Online Flashcards for Internal Medicine

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Pleural Effusions

["Causes of transudative effusions","atelectasis, heart failure, hepatic hydrothorax, hypoalbuminemia, constrictive pericarditis"],["Tuberculosis pleural effusion","exudative 90 to 95% lymphocytes"],["Chylothorax","exudative pleural effusion, lymphoma a common cause, protein-discordant"],["Parasitic disease exudative pleural effusions","Paragonimiasis, hydatid disease, amebiasis, ascariasis"],["Most common fungal pleural effusion with 10% eosinophils","Coccidioidomycosis is exudative pleural effusion with greater than 10% eosinophils"],["Post CABG pleural effusion","Exudative pleural effusion with 80% lymphocytes, occurs more than 2 months after surgery"],["Patient found to have serum eosinophilia and pleural fluid eosinophilia","Churg-Strauss syndrome"],["What drugs cause pleural effusion?","Dantrolene, bromocriptine, nitrofurantoin, valproic acid cause an exudative pleural effusion with more than 10% eosinophils"]

Neurology

["Reflexes absent in brain death","Pupillary response, corneal reflexes, oculocephalic, oculovestibular, gag reflex, spontaneous respiration"], ["Confirmatory tests for brain death","EEG, somatosensory evoked potentials, angiography"],["Define persistent vegetative state","absence of cerebral cortex function with normal brainstem function"],["Difference between vegetative state and coma","Patient is wakeful and has sleep-wake cycles in a vegetative state"],["Define Locked-In Syndrome","normal cerebral cortex function with no brainstem function"],["Location and signs of Locked In Syndrome","Pons - unable to speak, swallow, quadriplegia. Only able to communicate with eye blinks and vertical eye movements."],["An absolute contraindication for lumbar puncture","Increased intracranial pressure due to a mass lesion"],["A patient has lost corneal reflexes, pupillary reflexes are intact, oculocephalic reflexes and oculovestibular reflex are present. They are not wakeful and do not have sleep-wake cycles. Is this patient in a coma, vegetative state or brain death?","Coma"],["Potentially treatable causes of dementia caused by infection","Chronic meningitis, HIV dementia, neurosyphillis, Whipple disease"],["Most commonly used medication for Alzheimer's Dementia. Name two other drugs and identify their method of action","Donapezil. Other medications include rivastigmine and galantamine. They are all noncompetitive, reversible, cholinesterase inhibitors."],["What is the Merci Retriever?","Extracts clots from ischemic infarct strokes up to 8 hours later."],["Contraindications on CT for tPA","Intracranial hemorrhage, mass effect, greater than 1/3 infarction, midline shift"],["Dosage of tPA","0.9 mg/kg , maximum 90 mg, 10% bolus, rest over 60 minutes"],["Indication for surgery in intracerebral hemorrhage","Increased intracranial pressure or worsening condition"],["Symptoms and signs of cerebellar hemorrhage","Vomitting, inability to walk, ipsilateral gaze palsy, cn vi palsy, ipsilateral nuclear type cn vii palsy"],["Complication of cerebellar hemorrhage","Obstructive hydrocephalus"],["Early warning signs of subarachnoid hemorrhage","sentinel bleed with headache or aneurysm expansion with focal neurologic signs, partial cn iii"],["Hyponatremia after subarachnoid hemorrhage","Cerebral salt wasting syndrome or SIADH"],["Complications after SAH","hemorrhagic infiltration, hyponatremia, communicating hydrocephalus"],["symptoms of increased intracranial pressure","headache, vomitting, and papilledema"],["most common primary brain tumoros","Meningioma, astrocytoma, oligodendroglioma, lymphoma"],["Small, asymptomatic meningioma management","CT or MRI every 6 to 12 months"],["Indication for meningioma resection","tumor growth or symptoms"],["Indication for postoperative radiation after removal of meningioma","incomplete resection or anaplastic or malignant meningiomas"],["Genetics for better response to chemotherapy in oligodendrogliomas","Chromosome 1p/19q deletion"],["Most common chemotherapy for meningioma","Temozolomide"],["Groups at risk for primary CNS lymphoma","AIDS and immunodeficient patients"],["most common cause of altered mental status in cancer patients","toxic-metabolic encephalopathy"],["Less common causes of altered mental status in cancer patients","intracrainal metastasis, paraneoplastic limbic encephalitis, intracranial hemorrhage, infarct, bacterial meningitis"],["Toxic metabolic encephalopathy causes","hypercalcemia, SIADH, infections"],["Most common brain tumors","metastases from other parts of the body, lung cancer 50%"],["Treatment for brain edema from metastases","Dexamethasone 2 mg up to qid"],["Most common metastases to the spine","lung, breast, prostate cancer"],["radiosensitive metastasis to the spine","multiple myeloma, lymphoma, prostate, breast, small cell lung cancer"],["initial treatment for spinal metastasis","dexamethasone"],["Treatment for essential tremor","Propranolol, primidone, clonazepam, gabapentin, topiramate"],["Surgical management if pharmacotherapy fails for essential tremor or any other type of tremor", "deep brain stimulation of the thalamus"],["Valproic Acid Intoxication - lab and clinical findings","hypernatremia, metabolic acidosis, hypocalcemia, elevated serum ammonia, mild liver aminotransferase elevation, hypoglycemia. Coma with small pupils, cerebral edema, encephalopathy."],["Phenytoin intoxication","Ataxia, nystagmus, drowsiness, rarely choreathetoid movements"],["Carbamezapine Intoxication","drowsiness, coma, seizures, stupor, dilated pupils, tachycardia"],["A patient has temporal lobe epilepsy and trigeminal neuralgia, name one medication for both","Carbamezapine"]

Pulmonary Flash Cards

Cardiology

["Treatment for familial hypercholesterolemia if pharmacotherapy is ineffective","Plasmapheresis, LDL apharesis, then liver transplant"], ["Not indications for endocarditis prophylaxis", "Mitral valve prolapse, aortic regurgitaion, mitral stenosis, mitral regurgitation"]

Gastroenterology

["Steroid-sparing medications for Crohn's Disease","6-Mercaptopurine and azathioprine"],["Dilantin induced hepatitis","Similar to auto-immune hepatitis with hypergammaglobulinemai, positive ANA, false positive anti-HCV ELISA"],["Tests for auto-immune hepatitis","ANA, anti-LKM, anti-smooth muscle antibody"],["Screening for a patient with one family member with colon cancer","Age 40 or ten years prior to age of family member"]

Hematology and Oncology Flashcards

Define Evans' Syndrome and treatment - autoimmune hemolysis with autoimmune thrombocytopenia. Hemolysis - increased bilirubin, positive Coombs' test, high ldh. Steroids, then splenectomy.

A patient has normal platelet numbers but has platelet related bleeding - Bernard-Soulier syndrome - functional platelet disorder

A patient has rheumatoid arthritis, neutropenia and splenomegaly - Felty's Syndrome

von Willebrand Disease Lab findings - Prolonged bleeding time, mildly elevated PTT, low factor VIII level

Initial treatment for polycythemia vera - Phlebotomy and aspirin to prevent thrombosis

Bortezomib - indication, method of action, side effect - Proteosome inhibitor for relapsed and refractory multiple myeloma. Causes peripheral neuropathy.

Treatment of von Willebrand disease - Initial desmopressin, then try vWF concentrate

Eryhtropoetin level in polycythemia vera - low

Erythropoetin level in renal cell carcinoma - high

Deferoxamine - iron chelator used to treat iron overload

Factor XI deficiency - Hemophilia C, does not need special treatment prior to minor surgery

What is 5q- syndrome and its treatment? - Subtype of MDS with elevated platelet count and anemia. Treat with lenalidomide.

Usual treatment for MDS? - Azacitidine

Cause of transient anticardiolipin antibody or lupus inhibitor - Viral infections, need to be rechecked in 12 weeks.

Coombs negative hemolytic anemia, pancytopenia, and thrombosis. Diagnosis, etiology, related findings treatment? - Paroxysmal nocturnal hemoglobinuria. Loss of CD 55 and 59 leading to complement mediated destruction. Iron deficiency anemia due to iron loss in urine. Thrombosis due to loss of anticoagulants linked to GPI. Treat with eculizumab, C5 monoclonal antibody.

Elevated serum IgM concentration, lymphoplasmacytic infiltrates of the bone marrow, lymphadenopathy, IgM monoclonal gammopathy anemia, organomegaly, neuropathy, hyperviscosity syndrome. Diagnosis and treatment? - Lymphoplasmacytic lymphoma - Waldenstrom macroglobulinemia. Plasma exchange for hyperviscosity syndrome. Treat with rituximab or fludarabine.

Hyperviscosity syndrome - mucosal bleeding, headache, heart failure, altered mentation, blurred vision. Associated with Waldenstrom macroglobulinemia

Rheumatology

["Joint aspiration shows watery fluid with strongly negative birefringent crystals","Gout"],["Causes of a gout attack","Excessive alcohol use, dietary excess, surgery, trauma, glucocorticoid withdrawl"],["Inflammatory arthritis types and joint aspiration cell count","Gout, pseudogout, rheumatoid arthritis. WBC count 5,000 to 50,000"],["Pseudogout crystals","Weakly positive, rhomboid-shaped crystals"]

Infectious Disease

["Syphilis leading to EKG changes","Narrows intima of the coronary arteries, leading to ST depressions on EKG"],["Two treatments for chronic bacterial prostatitis","Ciprofloxacin for 4 to 6 weeks or Trimethoprim/Sulfamethoxazole for 12 weeks"],["A patient has Lyme disease with 2nd degree heart block. What is the treatment?","High grade AV block with PR >0.3 requires IV ceftriaxone or penicillin"],["A patient has a circular rash, facial palsy, and joint pains after hiking in the woods of Connnecticut. EKG shows first degree heart block. What is the treatment?","Minor Lyme Disease, oral doxycycline."],["An option for treating Group A Streptococci related necrotizing fascitis","Clindamycin with penicillin"],["Streptococcal exotoxin A","Similar to toxin from Staph aureus and causes toxic shock syndrome"],["Only infection causing Rheumatic fever","streptococcal pharyngitis"],["Lab findings with Rheumatic fever","elevated esr, crph, prolonged pr interval"],["Infections causing acute glomerulonephritis","S pyogenese related cutaneous infections and pharyngitis"],["Treatment for Group B Streptococcus agalactiae meningitis","Penicillin with gentamicin"],["Malignancy associated with Streptococcus bovis and treatment","Colon cancer, treat with penicillin or cephalosporins"],["Treatment for Enterococcus endocarditis","Penicillin plus gentamicin"],["Initial empiric antibiotics for meningitis","Vancomycin and ceftriaxone"],["Most common bacteria causing meningitis and treatment","Streptococcus pneumoniae, treat with penicillin G"],["Indications for pneumococcal vaccine","age greater than 65, chf, copd, emphysema, diabetes mellitus, asthma, cirrhosis, asplenia, csf leaks"],["common cause of subacute bacterial endocarditis","Streptococcus viridans"],["Most common cause of osteomyelitis","Staphylococcus aureus"],["Concern with Staph aureus UTI","bacteremia with secondary seeding in urinary tract"],["Treatment options for MRSA","Vancomycin, Linezolid, Daptomycin"],["Treatment options for community MRSA","Vancomycin, Clindamycin, tetracyclines, trimethoprim-sulfamethoxazole"],["Treatment of Bordetella pertussis","Macrolide - erythromycin, clarithromycin, azithromycin"],["Risk factors for brucellosis","meat handlers, exposure to livestock, consuming unpasteurized milk"],["Two causes of splenic calcifications","Histoplasmosis, Brucella"],["Treatment for Legionella","Macrolides, fluoroquinolones, doxycycline"],["Diagnosis of L pneumophilia","Urine antigen"],["Lab findings with Legionella","hyponatremia, increased liver function tests"],["Symptoms of Francisella tularensis","Eschar at innoculation site with regional lymphadenopathy and high fevers"],["Tularemia treatment","Streptomycin and gentamicin first line. Tetracycline"],["Infections after cat or dog bite with rapidly spreading cellulitis and bacteremia. What is the treatment?","Pasteurella multicoda, treated with Penicillin, amoxicillin, tetracyclines or fluoroquinolones"],["Cat scratch fever cause and management","Bartonella henselae. Supportive then azithromycin if needed"],["Bacillary angiomatosis","Bartonella henselaeo or Bartonella quintana, cutaneous manifestations that look like Kaposi sarcoma. Cutaneous neovascular proliferation"],["Risk factors for Vibrio vulnificus infection and mortality","Hemochromatosis, cirrhosis. 30%."],["Ingested raw oysters, developed fever, hypotension and multiple hemorrhagic bullae. Diagnosis and treatment","Vibro vulnificus, treate with ceftazidime or tetracycline"],["Listeria epidemics","Dairy products, hot dogs, luncheon meats. Causes diarrhea."],["Treatment of Listeria","Penicillin and ampicillin. For meningitis, combine with aminoglycoside. Treat for 2-4 weeks"],["Toxin mediated complications of Corynebacterium diphtheriae","Myocarditis, congestive heart failure, arrhythmias, polyneuritis, respiratory muscle paralysis"],["Needs a culture with Loffler medium","Diphtheria"],["Diphtheria treatment","Main - equine antiserum. Antibiotics - erythromycin or penicillin G. Diphtheria tetanus toxoid"],["Finding on cxr with inhalation anthrax","Widened mediastinum"],["Complication of inhalation anthrax","Hemorrhagic mediastinitus, bacteremia, hemorrhagic meningitis"],["Treatment for inhalation anthrax","Ciprofloxacin or doxycycline for 60 days"],["Antibiotics for Bacillus anthracis","Penicillins, tetracyclines, vancomycin, fluoroquinone, rifampin, clindamycin"],["Treatment of tetanus","Human tetanus immune globulin"],["After eating home-canned cherries, a patient develops fixed dilated pupils, dry mouth, diploplia, and descending paralysis with intact sensation. What's the diagnosis and treatment?","Clostridium botulinum. Treat with equine antitoxin, flushing the gut of any remaining food items."],["Sulfur granules","Actinomyces israelii"],["Sinus tract draining through the chest wall","Could be from pulmonary Actinomyces israelii"],["Treatment of Actinomyces","Long course of penicillin"],["The BCG vaccine can affect TB tests for how long?","Only for one year"],["Treatment for latent tuberculosis","Isoniazid for 9 months"],["Treatment of Leptospirosis","Penicillin G"],["Neurologic complications of Lyme Disease","facial nerve palsy, encephalitis, lymphocytic meningitis, chorea, myelitis, radiculitis, peripheral neuropathy"],["Diagnostic tests for Lyme Disease","ELISA then Western Blot for confirmation"],["Indications for parenteral treatment of Lyme Disease and treatments","3rd degree heart block, meningitis, radiculopathy, encephalitis. Treat with ceftriaxone 2 gm or penicillin G."],["Oral medications for Lyme Disease","Doxycycline, amoxicillin, cefuroxime for 10-21 days"],["Treatment options for Nocardia","First line is Trimethroprim-sulfamethoxazole. Other options include imipenem, amikacin, and cephalosporins"],["Cause of q-fever, exposure, and treatment","Coxiella burnetti. Inhalation of dust, earth or feces. Exposure to animal products - placentas, sheep, cats"],["Treatment of q-fever","Tetracyclines or fluoroquinolones"],["Lab findings with Ehrlicia","leukopenia, thrombocytopenia, increased levels of hepatic transaminases"],["Treatment of Ehrlichia","Doxycycline 100 mg po bid"],["Neurologic complications of Mycoplasma pneumoniae","Guillain-Barre syndrome, cerebellar peripheral neuropathy, aseptic meningitis, mononeuritis multiplex"],["Hematological complication of Mycoplasma","Hemolytic anemia from col hemagglutinins"],["Treatment for Mycoplasma","Fluoroquinolones, macrolides, tetracyclines"],["Treatment for coccidioidomycosis","Fluconazole, itraconazole, amphotericin B"],["Treatment for Histoplasmosis. Severe and Mild","Severe - Amphotericin B, Mild - Itraconazole"],["Treatment for Blastomycosis","Amphotericin B for severe infection. Itraconazole for mild infections"],["A rose gardener develops a crusty skin lesion on his leg after hitting a thorn. The lesions start ascending his leg. Diagnosis and treatment.","Sporothrix schenckii, treated with itraconazole for cuateous or lymphocutaneous infections"],["Treatment options for Aspergillus","Amphotericin B, Caspofungin, intravenous voriconazole"],["Treatment for candidemia","Amphotericin B, Fluconazole, Intravenous capsofungin"],["Mucormycosis findings and treatment","Black necrotic lesions on nose or palate. Amphotericin B and debridement"],["Complications of EBV infection","Splenic rupture, hemolytic anemia, airway obstruction, transverse myelitis, encephalitis"],["Diagnosis of mononucleosis","Monospot test - heterophile antibodies, EBV immunoglobulin M antibodies"],["Treatment of CMV in immunocompromised","Ganciclovir"],["AIDS CMV complication and treatment","CMV Retinitis in 20-30%, treat with Foscarnet or Ganciclovir"],["Complications of Varicella infection","Pneumonia, encephalomyelitis"],["Varicella immune globulin - uses","Give within 96 hours of exposure to immunocompromised or newborns whose mothers had varicella near delivery"],["Varicella vaccines","live vaccines contraindicated in immunocompromised. Varivax for primary prevention and Zostavax to prevent Zoster"],["Cause of roseola infantum","HHV-6"],["Treatment Influenza A and B","Neraminidase inhibitors - oseltamivir and zanamivir"],["Definitive diagnosis of rabies","Negri bodies on biopsy of hippocampus"],["Rabies treatment","Rabies immunoglobulin and 5-dose vaccine"],["Creutzfeldt-Jackob disease symptoms","rapid dementia and myoclonic seizures"],["Symptoms of measles","Rash, oral Koplik spots, fever, arthralgias, headache"],["Symptoms of rubella","posterior cervical lymphadenopathy, arthralgia, transient rash, fever"],["Pregnancy and rubella vaccine","contraindicated - can cause congenital abnormalities"],["Cause of erythema infectiosum and aplastic crisis","Parvovirus B19"],["Complications of Human T-cell Lymphotropic virus","Human t-cell leukemia/lymphoma and tropical spactic paraperesis - myelopathy"],["Neurocysticercosis treatment","Praziquantel or Albendazole"],["A patient develops muscle pain, eosinophilia and periorbital edema after eating undercooked pork. Diagnosis and Treatment","Trichinosis. Treat with mebendazole or albendazole"],["Complications and Treatment of Strongyloides stercoralis","Gram-negative bacteremia, super infection in immunocompromised. Treat with Ivermectin"],["Complications of Schistosomiasis and treatment","Hepatic cirrhosis, hematuria, bladder cancer, transverse myelitis. Treat with Praziquantel"],["Treatment for Entamoeba histolytica","Metronidazole with iodoquinol or paromomycin"],["Giardia testing and treatment","Stool antigen. Treat with metronidazole, tinidazole or nitazoxanide"],["Chlorquine sensitive areas for malaria prophylaxis","Central america, Mexico, Haiti, Dominican Republic, Middle East"],["Malaria prophylaxis","Chloroquine in sensitive areas. Mefloquine, Doxycycline or aovaquone-proguanil combination."],["Treatment for Plasmodium falciparum, malariae, or vivax","Chlorquine preferred. Quinine, doxycycline, atovaquone-proguanil, mefloquine, clindamycin are other options"],["Primaquine use and complications","kills exoerythrocytic P ovale and P vivax. Causes hemolysis in G6PD deficiency"],["Symptoms and Treatment for Cyclospora cayetanensis","Diarrhea, fever, fatigue among travelers to the tropics. Treat with Trimethorpirm-sulfamethoxazole."],["Babesia microti clinical findings and treatment","Fever, myalgias, hemolytic anemia. Tick borne disease of Northeastern US. Treat with clindamycin and quinine or atovaquone plus azithromycin"],["Organisms resistant to natural penicillin","Most staphylococci and gram negative organisms through b-lactamase"],["Treatment for otitis media and Listeria meningitis","Amoxicillin and IV ampicillin"],["Drug of choice for endocarditis and bacteremia caused by methicillin-susceptible staphylococci","Penicillinase Resistant Penicillins - oxacillin, nafcillin, dicloxacillin. More active than vancomycin."],["Uses of amoxicillin-clavulanate and ampicillin-sulbactam","Polymicrobial skin and soft-tissue infections. Otitis media, sinusitis, aspiration pneumonia"],["Antibiotics given to mononucleosis patients that cause a rash","Ampicillin and amoxicillin"],["Clinical uses of ceftriaxone","Urinary tract infections, community acquired respiratory tract infections, pyelonephritis, community acquired meningitis"],["Fourth generation cephalosporing with activity against Pseudomonas and Enterobacter","Cefepime"],["Preferred treatment of febrile neutropenia","Cefepime"],["Cephalosporin active against Methicillin-resistant Staph aureus","Ceftobiprole - a fifth generation cephalosporin"],["Clinical use of aztreonam","Aerobic gram-negative infections, used in patients with penicillin allergy"],["First line agent for Tularemia and Yersinia","Aminoglycosides - gentamicin, amikacin"],["Drug of choice for Rickettsia, Chlamydia, M pneumoniae, Vibrio cholera, Vibrio vulnificus, Brucella and B burgdorferi","Tetracycline, doxycycline, minocycline"],["Similar to minoscycline but with activity against MRSA, VRE, E Coli, Klebsiella but no significant activity against Pseudomonas","Tigecycline"],["Clindamycin activity","Aerobic and anaerobic gram-positives"],["Treatment of choice for giardiasis, amebiasis, bacterial vaginosis, and trichomoniasis","Metronidazole"],["Metronidazole activity","Anaerobic microorganisms including Bacteroides"],["Used to treat M pneumoniae, diphtheria, pertussis, C jejuni gastroenteritis, bacillary angiomatosis, Legionella pneumonia, Chlamydophila pneumonia, Bordetella pertussis","Erythromycin"],["First line STD agent against C trachomatis and chancroid","Azithromycin"],["Vancomycin activity","Bactericidal to most aerobic and anaerobic gram-positive organisms"],["Vitamin deficiency with isoniazid","Pyridoxine - vitamin B6"],["Common adverse effect of isoniazid, rifampin, and pyrazinamide","hepatitis"],["Good activity against Candida, Cryptococcus, Coccidiodes, Paracoccidioides","Fluconazole"],["Good activity against Aspergillus, Sporothrix schenckii, Histoplasma capsulatum and Blastomyces dermatitidis","Itraconazole"],["Good activity against Aspergillus and Candida","Voriconazole"],["Infusion related reaction to Amphotericin B","fever, chills or rigors, nausea, vomitting"],["Initial treatment of cryptococcal meningitis","Amphotericin B with flucytosine"],["Drug of choice for herpes encephalitis","High dose IV acyclovir"],["Activity of amantadine and rimantadine","Only Influenza A, not Influenza B. Must be given within first two days, cuts duration by 1-2 days."],["Activity of oseltamivir and zanamivir","Both Influenza A and B, and H1N1. Must be given with 48 hours, reduces symptoms by 24 hours."]

Other Flash Cards - Cardiology and Nephrology