1
Q
Amiodarone sfx and how to monitor
A
Pulmonary toxicity - interstitial pneumonitis, ARDS
Obtain CXR and PFTs at baseline
2
Q
S4 indicates
A
stiff/hypertrophied ventricle
DDX
- acute MI
- HTN
- aortic stenosis
- hypertrophic cardiomyopathy
3
Q
rheumatic heart disease murmur
A
mitral stenosis
aortic stenosis
4
Q
what should you avoid giving someone on cocaine?
A
beta blocker
5
Q
aortic dissection treatment/management
A
1) pain control
2) beta blocker
3) Na nitroprusside
6
Q
Dihydropyridine Calcium Channel Blocker sfx
and how to reduce it
A
sfx = peripheral edema
treatment = ACEi/ARB
7
Q
What should be avoided in treatment of an Acute MI that becomes Flash Pulmonary Edema?
A
Avoid beta blockers in the presence of flash pulmonary edema
Tx =
- ASA, Clopidogrel
- Statin
- Loop diuretic
8
Q
EKG:
High voltage QRS
Lateral (v5-v6) ST depression
Lateral (v5-v6) T inversions
A
LVH
9
Q
Treatment of beta blocker overdose
A
presentation = bradycardia, hypotension, AV block, diffuse wheezing, seizures, cardiogenic shock
treatment =
1) Airway
2) Isotonic fluid bolus
3) IV atropine (to fix bradycardia and hypotension)
4) IV glucagon
10
Q
Nitroprusside sfx
A
Cyanide toxicity
- occurs when pt is receives high doses or if someone has renal failure (elevated Cr)
- symptoms = AMS, lactic acidosis, seizures, coma
11
Q
When do you give IVIG for tetanus prophylaxis?
A
If un-immunized or received <3 toxoid doses or patient unsure AND large/dirty wound
12
Q
What is the CD4 cut off for receiving live vaccines?
A
Patients with CD4<200 should not receive live vaccines
- MMR
- VZV
- oral polio
- nasal influenza
- rotavirus
- yellow fever
13
Q
Malaria prophylaxis
A
- Mefloquine - starts before, throughought ends after return
- Atorvaqone-Proguanil
- Doxycyline
14
Q
Osteomyelitis - which two bacteria?
A
Staph aureus
Pseudomonas
15
Q
Young + HTN + Diuretic-induced hypokalemia
A
Primary hyperaldosteronism (Conn)
16
Q
Polydipsia + Polyuria DDX (5)
A
- DM
- Diuretic use
- Central DI (serum Na elevated)
- Nephrogenic DI (serum Na normal)
- Primary polydipsia (serum Na low)
17
Q
What does a positive Prussian blue stain indicate?
A
positive hemosiderin (indicates hemolysis)
18
Q
cirrhosis + ascites + low grade fever + abdominal discomfort + altered mental status =
tx
A
SBP
-fluid is positive if there are >250 PMNs or >500 WBCs
tx = IV Abx
-3rd generation cephalosporins to cover gram negative (EColi, Klebsiella) and gram positive (Enterococcus)
19
Q
What does OCP induced liver damage look like in lab and biopsy
A
Lab = abnormal LFTs
Biopsy = no evidence of necrosis or fatty changes
20
Q
IgA Nephropathy vs Post-Streptococcal Nephropathy
A
IgA Nephropathy = 5 days post-URI, normal compliment
Post-Streptococcal Nephropathy = 10-14 days post-URI/pharyngitis, low compliment (C3)
21
Q
What lab value indicates saline responsive metabolic alkalosis?
What lab value indicates saline resistant metabolic alkalosis?
A
Saline responsive: urine Cl <20
tx = NS MIVF + K
Saline resistant: urine Cl >20
tx = spironolactone
22
Q
COPD treatment with maximal impact on mortality
A
- smoking cessation
- home O2
23
Q
Treatment of an acute exacerbation of COPD (5)
A
- O2 (target SpO2 88-92%)
- inhaled bronchodilators
- systemic glucocorticoids
- antibiotics (if there are >2 symptoms)
- NPPV if respiratory failure
24
Q
woman + chronic dry cough + malaise + bilateral hilar lymphadenopathy =
A
Sarcoidosis (Chronic Granulomatous Inflammation)
25
What 3 cancers can cause malignant pleural effusions?
- Lung ca
- Breast ca
- Lymphoma
26
"dysmorphic RBC on the urinalysis"
Goodpasture's disease
27
treatment for spinal cord compression
1) IV glucocorticoids
| 2) MRI
28
elevated homocystiene + DVT or history of DVTs
What to do next?
Give pyridoxine
Pyridoxine, Vit B12, Folate are required for the metabolism of homocystiene
29
treatment for Cancer Related Anorexia/Cachexia Syndrome (CACS)
- progesterone analogues
| - corticosteroids
30
sfx of Epo therapy (4)
- worsening HTN
- headaches
- flu-like symptoms
- red cell aplasia
31
treatment of organophosphate poisoning
1) Atropine
| 2) Take off all clothes and wash body
32
how to dx arsenic poisoning
urine level
33
"variant lymphocytes with large vacuolated cytoplasms"
atypical lymphocytes of EBV
34
pneumaturia occurs in what disease?
pneumaturia = air in urine
| Occurs in colovesical fistulas in Diverticular disease, Chrons, Malignancy
35
4 main substrates of gluconeogenesis
- alanine (-> pyruvate)
- glutamine (-> Krebs)
- Lactate (-> pyruvate)
- glycerol-3-phosphate (-> glucose)
36
young patient (<55 yo) with unexplained heart block or unexplained ECG changes
Cardiac sarcoidosis
37
Hodgkin's lymphoma treated with chemo + radiation before the age of 30 increases your risk for _
a secondary malignancy
| Lung, Breast, Thyroid, Bone, GI, Acute leukemia, NonHodgkin's
38
wedge shaped infarct + pleuritic chest pain + hemoptysis =
PE
39
what two drugs to avoid in an asthmatic who just had an MI
- ASA
- Beta blocker
may trigger bronchoconstriction
40
a firm, non-tender, solitary lymph node in the head/neck is most likely _
squamous cell carcinoma
41
elderly patient + severe lymphocytosis + hepatosplenomegaly + lymphadenopathy + anemia + thrombocytopenia =
CLL
- elevated lymphocytes
- low platelets
- low Hgb
42
JAK2 mutation is associated with _
Myeloproloferative disease/ Polycythemia Vera
43
Lab values in tumor lysis syndrome and its consequences (2)
elevated uric acid
elevated K
elevated P
low Ca (because the elevated P binds to Ca)
Arrythmias due to elevated K
AKI due to uric acid deposition
44
epitrochlear lymphadenopathy is pathognomonic for _
Syphilis
- gray mucous patches
- maculopapular rash taht spreads from the trunk->out (including palms and soles)
- diffuse lymphadenopathy
45
sudden onset RUQ pain + fever + vomiting + leukocytosis =
acute cholecystitis
| stone in cystic duct
46
CT scan - pulmonary nodule surrounded by ground glass opacities
Halo sign
| -Invasive aspergilosis
47
after an endoscopy a patient gets L sided small pleural effusion + acute chest pain + subcutaneous emphysema =
esophageal perforation
| -gastrograffin swallow to dx
48
mechanism of HTN in thyroid disease
- Thyrotoxicosis/Hyperthyroid =
- Hypothyroid
Thyrotoxicosis/Hyperthyroid = HTN, tachycardia, wide pulse pressure
+inotropic
+chronotropic
decrease in systemic vascular resistance
Hypothyroid = HTN
increase in systemic vascular resistance
49
First step when you find a thyroid nodule
1)TSH + ultrasound
50
elevation of L mainstem bronchus on CXR indicates
L atrial enlargement
| -MS
51
mineral deficiency
- brittle hair
- skin depigmentation
- peripheral neuropathy
- ataxia
- sideroblastic anemia
- osteoporosis
Copper
52
mineral deficiency
- alopecia
- pustular skin rash
- hypogonadism
- impaired wound healing
- impaired taste
- immune dysfunction
Zinc
53
mineral deficiency
- hyperpigmented rash
- diarrhea
- dementia
Niacin (vit B3)
"Pellagra"
54
RBC casts
glomerulonephritis
55
WBC casts (2)
- interstitial nephritis
| - pyelonephritis
56
broad/waxy casts
chronic renal failure
57
What type of kidney stones are seen in someone with fat malabsorption disease
Calcium oxalate stones
Normally, calcium binds to oxalate in the gut to prevent its absorption
Fat Malabsorption diseases, there is increased fat in the gut that binds up calcium therefore leaving less calcium to bind with oxalate therefore the oxalate is absorbed and then secreted into the urine
58
Glomerular disease associated with lymphoma
minimal change disease
59
Glomerular disease associated with solid cancers
membranous glomerulonephritis
60
ASO titers are used to diagnose =
recent strep pharyngitis
| NOT infectious endocarditis
61
DDX pulus paradoxicus (3)
- Cardiac tamponade
- Asthma
- COPD
62
fluids used to resuscitate (fix volume status)
Normal saline (0.9% NS)
63
fluids used to fix hypernatremia
1/2NS + D5
64
diastolic sound with a squeaking quality at L sternal border
pericardial friction rub
65
How to know if someone is adequately compensated in their metabolic acidosis?
Winters Formula
| compensated PCO2 = 1.5 (HCO3) + 8 +/- 2
66
melanosis coli is pathognomonic for
factitious diarrhea/laxative abuse
67
autoimmune melanocyte injury
vitiligo
- occurs progressively
- complete depigmentation (not hypopigmentation)
- tx = topical corticosteroids
68
malasezia infection
tinea versicolor
69
RA + Neutropenia + Splenomegaly =
Felty syndrome
- extra-articular RA manifestations = necrotizing skin ulcers/lesions, vascuilits, mononeuritis multiplex, nodules
- increased risk for bacterial infections due to neutropenia
- Positive RF, Positive anti-CCP (RA), Elevated ESR
- Treatment = improves with RA treatments
70
higher BP in L arm vs R arm =
subclavian steal/stenosis
71
higher BP in R arm vs L arm
coarctation of the aorta
72
treatment of unilateral adrenal adenoma
surgery + spironolactone (Aldo antagonist)
73
treatment of bilateral adrenal hyperplasia
spironolactone (aldo antagonist)
74
what is the only detectable Hepatitis B lab finding during the window period?
Anti-HBcAb IgM
75
3 causes of traveler's diarrhea
- Cryptosporidium
- Cyclospora
- Giardia
Prolonged, profuse watery diarrhea
76
first line treatment for peripheral artery disease (PAD)
aspirin + statin + exercise program
77
male + large anterior mediastinal mass + elevated AFP + elevated beta-HCG
noneminomatous germ cell tumor
78
sudden onset eye pain + headache + nausea + conjunctival erythema + mid-dilated pupil (nonreactive) =
Acute angle closure glaucoma
tx = urgent tonometry
79
which oral diabetes medication can be added to metformin for weight loss
GLP-1 agonists ("-tide")
80
mechanism of anticolinergic urinary retention
detrusor hypocontractility
81
treatment of hypersensitivity pneumonitis
avoid triggers
82
Ventilator:
| PaO2 is influenced by _ and _
FiO2
| PEEP
83
Ventilator:
| PaCO2 is influenced by _ and _
RR
| TV
84
time limit for giving activated charcoal to someone with acetaminophen OD is _
4 hrs since ingestion
85
- elevated JVP
- 3rd heart sound
- tricuspid regurgitation murmur
- hepatomegaly
- lower extremity edema
- ascites
- pleural effusion
RV failure
86
impaired RV function secondary to pulmonary HTN secondary to underlying lung disease or pulmonary vasculature disease or OSA =
tx?
Cor Pulmonale
tx
- treat the underlying disorder
- O2 if hypoxic
- use diuretics carefully bc they might be preload-dependent
87
Acute Liver Failure 3 requirements
- elevated AST, ALT
- hepatic encephalopathy symptoms
- synthetic liver dysfunction
88
non-smoker + chronic/recurrent cough + productive of sputum + resolves with abx =
tx =
Bronchiectasis
tx
- abx
- inhaled bronchodilators
- fluids
- chest physiotherapy
89
What is next step when someone is in Vfib or pulseless Vtach
Defibrilator
90
2 most common infections in multiple myeloma patients
- respiratory
- UTI
etiology = neoplastic infiltration into bone marrow alters the lymphocytic production therefore resulting in ineffective Abs
91
increased tactile fremitus =
decreased tactile fremitus =
increased tactile fremitus = consolidation - solid
decreased tactile fremitus = air, fluid
92
first line medical therapy for fibromyalgia =
amytriptyline
93
DDX chronic cough (3)
chronic = lasting for 8+ weeks
- upper airway cough syndrome (post nasal drip)
- asthma
- GERD
94
elderly + acute back pain + point tenderness + mid-line
vertebral compression fracture
| -can occur after lifting someone or very minor trauma due to underlying osteoporosis
95
how to distinguish cause of ascites?
Serum-to-Ascites Albumin Gradient (SAAG)
if >1.1, then portal HTN is the cause (cirrhosis, cardiac/R heart failure)
if <1.1, then other cause (malignancy, pancreatitis, nephrotic, TB)
96
exertional heat stroke vs heat exaustion
exertional heat stroke =
- Body loses its ability to themoregulate when the humidity is >75% and the temperature is elevated
- Symptoms = Temp >40 C, altered mental status, hypotension, tachycardia, tachypnea
- May lead to rhabdo or other organ damage
heat exaustion
- Inadequate sodium and water replacement during physical activity
- No altered mental status, Temp <40 C
97
Pica is associated with what medical condition
iron deficiency anemia
| -responds to iron supplementation
98
"expansile and eccentric lytic area in the epiphysis"
Giant Cell Tumor
- benign
- tx = surgery
99
Tx of hypercalcemia
1) IV NS fluids
| 2) Loop diuretics
100
Next step in patient with Torsades
- if hemodynamically unstable =
- if conscious and stable =
- if hemodynamically unstable, then defibrillation
| - if conscious and stable, then IV magnesium (effective even if patient's serum Mag is normal)
101
Management of Paroxysmal Supraventricular Tachycardia (PSVT)
- Vagal maneuvers
| - Adenosine
102
medical management of atrial/ventricular tachycardia
-Amiodarone
103
obese + bilateral leg swelling + worse at night + ulcer on foot + varicose veins =
Chronic Venous Insufficiency (not edema secondary to HF - no JVD, do not give lasix!)
Tx = compression stockings, leg elevation
104
renal vein thrombosis is most commonly associated with which nephrotic syndrome
membranous glomerulonephritis - due to loss of ATIII therefore hypercoagulable
105
chronic epigastric pain that is relieved by leaning forward or sitting up + malabsorption =
how to dx
chronic pancratitis
| -dx via CT or ERCP
106
Glomerular hematuria vs Nonglomerular hematuria
Glomerular =
- microscopic > macroscopic bleeding
- no dysuria
- positive for blood, positive for protein
- RBC casts
Nonglomerular =
- microscopic < macroscopic bleeding
- yes dysuria
- positive for blood, no protein
- no casts
107
How to dx carpal tunnel syndrome
nerve conduction studies + clinical findings
108
Modified Well's Criteria
- number cut off between likely and unlikely
- what is the next step if likely vs unlikely
3 points = clinical DVT, most likely dx
1. 5 points = previous DVT/PE, HR >100, recent surgery or immobilization
1. 5 points = hemoptysis, cancer
if >4 = likely -> Anticoagulate
if <4 = unlikely -> CT angiogram or VQ scan
109
if suspected PE but patient has an absolute contraindication to anticoagulation, what is the next step?
what are the absolute contraindications to anticoagulation?
if cannot anticoagulate, then obtain a definitive test (CT angio/ VQ scan) and if still yes -> IVC filter
absolute contraindications to anticoagulation
- active bleeding
- hemorrhagic stroke
110
siladenosis indicates
Siladenosis = benign, noninflammatory, nontender enlargement of the submandibular glands
Indicates
- Advanced liver disease (alcoholic or nonalcoholic)
- Altered dietary pattern (diabetes, bulimia, malnutrition)
111
Acute limb ischemia after an MI suggests embolization from what potential 3 sources
and how can you rule them in/out
- LV thrombus - echo
- LA thrombus - echo
- atherosclerosis from aorta
112
calcium relationship with blood pH
elevated pH (alkalosis) -> more Ca bound to Albumin -> hypocalcemia
low pH (acidosis) -> less Ca bound to Albumin -> hypercalcemia
113
Treatment of DM gasroparesis
metaclopromide - prokinetic + antiemetic
114
Treatment of large-medium nonbleeding esophageal varices
beta blockers
115
Hypotension + Elevated JVD + Muffled heart sounds or Cannot palpate PMI =
Beck's Triad
| -Cardiac tamponade
116
Low frequency tinnitus + episodic vertigo + unilateral sensorineural hearing loss
Meniere disease
| -etiology = increased volume and pressure in inner ear
117
treatment of hypercalcemia
1) NS IVF
| 2) Bisphosphonates
118
Types of watery diarrhea (3)
- Osmotic = high Osmotic gap
- Functional
- Secretory = low Osmotic gap, occurs when fasting and asleep, large volume per day
119
elevated PCWP =
Cardiogenic shock
120
MALToma is associated with _
H Pylori
| -treat H Pylori and the MALToma will regress
121
smoking, increased salt diet, N-nitroso compounds are associated with what cancer?
gastric adenocarcinoma
122
how to dx upper airway cough syndrome
via treatment - first generation H1 blockers
123
Normal distribution
- 68% = _ SDs
- 95% = _ SDs
- 99.7% = _ SDs
- 1
- 2
- 3
124
prophylaxis of uric acid stones
- Fluids
- Alkalinization of urine (potassium citrate)
- Low protein diet
125
Anti-topoisomerase Ab
Systemic Scleroderma
126
Anti-centromere Ab
CREST/Limited Scleroderma
127
Anti-cardiolipin Ab
Antiphospholipid Ab Syndrome
128
AntiCCRP Ab
RA
129
Antismooth muscle Ab
Autoimmune hepatitis
130
How to dx pneumocystis pneumonia?
First try induced sputum but if that does not yield an adequate sample, do a bronchoscopy + bronchiolar lavage
Needs to be stained with special stain
- PCP cannot be cultured (blood cultures will not yield dx)
- Often found in immunocompromised/immunosuppressed patients
131
what to do when patient enters PEA (pulseless electrical activity)
CPR + vasopressors (Epi every 3-5 min)
investigate reversible causes
Defibrillation or synchronized cardioversion has no role in management
132
Reversible Causes of Asystole/PEA
5Hs + 5Ts
5Hs
- Hypovolemia
- Hypoxia
- Hydrogen ions (acidosis)
- Hypo or Hyperkalemia
- Hypothermia
5Ts
- Tension pneumothorax
- Tamponade, cardiac
- Toxins (narcotics, benzos)
- Thrombosis (pulmonary or coronary)
- Trauma
133
Empiric therapy for Infective Endocarditis
Vancomycin
134
Skin lesion that is stuck on, warty, hyperpigmented on trunk, face or upper extremities
Seborrheic keratosis
135
how to screen for an AAA?
when to repair?
USPSTF: men 65-75 yo who have previously or currently smoked cigarettes can have a one time screen via abdominal ultrasound
surgical repair of 5.5 cm or greater
136
BR found in urine is unconjugated or conjugated?
Conjugated
Unconjugated BR in urine = urobilinogen
137
Corneal vesicles and dendritic ulcers in the eye
Herpes Simplex Keratitis
- pain, photophobia, blurry vision, tearing, redness
- precipitated by excessive sun exposure, outdoor occupation, fever, immunodeficiency
- epithelial scrapings will show multi-nucleated giant cells
- tx = antiviral topical or oral
138
Older woman with hx of recurrent pneumonia and sinusitis and rib fractures. Normocytic anemia. Constant low grade fever.
Multiple Myeloma
- Monoclonal plasma cell proliferation -> impaired effective antibody production
- Bone pain, fractures, constitutional symptoms, recurrent respiratory and urinary infections
- CRAB
139
Problems with the compliment system predisposes to what kind of infections?
Compliment system helps form the MAC. Deficiencies cause problems with the innate immune system.
Patients are vulnerable to encapsulated bacteria infections.
140
Destruction of CD4 lymphocytes occurs in what infection
HIV
141
Impaired pahgocytic oxidative metabolism is see in what disease?
Chronic Granulomatous Disease
Defects in phagoytic oxidative metabolism results in an impairment in the ability of phagocytes to produce reactive oxygen intermediates that help in the destruction of cancerous cells and pathogens.
142
Infiltrating T lymphocytes and macrophages leading to segmental demyelination of peripheral nerves =
Guillian Barre disease
143
What bugs and what ppx for HIV Opportunistic infections (<200 CD4) (4)
PJP
- CD4<200
- ppx = TMP/SMX
Histoplasma
- CD4<150
- ppx = itraconizole
Toxoplasmosis
- CD4<100
- ppx = TMP/SMX
MAC
- CD4<50
- ppx = azithromycin
144
Erythema with raised edges =
Erysipelas
| -Group A strep
145
Contact lens associated keratitis is due to what bug?
Treatment?
Pseudomonas
Medical emergency - may lead to corneal perforation, scaring and permanent vision loss
Tx = remove contact, topical broad spectrum antibiotics
146
Hemolysis + Hypercoagulable + Middle aged woman
Paroxysmal Nocturnal Hemoglobinuria
- autoimmune - intravascular + extravascular hemolysis
- Dx via flow cytometry
- Treatment = iron, folate, eculizumab
147
How to calculate AG
AG = Na - (Cl + HCO3)
148
If you see digital clubbing, you should then look for
an occult malignancy
DDX of primary clubbing
-hereditary
DDX of secondary clubbing
- lung malignancy
- cystic fibrosis
- R->L cardiac shunt
- Hypertrophic Osteoarthropathy - painful joint enlargements, periostosis of long bones, synovial effusions, clubbing
149
Dense deposits within glomerular basement membrane that stain positive for C3 =
pathogenesis
Membranoproliferative glomerulonephritis Type 2
- IgG against C3 convertase ("C3 nephritic factor")
- results in persistent activation of the alternative compliment pathway
- leads to persistent compliment activation and kidney damage
150
High K, Low Na, Morning cortisol <15
What is the next step?
Evaluation of primary adrenal insufficiency (Addison's disease)
-Cosyntropin (ACTH) stim test
151
Treatment of pulmonary HTN caused by L heart failure
Loop diuretics + ACEi/ARB
Normal treatment for L heart failure
152
A high RAIU suggests _
A low RAIU suggests _
next steps
High = de novo hormone synthesis
Next step if High = diffuse pattern vs nodular pattern
Low = release of preformed hormone (thyroiditis) or exogenous hormone intake)
Next step if Low = measure thyroglobulin
- High = endogenous release
- Low = exogenous intake
153
gnawing epigastric pain + better after eating + occasional melena =
= Duodenal ulcer
- worse pain on an empty stomach, pain improves with food
- etiology = H pylori or NSAIDs
Gastric ulcer
-pain is worse with eating bc of increased acid secretion
154
To Dx acute pancreatitis =
- Typical abdominal pain that radiates to back
- Elevated lipase and amylase 3x normal limit
If those are equivocal, then get imaging
- CT abdomen with contrast
- ultrasound if you think it is gallstone pancreatitis
155
How to diagnose alveolar hypoventilation as the cause of respiratory acidosis?
resp acidosis = low pH, high HCO3 (compensation), high PaCO2
alveolar hypoventilation = high PaCO2, low PaO2
OR the PaCO2 is high and between 50-80mmHg
Etiologies:
- COPD, OSA, Obesity hypoventilation, Scoliosis
- Myasthenia gravis, Lambert eaton, Guillian barre
- Brainstem lesion, infection, stroke
156
Treatment of dermatitis herpetiformis
Dapsone + gluten-free diet
157
What kind of shock has elevated Mixed venous O2 saturation?
Septic/Distributive shock =
- low SVR (low afterload) 2/2 peripheral vasodilation
- low PCWP -> low preload
- elevated mixed venous O2 saturation 2/2 inability of tissues to effectively extract oxygen
This is the only type of shock that has elevated MVO2
158
CAP treatment
- outpatient
- inpatient
- icu
Outpatient
- macrolide
- doxycycline
- fluoroquinolone
- beta lactam + macrolide
Inpatient
- fluoroquinolone
- beta lactam + macrolide
ICU
- beta lactam + macrolide
- beta lactam + fluoroquinolone
159
fever + tinnitus +tachypnea + history of OD =
Aspirin
- mixed respiratory alkalosis + elevated anion gap metabolic acidosis
- pH will be close to normal
160
Homeless man + Optic disc hyperemia + epigastric pain + anion gap metabolic acidosis + bicarb very low + normal Cr
Methanol intoxication/poisoning
Methanol and Ethylene gylcol are very similar and both are used instead of alcohol. Both will give you an elevated anion gap metabolic acidosis with a very low bicarb.
Methanol -> damages eyes
Ethylene glycol -> damages kidneys
161
Pancreatic cancer modifiable risk factors (3)
- smoking
- obese, low physical activity
- nonhereditary chronic pancreatitis
162
fever + polyarthralgia + tenosynovitis + painless vesiculopustular rash +recent history of unprotected sex =
disseminated gonococcal infection
tenosynovitis = pain elicited along tendon sheaths
often there is no history of venereal disease
163
Psoriasis treatment =
- high potency glucocorticoids
| - Vit D
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