Things that lower mortality: ASA-- instant platelet inhibitor
thrombolytics (if can't to PCI within 90 minutes or new LBBB)
Clopidogrel (esp if asa allergy)
lower mortality in some cases
ace/arb (if low EF)
don't lower mortality but should still be done: beta blocker
o2; morphine; nitrates
Alts: CCB: beta blocker intol, cocaine or vasospasm
PAcemaker: AV blocks or bradycardialidocaine/ amiodarone: VT or VF
1. first line treatment
2. best benefit
2. GPIIb/IIIa inhibitors
when do you use ACE/ARBs in ischemic cardiac disease
cardiac failure (e.g. chf, systolic dysfunction or low ef).
elderly woman with SOB + rales and edema: 1. what tests do you order?
2. what meds do you order?
3. most likley dx:
4. if still symptomatic:
1.EKG, CXR, echo, oximetry, monitoring unit, ABG, BMP
2. O2, morphine, nitrates, furosemide
3. CHF exacerbation* transfer to ICU in CCS!*
4. order an inotrope (milrinone, amrinone or dobutamine).
what is the optimal treatment for:
1. murmurs that improve on valsalva (and which murmurs are these?)
2. murmurs that improves with amyl nitrate (and which murmurs are these?)
3. best therapy for regurgitant lesions
4. best therapy for stenotic lesions
how long do you treat late latent syphilis or latent syphilis of unknown duration?
3 weeks (penG)
acute fever, chills w/in 24 hours after initiating tx for syphilis:
1. jarisch- Herxheimer
2. no prevention
how to treat reiter's syndrome? (3)
2. progressive exercise
3. DMARD (MTX or sulfasalazine
shiny, discrete, intensely pruritic, polygonal shaped violaceous plaques and papules on flexural surfaces pf extremeties, +/- white lacy pattern on surfaces.
3. what disease is it associated w/ ?
1. lichen planus (white lacy= wickham's striae)]
2. punch bx for confirmation.
what do you use saw palmetto for? what is a/e of saw palmetto?
what is the treatment for priapism?
phenylepherine or epinepherine injection until erection resolves.
watery discharge + dysria in a male: dx? tx approach?
NGU (usually 2/2 chlamydia): tx w/ azithro or doxy--> if tx failure consider other causes (e.g. trich or resistant orgs), and treat with flagyl--> erythromycin
HIV neg pt with high-risk behavior and meningitis w/ following CSF: OP ^low WBC with mostly monos (lymphs or monocytes)^protein, low glucose
1. what's most likely pathogen?
2. what do you treat with?
2. ampho B and flucystosine--> fluconazole to be continued as outpatient
what is the next step in a pt being treated for crypto meningitis who improves and then relapses?
repeat LP-- can help relieve sx of ^ICP
75 yo M with vertigo, dizziness, diplopia, numbness and dysarthria, what to think about?
vertebrobasilar insufficiency (usually 2/2 emboli, thrombi or dissection)-- labyrinth/ brainstem
what are the gastric findings in a patient with pernicious anemia?
absent rugae in the fundusassociated with AMAG (autoimmune metaplastic atrophic gastritis)-- glandular atrophy, gastric metaplasia, and inflammation
what is the treatment of choice in decompensated liver cirrhosis (regardless of cause)-- eg. variceal bleeding?
liver transplant! especially if CTP score >7
what is the first thing to do when thyroid nodule is detected?