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what are some scenarios that make a UTI complicated? - -- <> ---pregnancy poor controlled DM hospital acquired renal trasnplant urinary tract obstruction immunocompromised
AKI or CKD what are the USPSTF guidelines for breast cancer screening? - -- <> ---recommend screening ages 50-74 biennially (every 2 years) with mammagraphy American cancer society recommends screening start at age 45 based on the finding that the absolute risks of breast cancer occurrence and death for women ages 45 to 49 are more similar to those for women ages 50 to 54 what is a long term side effect of phenytoin? - -- <> --- osteomalacia - altered bone and mineral metabolism and decreased bone density, related in part to induction of the CYP enzyme system and increased vitamin D catabolism differentiated spondylolysis and spondylolithesis - -- <> --- spondylolysis - unilateral or bilateral defect (fracture or separation) in the vertebral pars interarticularis, usually in the lower lumbar vertebrae when this defect is bilateral the vertebral body may slip anteriorly which is called spondylolitheisis
neovascularization commonly occurs in cental retinal vein occlusion ("blood and thunder") which immunoglobin is associated with urticaria? - -- <> --- IgE preferred treatment for toxoplasmosis - -- <> --- sulfadiazine and pyrimethamine what exactly causes the occlusive vascular disease of thromboangiitis obliterans? - -- <> ---aka Buerger's disease inflammatory thrombi affecting the medium and small vessels (nonatherosclerosis) polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be presen Treatment options for thromboangiitis obliterans? - -- <> --
- smoking cessation most important! cilostazol (PDE 3 inhibitor) has vasodilator properties (alleviated symptoms) if raynauds also present, CCB (nifedipine)
what heart failure treatment provides a benefit of reduction in morbidity and mortality? - -- <> ---ACE inhibitors beta blockers can also reduce M&M diuretics have no reduction in mortality how would you manage a patient with a MI in the setting of cocaine use? - -- <> ---benzodiazepine early no beta blockers If PCI cannot be done for a STEMI patient within 120 minutes, what should be done? - -- <> ---fibrolytic therapy then do PCI & coronary angiography when it can be done ideally PCI is done within 90 minutes fibrolytic therapy can be used up to 12 hours of symptoms If you suspect an acute limb ischemia due to arterial embolism, what imaging should you get? - -- <> ---catheter-based
If pheo suspected: measure fractionated metanephrines and catecholamines in a 24-hour urine collection other than atherosclerosis leading to renal artery stenosis and secondary HTN, what is another causes of a renal-associated secondary HTN? - -- <> ---fibromuscular dysplasia (usually in a young pt) most important modifable risk factor for AAA? - -- <> --- smoking cessation! when is it okay to do screening survelliance for AAA rather than repair and how often should you screen? - -- <> ---if AAA is <5. cm then annual screening with US is recommended. may need every 6 months if rapidly expanding or other concerns how should you educate a patient with AAA on exercise? - -- <> ---Patients should be counseled that moderate physical activity such as running, biking, swimming, hiking, or sexual activity and activities such as gardening, golfing, and horseback riding do not precipitate AAA rupture Moderate physical therapy may also limit aneurysm expansion. In experimental aneurysms, increased aortic blood flow appears to inhibit AAA expansion
However, heavy lifting, especially while holding the breath, and other activities that lead to Valsalva transiently induce significant increases in blood pressure and should be avoided gold standard for dx renal artery stenosis? what can be used to monitor disease progression? - -- <> ---renal arteriography But really a spiral CT angiography is very useful and probably more likely done first duplex doppler US can be used to monitor disease progression what are some symptoms of mitral valve prolapse syndrome? - -- <> ---various nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, anxiety disorders, and dizziness since symptoms are relatively uncommon, what physical exam findings are associated with mitral valve prolapse? - -- <> ---non- ejection click in systole click is mobile, meaning its timing varies with maneuvers that change the left ventricular volume, occurring earlier in systole with sitting,
where do karposi sarcoma lesions typically occur? describe their appearance. - -- <> ---often on distal extremities, such as lower legs and feet purplish, reddish blue, or dark brown/black macules, plaques, and nodules on the skin. Nodular lesions may ulcerate and bleed easily common in poorly controlled HIV how would you treat hidradenitis suppurativa? - -- <> --- topical clindamycin if fail topical therapy, oral tetracyclines are suggested Antiandrogenic drugs and metformin are additional treatment options that may be used alone or in conjunction with antibiotic therapy Pt with hypertriglyceridemia >885 mg/dL that required medical therapy due to no improvement after lifestyle changes and statin. how would you treat? - -- <> ---fenofibrate fenofibrate is better than gemfibrozil bc can be used with a statin. Gemfibrozil has a higher risk of muscle toxicity
how would you initially treat a pt with hypertriglyceridemia? - -- <> ---lifestyle changes (reduce EtOH consumption, aerobic exercise, better glycemic control) and statin what causes subacute thyroiditis? - -- <> ---presumed to be caused by a viral infection or a postviral inflammatory process. Many patients have a history of an upper respiratory infection prior to the onset of thyroiditis seasonal incidence (higher in summer) Large-needle thyroid biopsies reveal widespread infiltration with neutrophils, lymphocytes, histiocytes and giant cells, disruption and collapse of thyroid follicles, and necrosis of thyroid follicular cells how is the diagnosis of subacute thyroiditis made? - -- <> - --clinical dx neck pain, thyroid tenderness suppressed TSH T3/T4 mildly elevated
Taller than wide shape Rim calcifications with extrusion of soft tissue what makes up aspirin exacerbated respiratory disease (or NSAID- exacerbated respiratory disease)? - -- <> ---asthma, chronic rhinosinusitis (CRS) with nasal polyposis, and acute upper and lower respiratory tract reactions symptoms of nasal congestion and bronchoconstriction typically begin 20 minutes to 3 hours after administration what type of allergy is aspirin exacerbated respiratory diseaase (AERD)?
- -- <> ---pseudoallergy, not IgE mediated In contrast, IgE-mediated "allergic" reactions result from the formation of antibodies against a specific drug, haptenated drug, or a group of structurally similar drugs how would you treat otitis externa? what if the TM is perforated? - -- <> ---mild disease - topical acetic acid + hydrocortisone moderate disease - topical abx + steroid to cover staph and pseudomonas (first line consider quinolones (cipro) or polymyxin- neomycin to cover both)
Preparations containing aminoglycosides should be avoided in ears where the integrity of the tympanic membrane cannot be confirmed Treatment approach to HSV-1? - -- <> ---Acyclovir has the greatest in vitro activity against HSV-1 and HSV-2. However, famciclovir and valacyclovir have greater oral bioavailability than acyclovir and are dosed less frequently HSV-1 oral leads to gingivostomatitis. usually self limiting but treat if symptomatic. earlier the tx the better it works Pt has an acute onset of eye pain, vision blurring, and discharge. On physical exam you see dendritic lesions on the cornea. Dx? - -- <> ---herpes simplex keratitis how is the dx of herpes simplex keratitis established? - -- **_<<ANSWER IS
_** ---mostly clinical Dx should be made in conjunction with an ophthalmologist if dx uncertain can use detection of viral DNA via PCR testing from intraocular fluid
criteria and therapeutics for hypertensive emergency? - -- **_<<ANSWER IS
** ---SBP > 180 and/or DBP >120 WITH EVIDENCE OF END ORGAN DAMAGE sodium nitroprusside what are some topical agents that can be used for painful external hemorrhoids? - -- **<>** ---topical vasoactive agents: nitroglycerin (helpful for thrombosed), phenylephrine (aka prep H, relief for acute sx) topical corticosteroids for short term analgesic/inflammation relief - hydrocortisone (Anusol) local topical anesthetics for pain/pruritus (benzocaine, dibucaine) zinc oxide paste how would you treat symptomatic internal hemorrhoids? - -- **<>_** ---rubber band ligation (cannot use on external hemorrhoids, extremely painful) sclerotherapy (phenol 5%)
conservative treatment options for hemorrhoids - -- <> --- diet (increased insoluble fiber intake, drink more water) regular exercise avoid straining Sitz baths stool softeners (docusate) what vessel is most commonly involved in acute mesenteric ischemia? - -- <> ---SMA (superior mesenteric a.) Pt with a hx of HTN and PAD presents with acute abdominal pain out of proportion to PE with N/V. Pt denies bloody BMs. EKG shows atrial fibrillation. Your suspicions are confirmed with CT angiography. Dx? - -- <> ---acute mesenteric ischemia how would you manage a pt with acute mesenteric ischemia? - -- <> ---NPO fluid therapy avoid vasopressors anticoagulation (LMWH) endovascular intervention vs. surgery
A 46-yr-old man presents with weakness, weight loss over the last 2 months and fatigue. He endorses melena and dark colored urine. His palms appear red and he has gynecomastia. Dx? - -- <> --- cirrhosis other common s&sx include pruritus, jaundice, amenorrhea (women), hepato/splenomegaly, spider angiomata what sx of cirrhosis suggest advanced disease? - -- <> --- asterixis, jaundice, confusion, sleep disturbances, ascites what lab abnormalities are seen with cirrhosis? - -- <> --- Elevated AST/ALT with AST usually higher than ALT elevated alk phos thrombocytopenia (advanced disease) anemia low serum albumin prolonged PT, elevated INR hyponatremia elevated serum creatinine Clinical therapeutics for SVT? - -- <> ---Adenosine (if symptomatic)
BB/CCB (if regular) radiofrequency ablation (definitive) (if WPW do NOT give adenosine or CCB) clinical manifestations of arterial embolism? - -- <> ---6 Ps - paresthesias, pain, pulselessness, poikilothermic, paralysis Workup for acute arterial occlusion? - -- <> ---arterial doppler to check pulses CT angiography Describe ECHO findings for a patient with HOCM - -- <> --- asymmetric ventricular wall thickness (esp. septal) 15mm or more, systolic anterior motion of the mitral valve, & small LV chamber size Initial lab workup for pt newly diagnosed with htn? - -- <> - --UA Spot urine albumin: creatinine ratio bloodwork (creatinine, K, Na, fasting plasma glucose, lipid profile, and often TSH), and ECG Most common cause of secondary htn? - -- <> ---primary aldosteronism
