1. Medical management after MI: 
- ACE inhibitors prevent ventricular remodeling (i.e. aneurysm information after MI)
- Carvedilol may actually be able to to reverse remodeling 

2. Oral leukoplakia is a precancerous lesion. It will resolve with cessation of tobacco or alcohol. Transformation into a more nodular or ulcerated or indurated appearance suggests transformation into squamous cell carcinoma 

3. Vaccinations 

- HiB: Asplenia 

- Pneumococcus: everyone >65. If given to an HIV-positive person with a CD4 < 200 you should repeat when CD4 is higher.  Repeat at five years. 

- Indication for early pneumococcus: No spleen, chronic heart lung liver kidney disease, diabetes, alcoholics, smokers, cochlear implant, CSF leak, immunocompromised 

- Meningococcus: college students, military recruits, no spleen, travel to endemic areas. Can repeat At five years if still at risk. Indications for meningiococcus vaccine in HIV+ is same as in HIV-

- Hepatitis A – travel to endemic areas, MSM, IV drug use, concomitant hep B or hep C or liver disease that would amplify the consequences of hep a infection 

- Tetanus – TD q10, replace one of these with TDaP before 65 

4. Fibromuscular dysplasia in unilateral renal artery should be treated with stenting if the hypertension was recent onset or the hypertension cannot be managed with meds due to intolerance or ineffectiveness. The goal of stenting is to treat the hypertension. 

5. Dementias: 
- Alzheimer's disease: memory is first, then visual spatial, then later on possibly executive function, urinary incontinence, gait abnormalities

- NPH: marked gait abnormalities are the first presenting symptom. Later on, you get dementia and incontinence

- Lewy body dementia: visual spatial is affected first, and then memory later on. + Parkinsonian features. 

- Vascular dementia: In the early stages has significantly more executive function impairment than memory impairment 

6. PTU or methimazole
- If someone develops a fever and sore throat while taking these drugs, discontinue and check CBC. White count < 1000 = likely agranulocytosis (immune mediated destruction of granulocytes). If WBC > 1500, it's unlikely to be agranulocytosis.
- Treat PTU or methimazole induced agranulocytosis with IV broad-spectrum antibiotics - cover for Pseudomonas 

7. Acute Pancreatitis: 

- Viruses that cause: Mumps, HIV, coxsackie, CMV, HSV, Hep B

- Can present with ileus, lung pathology (including pleural effusions, atelectasis, ARDS due to release of enzymes and cytokines and pancreas -> systemic inflammation). 

- Clinical presentation ranges from very mild epigastric tenderness on palpation or severe abdominal pain with rebound/guarding. Occasionally the pain is made better with sitting up or leaning forward.

- Vs: Intra-abdominal abscess has a more indolent Course

8. AIDS CNS pathology 

- EBV DNA in the CSF is very specific for primary CNS lymphoma

- PML presents with unilateral weakness, changes in vision and hearing, and ataxia

- CNS toxoplasmosis infection is unlikely in someone taking bactrim 

9. Cystinuria 

- Decreased renal reabsorption of dibasic amino acids such as cysteine, arginine, ornithine, lysine

- Hexagonal crystals in the urine.

- Urine cyanide nitroprusside test + (test for urine Cysteine)

10. Drugs That cause hyperkalemia

- Bactrim inhibits ENaC transporter. It also causes an elevation in creatinine that is not associated with renal injury. And causes pseduo-type 4 RTA. 

- Beta blockers (notably B2 receptor, hence why you use albuterol to treat hyperkalemia) 

- Digoxin-  from blocking Na/K ATPase

- Heparin inhibits aldosterone synthesis

- Cyclosporine inhibits aldosterone activity

- NSAIDs - harm kidneys, reduce aldosterone

- ACE, ARB - Reduce aldosterone

- K Sparing diuretics