Master the board

1.vancomycin infusion cause red skin.i.e red meat syndrome.

2.osteomyelitis-best initial test xray,next MRI.xray-first change is periosteal
elevation.staphylococcus is the most common cause.oxacillin/nafcillin is iv
treatment for staphylococcal osteomyelitis.
3.malignant otitis externa-osteomyelitis skull.pseudomonas is the common
cause.ciprofloxacin/piperacillin/cefepime is the treatment.
4.otitis media-immobility of tympanic membrane is best sensitive.amoxicillin for 7
days is the best.
5.sinusitis-best accurate test sinus aspirate for culture.treatment is
amoxicillin/clauvulinate.
6.antifungal-clotrimazole,miconazole.(if no skin/nail
involvement).griseofulvin,itrconazole if scalp/nail involvement.
7recurrent gonorrhea-test for terminal complement deficiency.gonorrhea treatment
ceftriaxone im plus azithromycin.
8.pelvic inflammatory disease-treat with ceftriaxone im and doxycycline oral.
9.epididymo orchitis-ceftriaxone and doxycycline if ,<35 year age,cipro if >35 yr
age.
10.herpes simplex infection-treat with valacyclovir/acyclovir.
11.primary syphilis-most sensitive test-darkfield microscopy.secomdary syphilisFTA/RPR.treatment is penicillin.
12.cystitis treatment is TMP/SMX.for 3 days.
13.infective endocarditis-fever and murmur the next best step-blood
culture.treatment-vancomycin plus gentamicin.
14.hiv plus toxoplasmosis-pyremethamine plus sulphadiazine ,CMV retinitisfoscarnet/ganciclovir,Cryptococcus-india ink stain,cryptococcal antigenamphotericin.
15.lyme-rash suggestive treat with doxycycline.
Allergy:
16.anaphylaxis-treat with epinephrine subcutaneous and steroid.angioedemainfusion FFP.allergic rhinitis-intranasal steroid,x linke aggammaglobulin is exclusive
in male child and common variable immunodeficiency in adults.

17.chest pain initial test ecg,ckmb,troponin,then stress test-abnormal if reversible

ischemia present,angiography the next.the best initial therapy for ACS Is
aspirin.thrombolytic indicated for ST elevation,new LBBB.NITRATES SHOULD STOP
WHEN SILDENAFIL IS USED.acute pulmonary edemaoxygen,nitrates,morphine,frusemide.ventricular tachycardia with pulmonary edemasynchronised cardioversion.VF-asynchronised cardioversion,VTamiodarone,lidocaine,procainamide.CHF-spironolactone,ace
inhibitor/ARB.,betablocker.
18.syncope-if a murmur is present order echo,if neurological finding present order
head CT,if seizure is present order head CT AND EEG.
19.DM 2-if metformin cannot control blood sugar add glyburide.DKA-high glucose
plus low bicarbonate.give iv fluid plus insulin plus potassium.diabetes with
constipation,microalbumin,neuropathy,high LDL-GIVE
erythromycin,preglabin,ramipril,atorvastatin directly.
20.solitary thyroid nodule-FNA IS THE INITIAL TEST.
21.cushing syndrome-after 1 mg dexamethasone overnight and 24 urine for
cortisone confirm hypercortisolism,do ACTH level.
22.hyperaldosterism-hypokalemia,metabolic alkalosis,hypertension.hyperplasia
treatment spironolactone.
23.congenital adrenal hyperplasia-HIGH ACTH,low cortisol
24.asthma-methacoline stimulation test
25.pulmonary embolism-start heparin ,pcp trimethoprim plus sulphamethoxazole
plus steroid.
26.RA-anti ccp is the single most diagnostic test.RA has the lowest glucose level in
pleural effusion.treatment nsaid plus dmrd if joint erosion.juvenile RA-negative
RF,negative ana.
27.seronegative spondyloarthritis:RA negative,sacroiliac joint involvement,HLAB 27
POSITIVE.MRI of sacroiliac joint is most sensitive.tratment is
nsaid,infliximab,sulphasalazin.
28.reactive arthritis-knee,pee,see with chlamydia,shigella,Yersinia.
29.psoriatic arthritis-distal ip joint,antheisits,dactylitis.treatment-nsaid,infliximab,
30.whipple disease-joint pain,diarrhea,malabsorption.
31.lupus-rash,joint pain,fatigue.ana,antids- dna,anti ro positive is risk for baby heart
block.drug induced lupus-isoniazid,procainamide,hydralazine.

32.sjogrens syndrome-dry eye,dry mouth,early loss of teeth,anto ro and anti-sss

positive.
33.sclero derma-lung fibrosis,pulmonary hypertension,renal nephropathy.
34.polymyositis-weakness,raised cpk,raised aldolase,biopsy.anti jo-1 is associated
marked increase risk of interstitial lung disease.biopsy is accurate to diagnose
PM/DM.TREATMENT IS STEROID.THE HIGHEST RISK IS MALIGNANCY.
35.fibromyalgia-this is a pain syndrome with trigger point.in woman.
36.polymyalgia rheumatic-profound pain proximal muscle weakness,raised
esr.age>50.
37.polyarteritis nodosa-abdominal pain,renal,hypertension,pericarditis,no lung
involvement, accurate test to diagnose is biopsy of skin,muscle.,treat with
steroid,cyclophosphamide.
38.wegeners granulomatosis-upper and lower respiratory involvement ,c-,anca .
39.churgg-struss vasculitis,asthma,eosinophilia.
40.temporal arteritis-treat with steroid without any diagnostic test.
41.takayasu arteritis-asian female,diminished pulse,aortography,TIA,STROKE IS
most common risk.
42.inflammed joint-gout,pseudogout,septic arthritis-joint aspiration of fluid.gout-toe
involvement,pseudogout-knee/wrist involvement.treat nsaid/steroid.pseudogout is
seen in acromegaly,hyperparathyroid,hypothyroid conditions.
44.pagets disease-best initial test-alkaline phosphatase,most accurate test-xray.
43.septic arthritis-ceftriaxone and vancomycin is empiric therapy.
Hematology:
44.anemia-fatigue,pica for food ,short of breath.best initial test cbc with peripheral
smear.stool black do guaic test/hemooccult.microcytic anemia-above 50 do
colonoscopy.microcytic anemia with high retic count-hgb H ,chronic anemia-normal
ferritin with low iron.
45.megaloblastic anemia-high mcv with hypersegmented wbc,Vit b12 def
neurological abnormality.sickle cell anemia-exchange transfusion in pul
infarction,priapism,retinal infarction,stroke.sickle cell with sudden drop hemoglobinparvovirus infection involving bone marrow.treat with transfusion and
immunoglobin.autoimmune hemolysis-most accurate diagnostic test-coombs
test.treat with steroid.HUS-TRIAD autoimmune hemolysis,renal

failure,thrombocytopenia.TTP-pentad,FEVER,NEUROLOGY PLUS hemolysis,renal

failure,thrombocytopenia.
46.PNH-pancytopenia with dark urine,portal vein thrombosis.steroid plus
eculizumab.HELPP syndrome-hemolysis,low platelet,elevated LFT.
47.transfusion reaction-ALI-short of breath,igA deficiency-anaphylaxis,ABO
incompatibility-anaphylaxis,dark urine,ldh and bilirubin elebated.febrile reactionpost transfusion fever.leukemia-pancytopenia with peripheral smear shows blast
cell.leukostasis is treated with leukopheresis.myelodysplasia-pancytopenia,elevated
mcv.low reticulocyte,macro ovalocytes.CLL-above 50 with raised wbc ,peripheral
smear shows smugg cell.myelofibrosis-pancytopenia with splenomegaly ,tear drop
shaped cell smear.
48.polycythemia vera-high hematocrit,low erythropoietin level.ET-increased
platelets-risk of thrombosis-treat with hydroxyurea and aspirin.MM-bone marrow
biopsy is best diagnostic.lymphoma-B symptoms fever,weight loss,night
sweat.diagnosis-best initaial test-excisional biopsy.VWD-presents
epistaxis,petechial.treat with ddavp/factor 8 replacement.ITPepistaxis,petechial,normal spleen ,low platelet-steroid is the treatment.if intracranial
bleeding/melena start treatment iv immunoglobin.uremia induced platelet
dysfunction-ddvap.
Gastro49.odynophagia-suggest infectious hiv,candida,hsv,cmv.achlasia-young nonsmoker
both solid and liquid.esophageal cancer-elderly smoker,anemia.weight loss
,dysphagia.endoscopy is the diagnostic.esophageal spasm-manometry.chest pain
but absent risk factors of ischemia.treat with nitrates /calcium channel
blocker.scleroderma presents as symptoms of reflux,treat with PPI.ESOPHAGEAL
CANDIDIASIS-inHIV patients treat with fluconazole.in HIV negative patient do
endoscopy.
50.GERD-substernal chest pain with metallic taste treat with PPI.
51.PUD-h.pylori positive but no ulcer disease treat with PPI.IF ULCER IS NOT HEALED
AFTER ppi THEN DO GASTRIN LEVEL.hypercalcemia with ZES- MEN.DIAgnosis of
ZES-endoscopic US.
52.inflammatory bowel disease-UC and CD IS DIAGNOSED BY ENDOSCOPY.uc
presents with bloody diarrhea.treated by mesalamine.ASCA Is positive in CD.ANCA
is positive in UC.
53.INFECTIOUS DIARRHEA-fetal leukocytes present,stool culture .most
accurate.presence of blood exclude the following pathogen rota
virus,staph,giardia,cryptosporidias.nacillus cereas.ciprofloxacin is the best c=hoice.

54.chronic diarrhea-lactose intolerance,IBD,carcinoid syndrome.celiac disease

present with iron malabsortion and microcytic anemia.,a vesicular skin lesion.called
dermatitis herpetiformis.avoid wheat,oat,barley,bear,whisky,vodka.best accurate
test small bowel biopsy.whipple disease arthralgia,neurological and ocular
disease.diagnosis small bowel biopsy with pas positive organism.
55.colon cancer-colonoscopy start at 50 and every 10 year.
56.diverticulosis-presents as LLQ abdominal pain and lower GI bleeding.cipro and
metro is the choice for diverticulitis.
57.GIT bleeding-the most urgent step is fluid bolus.hematocrit less than 30 is
indicated blood transfusion.
58.constipation-diabetes,ferrous sulphate,hypothyroidism,narcotic,calcium channel
blocker.
59.pancreatitis-ercp to treat.bowel rest,hydration and pain.necrotic ct guided
biopsy shows infected necrotic tissue then sugocal debridement.
60.hepatitis presents jaundice,weight loss,fatigue,dark urine.hep B present joint
pain ,urticarial.only acute hep C is treated with ribavirin,INTERFERON.no treatment
foracute hepB.chronic hepB IS TREATED .no vaccine ,no postexposure prophylaxis
for hep C.indication of vaccine-chronic liver disease,iv drug user ,chronic blood
recipient,diabetes.cirrhosisedema,thrombocytopenia,ascites,encephalopathy,peritonitis,esophageal varices.
61.PBC:woman,itching,xanthelesma,AMA antibody.treat ursodeoxycolic acid.PSCitching,increased bilirubin,ASMA positive.ercp diagnostic.
62.hemochromatosis:genetic disorder.phlebotomy is the treatment.MRI liver.
63.AH-woman,look for other autoimmune coombs test,itp,thyroiditis.ANA,ASMA
positive.treat with prednisolone.