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Phaarmacology:

Drug & side fx-


methyldopa- hemolytic anemia (seldom depression)
halogen anesth- malignant hyperthermia
succinylcholine- malignant hyperthermia
ddI- pancreatitis & peripheral neuropathy
zidovudine- bone marrow suppression
metronidazole- disulfiram-like rxn c EtOh
cisplatin- nephrotox
ASA- GI bleed, ulcers, renal damage, incre gout
toxic doses- tinnitus, vertigo, resp alkalosis,
metabolic acidosis, hyperthermia, coma & death

Drug & antidote-


benzos: flumazenil
methanol/ethylene glycol: ethanol
beta blkers: glucagon
lead: succimer(kids), EDTA
CO: O2/hyperbaric
acetaminophen: acetylcysteine
iron: deferoxamine
quinidine/TCA: NaHCO3
opiods: naloxone
copper/gold: penicillamine
P450 inducers: GTQ CRABS
1. Griseofulvin,
2. Tetracycline,
3. Quinidine,
4. Carbamazepine,
5. Rifampin,
6. Alcohol,
7. Barbiturates,
8. Sulfa drugs (e.g. TMP-SMX etc.)
P450 inhibitors: IQ SMACKED
IQ SMACKED
1. Isoniazid (a.k.a. INH),
2. Quinolones,
3. Spironolactones,
4. Macrolides,
5. Amiodarone,
6. Cimetidine,
7. Ketoconazole,
8. erthromycin
9. Dapsone

Cardiology:
Atrial fibrillation In symptomatic patients, first slow ventricular rate with di
goxin, beta
blocker, or calcium channel blocker:
If acute (onset < 24 hr), cardiovert with amiodarone, pr
ocainamide, or
DC cardioversion.
If chronic, first anticoagulate, then cardiovert; if thi
s approach fails or
atrial fibrillation recurs, leave the patient on digoxi
n and warfarin.
Atrial flutter Treat like atrial fibrillation. You may try to stop arrhy
thmia with vagal
maneuvers (e.g., carotid massage).
Heart block:
First-degree No treatment, but avoid beta blockers and calcium channel
blockers, both
of which slow conduction.
Second-degree For Mobitz type I, use pacemaker or atropine only in symp
tomatic
patients; use pacemaker in all patients with Mobitz type
II.
Third-degree Use pacemaker.

WPW syndrome Use procainamide or quinidine[p450 inducer]; avoid digoxi


n and verapamil[central acting CCB].
Ventricular tachycardia Use amiodarone or lidocaine.
Ventricular fibrillationImmediate defibrillation.
PVCs Usually not treated; if severe and symptomatic, consider
amiodarone or
lidocaine.
Sinus bradycardia Usually not treated; use atropine if severe and symptomat
ic (e.g., after
heart attack). Avoid beta blockers, calcium channel bloc
kers, and other
conduction-slowing medications.
Sinus tachycardia Usually none; correct underlying cause. Use beta blocker
or calcium
channel blocker if symptomatic.
DC = direct current, WPW = Wolff-Parkinson-White, PVCs = premature ventricular c
omplexes.

SHOCK:
--------------------------------------------------------------------------------
------------------------------------
TYPE OF SHOCK CO PCWP SVR SV
02
Septic (early) High Low Low Hi
gh
Hypovolemic* Low Low High Lo
w
Cardiogenic Low High High Lo
w
Neurogenic Low Low Low Lo
w
CO = card
Shock Rx:
ABC's
1. fluid resuscitation with bolus of 10-20cc/kg of LR/NS.
2. approx 1-2 L as standard bolus
3. Monitor BP & UOP. if unchanged, 2nd bolus
4. if still refractory, do invasive monitoring with Swan-Ganz cath
to measure PCWP & identify cause of shock
5. Look at PCWP, CO, SVO2, SVR to det. cause
6. pharmacologic intervention as needed acutely
*dobutamine: ICU version of digoxin. increases contractility
*dopamine: maintains kidney perfusion. higher doses alpha & beta fx.
*NE: alpha then beta fx.
*EPI: used in cardiac arrest & anaphylaxis. alpha & beta fx. beta=lower
*phenylephrine: similar to NE BUT no beta effects.
*milrinone & amrinone: phosphodiesterase inhibitors. used in pt c refractory hrt
failure. +inotropic fx
--------------------------------------------------------
RHEUMATOLOGY:
*PAN: assoc c HepB & cryoglobulinemia. multi-organ systems. medium sized arteri
es
ssx: fever, abd pain, wt loss, renal problems.
dx c +ANCA & bx
*Kawasaki: ocular mucocutaneous dz. MC in Japanese & females.
ssx: children<5yo. high fever >5d, bilat conjuntival injection, truncal
rash,
skin desquamation, mucosal desquamation (strawberry tongue).
risk of coronary aneurysms.
Rx c ASA
*Takayasu's arteritis: MC in Asian females 15-30yo.
ssx: "pulseless" affects aortic arch & branches.
rx c steroids/cyclophosphamide
*Buerger's disease (Raynaud's symptoms in a young male smoker) SMOKER & vasculit
is.
---------------------------------------------------------
VASCULAR SX:
*dissecting abd aneurysm: rx conservatively c anti-HTN & elective sx
*abd aneurysm <5cm, follow c serial U/S exams
*abd aneurysm >5cm: advise sx
*abd aneurysm c hypotn: emergent laparotomy (likely ruptured)
*carotid stenosis>70%, advise carotid endarterectomy electively.
50-70%: stenting? conservative rx
<50%: monitor with routine carotid duplex scans.

*subclavian steal: CNS ssx. syncope, vertigo, ataxia, dysarthria, confusion 2/2
lack of circ into verte-
brobasilar artieries, instead flowing into L subclavian. (backwards flow
instead of forward to brainstem)
also upper extr claudication *L subclav artery obstruction prox to verte
bral artery origin
*TOS: px c upper extr paresthesias, weakness, cold temperature, edema & venous d
istention.
rx c cervical rib resection. decre muscle hypertrophy
----------------------------------------------------------
VITAMINS:
A Night blindness, scaly rash, xerophthalmia Pseudotumor cerebri, bo
ne
(dryeyes), Bitot's spots (debris on thickening, teratogeni
c
conjunctiva); increased infections
C Scurvy (hemorrhages/skin petechiae, bone,
gums; loose teeth; gingivitis), poor wound
healing, hyperkeratotic hair follicles,
bone pain (from periosteal hemorrhages)
D Rickets, osteomalacia, hypocalcemia Hypercalcemia, nausea,
renal
toxicity
E Anemia, peripheral neuropathy, ataxia Necrotizing enterocolit
is (infants)
K Hemorrhage, prolonged prothrombin timHemolysie s (kernicterus
)
B, (thiamine) Wet beriberi (high-output cardiac failure),
dry beriberi, (peripheral neuropathy),
Wernicke and Korsakoff syndromes
B2 (riboflavin) Cheilosis, angular stomatitis, dermatitis
B3 (niacin) Pellagra (dementia, dermatitis, diarrhea),
stomatitis
B6 (pyridoxine) Peripheral neuropathy, cheilosis, stomatitisPeriphera,l neuropat
hy (only B
convulsions in infants, microcytic anemia,vitamin with toxicity
)
seborrheic dermatitis
B12 (cobalamin) Megaloblastic anemia plus neurologic
symptoms
Folic acid Megaloblastic anemia without neurologic
symptoms
Zinc Hypogeusia (decreased taste), rash, slow
wound healing
Copper Menke's disease (X-linked; kinky hair, mental Wilson's disease
retardation)
Selenium Cardiomyopathy and muscle pain Loss of hair and nai
ls
Manganese "Manganese madness"
in
miners of ore
Chromium Impaired glucose tolerance
--------------------------------------------------------------------------------
---------------
*vitamin C: scurvy= def. petechiel hemorrhages, periosteal hemorrhagese[bone pai
n], loose teeth/gingivitis,
poor wound healing, hyperkeratotic hair follicles.
*vit A def: night blindness, bitot's spot[debris on conjunctiva], dry eyes, scal
y rash, incre infx
*vit A tox: pseudotumor cerebri, teratogenic[think isoretinoin]
*vit D def: rickets, osteomalacia, hypoCa
*vit D tox: renal tox, hyperCa
*vit E def: anemia, ataxia, peripheral neuropathy
*vit E tox: NEC
*vit K def: bleeding diathesis, hemorrhage, incre PT, hemolysis
*vit B1 def: wet beriberi(--> high output CHF)
thiamine dry beriberi (peripheral neuropathy)
wernicke/korsakoff syndromes
*vit B2 def: cheilosis, angular stomatitis, dermatitis
riboflavin
*vit B3 deinef: pellagra (dermatitis, dementia, diarrhea)
niacin
*vit B6 def: peripheral neuropathy, cheilosis
pyridoxine
*vit B6 tox: peripheral neuropathy
*fluoride tox: mottling of teeth & bone exotoses
*zinc def: decreased taste, rash
**decreased folate: phenytoin, MTX, TMP.
_______________________------------------------------
CARDIOLOGY:
*VSD: MC CHD, holosystolic murmur next to sternum
*ASD: oft asymp until adulthood. FIXEd, split s2.
*PDA: 2/2 non-closure of ductus arteriosus. machinery hum in LUSB.
rx c Prostaglandin E (to keep open) & indomethacin to close.
assoc c rubella & high altitudes.
*TOF: cyanotic CHD. "tet" spells relieved by squatting.
1)VSD
2)over-riding aorta
3)RVH
4)pulm stenosis
*coarct of aorta: UE HTN, radiofemoral delay. rib-notching on XR.
assoc c Turner's synd
**endocarditis prophylaxis required for all above x ASD ostium secundum
----------------------------------------------------------------------------
DERMATOLOGY:
*conditions assoc with pruritus: hyperbilirubinemia(pancreatic CA/liver failure)
, uremia, PCV,
*polycythemia rubra vera: pruritus s/p hot shower,
derm dz: LP, contact dermatitis, atopic dermatitis{red weepy scaly rash
on head, UE & diaper area], scabies
*atopic triad: atopic dermatitis, asthma, & allergies (esp to PCN)
*dermatophytosis (fungal infx) MCC by Trichophyton species.
Wood's lamp for tinea capitis: Microsporum
dx c KOH prep or cx b4 treating. onychomycosis & tinea capitis req oral
antifungals. others topical rx.
*scabies: rx c permethrin cream. Lindane= neurotox. 2nd line drug.
*head lice: pediculosis rx c permethrin
*pubic lice: Phthiruspubis. rx c permethrin cream.
*psoriasis: extensor surfaces & scalp. rx c UV light exposure, lubricants, topic
al steroids, keratolytics.
*tinea versicolor: flesh colored patched on trunk. caused by Pityrosporum fungi
infx.
dx c KOH prep. Rx selenium sulfide shampoo.
*pityriasis rosea: "herald patch" scaly ring shaped patch on trunk. -> then 1 wk
later, many more patched.
in Xmas tree distribution. rx: spont resoln in 1 mo
*LP: purple, polygonal pruritic papules. white lacy reticular patterns in mouth.
*erythema multiforme (SJS): MC et: PCN/sulfa drugs, herpes infx or idiopathic ca
uses.
*erythema nodosum: inflm of fat cells (panniculitis) under the skin. classically
over shin.
assoc c UC, sarcoidosis, coccidiomycosis. also caused by infx(strep, TB)
/drugs (sulfa)
*dermatitis herpetiformis: assoc c celiac sprue. dx c bx (IgA deposits in skin)
& look for ssx of celiac sprue
*PV: starts in oral mucosa then rest of body. bx & stain show "fishnet" or "lacy
" immunofluorescence
IgG Ab to desmoglein III.
*BP: milder dz. stain shows linear immunofluorescence, diff Ab. {to hemidesmosom
es}
*
--------------------------------------------------------------------------------
-
ACID BASE & ELECTROLYTES:
*hyperNa: ssx similar to hypoNa. N/V, mental status changes, coma. MCC= dehydrat
ion.
other etiologies: DI, diuretics, diarrhea, renal dz.
rx c water replacemt (NS). AVOID D5W.
*hypoK: muscle weakness (may affect smooth muscles too), paralysis, ventilatory
failure. EKG changes-> U waves, flat T waves
PVC/PAC, atrial/ventricular arrhythmias. seen in alkalosis 2/2 cellular
shift.
rx c slow oral replacemt. if IV replacemt needed, give 20mEq/hr & monito
r for cardiac changes.
also monitor Mg levels. Need Mg to retain K in body.
*hyperK: seen in acidosis 2/2 cellular shift. peaked T waves on EKG, incre PR in
terval, widen QRS, arrhythmias include
asystole & Vfib.
*dig & K: monitor closely. Hrt esp vulnerable to low K when on Dig.

-------------------------------------------------------------------
100 FACTS:
1. Exogenous causes of hyponatremia to keep in mind: oxytocin, surgery, narcotic
s, inap-
propriate IV fluid administration, diuretics, and antiepileptic medications
.
2. Vtach: rx c amiodarone or lidocaine. if unstable-> defibrillate
3. EKG changes:
hyperK: tall peaked T waves
hypoK: blunted/missing T waves & U waves
hyperCa: shortening of QT
hypoCa: prolongation of QT
4. Gastric ulcers (stomach): Bx to r/o malignancy. sm bowel, observe & treat.
5. Morpheine: sphincter of Oddi spasms. Avoid in pancreatitis.
6. Hereditary hemochromatosis is currently the most common known genetic disease
in
white people. The initial symptoms (fatigue, impotence) are nonspecific, bu
t patients often
have hepatomegaly. Screen with transferrin saturation test (serum iron/tota
l iron binding
capacity) and ferritin level. Treat with phlebotomy after confirming the di
agnosis with
genetic testing and liver biopsy.
7. corticosteroid side fx:
central obesity (wt gain) hirsutism
prox muscle weakness sex dysfn
abd striae poor wound healing
round facies glucose intol
buffalo hump DM
acne growth stunting
8. OA= MCC of arthritis (>15%)= DJD.
9. MCC CA in women: 1)breast 2) lung 3) colon
men: 1)prostate 2) lung 3) colon
MCC CA deaths women: 1)lung 2)breast 3)colon
men: 1) lung 2)prostate 3)colon
10. Potential risks and side effects of estrogen therapy (e.g., contraception,
post-
menopausal hormone replacement): endometrial (and possibly breast) cancer,
hepatic adenomas, glucose intolerance/diabetes, deep venous thrombosis, cho
lelithi-
asis, hypertension, endometrial bleeding, depression, weight gain, nausea/v
omiting,
headache, weight gain, drug-drug interactions, teratogenesis, and aggravati
on of pre-
existing uterine leiomyomas (fibroids), breast fibroadenomas, migraines, an
d
epilepsy.
11. Multiple sclerosis: dx c MRI, LP(incre IgG oligoclonal bands & myelin basic
protein & lymphocytes & prot),
evoked potentials c areas of slowed conduction thru areas of damaged mye
lin(demyelination of MS)
12. Dementia: attn us unaffected. Delirium= decre attn
13. The p-value reflects the likelihood of making a type I error, or claiming an
effect or
difference where none existed. P value= confidence in data.
14. potentially fatal in withdrawal include alcohol, barbiturates, and
benzodiazepines. Alcohol, cocaine, opiates, barbiturates, benzodiazepines,
phency-
clidine (PCP), and inhalants are potentially fatal in overdose.
15. Low maternal serum alpha-fetoprotein causes: Down syndrome, inaccurate dates
(most common), and fetal demise. High maternal serum alpha-fetoprotein caus
es:
neural tube defects, ventral wall defects (e.g., omphalocele, gastroschisis
), inaccurate
dates common), and multiple gestation. Measurement generally is obtained
between 16 and 20 weeks gestation.
16. conditions assoc with pruritus: hyperbilirubinemia(pancreatic CA/liver failu
re), uremia, PCV,
*polycythemia rubra vera: pruritus s/p hot shower,
derm dz: LP, contact dermatitis, atopic dermatitis{red weepy scaly rash
on head, UE & diaper area], scabies
17. atopic triad: atopic dermatitis, asthma, & allergies (esp to PCN)
18. dermatophytosis (fungal infx) MCC by Trichophyton species.
Wood's lamp for tinea capitis: Microsporum
dx c KOH prep or cx b4 treating. onychomycosis & tinea capitis req oral
antifungals. others topical rx.
19.
19.
1

--------------------------------------------
1. CMV colitis: HIV pt. bloody diarrhea. owl-eyes c intracytoplasmic {even intra
nuclear} inclusions & basophillic stippling.
2. crypto HIV diarrhea: watery diarrhea
3. ataxia + encephalopathy + oculomotor dysfn (in alcoholic pt)= Wernicke's ence
phalopathy. rx c thiamine
4. B12 stores last 3-4 yrs.
5. Sheehan's syndrome: infarction of pituitary gland postpartum
6. Addison's dz: hypoNa, HyperK.
7. Ethylene glycol poisoning: rx c etoh or Formizole. results in envelop-shaped
crystals.
8. terminal hematuria: bladder dz. clots= bladder dz. initial hematuria= urethra
injury. continuous hematuria: renal/ureter dz.
NO clots in renal injury
9.malignant otitis externa: no noticable ssx. BUT can lead to temporal bone/TMJ
infx. --> incre pain c chewing. incre pain at night.
10. renal failure + systemic eosinophilia: cholesterol embolism, PAN, AIN.
11. Roth's spots: retinal hemorrhagic spots 2/2 immune vasculitis
Osler's nodes: violaceous nodes on fingertips 2/2 immune complex deposit
ion
Janeway lesions: 2/2 septic emboli. spots found in palms/soles.
12. OM: can assoc c systemic ssx such as diarrhea. acute loss/abn of hearing. ca
n be painless in kids
13. boggy nasal/ear mucosa: risk of sinusitis
14. fluphenazine: high potency antipsychotic. side fx- decreases thermoregulatio
n & shivering response--> leads to hypothermia
15. Acute glaucoma: assoc with red eyes, Rx c beta blkers (timolol), carbonic an
hydrase inhibitor(acetazolimide), mannitol(osmotic diuretic), pilocarpine.
AVOID ATROPINE (mydriatic agent--> can worsen or even instigate glaucoma
).
16. HOCM: autosomal dominant d/o. Incre in AA.
see hypertrophies septum & abn mitral valve mvmt.
ssx: systolic ejection murmur along L sternal border. ***INCRE MURMUR c
VALSALVA(2/2 decre preload, which incre obstruction)
**Incre murmur with standing (decre SVR, thereby decre preload)
17. AS: R 2nd intercostal space murmur. crescendo-decrescendo.
Pulsus parvus et tardus (delayed carotid upstroke)
assoc c abn tricuspid valve
sustained handgrip (aka incre SVR) decreases murmur
18. spironolactone: BEST agent to use for cirrhotic ascites. improves M/M in CHF
.
19. improves M/M in CHF: spironolactone, beta blkers, ACEI/ARB, ASA.
NOT digoxin or diuretics such as loops (furosemide)
20. CMV retinitis: painless. no keratitis/conjunctivitis. red, fluffy fundal dis
c ---> CMV infx: rx c gancicyclovir
21. HSV retinities/ VZV retinitis: painful. initially as retinitis, conjunctivit
is. central retinal necrosis. pale fundal disc---> HSV: rx c acyclovir
22. bloody diarrhea: O157 EColi, shigella, samonelle, campylobacter, yersinia, C
. diff
23. organophosphate poisoning: miosis, urination, diarrhea, salivation, lacrimat
ion, bronchorrhea, bradycardia.
rx c ATROPINE. and remove clothing.
24. dacrocryoitis: MCC Staph & strep.
25. CMV: retinitis & colitis & pneumonitis. multifocal diffuse infiltrates.
26. trachoma: 2/2 chlamydia serotype A-C. MCC of blindness worldwide.
px c folliculitis, pannus (neovascularization) of cornea. concurrent nas
alpharyngeal infx--> nasal d/c.
rx c tetracycline/erythro
27. CRAO: painless unilateral loss of vision. fundus= pale with cherry red fovea
& segmentation of blood in arteries & veins.
28. CRVO: same. fundus= disk swelling. venous dilatation, tortuousity, cotton wo
ol spots.
29. amaurosis fugax: same. fundus= white edematous spots around retinal arteriol
es
30. vitreous hemorrhage: same. obscure fundus
31. torticollis (dystonia): oft caused by 1) typical antipsychotics (fluphenazin
e) 2)metoclopramide 3)perchlorazine
32. Essential tremor: disappears during sleep & decre c ETOH.
33. hemiballismus: 2/2 destruction of contralat subthalamic nucleus.
34. endometriosis: 1)dyspareunia (pain c sex) 2)dysmenorrhea 3)pain c defecation
? --> rx c OCP
35. dissociation: avoidance and complete disregard of upsetting event as if it d
id not exist.
36. tic d/o: assoc with developmt of ADHD & OCD.
37. schizoaffective: psychosis present for >2 weeks prior to onset of mood ssx.
38. folie a deux: separate pair and rx separately.
39. minor: only consent of 1 parent needed for rx.
40. TRAP+: seen in hairy cell leukemia
41. CML: incre in more mature elements(bands, segmented neutrophils). decre LAP(
leukocyte alk phos). +philadelphia chr
42. leukemoid rxn: incre LAP
43. PCV: no EPO detected in urine.
44. rate/rhythm control agents: digoxin, diltiazem(central-acting CCB), beta blk
er (also add warfarin to anticoag)
45. legionella: atypical PNA c neuro ssx(confusion), GI ssx, HIGH fever. assoc w
ith travel(cruise ships/hotel water cooling),
dx c urinary Ag testing/charcoal agar cx. not seen in stain 2/2 intracel
lular nature.
rx c macrolide(erythro/azithro), or levofloxacin
46. PV: IgG Ab against desmoglein, intracellular epidermis. +Nikolsky sign. (eas
y desquamation of skin layers with touch)
mucocutaneous dz. flaccid bullae. rx c steroids/azathioprine.
47. dermatitis herpetiformis: assoc with celiac sprue. pruritis papules & vesicl
es. IgA deposits. anti-endomysial Ab.
48. Indications to use O2 in COPD: 1) SaO2 <88% 2)PaO2<55 3)ssx of corpulmonale
4)Hct>55%
49. RA: MCP and PIP jt involvmt. greater pain in AM. stiffness >30min in AM. oft
c subQ nodules on extensor surfaces.
assoc c Baker's cyst (palpable popliteal mass)
50. psoriatic arthritis: greater pain in AM. DIP involvmt. also sausage fingers(
dactylitis), nail involvmt, silvery scales.
51. Zollinger Ellison: dx c fasting serum gastrin. if >1000, diagnostic.
if serum gastrin equivocal, then do secretin stimulation test.
52. Mallory Weiss tears: tears in mucosa of cardia. [submucosal tears in veins:
esophageal varices ruptures. oft 2/2 porten HTN]
53. tennis elbow (lateral epicondylitis): pain c active extension or supination
of wrist. pt tenderness over lateral epicondyle
54. high dose niacin(such as seen in lipid rx): produces Prostaglandin rxn (cuta
neous flushing, pruritus) that resolves 2-4wks s/p start of rx.
55. G6PD def: Xlinked recessive d/o common in mediterranean & AA men. results in
precipitated Hgb that stains c crystal violet.
px c episodic hemolysis (ie- dark urine) 2/2 lack of G6PD that oxidizes
glutathione.
see Heinz bodies & bite cells on smear. avoid antimalarials, sulfa, fava
beans
56. erythema nodosum: subQ fat cells inflmm (panniculitis). px c pretibial eryth
ematous nodules.
57. acyclovir: crystalluria. results in renal tubule obst--> ARF.
58. SVT: narrow QRS tachycardia. rx c carotid massage, adenosine then AV nodal b
lkers if stable. if unstable, immed DC cardioversion.
59. Vtach: rx c lidocaine
60. T test: needs 2 samples, 2 variances and 2 means.
61. Z test: needs 2 populations, population variances and 2 means.
62. ANOVA: 3 means/samples. Chi squared: looks at proportions.
63. nephroic syndrome: assoc c hypercoagulability. 2/2 to incre losses of Antith
rombin3, decre levels of prot C/S, abn platelet aggreg.
px c 1) proteinuria >3.5g 2)hypoalbuminemia 3)hyperlipidemia/lipiduria 4
)edema
64. Nocardia: weakly acid fast, GP, filamentous branching rod found in dirt/wate
r.
px c cavitary lesions. rx c TMP-SMX
65. chronic pancreatitis: MC risk factor for pancreatic CA. dx c Abd/Pelvic CT.
66. solitary brain met: rx surgical excision then whole brain radiotherapy. if m
ultiple mets, whole brain radiotherapy.
oft assoc with non-small cell CA of the lung. seen in the grey-white mat
ter junction.
can px c mass effect, ICP, etc.
67. ACE-I prevent cardiac remodelling (causing ventricular dilitation & wall thi
nning) s/p MI.
68. acute ascending cholangitis: charcot's triad: 1)RUQ pain 2)fever 3)jaundice
rx c fluids & IV abx. if refractory, then ERCP for decompression/drainage.
69. CMV infx: rx c gancicyclovir. CMV esphagitis- large shallow ulcers
70. HSV: rx c acyclovir. small deep ulcers.
71. reticulocytes stain c methylene blue. howell-jolly bodies 2/2 splenectomy. s
tain c wright giemsa.
72. Mycoplasma atypical PNA: px c erythema multiforme (target dusky) rash and in
dolent ssx. CXR= interstitial infiltrates
73. wedged shaped lesion on CXR: PE.
74. HUS: ARF, fever, recent diarrheal dz, microangiopathic Hemolytic anemia--> s
chistocytes, giant platelets, purpura.
intravascular hemolysis: incre INDIRECT bili, LDH, incre reticulocytes
75. Pancreatic CA: risk factors-> fam hx, chronic pancreatitis, smoking, DM, hig
h fat diets.
tumors in head px c: jaundice, steatorrhea, wt loss
tumors in body/tail: px c wt loss & pain
always dx c CT.
76. antiphospholipid syndrome: 3 diff Abs. 1)false + VDRL Ab 2)falsely elevates
PTT. 3)anticardiolipin Ab
anticoagulate in preg pts c ASA & Heparin. Otherwise, use warfarin (tera
togenic)
77. Klebsiella PNA: MC in alcoholics. CXR: upper lobe PNA. Cx: mucoid colonies.
encapsulated. currant jelly sputum
78. trochanteric bursitis: lateral hip pain. pain c sleeping on side
79. OA: pain in AM for <30 min. pain c incre activity & relieved c rest
80. Rx for nephrolithiasis: 1)decre protein & oxalate intake 2)incre fluids 3)de
cre Na intake 4)incre Ca intake
81. amitriptyline: can induce urinary retention. rx c cath.
82. Erythema nodosum (subQ fat necrosis esp on pretibial shins): assoc with IBD,
sarcoid, TB, strep infx. if dx EN, r/o recent other infx
c ASO titers, PPD, GI history & CXR for sarcoidosis.
83. contact dermatitis: type IV
84. torsades des pointes: rx c MgSO4. (induced by hypomagnesia(alcoholics), drug
s(TCA antidepressants, antiarrhythmics)
85. Erlichiosis: (spotless rocky mt spotted fever). 2/2 tick bite dz. ssx: N/V,
fever.
86. Baker's cyst: palpable popliteal mass.
86. Babiosis: 2/2 tick borne dz. clinically sig in pt s spleens--> hemolytic ane
mia, resulting in jaundice, incre LFT. may see ARF.
NO RASH. rx c quinine/clinda or
87. OA: 6 criteria- 1) age>50yo 2)cool jt(no warmth) 3)crepitus c active mvmt 4)
slight/no AM stiffness 5)
MC affects knee, hip, fingers. finger nodules-> Herbenden's (DIP) & Bouc
hard's (PIP) [like a pencil. HB]
px c episodic hemolysis (ie- dark urine) 2/2 lack of G6PD that oxidizes
glutathione.
see Heinz bodies & bite cells on smear. avoid antimalarials, sulfa, fava
beans

1. MG: weakness with repeated exercise. 2/2 cholinergic receptor Abs.


rx c anticholinesterase agents--> pyridostigmine & neostigmine. also co
nsider thymectomy.
2. Hodgkin's dz: reed-sternberg cells pathognomonic.
3. CLL: smudge cells. MC in elderly. us Asx, often incidental finding. dx c lymp
h node bx
4. enoxaparin: LMWH
5. HIT(heparin induced thrombocytopenia): 50% develop vascular thrombosis. and h
ave prolonged PTT.
6. PNH: suspect if 1)pancytopenia 2)intravascular hemolytic anemia (incre indire
ct bili, LDH, decre haptoglobin) 3)recurrent venous thrombosis (portal vein thro
mbus/budd chiari)
px c dark urine(hemoglobinuria) & anemia
dx c Hamm test/sugar lysis test.
7. ESRD & anemia: most likely 2/2 lack of EPO. rx c recombinant EPO if 1)Hgb<10
or Hct<30.
side fx of EPO: HTN (incre diastolic BP of >10mmhg), H/A, flu-like syndr
ome,
8. atrial myxoma: MC in LA. If in LA, can cause mitral valve murmur (diastolic r
umble like MS)
9. investigate (with echo) all diastolic murmurs.
10. chronic hep B: chronic dz c persistently elevated ALT, rx c lamivudine & alp
ha interferon.
11. aspergillosis: CXR: cavitary lesion. CT: nodules c halos or with air crescen
t
12. coccidio pulmonary infx: nonspecific findings. assoc c cutaneous sx--> eryth
ema multiforme/erythema nodosum
13. rubella: rash on face then trunk & extr. polyarthralgias. +postauricular/cer
vical LAD
14. RMSF: rash starts on wrists then moves to body.
15. diabetes & incontinence: overflow incontinence 2/2 bladder denervation & det
ruser weakness.
16. CO poisoning: 1)polycythemia 2)H/A
17. hemorrhagic strokes: us. occur when pt is awake & stressed. (85% of strokes)
18. ischemic strokes: us occur when pt at rest. (15% of strokes)
19. fibromyalgia: no physical ssx x pain. common pts= lateral upper quadrants of
buttocks, medial knees, SCM, trapezius.
worsen c exercise
20. Polymyalgia rheumatica: shoulder & pelvic girdle muscle weakness. assoc c te
mporal arteritis
21. MVP: MC murmur/valve defect assoc c infective endocarditis.
22. hyperTG > 1000 often leads to pancreatitis. HLD 1 & 5 assoc c pancreatitis.
23. viral arthritis: cause arthritis without swelling/warmth/erythema/pt tendern
ess of jts. MC caused by Parvovirus B19.
MC in PIP, MCP, wrist, ankles. dx c anti-B19 IgM.
24. Baker cyst: 2/2 inflamed synovium.
25. low glucose in pleural effusion: likely exudative.
26. Reiter's (reactive) arthritis: seronegative arthropathy. also commonly see A
chilles tendon pain & lower back pain.
px c nongonococcal urethritis, conjunctivitis, oligoarthritis. Rx c NSAI
Ds.
27. cohort= prevalence. cross sectional=incidence
28. SAH: assoc c hypoNa (2/2 to SIADH & increased ANP- cerebral salt wasting)
29. LBBB: paradoxical split of S2
30. IV drug abuse: MC right sided valve dz. TR= very common. results in septic e
mboli in lungs (scattered round lesions on CXR)
murmur incre c inspir
31. Primary adrenal insuff: et= MC in developed countries is autoimmune. MC in u
nderdev= TB.
32. calcified adrenal glands: pathognomonic for TB.
33> NTG: first line symptom relief for acute cardiogenic PE leading to orthopnea
, dyspnea.
34. severe hypoNa (Na<120) & CNS ssx (AMS, seizures) require hypertonic saline r
x. SLOW rx. otherwise central pontine myelinolysis
35. NPH(normal pressure hydrocephalus): triad of : ataxia, urinary incontinence
& dementia
36. waddling gait: seen in muscular dystrophy 2/2 weak gluteal muscles
37. cerebellar tumors: falls toward side of lesions. may titulate (move back &fo
rth) on standing still. abn RAM. ipsilateral ataxia
38. tabes dorsalis: destruction of posterior columns. loss of proprioception. WI
DE gait.
39. Grave's dz: pretibial myxedema, infiltrative ophthalmopathy

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