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6 Flashcards

1
Q

Treatment of pneumocystis jirovecii pneumonia (likely in setting of HIV)

A
  • 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
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2
Q

Clinical findings of drug induced lupus, and diagnostic test?

A
  • multisystem involvement: fever, malaise, myalgia, arthralgia/arthritis, serositis (pleuritis, pericarditis) and/or hepatomegaly/splenomegaly
  • test for ANA and anti-histone antibodies
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3
Q

which drug induces lupus?

A
  • procainimide
  • hydralazine
  • minocycline
  • TNF-alpha; etanercept, infliximab
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4
Q

Steps in diagnosing c.diff

A
  1. enzyme immunoassay or PCR (more sensitive) for toxins A and B
  2. negative lab testing and clinically high suspicion then proceeds to colonoscopy or limited sigmoidoscopy to document pseudomembranous colitis
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5
Q

Management of recurrent UTI in young women

A
  • prophylactic abx: fluoroquinolones, TMP-SMX, nitrofurantoin
  • abdominal US only if there’s obstruction or nephrolithiasis
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6
Q

How to diagnose brain death (neurologic exam?)

A
  • 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
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7
Q

Most common risk factors of carpel tunnel syndrome

A
  • diabetes
  • RA
  • hypothyroidism
  • others: wrist trauma, ESRD, obesity, pregnancy, acromegaly, menopause
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8
Q

Treatment of carpel tunnel syndrome

A
  • splint
  • if splint fails, then corticosteroids injection
  • surgery only if hypothenar eminence, motor weakness
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9
Q

3 important clinical criteria for diagnosing ankylosing spondylitis

A
  • 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
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10
Q

Most common extraarticular manifestations of ankylosing spondylitis

A
  • acute anterior uveitis
  • aortic regurg, MVP
  • apical pulmonary fibrosis
  • IgA nephropathy
  • restrictive lung disease
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11
Q

Treatment of bacterial enteritis in children, when is abx recommended and when is it not?

A
  • 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
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12
Q

Presentation of tinea versicolor and diagnosis, treatment

A
  • noninvasive fungal infection, multiple small macula that vary in color.
  • TV ddx by KOH prep which will show yeast and hyphae
  • treatment: topical antifungal
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13
Q

Intermittent episodes of chest pain, dysphagia, and “corkscrew” esophagus on barium swallow. Ddx?

A

diffuse esophageal spasm
can sometimes present without corkscrew.
normal relaxation of LES

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14
Q

Signs of chronic lithium toxicity >1.5mEq

A

confusion
ataxia
neuromuscular excitability

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15
Q

treatment of lithium toxicity

A
  • IV hydration
  • bowel irrigation
  • if >4mEq or >2.5mEq with renal failure then HD
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16
Q

In patients with PE, if low grade fever is present and WBC is elevated, what should you do?

A
  • get blood culture but don’t start empiric abx therapy as low grade fever is normal with PE
17
Q

Necessary step in managing hypothermic patients with hypoventilation, hypoxemia and AMS

A
  • 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.
18
Q

Severe PID treatment (usually gonorrhea and chlamydia)

A
  • IV cefoxitin and IV doxy

- IV ceftriaxone and IV doxy

19
Q

When is hypothyroidism treatment warranted?

A

In the presence of:

  • sx of hypothyroidism
  • antithyroid antibodies
  • abnormal lipid profile
  • ovulatory and menstrual dysfunction
20
Q

Treatment of recurrent c.diff

A
  • first recurrence: metronidazole for nonsevere, vanc for severe
  • second: pulsed tapering oral vanc 6-7 weeks
  • subsequent relapses: fidaxomicin, fecal microbiota transplant
21
Q

genital warts turning white with acetic acid application, ddx? treatment?

A

condylomata acuminate

- trichloroacetic acid application, then surgery if not effective

22
Q

carbamazepine SE

A
  • bone marrow suppression: neutropenia, aplastic anemia, thrombocytopenia
  • hyponatremia, SIADH
  • glaucoma
  • anticholinergic effects
23
Q

What medications are indicated for diabetic patients with renal failure/metabolic acidosis?

A

insulin
piloglitazone, rosiglitazone, acarbose, repaglinide are alternatives
need to stop metformin and glyburide

24
Q

what is melasma?

A

acquired hyperpigmentation disorder that occur in sun-exposed areas
*risk increases during pregnancy, resolves spontaneously

25
Q

Clinical features of ITP

A
  • antecedent viral infection
  • asymptomatic petechiae and ecchymosis
  • mucocutaneous bleeding
  • normal spleen size
  • large platelets
26
Q

Treatment of ITP

A
  • platelets >30,000 w/o bleeding: observe
  • platelets <30,000 OR bleeding: IVIG or steroids
  • recurrent episodes: splenectomy
27
Q

When is CBC w/ diff and blood culture required in newborns with GBS? When is observation for 48 hours required?

A
  • preterm (<37 weeks)
  • prolonged rupture of membranes (>18 hours)
  • 48 hours obs if abx ppx given within 4 hours of birth (ampicillin, cefazolin or penicillin) or the opposite of the above
28
Q

PFT results for asthma, and for asymptomatic asthma

A
  • asthma: reduced FEV1/FVC, normal or elevated TLC and DLCO

- asymptomatic asthma: may have normal PFT, need methacholine challenge

29
Q

acute abdominal pain, significant tenderness and guarding, lies perfectly still. Ddx and best initial test?

A

Bowel perforation with peritonitis

chest x-ray and abdominal x-ray

30
Q

Metoclopromide, D2 receptor blocker, has what SE?

A
  • akathisia
  • dystonia
  • parkinson like sx
31
Q

post exposure ppx to HIV-infected body fluids

A

4 weeks of 2 nucleoside reverse transcriptase inhibitors

add protease inhibitor if viral load is high

32
Q

Fractures on clavicles management if significantly displaced vs nondisplaced

A
  • significant displacement/shortening: ORIF

- nondisplaced: sling, conservative management, figure 8 bandage

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