features of sicca syndrome and best initial and diagnostic test
- dry eyes, dry mouth
- secretory deficiency (Schrimer test) and autoantibody screen
positive biferengence test with rhomboid crystals is what? what disease is it related to?
pseudogout, seen in hemochromatosis
features of sarcoidosis
- erythema nodosum
- peripheral nerve disease
- hepatic compromise
- hilar lymph node enlargement–> need x-ray to diagnose
- young population
definite diagnosis of sarcoidosis
biopsy of:
- any palpable lymph node
- subq nodule except erythema nodosum
- enlarged parotid
- lacrimal gland
Drugs that affect lithium level
- diuretics
- NSAIDs except aspirin
- SSRI
- Ace-I and ARBs
- antiepileptics
Management of lobular carcinoma in situ (nonmalignant– DCIS is worse)
- excisional biopsy then follow up surveillance
- alternative option: tamoxifen or raloxifene
Features and tests for chronic pancreatitis
- steatorrhea secondary to fat malabsorption (bulky foul smelling stool difficult to flush)
- epigastric pain with radiation to the back
- text: CT scan of abdomen, NOT serum lipase and amylase (more for acute pancreatitis)
Treatment of chronic pancreatitis
- first line: alcohol cessation and small meals with low fat
- pancreatic enzymes and possible opiate medications
Endometriosis treatment
- meds– NSAIDs, GnRH analogs, danazol (synthetic androgen), oral contraceptives
- surgery
Medications in recent MI (q waves in lead II, III, avF)
- antiplatelets
- beta blocker
- statins
- Ace-I or ARB
- aldosterone antagonist (eplerenone) IF LVEF <40%, add to beta blocker and ace-i
when should EGD be considered instead of colonoscopy as first step in hematochezia?
- UGIB suspected
- hemodynamically unstable
How does biliary colic present?
constant epigastric or RUQ pain, can radiate to shoulder
- n/v/diaphoresis
- <6 hours
Management of gallstones w/ vs w/o stones on imaging
with: cholecystectomy, or ursodeoxycholic acid in poor surgical candidates or patients refusing surgery
without: CCK- stimulated cholesyntigraphy
How does amaurosis fugax present?
- transient monocular blindness
- carotid bruit
How does IgA nephropathy usually present?
- gross hematuria following acute URI
- flank pain
- dysmorphic RBCs in urine
How does acute post strep glomerulonephritis usually present?
- strep throat/skin infection, then 10 days later renal issues
- hypertensive
- urine cast shows RBCs and RBC casts
- decreased complement levels
Timing, pathophysiology and signs of breastmilk jaundice
- starts at 3-5 days, peaks at 2 weeks
- high beta-glucuronidase in breast milk deconjugates intestinal bili and increase enterohepatic circulation
- normal exam, spontaneous resolution
Best prognostic indicator of acute pancreatitis
APACHE II
Positive LR vs Negative LR
\+= sensitivity/ 1- specificity -= 1- sensitivity/specificity
Which antibodies correlate to disease activity in SLE?
anti-ds DNA (most sensitive marker for disease as well)
Treatment of SLE
hydroxychloroquine and prednisone
Initial management of adrenal masses?
- studies of hormonal production: dexamethasone suppression, 24 hr urine catecholamines, metanephrine, VMA, etc
- if >4cm, then surgical excision
Treatment of sunburn from doxy
NSAIDs, steroids if severe
SE of isotretinoin (acne med)
hyperglycemia, hyptertriglyceridemia, hepatotoxicity, mucocutaneous rxns, teratogen (females need 2 concurrent contraception methods)
