septic shock management
- fluid resuscitation to CVP of 8-12
- vasopressors if MAP <65 after fluids
What is immune reconstitution inflammatory syndrome?
paradoxical worsening of pre-existing infections in HIV positive individuals days to week after starting HAART treatment.
- self limited
Secondary causes of restless leg syndrome?
- iron deficiency anemia
- diabetes
- uremia (ESRD, CKD)
- MS, parkinsons
- pregnancy
- drugs (antidepressants, metoclopramide)
features of lumbar spinal stenosis?
- worsens with extension, improves with flexion
- pain decreases with sitting down
- diagnosed with MRI
what is kappa statistic?
-inter rater reliability
what is validity?
accuracy
long term management of chronic hypoparathyroidism
- add a thiazide to increase serum calcium and decrease urinary calcium
- PTH increases renal calcium absorption
PMDD/PMS treatment
- first line: SSRI
- 2nd line: another SSRI or estrogen-progesterone oral contraceptive
- benzo and other GnRH agonist may be effective but has SE
Management of GBS
- intubation and mechanical respiration due to respiratory failure
- plasmapheresis and/or IVIG therapy
criteria for ARDS
- new or worsening resp sx in past week or w/i 1 week of clinical insult
- b/l lung opacities consistent with pulm edema
- no signs of cardiac failure or fluid overload
- ECHo needed for definite exclusion
- PaO2/FiO2 ratio <300mmHg
Sx and treatment of RA
- symmetric polyarthritis (MCP, PIP) with morning stiffness >30 min
- First line tx: NSAIDS
- DMARDS: antimalarials, sulfasalazine, methotrexate, azathioprine to slow down bone erosion
- RF only positive in 70-80% of ppl, it’s a CLINICAL ddx
- CCP another marker
Sx of SLE
- migratory morning stiffness that lasts minutes
- manifestation in skin and kidneys and msk
- anti ds DNA
Cardiogenic shock hemodynamic parameters
- low cardiac index (normal 2.8-4.2)
- elevated pulmonary capillary wedge pressure (normal 9)
- elevated SVR
Signs of pulmonary artery hypertension, and best ddx test
- loud S2
- enlarged pulmonary arteries
- right axis deviation EKG
- raynaud’s phenomenon
- ECHO as initial test
tx of PAH
- bosentan (endothelin inhibitor)
- epoprostenol and treprostinil (prostacyclin analogs)
- CCB
- sildenafil
Management of cocaine induced chest pain
- first line: benzo to help with anxiety
- second line: phentolamine if benzo fails
- alternatives: nitroprusside, nitroglycerin
- avoid bb to avoid coronary vasospasm
features and tx of primary dysmenorrhea
- presents in first 6-12 months of period, normal physical exam
- elevated levels of prostaglandin
- tx: first line is NSAIDs, then OCP
HPV vaccination timeline and contraindications?
- first dose at age 11-12, 3 doses in 6 month period
- hx of prior sexual activity, previous HPV infection, immunosuppression, abnormal pap smear are NOT contraindications
- hypersensitivity to yeast IS contraindication
features and treatment of primary billiary cirrhosis
- unexplained pruritis and elevated alk phos
- progressive cholestasis and liver failure
- HLD with xanthomas
- antimitochondrial antibodies
- tx: ursodeoxycholic acid and liver transplantation
- cx: osteoporosis, osteomalacia
symptoms of serotonin syndrome
- mental status changes
- autonomic dysregulation
- neuromuscular hyperactivity (hyperrflexia, myoclonus, ocular clonus)
- cause: combined use of SSRI and MAOI (eg phenelzine); need 5 week wait period
risk factors, sx and tx of candida endophthalmitis
- central venous catheter, TPN, broad spectrum abx, abd surgery, IV drug use, steroids, neutropenia
- ocular pain, scotomas, photophobia, fever
- vitrectomy and antifungal (amphotericin B or fluconazole)
treatment and cx of beta thalassemia major
- hypertransfusion regimen
- iron overload and resultant organ damage
Risk of hepatic adenoma with use of OCP in women
Stop OCP due to risks of sudden rupture with infra-abdominal bleeding and malignant transformation
Features of Rocky Mountain spotted fever and treatment
5-7 days after tick bite, low fever, lethargy, myalgia, petechial rash in ankles and wrists, spreads to palm soles and body.
TX: doxy is first line, chloramphenicol is alt option.
clinical diagnosis, no need to wait for confirmatory test
