coarse hair,
hoarseness, non-pitting edema
(myxedema), dec. DTRs, bradycardia,
goiter
associated
conditions with
hashimotos
thyroiditis
myxedema
coma + tx
hypothyroidism
1. dx
2. tx
subacute
thyroiditis
(granuomatous)
1. patho
2. clinical pres
3. dx/tx
subacute
lymphocytic
thyroiditis
1 .patho
2. clinical pres
3. dx
731.
732.
733.
734.
735.
736.
737.
chronic
lymphocytic
thyroiditis
1. patho
2. clinical pres
3. dx/tx
1. hashimoto's/lymphocytic
2. goiter, slow decline in thyroid function
3. antiperoxidase, antithyroglobulin
antibodies
irregular distribution of I-131 not
required for diagnosis
tx = thyroid hormone replacement
thyroid
associated
ophthalmopathy
fibrous
thyroiditis
1. patho
2. tx
thyroid nodules
1. what fraction
are cancerous
2. features of
malignant
nodule
3. diagnosis
1. 4-10%
2. nodule is fixed, no movement with
swallowing
solitary, history of neck radiation, history
of rapid development, vocal cord
paralysis, cervical adenopathy
3. Ultrasound guided FNA (reliable for
all cancers except follicular)
thyroid scan (radioactive iodine) - cold or
hot
thyroid ultrasound - diff between solid
and cystic
head/neck radiation
gardner's syndrome/cowden's syndrome
(papillary cancer)
MEN type 2 - medullary thyroid cancer
papillary
thyroid cancer
(most common)
1. risk factor
2. pattern of
mets
3. dx
follicular
carcinoma
1. pattern of
mets
2. risk factor
3. dx
4. hurthle cell
carcinoma
1. hematogenous spread*** to
brain/lung/bone/liver, 20% of pts have
distant mets
2. iodine deficiency
3. tissue sample because need to see
extension past fibrous capsule
4. abundant cytoplasm, tightly packed
mitochondria, oval nuclei with
prominent nucleoli - radioiodine
resistant
738.
739.
740.
741.
742.
743.
744.
medullary
carcinoma of the
thyroid
1. risk factors +
patho
2. dx
anaplastic
carcinoma
1. risk factors +
patho
longstanding follicular/papillary
thyroid carcinoma - death within a
few months- metastasis is by direct
extension
thyroid cancer
treatment
1. papillary
2. follicular
carcinoma
3. medullary
carcinoma
4. anaplastic
1. what fraction of
cold nodules are
malignant
1. 20%
- thus a cold nodule on thyroid scan
does not tell very much about the
mass, however a warm nodule
greatly reduces risk of malignancy
pituitary adenomas
1. what hormonal
abnormalities
2. other nonhormonal clinical
clues
3. dx/tx
1. inc. prolactin/GH/ACTH/TSH, or
hypopituitarism from compression of
the causes hypopituitarism
2. headache, bitemporal
hemianopsia (compression of the
optic chiasm)
3. MRI, pituitary hormone levels
tx = transsphenoidal resection,
radiation/medical therpy
hyperprolactinemia
1. causes
2. clinical pres in
men
3. clinical pres in
females
1. prolactinoma (MCC),
antipsychotics, H2 blockers,
metoclopramide (DA antagonist),
verapamil, estrogen, pregnancy,
renal failure, hypothalamic lesions,
hypothyroidism, idiopathic
2. hypogonadism, dec. libido,
infertility, impotence, galactorrhea,
gynecomastia, parasellar signs
3. menstrual irregularities,
amenorrhea (prolactin inhibits
GnRH release and thus LH/FSH),
vaginal dryness,
hyperprolactinemia
1. dx
2. tx
745.
746.
747.
748.
749.
750.
acromegaly
1. patho
2. clinical pres
acromegaly
1. dx
2. tx
craniopharyngioma
1. patho
2. clinical
presentation
causes of
hypopituitarism
top ddx of
polyuria/polydipsia
cause of central DI
cause of
nephrogenic DI
751.
752.
753.
diabetes
insipidus
1. clinical
pres
2. dx
3. tx
SIADH
1. patho
2. clinical
pres
SIADH
1. dx
2. tx
1. hyponatremia,
serum hypoosmolality
inappropriately elevated urine osmolality
low serum uric acid (hemodilution)
low BUN/Cr (diluted)
normal thyroid/adrenal
plasma/urine ADH level
2. underlying issue
water restriction, normal saline
lithium or demeclocycline (ADH blocker)
if symptomatic - restrict water intake, give
isotonic saline, hypertonic saline in severe cases
**DO NOT CORRECT FASTER THAN
0.5mEq/L/hour
754.
755.
756.
757.
hypoparathyroidism
1. causes
2. dx/tx
primary
hyperparathyroidism
1. patho
2. clinical pres
3. dx
4. radiographic dx
1. adenoma*, hyperplasia,
carcinoma (<1%) -->
parathyroids making too
much PTH
2. nephrolithiasis, bone
aches/pains, osteitis
fibrosa cystica (brown
tumors), muscle pains,
pancreatitis, PUD, gout,
constipation, depression,
fatigue, anorexia, sleep
disturbances, anxiety,
lethargy, nephrolithiasis
3. serum calcium/albumin,
PTH, hypophosphatemia,
hypercalciuria, elevated
urine cAMP, Cl:phos ratio
>33:1***
4. subperiosteal bone
resorption at radial aspect
of 2nd/3rd phalanges
primary
hyperparathyroidism
1. tx
pseudohypoparathyroidism
758.
759.
760.
761.
762.
secondary
hyperparathyroidism
1. patho
cushing syndrome
1. causes
2. clinical pres
effects of cortisol
Cushing syndrome
1. dx
response to low
dex/high dex/CRH :
1. healthy
2. Cushing disease
3. adrenal tumor
4. ectopic ACTH
1. suppress/suppress/mild increase
2. no suppress/suppress/LARGE
INCREASE
3. no suppress/suppress/NO
CHANGE
4. no suppress/no suppress/NO
CHANGE
763.
764.
765.
766.
767.
Cushing syndrome
tx
pheochromocytoma
1. patho
2. clinical pres
3. lab findings
during a paroxysm
pheochromocytoma
1. dx
2. tx
pheochromocytoma
rule of 10s
10% are...
familial, bilateral (MEN II), multiple,
pediatric, extra adrenal (organ of
zuckerkandl)
primary
hyperaldosteronism
1. patho
2. clinical pres
1. conns syndrome/adrenal
hyperplasia/adrenal carcinoma
excessive aldosterone production
independent of RAAS --> inc. Na/K
pump activity in cortical collecting
ducts--> sodium
retention/HTN/hypokalemia/met.alk*
2. HTN, headache, fatigue, weakness,
polydipsia, nocturnal polyuria, no
peripheral edema
768.
769.
770.
771.
primary
hyperaldosteronism
1. dx
2. tx
1. MEN type 1
2. MEN IIA
3.MEN IIB
adrenal
incidentaloma
adrenal
insuficiency
1. primary causes
2. secondary causes
3. tertiary adrenal
insufficiency
772.
773.
774.
775.
adrenal
insufficinecy
1. clinical
pres
2. dx
3. tx
congenital
adrenal
hyperplasia
1. patho
2. clinical
pres (male
vs female)
3. salt
wasting
form clinical
pres1
1. AUTOSOMAL RECESSIVE 21
HYDROXYLASE (90%) DEFICIENCY/11
HYDROXYLASE DEFICIENCY--> dec
cortisol/aldosterone production and inc.
ACTH secretion + shunting of intermediates
toward DHEA and testosterone
2. female - ambiguous genetalia but normal
ovaries/uterus
male - no genital abnormalities
3. emesis, dehydration, hypotension, shock
in first 2-4 weeks of life total lack of aldo
activity --> hyponatremia/hyperkalemia,
hypoglycemia
congenital
adrenal
hyperplasia
1. dx
1. 17 hydroxyprogesterone elevated
2. cortisol and mineralocorticoid
surgery - early correction of female genital
abnormalities
diabetes
mellitus
1. patho type
1
2. patho type
2
776.
777.
778.
779.
780.
781.
1. dawn
phenomenon
2. somogyi
effect
3. how to
diagnose/treat
for the above
diabetes
mellitus dx
diabetes
mellitus
1. screening
impaired
glucose
tolerance dx
diabetes
mellitus sx
diabetes
maintenance
1. patient
monitoring
...
782.
783.
784.
785.
stage 1 - genetic
susceptibility
stage 2 - autoimmune
beta cell destruction
stage 3 - continuded
beta cell destruction
and dec. insulin
release, glucose
normal
stage 4 - insulin
dependent C-peptide is
present
stage 5 - no C - peptide
present
side effects
1. sulfonylureas
2. metformin
3. acarbose
4. TZD (rosiglitazone,
pioglitizone)
- pramlintide, repaglinide,
nateglinide
1. hypoglycemia,
weight gain
2. GI upset, n/v,
abdominal pain, lactic
acidosis, metallic taste
3. GI upset (diarrhea,
cramping flatulence)
4. hepatotoxicity monitor LFTs
mechanism
1. sulfonylureas
2. metformin
3. acarbose
4. TZD (rosiglitazone,
pioglitizone)
1. stimulates pancreas
to make more insulin
2. enhances insulin
sensitivity, dec.
gluconeogenesis in the
liver
3. reduces glucose
absorption from the GI
tract
4. reduces fat/muscle
insulin resistance
786.
787.
788.
789.
790.
791.
advantages
1. sulfonylureas
2. metformin
3. acarbose
4. TZD (rosiglitazone,
pioglitazone)
1. cheap
2. mild weight loss
3. low risk, non-toxic
kg * 0.5 units/kg =
units/day
2/3 morning (all
70/30) or 2/3 NPH,
1/3 regular
1/3 evening (all
70/30) or 2/3 NPH,
1/3 regular
severe hyperglycemia
and type 1 patients >240 use insulin
oral hypoglycemia for
type 2 with moderate
hyperglycemia 110240
onset/duration
1. human insulin lispro
2. regular insulin
3. NPH insulin/lente insulin
4. ultralente insulin
5. 70/30 mixture
6. glargine (lantus)
1. 15 min/4hr
2. 30-60 min/4-6hr
(only insulin given
IV)
3. 2-4 hr/10-18 hr
4. 6-10 hr/18-24 hr
5. 30min/10-16 hr
6. 3-4hr/24hr (@
bedtime)
1. total number of SSI
regular insulin on
day 1 divide into 2/3
morning 70/30 and
1/3 evening 70/30
2. normal insulin
dosing - to avoid
DKA
3. 1/3-1/2 of usual
daily insulin
requirement
1. accelerated
atherosclerosis in
diabetics, 2-4x risk of
CAD, MCC death in
diabetics is CAD
2. CAD, PVD (60%),
cerebrovascular
disease
3. diabetic
nephropathy,
diabetic retinopathy,
diabetic neuropathy
792.
793.
794.
795.
796.
797.
diabetic
nephropathy
1. pathology
2. dx
3. tx
progression of
diabetic
nephropathy
what drugs if
patient has HTN
and
microalbuminuria
ACE inhibitors or
ARB
...
diabetic
retinopathy
1. frequency
2. background
3. proliferative
4. other ocular
problems
diabetic
neuropathy
1. peripheral
neuropathy
clinical pres
2. peripheral
neuropathy
treatment
3. CN abnormalties
diabetic
neuropathy
1.
mononeuropathies
2. autonomic
neuropathy
798.
799.
800.
801.
802.
803.
does diabetic
control help
micro or
macrovascular
disease
diabetic foot
1. patho
diabetic
infections
1. which
infections
treatment of
diabetic
complications
1.
macrovascular
disease
2.
nephropathy
3. retinopathy
4. neuropathy
5. diabetic foot
DKA
1. patho
2. causes
3. clinical pres
DKA
1. dx
804.
805.
806.
807.
808.
809.
810.
DKA
1. tx
DKA ddx
alcoholic ketoacidosis
hyperosmolar hyperglycemic nonketotic
syndrome
hypoglycemia
sepsis
intoxication - MUDPILES
lab orders
when a patient
presents with
suspected DKA
DKA
complications
hyperosmolar
hyperglycemic
nonketotic
syndrome
1. patho
2. clinical pres
3. dx
hyperosmolar
hyperglycemic
nonketotic
1. tx
physiologic
response to low
blood glucose
@ 80 insulin decreases
lower than 80 glucagon increases
epinephrine/cortisol are next hormone
@ 50s symptoms of hypoglycemia occur
811.
812.
813.
814.
815.
816.
hypoglycemia
1. why is
brain so
sensitive to
hypoglycemia'
2. causes
hypogycemia
1. clinical
pres
2. dx
3. tx
hypoglycemic
unawareness
1. patho
insulinoma
1. patho
how to
distinguish
between
sulfonylurea
abuse and
insulinoma
BOTH have
inc. insulin,
dec. glucose,
and inc. cpeptide levels
...
817.
818.
819.
820.
821.
822.
823.
glucagonoma
1. patho
2. clinical pres
necrotizing migratory
erythema, glossitis,
stomatitis, hyperglycemia,
with low amino acids, high
glucagon
tx = surgical resection
...
somatostatinoma
1. clinical pres
824.
825.
826.
827.
828.
TIA
1. patho
2. clinical pres
3. future risk
after TIA
4. risk factors
1. embolic, hypotension, carotid stenosis -> blockage of blood flow does not last
long enough to cause permanent
infarction
2.max 24 hours, usually less than 30
mins, but indistinguishable from a stroke
at time of presentation
3. 30% 5 year stroke risk
4. age, HTN, smoking, afib, HLD,
hypercoagulability, vasoconstrictive drugs
(cocaine/amphetamines), polycythemia
vera, sickle cell
ischemic
stroke
1. sources of
emboli
2. thrombotic
stroke
locations
3. lacunar
stroke
source of
embolic stroke
evaluation
1. echocardiogram
carotid doppler
ECG/Holter monitor
symptoms of
TIA
1. carotid
system TIA
2.
vertebrobasilar
TIA
3.
subclavian
steal syndrome
829.
830.
831.
832.
833.
834.
thrombotic stroke
1. clinical pres
2. MCA clinical
pres
3. lacunar stroke
clinical pres
4. anterior
cerebral artery
causes of carotid
bruit
stroke
1. dx / workup
2. complications
stroke
1. treatment
contraindications
to tPA
stroke
1. prevention
835.
836.
837.
838.
839.
840.
intracerebral
hemorrhage
1.
causes/patho
2. clinical
pres
3. dx
4. tx
1.
complications
of
hemorrhagic
stroke
2. brain
complications
associated
with cocaine
use
pupillary
findings in
intracerebral
hemorrhage
pinpoint - pons
poorly reactive pupils - thalamus
dilated pupils - putamen
subarachnoid
hemorrhage
1.
causes/patho
2. anatomic
locations
3. clinical
pres
subarachnoid
hemorrhage
1. dx/tx
1. non-contrast CT scan
lumbar puncture if CT scan is inconclusive-see blood in SAF, and xanthochromia from
RBC lysis
tx = neurosurgery,
reduce risk of rebleeding, stool softeners,
analgesia, HTN, lower BP gradually (to
account for possible decreased CPP), CCB
for vasospasm
SAH
complications
841.
842.
843.
844.
845.
parkinsons
disease
1. pathophys
2. clinical
pres
3. pathologic
finding
shy drager
syndrome
1.
patho/clincal
pres
2. tx
parkinson
syndrome
1. treatment
1. no cure
carbidopa-levodopa (Sinemet) relieves
symptoms - shows "on-off" phenomenon
bromocriptine, pramipexole (dopamine
agonists)
selegiline - MAOI ~ L-dopa adjunctive agent
amantadine - for early or mild disease
anticholinergic drugs - trihexyphenidyl
benztropine *best for tremor/rigidity
dominant disease
amitriptyline - both anticholinergic and
antidepressant
DBS for patients that don't respond
medications or develop disease before age 40
what drugs
cause
parkinsonian
side effects
huntington's
chorea
1. patho
2. clinical
pres
846.
847.
848.
849.
850.
huntingtons chorea
1. dx/tx
physiologic tremor
1. causes
essential tremor
1. patho
2. clinical pres
3. tx
different tremors
clinical
pres/associated
symptoms
1. parkinsonian
2. cerebellar
3. essential tremor
ataxia
1. causes
(acquired/inherited)
friedreich's ataxia
1. patho/clinical pres
852.
853.
854.
855.
856.
857.
858.
859.
860.
851.
ataxia
telangiectasia
1. patho/clinical
pres
tourettes
syndrome
1. patho
2. clinical pres
3. tx
dementia
1. diagnostic
criteria
2. vascular
dementia
3. binswanger's
disease
primary causes
of dementia
infectious
causes of
dementia
metabolic
causes of
dementia
what toxins
cause dementia
pseudodementia
1. dementia lab
workup
2. dementia
pharmacologic
treatment
861.
862.
863.
864.
865.
866.
alzheimers
disease
1. risk factors
2. pathology
findings
3. dx/tx
alzheimers
disease
1. clinical pres
lewy body
dementia
1. clinical pres
2. tx
altered mental
status
1. what part of
the brain is
responsible for
arousal
2. what part of
the brain is
responsible for
cognition
1. RAC in brainstem
2. cerebral cortex
causes of
delirium
P.DIMMWIT
postoperative, dehydration/malnutrition,
infection, medications, metals,
withdrawal stages, inflammation/fever,
trauma/burns
867.
868.
869.
delirium
1. clinical
pres
2. dx/tx
ddx for
coma/stupor
SMASHED
structural brain pathology - stroke,
subdural/epidural, tumor, abscess,
herniation
meningitis, mental illness
alcohol, acidosis
seizures, substrate deficiency (thiamine)
hypercapnia, hyperglycemia, hyperthermia,
hyponatremia hypoglycemia, hypoxia
endocrine - addisonian crisis, thyrotoxicosis,
hypothyroidism, encephalitis (uremia)
drugs - opiates, barbiturates, benzos,
dangerous compounds - monoxide, cyanide,
methanol
coma
1. criteria
2. causes
3. diagnosis
870.
871.
872.
873.
coma
1.
treatment
2 brain
death
3.
persistent
vegetative
state
multiple
sclerosis
1. patho
2. clinical
pres
multiple
sclerosis
1. dx
multiple
sclerosis
1. clinical
course
874.
875.
876.
877.
878.
multiple
sclerosis
1. tx
locked in
syndrome
1. clinical
pres
2. patho
guillain
barre
syndrome
1. patho
2. clinical
pres
guillain
barre
1. dx/tx
myasthenia
gravis
1. patho
2. clinical
pres
3.
myasthenic
crisis + tx
1. autoimmune disorder against nicotinic AchR, results in muscle fatigue especially rapidly
stimulated muscles
2. skeletal muscle weakness exacerbated by
use, involves cranial nerves
first symptoms often diplopia, ptosis, blurred
vision, dysarthria, dysphagia
3. infection or stressor -->
diaphragm/intercostal fatigue results in
respiratory failure
ET tube + withdrawl anticholinesterases +
plasmapheresis
879.
880.
881.
882.
883.
884.
myasthenia gravis
1. dx
duchenne's
muscular
dystrophy
1. patho
2. clinical pres
3. dx/tx
Becker's muscular
dystrophy
what drugs
exacerbate
myasthenia gravis
aminoglycosides, tetracyclines
beta blockers
quinidine, procainamide, lidocaine
neurofibromatosis
type 1
1. patho/clinical
pres
2. complications
1. AUTOSOMAL DOMINANT
DISEASE NF1 - cafe au lait spots,
macrocephaly, short stature, learning
disabilities neurofibromas, CNS
tumors (gliomas, meningiomas),
axillary or inguinal freckling, iris
hamartomas (lisch nodules), bony
lesions
2. scoliosis, disfiguring
neurofibromas, scoliosis, optic nerve
gliomas*, renal artery stenosis,
neurofibromatosis
type 2
1. patho/clinical
pres
2. complications
885.
886.
887.
888.
889.
890.
891.
892.
893.
tuberous
sclerosis
1.
patho/clinal
pres
sturge weber
1.
patho/clinical
pres
von-hippel
lindau
disease
1.
patho/clinical
pres
syringomyelia
1.
patho/clinical
pres
2. associated
conditions
brown
sequard
syndrome
1. patho
transverse
myelitis
1.
patho/clinical
pres
horners
syndrom
1.
patho/clinical
pres
2. causes
poliomyelitis
1. patho
2. tx
dizziness
1. causes
2. dx
894.
895.
896.
897.
898.
899.
1. central vertigo
2. peripheral
vertigo
peripheral vertigo
1. benign positional
vertigo + tx
2. menieres
disease + tx
peripheral vertigo
1. acute
labyrinthitis
2. ototoxic drugs
3. acoustic
neuromas
central vertigo
1. casues
syncope
1. definition
2. cardiac syncope
clinical pres
3. vasovagal
syncope
(neurocardiogenic,
vasodepressor,
simple faints) + dx
+ tx
1. transient loss of
consciousness/postural tone
secondary to decreased cerebral blood
flow + rapid recovery of consciousness
without resuscitation
2. sudden without prodrome - face hits
floor- from arrhythmias, aortic
stenosis, HCM, pulmonary HTN,
prolapsed mitral valve, massive MI
3. MCC syncope - emotional stress,
fear, fatigue, diagnose with the *TILT
TABLE STUDY - patient will have
symptoms when upright or standing,
but not when supine
tx = supine posture, elevate legs, Bblockers, disopyramide
syncope
1. orthostatic
hypotension +
dx/tx
- also consider
vertebrobasilar
TIA, hypoglycemia,
hyperventilation,
hypovolemia,
900.
901.
902.
903.
904.
905.
906.
what must be
considered if
patient has syncope
on exertion
seizures vs.
syncope
evaluation of
syncope
seizure
1. definition
2. epilepsy
definition
3. causes
witness account
baseline, anticonvulsants, recent
dose changes, seizure disorder
examine for head inj, spine fractures,
tongue lacerations, bowel/bladder,
papilledema/signs of inc. ICP
do complete neuro exam
1. pseudoseizures
2. which drugs
(intoxications) can
cause seizures
3. what infections
can cause seizures
4. what ischemic
events can cause
seizures
-inc. ICP (4 Ms and
4 Is)
treatment for
eclampsic seizure
magnesium infusion
907.
908.
909.
910.
911.
epilepsy
1. partial
seizure
2. simple
partial
seizure
3. complex
partial
seizure
4. gneralized
sizure
epilepsy
1. tonic clonic
2. absence
^ both of the
above are
generalized
seizures
epilepsy
1. dx
epilepsy tx
seizure risk
of recurrence
with normal
EEG vs
abnormal
EEG
912.
913.
914.
915.
916.
status
epiliepticus
Amyotrophic
lateral
sclerosis
1. patho
2. clincal
pres
Amyotrophic
lateral
sclerosis
1. dxt/tx
epilepsy
1. tx
aphasia
1. definition
2. patho
917.
918.
919.
920.
921.
922.
923.
aphasia
1. wernicke's
aphasia
2. brocas
aphasia
3. conduction
aphasia
4. global
aphasia
EMG/NCV
findings
1. lower motor
neuron
disease
2. myasthenia
gravis
3. myopathy
bells palsy
1.
causes/patho
2. dx
3. tx
trigeminal
neuralgia (tic
douloureux)
1.
patho/clinical
pres
2. dx/tx
cerebral
cortex lesions
clinical pres
(localization)
subcortical
lesions
clinical pres
(localization)
cerebellar
lesion clinical
pres
(localization)
924.
925.
926.
927.
928.
929.
930.
brainstem
clinical pres
(localization)
spinal cord
clinical pres
(localization)
plexopathy
clinical pres
(localization)
radiculopathy
clinical pres
(localization)
peripheral
neuropathy
clinical pres
(localization)
neuromuscular
junction
clinical pres
(localization)
myopathy
clinical pres
(localization)
931.
932.
933.
934.
935.
systemic lupus
erythematosus
1. patho
2. subtypes of
lupus
3. clinical pres
1. genetic/environ/hormonal -->
autoantibodies, deposition of immune
complexes, complement activation, tissue
destruction/vasculitis --> damage to
multiple organ systems
2. spontaneous, discoid, drug induced,
ANA negative
3. fatigue, malaise, fever, weight loss
butterfly rash, photosensitivity, discoid
lesions, alopecia, raynauds, joint pain,
arthritis (symmetric inflammatory),
myalgia, pericarditis**, libman sachs
endocarditis, myocarditis
pleuritis*, pleural effusion
hemolytic anemia,
leukopenia,lymphopenia,
thrombocytopenia
proteinuria >0.5g/day, azotemia,
glomerulonephritis, pyuria
impaired immune response
n/v, dyspepsia, dysphagia PUD
seizures, psychosis, depression,
headaches, TIA, CVA
conjunctivitis, raynauds, sjogrens
syndrome
ANA negative
lupus
1. clinical pres
2. dx
3. neonatal
lupus clinical
pres
systemic lupus
erythematosus
1. dx
4 or more:
mucocutaneous signs - rash, photosens,
oral or nasopharyngeal ulcers, discoid
rash,
arthritis, pericarditis, pleuritis, hemolytic
anemia, leukopenia, thrombocytopenia,
proteinuria,
seizures, psychosis, VDRL positive
positive ANA screening
anti-dsDNA (correlates with disease
activity), anti-Sm, anti-histone esp. in drug
induced lupus,
anti-Ro(SS-a), anti-La(SS-B) assc. with
sjogrens, subacute cutaneous SLE,
neonatal lupus
CBC, bun/Cr,
urinalysis,
serum
electrolytes
...
conditions
with elevated
ANA
936.
937.
938.
939.
940.
941.
1. C-anca
2. P-anca
3. lupus
anticoagulant
4. anti-Ro,
anti-La
5. ESR/CRP
1. wegeners granulomatosis
2. polyarteritis nodosa
3. antiphospholipid
4. sjogrens, subacute cutaneous SLE,
complement deficiency (C2/C4), ANA
negative lupus
5. infection, malig, rheumatologic disease,
tissue necrosis, preg, vasculitis,
pancreatitis
systemic lupus
erythematosus
1. tx
scleroderma
(systemic
sclerosis)
1. patho
2. clinical pres
drug induced
lupus
1. patho
2. what drugs
3. dx
scleroderma
1. dx/tx
CREST
syndrome
942.
943.
944.
945.
946.
947.
what
distinguishes
CREST from
diffuse
scleroderma
antiphospholipid
syndrome
1. patho
2. clincal pres
3. dx/tx
sjogrens
syndrome
1. patho
2. primary
sjogrens
3. secondary
sjogren's
sjogrens disease
1. dx
2. tx
mixed connective
tissue disease
1. patho
2. dx
948.
949.
rheumatoid
arthritis
1. patho
2. clinical pres
3.
extraarticular
manifestations
rheumatoid
arthritis
1. skin
2. pulm
3. cardiac
4. ocular
5. nervous
system
6. felty's
syndrome
7. blood
8. vasculitis
950.
951.
952.
rheumatoid arthritis
1. poor prognostic indicators
2. dx
3. tx
Gout
1. causes/patho
1. insidious/weight bearing
joints/no inflam/narrowed joint
space, osteophytes, subchondral
sclerosis/subchondral cysts
2. insidious/PIP, MIP, wrists,
ankles, knees, ulnar deviation,
swan neck deformity, boutonniere
deformity/yes inflam/narrowed
joint space, bony EROSIONS/inc.
ESR, RF, anemia/extra-articular
findings
3. sudden/great toe, knees, ankles,
elbows/Yes inflamm/punched out
erosions with rim of cortical
bone/crystals/tophi,nephrolithiasis
1. asymptomatic, 40-60 years old,
initial attack typically one joint,
often first MTP (podagra), pain,
erythema, warmth, desquamation
of overlying skin, 60% have second
attack within one year,
2. >10-20 years, tophiaggregations of urate crystals
surrounded by giant cells 2/2
multiple gout attacks- located: ext.
surface of forearm, elbow, knees,
achilles tendons, pinna of ear
joint aspiration- needle shaped
negatively birefringent urate
crystals
serum uric acid - NOT helpful can
be normal
XR - punched out erosions with
cortical bone
tx= lifestyle modification (low
purine diet), early bed rest ,
NSAIDs* (indomethacin),
colchicine (contraindicated in
renal insufficiency or stones*
/cytopenia)
7-10 day oral prednisone if no
response to NSAID/colchicine, or
intra-articular injection
prophylaxis - >2 attacks
probenecid/sulfinpyrazone (if urine
urate is <800mg/day) or
allopurinol (if >800mg/day) +
colchicine/NSAID for 6 months to
prevent another attack (SE = SJS)
956.
957.
958.
959.
960.
961.
962.
pseudogout
1. patho
2. clinical pres
3. dx/tx
1.
963. inflammatory myopathy
age/hemochromatosis/hyper (polymyositis/dermatomyositis)
PTH/hypothyroid/Bartter's 1. dx
syn--> calcium pyrophosphate 2. tx + monitoring
crystals in joints, inc. with
age,
2. knees***/wrists, can be
mono or polyarticular, fever,
leukocytosis
3. joint aspirate weakly
positively birefringent rod
shaped and rhomboid crystals
(CPP crystals)
XR CHONDROCALCINOSIS**
tx= underlying cause,
NSAIDs/colchicine, intra
articular steroid injections*
1. common in elderly
(M>F), proximal AND
distal muscle
weakness, loss of
DTRs
2. elevation in CK,
absence of
autoantibodies,
tx = treatment
refractory
nephrolithiasis, tophaceous
gout, degenerative arthritis
idiopathic inflammatory
myopathy
(polymyositis/dermatomyositis)
1. diseases
2. childhood onset
dermatomyositis key clinical
inflammatory myopathy
(polymyositis/dermatomyositis)
1. common clinical pres
2. dermatomyositis unique
features
1. autoimmune (HLADR4)
2. hip/shoulder muscle
pain after a period of
inactivity, pain with
movement, but
strength is normal.
constitutional
symptoms - malaise,
fever, depression,
weight loss, fatigue
joint swelling of knees,
wrists, hands
signs/symptoms of
temporal arteritis
3. elevated ESR
correlates with disease
activity
tx = corticosteroids
966.
967.
968.
969.
970.
fibromyalgia
1. clinical pres
2. dx
3. tx
ankylosing
spondylitis
1. patho
2. clinical pres
3. dx/tx
causes of
monoarticular
joint pain
2. causes of
polyarticular
joint pain
reactive
arthritis
1. patho
2. clinical pres
3. dx
ankylosing
spondylitis
1.
complications
971.
972.
973.
974.
975.
psoriatic
arthritis
1. clinical pres
temporal
arteritis
1. patho
2. clinical
pres
3.comorbid
conditions
4. dx/tx
takayasu's
arteritis
1. patho
2. clinical
pres
3. tx
4.
complications
vasculitis by
vessel size
1. large vessel
2. medium
vessel
1. takayasu's, temporal
2. PAN, kawasaki's disease, wegener's
granulomatosis, churg-strauss microscopic
polyangiitis
3. henoch schonlein purpura,
hypersensitivity virus, behcets syndrome
churg strauss
1. patho
2. clinical
pres
3. dx/tx
Medicine 2_1
Study online at quizlet.com/_14lxem
1.
2.
3.
4.
5.
wegeners
granulomatosis
1. patho
2. clinical pres
3. dx/tx
polyarteritis
nodosa (PAN)
1. patho
2. clinical pres
3. dx/tx
behcets
syndrome
1. patho
2. clinical pres
3. dx/tx
buergers
disease
1. patho
2. clinical pres
3. tx
hypersensitivity
vasculitis
1. patho
2. clinical pres
3. dx/tx
6.
7.
8.
9.
10.
11.
12.
RIFLE criteria of
AKI
1. risk
2. injury
3. failure
4. loss
5. ESRD
three possible
locations of AKI
what causes
azotemia
pre-renal failure
1. patho
2. causes
3. what drugs
should be avoided
in patients with
prerenal failure
monitoring patient
with AKI
urine
osmolarity/urine
Na/FeNa/urine
sediment
1. pre-renal
2. ATN
13.
14.
15.
16.
17.
18.
19.
20.
pre-renal
failure
1. clinical pres
2. dx
intrinsic renal
failure
1. patho
2. clinical pres
3. lab findings
rhabdomyolysis
1. patho
2. lab findings
ATN
1 . two types of
ATN
2. nephrotoxic
agents
ATN
1. phases
palpation of bladder
ultrasound of kidney/bladder- residual
volume, hydronephrosis, obstruction
catheter insertion - voids large urine
volume
AKI
1. Blood labs to
order
2. UA findings
3. how to rule
out post-renal
failure
21.
22.
23.
24.
25.
26.
UA : urine
sediment/protein/blood
1. pre-renal failure
2. ATN
3. acute
glomerulonephritis
4. acute interstitial
nephritis
5. post renal
1. few hyaline
casts/negative/negative
2. muddy brown casts, renal
tubular cells/trace/negative
3. dysmorphic RBCs, RBCs with
casts, WBCs with casts, fatty
casts/4+ protein/3+ blood*
4. RBCs, WBCs, eosinophils/1+
protein/2+ blood
5. +/RBC+WBC/negative/negative
AKI
4. urine chemistry
5. FENa
6. imaging
AKI
1. volume complications
+ tx
2. metabolic
complciations
3. fatal complications
what is the
pathogenesis of AKI
related infection/sepsis
1. intrinsic AKI tx
2. post renal AKI tx
27.
28.
29.
30.
31.
32.
33.
CKD
1. definition
2. MCC
3. how to measure
CKD
CKD
1. clinical
presentation (CV,
GI, neuro)
radiographic
contract induced
ATN pathogenesis
azotemia vs uremia
chronic renal
insufficiency
CKD
1. hematologic
effects
2.
endocrine/metabolic
effects
3. sexual effects
-also pruritus
CKD
1. dx
2. radiologic dx`
34.
35.
36.
37.
38.
39.
CKD
1. tx
CKD
1. how to correct the
hyperphosphatemia
2. hypo to correct
hypo D3 and
acidosis
3. """ anemia
4. """" pulmonary
edema
5. """" pruritis
1. indicates for
emergent
hemodialysis
AEIOU
Acidosis - intractable metabolic
acidosis
electrolytes - hyperkalemia (refractor
to other treatments)
I - intoxications: methanol, ethylene
glycol, lithium, aspirin, magnesium
containing laxatives
O - hypervolemia
U - severe based on clinical
presentation, uremic pericarditis,
uremic encephalopathy
vascular access in
dialysis
1. disadvantages of
hemodialysis
2. disadvantages of
peritoneal dialysis
1. complications of
dialysis
40.
41.
42.
43.
proteinuria
1. definition
2. glomerular
proteinuria
3. tubular
proteinuria
4. overflow
proteinuria
nephrotic syndrome
1. key features
2. causes
nephrotic syndrome
3. what drugs cause
nephrotic
syndrome- also infections,
MM, malignant
HTN, and
transplant rejection
4. dx***** ~ do this
diagnostic sequence
for hematuria as
well, basically any
renal failure that
there is not a clear
etiology
urinalysis
1. pH
2. specific gravity
3. protein
- also glucose, blood,
ketones, nitrite,
leukocyte esterase
4. Microscope
44.
45.
46.
47.
48.
49.
50.
51.
nephrotic
syndrome
1. tx
Hematuria
1. definition
2.
microscopic
vs. gross
hematuria
3. painless
hematuria
- check CBC
for IDA
common
causes for
hematuria
hematuria
1. causes
2. systemic
causes
3.
medication
causes
hematuria
1. dx
glomerular
disorders
1. patho
2. clinical
pres
nephritic
syndrome
1. patho
2. lab
findings
3. clinical
findings
nephrotic
syndrome
1. patho
2. causes
3. lab
findings
52.
53.
54.
55.
56.
57.
minimal change
disease
1. patho
2. diagnosis
3. tx
1. hodgkin's disease*/nonhodgkin's/idiopathic/post
infectious/rifampin --> systemic T
cell dysfunction--> nephrotic
syndrome
2. no histologic findings of light
microscopy, foot processes fusion
on electron microscopy, OVAL
FAT BODIES ON URINE
ELECTRON MICROSCOPY
3. 4-8 weeks of steroid therapy,
usually full recovery
FSGS
1.
demographics/clinical
pres
2. dx
3. tx
IgA nephropathy
1. patho
2. dx
3. tx
membranous
glomerulonephritis
1. patho
2. clinical pres
2. dx
hereditary
nephropathy (alports
syndrome)
1. patho
2. clinical pres
-no treatment
membranoproliferative
glomerulonephritis
1. patho
2. dx
58.
59.
60.
61.
62.
63.
poststreptococcal
GN
1. patho
2. clinical
pres
3. dx
4. tx
goodpasture's
syndrome
1. patho
2. clinical
pres
3. dx
4. tx
HIV
nephropathy
1. clinical
pres
2. dx
3. tx
AIN
1. patho
2. clinical
pres
3. dx/tx
renal
papillary
necrosis
1. patho
2. tx
type 1 RTA
1.
patho/clinical
pres
2. causes
3. dx
4. tx
64.
65.
66.
67.
68.
69.
70.
71.
type 2 RTA
1. patho
2. causes
3. tx
type 4 RTA
1.
patho/causes
hartnups
syndrome
1. patho
2. clinical
pres
3. tx
analgesic
nephropathy
patho
fanconi's
syndrome
1. patho
2. clinical
pres
3. dx/tx
ADPKD
1. patho
2. clinical
pres
3.
complications
4. dx/tx
ARPKD
1. patho
2. clinical
pres
3. dx /tx
potter
syndrome
72.
73.
74.
75.
76.
77.
78.
79.
80.
renal artery
stenosis
1. patho
2. clinical pres
3. dx/tx
1. atherosclerosis/fibromuscular dysplasia
-->RAS causes dec. blood flow to JGA -->
RAAS --> HTN
2. HTN refractory to medical therapy, may
be malignant, abdominal bruit, dec. renal
function
3. renal arteriogram, BUT NO CONTRAST
IN PTS WITH RENAL FAILURE.
MRA
duplex doppler ultrasound
tx = revascularization, by PCI with stent
ACE inhibitors, CCBs.
renal vein
thrombosis
1. patho
2. clinical pres
3. dx/tx
atheroembolic
disease of renal
arteries
1. patho
2. risk factors
3. clinical pres
hypertensive
nephrosclerosis
1. patho
2. clinical pres
sickle cell
nephropathy
1. patho
renovascular
hypertension
clinical pres
nephrolithiasis
1. predisposing
conditions
calcium stones
1. patho
2. microscopic
findings/radio
findings
causes of
hyperoxaluria
81.
82.
83.
84.
85.
86.
uric acid
stones
1. patho
2. microscopic
findings/radio
findings
struvite stones
1. patho
1. what size
stones can
pass
spontaneously
2. clinical pres
of urinary
stone
3. dx/tx
1. <0.5cm
2. sudden onset paroxysms of flank pain
that radiates anteriorly to the groin, n/v,
hematuria***, UTI
3. urinalysis - microscopic or gross
hematuria
UA micro- shows crystals possibly
urine pH - alkaline suggests infection stone,
acidic urine suggests calcium oxalate or uric
acid stones,
serum chemistry - BUN, Ca, Cr, oxalate,
citrate levels
KUB- does not show cystine/uric acid
stones
*CT scan without contrast*
IVP
renal ultrasound
tx = analgesia - IV morphine/ketorolac
fluid hydration, ABX for infection
>3 days - consider urology consult
indications
for admission
for renal
calculi
renal calculi
prevention
2L/day of water
limit animal protein intake if patient has
hyperuricosuria
thiazide diuretics - dec. urine calcium,
allopurinol
UTO
1. lower
urinary tract
causes
2. upper
urinary tract
causes
3. clinical pres
87.
88.
89.
90.
91.
92.
93.
94.
95.
UTO
1. dx
2. tx
prostate
cancer
1. risk factors
2.clinical
pres
prostate
cancer
1. dx
what causes
an elevated
PSA
what
diagnostic
studies
1. PSA >10
2. abnormal
DRE
3. PSA <4
DRE negative
4. PSA 4.1-10,
DRE negative
PSA
adjustmentsage adjusted,
PSA velocity,
PSA density
....
when is TRUS
with biopsy
indicated
prostate
cancer
1. treatment
RCC
1. patho
2. sites of
mets
3. risk factors
1. sporadic, or VHL
2. lung, liver, brain, bone
3. cigarettes, phenacetin PCKD, chronic
dialysis (multicystic kidney disease), heavy
metals (mercury/cadmium), hypertension
96.
97.
98.
99.
100.
101.
RCC
1. clinical pres
2.
paraneoplastic
syndromes
3. dx
4. tx
bladder cancer
1. patho
2. risk factors
3. clinical pres
bladder cancer
1. dx
2. tx
testicular
cancer
1. germ cell
2. non-germ
cell
3. risk factors
1. germ cell =
seminomas (radiosensitive),
non-seminomas (embryonal
[necrosis/malig], chorio [mets quickly,
yolk sac, teratoma)
2. leydig cell tumors - secrete
androgens/estrogens, precocious
puberty/gynecomastia
sertoli cells -usually benign
3. cryptorchidism, klinefelter's syndrome
4. dx - testicular exam/ultrasound, b-HCG
(chorio/non-sem), AFP (embryonal), CT
chest
penile cancer
1. risk factors
2. ddx for
testicular
mass
testicular
torsion
1. patho
102.
103.
104.
105.
106.
107.
108.
epididymitis
1. patho
2. clinical pres
fluids
1. TBW
2. ICF
3. ECF
4. plasma,
interstitial fluid
fluids
1.
normal/minimum
urine output
2. insensible loss
3. what is the best
way to assess
volume status
- lower extremity
edema may not be
volume overload,
TBW may be high,
but patient may be
intravascularly
1. 800-1500 ml/day,
minimum = 500-600ml/day
2. 600-900 ml/day
3. urine output 0.5-1.0ml/kg/hour
causes of oliguria
1. what fraction of
intravascular
volume is in venous
vs arterial system
2. what patients
third space fluids
fluid replacement
uses
1. normal saline
2. D51/2NS + 20
mEq kcl/L
3. D5w
4. lactated ringers
causes of
hypovoluemia
109.
110.
111.
112.
113.
1. clinical
presentation
hypovolaemia
2. urine panel
findings
hypervolemia
1. causes
2. clinical
features
3. tx
Na+
concentration
is reflection of
water
homeostasis
Na+ content is
reflection of
sodium
homeostasis
1. sodium
homeostasis
2. water
homeostasis
3. NATREMIA
VS VOLEMIA
hyponatremia
1. definition
2. symptomatic
hyponatremia
level
3. symptoms of
hyponatremia
114.
115.
116.
117.
118.
119.
120.
hypotonic
hyponatremia
1. hypovolemic
hypotonic
hyponatremia
2. euvolemic hypotonic
hyponatremia
3. hypervolemic
hypotonic
hyponatremia
isotonic hyponatremia
(pseudohyponatremia)
hypertonic
hyponatremia
adjusting Na for
glucose
diagnosis of specific
type of hyponatremia
hyponatremia
1. treatment
hypernatremia
1. definition
2. hypovolemic
hypernatremia cause
121.
122.
123.
124.
125.
126.
127.
hypernatremia
1. clinical pres
2. dx
3. tx
water deficit
calculation
calcium
1. normal
range
2. corrected
calcium
3. effect of pH
1. 8.5-10.5
2. corrected = total - [albumin*0.8]
3. high pH calcium binds albumin thus
total Ca is normal, but ionized is low
PTH
1. actions
calcitonin
1. actions
vitamin D
1. actions
hypocalcemia
1. causes
128.
129.
130.
131.
132.
hypocalcemia
1. clinical pres
2. cardiac
manifestations
3. lab workup
4. tx
1. rickets, osteomalacia,
neuromuscular irritability- numbness,
tingling, tetany, chvostek's sign,
trousseau's sign, grand mal seizures, basal
ganglia calcifications
2. LONG QT***
3. BUN, Cr, magnesium, albumin, ionized
calcium, amylase, lipase
4. IV calcium gluconate, oral calcium
supplements, vitamin D, thiazide diuretics
(dec. urinary calcium), magnesium
hypercalcemia
1. causes
2. what drugs
cause
hypercalcemia
- sarcoidosis
-familial
hypocalciuric
hypercalcemia
(low urine
Ca2+
hypercalcemia
1. clinical pres
2. cardiac
findings ECG
3. dx
hypercalcemia
1. tx
1. IV fluids
diuretics - furosemide
BISPHOSPHONATES (pamidronate)
calcitonin
glucocorticoids
hemodialysis
phosphate- risk of metastatic calcification
potassium
1. where is it
located in the
body
2. hypokalemia
causes
3.
hyperkalemia
causes
4. potassium
secretion`
1. intracellular
2. alkalosis, insulin, albuterol
3. acidosis, renal failure
4. kidneys, GI tract
133.
134.
135.
136.
137.
138.
139.
hypokalemia
1. causes
2. bartter
syndrome
what acid
base
disturbance
with
diarrhea
in a patient
who is
hypokalemia
1. what does
it mean if
they are
hypertensive
2. what does
it mean if
they are
normotensive
3. what drugs
cause
hypokalmeia
hypokalemia
ECG findings
what
electrolyte to
monitor in
patients on
digoxin
hypokalemia
1. clinical
pres
2. tx
hyperkalemia
1. causes
140.
141.
142.
143.
pseudohyperkalemia
hyperkalemia
1. clinical pres
2. ECG
3. tx
hypomagnesemia
1. causes
2. renal causes
3. clinical pres
4. relationship
between mg and k
5. ECG changes
- tx = oral or
parenteral Mg
1. malabsorption, prolonged
fasting, fistulas, TPN w/o mg,
alcoholism
2. SIADH, diuretics, bartter's,
gentamicin, ampho B, cisplatin,
renal transplant
3. COEXISTING HYPOCALCEMIA,
neuromuscular/CNS
hyperexcitability, muscle twitching,
weakness, tremors, hyperreflexia,
seizures, altered mental status
4. when Mg or K decreases, the
other ion decreases
5. prolonged QT, T wave flattening,
torsade de pointes
hypermagnesemia
1. causes
2. clinical pres
3. ECG changes
4. tx
144.
145.
146.
147.
148.
149.
150.
hypophosphatemia
1. causes
2.clinical pres
hyperphosphatemia
1. causes
2. clinical pres
3. tx
metabolic acidosis
1. criteria
2. anion gap
3. AG metabolic
acidosis causes
effect of acidosis on
the body
effects of alkalosis
on the body
how to tell if
met.acid is a mixed
disorder
salicylate toxicity
acid/base
disturbance
151.
152.
153.
154.
155.
1. non-AG met
acid causes
1. metabolic
acidosis
clinical pres
2. dx
metabolic
acidosis
1. tx
metabolic
alkalosis
1. definition
2. first step in
evaluation
3. causes:
saline
sensitive
4. causes:
saline
resistant
5. how high
should
respiratory
compensation
be
metabolic
alkalosis
1. dx
2. tx
156.
157.
158.
159.
160.
161.
162.
respiratory
acidosis
1. definition
2.
compensation
3. causes
4. clinical pres
respiratory
acidosis
1. treatment
respiratory
alkalosis
1. definition
2.
compensation
3. causes
respiratory
alkalosis
1. clinical pres
2. tx
anemia
1.
compensatory
mechanisms
2. when to
transfuse
3. clinical pres
anemia
1. dx
2. tx
pseudoanemia
163.
164.
165.
166.
167.
168.
169.
cryoprecipitatecomponents+what is it
used to treat
1:1:1 - platelets:FFP:PRBCs
hemolytic transfusion
reactions: intravascular
hemolysis
1. patho
2.
symptoms/complications
3. tx
hemolytic transfusion
reactions: extravascular
hemolysis
1. patho
2. clinical pres + tx
anemia
1. interpretation of
reticulocytes
2. microcytic anemia ddx
170.
171.
172.
173.
174.
175.
176.
anemia
1. macrocytic ddx
2. normocytic
ddx
evaluation of
suspected
hemolytic anemia
microcytic
anemia
1. causes
2. clinical pres
3. dx
4. tx
beta thalassemia
(cooley's anemia)
1. patho beta thal
2. demographics
3. clinical pres +
tx
alpha
thalassemia
1. patho
2.
what is the
consequence of
frequent
transfusions in
beta thal patients
what type of
microcytic
anemia is inc.
RDW
characteristic of
IDA
177.
178.
179.
180.
181.
182.
183.
thalassemia
minor
1. patho
2. clinical pres
what is next
diagnostic test in
patient who has
IDA, but does not
respond to iron
alpha thalassemia
1. one
mutation/deletion
clinical pres
2. alpha
thalassemia trait
clinical pres
3. HbH disease
4. 4 alpha loci
mutations
sideroblastic
anemia
1. patho
2. dx
3. tx
1. hereditary
acquired - chloramphenicol, INH,
alcohol, lead*, collagen vascular
disease, myelodysplasia
2. inc. serum ferritin**, inc. serum
iron*, BASOPHILIC STIPPLING,
normal TIBC, TIBC saturation
normal/elevated
ringed sideroblasts on marrow biopsy
3. remove offending agent, B6
supplementation
anemia of chronic
disease
1. patho
2. dx
3. tx
aplastic anemia
1. patho
2.clinical pres
1.radiation, chloramphenicol,
sulfonamides, gold, carbamazepine,
parvo B19, hep C, hep B, EBV, HZV,
HIV, benzene, insecticides--> bone
marrow failure-->pancytopenia
2. fatigue, dyspnea, petechiae, easy
bruising, inc. infections (neutropenia),
3. normocytic, normochromic anemia,
bone marrow shows hypocellular
marrow, absence of progenitors
tx = bone marrow transplant,
PRBC/platelt transfusion,
pernicious
anemia
184.
185.
186.
187.
188.
189.
190.
191.
B12 deficiency
1. function of
b12
2. dietary
sources/storage
3. causes of
deficiency
b12 deficiency
1. clinical pres
193.
194.
b12 deficiency
1. dx
2. schilling test
3. tx
folate
deficiency
1.
sources/storage
2. clinical pres
3. dx/tx
causes of
hemolytic
anemia
intravascular
vs
extravascular
smear findings
for hemolytic
anemia
192.
195.
196.
sickle cell
anemia
1. patho
2. what
triggers
sickling
3. correlation
of sickle crisis
and age of
death
4. treatment
of aplastic
crisis
sickle cell
anemia
1. clinical pres
2. painful
bone crisis
3. hand foot
syndrome
4. acute chest
syndrome
sickle cell
anemia
1. splenic
disease
2. avascular
necrosis
3. priapism +
treatment
4. CVAs
sickle cell
anemia
1. renal
complications
2. extremity
complications
3. abdominal
complications
4. infectious
complications
1. sickle cell
anemia
diagnosis
2. sickle cell
pain crisis tx
3. sickle cell tx
197.
198.
199.
200.
201.
hereditary
spherocytosis
1. patho
2. clinical
pres
3. dx
4. tx
causes of
spherocytosis
G6PD
deficiency
1. patho +
triggers
2. clinical
pres
3. peripheral
smear
findings
1. x linked disorder
infection- G6PD cannot generated NADPH
to reduce glutathione
OXIDIZING DRUGS- sulfonamides,
nitrofurantoin, primaquine, dimercaprol,
fava beans, infection
2. episodic hemolytic anemia, dark urine,
jaundice on exam,
peripheral smear shows BITE CELLS,
HEINZ BODIES (Hb precipitates),
PRUSSIAN BLUE STAIN POSITIVE
tx = avoid triggers, maintain hydration, RBC
transfusion
3. bite cell from removal of heinz bodies by
splenic macrophages
AIHA
1. patho
2. warm
AIHA
3. cold AIHA
AIHA
1. clinical
pres
2. dx
3. tx
202.
203.
204.
205.
206.
paroxysmal
nocturnal
hemoglobinuria
1. patho
2. clinical pres
3. complications
4. tx
1. HIT type 1 + tx
2. HIT type 2 + tx
1. causes of bone
marrow failure
2. causes of bone
marrow invasion
3. causes of bone
marrow injury
paroxysmal
nocturnal
hemoglobinuria
1. diagnosis
platelet disorders
1. causes of
thrombocytopenia
2. causes of
thrombocytosis
3. qualitative
platelet disorders
4. hereditary
platelet disorders
207.
208.
209.
210.
211.
1. what causes
increased platelet
destruction
2. dilutional
thrombocytopenia
3.
thrombocytopenia
in pregnancy
thrombocytopenia
1. clinical pres
immune
thrombocytopenic
purpura
1. patho
2. clinical pres
3. dx
immune
thrombocytopenic
purpura
1. tx
thrombotic
thrombocytopenic
purpura
1. patho
2. clinical pres
3.dx tx
212.
213.
214.
215.
216.
217.
heparin induced
thrombocytopenia
1. patho
2. dx/tx
3. complications
bernard soulier
1. patho
2. dx
glanzmann's
thrombasthenia
1. AR - GpIIb-IIIa deficiency
2. prolonged bleeding time, platelet
count normal
von willebrand's
disease
1. patho
2. sub regions of
factor VIII
3. type 1/2/3
4. clinical pres
von willebrand's
disease
1. dx
2. tx
hemophilia A
1. patho
2. clinical pres
3. dx
218.
219.
220.
221.
222.
223.
224.
225.
226.
treatment of
hemophilia B
disseminated
intravascular
coagulation
1. patho
2. clinical
pres
disseminated
intravascular
coagulation
1. dx
2. tx
what does
thrombin
time measure
liver disease
vs vitamin K
deficiency
coagulopathy
complications
of DIC
vitamin K
deficiency
1. patho
2. dx
coagulopathy
of liver
disease
1. patho
2. poor
prognostic
indicator
antithrombin
3 deficiency
1. patho
227.
228.
229.
230.
231.
232.
233.
234.
235.
antiphospholipid
syndrome
1. patho
- lupus anticoagulant,
anticardiolipin, beta 2
microglobulin etc.
1. acquired hypercoagulable
state (LUPUS) -- >
recurrent arterial/venous
thrombosis
protein C deficiency
1. patho
factor V leiden
1. patho
secondary hypercoagulable
states
HEPARIN
heparin
1. mechanism
2. indications
mechanism - potentiates
action of antithrombin to
inhibit II and X, prolongs
PTT
2. DVT, PE, ACS, unstable
angina/MI, LMWH, a.fib
IV heparin
dosing/monitoring/reversal
bleeding, HIT,
osteoporosis, transient
alopecia, rebound
hypercoagulability
contraindications - previous
HIT, active bleeding,
hemophilia,
thrombocytopenia, HTN,
brain, eye, spine surgery
LMWH
236.
237.
238.
239.
240.
warfarin
1. monitoring
2. administration
3. side effects
4. reversal
clopidogrel
1. patho
2. important drug
interaction
most
common/mortality
cancers in men vs
women
oncologic
emergencies that
require treatment
features of benign
breast masses
age <35
fibroadenoma - round movable mass,
which changes based on menstrual
cycle
cysts - benign if not bloody
premalignant
breast cancers
monoclonal
gammopathy of
undetermined
significance MGUS
1. diagnosis
2. tx
3. progression
243.
244.
245.
246.
241.
242.
247.
multiple myeloma
1. patho
2. clinical pres
multiple myeloma
1. dx
2. tx
waldenstroms
macroglobulinemia
1. path
2. clinical pres
3. tx
1. plasmacytoid lymphocyte
proliferation --> IgM paraprotein
>5g/dL, bence jones proteinuria,
2. NO BONE LESIONS, fatigue,
weight loss, anemia, abnormal
bleeding, hyperviscosity syndrome
3. chemotherapy and plasmapheresis
hodgkins
lymphoma
1. patho
2. clinical pres
hodgkins disease
3. dx
4. tx
248.
249.
250.
251.
252.
253.
254.
255.
non-hodgkins
lymphoma
1. risk factors
2. clinical pres
epidemiological
associations
with NHL
non-hodgkins
disease
1. dx
2. markers of
tumor load
3. tx
indolent or low
grade
lymphomas
1. types
2. clinical pres
3. progression
4. tx
intermediate
grade
lymphoma
1. types
2. clinical pres
3. tx
high grade
lymphomas
1. types
2. tx
mycosis
fungoides
1.
patho/clinical
pres
2. dx
3. tx
sezary
syndrome
256.
257.
258.
259.
260.
261.
262.
263.
264.
265.
HIV
associated
lymphomas
CHOP
therapy
cyclophosphamide, hydroxydaunomycin
(doxorubicin), oncovin (vincristine),
prednisone
AML
1. risk factors
2.
promyelocytic
clinical
pres/tx
ALL
1. patho
2. age
3. poor
prognostic
indicators
ALL/AML
1. clinical
pres
2. key classic
locations for
extranodal
ALL/AML
tumor lysis
syndrome
1. ALL
response to
treatment
CLL
1. age
2. patho
3. dx
4. tx
1. >50
2. monoclonal mature lymphocytes that are
not functional
3. WBC 50k-200k, anemia
(AUTOIMMUNE HEMOLYTIC),
thrombocytopenia, neutropenia
SMUDGE CELLS - fragile leukemic cells
flow cytometry
bone marrow biopsy - infiltrating leukocytes
4. symptomatic chemotherapy
myeloid cell
line
CML
1. patho
2. clinical
pres
266.
267.
268.
269.
270.
271.
CML
1. dx
2. tx
polycythemia
vera
1. patho
2. clinical pres
polycythemia
vera
1. dx
2. tx
myelodysplastic
syndromes
1. patho
2. dx
3. tx
4. progression?
1. idiopathic/radiation-> ineffective
hematopoiesis, apoptosis of myeloid
precursors, pancytopenia, hypercellular
marrow
2. marrow biopsy shows dysplastic cells
with ringed sideroblasts, blasts
normal MCV
low reticulocyte count
Howell jolly bodies, basophilic
stippling,
3. EPO, G CSF, B6, B12, folate
supplementation
4. can become AML with very poor
prognosis
essential
thrombocythemia
1. dx
2. tx
3. clinical pres
reactive
thrombocytosis
272.
273.
274.
275.
276.
277.
pneumonia
1. most common
community
bacterial
pathogen
2. most common
nosocomial
3. indications
for
pneumococcal
vaccine
1. s.pneumo
2. gram negative rods
(E.coli/pseudomonas), s.aureus
3. age >65, heart disease, SCD,
pulmonary disease, diabetes, cirrhosis,
cigarette smokers***
community
acquired
pneumonia
1. patho
2. clinical pres
3. dx
atypical
pneumonia
1. clinical pres
2. patho
3. dx
what is a good
sputum cultures
pneumonia
organisms
1. in alcoholics
2. in immigrants
3. in nursing
home
4. HIV patients
5. transplant
patients/renal
failure/lung
disease/smokers
stains
1. acid fast
2. methenamine
silver stain
3. urine antigen
assay
1. myco TB
2. pneumocystis and other fungi
3. LEGIONELLA
278.
279.
280.
281.
282.
283.
284.
285.
286.
community
acquired
pneumonia
1. tx <60
2. tx >60
3. tx for
hospitalized
hospital
acquired
pneumonia
treatment
pneumonia
complications
what to test
thoracentesis
fluid for
ventilator
associated
pneumonia
1. dx
2. tx
likely
locations of
lung
abscesses
lung abscess
1. patho
2. micro
1.aspiration of oropharyngeal
contents/hematogenous spread/direct
contact/food --> 2cm or larger suppurative
cavitary lesions
2.prevotella, peptostrepto, fuso, bacteroides,
s.aureus, s.pneumo, aerobic gram negative
bacilli
lung abscess
1. risk factors
2. clinical
pres
lung abscess
1. tx
287.
288.
289.
290.
291.
292.
293.
294.
tuberculosis
1. patho
2. secondary TB
3. risk factors
for TB
tuberculosis
1. primary TB
clinical pres
2. secondary TB
""
3. radiographic
findings
tuberculosis
1.
extrapulmonary
sites
tuberculosis
1. dx
PPD positive
+ PPD, what is
next step in
management
...
tuberculosis
1. treatment for
latent TB
2. treatment for
active TB
TB treatment
1. toxicity
295.
296.
297.
298.
299.
300.
301.
1. flu epidemic vs
pandemic
influenza
(orthomyxovirus)
1. clinical pres
meningitis
1. patho
2. bacterial pathogens
neonates + tx
3. "" children+ tx
4. adults + tx
5. elderly >50+ tx
6.
immuo/hospitalized+tx
chronic meningitis
causes
meningitis
1. complications
aseptic meningitis
1. patho
2. treatment
meningitis
1. clinical pres
302.
303.
304.
305.
306.
307.
meningitis
1. dx
2. tx
1. <5/lymphos or mono/5075/<60
2. >1000/PMNs/low/high
3. <1000/lymphos or mono/5075/moderate elevation
encephalitis
1. patho
2. causes
3. risk factors
encephalitis
1. clinical pres
encephalitis
1. dx
2. tx
308.
309.
310.
311.
312.
313.
vasculitis associated
with hep B/C
hep B - PAN
hep C - cryoglobulinemia
hep B vs hep C
1. what percent have
clinical hepatitis
after exposure
2. what percent have
chronic hepatitis
after clinical
hepatitis
3. what percent of
chronic hepatitis
develop cirrhosis
4. what fraction
develop HCC
1. 70% vs 75%
2. 10% vs 90%
3. 25% vs 20%
4. 40% vs 25%
mechanism of
transmission
1. hep A/E
2. hep B
3. hep D
4. hep C
1. fecal oral
2. parenterally or sexually
3. coinfection with hep B or
superinfection in chronic hep B
carrier
4. parenteral (most commonly in
IVDU)
hepatitis
1. clinical pres
2. fulminant
hepatitis clinical
features
3. dx
314.
315.
IgM anti-HBc
HBsAg is earliest* detectable
marker but disappears during
window period (1-2 weeks)
TEST FOR BOTH IN SCREENING
hepatitis B serologies
1. HBsAg
2. HBeAg
3. anti-HBsAg
4. anti-HBcAg
5. diagnosis of hep C
316.
317.
318.
319.
320.
botulism
1. patho
2. clinical pres
3. dx
4. tx
ddx in foodborne
"botulism"
UTI
1. patho
2. risk factors
non-infectious
causes of cystitis
UTI
1. dx
UTI
1. clinical pres
2. what diagnostic
tests for suspected
structural
abnormalities
complicated UTI
1. definition
2. what risk factors
321.
322.
323.
324.
UTI
1.
uncomplicated
cystitis
treatment
2. UTI in
pregnant
patient tx
3. UTI in men
tx
4. treated UTI
that relapses
5. > 2
UTI's/year
pyelonephritis
1. patho
2. organisms
3.
complications
pyelonephritis
1. clinical pres
2. dx
3. tx
prostatitis
1. acute
bacterial
prostatitis
patho
2. chronic
bacterial
prostatitis
patho
3. clinical pres
325.
326.
327.
328.
329.
330.
331.
prostatitis
1. dx acute vs
chronic
2. tx acute vs
chronic
- tends to
recur
genital warts
patho
chlamydia
1. patho
2. clinical
pres
3. dx
4. tx
5.
complications
gonorrhea
1. patho
2. clinical
pres
3.
complications
what cancer
associated
with
chlamydia
cervical cancer
gonorrhea
1.
disseminated
disease
clinical pres
2. dx
3. tx
4. tx for
disseminated
HIV
1. when is
cesarean
delivery
indicated
2. phases of
HIV
3. cause of
death
332.
333.
334.
335.
HIV/AIDS
1. primary
infection
2.
asymptomatic
infection
3.
symptomatic
HIV (preAIDS)
4. AIDS
HIV/AIDS
1. best
indicator of
immune
status/risk of
infection
2.
progression
of CD4 decline
3. at what CD4
do
opportunistic
infections
occur
1. CD4
2. 50/year
3. 200-500 - HZV, TB lymphoma,
pneumonias, kaposi's
<200 get more opportunistic infections
HIV/AIDS
1. best
indicator of
effectiveness
of
antiretroviral
therapy
2. when does
medication
regimen
- measure
CD4 and viral
load every 3-4
months
1. viral load
2. when viral load is >50 after 4 months of
treatment, NEVER STOP TREATMENT
AIDS
pulmonary
complications
1. CD4 count
2. PJP clinical
pres and dx
3. other
pulmonary
infections
1. <200
2 .fever, non-productive cough, SOB
w/exertion-->rest, d
x = diffuse interstitial infiltrates,
methenamine silver stain tx = 3 wks bactrim
+steroids
prophylaxis bactrim 1x/day
3. TB (may be PPD neg), CMV/MAC
(CD4<50), crypto, histo, kaposi
336.
337.
338.
339.
340.
341.
AIDS nervous
system
complications
1. AIDS
dementia
2.
toxoplasmosis
clinical pres +
dx
AIDS nervous
system
complications
1. cryptococcal
meningitis +
tx
2. other CNS
infections
AIDS GI
complications
1. diarrhea
2. oral lesions
3. esophageal
AIDS skin
complications
AIDS
opportunistic
infections
1. CMV + tx
2. MAC + tx
3. HIV
wasting
syndrome
4.
malignancies
HIV/AIDS
1. dx
2. tx
342.
343.
344.
pneumocystis
pneumonia
1. CD4
2. clinical pres
3. dx
4. tx
1. <200
2. dyspnea, dry cough, fever
3. CXR (bilateral interstitial
infiltrates), LDL (elevated), ABG (inc.
A-a + hypoxia), bronchoscopy/BAL
***methenamine silver stain
4. tx = bactrim + steroids
prophylaxis with bactrim, atovaquone
or pentamidine
MAC prophylaxis
in AIDS
toxoplasmosis
prophylaxis +
treatment in AIDS
AIDS vaccinations
genital ulcers
1. syphilis
2. primary HSV
3. chancroid
4.
lymphogranuloma
venereum
5. granuloma
inguinale
HSV
1. patho
2. HSV 1 clinical
pres
3. HSV 2 clinical
pres
348.
349.
345.
346.
350.
351.
347.
352.
HSV
1. what
causes
recurrences
2. herpetic
whitlow
3.
disseminated
HSV
4/ HSV in
pregnant
women
5. neonatal
HSV
6. ocular HSV
HSV
1. dx
2. tx
syphilis
1. patho
2. primary
3. secondary
4. latent
5. tertiary
syphilis
1. dx
2. tx
chancroid
1. patho
2. clinical
pres
3. dx
353.
354.
355.
356.
357.
lymphogranuloma
venereum
1. patho
2. clinical pres
3. dx
4. tx
1. c.trachomatis STD
2. painless ulcer at inoculation, tender
unilateral adenopathy and
constitutional symptoms -->
proctocolitis, stricture, elephantitis of
genitals ,
3. serologic compliment fixation,
immunofluorescence
4. doxy 21 days
pediculosis pubis
(capitis,corpora)
1. patho
2. clinical pres`
3. dx
4. tx
cellulitis
1. patho
2. most common
pathogens
3. clinical pres
4. dx/tx
cellulitis
pathogens
1. local
trauma/skin
breaks
2.
wounds/abscesses
3. water
immersion
4. acute sinusitis
1. strep pyogenes
2. s.aureus
3. pseudomonas, aeromonas, vibrio
vulnificus
4. haemophilus influenzae
erysipelas
1. patho
2. clinical pres
3. risk factors
4. complications
5. tx
358.
359.
360.
361.
362.
363.
364.
necrotizing
fasciitis
1. patho
2. risk factors
3. clinical pres
4. tx
differentiating
DVT from
cellulitis
necrotizing
fasciitis
1. tx
lymphadenitis
1. patho
2. clinical pres
tetanus
1. patho
2. clinical pres
3. dx/tx
when to give
tetanus
immunization
for wound
management
osteomyelitis
1. patho
2. risk factors
3. clinical pres
365.
366.
367.
368.
369.
370.
371.
osteomyelitis
organisms
1. catheter
septicemia
2. prosthetic
joint
3. diabetic
foot ulcer
4.
nosocomial
infections
5. IVDU
5. sickle cell
1. s.aureus
2. coagulase negative staph
3. polymicrobial
4. pseudomonas
5. fungal species, pseudomonas
6. salmonella
osteomyelitis
1. dx
2. tx
potts disease
acute
infectious
arthritis
1. patho
2. pathogens
1. hematogenous/contiguous
/traumatic/iatrogenic --> microorganisms
invade the joint space --> cytokine release
and and destruction of the joint
2. s.aureus,
n.gonorrhoeae in young sexually active
adults
salmonella - sickle cell disease or
immunodeficiency
372.
373.
acute
infectious
arthritis
1. clinical
pres
gonococcal
arthritis
1. clinical
pres
2. tx
acute
infectious
arthritis
1. dx
2. tx
374.
375.
376.
acute
bacterial
arthritis
treatments
1. s.aureus
2.
immunocomp
or risk for
gram negative
3. high risk
for
gonococcal
lyme disease
1. patho
2. stage 1
clinical pres
3. stage 2
clinical pres
4. stage 3
clinical pres
lymes disease
serology
lymes disease
1. diagnosis
2. tx
rocky
mountain
spotted fever
1. patho
2. clinical
pres
3. dx/tx
377.
378.
379.
380.
381.
malaria
1. patho
2. clinical pres
3. dx
4. tx
rabies
1. patho
2. clinical pres
3. dx/tx
other zoonosis
page 400,
review this
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candidiasis
1. risk factors
2. clinical pres
1. antibiotics, immunosuppression,DM,
immunocompromised
2. yeast infection - thick white cottage
cheese like vaginal discharge- painless,
pruritic
oral thrush - thick white plaques (suggests
HIV)
cutaneous - erythematous eroded patches
with satellite lesions
GI tract - esophagitis (odynophagia),
candidiasis
1. dx
2. tx
382.
383.
384.
385.
386.
aspergillus
1. patho
2. allergic
bronchopulmonary
aspergillosis
3. pulmonary
aspergilloma
4. invasive
aspergillosis
5. tx
cryptococcus
1. patho
2. clinical pres
3. dx
ergwregtrwaefsdz
fever of unknown
origin
1. definition
1. fever of unknown
origin diagnostic
workup
2. tx
387.
388.
389.
390.
391.
392.
393.
toxic shock
syndrome
1. patho
2. clinical pres
3. lab findings
fever vs
hyperthermia
toxic shock
syndrome
1. tx
catheter
related sepsis
1.
causes/clinical
pres
neutropenic
fever
1. causes
2. dx
3. tx
neutropenia
definition
neutrophil <1500/mm3
ANC <500 is at risk for severe infection
infectious
mononucleosis
1. causes
2. what should
be tested for in
pregnant
woman
3. clinical pres
394.
395.
396.
397.
398.
399.
400.
infectoius
mononucleosis
1. dx
2. tx
infectious
mononucleosis
1. complications
rosacea
1. clinical
findings
2. tx
keratoacanthoma
tinea versicolor
1. patho
2. clinical pres
3. dx /tx
common
locations of
seborrheic
dermatitis
tx
contact
dermatitis
1. irritant type
2. allergic type
3. clinical pres
4. dx/tx
401.
402.
403.
404.
405.
406.
407.
408.
pityriasis
rosea
1.
patho/clinical
pres
2. tx
erythema
nodosum
1. patho
2. dx
erythema
multiforme
1. patho
2. tx
lichen planus
1. clinical
pres
bullous
pemphigoid
1. patho
2. clinical
pres
2. tx
pemphigus
vulgaris
1. patho
2. clinical
pres
3. tx
genital warts
1. treatment
409.
410.
411.
412.
413.
414.
415.
416.
417.
molluscum
contagiosum
tx
herpes zoster
treatment
dermatophytes
1. organisms
2. dx
scabies
1. patho
2. clincial pres
3. tx
dermatophyte
infections
1. tinea
corporis dx/tx
2. tinea capitis
dx/tx
3. tinea
unguium dx/tx
4. tinea pedis
dx/tx
5. tinea cruris
dx/tx
actinic
keratosis
1. patho
2. dx/tx
basal cell
carcinoma
1. patho
2. dx
3. tx
squamous cell
carcinoma of
skin
1. patho
2. clinical pres
3. dx/tx
marjolin's
ulcer
418.
419.
420.
421.
422.
423.
424.
melanoma
1. most
important
prognostic
factor
2. features
of
melanoma
1. depth of invasion
2. asymmetry, border irregularity, color
vairation, diameter >6mm, elevation -
stages of
decubitus
ulcers
psoriasis
1. patho
2. clinical
pres
3. tx
seborrheic
keratosis
1. patho
2. clinical
pres
3. tx
vitiligo
1. patho
2. clinical
associations
3. tx
urticaria
1. patho
hereditary
angioedema
425.
426.
427.
428.
429.
430.
431.
432.
hypersensitivity
types
1. IgE -anaphylaxis/asthma
2. IgG or IgM cytotoxic - good
pastures.pemphigus
3. antigen antibody complexes - SLE,
arthrus reaction, serums sickness
4. T cell mediates - allergic contact
dermatitis , tuberculosis, transplant
rejection
anaphylaxis
1. patho
2. clinical pres
3. tx
amoebic liver
abscess
1. patho
2. clinical pres
3. dx/tx
ecoli 0157:H7
1. sources
2. clinical
presentation
parvo b19
1. clinical pres
in children
2 clinical pres
in adults
target O2
saturation in
COPD patients
meperidine
side effects
septic arthritis
1. patho
p-anca
anti - myeloperoxidase
434.
435.
436.
437.
438.
439.
440.
441.
442.
microscopic
polyangiitis
1. patho
2. clinical pres
3. dx
cryoglobulinemia
1. patho
2. clinical pres
3. dx
tarsal tunnel
syndrome
clinical pres
hypertrophic
osteoarthropathy
clinical
associations
exudative pleural
effusion fluid lab
findings
...
complicated vs
uncomplicated
444.
445.
446.
447.
448.
449.
...
pulmonary
embolism
1. sources
2. clinical pres
3. dx
4. tx
recommended PE
prophylaxis
during hip
replacement
443.
450.
451.
452.
453.
454.
455.
456.
fenfluramine/phentermine
clinical association
workup of suspected
carbon monoxide poisonin
venous carboxyhemoglobin
CXR
then start supplemental O2
cimetidine, erythromycin,
ciprofloxacin, allopurinol,
and zafirlukast
digoxin specific
indications
symptomatic systolic
dysfunction
atrial flutter, atrial
fibrillation
smoking, hypertension
supraventricular
tachycardia SVT treatment
congenital QT prolongation,
and deafness--- family
history of sudden cardiac
death
457.
458.
459.
460.
461.
462.
463.
464.
treatment of
symptomatic
claudication
1 . vitamin D
deficiency lab
findings
2. postmenopausal
osteoporosis
findings
pagets disease
(osteitis deformans)
1. complications
2. dx
3. treatment
struma ovari
ectopic thryoids
1. effect of HRT on
lipid panel
2. adverse effects of
HRT used for postmenopausal
osteoporosis
cushing disease vs
exogenous
glucocorticoid
difference in clinical
presentation
prolactinoma
clinical pres
empty sella
syndrome
1. patho
465.
466.
467.
468.
469.
470.
471.
472.
473.
474.
475.
1. how to
determine if
ascitic fluid is
from portal
hypertension
c.difficile best
diagnostic test
disease associated
with
microvesicular fat
(micronodular
sclerosis
autoimmune hepatitis
chronic viral hepatitis
1. how to dec. GI
Side effects with
chronic NSAID
use
bleeding
prophylaxis for
cirrhotic patients
with varicies
intermittent
mesenteric
ischemia
1. patho
2. post-prandial
abdomina
pain/weight loss
1. atherosclerotic obstruction of
visceral arteries
lab findings in
rhabdomyolysis
ARF
hyperkalemia, hyperuricemia,
hyperphosphatemia, hypocalcemia,
elevated creatinine
high RBCs on urine dipstick
but few RBCs on urine microscopy
osmolar gap
1. calculation
1. 2Na+BUN/28+glu/18
2. patients have toxic ingestion of
methanol, ethylene glycol, paint
thinners
476.
477.
478.
479.
480.
481.
482.
483.
484.
485.
486.
hyponatremia
1. with inc. ECF fluid
overload
2. normal volume
status
3. low volume (ie low
blood pressure/high
pulse)
4. when see
hyponatremia then
evaluate volume status
THEN WHAT
1. analgesic
nephropathy
2. protease inhibitor
effect on GU
refeeding syndrome
hypophosphatemia, hypokalemia
due to intracellular shifts after
feed starving person or alcoholic
alcoholic with
hypocalcemia
hyporeninemic
hypoaldosteronism
1. patho
cause of postoperative
hyponatremia
testicular cancer
1. patho
myeloproligerative
disorders
gaisbock syndrome
breast cancer
1. adjuvant for
pre/post menopausal
women
487.
488.
489.
490.
491.
492.
493.
494.
495.
496.
transfusion related
acute lung injury
1. patho
2. clinical pres
ABO or Rh mismatch
reaction
delayed hemolytic
transfusion reaction
hypercoagulable
states
prothrombin G202
factor V leiden,
OCPs
pregnancy
Protein C, S and ATII deficiencies
lupus
cancer
antithyroid
medications (PTU,
methimazole)
complications
leukopenia
rare agranulocytosis
what imaging
modality is best for
spinal cord and
posterior fossa
MRI
carotid sinus
hypersensitivity
1. patho
2. clinical pres
497.
498.
499.
500.
501.
502.
503.
504.
505.
parkinsons disease
1. treatment
2. SE of parkinsons
treatment
paraneoplastic
cerebellar
degenerations
1. associated
cancers
2. patho
3. other
paraneoplastic
neuronal syndromes
hypertension
management in the
context of acute
cerebral
ischemia/stroke
medication overuse
headache
complex partial
seizures
vascular dementia
treatment for a
patient who had a
TIA
diffuse itchiness
associated with
what condition
CYP450 inducers
506.
507.
508.
509.
510.
511.
512.
513.
514.
CYP450 inhibitors
1. joint complications of
diuretics
2. what type of beta
blocker should be used
in COPD/asthma
3. what antihypertensives are
contraindicated in
pregnancy
4. alpha blockers long
term risk
common variable
immunodeficiency
1. patho
2. clinical pres
nasal turbinates in
allergic vs infectious
rhinitis
premedicate with
antihistamines and
corticosteroids-- don't need to
avoid altogether
IgA deficiency
1. clinical pres
ataxia telangiectasia
1. patho
postprandial
hypotension
515.
516.
517.
518.
519.
520.
521.
522.
523.
524.
525.
526.
527.
528.
529.
pulmonary
hyptension physical
examination
findings
pacemaker
indicatiosn
contrast medium
side effects
what is
electrocardiography
useful to detect
treatment of atrial
flutter
VSD***
mitral prolapse, mitral stenosis,
asymmetric septal hypertrophy,
Low risk = ASD
AV dissociation
independent beating of
atria/ventricles
fixed P-P, fixed R-R, variable P-R
causes of coronary
artery aneurysm
atherosclerosis, trauma,
angioplasty, atherectomy,
vasculitis, mycotic emboli,
kawasaki syndrome, arterial
dissection
ventricular aneurysm
look for calcified bulge on CXR
clinical presentation
of familial
hyperchoesterolemia
AUTOSOMAL DOMINANT
tendon xanthomas, xanthelasma,
arcus senilis
hypertension effect
on the eyes
left ventricular
hypertrophy EKG
findings
530.
531.
532.
533.
534.
1. pulsus tardus et
parvus
2. pulsus
paradoxus
3. hyperkinetic
(bounding) pulse
4. bisferiens pulse
1. dicrotic pulse
2. pulsus alternans
3. pulsus
bigeminus
JVP findings
1. large a waves
2. kussmaul's sign
3. slow y descent
4. prominent v
wave
5. prominent x
descent
6. prominent y
descent
JVD waveform
1. a wave
2. x descent
3. v wave
4. y descent
1. atrial systole
2. atrial relaxation during ventricular
systole
3. rising atrial pressure from
increased atrial filling,
4. tricuspid opens
1. which murmurs
are increased by
handgrip/pressure
cuff
2. which murmurs
are increased by
valsalva/standing
- most murmurs
decrease with
valsalva/standing
535.
536.
537.
538.
539.
540.
how to differentiate
constrictive pericarditis
vs cardiac tamponade on
physical exam
1. best antihypertensive
for those with CAD
2. best antihypertensive
for patients with left
ventricular dysfunction
or multiple
cardiovascular risk
factors
3. what type of antihypertensive is
contraindicated in
patients with bilateral
renal artery stenosis
1. beta blockers
2. ACE
3. ACE
carcinoid syndrome
effect on the heart
urticaria/pruritic
erythematous lesions
progressing to nikolsky's
negative bullous lesions
keratoacanthoma
543.
544.
545.
546.
547.
548.
549.
550.
551.
552.
541.
542.
atopic dermatitis
1. clinical pres
2. management
1. erythematous excoriated
papules/plaques that weep and
become secondarily
impetiginized
2. change in environment
topical steroids
adequate humidity
553.
554.
555.
zinc deficiency
clinical
presentation
what type of
melanoma is
invasive early
nodular melanoma
sezary syndrome
cutaneous
reactions of TMP
SMX
tetracycline
dermatologic
changes
chloroquine
dermatologic side
effect
dermatologic side
effects of antineoplastics
stomatitis, alopecia
dystrophic nail changes (bleomycin,
hydroxyurea, 5FU)
cellulitis, ulceration, urticaria
erythroderma
1. causes
2. clinical pres
2. diffuse rash,
fever,
eosinophilia,
interstitial
nephritis
...
captopril
penicillamine
what lipid
disturbance is
seen in patients
with insulin
resistance
hypertriglyceridemia
556.
557.
558.
559.
560.
561.
562.
563.
564.
565.
566.
567.
568.
in adrenocortical
insufficiency what
occurs with water
balance
hyperparathyroidism
1. effect on bones
1.
androgen
insensitivity
1. patho
572.
treatment for
erythropoietic
protoporphyria
beta carotene
573.
vitamin A toxicity
clinical pres
...
what vitamins
classically deficient in
alcoholics
magnesium, folate
1. causes of
hypomagnesemia
2. clincal pres of
hypomagnesemia
cystinuria
1. patho
2. clinical pres
mcardles disease
1. patho
2. clinical pres
gauchers disease
1. patho
2. clinical pres
569.
570.
571.
574.
type 3
hyperlipoproteinemia
575.
576.
577.
578.
579.
580.
type 1
hypolipoproteinemia
familial combnined
hyperlipidemia
autosomal
...
...
causes of secondary
dyslipidemias
osteomalacia
vitamin D resistant
rickets
1 patho
2. clinical pres
3. dx
hormone replacement
therapy
1. advantages
failure of detumescence
associated with what
conditions
1. niacin deficiency
clinical pres
1a. niacin excess
clinical pres
2 .thiamine deficiency
clinical pres
581.
582.
583.
584.
585.
586.
587.
588.
1. vitamin C deficiency
clinical pres
1. perifollicular
hyperkeratotic papules,
tendency to hemorrhage
dumping syndrome
1. patho/clincal pres
whipples disease
1. patho
2. dx
iron deficiency
lab characteristics of
cirrhotic ascitic fluid
593.
594.
595.
596.
597.
598.
599.
589.
590.
591.
592.
600.
601.
rectosigmoid
602.
603.
1. hep b
mentriers disease
1. patho
2. clincal pres
3. dx/tx
1. rotors syndrome
2. dubin johnson
what noncardiac
condition presents like
angina and is relieved by
sublingual nitro
secretory diarrhea
clinical pres
hepatic complications of
anabolic steroids
cholestasis/jaundice without
inflammation
peliosis hepatis (blood in the
liver)
hemoglobin C disease
1. patho
2. clinical findings
604.
605.
606.
607.
608.
609.
610.
611.
612.
613.
614.
increased erythroid to
myeloid ratio
causes of anemia in
preganncy
folate deficiency
(megaloblastic)
dilutional anemia disproportionate increase in
plasma volume
IDA
DEPTH OF TUMOR
PENETRATION (DUKES
STAGE)
...
Adult T cell
leukemia/lymphoma
1. patho
2 . tx
615.
616.
617.
618.
619.
620.
enlarge cervical or
supraclavicular lymph nodes
621.
622.
623.
chemotherapy side
effects
1. cyclophosphamide
2. doxorubicin
3. bleomycin
4. MTX
5. cisplatin
1. hemorrhagic cystitis - tx =
mesna + hydration
2. cardiomyopathy/CHF
3. lung injury, skin reactions
4. liver toxicity,
myelosuppression, GI mucositis
5. renal, ototoxicity,
myelosuppression, peripheral
neuropathy
paraneoplastic
syndromes associated
cancers
1. eaton lambert
2. SIADH
3. cushings syndrome
4. non-metastatic
hypercalcemia (PTHrP)
nasopharyngeal carcinoma,
liver cancer
1. steroids
2. leukopenia,
thrombocytopenia
posterior circulation
TIA
1. clinical pres
2. what structures does
the basilar artery supply
acoustic neuroma
clinical presentation
subdural hematoma
624.
625.
626.
627.
628.
629.
630.
631.
632.
633.
634.
635.
wernicke korsakoff
1. patho
2. clinical pres
3. tx
benign paroxysmal
positional vertigo
1. patho
2. clinical pres
hypokalemic periodic
paralysis
1. patho
2. clinical pres
3. tx
1. familial/thyrotoxicosis -->
hypokalemia after large
carbohydrate meals/stress
2. recurrent attacks of weakness,
loss of DTR, paralysis
3. potassium supplementation,
low carbohydrate,
acetazolamide, imipramine
637.
638.
arteriovenous
malformation clincial
pres
hypertensive
encephalopathy
1. locations of
hemorrhage
cerebellar hemorrhage
1. clincal pres
pontine hemorrhage
key clinical findings
636.
639.
640.
641.
642.
643.
PML pathogen
smallpox or rabies
which vitamin
deficiency can cause
demyelination
B12
644.
645.
646.
647.
cavernous sinus
thrombosis
1. patho
2. clinical pres
1. oculomotor palsy
clinical
presentation
2. argyll robertson
pupil
3. tonic pupil
(holmes-adie
syndrome)
1. horners
syndrome pupil
seizure treatments
1. status
epilepticus
2. partial seizures
3. tonic clonic
seizures
4. myoclonic
seizures
5. absence seizures
1. lorazepam or diazepam
2. phenytoin, carbamazepine,
3. phenytoin, carbamazepine,
valproic acid
4. valproate
5. ethosuximide, valproate
phenytoin side
effects
phenytoin, carbamazepine
1. hyperuricemia
renal effect
2. sickle cell
anemia renal effect
post-strep
glomerulonephritis
1. microscopic
findings
glucocorticoid
drug acid base
disturbance
hepatic cirrhosis
acid base
disturbance
648.
649.
650.
651.
652.
653.
654.
655.
656.
657.
658.
659.
660.
henoch schonlein
1. patho
2. kidney injury type
polycystic kidney
disease clinical pres
why do osteophytes
cuase pain in
osteoarthritis
what cardiac
complication of
ankylosing spondylitits
side effect of
phenylbutazone (an
NSAID used to treat
joint pains)
aplastic anemia
what to think in a
patient with new onset
clubbing of the distal
extremities
secondary hypertrophic
osteoarthropathy - next step
should be a chest x ray
668.
most common
extraarticular
manifestation of
ankylosing spondylitis
669.
rheumatoid arthritis
radiographic findings
early vs late
early = NORMAL
late = bony erosions and loss of
cartilage, periarticular
osteopenia, joint margin erosions
(narrowing of joint space)
ehlers danlos
1. clinical pres
1. skin hyperextensibility
/fragility/ bruisability, habitual
dislocation of joints
relapsing
polychondritis
1. clincial pres
2. associated
underlying conditions
rheumatoid arthritis
cellular/molecular
mechanism
661.
662.
663.
664.
665.
666.
667.
670.
671.
672.
673.
marfans syndrome
1. heart lesions
2. body features
where do rheumatoid
nodules typically
occur
caplans syndrome
sjogrens
anti-RNP associated
diseases
what serologic
marker correlates
with disease activity
in lupus
anti-dsDNA
CPPD prophylaxis
colchicine
clinical presentaion
that favors
pseudogout over gout
measels
1. clinical pres
2. complications
3. treatment
1.cough/fever/coryza--> koplik
spots, fever, rash that starts at the
head and DESCENDS
CONFLUENTLY (compare to
rubella)
2. otitis media (most common),
bronchitis, lymphadenitis
pneumonia, encephalitis
(sclerosing panencephalitis that
leads to death by 1 year)
3. aerosolized ribavirin for
pneumonia
treamtent for
diarrhea
oral hydration
loperamide or bismuth
fluoroquinolones or TMP SMX
674.
HIV
1. detection
675.
treatment of tetanus
penicillin or metronidazole,
respiratory support
676.
CMV
physical manifestations of
congenital syphilis
prophylactic antibiotic
choice for travelers
diarrhea
macrolides - azithromycin
fluoroquinolones levofloxacin or
moxifloxacin
hospital acquired
pneumonia organisms
...
EBV associated
malignancies
anaplastic nasopharyngeal
carcinoma (US)
burkitts lymphoma (Africa)
HIV associated CNS
lymphomas
multiple myeloma
infectious risk
congenital toxoplasmosis
chorioretinitis, strabismus,
epilepsy, hydrocephalus
sulfonamides by displacing
phenytoin from albumin
sulfonamides
candida infection
positive reaction means
intact T cell response
677.
678.
679.
680.
681.
682.
683.
684.
685.
686.
687.
688.
689.
690.
691.
692.
693.
694.
695.
696.
697.
698.
699.
aspirin allergy
mechanism
HLA associations
1. ank spondy
2. juvenile arthritis,
rheumatoid arthritis
3. type 1 DM
4. reiters syndrome
1. B27
2. DR4
3. DR3
4. B27
ant/middle/posterior
mediastinal masses
hypoxemia while
recieving 100%
oxygen
causes of pulmonary
eosinophilia
Allergic bronchopulmonary
aspergillosis (in asthmatics),
parasitic reactions, and drugs
loeffler's syndrome - benign
idiopathic pulm. eosinophilia
churg-strauss
side effects
associated with
quinidine
drug/platelet complex
thrombocytopenia* , hepatitis,
bone marrow suppression, lupus
syndrome, GI side effects,
700.
701.
702.
703.
704.
705.
706.
707.
708.
709.
710.
711.
712.
713.
folate deficiency
causes
perchlorate and
thiocynaate
which
fluroquinolones need
renal adjustment
ampicillin vs
penicillin
ADH effects
neurocardiogenic
syncope (situational
syncope)
coxsackie b
adeno, cmv, echo, hep c,
isolatd systolic
hypertension
+ TX OF CHOICE
treatment of choice is
HCTZ
...
tuberculosis
HCM
ie. during valsalva, or standing
which murmurs
inc/dec. with inc.
afterload
714.
715.
716.
717.
718.
719.
720.
721.
722.
723.
724.
725.
726.
how to differentiate
restrictive cardiomyopathy
from HCM on echo
theophylline toxicity
headache, insomnia, GI
disturbance, arrhythmias
ciprofloxacin and
erythromycin both inhibit
P450 and inc. theophylline
levels
flow loops
1.obstructive disease
processes
2. restrictive lung disease
3. upper airway obstruction
aspergilloma
1. CXR
iliofemoral veins
~ calf veins less likely to
make it to the heart
auscultatory findings in
emphysema
prolonged expiratory
phase, end expiratory
wheezing
inpatient - levofloxacin
outpatient azithromycin, or
doxycycline
hypertrophic
osteoarthropathy clinical
pres
digital clubbing,
**sudden onset**
arthropathy of the wrist
and hands
- first diagnostic test is a
chest x ray
bronchiectasis, bronchial
stenosis, foreign body
727.
728.
729.
730.
731.
732.
733.
734.
735.
736.
737.
738.
739.
740.
...
auscultatory findings of
lobar pneumonia
dullness to percussion
bronchial breath sounds with
prominent expiratory
component
E-->A egophony
whispered pectoriloquy
crackles
resonant to percussion,
vesicular breath sounds
FINE END INSPIRATORY
CRACKLES
distinguishing clinical
features of atypical
pneumonia
chronic bronchitis- 1.
definition, 2. patho
741.
742.
complications of PEEP
differentiation of
asthma and COPD
...
causes of
choriocarcinoma
743.
744.
745.
746.
GERD - up to 75% of
patients
multiple myeloma
constipation is 2/2
hypercalcemia
renal impairment is 2/2
BJ proteinuria
celiac disease
1. clinical pres
hemorrhage
treatment of ascites
747.
748.
749.
750.
751.
752.
753.
754.
755.
drug induced
pancreatitis
furosemide, thiazides
IBD drugs - ASA, sulfasalazine
immunosuppression azathioprine, L-asparaginase
valproic acid
AIDS drugs - didanosine,
pentamidine
antibiotics - metronidazole,
tetracycline
chronic pancreatitis
best diagnostic test
lactose intolerance
1. dx
gallstones
1. pigment stones
2. treatment for nonsurgical candidates
hepatitis B
1. chronic treatment
2. post exposure
prophylaxis
ERCP
hepatitis C
1. extrahepatic
manifestations
1. cryoglobulinemia (renal/GI),
b cell lymphoma, autoimmune
(sjogrens/thyroiditis), lichen
planus, ITP, porphyria cutanea
tarda
756.
757.
758.
759.
760.
761.
762.
763.
764.
765.
766.
hepatotoxic drugs
1. hepatitis causing drugs
2. cholestatic drugs
1. acetaminophen,
tetracycline,
isoniazid,
chlorpromazine,
halothane,
antiretroviral therapy,
2. chlorpromazine,
nitrofurantoin,
erythromycin
anabolic steroids,
colestipol
ballooning of
cytoplasm, PMN
infiltration, fibrosis,
necrosis, mallory
hyaline
PAS positive
hepatocyte
granules***
Panacinar
emphysema
...
refractory cirrhotic
hydrothorax
refractory ascites
recurrent variceal
bleeding
patients waiting for
liver transplant and
needing portocaval
shunts
pancreatitis hypotension
pathogenesis
inflammatory effects
from pancreatic
enzyme release inc.
vascular permeability
...
fulminant includes
hepatic
encephalopathy
...
767.
768.
769.
770.
771.
772.
773.
774.
775.
776.
777.
non-bloody, SAAG>1.1
complications of
ERCP
hemolytic reactions\
1. diagnosis of ABO
mismatch
2. complications of
ABO mismatch
3. febrile transfusion
reaction
male sex
age of infection >40
longer duration of infection
coinfection with HIV
immunosuppression
liver comorbidities
hepatic adenoma
1. definition
2. associated
conditions
3. histological
findings
focal nodular
hyperplasia
what primary
malignancies
metastsize to the
liver
creatinine >3-3.5 ~
will worsen the renal
failure
-
...
initial hematuria
terminal hematuria
total hematuria
incontinence
1. what medications
associated with
overflow
incontinence
1. anticholinergics, antipsychotics,
TCAs, sedative hypnotics
778.
779.
780.
781.
782.
783.
784.
785.
786.
787.
DRE
urinalysis, serum
creatinine - to rule out
infection
bladder cancer
do repeat prostatic
cultures and
cystoscopy
loss of antithrombin
3/S/C leads to
hypercoagulable state
in the renal vein
2. sudden onset
abdominal pain, fever,
hematuria
3. membranous
glomerulonephritis
fibromuscular dysplasia
1. dx
1. hypertension,
string of beads on
angiography
hum or bruit in the
costovertebral angle
inc. GFR
GBM thickening
mesangial expansion
nodular sclerosis
allopurinol pretreatment
penicillins, PPIs,
NSAIDs
sulfonamides, rifampin,
phenytoin, allopurinol
...
788.
789.
790.
791.
792.
793.
794.
795.
796.
cyclosporine
1. toxicity
2. mechanism
3. advantage/disadvantage of
tacrolimus
1. nephro, renal
vasoconstriction/HTN,
hyperkalemia,
neurotoxicity/tremor
gingival hypertrophy,
hirsutism*
infection, SCC, anorexia,
n/v, diarrhea
2. calcineurin inhibitor
(thus no transcription of
IL2 via NFKB)
3. no hirsutism or gum
hypertrophy - higher
incidence of neurotoxicity
diarrhea
797.
798.
799.
azathioprine
1. mechanism
2. SE
1. purine analog
metabolized to 6-MP
2. diarrhea, leukopenia,
hepatotoxic
800.
mycophenolate
1. mechanism
2. SE
1. reversible inosine
monophosphate
dehydrogenase inhibitor
~ rate limiting purine
synthesis step
2. bone marrow
suppression
801.
serum osmolality
1. high >295
1. hyperglycemia,
radiocontrast, mannitol
...
802.
803.
804.
805.
806.
807.
808.
broad categories of
causes of metabolic
acidosis
ketoacidosis - alcoholic,
diabetic, starvation
intoxications - methanol,
formalin, salicylate, ethylene
glycol, INH, metformin
tissue hypoxia
renal failure
cause of hypocalcemia in
an alcoholic
alcoholism electrolyte
imbalance
hypomagnesemia,
hypokalemia,
hypophosphatemia
aspirin toxicity
1. patho
2. clinical pres
1. corticosteroids, alcoholism,
hemoglobinopathies, lupus
(antiphospholipid)
2. progressive hip or groin
pain without restriction of
range of motion
3. MRI
viral arthritis
1. patho
2. dx
3. tx
809.
810.
811.
812.
813.
814.
what inflammatory
diseases associated with
aortic aneurysms
...
what inflammatory
diseases associated with
renal failure
what inflammatory
diseases associated with
alveolar hemorrhage
goodpasture, wegener's,
PAN, churg strauss, behcets,
antiphospholipid syndrome
what inflammatory
diseases associated with
depositional disease and
carpal tunnel syndrome
it is NON-DEFORMING
1. hypoxanthine guanine
phosphoribosyltransferase
deficiency --> elevated uric
acid
2. self mutilation, neurologic
disabilities in childhood
823.
824.
825.
826.
827.
815.
816.
817.
818.
819.
820.
821.
822.
vertebral compression
fractures
1. risk factors
2. clinical pres
1. demineralization/trauma
- osteomalacia,
osteoporosis,
2. intense focal pain, worse
when lying down
RETINA
rheumatoid arthritis
increases risk of
osteopenia/osteoporosis
828.
829.
830.
normal pressure
hydrocephalus
1. patho
2. clinical pres
3. tx
metoclopramide
1. mechanism
2. side effects
features of
cerebellar
disorders
benztropine (anticholinergics)
familial
dysautonomia
(riley day)
pseudotumor
cerebri
1. risk factors
2. clinical pres
3. dx/tx
anticholinergic
symptoms
831.
832.
833.
834.
835.
836.
837.
838.
839.
840.
side effects of
levodopa
TCAs or SSRIs
propranolol used to
specifically treat
which conditions
portal hypertension
essential tremor
hyperthyroidism (symptoms only)
aminoglycoside
toxicity
ototoxicity, nephrotoxicity
what electrolyte
abnormality
associated with
intracerebral
hemorrhage
1. medial medullary
syndrome
2. lateral medullary
syndrome
(wallenberg)
2. lateral pontine
syndrome
mid pontine
syndrome
842.
843.
844.
845.
creutzfeldt jakob
disease
1. patho
2. clinical pres
1. prion disease
2. rapidly progressing dementia,
myoclonus, periodic high EEG
voltage showing sharp triphasic
pattern
1. picks disease
2. lewy body disease
3. multi infarct
dementia
carotid artery
stenosis
1. when to operate
2. medical therapy
841.
846.
847.
848.
849.
850.
thiamine, supplemental
O2, naloxone, dextrose
waterhouse friderichsen
syndrome
bilateral hemorrhage of
adrenal glands 2/2 DIC
during neisseria meningitis
results in acute adrenal
insufficiency
antiarrythmics
1. procainamide + SE
2. synchronized DC
cardioversion
3. lidocaine + SE
1. antiarrhythmic used to
treat both supraventricular
and ventricular
arrhythmias
SE= drug induced lupus,
agranulocytosis, QT
prolongation
2. used to treat afib/aflutter
3. ventricular arrhythmias
in ACS patients,
****increases risk of
asystole
SE = confusion, seizures,
resp. depression
tetralogy of fallot
situational syncope
(autonomic dysreg syncope)
851.
852.
853.
854.
855.
856.
857.
858.
859.
860.
hypovolemic and
neurogenic
shock have dec.
MVO2 from inc.
oxygen
extraction
...
how do OCPs
cause
hypertension
amyloidosis
1. causes
2. clinical pres
in what specific
situation is beta
blocker
contraindicated
in MI
pulmonary edema
endocarditis
1. clinical pres
2. complications
why is
nifedipine
contraindicated
STEMI
- diltiazem and
verapamil dont
help either
...
amiodarone side
effects
slows SA/AV
node conduction
thus can cause
bradycardia
...
cocaine
mediated
cardiac
ischemia
1. tx
2. why are pure
beta blockers
contraindicated
861.
862.
863.
864.
865.
866.
867.
868.
869.
progressively decreasing
baroreceptor sensitivity *
worsening diastolic
function, dec.
resting/maximal CO.
dec. # of myocytes
...
others - speech
difficulty,
diaphoresis, altered
sensorium, cyanosis,
silent lungs
...
what decreases
mortality in COPD
home oxygen
smoking cessation
respiratory distress
pH <7.35, PaCO2>45, RR>25/min
complete
opacification of a
SINGLE lung with
shifted mediastinum
reyes syndrome
1. patho
2. tx
870.
871.
872.
873.
874.
875.
876.
877.
878.
879.
880.
881.
legionella
pneumonia
1. clinical pres
2. treatment
3. dx
hypoventilation
syndrome
882.
883.
884.
885.
aspirin
sensitivity
syndrome
886.
what
conditions will
increase fecal
fat
887.
D-xylose test
888.
acid fast
oocysts
also may be
isospora
...
when to order
EGD for
patients with
GERD
n/v
weight loss, anemia, melena/blood
long duration of symptoms >1-2 years
failure to respond to PPI
^ALARM
SYMPTOMS
...
GI bacterial
overgrowth
nutrient
defiencies
Vitamin D
Vitamin A - night blindness
B12 - neuropathy
what vitamin
deficiency in
carcinoid
syndrome
which type of
polyps are most
likely to
progress to
malignancy
889.
890.
891.
892.
893.
what GI pathology
is often associated
with elevated BUN
upper GI bleeding
two situations
where you can see
elevated BUN
without elevated Cr
upper GI bleeding
steroids
1. vitamin E
deficiency clinical
pres
2. Vitamin C """
most common
complication in UC
gallstone risk
factors
pancreatic
pseudocyst
treatment
how to evaluate
liver damage in
acute vs chronic
hepatitis
acute - LFTs
chronic - liver biopsy
causes of liver
biliary ductopenia
entamoeba
histolytica
1. patho
2. clinical pres
3. dx/tx
esophageal varices
HCC - (AFP)
894.
895.
896.
897.
...
906.
907.
...
RCC
diagnose with CTA
900.
amikacin
aminoglycoside
901.
causes of priapism
erythropoietin side
effects
1. hypertensive
nephropathy
histological
progression
898.
899.
urine sediments
1. muddy brown casts
2. RBC casts
3. WBC casts
4. Fatty casts
5. Broad and waxy casts
1. ATN
2.glomerulonephritis
3. interstitial
nephritis/pyelo
4. nephrotic syndrome
5. CRF
risk of urosepsis
just get a midstream urine
sample/culture and treat
empirically pending
culture results
MRI of spine
ILD, neuromuscular
disease, alveolar edema,
pleural fibrosis, chest wall
abnormalities
ethanol metabolized to
lactate which competes
with urate for renal
excretion
912.
913.
dihydrofolate reductase
inhibitor
macrocytic anemia*
nausea, stomatitis, rash,
hepatotoxicity, ILD,
alopecia, fever
914.
viral
infections/lymphoma,
nephrotoxicity
915.
adhesive capsulitis
908.
909.
910.
911.
902.
903.
904.
905.
causes of kidney
transplant rejection +
tx
1. risk
most common cause of
death in dialysis
patients
cardiovascular disease
hyperphosphatemia, inc. PTH,
inc. homocysteine, accelerated
atherogenesis 2/2
uremia/dialysate oxidative stress,
inc. calcium intake
916.
917.
918.
919.
920.
921.
922.
923.
924.
925.
926.
927.
lateral epicondylitis
anserine bursitis
1, clinical pres
prepatellar bursitis
hypervitamin D
causes
progressive multifocal
leukoencephalopathy
1. patho
1. JC polyomavirus reactivation in
immunocompromised patients.
causes destruction of white matter
2. hemiparesis, disturbance in
speech, vision, gait
causes of enhancing
lesions in the brain of
immunocompromised
patients
1. anterior vs
posterior circulation
of the brain
toxoplasmosis (strongly
enhancing) - MCC - avoid with
bactrim prophylaxis
primary CNS lymphoma (weakly
enhancing) - check for EBV DNA
in CSF
928.
929.
930.
931.
932.
934.
935.
936.
2. contralateral motor/sensory
deficits more pronounced in the
lower limbs, urinary
incontinence, primitive reflexes
3. contralateral motor/sensory
deficits more pronounced in the
upper limbs and homonymous
hemianopsia
4. homonymous hemianopsia,
alexia without agraphia,
sensory symptoms, third nerve
palsy with vertical gaze, motor
deficits (cerebral peduncle and
midbrain)
5. pure motor, pure sensory,
dysarthria clumsy hand, ataxic
hemiparesis- most common
location is the putamen (very
close to internal capsule)
glioblastoma multiforme
1. clinical pres
stroke
primary/secondary
prevention
sumatriptan/ergotamine
contraindications
1. uncomfortable sensation to
move legs, worse during sleep,
alleviated by movement
2. iron deficiency, elderly, CKD
3. dopamine agonists*pramipexole, ropinerole,
levodopa
...
...
937.
938.
939.
940.
941.
942.
943.
944.
945.
946.
947.
948.
atherothrombotic
strokes
paraplegia, bowel/bladder
incontinence, anesthesia from
the nipples down
what is best
measurement of
respiratory function in
GBS
FVC
atrial fibrillation
treatment
1. lone afib
2. afib + risk factors
1. aspirin alone
2. warfarin
**right ventricular
infarction/inferior wall
MI**DO NOT WANT TO DEC.
PRELOAD TREAT WITH IV
FLUIDS
aortic stenosis, recent
phosphodiesterase use,
950.
951.
952.
spina bifida
chagas disease
1. patho
2. clinical pres
1. t.cruzi protozoa
2.megacolon, megaesophagus,
dilated cardiomyopathy
antiarrhythmics
1. quinidine + SE
2. digoxin + SE
1. atrial arrhythmias
SE= tinnitus, QT, hemolytic
anemia, thrombocytopenia
2. inotrope and treats atrial
arrhythmias, especially in the
context of systolic dysfunction
SE= nausea, anorexia, AV
block,
ventricular/supraventricular
arrythmias
what electrolytes
abnormalities
associated with loop
diuretics
949.
953.
954.
955.
956.
hypokalemia,
hypomagnesemia, and
potentiate digoxin toxicity
957.
958.
959.
960.
961.
treatment of
congenital long QT
syndrome
beta blockers
what electrolyte
abnormality indicates
the severity of heart
failure
in what medical
context is FeNA
useless to determine
volume status
if patient is on diuretics
pneumoconiosis PFTs
acute massive PE
echo/EKG findings
hemodynamic instability
echo - RV dilatation
ekg - RV strain/ right axis
deviation
this is an indication
for thrombolytics
...
what is suggested by
new clubbing in a
COPD patient
what is key
distinguishing feature
between asthma and
COPD on PFTs (both
have dec. FEV1:FVC)
COPD shows no
change in FEV1 with
bronchodilator
...
962.
963.
964.
965.
966.
967.
968.
969.
970.
971.
972.
bronchogenic carcinoma,
mesothelioma
blastomycosis clinical
pres and treatment
serial CT scans
CHF exacerbation
blood gas findings
pickwickian
syndrome (obesity
hypoventilation
syndrome)
1. clinical pres
2. ABG findings
973.
974.
975.
976.
if patient is overly
ventilated on a
mechanical ventilator
what should be
adjusted first
977.
978.
979.
980.
981.
982.
causes of TIA
what pathologic
processes is
responsible for
diabetic
mononueropathies
nerve ischemia
cerebellar
lesions/tumors
clinical pres
HSV encephalitis
1. patho
2. dx
TB and fungal
meningitis
most common
organisms in brain
abscesses
what is most
important risk
factor for stroke
hypertension
CHADS2 - CHF, hypertension,
age>75, diabetes, previous stroke
complications of
heat stroke
983.
984.
985.
986.
987.
988.
989.
990.
991.
992.
993.
994.
niacin flushing
mechanism + how to avoid
non-hypersensitivity
histamine/prostaglandin
release
...
which antihypertensive
should be avoided in
asthmatics
beta blockers
hypothyroidism, adrenal
insufficiency
hypertension/hypokalemia
possible casues
primary hyperaldo
renovascular HTN
renin tumor
SAME
CAH
glucocorticoid suppressible
hyperaldosteronism
metabolic syndrome
(uworld)
995.
996.
997.
998.
999.
1000.
1001.
1002.
1003.
which antihyperthyroid
treatment can actually cause
atrial fibrillation
papillary carcinoma
GBS, ecoli
EHEC, shigella,
salmonella,
campylobacter
1004.
1005.
1006.
1007.
1008.
1009.
biliary sludging
anti-pseudomonals
cefepime
piperacillin-tazobactam
ciprofloxacin
aztreonam
imipenam/cilastatin
tobramycin
gentamicin
amikacin
coronary artery
disease equivalents
infectious screening
after patient is
diagnosed with HIV
why should
fluoroquinolones not
be used in children
management of
suspected
esophagitis in an HIV
patient
pulmonary cavitary
lesion in an HIV
patient possible
causes
mycobacterium TB
atypical mycobacterium
Nocardia - gram + weakly acid
fast branching rods- tx = bactrim
gram negative rods
anaerobes
1016.
1017.
1018.
1019.
1020.
1010.
1011.
1012.
1013.
1014.
1015.
amoxicillin clavulanate
treatment of
histoplasmosis in an
HIV patient
amphotericin B followed by
lifelong treatment with
itraconazole
what kind of
pneumonia post
influenza
actinomycosis
dx/treatment
1021.
1022.
1023.
1024.
1025.
bacillary
angiomatosis
bartonella henselae in
immunosuppressed patients
large pedunculated exophytic
papule with collarette of scale
looks like large cherry angioma
****careful before biopsy because
these lesions hemorrhage
tx = azithromycin**
treatment for
enterobius
albendazole, mebendazole, or
pyrantel pamoate
babesiosis
1. clinical pres
2. dx
3. tx
1. NO RASH - jaundice,
hemoglobinuria, renal failure,
death
2. giemsa thick/thin blood
smears, intravascular hemolysis,
anemia, thrombocytopenia,
atypical leukocytes (maltese
cross)
3. quinine-clindamycin,
atovaquone-azithromycin
lead poisoning
1. clinical pres
2. tx
1. non-specific complaints,
peripheral neuropathy, microcytic
anemia, renal damage/interstitial
nephritis
2. succimer, or EDTA chelators
1. acute monocytic
special diagnostic test
2. acute
lymphoblastic
leukemia diagnostic
test
metastatic brain
tumors
1. location
2. treatment
what conditions
should leukocyte
alkaline phos be used
to confirm a
diagnosis
hyposthenuria
1026.
1027.
1028.
1029.
1030.
why must
warfarin always be
bridged
graft vs host
disease
1. patho
2. organs effected
mycobacterium
leprae
1. clinical pres
contact dermatitis
1. what kind of
reaction
1. type 4 hypersensitivity
urushiol, nickel, formaldehyde,
certain fragrances, preservatives,
rubber, chemicals
2. calamine lotion, topical
antihistamines, topical
corticosteroids, oral steroids
1037.
1038.
1039.
1040.
1031.
1032.
1033.
1034.
1035.
1036.
prophyria cutanea
tarda
1. patho
1. uroporphyrinogen decarboxylase
deficiency in heme synth path
triggers - ethanol/estrogens
2. painless blisters,, skin fragility,
facial
hypertrichosis/hyperpigmentation
3. elevated urinary porphyrin
tx = phlebotomy,
hydroxychloroquine, interferon alpha
treatment for
seborrheic
dermatitis
ichthyosis
1. cherry
hemangiomas
2. strawberry
hemangioma
what skin
conditions
associated with
parkinsons
disease
seborrheic dermatitis
1041.
1042.
1043.
1044.
1045.
1046.
1047.
1. chalazion
2. hordeolum
3. stye
immune
deficiency
associations
1. C3 deficiency
2. C5-C8
deficiency
3. C1 inhibitor
deficiency
4. phagocytosis
5. C1q deficiency
scarlet fever
1. patho
2. clinical pres
eczema
herpeticum
felon
what patients at
high risk for
herpetic whitlow
rubella
1. clinical pres
dermatitis
herpetiformis
treatment
vancomycin side
effects
delirium tremens
1048.
1049.
1050.
1051.
1052.
1053.
1054.
treatment of
neuroleptic
malignant
syndrome
dantrolene
bromocriptine (dopamine agonist)
amantadine (antiviral with
dopamine agonist properties)
bradypnea
- not miosis becuase there are often
coingestions
5 phases
1. GI phase - first 6 hours - nausea,
vomiting, hematemesis, melena,
abdominal plain
latent phase - 24 hours asymptomatic
metabolic acidosis/shock - 72 hours
hepatotoxicity - 96 hours
mucosal scarring and bowel
obstruction weeks to months post
ingestion
TCA overdose
clinical
presentation
torsade de pointes
1.risk factors
2. tx
1. methanol
overdose clinical
pres
2. ethylene glycol
clinical pres
3. aspirin overdose
clinical pres
4. lithium ""
how to differentiate
alcohol from
benzodiazepene
intoxication
poisoning
treatments
1. aspirin/TCA
overdose
2. torsades 2/2
prolonged QT
3. lithium
4. lead poisoning
5. acetaminophen
6. iron
7. ethylene glycol
8. organophosphate
9.
diphenhydramine
1. sodium bicarb
2. mgSO4
3. hemodialysis
4. succimer, calcium EDTA
5. N-acetylcysteine
6. deferoxamine
7. ethanol, fomepizole (ADH
inhibitor), sodium bicarbonate,
hemodialysis
8. atropine, pralidoxime
9. physostigmine
1056.
1057.
1058.
1059.
1060.
1061.
1062.
1063.
1064.
1065.
1066.
1055.
1067.
1068.
1069.
ethylene glycol
poisoning
1. patho
phencyclidine
intoxication
treatment
bradycardia, AV block,
hypotension, diffuse wheezing***
tx = atropine, IV fluids, calcium,
glucagon** (inc. cAMP and inc.
Calcium levels --> improved cardiac
contractility)
digoxin toxicity
clinical pres
acetaminophen
toxicity
1. treatment
carbon monoxide
poisoning diagnosis
carboxyhemoglobin levels
tx = hyperbaric oxygen
cyanide poisoning
1. patho
methemoglobinemia
1. clinical pres
organophosphate
poisoning
1. clinical pres
2. tx
what kind of
immune response
from pneumococcal
vaccine
>200
fibrates
CRAO vs CRVO
1070.
1071.
1072.
1073.
1074.
1075.
1076.
1077.
1078.
1079.
1080.
1081.
...
CRAO treamtent
trachoma
1. clinical pres
1. follicular conjunctivitis,
pannus neovascularization of the
cornea,
2. oral tetracycline or
erythromycin
1. HSV retinitis
2. CMV retinitis
3. toxo retinitis
sympathetic
ophthalmia
1082.
1083.
1084.
1085.
1086.
1087.
1088.
1089.
retropharyngeal
abscess
1. clinical pres
1090.
diphtheria
1. clinical pres
1. pseudomembranous
pharyngitis, low grade fever,
nasal discharge, cervical
adenopathy
1091.
otitis externa
1. patho
2. treatment
1. pseudomonas>staph infection
of the external ear - causes severe
ear pain/drainage, can progress
to skull base or TMJ, destruction
of VII
2. topical neomycin, or systemic
ciprofloxacin if severe
key distinguishing
features of orbital
cellulitis vs preseptal
cellulitis
...
cough, hyperkalemia,
angioedema
most common
middle ear
pathology in HIV
patients
cholesteatoma
1. patho
aspirin
exacerbated
respiratory disease
peritonsillar
abscesses clinical
pres
allergic rhinitis
diagnosis
cause of ascending
vs descending
aortic aneurysms
PTU/methimazole
side effects
hypercalcemia of
bedrest
***give alpha
blocker first THEN
beta blocker
...
MEDICINE2 - step up to
medicine/pretest/lange/uworld/MKSAP4
Study online at quizlet.com/_iq4nz
1.
2.
3.
4.
5.
6.
7.
8.
9.
transplant/immunosuppressed
patients
patchy lung infiltrates
(compare to PJP) and colitis
(2/2 ulcerations)
1. vivax, ovale
2. malariae
3, falciparum
oseltamivir/zanamivir vs
amantadine/rimantadine
10.
11.
12.
13.
14.
oseltamivir/zanamivir
(neuraminidase inhibitors) type A/B
amantadine/rimantadine only type A
cultures grow
s.bovis/gallolyticus in
someone with
endocarditis
what is the next step
ehrlichiosis clinical
pres/tx
systemic symptoms,
leukopenia, thrombocytopenia,
elevated LFTs
tx = doxycycline
15.
16.
17.
1. pancreatitis
2. hypersensitivity syndrome
3. liver failure
4. crystal induced
nephropathy***
5. lactic acidosis
6. stevens johnson
1. pseudomonas,
stenotrophomonas
2. klebsiella
3. anaerobes (oral flora)
4. staph aureus - can
necrotize forming small thin
walled abscesses
infectious diarrhea
1. seafood
2. daycare
3. ground beef
4. undercooked pork
5. poultry
1. v.parahaemolyticus
2. shigella
3. EHEC
4. yersinia enterocolitica
5. campylobacter jejuni
mitral regurgitation
nocardia
1. patho/risk
factors/clinical pres
2. dx/tx
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
when to use
prednisone in
addition to TMPSMX
for treatment of PJP
disseminated
histoplasmosis
clinical pres
30.
31.
bartonella henselae
1. clinical pres
2. dx/tx
infection
32.
how to correct
elevated
homocysteine levels
senile purpura
lupus anticoagulant
1. patho
what should be
evaluated before
starting EPO for a
patient with CKD
migratory thrombophlebitis
look for occult malignancy
especially pancreatic cancer
CT abdomen
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
ewings sarcoma
1. patho
1.
2. white males first or
second decade, inc.
ESR, onion skinning
periosteal reaction,
and moth eaten soft
tissue
- often affects
metaphysis of femur,
tibia and humerous
bronchoalveolar
carcinoma,
adenocarcinoma
splenomegaly, anemia,
thrombocytopenia***
testicular suppression,
gynecomastia,
erythrocytosis,
hepatotoxicity, inc.
LDL
megestrol acetate
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
>200ml/hr
metastatic cord
compression treatment
algorithm
neurological examination, IV
steroids, MRI/CT myelogram,
radiotherapy or surgery
direct thrombin
inhibitors
clinical pres/treatment
for primary
dysmenorrhea
57.
58.
59.
60.
61.
62.
63.
64.
65.
53.
54.
55.
56.
anoscopy
subclinical
hyperthyroidism vs
thyroiditis diagnosis
furosemide, thiazide
sulphasalazine, 5-ASA
azathioprine, Lasparaginase
valproate
didanosine, pentamidine
metronidazole,
tetracycline
fibrates, octreotide,
ceftriaxone (use
cefotaxime to avoid
biliary sludging)
PT
limited hepatic
inactivation of
aldosterone and
increased aldosterone
secretion is most
responsible for cirrhotic
ascites
1. famciclovir
2. valacyclovir
3. ganciclovir
4. valganciclovir
5. acyclovir
1. herpes zoster
2. herpes zoster
3. CMV
4. CMV
5. HSV
dermatomyositis/polymyositis
clinical assc.
pneumococcal vaccine
ages/indications
amitriptyline,
desipramine,
nortriptyline, gabapentin,
NSAIDs
66.
67.
68.
69.
70.
71.
causes of ST elevations
STEMI, prinzmetal's
variant angina,
pericarditis
76.
77.
non-ICU - beta
lactam +macrolide
or doxy or
fluoroquinolone
monotherapy
ICU - beta lactam +
macrolide or
fluoroquinolone
Oral valacyclovir
trichomonas and
bacterial vaginosis
pH <7, pus
DIP
needle - small,
primary
spontaneous
tube - large,
secondary/complex
1. bacterial vaginosis
2. trichomonas vaginalis
1. increased
malodorous fishy
discharge, vaginal
erythema - clue
cells, tx =
metronidazole or
clindamycin
2. yellow green
pruritic frothy
discharge - not
malodorous
73.
74.
LOW MOLECULAR
WEIGHT HEPARIN
LONG TERM
NOT WARFARIN , NOT
IVC FILTER
79.
80.
cannot be detected by
conventional monitors
and pulse-ox
81.
78.
relative vs secondary
erythrocytosis
82.
83.
with systemic
complications acyclovir
85.
86.
conjugated hyperbilirubinemia
84.