uword

Question Id

Main Division Sub Division Notes

2141 Medicine Cardiovascular System In Sinus bradychardia use atropine, if hypotensive go EPI. IF still bad go for Transcutaneous Pacing2145 Medicine Pulmonary & Critical Care PE cause Hypotension, JVD and WAIT FOR IT RBBB2156 Medicine Cardiovascular System In RV MI (II, III and AVf) avoid nitrate BB ,, give IV fluid to prevent hyotension

2166 Medicine Gastrointestinal & NutritionRetained gastric content over 3 hours will produce a splash upon stethoscope auscultation when move patient aka "succussion splash".. Happening in Gastric Outlet Obstruction

2169 Medicine Renal, Urinary Systems & ElectrolytesHyperclcemia is FIRST TREATED with IV SALINE .. CAN ALSO GIVE CALCITONIN,, FOR LONG TERM BISPHOSPHONATES

2171 Medicine Endocrine, Diabetes & Metabolism DKA: Stupourous patient, rapid breathing, hx of weight loss, polydispia, polyuria

2174 Medicine Endocrine, Diabetes & MetabolismCosyntropin stimulation test is like ACTH stimulation test to check etiology of adrenal insuffisciency

2174 Medicine Endocrine, Diabetes & MetabolismIn Adrenal Insuffiscienct: First line DO COSYNTROPIN STIMULATION TEST (NOT 24h Urine collection cortisol)

2179 Medicine Endocrine, Diabetes & MetabolismRadioactive iodine is definitive treatment for Graves and not Surgery (unless pregnant or have severe ophtalmopathy which are contraindications)

2180 Medicine Renal, Urinary Systems & Electrolytes Chronic NSAID use can cause SIADH

2184 Medicine Endocrine, Diabetes & Metabolism

In DKA: Give normal saline to restore IntraVascular volume Correct hyperglycemia with regular insulin, and correct electrolyte imbalance (Potassium) Treat precipitatingg cause (infection..) After recovery add 5% dextrose to fluids given to avoid hypoglycemia

2186 Medicine Renal, Urinary Systems & Electrolytes In non ketotic hyperglycemia coma first GIVE NORMAL SALINE

2189 Medicine Endocrine, Diabetes & Metabolism In DKA follow up based on pH and anaion gap to assess improvement

2190 Medicine Endocrine, Diabetes & MetabolismDiabetic nephropathy: 1st control BP (more importnt than sugar level especially if controlled HbA1C)

2195 Medicine Ear, Nose & Throat (ENT) Deviation of uvula unilateral lymphadenopaty: peritonsillar abscess (not epiglotittis)... drain it now

2199 Medicine Gastrointestinal & Nutrition If have achalasia symptoms: Even after Barium done ==> Do endoscopy to rule out MALIGNANCY (In elderly ..)2210 Medicine Gastrointestinal & Nutrition A single negative occult blood test does not exclude colon CA

2212 Medicine Gastrointestinal & Nutrition

In esophageal motility disorders DO: BARIUM, THEN MANOMETRY.. (THINK ABOUT BIRD's PEAK APPEARRANCE THAT WE LIKE TO SEE FIRST) IF MECHANICAL START endoscopy UNLESS HAVE A HX OF Sx, Caustic injury or PRIOR RADIATION BE SAFE AND DO BARIUM FIRST

2218 Medicine Gastrointestinal & Nutrition In ascites of cirrhosis ==> restrict water and Na+==> give sipronolactone ==> furosemide ==> if still not enough: do parascentesis (2-4 L/day as long as renal are OK! )

2229 Medicine Renal, Urinary Systems & Electrolytes

If get a lot of blood in urinalysis (RBC) but on microscopical analysis no RBC are seen suspect the false positive of myoglobin which might indicate rhabdomyolisis which can occur following massive seizure maybe due to alcoholic withdrawal LOL


HSP or IgA nephropathy occurs post-URI (few days later not weeks (post-strep) ) ==> diagnosis is IgA nephropathy if no rash and systemic symptoms etc.. (instead of HSP, which is more common in kids)

2238 Medicine Male Reproductive System Non inflamatoory chronic prostatis exists !!!!!!2239 Medicine Infectious Diseases EPIDIDMYTIS IN YOUNG = STD = chalmydia, Gonorhea IN elderly: Gram (-) rods

2242 Medicine Renal, Urinary Systems & Electrolytes Sulfonamide and allergic interstitial nephritis BIG SHIT

2248 Medicine Hematology & Oncology AIHA can cause splenomegaly

2249 Medicine Hematology & Oncology MGUS is multiple myeloma withotu RENAL, ANEMIA, HYPERCALCEMIA (and lytic bone lesions logically).. but it has the risk to become MM: so do xray

2264 Medicine Infectious Diseases Toxoplasma : AIDS patient with multiple ring enhanced lesion on CT. Give sulfadiazine and pyrimethamine (which are both diagnostic and therapeutic (SD) )

2265 Medicine Infectious DiseasesWhen diagnose syphilis with dark field microscopy (VDRL and FT-ABS are serologies used for advance stages not chancres) suspect HIV and screen with ELISA since the patient is exposed to all the dirt that could potentially get you HIV

2268 Medicine Infectious DiseasesMAC prophylaxis with AZYSTHROMYCIN Starts with CD4

2276 Medicine Nervous System

IF AIDS and have EBV in CSF with PERIVENTRICULAR RING ENHANCED LESION = OF COURSE LYYMPHOMA .. Even if TOXO serology (+) coz MANY MANY PPLE ARE (+) for this (but only immunocompromised get it ) in addition to that patient is TAKING TMP-SMX

2277 Medicine Infectious Diseases Progressive multifocal leukoencephalopathy (JC vrius) is suspected in AIDS with focal neurological signs and multiple enhancing lesions with no mass on CT

2289 Medicine Nervous SystemTick borne ascending paralysis (in colorado hiking trip) causes no autonomic dysffunction like in Guillain Barre symdrome and presents with no fever or other complaints

2298 Medicine Pulmonary & Critical Care Hypertrophic osteoarthropathy can occur in lung CA patients.. also have clubbing

2305 Medicine Rheumatology/Orthopedics & Sports

OA can present with crepitus due to cartilage erosion and incongruous join surfaces, it has 10min morning stiffness if more than 30 min its inflmatorry.. INITIALLY GIVE ACETAMINOPHEN

2310 Medicine Cardiovascular System

Atheroembolism aka cholesterol embolism is a complication of any kind of catheterisation.. can cause cutaneous findings (blue toe syndrome..) cerebral, intestinal ischemia, acute kidney injury .. Treatment: Supportie + give Statin and reduce risk factors..

2314 Medicine Rheumatology/Orthopedics & Sports Birefringent crystals: Bseudogout not gout Calcium pyrrophosphate crystals


SLE: BLack 20-40 women Fatigue Fever, Weight loss Oral ulcers (not just Behcet) Hematological abnormalites Proteinuria Rash Arthritis (MCP, PIP like RA but no bone erosion on Xray)

2317 Medicine Rheumatology/Orthopedics & SportsErythema nodosum and sx suggestive of sarcoid, or African American lady.. Do CXR to look for cause

2341 Medicine Gastrointestinal & Nutrition Diverticulosis is most common bleeding LOWE GI BLEEDING in elederly

2342 Medicine Gastrointestinal & Nutrition When suspect pancreatitis ==> Do GB U/S to narrow ur differential or get the cause since stones are most common cause of pancreatitis (if not alcoholic)

2375 Medicine Ophthalmology Progressive and central bilateral vision loss in elderly >50= Age related macular degeneration

2380 Medicine Rheumatology/Orthopedics & Sports Stop PAP SMEAR after 65.. Do DEXA scan for osteoporosis above 65 instead

2384 Medicine Infectious Diseases Hep B exposure algorithm: -Documented vaccine: Reassure (HBsAb positive) -Unknown status or not immune: HBIG (immunoglobulin) and Vaccine series

2581 Medicine Gastrointestinal & Nutrition IBD Has a bimodal distribution: 20's and 60's ==> In Both forms you see Neutrophilic cryptitis.. (Bimodal since there BiForm of the disease)

2582 Medicine Gastrointestinal & Nutrition Ulcerative colitis: (increased colorectal cancer risk) Start colonoscopy 8 year afer diagnosis or a bit longer if not extensive. Repeat every 1-2 years

2597 Medicine Hematology & Oncology Waldenstrom: IgM spike Hyperviscosity Multiple myeloma: IgG and IgA (rarely hyperviscosity) MGUS are rarely symptomatik Heavy chain diseaseL IgA excess

2599 Medicine Hematology & OncologyIn breast Ca mets to bones: go for bisphosphonate (zoledronic acid, etidronate sodium and pamidronate THE DRONATES), if >12 sever hyperCa2+ use calcitonin with bisphosphonate But radiation is always better for alleviating pain

2615 Medicine Pulmonary & Critical CareAdenoCa of lungs is most common in smoker and non smoker (think of it in non smoker).. ususlay peripheral Large cell carcinoma also is peripheral but gives u large breast with galactorhhea

2616 Medicine Infectious Diseases Febrile neutropeniia: always cover first pseudomonas (cefepime, mero, tazosin)

2623 Medicine Hematology & Oncology Chemotherapy malaise nausea vomiting is treated with Sertonin Antogonist rather than Dopamine antagonists

2624 Medicine Hematology & OncologyTrousseau's syndrome: Hypercoagualibility and thrombophlebitis at unusual sites (arm, chest.. ) ==> Indicative of possible visceral malignancy as pancreatic, stomach, lung or prostate CA

2633 Medicine Renal, Urinary Systems & ElectrolytesSypmtomatik Hypercalcemia (>12 usually) require IV HYDRATION.. Bisphosphonate are long term managemetn of HYPERCALCEMIA of MALIGNANCY

2636 Medicine Pulmonary & Critical Care SIADH treatment: 1-Fluid restriction.. If fail 2-Hypertonic saline and increase salt intake.. If fail 3-Demeclocycline (rarely needed)2641 Medicine Hematology & Oncology Tumor lysis: HIGH K, PO4, URIC Acid LOW: Calcium

2642 Medicine Social Sciences (Ethics/Legal/Professional)

Before the tests are out revieling bad news: Ask the patient how he wld like to be approaches as it is important to have a good strategy and plan to deliver the news according to patient's wish. In case of delivering bad news, first start with open ended discussion asking the patient to tell you what he thinks of his current situation, in order not to shock him if hes not expecting bad news

2646 Medicine Hematology & OncologyProgesterone analogues: (and steroids) increase apetite weight gain in cachexic cancerous patients.. USE FOR PALLIATIVE (less side effects than steroids so prefer it) THINK WOMAN LOVE TO EAT COZ OF THEIR HIGH PROGESTERONE

2659 Medicine Cardiovascular System Torsades: If Stable Give Mg, If not Defibrillate

2661 Medicine Psychiatric/Behavioral & Substance AbuseTreat alcohol withdawal (Delirium tremens: Fever, hallucination, tremor, agitation) with benzo

2664 Medicine Poisoning & Environmental ExposurePhenyton toxicity: Horizontal nystagmus Cerebellar ataxia Confusion (like CAN of Wernike in alcoholics)

2671 Medicine Nervous System In ER settings ALWAYS!!! CT without contrast (FOR BRAIN ONLY).. also for urine stones dont use contrast !

2672 Medicine Nervous SystemHTN bleeds into Basal Ganglia, Pons and Cerebellum and Lobes (less commonly).. Basal gglia sx: Contralateral Hemiparesis and Hemisensory loss, Homonymous Hemianospia and Gaze palsy

2673 Medicine Nervous System CN III opens eye, CN VII closes it.. The level of pons determine Upper face paralysis and Bell's palsy2686 Medicine Cardiovascular System Hypertrophic cardiomyopathy = give Beta blockers2687 Medicine Cardiovascular System Hypertrophic cardiomyopathy is Autosomal Dominant

2695 Medicine Cardiovascular System MVP Is the most common MR in DEVELOPING COUNTRIES and is DUE TO MYXOMATOUS DEGENERATION OF MITRAL VALVE LEAFLETS AND CHORDAE2698 Medicine Cardiovascular System Aortic stenosis in patient belo 70 with no rheumatic disease = Biscupid valve

2711 Medicine Cardiovascular System In hypertrophic cardiomyopathy the mitral valve leaflet motion is abnormal.. SAM (systolic anterior motion of mitral valve) SAM and Septal hypertrophy cause the sound of murmur

2713 Medicine Cardiovascular System MYXOMAS are MOST COMMON HEART TUMORS.. can cause embolic events or rupture chorda tendina..2717 Medicine Cardiovascular System US is best for diagnosis and f/u of AAA use CT w contrast if not clear image for ex

2722 Medicine Cardiovascular System Variant angina is like angina bbut Prinzmetal (see ST elevation during episode, not depression.. ) it is similar to raynaud's phenomena2723 Medicine Cardiovascular System PRinzmetal angina (findings only during episodes) are treated with CCB2731 Medicine Cardiovascular System Post MI aneurysm causes pesrsitent ST elevation on ECG FUN FACT2732 Medicine Cardiovascular System ACEi reduce remodeling of heart post stress (mainly MI's)2741 Medicine Cardiovascular System CHF and lung infection in young patient ==> VIRAL INFECTION2742 Medicine Cardiovascular System SLE and STEROIDS can accelerate coronnary atherosclerosis

2743 Medicine Cardiovascular System Pulmonary edema = give furosemide (even post MI.. and cz decompensated Heart failure dnt give Beta blockers)

2744 Medicine Cardiovascular System Reversible causes of PAC's: Alcohol, Tobacco.. Do holter if get symptoms of arrythmias like Syncope or Palpitations

2750 Medicine Dermatology

Scabies: pruritic rash on flexor surfaces of the wrist, lateral surfaces of the fingers and finger webs.. excoriations with small crusted red papules scattered around affected areas. Dx by skin scrapngs and excoriated lesions. Tx: topical permethrin 5% cream or oral Ivermectin (more preferred in adults)

2762 Medicine Dermatology Basal cell Ca is slow growing (6months...) unlike SCC.. and can appear below the nose, in neck.... (not only up)

2771 Medicine Dermatology-Tetracycline: Photoxicity (exaggerated sunburn) -Erythromycin (marcolide) : GI upset and cholestatic jaundice -Steven Johnson: TMP-SMX. penicillin, sulfa drugs NSAIDs, Anticonvulsant, allopurinol

2774 Medicine Dermatology In Celiac, Treat Dermatitis Herpetiform with Gluten restrication and Dapsone (coz like leprosy lesions )

2817 Medicine Renal, Urinary Systems & ElectrolytesIn endemic areas (Russia one of them) think TB if B symptoms --> Addisionian presentation maybe --> Hypoaldosterone

2821 Medicine Renal, Urinary Systems & Electrolytes Postictal lactic acidosis is common after tonic clonic episode. and resolve on its own

2836 Medicine Ear, Nose & Throat (ENT) Presbycusis: Start at 60's, bilateral seunsorineural loss with high frequency sounds

2839 Medicine Ear, Nose & Throat (ENT)Serous otitis media is definec as the presence of a midlle ear effusion without signs of active infection. Have a Dull Tympanic Membrane that is HIV lymphadenopathy, or obstructing Lymphoma... Get conductive hearing loss

2842 Medicine Ear, Nose & Throat (ENT) Nasal polyps can get worse with NSAID use

2844 Medicine Ear, Nose & Throat (ENT)

Oral leukplakia: White patches or plaques over the oral mucosa and cannot be scraped off. Tobacco and Alcohol are risk factors: Like SCC and can progress to SCC.. butt SCC present with erosive ulcerative lesion with surrounding erythema (white and red and ugly) with possible lymphadenopathy HSV gingivostomatitis: multiple vesicularlesions with erythematous and inflamatory base and erythematous border in oral cavity and perioral. without white plaques

2845 Medicine Infectious Diseases Epiglotitis can happen in adults..2850 Medicine Ophthalmology Cataract = progressive thickening of lens ==> Blurred vision

2852 Medicine Ophthalmology Open angle glaucoma: More common in Blacks and is characterised by loss of peripheral vision

2856 Medicine Ophthalmology Optic neuritis: female 20-45 (usually seeni n MS) change in color perception, loss of afferent pupillary, central scotoma (bigger blind spot)

2860 Medicine Ophthalmology

Herpes simplex keratitis (common cause of blindness) Photophobia, pain, blurred vision, tearing and redness. Recurrence: associated with sun exposure (outdoor occupation), fever, immunodeficiency You see Corneal Vesicles and Dentritic Ulcers.. treat with Acyclovir


Vitreous hemorrhage is a very common complication of diabetic retinopathy, where fundus is barely seen on exam and if seen its details are obscured.. It presents acutely (also patient sees floater like detachment; usually associated with metabolic stuff, trauma, vascular disease or myopia )

2868 Medicine Hematology & Oncology Tartrate resistant acid phosphatase (TRAP) seen in hairy cell leukemia

2869 Medicine Hematology & Oncology Heterophile antibodies can be negative in early disease.. se leukocytosis and variant atypical lymphocytes on smear. A - test will not exclude disease.. Repea test2869 Medicine Hematology & Oncology CAN HAVE MONO WITH NEGATIVE TESTS

2872 Medicine Hematology & OncologyMeglaoblastic anemia can cause anisocytosis, poikilocytosis.. Basophilic stippling is not super sensitive can also happen here.. usually see it in lead poisoning, alcoholism, thalassemia..

2886 Medicine Hematology & Oncology Leukocyte alkaline phosphatase HIGH = Leukemoid reaction LOW in CML.. can be high with secondary infection so need a BCR ABL

2887 Medicine Hematology & Oncology CLL IS DIAGNOSED WITH FLOW CYTOMETRY JAK2 in myelodysplasia specially polycythemia like my patient with SAGHIR EL ZABER

2888 Medicine Hematology & OncologyCLL has a poor prognosis in thrombocytopenia Anemia is the second worst prognosis Its a B cell disease (but not plasma like multiple myeloma) It has smudge cells (lymphocytes that break down easily)

2889 Medicine Hematology & Oncology MULTIPLE MYELOMA: ELDERLY Anemia Renal Failure Hypercalcemia Diagnosis ==> Serum immunoelectrphoresis

2894 Medicine Hematology & Oncology BCR/ABL is 9 22 chromosome translocation treated with Wyrosine Kinase inhibitors (inhibits abnormal BCR/ABL gene) AN AWSEOME TREATMENT FOR CML

2895 Medicine Gastrointestinal & Nutrition Hepaticolenticular degeneration = Wilson's disease affecrting liver basal ganglia with greenish brown deposits around cornea

2903 Medicine Gastrointestinal & Nutrition U/S is better than HIDA. But HIDA is better in suspected Cholecystitis (especially acaluculous)2905 Medicine Gastrointestinal & Nutrition Hep A A vesrion to cigarettes and recent trip where sista has same disease


Alcoholic hepatitis: No evidence of cirrhosis like gynecomastia, ascites, spider angioma but do have jaundice. AST/ALT >2 but absolute value less than 500 Also have high gamma GT which is also present in liver cells and Ferritin (as an acute phase reactant) If values >25x upper limit it is toxic induced (acetaminophen), ischemic or viral

2919 Medicine Gastrointestinal & Nutrition Alpha 1 antitrypsin deficiency stain with PAS (like PAN ancinar)

2923 Medicine Gastrointestinal & Nutrition Gilbert is milder thand criggler 2 exacerbated with fasting low fat diet and hemolysis, stress fatigue, sport fever Unconugated

2984 Medicine Infectious Diseases Follow up on Hep B clearance with ALT and HBeAg until there is viral clearance2994 Medicine Infectious Diseases Mucormycosis: Debridement + Amphotericin B (Naim Shraif who ddnt have it)

2998 Medicine Infectious DiseasesHistoplasma: Southeastern US and central.. Acute pneumonia Blastomycosis: in southcentral and north central.. Lungs, skin, bones, joints and prostate (immunocompromised patients).. Primary pulmonary infection is flu like

2999 Medicine Infectious Diseases

Blastomycosis is a fungal infection endemic to Central USA. It causes mild respiratory illness but dessiminated infection (even in immunocompetent pple) may cause cutaneous disease with WELL CIRCUMSCRIBED VERRUCEOUS NODULE AND PLAQUES THAT PROGRESS TO MICROABSCESSES

3011 Medicine Infectious Diseases HUMAN BITE GIVE AUGMENTIN 3012 Medicine Infectious Diseases In suspected Infective Endocarditis draw blood cultures3013 Medicine Infectious Diseases Right sided endocarditis is treated empirically with VANCO coz u know US and MRSA..3014 Medicine Infectious Diseases Strep sanguinis is part of Strep viridans ,, involved in IE

3016 Medicine Pulmonary & Critical Care Hypersensitivity pneumonitis also occurs from exposure to birds not only in a farmer. Remove exposure and all is good

3020 Medicine Pulmonary & Critical CareARDSL PaO2/FiO2 Macrolides or Fluoroquinolones


Polymyositis: Progressive 40-50 women with proximal muscle (hip, shoulder) weakness. It is usually Drug induces (statins, antipsychotics, and alcohol..). Elevated ESR ans Creatine Kinase make the diagnosis (25% anti-JO) ==> Treat with STEROIDS give IVIG if life threatening Inclusion body myositis: same as up but >50 and male, with eosinophilia on bx In all EMG: spontaneous muscle stimulation with descreased amplitude

3067 Medicine Hematology & OncologyPernicious anemia In EASTERN EUROPE: Causes vit B12 deficiency with Atrophic glossitis.. Vitiligo Thyroid disease Neurological abnormalities (ataxia, loss of position sense..)

3068 Medicine Infectious Diseases Nosocomial UTI may cause Enteroccocci endocarditis

3072 Medicine Nervous System Central cord syndrome occurs with Hyperextension injuries ==> Like synringomyelia (whichis central) affects mainly upper extremities but mototr first3080 Medicine Dermatology celluitis: Group A strep is most common cause

3099 Medicine Endocrine, Diabetes & MetabolismRespiratory Alkalosis will Increase Calcium affinity to Albumin ==> Decrease free Calcium ==> Hypocalcemia signs (AWSEOME)

3101 Medicine Endocrine, Diabetes & MetabolismIn bone mets it not tumor itself that directly break the bone but instead release factors that activate osteoclast (like in breat tumor, which also can cause PTHrP secretion)

3105 Medicine Infectious Diseases Trimethorpim sulfamethoxazole is gevien in transplant patients to prevent PCP.. shld also be vaccinated for influenca, pneumococcus and Hep B


Bright red firm friable exophytic nodules in an HIV infected patient are most likely due to bacillary angiomatosis Molluscum contagiosum is umbilicated lesions non pruritic Herpes lesions are painful and vesicular Kaposi: On trunk, face and extremities, papules that become plaques or nodules and start from light brown to pink to dark violet

3126 Medicine Poisoning & Environmental Exposure TCA OD severity is assessed with QRS widening extent.


associate EBV with autoimmune hemolytic anemia and thrombocytopenia due to cross reactivity of EBV induced antibodies against red blood cells and platelets. (IgM cold-agglutin antibodies aka anti-i-antibodies) Diphterium also present with sore throat but with pseudomembrane formation, and can cause dilated cardiomyopathy

3131 Medicine Infectious Diseases mononucleosis: Not splenic infarct but splenic rupture, can also hemolytic anemia and thrombocytopenia for 2-3 weeks

3134 Medicine Poisoning & Environmental ExposureIn organophosphate poisoning remove patient's clothes since they soacked with the poison

3135 Medicine Poisoning & Environmental Exposure

Neuroleptic maligant syndrome is a side effect of antipsychotic: Fever, Muscle rigidity, Autonomic instabilty and mental status change (high creatine kinase, leukocytosis and electrolytes abnormalitites are also seen).. a bit like parkinosim induced antipsychotic but with fever


Uses of NaHCO3 -Hyperkalemia: reduces it -Aspirin OD: Alkalanize urine and increase excretion -TCA OD (inhibit fast sodium channels in Purkinje and myocardium) so Increase QRS and Hypotension and possibly Vtach and Vfib (coz slow normal cndction and will then rely on ectopic beats) ==> Here the use og NaHCO3 will first increase Na+ which will decrease TCA binding on Na+ channels, and then Bicarb will alkalanise medium which decrease drug affinity for the channels

3139 Medicine Poisoning & Environmental ExposureTypical Antipsychotics like Risperidone, Fluphenazine can cause Hypothermia so AVOID Long cold Exposures

3151 Medicine Rheumatology/Orthopedics & Sports HyperPTH can predispose to pseudogout other stuff too..

3157 Medicine Rheumatology/Orthopedics & Sports Spinal stenosis is also called Spinal canal narrowing

3161 Medicine Poisoning & Environmental ExposureBOTH CAUSE HIGH ANION GAP ACIDOSIS To recognise difference: Methanol Affect EYES Ethylene Glycol Affect Kidneys (coz we know it also cause Stones)

3164 Medicine Rheumatology/Orthopedics & Sports Visual sx in giant cell arteritis shld be treated with steroids.

3167 Medicine Rheumatology/Orthopedics & Sports Ankylosing spondylitis is diagnosed with XR not HLA B27 coz not specific


Parvo B19 can cause Rheumatoid like arthritis with MCP PIP involvement but morning stifness less than 30 min and onset of disease is acute. Must resolve within 2 months.. dnt have slapped cheeks in adults. anyways cant diagnose RA if less than 6 weeks sx Psoriasi affects DIP (like Dactylitis "D" which means sausage digit)

3173 Medicine Rheumatology/Orthopedics & Sports COMMON SIDE EFFECT of Hydroxychloroquine: Retinopathy

3177 Medicine Rheumatology/Orthopedics & Sports In symptomatik sarcoid give steroids (steroid sounds like sarcoid TEKRAM)

3202 Medicine Rheumatology/Orthopedics & Sports Fibromyalgia: SPORT and TCA's


Carpal tunnel: -Pregnancy: Flui accumulation *3rd trimester most of time) -Hypothyroid: Mucopolysacchardie deposition with perineum and endoneurium of median nerve DA FUCK!!

3208 Medicine Rheumatology/Orthopedics & Sports Polymyositis increase risks of many cancers

3209 Medicine Rheumatology/Orthopedics & SportsDiagnose polymyositis with MUSCLE BX.. It presenest with muscle weakness, often with pain too, and difficulty climbing stairs or rising from a seated position

3230 Medicine Endocrine, Diabetes & MetabolismHyperaldosteronism may not have primary hypokalemia but are to have so if with diuretic for ex

3231 Medicine Endocrine, Diabetes & Metabolism In hyperaldosteronism managed non surgically give Spironolactone or Eplerenone

3247 Medicine Infectious DiseasesEhrlichia some new shit But dont wry same treatment as Lyme,, Do leukocytosis, thrombocytopenia, elevated liver enzymes malaise, fever, confusion and very rarely rash. IN SOUT CENTER US, AND SOUTH EAST not like lyme in NYC

3249 Medicine Infectious DiseasesCryptosporidium (can also be other parasites. cystoIsospora or Giardia.. ): Traveler's non bloody watery diarrhea for more than 2 weeks Entameba's diarrhea is bloody and is endemic in all areas except europe and north america

3254 Medicine Infectious Diseases Cryptococcal meningo encephelatis in AIDS with CD440 compared to ~ 38 in rubella.. and spread of rash is slower.. and no joint involvement like in Rubella


Trichinellosis: In China, Thailand, Latin america.. Cause GI sx within 1 week of undercood meat ingestion: Abdominal pain, nausea, vomiting and Diarhhea Up to 4 week stage II Myositis, Periorbital edema and Eosinophilia (Triad, coz TRIchinellosis).. can also get fever and subungual splinter hemorrhages


Preplatellar syndrome is like ME.. Anserine bursitis: shaarply localised pain over the anteromedial part of the tibia just below the joint line of the knee. Valgus test is (-) so MCL is ruled out : Causes are overuse, abnormal gait..


Polymyalgia rheumatica has HIGH ESR CRPand can be associated with temporal arteritis.. Treat with STEROIDS (sometimes no arteritis ) It is bilateral,, worse in morning.. proximal arms thigh hip.. can have normocytic anemia

3320 Medicine Infectious Diseases Disseminated Gonococcus: Fever, poly arthralgia and pustular rash (not dessiminated rash all over body like in SSS)


Systemic sclerosis (scleroderma substype) presents with GERD, Right heat Faulure, pulonary and renal arteries and esophagus as well. ANA and Anti Topoisomerase I antiibodies are likely to be +

3327 Medicine Nervous System If extraocular muscles are involved in eye infection think or orbital cellulitis that can give Cavernous sinus thrombosis which is right behind it

3330 Medicine Ophthalmology3 Kind of diabetic neuropathyL -Background or simpleL microaneurysms, hemorhages, retinal edema -Pre proliferative: cotton wool spot -Proliferative or malignant: Neovascularisation

3422 Medicine Infectious Diseases Treat zoster recurrence post stress with Valacyclovir and to present pain can give TCA's

3425 Medicine Infectious Diseases LeprosyL Asian with hypopigmented patch of skin affecting sensation of area too. Diagnose with skin BX showing acid-fast bacilli


Ocular tonometry measure intraocular pressur when we have emergency suspecting acute cosed angle glaucoma.. Can be precipitated by Decongestant, Antiemetic and Anticholinergic drugs in patient with predisposed anatomy. Get headache nausea, diminished vision and halos around lights and mid dilated non reactive pupil, redness and corneal opacification

3433 Medicine Pulmonary & Critical Care In ARDS have to increase PEEP3446 Medicine Nervous System MS suspected Do MRi (Ms and Mr MS and MRI)

3453 Medicine Hematology & Oncology

INCIDENTAL NODULE in LUNGS found ALGORITHM !! Check for previous Xrays. Stable over 2-3 yrs in non risk young patient==> let go Changing mass or no previous Xray==> CT CT benign ==> follow up later with CT's Suspicious CT==> Bx or Pet CT HIGHLY SUSPICIOUS==> Surgical Excision

3467 Medicine Gastrointestinal & Nutrition Acute episode of diverticulitis is best diagnosed with CT

3474 Medicine Pulmonary & Critical Care Bronchiectasis: Dilated bronchi with thickened wall on CT .. Hemoptysis is a potential complication (often severe and require bronchial artery embolization).. See it in COPD

3475 Medicine Infectious DiseasesIn pyelonephritis or UTI sx do Imaging if sx do not resolve in 2-3 days of therapy.. or if have hx of nephrolithiasis, complicated pyelonephritis or unusual findings (gross hematuria, suspicion for obstruction... )

3481 Medicine Renal, Urinary Systems & Electrolytes When have BPH and symptoms and DRE done, do Urinalysis to look for infection

3483 Medicine Endocrine, Diabetes & Metabolism Hypothyroid can cause elevated AST ALT, HyperLipidemia and Hyponatremia (the fuck)

3484 Medicine Endocrine, Diabetes & Metabolism Before any FNA of thyroid, do TSH level and US


RAI is likely to cause Hypothyroidism But ususally cause Hypothyroid when whole gland will absorb the radioactive Iodine like in GRAVES In toxic adenoma the radioactive Iodine will mainly be uptaken by this single mass..

3490 Medicine Endocrine, Diabetes & MetabolismOsteolmalavia (vit D deficiency): defective mineralisation of organic bone matrix.. can happen in celiac

3495 Medicine Endocrine, Diabetes & MetabolismSick euthyroid syndrome aka "low T3 syndrome" occurs with acute, severe illness. Get a fall in total and free T3, with normal T4 and TSH levels

3497 Medicine Endocrine, Diabetes & Metabolism HASHIMOTO INCREASe LYMPHOMA OF THYROID RISK (MANTE2)

3513 Medicine Nervous SystemPrimidone is an anticonvulsant usd for essential tremor but can precipitate acute intermittent porphyria (abdomincal pain, confusion, headache and hallucinations, dizziness)

3516 Medicine Rheumatology/Orthopedics & Sports Paget: HYDOXYPROLINE IN URINE

3518 Medicine Endocrine, Diabetes & Metabolism Paget's labs: ALL GOOD WITH HIGH ALP TREAT ONLY IF SYMPTOMATIK

3526 Medicine Cardiovascular System In limb embolisation dont forget to do an ECHO..

3583 Medicine Infectious Diseases As already said Early HIV = EBC symptoms (dnt forget possible GI symptoms, night sweats, lymphadenopathy.. )

3589 Medicine Gastrointestinal & Nutrition Peptic ulcers are most commonly complication is Hemorrhage, and other less frequent complications are perforation, penetration and obstruction.

3605 Medicine Gastrointestinal & Nutrition Lactose intolereanc eis easly diagnosed with a POSITIVE HYDROGEN BREATH TEST (bacteria metabolism of carbs not being absorbed)3606 Medicine Pulmonary & Critical Care INR goal 2-3 for DVT 2.5-3.5 for idiopathic venous thromboembolism3610 Medicine Hematology & Oncology Macrovascular traumatic hemolysis is microcytic


Post BMT Pneumonitis and colitis: CMV Only diarrhea no lungs: Cryptosporidum Skin rash, and less commonly intestine, liver, lung: GVHD (always get rash) Can get PCP pneumonia in early stage but very rare coz have good prophylaxis Cryptosporidium= Diarrhea NOT LIKE CRYPTOCOCCUS (IN HEAD)

3617 Medicine Social Sciences (Ethics/Legal/Professional)Respect patient's opinion about not wanting life saving treatment, but first discuss issue.. DONT JUST SAY YEA ITS UR LIFE MOFO

3619 Medicine Nervous System TCA, Beta blocker; migraine prophylaxis During episodes give ANTIEMETICS: Chlorpromazine, prochlorperazine, metoclopramide..

3622 Medicine Nervous System Non traumatic subarachnoid hemorrhage is most commonly due to saccular or berry aneurysm rupture. we see bleeding in cisterns.. if CT - , do LP

3634 Medicine Endocrine, Diabetes & Metabolism Acromegaly get huge hearts then cardiomyopathy

3635 Medicine Cardiovascular System Constrictive pericarditis (calcification.. ) in Africa India china.. THINK TB

3637 Medicine Nervous System Pseudotumor cerebi aka idiopathic intracranial HTN in young obese women taking too much isotretinoin or tetracycline --> Treat with Acetazolamide +/- furosemide

3643 Medicine Nervous System Acute MS exacerbation = Steroids but if u want to decrease episode frequency give beta interferom or glatiramer, cyclophosphamide,IVIG, or plasmapheresis3644 Medicine Nervous System MS CSF: Normal pressure, Oligoclonal bands (with normal overall protein level.

3644 Medicine Nervous SystemMS: (also have autonomous dysregulation) ==> See Oligoclonal bands and All the rest is normal in CSF (normal proteins) Guillain Barre: Get elevated protein with Albumino-cytologic dissociation


Check Question for different rashes Cutaneous larva migrans: common in travel to tropics including SE USA characterised with pruritic speriginous lesions on skin which elongate ate rate of several mm/day as larvae migrate in epidermis and usually seen in lower extremitites and can also involve upper extremity.. associated with sand contact (soil contaminated with dog or cat feces containing infective larvae) Brown reclus spider cause papul with erythema flwd w ulceration

3680 Medicine Hematology & Oncology in mets to epidura from prostate Ca for ex. give steroids to alleviate the swelling and sx. Imaging Do MRI not bone Scan


Malignant hyperthermia: is uncontrolled accumulation of Ca2+ is cells (due to uncontrolled efflux from sarcoplasmic reticulum) ==> Susceptible patients gets the event after halothane and succynylcholine ==> Treat with dantrolene: BLOCKS Ca2+ ryanodine receptors

3691 Medicine Nervous System Heat stroke is managed with ICE cooled bath no chillin cold bath

3693 Medicine Renal, Urinary Systems & ElectrolytesIn UTIs: Leukocyte esterase= pyuria.. Nitrites:conversion of nitrate to nitrite with enterobacteriacea (E.coli.. SO BOTH ARE POSITIVE IN UTI

3697 Medicine Cardiovascular System In Afiv with rapid ventricular response need rate control with Betablockers or CCB.. Cardioversion is indicated if hemodinamycally unstable3698 Medicine Cardiovascular System Vfib and Vtack = DEfibrillate then give antiarrythmic if Dfib fails

3699 Medicine Cardiovascular System Afib Hemodinamically stable: Digoxin Non Stable: DC cardioversion (also in Vfib and Vtach)3704 Medicine Gastrointestinal & Nutrition Acute erosive gastritis is seen in NSAIDs or Aspirin OD's3717 Medicine Pulmonary & Critical Care Also treat before diagnosing if high suspicion of problem. THINK CLINICALLY3725 Medicine Nervous System GLIOBLASTOMA OF BRAIN HAS A BUTTERFLY APPEARANCE

3727 Medicine Nervous System Mysthemia crisis can cause fever and respiratory distress ==> Give steroids and IVIG, but Intubate if desaturating and weak effort of respiration3728 Medicine Nervous System HTN brain ischemia: Basal gglia, pons, cerebellar NEVER CORTEX

3738 Medicine Nervous System NON DOMINANT BROCA: AFFECT EMOTIONS RELATED TO SPEECH NOT SPEECH ITSELF

3750 Medicine Psychiatric/Behavioral & Substance Abuse If there is somatization 3abber the patients as it can help him,, dont send him the psych

3763 Medicine Cardiovascular System VTach: -Cardioversion: iIF hemodynamically unstable -IV Amiodarone: IF Stable 3771 Medicine Nervous System Riluzole In ALS Plasmapheresis in Guillain Barre

3775 Medicine Pulmonary & Critical Care Germ c tumors are the only ones that produce both Bhcg and AFP.. usually AFP is in HCC and endodermal sinudoid (yolk sac )tumor and and Bhcg is choriocarcinoma a

3781 Medicine Endocrine, Diabetes & MetabolismDiabetic neuropathy is assessed with Monofilament testing which assess pressure sensation (altered in this disease)

3789 Medicine Infectious Diseases Echinococcus (Big round cyst and smaller cysts inside of it) occur in Mexico with Sheep contact (DAYM SHEEP)

3790 Medicine Gastrointestinal & Nutrition Zinc deficiency results from TPN or malabsorption: Sx: Alopecia, skin lesions, abnormal taste and impaired wound healing

3797 Medicine Endocrine, Diabetes & MetabolismDiabetic gastroparesis is treated with prokinetic agents like METOCLOPRAMIDE, ERYTHROMYCIN, CISAPRIDE

3800 Medicine Endocrine, Diabetes & MetabolismTCA's are drug of choice for diabetic neuropathy pain so are NSAID's (but avoid in renal dysfunction)

3808 Medicine Infectious Diseases NEUROCYSTICERCOSIS: PArasite in BRAIN, Like name implies it cause several Cyst is brain it is caused by TANEIA SOLIUM

3819 Medicine Infectious Diseases cyst in liver after travel in endemic area: entameba histolytica ==> Treat with Metronidazole ==> IF fail go fo drainage

3820 Medicine Cardiovascular System ACEi ARB Spirono BBlocker and ASPIRIN (if due to CAD) IMPROVE CHF survival but Digoxin and Furosemide DO NOT although are good for symptoms3823 Medicine Cardiovascular System Start statin in a high risk patient with bad lipids level.. not exercecice only

3829 Medicine Cardiovascular System PVCs post MI are common or cardiac pathologies.. they indicate worse prognosis, but treating them with antiarrythmic will even worsen prognosis. So observe, or can give Beta Blockers.

3837 Medicine Nervous System In myasthemia DTR are preserved unlike Eaton Lambert (Ab's against voltage gated calcium channesls in presynaptic nerve terminal)

3847 Medicine Hematology & Oncology For prostate CA, aftr orchioectomy, go for radiation not hormonal (u already went too far by removing balls u wont go back to stupid meds go for the big shit the radiations)3852 Medicine Nervous System Diagnose MS with MRI

3859 Medicine Pulmonary & Critical Care In PE, if very likeley go do CT ANGIO (=with IV contrast)... If not likely Do dimer.. Leg doppler if DVT

3878 Medicine Endocrine, Diabetes & Metabolism Hypothyroid causes myopathies with elevaed Creatine Kinase

3887 Medicine Gastrointestinal & Nutrition Foul smelling stool from a recent trip = Giardia = Metronidazole

3894 Medicine Cardiovascular System Young person with renal stenosis = fibromsucular dysplasis ==> treat with stent Use ACEi in old people with renal stenosis (probably due to atherosclerosis) since they are not candidate for stent


SLE Nephropathy is Imune mediated involving also C3 thereby it lowers in the serum Ig E medicated reaction is in allergic interstitial nephritis like methicillin induced interstitial nephrtis Goodpasture = Cytotoxic antibodies Non immune nephropathy in toxins, HTN, DM

3902 Medicine Endocrine, Diabetes & Metabolism ACEi decrease the progression of diabetic nephropathy (NEVER FORGET THAT)

3916 Medicine Male Reproductive System Trazodone causes boner3920 Medicine Cardiovascular System Peripheral CCB vasodilate veins ==> EdeMa3930 Medicine Hematology & Oncology In alcoholism think FOLATE deficiency not B12

3934 Medicine Biostatistics & Epidemiology p value= N N is the probability that the results of the experiment are random (so the lower p the better)

3938 Medicine Infectious Diseases In AIDS PCP TMP-SMX is alway better if we add steroids if paO2 35

3939 Medicine Renal, Urinary Systems & Electrolytes Never forget Berry aneurysm and ADPKD

3943 Medicine Hematology & OncologyElderly with bone pain, renal failure, HyperCa2+ = Multiple myeloma (50% of these devellop renal insuffisciency) by obstructing collecting and distal tubules with paraproteins (Bence Jones proteins)

3949 Medicine Renal, Urinary Systems & ElectrolytesCystinuria is familial and causes recurretn stones. Hard radiopaque hexagonal crystals with positive Urinary Cyanide Nitroprusside Test


HTN Hypothyroid: Increase SVR Hyperthyroid: Decrease SVR +Increase heart contractility ==> Increase BP Overall Hypeparathyroid: Contractility increase and arterial effect Hyperthyroid can cause mild Hypercalcemia due to increase bone turnover

3956 Medicine Cardiovascular System Aortic dissection algorithm

3958 Medicine Cardiovascular System Hypovolemia BUN/Cr is elevates >20 Na+ excretion should also be low, unless using diuretic BE CAREFUL SO CHOOSE FIRST ONE IN DISEASED OLD FUCKER USING DIURETICS

3959 Medicine Nervous SystemIF ONLY MUSCLE PROBLEM POST STROKE THINK BASAL GGLIA (LACUNAR STROKE) NOT CORTICAL STROKE (PRESENT WITH SPEECH PROBLEMS TOO.. etc.) NOTE: Slurred speech is only muscular not related to cortex


Vasovagal syncope: -triggered by: Stress, pain, prolonged standing (in OR doing nothing).. Get vagal induced bradychardia with a dizziness prodrome and black out for seconds to minutes. Wake up full oriented Do tilt table stress which is super stressful and will provoque episode

3965 Medicine Renal, Urinary Systems & Electrolytes In goodpasture ==> go for plasmapheresis to remove antibodies

3966 Medicine Renal, Urinary Systems & ElectrolytesIn carcinomas we see Membranous nephropathy But in HODGKIN: See Minimal change disease (as it is a minimal cancer)

3973 Medicine Cardiovascular System niacin side effects are prostaglandin induced like NSAIDS in asthma

3977 Medicine Cardiovascular System Malignant HTN (emergency; doesnt depend on values but on damage): severe HTN (>180/120) with retinal hemorrhafes, exudates or papilledema.. HtN encephalopathy is associated with cerebral edema

3978 Medicine Hematology & Oncology EPO side effects: -HTN -Headache -Flu like symptoms -Red cell aplasia3979 Medicine Cardiovascular System If get uremic carditis encephelitis.. DIALYSIS (BUN>60)3980 Medicine Allergy & Immunology Check Immunosupressant side effects


Diabetes NEphropathy early on is due to GLOMERULAR HYPERINFILTRATION and ACEi Will decrease Glomerular P, decreasing Ifurther GLOMERULAR DAMAGE (D"J"G Diabetes)


Suspect amyloidosis in RA (predisposes to that) With Hepatomegaly and enlarged kidneys ==> See amyloid deposits with apple-green birefringence under polarized light after congo red stain -Crescent shape in RPG (remember Hezbolla) -Linear immunoglobunin deposit in Goodpasture's -Granular deposits: In immune complex mediated glomerulonephritis like Lupus and Post strep

3997 Medicine Renal, Urinary Systems & ElectrolytesRA predisposes to amyloidosis.. Suspect amyloidosis also if hav hepatomegaly and enlarged kidneys

4000 Medicine Rheumatology/Orthopedics & SportsAfter strenuous movement: Even if leg raise test is positiv ebut no other neurological symptoms ==> Use NSAIDs Early mobilization and Muscle relaxant

4004 Medicine Renal, Urinary Systems & ElectrolytesLong term analsegic can cause tubulointerstitial nephritis and hematuria due to papillary necrosis,

4007 Medicine Renal, Urinary Systems & ElectrolytesAnalsegic abuse: Papillary necrosis or Tubulointerstitial nephritis.. Get polyuria and sterile pyuris (WBC casts)

4011 Medicine DermatologyHerpetic withlow is a common viral infection of the hand. It is causedby either type 1 or 2 HSV and is self limiting. Dentisits who come in contact with infected orotracheal secretions get it

4015 Medicine Ophthalmology Fperign body in eye: Initially pen ligh examination id negative go for FLUORESCEIN EXAMINATION


Sympathetic ohptalmia aka "spread eye injury": immune mediated inflammation of one eye after penetrating injury to other eye. It is due to uncovering of hidden antigens which means that you have antigen that are not being attacked in the eye du to some natural barriers but breaking these barriers will induce an immune response and anterior uveitis...

4027 Medicine Renal, Urinary Systems & ElectrolytesUric acid stones: Alkalanise them to make them soluble: Give K+ citrate (citrate also prevents stone formation) SAME TREATMENT AS CYSTEIBNE SOTONES

4034 Medicine Renal, Urinary Systems & ElectrolytesEVEN IF HYPOTENSiVE DNT USE CRYSTALLOIDS KEEP THEM FOR BURN AND HYPOPROTEINEMIA

4036 Medicine Pulmonary & Critical Care Steroids= Demarginalisation: Increase WBC and PMN's but decrease basophils esonipholis..

4040 Medicine Pulmonary & Critical Care COPD exacerbation, besides med management give NON INVASIVE Positive-pressure ventilation 4042 Medicine Cardiovascular System In cocaine OD give benzos not beta blocker.. can also give CCB, Aspirin, Nitroglycerine

4049 Medicine Nervous System in NF type I can have optic gliomas or accoustic neuromas (we diagnose accoustic neuroma with MRI and gadolinium)

4065 Medicine Pulmonary & Critical Care ASpirin mediated respiratory disease in Hay fever in not IgE mediated but from prostaglandin and leukotrienes.

4068 Medicine Cardiovascular System in PVB in MI shld nt be treated since it wldnt change the prognosis (PVB are associated with worse prognosis) and increase the risk of asystole

4071 Medicine Infectious Diseases Intubated patients: Think Pseudomonas ==> Cefemin, piperacillin-tazobactam, meropenem4074 Medicine Gastrointestinal & Nutrition Crypt Abscess = UC Non caseating granuloma = Crohn

4075 Medicine Pulmonary & Critical CarePost Hemothorax (good medium for infection) empyema is common also post pneumonia empyema.. Remove empyema if localised, complex with thick rim and is not draindable .. present with fever

4076 Medicine Dermatology Roacutan is mainly used in non inflamatory huge acne if its inflamatorry go for topical antibiotics first4080 Medicine Allergy & Immunology Do Hep A vaccine when u go to developing countries


Vertebral compression fracture can happen in osteoporotic people and present with acute pain following minimal trauma (bending, coughing, lifting..) ... GET POINT TENDERNESS, BUT NEURO WISE SUPER NORMAL


Angiodysplasia: common recurrent or occult painless lower abdominal bleeding in patients age>60. They cause lower GI bleeding in patient with AORTIC STENOSIS (HEYDE'S SYNDROME( AND ESRD. NO COLONO FINDINGS UNLIKE DIIVERTICULOSIS (WHICH IS MOST COMMON CAUSE)

4087 Medicine Pulmonary & Critical Care Pleural effusion of unknown etiology ==> Thoracocentesis

4089 Medicine Nervous System Status epilepticus (>5min) can lead to CORTICAL NECROSIS Due to overexitation, and may lead to irreversible damage

4099 Medicine OphthalmologyCMV retintis is painless with fundoscopic hemorrhages and fluffy granular lesions around retinal vessels.. HSV and VZV pain with keratitis, uveitis, peripheral pale lesions and central retinal necrosis

4106 Medicine Gastrointestinal & Nutrition In ZE syndrome pancreatic enzymes are inactivated by excess acid

4108 Medicine Cardiovascular System Inferior wall MI is due to RCA:LCX, 5:1.. if RCA can get AV block bcoz it supllies the AV node, and can get a Mobitz II

4112 Medicine Hematology & Oncology Vit K deficiency occurs 7-10 days after inadequate dietary intake (post op), liver disease.. prolonged PT followed by prolonged PTT

4118 Medicine Pulmonary & Critical Care Excessive alcohol factor is a BIG Risk factor for Aspiration, also GERD, Seizures and Achalasia can do so


Dermatomyositis can be a PARANEOPLASTIC FINDING affecting muscle fibers (Unlikw Lambert eaton affecting presynpatic membrane calcium channels),, with symetrical muscle weakness and erythematous rash over dorsum of fingers or upper eyelids

4127 Medicine Cardiovascular System Beta blockers are best initial treatment of STABLE ANGINA (use CCB or nitrate if BB contraindicated or not enough)

4128 Medicine Endocrine, Diabetes & Metabolism In Men II can screen with RET genetic testing if have + family history

4131 Medicine Pulmonary & Critical CareCOPD with PaO260's ususally males with neck mass (possible) is mainly due to upper sphincter dysfunction and eosophageal dysmolity (motor issues) and is diagnosed with Barium esophgram or Eosophageal mannometry since it is motor in nature.

4190 Medicine Cardiovascular System Remember from pharmaco TBL that late stage CHF comes with Hyponatremia

4191 Medicine Cardiovascular System IF U GIVE SILDENAFIL AND ALPHA BLOCKER TOGETHER GIVE THEM 4h APART TO PREVENT HYPOSTENSION

4202 Medicine Ophthalmology When pigmentation is stated think of neurofibromatosis, and associated eye mass is Optic Glioma4203 Medicine Nervous System Thalamic stroke cause sensory problem4210 Medicine Pulmonary & Critical Care Aspergilloma is a mobile lesion

4216 Medicine Renal, Urinary Systems & ElectrolytesHypocalcemia can occur after major surgery and in patients requiring extensive transfusions.. Will have hyperactive DTRs

4218 Medicine Nervous System Most common Mutation in Neurofibromatosis II (on chromosome 22) is NONSENSE DA FUCKKKK

4226 Medicine Gastrointestinal & Nutrition Diffuse esophageal spasm occur in young ladies with intermittent episodes of chest pain and dysphagia

4228 Medicine Endocrine, Diabetes & Metabolism Check table for diabetic neuropathy symptoms

4243 Medicine Cardiovascular System CHF: (LV) Decrease CO, Incresed SVR, and logically since decrease CO we get Increase LVEDV

4257 Medicine Infectious Diseases Rusty nail (cloue) = Pseudomonas

4259 Medicine Rheumatology/Orthopedics & Sports Prevent Alchol in Gout coz its metabolite lactate compete with uric acid exrection

4261 Medicine Endocrine, Diabetes & Metabolism Paget = Disorganised bone remodeling

4265 Medicine Infectious Diseases Meningococcus: Rash, strong myalgia..

4266 Medicine Renal, Urinary Systems & Electrolytes In Nephrotic get Hypercoagulable state

4267 Medicine Dermatology Antihistamine in mild drug allergy keep steroid and epi for more systemic symptoms (anaphylaxis)

4284 Medicine Infectious Diseases Give Oseltamivir and Zenamivir for flu only in fucked up elderly no for healthy patient who require symptomatik treament

4288 Medicine Renal, Urinary Systems & Electrolytes Only give Iv ca2+ gluconate if ECG changes otherwise look for etiology and abort it

4298 Medicine Cardiovascular System Clopidogrel: Given to prevent MI after a NSTEMI for at least 12 months.. and following PCI (30days if bare metal stents) (1yr: drug eluting stents) or if aspirin not tolerated Otherwise only give: Aspirin BB ACEi Statins

4307 Medicine Endocrine, Diabetes & MetabolismUntreated Hyperthroid are at risk of for Tachyarrythmias and Rapid BONE LOSS from increased osteoclastic activity in bone cells

4316 Medicine Hematology & Oncology

Heparin induced thrombocytopenia -Type I: More common 1-4 days after heparin Platelet > 100 000 Management: Continue heparin but slowlier and observe -Type II: Much less common 5-10 days, or less than 1 days if previous hep was given this month Incerased risk of thrombosis (venous, arterial).. Necrotic lesions at hep site injection STOP HEP GIVE OTHER ANTICOAGULATIONS Due to Ab agaisnt Heparin platelet factor 4

4321 Medicine Gastrointestinal & Nutrition Nonalcoholic fatty liver occurs in Diabetes cause of insulin resistance causing lipolysis everywhere and uptake of the fatty acids by the liver and triglceride production

4322 Medicine Nervous System Parkinson TRAP Mnemonic: Tremor, Rigisity, Akinesia, Postural instability and Shuffling gait (equivalent to hypokinetic gait)


Hypovolemic shock: SVR Cardiogenic shock: Ra P, PCWP, SVR Septic shock: Mixed venous oxygen saturation, CO(1/~ to extraction) -CO, MVO2sat and SVR (inversely proportional)=> GD if vasodilation but will get less extraction coz no P (hypotension, sepsis.. -RA P and PCWP (proportional, increase if heart problem, decrease if blood loss from circulation)

4327 Medicine Infectious Diseases crystal induced nephropathy is a well known side effects of indinavir

4328 Medicine Gastrointestinal & Nutrition Achalasia: High Esophageal sphincter tone Scleroderma: Low Esophageal sphincter tone But in botch get lower or absent lower peristaltic activity

4329 Medicine Hematology & Oncology splenomegaly is rarely seen in bone marrow Aplasia,, but do happen in bone marrow infiltration

4336 Medicine Endocrine, Diabetes & Metabolism Give statin in diabetes above 40 regardless of levels also in CAD

4337 Medicine Renal, Urinary Systems & ElectrolytesIn acute ill patient with renall failure, liver failure or sepsis STOP METFORMIN coz it can cause LACTIC ACIDOSIS

4339 Medicine Hematology & OncologyTTP: Anemia (hemolysis) + thrombocytopenia + Neuro (unlike HUS) + Kidney : Lethal if untreated ==> Plasmapheresis (assess improvement with normalization of platelets and LDH coz Renal and Smear may still be abnormal few weeks post recovery)

4344 Medicine Pulmonary & Critical Care Young ladis with OCP can cause PE .. present with tachypnea tachycardia pleuritic pain and hemoptysis

4345 Medicine Cardiovascular System In tamponade since preqssure equalises in all chambers so naturally LV will be smaller and lower LV preload and Deacrease stroke volume and CO that may cause pulmo or neuro sx

4347 Medicine Endocrine, Diabetes & Metabolism Prussian blue positive for Hemosiderin which we see in RBC hemolysis..

4352 Medicine Hematology & Oncology Non tender firm solitary lymph nodes in neck are suggestive of head and neck scc metastasis to lymph node, especially in smokers

4357 Medicine Hematology & Oncology B9 B12 deficiency will both increase HOMOCYSTEINE, and B12 will also increae methylmalonic acid

4361 Medicine Renal, Urinary Systems & ElectrolytesIn suspected renal calculi (lower abd pain radiating to groin ie.) US or cT of abdomen and pelvis is cool.. US in pregnant ladies

4366 Medicine Nervous System Metoclopramide is a prokinetic agent that can cause drug induced extapyramidal symptoms

4368 Medicine Rheumatology/Orthopedics & SportsCord compression: Do MRI Tumor red flag in back: Xray and ESR and if bad results do MRI to still r/o other ortho causes


Lumbar Disc Herniation: Back pain +/- radiation down to one leg (usually recall an inciting event) Sitting and and flexion makes it worse. Lumbar spinal stenosis: We have radiation with neurological signs (tingling..) relieved by flexion.

4371 Medicine Rheumatology/Orthopedics & SportsOsteomylistis Fever and WBC unreliable (ca be normal) rely only on ESR (Staph causes it especially in drug injectors)


Osteomylitis can happen without fever or leukocytosis, we rely on ESR (hx of injection drug use, or other infection before that like UTI) and pain.. ==> Confirm with MRI STRAIGHT LEG RAISE TEST + = HERNIATED DISC

4373 Medicine Infectious DiseasesImmunocompromised with visceral and cutaneous angioma like blood vessels growth: Bacillary angiomatosis caused by BARTONELLA QUINTANA.. give antibiotics to regress lesions

4376 Medicine Ear, Nose & Throat (ENT) Meniere diseaseL Vertigo, ear fullness, tinnitus and hearing loss ==> Start with lifesyle modification: Low Salt Diet..4381 Medicine Nervous System Pronator drift is an Upper motor neuron thing


PROXIMAL MUSCLE WEAKNESS WITH OR WITHOUT ATROPHY: SUSPECT HYPO OR HYPERThyroid especially when have weight changes, mood changes, energy changes... etc.

4383 Medicine Hematology & Oncology ITP: platelets are destroyed by IgG, it is a diagnosis of exclusion. Give steroids with low count ( lesions are erythematous papules with central scale and sand paper texture.. ==> can become squamous cell carcinoma4412 Medicine Hematology & Oncology SLE HYPERCOAGULABILITY = HIGH PTT ( WEIRD BUT TRUE )

4414 Medicine Renal, Urinary Systems & Electrolytes To prevent Acyclovir crystalline nephropathy give agressive IV HYDRATION

4415 Medicine Endocrine, Diabetes & Metabolism Radioactive iodine fuck up exophtamous so avoid it

4416 Medicine Hematology & Oncology Non white child bearing women can get SLE: Get autoimmune pancytopenia (not alway all).. and in late stage the renal disease they get is FGS 4417 Medicine Infectious Diseases Branching: Nocardia, Actinomyce Acid Fast: Mycobacterium, Nocardia

4419 Medicine Renal, Urinary Systems & ElectrolytesAsthma meds think of steroids or albuterol: anywayz both will produce Hypokalemia and muscle weakness

4428 Medicine Renal, Urinary Systems & ElectrolytesNever use Succinylcholine with Hyperkalemia like BURN or CRUSH injuries, TUMOR lysis or Demylinating like Guillain Barre

4431 Medicine Gastrointestinal & NutritionHERPES ZOSTER IS REACTIVATED WITH ILLNESS or SEVERED STRESS LIKE CA.. CLOVIRS WIL SHORTEN COURSE AND DECREASE CHANCES OF POST HEPETIC NEURALGIA

4435 Medicine Renal, Urinary Systems & Electrolytes DIURETICS MUST BE USED WITH CARE TO PREVENT RENAL DAMAGE

4436 Medicine Hematology & OncologyHyposthenuria: inabilty to concentrate urine in sickle cell disease and sickle trait (sciling in vasa rectae of inner medulla imparing counturcurrent exchange and free water reabsoption)

4443 Medicine Nervous SystemSteroids induced myopathy is similar to polymyalgia rheumatica (of giant cell arteritis) but with normal ESR but in both CK is normal In statin induced myopathy it is like Hypothyroid one with normal ESR and high CK Steroids myopathy both are normal

4446 Medicine Hematology & Oncology Headache, nause, diziness in a person who works in an enclosed space.. CO poisoning especially if high HCT to compensate Pvera: get high RBC and others..

4447 Medicine Hematology & OncologyOsler Weber Rendu syndrome is a hereditary telegenctasisa (Autosomal Dominant) with Widespread AVM's causing telegenctasia, epistaxis, (AVM's everywhere) and AVM's in lungs causing pulmonary HTN and eventually high HCT (like polycythemia).

4449 Medicine Rheumatology/Orthopedics & SportsGout can happen in myeloproliferative disorders.. since we have increase catabolism turnover

4450 Medicine Cardiovascular System Vagal maneuvers which are helpful in SVT like putting cold stuff on face will work by increasing vagal tone and decreasing AV conductivity

4451 Medicine Cardiovascular System Not all that wheezes is asthma ,, if patient has Uncontrolled HTN for so long think of heart failure and pulmo edema.. Tx: O2 and ventilation, Agressive diuresis (furosemide) and possible vasodilators..

4454 Medicine Cardiovascular System In patient taking digoxin follow up on its level coz it can cause vomiting, diarrhea, vision changes and arrythmias4459 Medicine Cardiovascular System AVM can cause increase preload and AVM can happen with trauma, fistula or CA

4460 Medicine Rheumatology/Orthopedics & Sports Giant cell arteritis can cause Aortic aneurysm as complication

4461 Medicine Nervous System Coerneal abrasion can happen due to V1 dysfunction of Trigerminal that supllies eye4465 Medicine Nervous System Guillain barre is an ascending paralysis with elevated protein on CSF ONLYYY4466 Medicine Hematology & Oncology MM patients can get recurrent infection due to inffective antibodies.. Also get bone pain

4468 Medicine Hematology & OncologySickle cell usually do normocytic anemia due to hemolysis.. but can get folate deficiency with increase cell turnover and increased folate consumption.. Suplement folate to all sickle cell patients

4469 Medicine Cardiovascular System If have Afib with no other cardiopulmonary disease==> No treatment since there is super low risk of embolisation (CHADS score of 0)4471 Medicine Nervous System Consider in DDx of dementia (old memory preserved) Hypothyroid

4476 Medicine Infectious DiseasesChronic liver disease vaccine workup: Hep A Hep B Tdap (then every 10 yrs Td) Pneumoccocal vaccine (start always with fancy PPSV23 then sequential PCV13 and redo PPSV23 at 65) Influenza anually

4488 Medicine Infectious Diseases women with PID which are high risks for infections are encouraged to go for HIV, syphillis, Hep B, Hep C (if use drugs or got transfusions before 1992)4488 Medicine Infectious Diseases Screen for syphilis in youngs with STF (RPR test)

4492 Medicine Gastrointestinal & NutritionUC patient should regularly screened yearly for Colon CA 8-10 year after diagnosis. We dont screen for uveitis, erythema nodosum, spondyloarthropathy or sclerosing cholangitis

4502 Medicine Renal, Urinary Systems & Electrolytes NEVER SCREEN FOR BLADDER CA

4513 Medicine Nervous System Brain abscess resulting from sinusitus usually is due to anaerobes like Strep Viridans.. (think like tooth abscess becoming brain abscess)

4517 Medicine Infectious DiseasesS. aureus post viral pneumonia, causes acute necrotizing pneumonia with secondary pneumatoceles, and necrotizing pulmonary bronchopneumonia with multiple nodular infiltrates that cavitates and cause small abscesses

4519 Medicine Pulmonary & Critical Care DONT forget postnasal drip in cHronic Cough.. also Asthma and GERD can do so

4520 Medicine Pulmonary & Critical Care COPD patient can present with Pneumothorax if having catastrophic respiraatoy findings and is usully due to dilated alveolar blebs that rupture into pleural space


antipsychotic causing Neuroleptic Malignant Syndrome presents wiith fever , muscle rigidity and autonomic instability and mental status change ==> give DANTROLENE CZ SERUM CK IS HIGH SO U NEED TO RELAX MUSCLES

4523 Medicine Pulmonary & Critical Care If acute dyspnea and dysphagia think upper obstruction

4532 Medicine Cardiovascular System AAA screning: any 65-75 male actual or former smoker (at least one screening in a lifetime)

4536 Medicine Pulmonary & Critical Care In PEEP increase intrathoracic pressure so decreasure RA filling, so be careful with heart disease

4564 Medicine Rheumatology/Orthopedics & Sports Degenerative joint disease = Osteoarthritis

4565 Medicine Rheumatology/Orthopedics & SportsAvascular necrosis (disruption of bone vasculature): Due to chronic steroid use and Excessive Alcohol.. Progressive anterior hip pain with limitation of range of motion

4566 Medicine Pulmonary & Critical Care In afebrile acute bronchitis with no complications can just OBSERV And Follow up

4567 Medicine Renal, Urinary Systems & ElectrolytesIN DISEASED ELEDERLY WHO ARE ON ACEi OR NSAIDs, HAVE A DECREASED GLOMEULAR FILTRATION, and + they dont feel thirst.. beware

4574 Medicine Rheumatology/Orthopedics & Sports When RA affects the spine it affects the CERVICAL PORTION

4576 Medicine Rheumatology/Orthopedics & SportsIn Ankylosing spondylitis can get ENTHESITIS which is pain at site of tendon and ligament attachment to bone.. Heel, tibial tuberosity, iliac crest

4578 Medicine Rheumatology/Orthopedics & SportsAnkylosing spondyltis for long time (~2decades) cause decreased bone mineral density and Increased risk of bone fracture even with minimal trauma.

4583 Medicine Rheumatology/Orthopedics & Sports Baker cyst = inflamed synovium


Polycystic Kidney do not have Proteinuria or Edema Secondary amyloidosis can occur sexondary to chronic infection or diseases like IBD or RA.. Leading to enlarged LV, palpable kidney and hepatomegaly

4590 Medicine Rheumatology/Orthopedics & Sports Disseminated gonoccocal triad: Polyarthralgia Tenosynovitis Vesiculopapular rash

4594 Medicine Cardiovascular System In CHF get efferent renal eterioles constriction as a response of ATII as a result get a high glomerular pressure


acute pancreatitis is a burn and causes fluid loss as any other inflamation with increased vascular permeability in addition to release of pancreatic enzyme which cause further vasodilation Mnemonic: since we give H2O to those patients, think that the also loose water (other thand coz of burns) due to increase vascular permeability (LOL)

4613 Medicine Pulmonary & Critical CarePE: Sudden, Chest pain, Tachycardia, Tachypnea (dyspnea) with Hemorrhagic (as Dr. Sfeir once told us), Exudative pleural effusion (With no consolidation on CXR) (25% of time it is a transudate coz no infarct happened)

4615 Medicine Renal, Urinary Systems & ElectrolytesDisc herniation with autonomic dysfunction will cause urinary overflow incontinence and loss of anal sphincter.. not retention

4617 Medicine Pulmonary & Critical Care Asthma treatment: Inhaled albuterol PRN ==> Inhaled steroid ==> LABA ==> Oral prednisone

4626 Medicine Gastrointestinal & Nutrition Any liver disease wether hep C or not .. give hep A and hep B vaccines (if not given) If anti HAV is positive cant tell if coz of immunity or infection.. check symptoms

4633 Medicine Hematology & Oncology Spleen kill bacterias via PHAGOCYTOSIS by dentritis cells in white pulp.. SPleen eats these mofos4634 Medicine Infectious Diseases Post splenectomty wait 2 weeks before or after Sx

4639 Medicine Cardiovascular System Hemochromatosis cause PAncreas liver heart (sick sinus sindrome (conduction problem) or dilated cardiomyopathy) testicles atrophy (loss of libido too) and bronze skin4641 Medicine Nervous System MS acute episodes must be treated with steroids

4645 Medicine Pulmonary & Critical Care COPD Increase TOTAL LUNG CAPACITY and DECREASES VITAL CAPACITY.. LIMITS EXPIRATORY AIRFLOW4646 Medicine Cardiovascular System Weight loss is supper effective in HTN

4647 Medicine Hematology & Oncology Put IVC filter if reccurent DVT with therapeutic INR on warfarin, or if contraindication to anticoagulant (but if fail to get therapeutic INR, change meds)

4649 Medicine Cardiovascular System Warfarin reduces the risk of thromboembolityc events cause despite antiarrythmic u can still have these emboli showering that were previously formed

4653 Medicine Social Sciences (Ethics/Legal/Professional) BRAIN DEAD EQUAL DEAD.. NO NEED LEGAL STUFF ARE NEEDED TO EXTUBATE

4659 Medicine Rheumatology/Orthopedics & Sports Paget is due to osteoclast dysfunction

4663 Medicine Pulmonary & Critical Care Chloride is exchanged with Bicarb if metabolic alkalosis compensation is needed4665 Medicine Pulmonary & Critical Care In COPD diaphragm flattens increasing the work of breathing4668 Medicine Cardiovascular System Endocarditis presentation

4676 Medicine Cardiovascular System QT syndrome:congenital prolonged or shortened QT associated with deafness (+mild chance of developing Afib) Afib with no cardiac or pulmo disease, think of DM, Hyperthyroid, Obesity, Alcohol abuse, and stimulant abuse

4679 Medicine Cardiovascular System In MI, can hear S4 like in hypertrophic cardiomyopathy because we have stiffness of the Ventricles due to ischemia.

4685 Medicine Dermatology Firm, Flesh colored, domed shape, umbilicated apules are typical of MOLLUSCUM CONTAGIOSUM due to Celluar immunodeficiency, Steroid use, Chemo, HIV

4693 Medicine DermatologyHepes zoster may reappear after immunosupressant therapy (TNF alpha inhibitor: infliximab) in a dermatomal fashion starting with erythematous papules then to vesicles, bullaes the crusting a week later

4700 Medicine Nervous Systemconfusion, ataxia, ophtalmoplegia (CAN) in malnourished alcoholics (homeless) : Wernicke's ==> Treat with Thiamine before giving anything else even if malnourished (Thiamine before Dextrose or worsen Wernicke's)

4706 Medicine Pulmonary & Critical Care Acute ASTHMA COCKTAIL with low respiratory drive and muscles and respiratoy failure INTUBATION VENTILATION SABA ANTICHOLINERGIC STEROIDS

4707 Medicine Cardiovascular System Diastolic dysfunction is due to impaired ventricles relaxation which will diminish their compliance and will cause left atria dilation and Afib.. upon lying will have backflow to lungs and dyspnea ==> Treat with Diuretics and antihypertensives

4709 Medicine Cardiovascular System IN HEMODYNAMICALY SVT: VAGAL MANEUVERS, ADENOSINE, CCB UNSTABLE: DC CARDIOVERSION4714 Medicine Infectious Diseases Infective endocarditis can cause splenic abscess causing pleuritic chest pain

4716 Medicine Pulmonary & Critical Care Malignancy and Respiratory sx ==> Hypercoagulable state: PE's ==> Right heart failure (RV dilation)

4718 Medicine Pulmonary & Critical CareIn COPD if u give too much O2 u will supress the drive for respiration (normally it is dependant on CO2 but in COPD it becomes dependant on low O2) .. So lower respiration and CO2 will accumulate and BAM seiures... etc (WEIRD SHIT)

4722 Medicine Cardiovascular System high PTH cause HTN (WTF)

4725 Medicine Cardiovascular System Only in Vtach Pulseless Electrical Activity DEFIBRILLATE, otherwise CPR


Grave's ophtalmopathy presents with impaired gaze and diploplia, with increase retroorbital tissue (ct, muscularm adipose tissue and lymphocityc infiltrate).. risk factor for ophtalmopathy is old (50 is old here) female smoker

4728 Medicine Cardiovascular System With age baroreceptors get tired causing orthostatic decrease in BP

4730 Medicine Pulmonary & Critical Care like my patient on 5 south: she stopped smokin but is still COPDer. On exacerbation we gave her O2, bronchodilators, AB's and systemic steroids4738 Medicine Cardiovascular System Smoking and AAA is MAX association

4740 Medicine Cardiovascular System In MI, if get water in lungs and regurg murmur it is due to papillary muscle ischemia or rupture..4742 Medicine Cardiovascular System never use Beta Blocker with Asthma !!!


SAAG >1.1: Portal HTN 10 on inspiration) in pericardial fluid (Tamponade or pericardial fluid by the same rationale we get variation in QRS; inspiration restricts LV volume so lower BP), Asthma, COPD (coz inspiration will drop intrathoracic pressure by much more than normally, so most of blood will be located in chest as in the lungs and less to systemic circulation and BAM lower BP


Interstitial cystitis (paiful bladder syndrome): idiopathic, chronic with Bladder Pain worsened by filling and relieved by urination (a bit like IBS). Also get Dyspareunia and Frequency Treat with Behavioral modification Amitryptilline and Analsegic for exacerbations (Like fibromyalgia, IBS etc..)

4860 Medicine Hematology & Oncology ITP should make you suspicious for HIV and Hep C

4860 Medicine Hematology & Oncology Low Platelets with no know cause or no clues: Test For Hep C and HIV which commonly cause ITP

4866 Medicine Renal, Urinary Systems & Electrolytes In metabolic alkalosis give normal saline infusion

4867 Medicine Infectious Diseases post flu pneumonia is Staph pneumonia (superimposed)4902 Medicine Ear, Nose & Throat (ENT) Otosclerosis is a common cause of conductin hearing loss in 20s and 30s

4909 Medicine Cardiovascular System S4 comes just before S1 can even confuse it with S1 and think there is a murmur.. it occurs from longstanding HTN causing LV hypertrophy MVP: mid systolic click and a late systolic murmur heard best over the cardia apex


Essential tremor: Bilateral action tremor of the hands, without leg involvement. No other neuro signs, can present with head tremor without dystonia Parkinson: Resting tremor and decrease with voluntary movements, involve legs and hands, and less commonly facial involvement Cerebellar: with ataxia, dysmetria or gait disorder. Increases with movement (finger to nose test) Physiologic: not vsible, increased with stimulants. Worse with movements and can involve face and extr

4914 Medicine Nervous System Essential Tremor: Give Beta Blocker (caffeine not very much associated with the tremor)

4920 Medicine Cardiovascular System PSVT: Dont see P waves Give Adenosine If sinus Tachycardia, see P waves So it most likely Anxiety


Dependat effect = seen when increase rate QRS widening in IC : coz they have not time to dissociate from the channels and will cause this widening (in normal rythm they have time to dissociate before furthur rythms) PR prolongation in CCB: coz they cause prolongation of the refractoy period of the AV node

4927 Medicine Gastrointestinal & Nutrition Wathever is the case when someone is obtunded intubate even they talk about varice bleeding.. Before u put a scope intubate

4934 Medicine Gastrointestinal & Nutrition Drugs that cause esophagitis: Aspirin, NSAIDs, Alendronate, Tetracycline, KCl Fe Quinidine

4938 Medicine Infectious DiseasesHistosplasma in Central and South US diagnosed in urine, bone marrow if affecting it, or antigen but less sensitive and takes more time. Treated with amphotericin in AIDS or itraconazole (usually in immunocompetant pple)

4938 Medicine Infectious Diseases Histoplasma is diagnosed through urine testing4939 Medicine Infectious Diseases Trest H(I)stoplasma with (I)troconazole 4940 Medicine Hematology & Oncology Salvage therapy is complementary post surgery, unlike Adjuvant is used if surgery fails

8331 Medicine Renal, Urinary Systems & ElectrolytesTrimethoprim cause Hyperkalemia (blocks epithelial sodium channel in collecting tubule).. and inhibitis with Cr filtration giving HIGH Cr but with no change in GFR

8819 Medicine Cardiovascular System THINK of coarctation if epistaxis, headaches, LVH with ST and T waves changes and QRS increased voltage in left heart, HTN

8822 Medicine Psychiatric/Behavioral & Substance Abuse

Delayed (wake up late like chris who is always delayed)or Advanced (sleep early like ME i am advanced) sleep phase syndrome are independant of socoal stress or job etc.. if depends on activity etc. it is poor sleep hygiene

8823 Medicine Psychiatric/Behavioral & Substance AbuseAdvanced sleep phase disorder: like Chris canot wake up well in morning Delay sleep phase syndrome: Cannot sleep early like Chris too

8866 Medicine Infectious DiseasesQuinolones can cause tendinopathies with Achilles most common (on average 8 days after the drug started, but can start as soon as 1 day).. Patient shld stop the drug avoid exercice..

8876 Medicine Endocrine, Diabetes & MetabolismWilson and hemochromatosis can lower blood calcium!!! but with normal to low PTH (NOT HIGH LIKE EXPECTED)

8880 Medicine Infectious Diseases HACEK Endocarditis like other endocarditis come fom oral infection8894 Medicine Hematology & Oncology Best screening test for thalassemia in preconception is CBC (THUG LIFE!!)

8905 Medicine Pulmonary & Critical Care Sometimes asthma can presents first time in ADulthood How to tell Asthma from COPD: Diffusion capacity (DLCO): Reduced in COPD, Normal in Asthma

8918 Medicine Endocrine, Diabetes & Metabolism Risperidone causes hyperprolactinemia but doesnt affect rest of axis like thyroid..

8925 Medicine Ophthalmology Viral conjuctivitis or pink eye is self limited and just need cooling and moisting


Cystoscopy: Gross hematuria with no glomerular disease Microscopic hematuria with no glomerular disease or infection and increase risk of CA Recurrent UTIs Obstructive symptoms Irritative symptoms without UTI Abnormal imaging or urine cytology

8959 Medicine Infectious Diseases If candida eosophagitis u see oral thrush.. otherwise viral

9885 Medicine Infectious DiseasesCryptoccocal (no MRI findings) is chilling meningitis in AIDS unlike HSV (see temporal involvement in MRI) JC (white matter patchy area suggesting demylination on MRI) or Toxo who presents with ring lesion

10145 Medicine Poisoning & Environmental ExposureCyanide block oxidative phosphorylation and promote anaerobic metabolism causing LACTIC ACIDOSIS, by binding to ferrous in cytochrome oxidase a3 in mitochondrial ETC


smoke inhalation victims can get cyanide toxicity and shld be treated empirically with HYDROXOCOBALAMIN or SODIUM THIOSULFATE or with nitrites to induce METHEMOGLOBINEMIA

10179 Medicine Cardiovascular System CCB can cause peripheral edema

10287 Medicine Renal, Urinary Systems & ElectrolytesHematuria suggest GLOMERULAR DIASEASE IF have PROTEINURIA, DYSMORPHIC RBC and RBC casts (usually microscopic hematuria unlike non glomerular)

10434 Medicine Rheumatology/Orthopedics & SportsPyoderma gangrenosum: Purulent base painful ulcer with violaceous borders, Associated with IBD

10485 Medicine Dermatology HPV CAN DO PLANTAR WARTS (FOOT) IN YOUNG AUDLTS OR IMMUNOCOMPROMISED

10553 Medicine Dermatology

Autoimune alopecia areata: round loss Pressure induced alopecia: is post op.. Trichotillomania: is due to hair plucking but dont get regular loss pattern Tinea capitis: Scaly, erythematous, with residual black dot. Possible painful lymphadenopathy. In Blacks. (Human to Human, or formite transmission) Diagnosed with KOH .. treated with Griseofulvin

10763 Medicine Cardiovascular System Nitroprusside for long time = CN toxicity: lactic acidosis, seizure, coma, alterend mental status ==> treat with amyl nititre.. or glutathione

10764 Medicine Cardiovascular System Constrictive pericarditis: Important cause of Right heart failure with progressive edema, ascites, elvated JVD and pericardial knock (middiastolyc sound) and pericardial calcification on CXR

10767 Medicine Cardiovascular System Scleroderma crisis: Acute renal failure,, proteinuria malignant HTN microangiopathic hemolytic anemia: thrombocytopenia and fragmented RBCs

10904 Medicine Infectious DiseasesIn TNF antagonis beware of live vaccines like MMR, Varicella, yellow fever, and intranasal influenza. Meningococcal shld be give at 11 and regiven at 16 if high risk of first year college give back above 21 if high risk

2330Obstetrics & Gynecology

Female Reproductive System & Breast In lower abd pain: Do HCG before any workup


Female Reproductive System & Breast

Palpable breast mass: If below 30 do only US if above do Mammo (+/- US).. if cyst do needle aspiration (not obliged) if suspicius for malignancy or complex cyst (solid mass) do image guided core biopsy



Fat necrosis has similar radiographics than breast cancer, including skin or nipple retraction and calcifications on mammography. Biopsy will reveal fat globules and foamy histiocytes in fat necrosis. DONT TREAT


Pregnancy, Childbirth & Puerperium

Post tonic clonic seizure can have Erb duchenne like presentation due to posterior shlder dislocation



All ladies with abscence of menses for more than 1 month should be evaluatd for pregnancy wathever are the season



Endometrial biopsy is indicated for evaluating abnormal uterine bleeding in: Women >45 and all postmenopausal women Women age 30degree upon increase in intrabdominal pressure Oxybutinin is given in urge incontinenece (detrusor hyperactivity; sudden urge to urinate not related to increase intaabdominal pressure)


Endocrine, Diabetes & Metabolism

Oral glucose tolerance testing shld be performed in all pregnant ladies at 24-28 weeks of gestation to screen for gestational diabetes


Pulmonary & Critical CareAmniotic flui embolism syndrome typically present with rapid onset respiratoy failure, severe hypotension and DIC, during labor or immediate postpartum period. Clinical dx and Supportive management.. Bad condition with poor outcomes


Cardiovascular System Bilateral lower leg edema is normal in pregnancy.. Always be suspicious for DVT but if no signs just send patient home



Placental abruption: (bleed in 80% of cases) Abdominal pain Uterine tenderness Uterine contractions with increased tone Recurrent late or variable decelrations with bradychardia and does not improve with resucitation measures



Raloxifene: Antagonist in breast and vagina (good) Bone tisue agonist also good BUT BUT not so fast, it INCREASES RISK of thromboembolism


Pregnancy, Childbirth & Puerperium Asthma drugs like inhaled beclamethasone or albuterol are safe during pregnancy



Tamoxifen Antagnist on breast tissues Agonist on endometrium (increase risk of CA) Decrease risk of osteporosis



Transvaginal US is better than Transabdominal US for ectopic diagnosis, and should be performed when BHCG are between 1500-6500 (coz below 1500 not visible.. a doubling bHCG every 2 days is normal pregnancy if rise is slower suspect abnormal pregnancy..



Breech presentation before 37weeks is normal, and these convert to vertex by 37 week usually. External cephalic version is indicated after 37 weeks if still breech--> IF fail--> Csection must be planned



PCOS patient have unbalanced estrogen (no progesterone) resulting in endometrial hyperplasia and potential endometrial CA



Pregnancy luteomas and thea lteum are most common causes of hyperandrogenism in pregnancy. Luteomas:Solid masses on US + virilization. DONT MANAGE Theca Luteum: Cysts and unlikely will cause virilization If underlying cause is molar pregnancy do D&C


Infectious DiseasesPID: inpatient: If high fever, failure to respond to PO antibiotics, inability to take PO due to nausea, vomiting, pregnancy, and people with noncompliance risk GIVE cephalo + doxy



In women with AUB do endometrial biopsy. If hyperplasia with no atypia give Progestin (no mixed OCP to Obese >35 women to avoid DVTs.. ) If have atypia do Hysterectomy



PMS: mood swing, irritability, fatigue, bloating and breast tenderness. Sx occur in the 1-2 weeks prior to menses and resolves with onset of menstrual flow. Dx is confirmed by menstrual diary Tx: first line is SSRI (intermitently of continuously throughout cycle)



Vaginismus (pain and tightness upon intercourse): Tx with relaxation techniques, Kegel exercices (relax vaginal muscles) and insertion of objects gradually increasing in size to encourage desensitization


Endocrine, Diabetes & Metabolism

Grave's in pregnancy: TSH antibodies cross placenta. So baby will have it Affected infant: Irritable, tachucardic, does not gain weight --> Give beta blocker and Methimazole until symptoms subside



Placenta previa: Risk factor: Prior placenta previa, Csection or uterine surgery, multiparity and advanced age Painless 3rd trimester bleed with uterine contraction Dx: transabdominal US followed by transvaginal (dont do digital exam) The lack of abdominal pain r/o placental abruption (ischemic pain.. )



In previa, hen bleeding and mom's vitals cannot be controlled do immediate Csection even if 34 NVD trial Unstable or bad fetal heart rate: Csection



Placental abruption: risk factors: Maternal HTN, preeclampsia, eclampsia, abdominal trauma, prior abruption, cocaine, tobacco Presentation: Sudden onset vaginal bleeding, abdominal or back pain, high frequency, low inensity contractions, hypertonic tender uterus Dx: by clinical presentation, US to r/o previa. Tx: Unstable or low fetal heart rate--> Csection Stable: >34 NVD trial



Symptomatically uterine rupture can be discerned from placental abruption in that baby's position (station) will change and may feel abdominally his organs passing through the rupture Risk of Placenta accreta is also increased with previous Csection (when uterus is next to scar)and can also cause bleeding..



Uterine rupture: Risk factors: Uterine scars or abdominal trauma Sx: Sudden onset abdominal pain, fetal heart rate abnormalities, and recession of babie's position when in active labor.



Antepartum bleed: Normal: Intermittent pain with contraction, cmall amount of blood-tinged mucus Placental abruption: Sudden-onset vaginal bleeding, abdominal pain, hypertonic/tender uterus Placenta previa: Painless vaginal bleed, low lying placenta Uterine rupture: Sudden-onset vag

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