Treatment of pneumocystis jirovecii pneumonia (likely in setting of HIV)
- IV TMP-SMX
- adjunctive treatment with corticosteroids if alveolar to arterial gradient is greater than 35mmHg or arterial oxygen tension of 70 or less in patients on RA
Clinical findings of drug induced lupus, and diagnostic test?
- multisystem involvement: fever, malaise, myalgia, arthralgia/arthritis, serositis (pleuritis, pericarditis) and/or hepatomegaly/splenomegaly
- test for ANA and anti-histone antibodies
which drug induces lupus?
- procainimide
- hydralazine
- minocycline
- TNF-alpha; etanercept, infliximab
Steps in diagnosing c.diff
- enzyme immunoassay or PCR (more sensitive) for toxins A and B
- negative lab testing and clinically high suspicion then proceeds to colonoscopy or limited sigmoidoscopy to document pseudomembranous colitis
Management of recurrent UTI in young women
- prophylactic abx: fluoroquinolones, TMP-SMX, nitrofurantoin
- abdominal US only if there’s obstruction or nephrolithiasis
How to diagnose brain death (neurologic exam?)
- clinical/imaging of brain damage
- absence of confounding factors
- hemodynamic stability
- absence of cortical and brainstem function (pupillary, oculocephalic, oculovestibular (caloric), corneal, gag, sucking, swallowing, and extensor (posturing)
- reflexes can still be present, but originating from peripheral nerves
Most common risk factors of carpel tunnel syndrome
- diabetes
- RA
- hypothyroidism
- others: wrist trauma, ESRD, obesity, pregnancy, acromegaly, menopause
Treatment of carpel tunnel syndrome
- splint
- if splint fails, then corticosteroids injection
- surgery only if hypothenar eminence, motor weakness
3 important clinical criteria for diagnosing ankylosing spondylitis
- lower back pain and stiffness for >3 months that improves with activity
- limitation on ROM of lumbar spine
- limitation of chest expansion relative to normal values
- ddx with x-ray of sacroiliac spine
Most common extraarticular manifestations of ankylosing spondylitis
- acute anterior uveitis
- aortic regurg, MVP
- apical pulmonary fibrosis
- IgA nephropathy
- restrictive lung disease
Treatment of bacterial enteritis in children, when is abx recommended and when is it not?
- oral rehydration
- abx recommended in immunocompromised kids, age <3 months, cholera, invasive disease (sepsis, osteomyelitis, meningitis)
- abx not recommended in e.coli O157:H7 infx due to HUS
Presentation of tinea versicolor and diagnosis, treatment
- noninvasive fungal infection, multiple small macula that vary in color.
- TV ddx by KOH prep which will show yeast and hyphae
- treatment: topical antifungal
Intermittent episodes of chest pain, dysphagia, and “corkscrew” esophagus on barium swallow. Ddx?
diffuse esophageal spasm
can sometimes present without corkscrew.
normal relaxation of LES
Signs of chronic lithium toxicity >1.5mEq
confusion
ataxia
neuromuscular excitability
treatment of lithium toxicity
- IV hydration
- bowel irrigation
- if >4mEq or >2.5mEq with renal failure then HD
In patients with PE, if low grade fever is present and WBC is elevated, what should you do?
- get blood culture but don’t start empiric abx therapy as low grade fever is normal with PE
Necessary step in managing hypothermic patients with hypoventilation, hypoxemia and AMS
- intubation
- active rewarming measures; if severe hypothermia (<82F) then warm humidified oxygen and warm peritoneal lavage. Otherwise, warm IV fluids with 1-2 C/hour.
Severe PID treatment (usually gonorrhea and chlamydia)
- IV cefoxitin and IV doxy
- IV ceftriaxone and IV doxy
When is hypothyroidism treatment warranted?
In the presence of:
- sx of hypothyroidism
- antithyroid antibodies
- abnormal lipid profile
- ovulatory and menstrual dysfunction
Treatment of recurrent c.diff
- first recurrence: metronidazole for nonsevere, vanc for severe
- second: pulsed tapering oral vanc 6-7 weeks
- subsequent relapses: fidaxomicin, fecal microbiota transplant
genital warts turning white with acetic acid application, ddx? treatment?
condylomata acuminate
- trichloroacetic acid application, then surgery if not effective
carbamazepine SE
- bone marrow suppression: neutropenia, aplastic anemia, thrombocytopenia
- hyponatremia, SIADH
- glaucoma
- anticholinergic effects
What medications are indicated for diabetic patients with renal failure/metabolic acidosis?
insulin
piloglitazone, rosiglitazone, acarbose, repaglinide are alternatives
need to stop metformin and glyburide
what is melasma?
acquired hyperpigmentation disorder that occur in sun-exposed areas
*risk increases during pregnancy, resolves spontaneously
