356 Notes

Question Main
Sub Division Notes
Id Division
angioedema from ace inhibitors can occur at any time, not just
within weeks of starting the medicine
2770 Medicine Allergy & Immunology -check for airway compromise, vasomotor stability, give epi if
needed
-emergency trach sometimes if needed
3650 Medicine Biostatistics & Epidemiology Case Control = Determine predisposing RFs for a condition
attrition bias is a type of selection bias where pts are lost of
follow up which can skew data.
4178 Medicine Biostatistics & Epidemiology reporting bias = ppl are reluctant to report an exposure due to
stigma about the exposure (sexual behaviors, drug use, et
cetera.
Susceptibility Bias
-if treatment regimen "selected" for a pt is a function of how
sick that patient is, then results are likely to be skewed (sicker
7691 Medicine Biostatistics & Epidemiology patients will do more poorly than healthier patients as a whole)
-Do an ITT (intention to treat) analysis to compare initial
randomized treatment groups instead of groups that eventually
get treated on to avoid this sort of bias.
Uremic Pericarditis:
-high BUN -> pericardial inflammation
-Look for in pts with CKD who present with pleuritic CP that
2224 Medicine Cardiovascular System
improves with siting up +/- pericardial friction rub
-nonspecific T wave changes
-tx with dialysis +/- rule out tamponade
BB overdose: bradycardia, AV block, hypotension, *diffuse
wheezing* (specific to BBs vs. CCBs)
2663 Medicine Cardiovascular System
-tx with glucagon: increases intracellular cAMP. Also could
give epinephrine, iv lipid emulsion therapy
2687 Medicine Cardiovascular System HOCM is auto dominant inheritance
MVP mid to late systolic click that shortens with squatting.
2696 Medicine Cardiovascular System young females. atypical CP, dyspnea, palpitations, dizziness,
anxiety, panic d/o
Amyloidosis:
-cardiac (restrictive cardiomyopathy) CHF + ECHO findings of
constrictive LV hypertrophy with predominant RHF sx
2699 Medicine Cardiovascular System
-asymptomatic proteinuria, nephrotic syndrome, waxy skin,
anemia, bruising, hepatomegaly, subq nodules, enlarged
tongue, peripheral/autonomic neuropathy.
AAA "pulsatile mass" first test is the abdominal u/s. 100%
2717 Medicine Cardiovascular System sensitive and specific. can measure size, associated thrombus
can be found, and then f/u wih surgery or nah.
Prinzmetal Angina
-Tx with Diltiazem or nitrates
2723 Medicine Cardiovascular System
-young females, RF = smoking; seen with transient ST
elevations on EKG.
 Ventricular free wall rupture = LAD
2728 Medicine Cardiovascular System
Papillary muscle rupture = RCA
2732 Medicine Cardiovascular System Start ACE in a pt with an MI within 24 hr unless they have a CI
acute aortic dissection
3056 Medicine Cardiovascular System morphine, BB, ICU transfer, nitroprusside if SBP is still high,
surgery if asc aortic dissection
If someone has WPW (accessory pathway) AND they have
Afib; treat with procainamide as if they have just regular WPW.
3069 Medicine Cardiovascular System
-DO NOT BLOCK THE AV NODE! aka no adenosine, bb,
ccbs, digoxin. may precipitate VF.
3094 Medicine Cardiovascular System diet intervention > smoking cessation to reduce BP
Digoxin toxicity: Heart manifestations include increased ectopy
and increased heart block, so you get a very unique EKG
3096 Medicine Cardiovascular System
finding: atrial tachycardia with AV block. atrial speed is less
than what you'd see in flutter (250 instead of 350)
amiodarone toxicity = can lead to pulmonary toxicity in the
3506 Medicine Cardiovascular System
long run
Dressler's Syndrome
-fever, high ESR, malaise, pleuritic CP that improves with
3521 Medicine Cardiovascular System
leaning forward
-tx with nsaids
In a wide complex tachycardia, look for fusion beats
(diagnostic!) of sustained monomorphic ventricular tachycardia.
3763 Medicine Cardiovascular System
-increased R for V. arrythmias, VT, and VF.
-if stable, IV amiodarone
Amiodarone Toxicity
-Consider in a pt with dyspnea, cough, bilateral inspiratory
crackles, and diffuse reticular opacities on cxr, restrictive
pattern on PFTs in patients with ischemic cardiomyopathy
3769 Medicine Cardiovascular System
when other answer choices don't seem to fit
-class III antiarrythmic drug for v. arrythmias in pts with CAD
and isc. cardiomyopathy. monitor tsh, pneumonitis, ards,
aveolar hemorrhage, solitary masses
niacin may worsen glucose control in diabetics though it is
good for HDL upping
3822 Medicine Cardiovascular System
-fish oil to reduce TGs
-statins for everyone with an elevated ASCVD risk >7.5%
hypertensive emergency vs. urgency
3977 Medicine Cardiovascular System -retinal hemorrhages, exudates, papilledema
-cerebral edema, non-localizing neurologic s/sx
Cocaine MI Tx
-Supp O2, IV Benzos to decrease sympathetic outflow, reduce
4042 Medicine Cardiovascular System
BP, HR, CV sx
-Aspirin, nitrates, CCBs to decrease thrombus formation
 thoracic abdominal aneurysm
-vague CP, negative markers, asx but may present with back,
flank, abdominal pain
4129 Medicine Cardiovascular System
-more with EDS and marfans
-desc AA = atherosclerosis
-asc AA = due to cystic medial necrosis (age, EDS, marfans)
furosemide = increased K excretion
acei + loops = correct electrolyte abnormalities
4190 Medicine Cardiovascular System
hypoNa in CHF = bad = high renin, nepi, adh. restrict fluids,
add acei and loops
4243 Medicine Cardiovascular System cardiac index = cardiac output / body surface area
aortic valve closure in aortic stenosis is delayed and thus there
4277 Medicine Cardiovascular System
is a soft and single 2nd heart sound.
beck's triad
-hypotension
-distended neck veins
-muffled heart sounds
4345 Medicine Cardiovascular System pulsus paradoxus drop in bp with inspiration greater than
10mmhg
-positive hepatojugular reflux on abd exam
-look for viral pericarditis in a patient with a recent URI.
-clear lungs on exam in tamponade
orthostatic hypotension can cause syncope in old people, or
4377 Medicine Cardiovascular System people with prolonged recumbency, or ppl with autonomic
neuropathy (dm2, parkinson's)
4396 Medicine Cardiovascular System CXR findings are nonspecific in PE
Infective Endocarditis in IV Drug Users
-Staph most common
-HIV increases IE risk
-Tricuspid valve involvement more common than aortic valve
-septic embolus common *to the pulmonary circuit, which is
4398 Medicine Cardiovascular System
why pts have multiple round peripheral opacities in their lungs
-fewer peripheral manifestations of IE (no splinter
hemorrhages, janeway lesions)
-HF rare with tricuspid disease
-present with cough, CP, hemoptysis
"abrupt onset of reg tachycardia resolving with cold-water
immersion" = AVNRT (type of PSVT)
-nl hearts young ppl, presents with palpitations +/- dizziness,
SOB, CP
-2 conduction pathways slow and fast in the AV node. atrial
4450 Medicine Cardiovascular System
premature beat --> reentry mechanism sustained loop.
anterograde through slow, retrograde through fast
-VAGAL MANEUVERS - carotid sinus massage, cold water
immersion, diving reflex, valsalva, eyeball pressure -> PNS
tone increases --> slows condution AV
noncompliance is the MC cause of acute decompensated
4451 Medicine Cardiovascular System
heart failure
 digoxin toxicity
-renally cleared, narrow therapeutic index
-n/v, confusion, weakness, blurry vision/blindness
4454 Medicine Cardiovascular System -precip by viral infx, excessive diuretic use, renal injury -->
acute elevation of digoxin level
-HYPOKALEMIA is assoc with loop diuretic use; inc
susceptibility to toxic effects of digoxin.
pulsus parvus et tardus = delayed, slow-rising and diminished
(weak) carotid pulse. It is a sign of aortic stenosis
4455 Medicine Cardiovascular System
will also see single and soft 2nd heart sound S2
mid to late peaking systolic murmur
arterial occlusion of artery
4507 Medicine Cardiovascular System -left atrial thrombus (afib), LV thrombus after an anterior MI;
infective endocarditis / prosthetic valve
apixaban (and other nti-xa inhibs) shown to significantly
reduce risk of systemic embolization
4649 Medicine Cardiovascular System
-antiplatelet therapy with aspirin or clopidogrel is leff effective
than warfarin or DOACs
HOCM: The classic HOCM murmur is a
crescendo-decsecendo murmur in the L sternal border that
4673 Medicine Cardiovascular System
does not radiate to the carotids. Also will be seen in younger
more athletic male patients
ADPKD = bilateral asx masses + hypertension
-early flank pain, stones, UTIs
4680 Medicine Cardiovascular System -cerebral aneurysms, hepatic/pancreatic cysts;
MVP/AorRegurg; colonic diverticula; ventral/inguinal hernias
-tx ACE
Pulseless electrical activity:
-very different from pulseless lack of electrical activity (in
which case you shock)
4725 Medicine Cardiovascular System
-if there is any sort of rhythm that is appreciable on the cardiac
monitor, do CPR + give epinephrine uninterrupted. There is no
role for cardioversion or defibrillation in this case
asthma can be exacerbated by aspirin. Also nonselective beta
4742 Medicine Cardiovascular System
blockers.
pulsus paradoxus = >10mmhg drop of BP during inspiration
4771 Medicine Cardiovascular System (tamponade, severe asthma, COPD)
-
decreased tracer uptake with exercise with normal tracer
9648 Medicine Cardiovascular System
uptake at rest = inducible ischemia. Likely CAD
add an ACEi or ARB to reduce CCB-assocaited peripheral
10179 Medicine Cardiovascular System
edema
nitroprusside infusion for hypertensive emergency to rapid BP
lowering. breaks down into cyanide and nitric oxide. -->
10763 Medicine Cardiovascular System arteriolar / venous vasodilation --> lower BP
-BUT it causes cyanide toxicity if too high dose. MC in pts with
renal insufficiency. AMS, lactic acidosis, seizures, coma.
 constrictive pericarditis
-RHF important cause!
-progressive peripheral edema, ascites, elevated JVP,
pericardial knock; pericardial calficiations on CXR
10764 Medicine Cardiovascular System
-usually idiopathic or viral, surgery, radiation, TB
-EKG: "low voltage QRS + Afib"
-pericardial thickening, calcifications
-prominent x/y descents on JVD
tinea versicolor = ptiaryasis = malasezia furfur/globosa
infection. Will see spagetti and meatballs
-hot humid weather
-KOH prep budding yeast
2747 Medicine Dermatology
-tx with selenium sulfide, ketoconazole

dermatophyte infection = ringworm. tinea corporis. these need

keratin for growth.
bullous pemphigoid
-tx clobetasol
2751 Medicine Dermatology
->65 in MS or parkinsons pts
-IgG autoantibodies vs hemidesmosomes
diffuse dermal scaling = ichthyosis vulgaris. chronic inherited
2754 Medicine Dermatology skin disorder --> diffuse dermal scaling. basically just ashy
skin disorder
Rosacea rash tx:
-avoid etoh, spicy foods
-sun protection
2776 Medicine Dermatology -cleansers/emolients
-topical metronidazole for papulosquamous type
-laser
-topical brimonidine for erythematotalngiectactic type
Classic infectious cause of TEN/SJS is mycoplasma
2777 Medicine Dermatology
pneumoniae
vitiligo = autoimmune destr of melanocytes
2779 Medicine Dermatology
-tx steroids topical then steroids
3811 Medicine Dermatology nickel allergy = type 4 = tx with topical corticosteroids
SCC is the most common malignancy in pts on
immunosuppressive therapy for a history of organ
4033 Medicine Dermatology transplantation
-more aggressive, higher risk of recurrence and regional
metastasis
PCT seen in HepC, HIV, Etoh, estrogen use, smoking pts
-test for urine or plasma porphryn levels
4314 Medicine Dermatology
-pct sx include blisters/bullae/scars in sun exposed areas;
similar to scleroderma
senile purpura
-skin fragile, ecchomoses, nl lab results
4355 Medicine Dermatology -seen with extensive sunlight
-loss of elastic fibers in perivascular connective tissue
-no further w/u required, but need careful wound care
 Steroid-Induced Acne
-systemic / topical steroids, azathioprine, cyclosporine, and
other drugs like anti-TB or anticonvulsant drugs
4812 Medicine Dermatology
-vs. acne vulgaris: steroid-induced is more monomorphic and
at the same stage of development
-resolves upon d/c of tx
10298 Medicine Dermatology idiopathic acute urticaria
Warts (HPV)
-can be plantar, palmar, or genital
10485 Medicine Dermatology
-IC pts
-look like little white circles
epidermal inclusion cyst waxes and wanes, freely movable
10670 Medicine Dermatology cyst or nodule with a central punctum
-leave alone
malignant otitis externa
-elderly diabetic with ear pain, drainage. poorly controlled
2828 Medicine Ear, Nose & Throat (ENT) dm2. granulation tissue visible inside the ear.
-facial droop -- facial n destruction 2/2 osteomyelitis of the
skull base
furosemide === hearing loss; med induced ototoxicity. also
2838 Medicine Ear, Nose & Throat (ENT) seen with aminoglycosides, chemo, aspirin, and loop diuretics
-reverisble hearing loss and tinnitus
MC INFECTION IN AIDS
-Serous otitis media
2839 Medicine Ear, Nose & Throat (ENT) -2/2 HIV lymphadenopathy leading to auditory tube dysfxn;
-sx = conductive hearing loss
-dull tympanic membrane hypomobile on pneumatic otoscopy
Nasal Polyps
-NSAIDs + rhinitis + post-nasal drip = aspirin exacerbated
2842 Medicine Ear, Nose & Throat (ENT)
respiratory disease (leads to nasal polyps)
-food can taste bland, rec nasal discharge/block
Ovarian / Adrenal Tumors: If there is a precipitous rise in the
manliness of a female patient (<6 mos) that occurs in a middle
Endocrine, Diabetes & aged woman rather than a young one, or in a woman who's
2170 Medicine
Metabolism not fat enough to have PCOS, think of ovarian / adrenal
masses first. Check DHEAS (adrenal) and Testosterone
(ovarian) before checking LH / FSH
Cushing's Syndrome: Painless muscle weakness associated
with wt gain, bone loss, htn, hirsutism.
-myopathy caused by weakness in proximal muscles
Endocrine, Diabetes &
2173 Medicine (catabolic effects of cortisol on skeletal muscles --> muscle
Metabolism
atrophy)
-be suspicious of this if the patient has bone demineralization
and hirsutism as well.
HYPOPITUITARISM
-LOW ACTH, CORTISOL, FSH, LH, TEST, FT4
Endocrine, Diabetes &
2175 Medicine -Aldosterone will be NL since it is mostly controlled by RAAS
Metabolism
(vs. 1* adrenal insufficiency = low aldo, high K, low BP, high
ATCH, hyperpigmentation)
 Endocrine, Diabetes &
2176 Medicine symptomatic hypercalcemia necessitates parathyroidectomy
Metabolism
PTU / Methimazole
Endocrine, Diabetes & -agranulocytosis
2178 Medicine
Metabolism -if pt with fever/sore throat --> D/C!!! especially if white count is
<1000.
Graves Disease
Endocrine, Diabetes & -Hyperthyroidism with diffuse RAI uptake
2179 Medicine
Metabolism -use anti-thyroid drugs like methimazole and propanolol as a
bridge to thyroidectomy if pt has increased r of complications
sulfonylurea OD can be hard to dx as c-peptide lvls will be
Endocrine, Diabetes &
2188 Medicine high. they lead to extra insulin release from the beta cells.
Metabolism
measure plasma sulfonulurea levels to dx.
Endocrine, Diabetes & best way to reduce progression of diabetic nephropathy is
2190 Medicine
Metabolism strict blood pressure control
-hashimoto's = hypothyroid = TPO antibody; diffuse goiter;
variable uptake
Endocrine, Diabetes & -painless thyroiditis = hyper then hypo, self-resolving.
2191 Medicine
Metabolism NONTENDER goiter; low uptake
-subacute thyroiditis = postviral hyperthyroidism; PAINFUL
goiter; high esr/crp, low radioiodine uptake
carcinoid syndrome
-presents with flushing, telangiectasias, diarrhea, cramps,
valvular lesions (R>L), bronchospasm
Endocrine, Diabetes & -can co-present with sx of niacin deficiency (dermatitis,
2220 Medicine
Metabolism diarrhea, dementia)
-dx with high 5-HIAA excretion; CT/MRI of abdomen/pelvis to
localize tumor
-ECHO
MEN1 = parathyroid adenoma, gastrinoma, pituitary adenomas
Endocrine, Diabetes &
2630 Medicine -symptomatic hypercalcemia looks like constipation, polyuria,
Metabolism
abdominal pain
VIPoma
-watery diarrhea, low Cl (low gastric acid secretion), flushing,
lethargy, n/v, muscle weakness/cramps
Endocrine, Diabetes &
2649 Medicine -low k, high ca, high glu
Metabolism
-high sodium in the poop with osmolal gap <50
-VIP level >75 dx-stic
-CT/MRI to localize tumor
patients with mild hyper-aldo may not have spontaneous hypo
Endocrine, Diabetes &
3230 Medicine K, but they are prone to develop diuretic-induced hypokalemia
Metabolism
when they take thiazides
hypothyroidism can cause hyperlipidemia, hyponatremia, and
Endocrine, Diabetes &
3483 Medicine asx elevations of creatinine kinase (<10x nl) and
Metabolism
transaminases. Can cause hyper TGs also
normal everything else and low T3 = euthyroid sick synrome
Endocrine, Diabetes & -caused by caloric deprivation, high inflammatory state, high
3495 Medicine
Metabolism glucocorticoids inthe blood, etc.
-seen in hopital patients
 causes of recurrent preg loss include
Endocrine, Diabetes &
3496 Medicine -thyroid, pcos, dm2, hyper PRL, celiac dz, and uterine
Metabolism
structural probs of all kinds (fibroids, etc.)
DM neuropathy - axonopathy of large fibers. length-dependent
axonopathy - longest = leg nerves = affected first.
Endocrine, Diabetes &
3795 Medicine small fiber = pain, parasthesias, allodynia = "positive" sx
Metabolism
large fiber = LOSS OF sensation, proprioception, vibration,
reflexes
diabetic neuropathy (loss of reflexes, vibr/prop alterations,
pain, paresthesias.
Endocrine, Diabetes &
3800 Medicine -tx with TCAs, duloxetine, pregabalin, gabapentin. USE TCAs
Metabolism
WITH CAUTION IN >65yo due to its ANTICHOLINERGIC
EFFECTS!
polyuria with dilute urine in the setting of high serum Na points
towards diabetes insipidus.
Endocrine, Diabetes & central DI: low ADH from pituitary --> less water reabsorbed
3899 Medicine
Metabolism --> water loss with polyuria.
nephrogenic: ADH receptor issue. intact thirst mechanism and
may have a normal Na level.
ACE-i
Endocrine, Diabetes &
3902 Medicine -reduces urinary albumin
Metabolism
-decreases intraglomerular pressure
thyrotoxicosis causes htn by directly increasing cardiac
contractility. Not by increasing catecholamine release.
-causes afib/flutter
-sys HTN + high pulse pressure; high myocardiac o2 demand
Endocrine, Diabetes &
3952 Medicine -leads to high output HF or exacerbation of pre-existing
Metabolism
low-output HF
-coronary vasospasm
-effects on myocytes are mediated by T3
-there is a minor effect of inc catecholamines
Pheochromocytoma
Endocrine, Diabetes &
3976 Medicine -severe htn can be precipitated by surgical procedures, use of
Metabolism
bb, induction of anesthesia, and serveral other medications.
increased thyroid-binding globulin: estrogens (pregnancy,
Endocrine, Diabetes & OCPs, HRT), hepatic dysfnction, tamoxifen.
4132 Medicine
Metabolism decreased TBG: cushings, glucocorticoids, nephrotic
syndrome, starvation, niacin, androgens
Thyroid disease: If you do a radioactive iodine uptake test
(RAIU) and you see lots of stuff lighting up then it's graves dz
or a toxic nodular goiter (tx methimazole). If there is decreased
Endocrine, Diabetes &
4286 Medicine uptake, then consider subacute thyroiditis or painless
Metabolism
thyroiditis, where the sx are a result of released of preformed
hormones from the thyroid (tx propanolol). CHeck peroxidase
abs also for hashimotos.
 1* Adrenal Insufficiency
-50% of people with autoimmune adrenalitis have other
autoimmune conditions involving the endocrine glands
(thyroid, parathyroid, ovaries)
Endocrine, Diabetes &
4305 Medicine -Also common are pernicious anemia and vitiligo
Metabolism
-Presents with hypotension, pigmentation, hyponatremia,
hyperkalemia, esinophilia, HIGH ACTH, low serum cortisol
levels)
-1* = autoantibodies vs. adrenal steroidogenic hormones
Endocrine, Diabetes & excess thyroid hormone leads to inc osteoclast activity -->
4307 Medicine
Metabolism high Ca --> low PTH --> calciuria, calcium wasting
Lid lag = thyroid
hyperreflexia, afib, tremors, prox muscle weakness also =
Endocrine, Diabetes & THYROTOXIC MYOPATHY
4382 Medicine
Metabolism -muscle atrophy in the prox
polymyositis has muscle atrophy as a late finding instead of an
early finding like in thyroid myositis
graves disease tx caveats
-methimazole and ptu cause agranulocytosis
Endocrine, Diabetes &
4415 Medicine ptu = heaptic failure
Metabolism
raiu = WORSENING OPTHALMOPATHY
surgery = risk of nerve damage hoarseness, r of hypoPTH ism.
Endocrine, Diabetes & hoarseness is apparently a sign of hypothyroidism, as are
4471 Medicine
Metabolism memory changes.
HHS - more AMS, gradual onset of hyperglycemic s/sx;
glucose >600 (vs. <500 in DKA); bicarb >18, normal AG, trace
Endocrine, Diabetes & ketones, high serum osm >320
4516 Medicine
Metabolism -caused by things like steroid use, infections, thiazides,
pentamidine, atypical antipsychotics, insulin thereapy
noncompliance, trauma/acute illness
tight glycemic control has microvascular benefits (less
Endocrine, Diabetes & retinopathy, nephropathy) but the macrovascular benefits (MI,
11367 Medicine
Metabolism stroke) are unknown. all-cause mortality is not affected by
glycemic control.
BRCA
Female Reproductive
2605 Medicine -best prognostic factor is TNM staging, following by receptor
System & Breast
status (ER+ PR+)
d xylose test = celiac's
-absorbed by the small intestine without modification and is
excreted in the urine. Can measure.
2198 Medicine Gastrointestinal & Nutrition
-mucosal dz = poor absorption
-enzyme deficiency = good absorotpion
-
 toxic megacolon
-IBD, c dif infection
-fever, tachy, hypotn, bloody diarrhea, abd distention,
peritonitis, colonic distention on imaging
-mgmt bowel rest, NG suction, abx, +/- corticosteroids if
2205 Medicine Gastrointestinal & Nutrition
IBD-related.
-may be the initial presentation of IBD - be on the look out.
Radiologic diagnosis with >6cm distention with severe
systemic toxicity. Tx with conservative mgmt and
corticosteroids
Pancreatic cancer:
-mostly in head of pancreas
-compress panc duct and common bile duct...painless
2209 Medicine Gastrointestinal & Nutrition
jaundice! "double duct sign"
-intra and extra hepatic biliary duct dilation, distended
gallbladder (courvoisier's sign)
lower GI bleeding MC due to diverticulosis
-mc in sigmoid colon
-painless, large-volume (+/- lightheadedness, hemodynamic
instability)
2341 Medicine Gastrointestinal & Nutrition
-most will relieve spontaneously
-confirm on colonoscopy
-AVMs less common than diverticulosis. ALso they don't cause
large volume bleeds
maltomas spontaneously regress most of the time when tx the
2596 Medicine Gastrointestinal & Nutrition
underlying pylori infection unless there are already mets
malabsorption related problems lead to the most of the
complications of PBC --> osteoporosis, osteomalacia, HCC
2759 Medicine Gastrointestinal & Nutrition
(not colorectal cancer)
-osteomalacia is a big one
2920 Medicine Gastrointestinal & Nutrition PSC = UC = fatigue and pruritus; asx at time of dx
pts with varices in cirrhosis should be started on a nonselectie
2921 Medicine Gastrointestinal & Nutrition B blocker to reduce risk of bleed.
-1/3 of varices bleed. sig rr morbiditiy and mortality
ALT more specific for hepatic injury
AST all over body including liver heart kidney muscle
2937 Medicine Gastrointestinal & Nutrition -asx elevation can be caused by the following meds: NSAIDs,
antibiotics, hmg-coa inhibitors, anti-epileptic drugs,
antituberculous drugs, herbal preparations)
Primary Biliary Cholangitis = + anti-mitochondrial ab
-autoimmune destruction of intrahepative bile ducts
-pruritis, fatigue are first sx
2950 Medicine Gastrointestinal & Nutrition
-tx with ursodeoxycholic acid: decreases biliary injury by inc
secretion, delay histologic progression in PBC.
-late stage = liver transplant
 hepatic hydrothorax
-cirrhosis pts with ascites
-MC on right side bc less muscular hemidiaphragm
2969 Medicine Gastrointestinal & Nutrition
-defects in the diagraphm lead to ascitic fluid to pass into the
lung space
-tx with salt restrict, diuresis, thora
Acute cholangitis: tx with beta-lactam+lactamase; 3rd gen
2978 Medicine Gastrointestinal & Nutrition
cephalosporin + metronidazole
After Coronary Angiography
-cholesterol embolism is common
-leads to livedo reticularis (blue toe) or GI issues (mesenteric
2982 Medicine Gastrointestinal & Nutrition
ischemia, acute pancreatitis)
-if pt has acute panc d/t atheroembolism, mgmt is conservative
and as usual
3086 Medicine Gastrointestinal & Nutrition b12 def = high methylmalonic acid levels
Pellagra = niacin deficiency
-diarrhea, dementia, dermatitis
-3rd world people who have corn based diets only
3087 Medicine Gastrointestinal & Nutrition -1st world in Etoh, chronic illness; carcinoid syndrome
-hartnup disease
-prolonged isoniazid therapy can mess with tryptophan
metabolism and lead to pellagra
pneumoperitoneum = likely perforated PUD; peritonitis from
acid from the stomach irritation
3178 Medicine Gastrointestinal & Nutrition
-rebound tenderness, guarding
-delay of dx inc mortality and complication rates
Colovesical fistula
3467 Medicine Gastrointestinal & Nutrition -complx of acute diverticulitis
-fecaluria, pneumaturia (air), rec UTIs; mixed flora,
diarrhea, abd pain, weight loss in middle aged man with
3582 Medicine Gastrointestinal & Nutrition
chronic ough. skin hyperepigmentation = whipple's disease
Gastrinoma
-gastrin <100 r/o, 100-1000 secretin test, 1000+ diagnostic.
3591 Medicine Gastrointestinal & Nutrition -seen in pts with MEN1 also.
-refractory GERD to PPIs, or super distal ulcer locations like in
the duodenum or jejunum
collagenous collitis = chronic watery diarrhea in a pt with nl
colonoscopy mucosa, subepi collagen deposition
3602 Medicine Gastrointestinal & Nutrition -biopsy-confirmed celiac dz can have negative results on
anti-TTG ab screen d/t selective IgA deficiency that can be
seen in pts with celiac disease!
 small intestinal bacterial overgrowth
-etiology: strictures, surgery, dm, scleroderma, esrd, aids,
cirrhosis
-s/sx: abd pain, diarrhea, bloating, flatulence, malabsorption,
wt loss, anemia, nutr deficiencies
3603 Medicine Gastrointestinal & Nutrition -dx with endoscopy with jejunal aspirate showing >10^5
organisms/mL
-glucose breath hydrogen testing
-strep, bacteriodes, etc.
-tx with rifaximin, amox-clav, NO narcotics, dietchanges, or
pro-motilitity agents
lactose tolerance test = measure breath H level after lactose
ingestion. + = bacterial carbohydrate metabolism rather than
metabolism by your body.
3605 Medicine Gastrointestinal & Nutrition
Diarrhea 2/2 lactose intol has a high osmotic gap
(unmetabolized lactose and other organic acids)
290 - 2*(na+k) = osm gap and is >50
porcelain gallbladder
-chronic cholecystitis
3732 Medicine Gastrointestinal & Nutrition
-CXR shows rimlike calcifications, CT = rim; high risk for
progression into gallbladder adenocarcinoma. cut it out = tx
Acute Pancreatitis
-2/2 to valproic acid use
3833 Medicine Gastrointestinal & Nutrition
-furosemide, thiazides, sulfasalazine, 5-asa, azathioprine, HIV
drugs, metronidazole, tetracyclines
IBD / UC pts are high risk for getting toxic megacolon within 3
years of dx.
s/sx of megacolon = total/segmental non-obstructive colonic
3834 Medicine Gastrointestinal & Nutrition
dilation, bloody diarrhea,fever, tachycardia. treat with iv fluids,
abx, and bowel rest. IV corticosteroids are for IBD-induced
toxic megacolon. surgery if the colitis doens't resolve
Minimal BRBPR: <40: anoscopy, 40-49: sigmoidoscopy; 50+
colonoscopy. Has to do with risks for cancer vs. hemorrhoids
3857 Medicine Gastrointestinal & Nutrition
(benign). If there are changes in bowel habits, IDA, abd pain,
wt loss, or FH of colon ca, then go straight to the colonoscopy
Chronic giardiasis is a thing. Pts with nonbloody diarrhea for a
long time after travel to an endemic location should be w/u for
3887 Medicine Gastrointestinal & Nutrition
giardiasis. tx with metronidazole. Confirm first with stool
microscopy or a nucleic acid amplification assay.
nsaid + aspirin use in someone with conjunctival pallor = IDA.
3936 Medicine Gastrointestinal & Nutrition Look for gastritis or ulcers, or chronic GI blood loss. then
panscope.
angiodysplasia = mc painless GI bleed. cautery if pt is
4085 Medicine Gastrointestinal & Nutrition
symptomatically anemic
 osm vs. secretory diarrhea
-stool osmolal gap = plasma osm - 2(stool Na + K)
if osmotic, then >125 gap (high)
4150 Medicine Gastrointestinal & Nutrition if secretory, then there is increased secretions of ions and the
plasma osm vs. fecal sodium difference is LOW (<50)
-causes of secretory diarrhea: vibrio, rotavirus, CF, ileocolitis,
postsurgical changes)
zenker's
-neck mass varies in size with intake of food and fluids
4188 Medicine Gastrointestinal & Nutrition -caused by sphincter dysfunction and esophageal dysmotility -
leads to posterior herniation between the fibers of the
cricopharyngeal muscle
tx diffuse esophageal spasm with CCBs (dilt) to relieve pain
4226 Medicine Gastrointestinal & Nutrition
and reduce dysphagia
Alcoholic Hepatitis
-fever, jaundice, anorexia, tender hepatomegaly, and mild
elevation of AST:ALT 2:1; macrocytic anemia; and
thrombocytopenia and high INR.
4278 Medicine Gastrointestinal & Nutrition
-Clinical dx; no need for RUQ U/S or anything
-radiograph reveals fatty liver dz, cirrhosis, ascites
-tx with abstinence, hydration, nutritional support, and acid
suppression +/- biopsy if there is dx uncertainty
the most common cause of cancer metastasis is the liver; if
4389 Medicine Gastrointestinal & Nutrition there is unexplained hepatomegaly, look for clues as to where
the cancer could be (cough cough positive FOBT)
Biliary Colic
4433 Medicine Gastrointestinal & Nutrition -pain resolution within 4-6 hours and absence of abdominal
tenderness, fever, leukocytosis
multiple liver lesions on CT; metastatic dz most likely
originating in the COLON. Colon blood moves through the
4612 Medicine Gastrointestinal & Nutrition
portal circulation directly into the liver.
-lung and brca also. get a cxr, but not 1st
GERD --> Barrett's --> Strictures --> progressive dysphasia
4694 Medicine Gastrointestinal & Nutrition (solid foods) + block reflux --> improved symptoms (strictures
that are symmetric) --> DO A BIOPSY to r/o adenocarcinoma
mesenteric ischemia = POOP to physical exam findings
4697 Medicine Gastrointestinal & Nutrition
-cardiac embolus from afib, shock, vasoconstriction
pill esophagitis = sudden onset odynophagia and retrosternal
4934 Medicine Gastrointestinal & Nutrition
CP that can cause difficulty swallowing.
small int. bacterial overgrowht = seen in DM or ppl with fistulae.
12406 Medicine Gastrointestinal & Nutrition
asians = lactose intol
LOW HAPTOGLOBIN = intravascular hemoglobin
-hgb-haptoglobin form a complex and are cleared by the liver.
Will also see higher indirect bili and high LDH levels (which is
released from RBCs)
2248 Medicine Hematology & Oncology
Extravascular hemolysis = nl ish ldh, bili, haptoglobin; usually
due to antibody or intrinsic enzyme pathology (g6pd, hered.
spherocytosis)
 PNH
-hemolysis, fatigue, cytopenia, VENOUS THROMBOSIS
(intraabdominal + cerebral veins)
2258 Medicine Hematology & Oncology
-high LDH, low haptoglobin, indirect bili up, hemoglobinuria
-flow cyt shows absence of cd55/59
-tx eculizumab; supp Fe folate
young pt with swollen knee, soap bubble lesions on the
epiphysis of bone == giant cell tumor of bone. seen with
pathologic fractures
sheets of giant cell osteoclasts on histology.
osteitis fibrosa cystica = hyperPTH from cancer in multiple
2618 Medicine Hematology & Oncology
bones, presents with brown tumors.

OSTEOID OSTEOMA = sclerotic cortical lesion with a central

nidus of lucency. NOT IN THE EPIPHYSIS. pain is relieved
with Nsaids.
migratory superficial thrombophlebitis (Trousseau's Syndrome)
-hypercoagulable d/o presents with superficial venous
2624 Medicine Hematology & Oncology thrombosis at unusual sites (arm, chest, etc.) and is usually
dx'd weeks/months prior to dx of occult visceral malignancy
(MC pancreatic cancer), followed by lung, prostate, stomach.
cancer-related anorexia can be managed by giving megestrol
acetate (a progesterone analog)
2646 Medicine Hematology & Oncology
-nutritional counseling also
HIV cachexia = synthetic cannabinoid tx
warfarin-induced skin necrosis occurs in normal people when
they start warfarin without a bridge bc protein c depletes first.
2658 Medicine Hematology & Oncology
this process is accelarated in patients who have protein c
deficiency as a defect
Hairy Cell
-BRAF mutation, B cell neoplasm
-middle age or older
2868 Medicine Hematology & Oncology
-pancytopenia, splenomegaly
-bone marrow bx; hairy leukocyte cells
-chemo with great life expectancy
aniscocytosis, poikilocytosis can be seen in b12 deficiency
2872 Medicine Hematology & Oncology -basophilic stipping is assoc w lead poisoning but is
nonspecific. also from etoh, thalassemias,e tc
CLL = lymph nodes painless enlargement
-hepatosplenomegaly, mild thrombocytopenia/anemia, asx
-lymphocytosis + smudge cells on smear
2887 Medicine Hematology & Oncology
-flow cytometry to dx; LN / BM Bx not needed
-complicated many times by being prone to infections, AHA,
secondary malignancies - Richter transformation
2889 Medicine Hematology & Oncology BM bx to confirm MM. should show >10% clonal plasma cells
chronic myeloid leukemia
2894 Medicine Hematology & Oncology -BCR-ABL gene fusion causes it (9 and 22 chr fusion)
-leukemogenesis due to tyr kinase activation. tx with imatinib.
 Hereditary spherocytosis
-hemolytic anemia, jaundice, splenomegaly
-RR bilirubin gallstones, parvo v19 infections --> aplastic crisis
3062 Medicine Hematology & Oncology
-high MCHC, reticulocytosis, high RDW
-osmotic fragiility or eosin-5-maleimide binding test
-tx with folic acid
correction of the folic acid deficiency without correction of the
3066 Medicine Hematology & Oncology B12 deficiency can lead to rapid progression of neurologic
complications
pernicious anemia is associated with autoimmune thyroid
problems and vitiligo in the eastern european population
-shiny tongue atrophic glossitis
3067 Medicine Hematology & Oncology -thrombocytopenia (sometimes)
-b12 anemia = pernicious
isoniazid tox = neuropathy, hepatotoxicity. that's it. Can also
cause sideroblastic anemia
if there is confirmed clinical suspicion of PE, then
anticoagulate before tests. If there is only signs of DVT, then
3596 Medicine Hematology & Oncology
do tests before anticoagulation bc anticoagulation has risk! 1st
step is compression U/S
hereditary hemochromatosis = dark skin, diabetes, slightly
3890 Medicine Hematology & Oncology elevated liver enzymes, future HCC risk, can also see erectile
dusfunction.
EPO deficiency:
-common in ESRD.
3978 Medicine Hematology & Oncology
-SE include: worse HTN (mechanism unknown)
also headaches, flu-like sx; red cell aplasia (rare)
chronic GI blood loss even in asx pts is the first thing to look
4081 Medicine Hematology & Oncology
for in IDA in males or post-menopausal females
Phenytoin causes folic acid deficiency
-also primidone, phenobarbital
4147 Medicine Hematology & Oncology
-less absorption in the small intestine
-also bactrim, methotrexate
GVHD disease = 50% of sibling to sibling BMTs
4151 Medicine Hematology & Oncology
-skin, intestine, and liver are most often affected
Anemia:
-loss of RBC production, increase RBC production, or blood
loss
4329 Medicine Hematology & Oncology
loss of production = lymphoproliferative cancer (leukemia,
lymphoma)
 TTP
-thrombocytopenia
-neurologic
-maha
-kidney failure
-fever
4339 Medicine Hematology & Oncology
look for a normal PT, RBC fragments
-tx with plasma exchange

vs. HUS: HUS is assoc with O157H7, renal sx mostly. Will not
see neuro and fever
ESRD Anemia
-low EPO --> normochromic, hypoproliferative, normocytic
4349 Medicine Hematology & Oncology anemia
-replete Fe with EPO because increase Hgb will deplete iron
stores
hard, unilateral non-tender lymph nodes = eval immediately.
4352 Medicine Hematology & Oncology
older pt === HNSCC
B12 deficiency: macrocytic anemia, glossitis, neurologic
changes (neuropathy). pernicious anemia --> MC cause;
4356 Medicine Hematology & Oncology -anti-intrinsic factor Abs block b12 absorption
-chronic atrophic gastritis develops, with reduced intrinsic
factor production, and inc rr of gastric and carcinoid tumors.
Anemia of Chronic Disease
-low tranferrin saturnation, normal to elevated ferritin, and low
4358 Medicine Hematology & Oncology TIBC.
-tx the underlying chronic condition to resolve the anemia
-RA: hydroxychloroquine, methotrexate, infliximab, etc.)
DVT + high homocysteine
4384 Medicine Hematology & Oncology -high homocys = predisposed to thrombosis. tx with pyridoxine
*(vitamin B6), and potentially B12 if it is found to be low.
anti-phospholipid syndome
-1 clx + 1 lab criteria must be met
-a/v thrombosis, >3 fetal losses before 10th week, >1 fetal loss
4412 Medicine Hematology & Oncology
after 10th week, >1 premie birth of nl neronate before 34th
week d/t pre-e, e- or placental insufficiency
-lupus anticoag, anti-cardiolipin, anti-b2GP1 ab
Pancytopenia in SLE is due to many mechanisms, including
peripheral immune-mediated destruction of all 3 cell lines.
4416 Medicine Hematology & Oncology
there are also other mechanisms 2/2 to drugs, etc. but they
are less common
osler-weber-rendu syndrome
-AD
-diffuse telangiectasias, recurrent epistaxis, widespread AVMs
4447 Medicine Hematology & Oncology -ruby-colored lips lesions that blanche with pressure, GI
bleeds, recurrent nosebleeds, +FH
-lung AVM --> R to L chronic hypoxemia and reactive
polycythemia
 multiple myeloma
-bone pain, fractures, weight loss, fatigue, RECURRENT
4466 Medicine Hematology & Oncology
INFECTIONS, normocytic anemia, renal insufficiency,
hypercalcemia, monoclonal paraproteinemia
Anaphylaxis after blood products = IgA deficiency
-ABO mismatch - fever/flank pain within 1 hr
-anamnestic ab response = delayed mild hemolysis 2-10 days
4672 Medicine Hematology & Oncology
after transfusion
-TRALI = resp distress within 6 hours; pulm edema, bilatareal
interstitial infiltrates (due to donor anti-leukocyte antibodies)
enoxaparin --> low platelet count a few days later -->
heparin-induced thrombocytopenia
-Platelet factor 4 IgG heparin complex --> thrombosis and
4859 Medicine Hematology & Oncology
thrombocytopenia
-thrombocytopenia from splenic mphage removal of
HIT-antibody coated platelets
HIT = test with serotonin release assay - suspect HIT in
anyone with >5d heparin and plt count drop, a/v thrombosis,
6993 Medicine Hematology & Oncology
necrotic skin at injection sites, and anaphylactoid reactions
after heparin.
age >35 = epididimitis from bladder outlet obstruction like e
2239 Medicine Infectious Diseases
coli. <35 from stds like chlamydia or gonorrhoeae
even if VDRL is negative, do a test with FTA-ABS if the person
2265 Medicine Infectious Diseases
looks like they have syphillis. not very good test.
hiv pts higher rr for CAP than nl ppl
2267 Medicine Infectious Diseases -strep pneumoniae MC
-lobar, interstitial, cavitary infiltrate
pneumocystis jirovecii pneumonia
-HIV / acute resp failure pts
2273 Medicine Infectious Diseases -tx with bactrim steroids
-high LDH, reticular infiltrates on imaging
-sx develop over several weeks
tx anaerobic pna with clinda
tx gm- pna with cipro
tx cap with macrolide resistance with doxy
2292 Medicine Infectious Diseases
tx pneumocystic pna with bactrim
don't use mtz for anerobic pna tx due to high rates of
resistance
neutropenic fever: start broad-spectrum pip/tazo. Add vanc if
there is an indication: known colonization with mrsa, ivda,
2616 Medicine Infectious Diseases
catheter related infection, skin/tissue infection; pna, or
hemodynamic instability
 ***IF SOMEONE HAS BLOOD TRANSFUSION HISTORY,
CHECK THEIR HEP B AND C

HIV screening indications

-15-65yo, tb or STD tx
2916 Medicine Infectious Diseases
ANNUAL: IVDU, MSM, prostitutes, homeless, jail, partner of
HIV+

EXTRA: preg, occup exposure to blood/body fluids

-s/sx;
-prior to any new sexual relationship
hydatid cyst = echinococcus granulosus infxn
-dogs
2970 Medicine Infectious Diseases -unilocular cystic lesions incidental
-fatty food intolerance, tx with resection + albendazole; can be
sometimes aspirated
Mucormycosis
2993 Medicine Infectious Diseases -IC pts get necrosis of the nasal turbinates
-surgx debridement, antifungals, ctrl hyperglycemia
2994 Medicine Infectious Diseases mucormycosis = tx with debridement and ampho B
Blastomycosis:
-pneumonia, wartlike/violaceious lesions + ulcers,
2999 Medicine Infectious Diseases
osteomyelitis, prostatitis/orchitis, abscesses/meningitis
-itraconazole +/- amphotericin B if IC
MRI = temporal lobe abnormalities
CSF = high white count, nl glucose, high protein
normal opening pressures
above = HSV encephalitis
3003 Medicine Infectious Diseases
crypto meningitis = subacute for weeks, IC pts, high ICP
(headache), high OPENING PRESSURE
bacterial meningitis = low glugose and high protein (>250) on
CSF analysis
recommend 3 week bed rest in mono pts
3007 Medicine Infectious Diseases -no abx or antivirals needed.
-not contageous
3011 Medicine Infectious Diseases Amox-Clav for polymicrobial skin infections
in pts with stable subacute illness, obtain serial blood cultures
3012 Medicine Infectious Diseases over several hours, delyaing abx therapy till after collection.
obtain from 3 diff sites
3054 Medicine Infectious Diseases tx legionella with macrolide or fluoroquinolone
Baciliary Angiomatosis
-bright red exophytic nodules in an HIV pt --- MC
3107 Medicine Infectious Diseases
-Caused by bartonella henslae
-tx oral erythromycin
 parvovirus B19 infection
-erythema infectiosum (fifth disease)
-fever, nausea, slapped cheeks; acute symmetric arthalgias
(more common in children)
3172 Medicine Infectious Diseases -pure red cell aplasia
-dx with B19 IgM abx in immunocompetent ppl
-school teachers, daycare
-nonspecific rash in adults + polyarticular arthalgia that is
symmetric
nearly a 1/3 of world has latent tb. Reactivation risk varies in
different populations
3246 Medicine Infectious Diseases -hiv = 30-100x higher
-9 months of isonizid + pyridoxine to prevent b6 peripheral
neuropathy
Ehrlichiosis = tick bite, fever, systemic sx, thrombocytopenia;
3247 Medicine Infectious Diseases
tx with doxycycline
crypto meninoencha[elitis - tx with amphoB + flucytosine for 2
3254 Medicine Infectious Diseases weeks, then 2 weeks fluconazole for consolidation, then
maintanenece therapy for 1 year. +/- serial LPs
malaria ppx
-mefloquine until 4 weeks after they get back from india
3259 Medicine Infectious Diseases -chloroquine resistance is high
-start it >2 weeks before starting the trip
-se: anxiety, depression, restlessness in 5%
3261 Medicine Infectious Diseases dermatomyositis can cause AV block
UTI with an alkaline pH is MC proteus (d/t urease production)
3262 Medicine Infectious Diseases -struvite stones d/t reduced solubility of phosphate in high pH
(mg ammonia phosphate stones = struvite)
3264 Medicine Infectious Diseases ingested toxin = early vomiting after ingestion 1-6 hours
only give TIG if unsure about vaccination hisory + wound looks
3325 Medicine Infectious Diseases really bad. otherwise just a Tdap booster shot if >10 or >5 out
from last booster (depending on severity of wound)
causes of diarrhea in AIDS patients
crypto - <180 cd4 - severe watery, low fever
micro/isosporidium - <100 - watery diarrhea, no fever
3917 Medicine Infectious Diseases
MAC - <50 high fever, watery diarrhea
CMV - <50 low fever, small vol diarrhea, hematochezia, abd
pain
PCP pneumonia
-dry cough, dyspnea, fever
-"hypoxia out of proportion to radiographic findings" + b/l
interstitial infiltrates on cxr
-LDH elevated
3938 Medicine Infectious Diseases
-bactrim + corticosteroids (decrease mortality in servere dz)
-indications for steroids: paO2 <70, a-a gradient >35 on room
air.
-pentamidine = high adverse effects (low BP, low sugar,
kidney failure, arrythmias)
 Puncture wounds
-Pseudomonas most commonly if it's through the sole of a
shoe since the warm, moist environment grows pseudomonas
4257 Medicine Infectious Diseases
well
-bony changes take >2 weeks to form
-tx IV abx (cipro, zosyn)
meningococcal meningitis = neisseria
-gm- diplococcus in young adolescents. loop for myalgias,
4265 Medicine Infectious Diseases DIC, adrenal hemorrhage;
-ceftriaxone vanc
-rifampin/cipro/ceftriaxone for sick contacts
Mononucleosis
-EBV
-Pharyngitis, lymphadenopathy, splenomegaly
-Dx with heterophile abx test "monospot" as abs arise within a
4354 Medicine Infectious Diseases week of sx, but can be false neg in the 1st week. Will persist
for 1 year in some cases
-Usually will be a prolonged infection in a young person. Other
infections will usually either get better or worse in a 2 week
time span, but mono holds steady.
lumbar spinal stenosis
>60+ back pain radiates to back and thighs
4371 Medicine Infectious Diseases
worse with walking and lumbar extension; improve with lumbar
flexion; numbness/parasthesias occur
Baciliary Angiomatosis
-bartonella cat exposure, homelessness
-advanced HIV (CD4 <100)
4373 Medicine Infectious Diseases -vascular cutaneous lesions (papular, nodular, peduncular;
systemic symptoms (fever, sweats, fatigue)
-lesional biopsy
-doxy / erythromycin or ART
nocardia
-partially acid fast gm+ branching rod
4417 Medicine Infectious Diseases
-IC hosts brain lung abscess
-tmpsmx or carbapenems
Review this later! Vaccines for adults with HIV
4478 Medicine Infectious Diseases haemophilus vaccination is not indicated bc infxn is usually
with non typable strains
suspect syphillis in anyone that's sexually active. we don't
4488 Medicine Infectious Diseases
routinely screen for HSV
diffuse rash + lympadenopathy + condyloma lata, grey
4656 Medicine Infectious Diseases mucous patches, hepatitis seen in 2* syphillis
-epitrochlear lymphadenopathy pathognomonic
Lyme Ticks
-tick must be attached for >36h or be engorged
4662 Medicine Infectious Diseases -no CI to doxy
-local inf rate >20% (must be endemic)
-prophy started within 72 of tick removal
10301 Medicine Infectious Diseases p24 test is the 4th gen screening test
 incr rr of infection of vibrio vulnificus in pts with cirrhosis or
hepatitis
12168 Medicine Infectious Diseases -cause by wound inf or ingestion
-septicemia, cellulitis, rapidly progressive
-iv ceftriazone, doxy
Testicular cancer
-Perform radical orchiectomy
2589 Medicine Male Reproductive System
-no chemo
-high cure rate
leydig cell tumor = testosterone production. most common
3594 Medicine Male Reproductive System type. can also increase estrogen due to conversoin. seen in
young people, presents with gynecomastia.
GBS
2290 Medicine Nervous System -albuminocytologic dissociation: high protein with nl WBC
-tx = supportive, IVIG, plasmapharesis
Unprovoked First Seizure
-Do a CT or MRI as part of a work-up for all unprovoked
seizures!
2671 Medicine Nervous System
-can exclude bleeds that require urgent intervention.
-noncontrast
-only do LP after you have excluded bleeds with CT
ALS = Upper and lower motor neuron lesions
2674 Medicine Nervous System upper = spasticity, bulbar, hypperreflexia
lower = fasciculations
Creuzfield-jacob
-14-3-3 proteins
2990 Medicine Nervous System
-50-70 year olds with rapidly progressive dementia and
myoclonus
intracerebral hemorrhage
-fast progression mins to hrs
-first focal neuro signs
-then high ICP (vomit, HA, bradycardia)
3060 Medicine Nervous System
vs.

emoblic stroke
-abrupt and maximal sx at the start of the stroke
Head CT with parietal lobe hemorrhage mc due to cerebral
amyloid angiopathy
-spontaneous lobar hemorrhage mc cause
3537 Medicine Nervous System -age>60
-same proteins as in alzeimers
-hemorrhage occurs during nl activities and cause
CONTRALATERAL hemineglect
Hand tremor in parkinson's disease
-tx with trihexyphenydyl anti cholinergic
-aka it occurs at rest and improves with activity (vs. essential
3718 Medicine Nervous System
tremor, which is the opposite)
-usually presents asymetrically (one hand before other)
-
 stroke risk
3879 Medicine Nervous System -htn strongest association with stroke
-etoh consumption has a protective effect (higher HDL)
acoustic neuromas
-NF2
4049 Medicine Nervous System -noisy ears with hearing loss on one side
-do MRI
-pts will be young and have cafe au lait spots
HSV Encephalitis
-seen in healthy adults
-lymphocytic pleocytosis
4139 Medicine Nervous System -more RBCs in CSF (d/t hemorrhagic destruction of temporal
lobes)
-temporal lobe lesions!
IV acyclovir
Angle-closure glaucoma
-sudden narrowing of anterior chamber angle
-prevents aqueous humor, increases IOP
-more common in women >40, asians, inuit, ppl with
4367 Medicine Nervous System
farsightedness
-severe eye pain, halos, injected, dilated, nonresp to light,
headache that's bad + n/v
-vision loss in 2-5 hours
torticollis
4399 Medicine Nervous System -caused by antipsychotics, metoclopramide, and
proclorperazine
4427 Medicine Nervous System Review common causes of gait disorders!
Guillain-Barre
-URI or diarrheal illness precedes it
-CSF shows high protein 2/2 inc permeability of the BBB.
4465 Medicine Nervous System
Albumin and other things are normal (albuminocytlogic
dissociation); Tx = IVIG or plasmapheresis.
-monitor for resp failure
Lacunar Strokes
-internal capsule = one sidedpure motor hemiparesis
4482 Medicine Nervous System -caused by microatheroma formation and lipohyalinosis that
leads to thrombotic small-vessel occlusion
-often missed on noncon-CTs
Alcoholic Cerebellar Degeneration
-gait dysfunction, truncal ataxia, nystagmus, intention
tremor/dysmetria, impaired rapid alternating movements
4618 Medicine Nervous System
(dysdiadocokinesia), hypotonia, pendular knee reflex
(persistent swinging movements of the libs after liciting the
deep tendon reflxes)
Cancers of the spine:
-breast, lung, renal, prostate, and multiple myeloma
4691 Medicine Nervous System -thoracic 2x vs. lumbar
-progressive back pain worse with recumbency, point
tenderness, 3+ DTRs, upgoing plantar reflexes
 age-related macular degeneration -> pts >50yo;
progressive/b/l loss of central vision; peripheral fields and
2375 Medicine Ophthalmology navigation vision are always maintained. -d/t degen and
atrophy of the outer retina, RPE, bruch's membrane, and
choriocapillaries
Open Angle Glaucoma
-"Cupping of the optic disc" + asyx
-periph vision loss
2852 Medicine Ophthalmology
-high IOP, beta blockers (timolol eye drops), laser
trabeculoplasty (adjunctive) if there is a continuous increase in
IOP
bacterial keratitis = contact lenses after corneal trauma with
hazy cornea
2854 Medicine Ophthalmology dacryocystitis = tear duct redness
herpes keratitis = clear vesicles in the corneal epithelim. no
rash outside eye.
central retinal vein occlusion --> painless monocular visual
loss.
amaurosis fugax --> atheroemboli (arterial) temporary vision
loss + optic disk swelling
3328 Medicine Ophthalmology
optic neuritis --> MS presentation. F <50yo
ant. uveitis --> vision loss, eye is red and painful
angle closure glaucoma --> super painful, blurry vision, n/v,
"steamy cornea", dilated pupil.
diabetic eyes
3330 Medicine Ophthalmology -microaneurysms, hard exudates, macular edema
-cotton wool spots; newly formed vessels
acute glaucoma - tx with pilocarpine, AVOID atropine (dilate
the pupil, wrosen the glaucoma) IT can even precipitate
glaucoma.
3430 Medicine Ophthalmology
1st line tx of glaucoma is to give mannitol IV. to diurese and
work immediately. also acetazolamide to reduce aqueous
humor production. also timolol to do the same.
Fluorescein examination = after a wood's lamp or slip lamp
4015 Medicine Ophthalmology examination to assess for intraocular foreign objects following
high-velocity injuries
sympathetic eye injury = contraleteral eye becomes inflamed
4021 Medicine Ophthalmology when the other eye is hurt. hypersensitive to existing antigens
aka "uncovered antigens"
acute retinal necrosis in HIV pt = herpes simplex. usually very
painful; see wit keratitis, conjunctivitis + eye pain, visual loss,
4099 Medicine Ophthalmology central necrosis of retina
-CMV retinitis = MC in HIV pts; PAINLESS and funduscopy
shows fluffy granular retinal lesions instead.
NF type 1 - 15% get optic gliomas
-axillary freckling, cafe au lait spots
4202 Medicine Ophthalmology -progressive unilateral visual loss, dyschromatopsia;
exopthtlamos, optic dick looks variable. sometimes nl
sometimes not
 types of conjunctivitis
-bacterial: erythmryomicin/polymyxin-trimethoprim drops
-viral: warm/cold compresses; antihistamine drops
8925 Medicine Ophthalmology -allergic: OTC H1/decongestant; mast cell stabilizers / drops
for freq episodes
-adenovirus = MC pink eye. small children, caregivers, rarely
bacterial superinfection
caustic ingestion
-IV hydration
-serial cxrs to identify perforation
Poisoning & Environmental -early endoscopic eval --> only if hemodynamically stable to
2377 Medicine
Exposure assess degree of damage
-avoid activated charcoal - will obstruct view during scope and
does not actually help with lye, which causes immediate
damage.
diphenhydramine toxicity
-antihistamine + anticholinergic
Poisoning & Environmental
2662 Medicine -confusion, drowsiness, blurry vision, dry mouth, urinary
Exposure
retention, hyperthermia, low bowel sounds
-delirium if severe
TCA OD --> give NaHCO3 --> helps bc increase sodium to
increase serum pH and extraceulluar sodium. this decreases
drug affinity for sodium channels.
Poisoning & Environmental
3138 Medicine -TCA usually bind to fast Na channels in the his-purkinje
Exposure
system and myocardium --> decreased conduction velocity;
more repolarization; --> hypoten, qrs prolongation; ventricular
arrythmias.
Poisoning & Environmental flank pain, hematuria, calcium oxalate crystals --> AGMA; high
4511 Medicine
Exposure osm gap --> EG ingestion
In veterans with amnesia, nightmares, sleep disturbances,
Psychiatric/Behavioral &
11811 Medicine irritability, numbness, and hypervigilance, increased startle
Substance Abuse
response, think of PTSD
convex nail beds = digital clubbing. Get a chest xray
2298 Medicine Pulmonary & Critical Care -hypertrophic osteoarthropathy = digital clubbing + sudden
onset arthropathy in the wrist and hand joints
Apical Pancoast Tumor
-shoulder pain, horner's, C8-T2 neuro involvement
-weakness/atrophy of handmuscles, 4/5 digits, medial
2602 Medicine Pulmonary & Critical Care
arm/forearm
-supraclav lymph node enlargement
-wt loss
adenocarcinoma of lung
-nonsmokers, clubbing, hypertrophic osteoarthorpathy
-periphery
2615 Medicine Pulmonary & Critical Care
-solitary nodule
-stage at dx is the most important prognostic factor**
-survival determined by resectability
 Check the PaCO2 in a patient who is acidotic. If it is high,
hypoxemia is likely from alveolar hypoventilation instead of
2788 Medicine Pulmonary & Critical Care something like a PE, atelectasis, PEffusion, edema where you
would have compensatory tachypnea to decrease the CO2
with a high A-a gradient
ARDS
-decreased lung compliance
-decreased PaO2 / FiO2 ratio (<300)
3020 Medicine Pulmonary & Critical Care -nl PCWP
-high pulm art pressure
-decreased lung compliance
-pulmonary htn
asbestosis without mention of mesothelioma presents just like
3022 Medicine Pulmonary & Critical Care
any ole pneumoconiosis, RLD pattern
Watch out for hypokalemia and subsequent muscle weakness
3026 Medicine Pulmonary & Critical Care
in pts on beta2 agonists, also EKG abnls, tremor, headaches
Bronchiectasis
-cough with daily mucopurulent sputum production, dyspnea,
hemoptysis, rhinosinusitis, crackles/wheezing
-caused by poor bacterial clearance
3038 Medicine Pulmonary & Critical Care
-can be caused by CF, RA, sjogren's, toxins, IC, A1AD
-Tx with HRCT scan and f/u with PFTs and Ig quantification
-Look for bronchial wall thickening, bronchial dilation, and lack
of airway tapering as findings
granulomatosis with polyangiitis
-wegeners
-whites 30-50yo
-chronic rhinosinusitis, tracheal narrowing with ulceration****,
3049 Medicine Pulmonary & Critical Care cavitation in the lung, anemia of chronic disease, renal
involvement (fast worsening, very common - high creatinine,
high rr of ESRD)
-check ANCA, tx with steroids
-definitive dx by bx
3579 Medicine Pulmonary & Critical Care goospastures = linear IgG abs olong the GBM
mitral stenosis = LAE --> recurrent largyn n compression
3874 Medicine Pulmonary & Critical Care cough, displace L main bronchus upwards. 70% get afib;
palpitations
Hypovolemia
-diarrhea, poor diet, flat neck veins, orthostatic hypotn,
3958 Medicine Pulmonary & Critical Care orthostatic syncope
-accompanied by aggressive RAAS activation: high aldo, Na
reabsorption, Super low FENa (<1%)
Inpatient tx of CAP:
-IV Fluoroquinolone (Moxi usually) OR Beta lactam +macrolide
Outpatient tx of CAP:
-Doxy or Azirthy if healthy OR, if unhealthy, then Moxi OR
4024 Medicine Pulmonary & Critical Care
azithro + beta lactam

ICU CAP:
-beta lactam + IV macrolide or fluoroquinolone
 -Mg Sulfate used for severe life threatening asthma
exacerbations
-Only check sputum cultures if there are risk factors for
4039 Medicine Pulmonary & Critical Care
pseudomonas infection
-Roflumilast = PDE inhibitor that decreases inflammation and
mucociliary malfunction. Maintenance therapy for COPD.
theophylline toxicity
-CNS stim - headache, insomnia, seizures, n/v, arrythmias
4048 Medicine Pulmonary & Critical Care -cipro decreases clearance of theophylline
-also cimetidine, erythromicin, calrithro, verapamil, cirrhosis,
cholestasis, resp infs
4053 Medicine Pulmonary & Critical Care Transudate has higher pH (7.4) than exudate (<7.3)
aspirin-exacerbated respiratory disease (AERD) -
pseudoallergic rxn to NSAIDs
-occur in pts with asthma, chronic rhinosinusitis w/ nasal
polyps.
4065 Medicine Pulmonary & Critical Care -presents with asthmatic sx (cough, wheeze, chest tightness),
nasal and ocular sx, and facial flushing within 30 mins to 3
hours after nsaid ingestion
-incr released pro-infl leukotrienes, dec anti-infl prostaglandis.
-tx with avoid nsaids
Pt with a PE that is malignant vs. infectious
-do a frickin thoracentesis first, if it's loculated then you can
4087 Medicine Pulmonary & Critical Care
think about doing a VATS or anything else
-look for cytology
advanced dementia pts frequently have impaired swallowing,
cough reflex. cannot properly form food into a bolus.supine pt
4119 Medicine Pulmonary & Critical Care = posterior portions of RUL and superior segments of RLL
most affected.
-clinda, amox-clav
LTOT indicated if <59 mmhg or <89 in patients with
-cor pulmonale
4131 Medicine Pulmonary & Critical Care
-right hf
-hematocrit >55%
Non-allergic rhinitis
-no allergies or assoc prodrome
4201 Medicine Pulmonary & Critical Care -poor response to oral antihistamines
-tx with intranasal steroids or intranasal antihistamine spray
(azelastine, olopatadine) or both
4208 Medicine Pulmonary & Critical Care A-a gradient elevated in patients with PE
RHF 2/2 to LHF or congenital heart disease is not considered
cor pulmonale
4297 Medicine Pulmonary & Critical Care
-loud p2, tric regurg, jvp, hepatomeg, etc.distant heart sounds
(as in all copders bc of hyperinflated lungs)
Comorbid GERD and ASTHMA
-microaspiration of GI contents can irritate the bronchi, leading
4335 Medicine Pulmonary & Critical Care to inc vagal tone, sore throat, morning hoarseness, and
worsening cough only at night.
-tx with PPI
4387 Medicine Pulmonary & Critical Care pulmonary auscultation exam findings - important to look over
obesity hypoventilation syndrome:
-chronic r acidosis
-high bicarb
4489 Medicine Pulmonary & Critical Care
-can't breathe bc weight and altered lung mechanics
-won't breathe becuase of decreased chemosensitivty to
hypercapnia from persistent nocturnal hypoventilation
Rupture of Alveolar Bleb
-COPD with acute SOB, hypoxia, with dec breath sounds on
one side == 2* spont. pneumothorax. Rupture of a large sac of
4520 Medicine Pulmonary & Critical Care air (alveolar bleb) can rupture and lead to leak of air into the
pleural splace.
-Dx CXR, no tracheal dev
-tx with supp O2, consider tube thoracotomy
Pts on ventilators need to have FiO2 < .6 (60%) to prevent O2
4536 Medicine Pulmonary & Critical Care
toxicity
ARDS Management
-resp distress + bilateral opacities + hypoxemia
-Look for hypoxemia if pt is on ventilator PaCO2 <60mmHg ==
4562 Medicine Pulmonary & Critical Care poor oxygenation. Increase FiO2 or increase PEEP
(preventing alveolar collapse, allowing for greater recruitment).
We don't want FiO2 to be too high in the patient (<60% pref)
bc of risk of O2 toxicity - free radical formation.
SABA
SABA + ICS
4617 Medicine Pulmonary & Critical Care
SABA + ICS + LABA
SABA + ICS + LABA + PO Steroids
Fixed upper-airway obstruction
-limits air flow during in and out, which causes flattening of the
4630 Medicine Pulmonary & Critical Care Flow-Vol loop.
-Usually 2/2 laryngeal edema from a food allergy (tx with
epinephrine, systemic corticosteroids, and antihistamines)
Endotracheal tube placement
-2-6cm above the carina
4632 Medicine Pulmonary & Critical Care
-preferentially enter RM bronchus --> quiet L sounds
-asym chest exp
Hodgkin's lymphoma
-young patients and treatable
4689 Medicine Pulmonary & Critical Care
-high risk of 2* malignancies down the line
-lung, breast, thyroid, bone, GI cancers
Signs to intubate asthma/copd exacerbation
-elevated or normal PaCO2 (resp fatigue)
-dec breath sounds markedly
4706 Medicine Pulmonary & Critical Care
-absent wheezes
-decreased AMS
-hypoxia/cyanosis
 Pneumonia mechanisms
-Causes R to L shunting 2/2 V/Q mismatch
-perfusion of lung tissue without alveolar ventilation (the alveoli
4717 Medicine Pulmonary & Critical Care get filled with inflammatory exudate, preventing effective air
flow)
-cannot correct hypoxemia with more FiO2.
-
Hypercapnia can cause reflex cerebral vasodilation that can
4718 Medicine Pulmonary & Critical Care
induce seizures
parapneumonic effusion
-ALL are due to imbalances b/w hydrostatic and oncotic
pressures
4753 Medicine Pulmonary & Critical Care glucose <60 = rheumatoid pleurisy, complicated effusion or
empyema, malignant effusion, TB, lupus, or esophageal
rupture. there is metabolic activity of leukocytes in the fluid
which eats up the glucose
8815 Medicine Pulmonary & Critical Care tx postnasal drip with 1st gen antihistamine
witnessed aspiration event followed by hypoxemia with
bilateral infiltrates on cxr. aspiration pneumonitis -->
11669 Medicine Pulmonary & Critical Care acidic/sterile stomach contents aspiration, happens within
hours of the aspiration event
it's PNEUMONITIS not PNEUMONIA
Renal, Urinary Systems & FHH = normal or slightly elevated PTH levels in the setting of
2165 Medicine
Electrolytes hypercalcemia that is asx
Hypovolemic Hypernatremia:
Renal, Urinary Systems & -pt gets NS until euvolemic, then give 5% dextrose
2182 Medicine
Electrolytes -finally can switch to free watch when pt is not shocky
-correct slowly or else cerebral edema
Hepatorenal syndrome: splancnic vasodilation --> blood gets
Renal, Urinary Systems & diverted away from the kidneys; any insult that would
2219 Medicine
Electrolytes decrease intravascular volume flow can precipitate
hepatorenal syndrome
scrotal l sided varicoecele in a patient with the RCC trifecta =
Renal, Urinary Systems & metastatic RCC. flank pain, hematuria, palpable abdominal
2221 Medicine
Electrolytes renal mass) +/- family history, ectopic EPO producton -->
polycythemia (sometimes)
calcium oxalate = envelope shaped = radioopaque on xray
Renal, Urinary Systems & -ca phosphate stones in 1* hyperPTH, RTAs
2228 Medicine
Electrolytes -Uric acid stones - cell turnover, dehydration,
-struvite = alkaline urine - proteus
uncomplicated cystitis: tx first with bactrim or nitrofurantoin or
fosfomycin. If there are contraindications to the above, then
Renal, Urinary Systems &
2235 Medicine consider fluoroquinolones.
Electrolytes
-cystitis becomes complicated if it's in a man, dm2, ckd,
pregnancy, IC, UTObstruction; hospital-acquired infection
ureteral colic --> vagal rxn --> ileus
Renal, Urinary Systems & needle shaped crystals = uric acid stones = radiolucent, need
2324 Medicine
Electrolytes CT or IV pyelography
-can apparently precipitate ileus.
 Renal, Urinary Systems &
2633 Medicine avoid loop diuretics in hypercalcemia
Electrolytes
aspirin tox
Renal, Urinary Systems &
2803 Medicine -met acidosis (low bicarb)
Electrolytes
-resp alkalosis (high CO2)
RTA
-metabolic acidosis with hyperkalemia!!!
-renal dysfunction
-non-anion gap metabolic acidosis and hyperkalemia that
occur out of proportion to renal dysfunction indicates an RTA.
Renal, Urinary Systems &
2810 Medicine Hyperkalemia and met. acidosis are normal parts of CKD, but
Electrolytes
you would expect your BUN/Cr to be very elevated at that
point and the patient would likely be on dialysis
-RTA type 4 = hyperkalemic RTA and is seen when you have
impaired function of the collective tubuls due to aldo
deficiency. DM.
1* Adrenal Insufficiency (Addison's)
Renal, Urinary Systems & -low cortisol, low adrenal sex hormone, and aldosterone
2817 Medicine
Electrolytes secretion
-high K, low Na --- NL AG met acidosis
Aspirin
1. AG metabolic acidosis due to decreased elimination of
Renal, Urinary Systems &
2820 Medicine organic acids (lactic, keto)
Electrolytes
2. Medullary resp centers of the brain - tachypnea and resp
alkalosis
post-ictal lactic acidosis is transient and resolves in 90 minutes.
Renal, Urinary Systems &
2821 Medicine -due to skeletal muscle hypoxia and impaired hepatic lactic
Electrolytes
acid uptake
loop diuretics will cause a metabolic alkalosis eventually
Renal, Urinary Systems &
2826 Medicine -loss of Na; volume contraction; high aldo levels --> secrete H
Electrolytes
in urine.
AIN: bactrim, cephalosporins, nsaids, occasionally
mycoplasma
Renal, Urinary Systems &
3061 Medicine -maculopapular rash, fever, arthralgias
Electrolytes
-AKI, wbc casts, urinary eosinophils, edema
-tx glucocorticoids
Renal, Urinary Systems & Diuretic Abuse
3085 Medicine
Electrolytes -dehydrated patient who continues to have high UNa and UK
Calcium Oxalate stone prevention
-low Na diet -> decreases Ca excretion -> prevent stones
Renal, Urinary Systems &
3895 Medicine -also consider HCTZ
Electrolytes
-fructose may worsen calciuria
-high vit C increases oxaluria (restrict chocolate, tea, peanuts)
 Abnormal Platelet Fxn in CKD
-ecchymoses and epistaxis are the only major bleeding
manifestations now bc of dialysis
Renal, Urinary Systems & -Uremic coagulopathy can still cause gi bleeds,
3951 Medicine
Electrolytes hemopericardium, subdural hematoma, and surg site bleeding
-uremic toxin = ganidinosuccinic acid accumulation = nl PT,
PTT, TT; prolonged bleeding time
to fix coagulopathy: DDAVP, cryo, conjugated estrogens
glomerular hyperfiltration earliest sign of T2DM. will cause
intraglomerulatr HTN and lead to damage and renal fxn loss.
Renal, Urinary Systems &
3986 Medicine NEXT comes thickening of the GBM. FOLLOWED by
Electrolytes
mesangial expansion. Nodular sclerosis is an endpoint that is
specific for diabetic nephropathy
acyclovir, MTX, sulfonamides, ethylene glycol, and protease
inhibitors can cause a crysta-induced AKI where the kidney
Renal, Urinary Systems &
3987 Medicine excretes the drug but it has low solubulity and clumps up the
Electrolytes
tubules leading to an AKI. Seen 1-2d after starting the IV drug.
dc drug, fluids.
AA Amyloidosis
-seen in chr infl conditions RA IBD
Renal, Urinary Systems &
3997 Medicine -osteo, TB
Electrolytes
-beta2 microglobulin, transthyretin
-cause a nephrotic syndrome and bilaterally enlarged kidneys
URIC ACID STONES = tx with potassium citrate to alkalinize
Renal, Urinary Systems & urine
4027 Medicine
Electrolytes CALCIUM OXALATE STONES = tx with HCTZ to re-absorb
calcium
Renal, Urinary Systems &
4034 Medicine prolonged prerenal will lead to ATN
Electrolytes
Renal Transplant Dysfunction
-Immediate rejection - oliguria, hypertension, bun/cr up; MAY
Renal, Urinary Systems &
4152 Medicine OR MAY NOT BE acute rejection. Could also be ureteral
Electrolytes
obstruction, cyclosporine tox, vasc obstruc, ATN
-tx with high dose IV steroids
Thiazides
-impair insulin release from panc and glucose use i the
Renal, Urinary Systems & periphery
4171 Medicine
Electrolytes -causes glucose intolerance as a side effect in patients
-dose dependent
-causes low Na, K, Mg, and high Ca; reduce
Renal, Urinary Systems & HOLD metformin in AKI as it can cause lactic acidosis. Should
4337 Medicine
Electrolytes be withheld until Renal Fxn improves
Renal, Urinary Systems &
4379 Medicine amikacin can cause ARF and is used to treat MDR pyelo
Electrolytes
Inclusion Body Myositis
Renal, Urinary Systems & -adult-onset musc weakness + atrophy
4424 Medicine
Electrolytes -usually present with dysphagia
-2/2 other medical conditions, poor free h2o intake
 COPD exacerbation tx: Be careful with using diuretics to
Renal, Urinary Systems &
4435 Medicine alleviate sx of cor pulmonale as they can lead to AKI
Electrolytes
*(prerenal)
avoid ct contrast AKI
Renal, Urinary Systems &
4491 Medicine -IV fluids, isotonic bicarb, acetylecysteine
Electrolytes
(vasodilatory/antioxidant properties)
Renal, Urinary Systems & no good screening tools for bladder cancer. mean age of dx
4502 Medicine
Electrolytes 65 in smokers and chemical exposure ppl mostly
Renal, Urinary Systems & Edema in nephritic syndrome is usually 2/2 decreased GFR
4591 Medicine
Electrolytes and retention of water and sodium by kidneys
Urinary Retention in H1s given to elderly
Renal, Urinary Systems &
4733 Medicine -detrusor muscle contraction is impaired; poor voiding ability
Electrolytes
-inc risk in males bc BPH
microscopic hematuria = glomerular. Will see blood and
protein on UA + RBC casts. Non-microscopic hematuria =
Renal, Urinary Systems & blood, no protein. nl appearing RBCs.
10287 Medicine
Electrolytes
proteinuria and transient gross hematuria after haryngitis = IgA
nephropathy (starting <5d of URI)
alpha blockers kidney stones
Renal, Urinary Systems & -sympathetic activation --> alpha receptors in the urinary tract
11109 Medicine
Electrolytes clamp down; use alpha blockers to open up the pathways
-facilitates stone passage and reduces the need for analgesics
URGE INCONTINENCE
-detrusor overactivity
Renal, Urinary Systems & -tx 1st with bladder training (kegels)
12033 Medicine
Electrolytes -reduce caffeine, etoh, etc.
-oxybutynin = antimuscarinic to tx by reducing ach activity
-monitor for urinary retention
paget's bone
-skull, spine, and long bones
-HA, hearing loss
-spinal stenosis, radiculopathy
-bowing, fracture, arthritis
Rheumatology/Orthopedics -giant cell tumor, osteosarcoma
2144 Medicine
& Sports
-high alk phos, high PINP, urine hydroxyproline
-nl ca and phos
-xray showing osteolytic or mixed lytic/sclerotic lesions
bone scan shows focal inc in uptake
bisphosphonates to tx
Rheumatology/Orthopedics no crystals in arthrocentesis = no gout attack. treat as OA -->
2305 Medicine
& Sports diclofenac
 Pseudogout
->65, monoarticular arthritis, chondrocalcinosis
-MC knees and ankles
-occurs in the setting of trauma, overuse, or medical illness
Rheumatology/Orthopedics
2314 Medicine -inflammatory effusion + rhomboid shaped positively
& Sports
birefringent cyrstals
-tx with rest, corticosteroids, and arthocentesis

*key difference vs. urate gout is the chondrocalcinosis!*

Rheumatology/Orthopedics felty syndrome = advanced RA assoc with splenomegaly,
2315 Medicine
& Sports neutropenia
Rheumatology/Orthopedics cyclophosphamide = hemorrhagic cystitis but also bladder
3169 Medicine
& Sports cancer and myelosuppresion
WORK IN A FUCKING DAY CARE CENTER = PARVO
Rheumatology/Orthopedics
3171 Medicine -FUCK
& Sports
-polyarticular symmetric arthritis in adults. tx with nsaids
sarcoidosis
Rheumatology/Orthopedics
3177 Medicine -young AA with hilar adenopathy, hypercalcemia, skin lesions,
& Sports
uveitis, ACE level high
Dermatomyositis:
-prox, symmetric muscle weakness
-heliotrope rash + grotton's papules
-ILD, dysphagia, myocarditis
-Dx with high CPK, aldolase, LDH, anti Jo1 mi2
Rheumatology/Orthopedics -Do an EMG or bx if you are suspicious
3208 Medicine
& Sports -tx with high dose steroids AND a glucocortidoid-sparing agent.
-SCREEN FOR MALIGNANCY

*15% inc risk for ovarian, lung, panc, stomach, colorectal

cancers; NHL.

polymyositis is assoc with ILD, myocarditis, and malignancy

Rheumatology/Orthopedics -tx with systemic glucocorticoids, methotrexate, azathioprine
3209 Medicine
& Sports -lower extremity weakness precedes upper extremity
weakness
per anserinus pain syndrome = PAPS
-medial knee pain, focal tenderness.
-pain over the anteromedial tibia caused by overuse, trauma,
or abnormal gait.
Rheumatology/Orthopedics patellofemoral: women, worse with activity or prolonged sitting,
3303 Medicine
& Sports creptius
-prepatellar bursitis - pain and swelling over patella after
trauma.
-medial compartment OA - pts >40y, stiffness pain of joint.
xray = narrowing of joint space, osteophyte formation
 Paget's Dz of Bone (AKA osteitis deformans)
-Isolated elevated of Alk Phos in the 400s that is asx
Rheumatology/Orthopedics -Alk phos found in the hepatobiliary tree and the bones
3304 Medicine
& Sports -caused by osteoclast dysfunction --> defective osteoid
formation
-osteolytic/sclerotic mixed lesions everywhere
-RA pts should be on MTX asap to prevent joint damage
progression. NSAIDs only provide sx relief; glucocorticoids
block sx + reduce progression but not as good as DMARDS
(also result in eventual bone loss).
Rheumatology/Orthopedics
3318 Medicine choose from: mtx, hydroxycholoroquine, sulfasalazine,
& Sports
leflunomide, azt) - dmards
before starting mtx, check for hep b/c/TB.
If no response in 6 months, start etanercept, infliximab as
step-up therapy.
Rheumatology/Orthopedics
3322 Medicine anti scl 70 = topoisomerase 1 = systemic sclerosis
& Sports
de quervain tenosynovitis = new mothers who hold their
Rheumatology/Orthopedics
3576 Medicine infants with the thumb outstretched. abductor pollicis longus
& Sports
and extensor. stupid fucking question
Rheumatology/Orthopedics
3778 Medicine uric acid tophi = white chalky blobs in the fingers. bad gout.
& Sports
Behcet Dz
-middle easten young adults with oral ulcers that are recurrent,
Rheumatology/Orthopedics
3815 Medicine genital, eye lesions, erythema nodosum, acne, thrombosis
& Sports
-path: exaggerated skin ulceration with minor trauma
-bx: vasculitis of the different sized vessels
avascular necrosis
Rheumatology/Orthopedics -common complication of SLE
4047 Medicine
& Sports -inc rr in pts on glucocorticoids
-xray may be normal, f/u with MRI if clx suspicion
Rheumatology/Orthopedics acute back pain and point tenderness after lifting = vertebral
4083 Medicine
& Sports compression fracture.
paraneoplastic syndromes with lung ca include LEMS,
dermatomyositis, myasthenia.
Rheumatology/Orthopedics -dermatomyositis: symmetrical prox muscle weakness,
4123 Medicine
& Sports erythematous rash ont he dorsum of the fingers (grotton's
sign) and/or upper eyelides (heliotrope rash). It effects
peripheral nerve and/or muscle.
Bone spur = cervical spondylosis
Rheumatology/Orthopedics -10% of ppl >50yo
4205 Medicine
& Sports -limited rotation, lateral bending of neck
-aka osteophytes (low specificifity)
check blood smears every 3 months in pts taking mtx. can
Rheumatology/Orthopedics also cause ILD, alopecia, hepatotoxicity.
4295 Medicine
& Sports hydroxychloroquine = g6pd exacerbation
cyclosporine = nephrotoxic, viral infection predisposition
 systemic sclerosis
-tissue fibrosis that is insidious, vasc dysfxn
-telangiectasias, sclerodactyly, digital ulcers, calcinosis cutis,
Rheumatology/Orthopedics
4328 Medicine contractures of extremities, esoph dysmotility, dysphagia,
& Sports
dyspepsia, raynaud's
-complications: ILD, pulm arterial HTN, HTN, renal crisis
(MAHA), pericardititis/effusion
Eval of LBP: 1. radiograph + ESR. 2. MRI if 1. is abnormal or if
there are neurological deficits. 3. bone scan if MRI is not
feasible. Only do #1 if there are alarm symptoms. Otherwise
Rheumatology/Orthopedics
4368 Medicine the LBP doesn't need imaging.
& Sports
Alarm sxs: >50yo, history of ca, fever, wt loss, nocturnal pain,
no response to pain tx, neuro deficits
lumbar spinal stenosis
-thickened ligamentum flavum
-back pain radiating to thighs, seen in degen arthrtis with
Rheumatology/Orthopedics
4369 Medicine osteophyte formation affecting the facet joints (spondylosis).
& Sports
-the s/sx are posture-dependent; extension of the lumbar
spine = narrows spinal canal, worse sx. flexion = nl no pain
("neurogenic claudication")
Rheumatology/Orthopedics
4460 Medicine aortic aneurysm is a complication of giant cell arteritis
& Sports
AVN = groin pain on weight brearing
-no redness swelling or point tenderness
Rheumatology/Orthopedics -normal esr, crp, white count
4565 Medicine
& Sports MRI to dx
-trochanteric bursitis = lateral hip pain localized, caused by
friction of the tendons
Rheumatology/Orthopedics RA joint involvemt = cervical spine. trigger finger. RA nodules
4574 Medicine
& Sports on elbows.
posterior knee pain swelling or stiff = baker cyst
Rheumatology/Orthopedics can lead to venous compression = swelling
4583 Medicine
& Sports can dissect into the calf = red, edema
rupture = ecchymosis, acute calf pain
ACL tear = pulled forward easily relative to the femur
-assoc with sig. knee effusion d/t hemarthrosis. dx confirmed
on MRI.
Rheumatology/Orthopedics vs. MCL tear --> laxity on abduction; not usually assoc with
8895 Medicine
& Sports hemarthrosis.
vs. meniscal tear --> subacute sx, sx develop slowly
vs. stress frac of tibial plateau --> fat ppl starting to exercise
1st time after long time.
Rheumatology/Orthopedics pseudogout = rhomboid crystals
8933 Medicine
& Sports gout = needles, negatively birefringent
 raynaud's
-abnormal vasoconstriction of digital arteries in response to
cold or emotional distress. 1* = idiopathic. 2* = SLE,
Rheumatology/Orthopedics
9939 Medicine scleroderma, thomboangiitis obliterans, nicotine)
& Sports
-2* older pts asymetric and male pts, 1* younger (15-30)
-w/u - CBC, BMP, UA, ANA, RF, ESR, complement levels -->
anti-topoisomeriase1 for scl-70
Pyoderma Gangrenosum
Rheumatology/Orthopedics -neutrophlic ulcerative skin dz
10434 Medicine
& Sports -assoc w underlying systemic disorder like IBD, RA, AML.
-Tx with corticosteroids
= triad of inflammatory arthritis, splenomegaly, and
Rheumatology/Orthopedics
11980 Medicine neutropenia. Seen in patients with RA but can sometimes be
& Sports
the first manifestation of RA.
Rheumatology/Orthopedics chronic uncomplicated LBP = exercise therapy will help.
12059 Medicine
& Sports aerobic. short courses or nsaids or acetaminophen
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