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7 Flashcards

1
Q

SSRI + MAOI (phenelzine)

treatment of serotonin syndrome

A

Washout period of 14 days
Fluoxetine-washout period of 5 weeks
give benzos->cyproheptadine

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2
Q

Acute MR

A

Rupture of papillary muscle (in MI) or chordae tendinae (MVP, connective tissue disease)

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3
Q

velvety skin, atrophic scars, easily bruised, recurrent joint dislocations, scoliosis, hernias

A

Ehlers-Danlos

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4
Q

transmission of lyme from tick

A

attached >36 hours, engorged tick

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5
Q

precautions for patients on long term opioids

A

monitor on database, RANDOM drug screening, frequent follow up

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6
Q

ASD, secundum type

A

R atrium and ventricular dilation
wide and fixed splitting of second heart sound, mid systolic ejection murmur over pulmonary valve, mid diastolic rumble
associated with a fib/flutter

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7
Q

> 30 yo with breast mass

A

mammogram

in anyone, core biopsies only, no FNAs only aspirate simple cysts

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8
Q

Healthy adolescents with upper extremity morning myoclonus and subsequent generalized seizures

treatment

A

juvenile myoclonic epilepsy
EEG- bilateral polyspike and slow wave discharges

Valproic acid (side effects: hepatotoxicity, thrombocytopenia, NTDs, pancreatitis)

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9
Q

Digital injuries

A

tendons (run on anterior surface)

nerves, veins and arteries run on sides of digits

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10
Q

overflow fecal incontinence

treatment

A

impacted stool

disimpaction ffed by enemas

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11
Q

Hydatidiform mole management

complication

A

suction curettage, then contraception and serial b-hcg till undetectable for 6 months

gestational trophoblastic neoplasia->pelvic u/s and cxr->methotrexate to treat

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12
Q

Stone <1cm with no complications

A

alpha blocker, pain control, hydrate, d/c

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13
Q

Bell’s palsy

A

peripheral facial nerve palsy->steroids and artificial tears, eye patching

  • central: forehead is spared
  • bilateral facial palsy->sarcoidosis*
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14
Q

antidepressant induced mania

severe or refractory mania meds

A

discontinue antidepressant
if persistent, start mood stabilizer/ antipsychotic

mood stabilizer + antipsychotic

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15
Q

ear pain+ external auditory vesicles+ ipsilateral facial paralysis

A

ramsay hunt syndrome, vzv

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16
Q

malignant external otitis treatment

A

IV pseudomonal (fluroquinolones) until ESR, CRP normalize, then PO

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17
Q

Adolescent preg, increased risk of

A

fetal complications, preterm, postpartum depression, preeclampsia

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18
Q

Calcitonin elevation after thyroidectomy for MTC

A

Metastatic, obtain CT head and neck->CT abdomen

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19
Q

treated lyme disease in pregnancy

treatment

A

benign
oral amoxicillin, cefuroxime
non preggo-doxycycline

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20
Q

hypothyroidism labs

A

hyponatremia, macrocytosis, bradypsychia

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21
Q

STEMI ECG

A

> 1mm ST elevation in contiguous leads, left bundle branch block
1.5mm ST elevation in V2, V3

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22
Q

tetracycline side effect

A

phototoxicity

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23
Q

isotretinoin precautions

A

2 pregnancy tests, 2 forms of contraception before starting

discontinue all other anti-acne meds

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24
Q

warfarin preggo

A

switch to lovenox in first trimester, continue warfarin in 2nd and third trimesters, unfractionated heparin in last weeks

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25
Q

organophosphate poisoning treatment

A

atropine, pralidoxime->reactivates acetylcholinesterase

pyrostigmine->anticholinesterase for treatment of myasthenia gravis

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26
Q

multifollicular ovaries

A

polycystic ovaries
PCOS treatment: OCPs/ progestin IUD
(women with anovulation-estrogen excess)

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27
Q

COPD prognosis

A

FEV1 <40%, age

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28
Q

diabetes, hypertension, hypokalemia, metabolic alkalosis

diagnosis

A

cushing’s

dexamethasone suppression test

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29
Q

small rough papules

fleshy nodule with ulceration

A

actinic keratosis->squamous cell carcinoma

basal cell carcinoma

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30
Q

UTI diagnosis
treatment
physical exam and labs needed

A

history alone is sufficient
Bactrim/nitrofurantoin (Cipro for pyelo)
pregnant, pyelo, vaginal infection

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31
Q

SBO: air in distal colon

no air

A

partial obstruction, conservative management, surgery in a day if no improvement
complete obstruction->surgery

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32
Q

Marked increase in creatinine after ACEI

A

renal artery stenosis

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33
Q

diffuse esophageal spasm treatment

systemic sclerosis manometry

A

CCBs

hypomotility

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34
Q

naltrexone

A

for moderate to severe alcohol use disorder
decreases cravings and heavy drinking
use in opioid free patients without hepatic dysfunction
disulfiram is for patients who are abstinent and highly motivated

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35
Q

post op hypercapnic and hypoxic respiratory failure, somnolent with decreased resp rate and hypoventilation

A

residual anesthesia effect

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36
Q

Postop atelectasis

treatment

A

low lung volumes, linear opacifications

CPAP if no secretions, secretions: chest PT and suctioning

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37
Q

Choking, >1 yo with complete airway obstruction
<1 yo
unconscious

A

abdominal thrusts
back blows and chest thrusts
CPR

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38
Q

dysuria, itching at urethral meatus, urethral discharge

A

gono vs chlamydia
gono: orgs in discharge
chlamydia: no orgs in discharge->azithromycin
can be m. genitalium->moxifloxacin

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39
Q

Untreated celiac disease cancer

A

enteropathy associated T cell lymphoma
abdominal pain, B symptoms, GI bleeding
median survival of 10 months

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40
Q

Untreated celiac disease cancer

A

enteropathy associated T cell lymphoma
abdominal pain, B symptoms, GI bleeding
median survival of 10 months

41
Q 
Strep agalactiae (GBS) bactiuria during pregnancy
acute pyelo in pregnancy
A

amoxicillin now, penicillin prophylaxis during labor

daily antibiotic supression

42
Q

tension headache vs migraine

A

non throbbing, bilateral, band-like vs throbbing, disabling, aura

43
Q

lithium toxicity
causes
dialysis

A

confusion, ataxia, NM excitability
volume depletion, thiazides, ACEI, NSAIDs
lithium >4/ neurologic symptoms/ AKI
hydrate with isotonic saline

44
Q

hyperbilirubinemia and anemia in infancy

hemolytic disease of newborn (ABO incompatibility)

A 
G6PD deficiency (day 2-3)
within 24 hours
45
Q

Dementia labs

acetylcholinesterase inhibitors
NMDA antagonist

A

TSH, CBC, CMP, B12
RPR, Vitamin D, folate, CSF if appropriate
rivastigmine, donepezil, galantamine
memantine

46
Q

Age 65 pneumo vaccine

A

prevnar first, then PPSV23 in 6-12 months

47
Q

Preggo mania

If SI/HI, not eating

A

Haldol/ lithium

ECT

48
Q

women who have sex with women at increased risk for

A

BV and cervical cancer

49
Q

vasovagal syncope management

A

educate and reassure

only tilt table test if etiology is unclear

50
Q

post bariatric surgery preggo

A

wait for a year

51
Q

DVT anticoagulation length

A

If time-limited/ reversible risk factor: 3-6 months

52
Q

hypokalemia ileus, cardiac/neuro complications

A

replete

53
Q

pancoast tumor

complication

A

non small cell lung cancer
shoulder pain, horner’s syndrome, hand weakness
spinal cord compression

54
Q

length-time bias vs lead time bias

A

detecting more benign cases vs detecting disease early

55
Q

company sponsorship for conferences

A

lecturers can accept, attendees can’t

56
Q

requests for euthanasia prompted by

A

loss of sense of autonomy, fear of future suffering

57
Q

pioglitazone side effect

A

fluid retention

treat with spirinolactone

58
Q

swinging fever and leukocytosis post abdominal surgery

A

subphrenic abscess->abd u/s

59
Q

lead poisoning labs

A

CBC, iron, ferritin, rec count

60
Q

lobular carcinoma in situ

A

nonmalignant->excisional biopsy

61
Q

High fever and severe polyarthralgia
abdominal fever
fever+leukopenia+thrombocytopenia+elevated aminotransferases

A

chikungunya
typhoid
Ehrlichiosis

62
Q

Corneal foreign bodies org

A

staph

63
Q

Sjogren’s cancer

A

B cell non-Hodgkin’s lymphoma

B symptoms are associated with Hodgkin’s lymphoma

64
Q

Trichomoniasis treatment

if breastfeeding

A

single dose flagyl

express and discard for 24 hours

65
Q

chlamydia cervicitis treatment

A

doxycycline

66
Q

GGT
elevated alk phos and GGT only
hepatic sarcoidosis treatment

A

liver
infiltrative disease
steroids

67
Q

Alcoholic ketoacidosis labs

treatment

A

osmolal and anion gaps

IV dextrose, normal saline, thiamine, CIWA protocol

68
Q

GBS management, first step
treatment
prognosis

A

frequent monitoring of TV and NIF
IVIG or plasma exchange if nonambulatory if <4 weeks
spontaneous recovery, treatment decreases duration

69
Q

Gestational DM screening

A

24-28 weeks with 1 hour 50g glucose challenge
if positive (>140), 3 hour 100 g glucose tolerance test
fasting glucose <95, 2hour test <120

70
Q

Strong correlation

A

close to -1 or 1.

71
Q

Elevated c-peptide

A

endogenous insulin->from insulinoma/ oral hypoglycemic

serum assay for hypoglycemics, then ->imaging

72
Q

Most effective non pharm antihypertensive

A

weight loss

DASH diet, sodium restriction, decrease alcohol, exercise, smoking cessation

73
Q

lyme arthritis treatment

A

28 days of amoxicillin/ doxy, refrain from high impact activity

74
Q

thin, homogenous d/c, stippled cells, clue cells, amine odor

treatment

A

BV

flagyl/clindamycin, treat to relieve symptoms

75
Q

partial response to antidepressant

A

add second agent

76
Q

subchorionic hematoma

increased risk of

A

expectant management
spontaneous abortion, abruption placentae, PPROM, preterm labor, preeclampsia, fetal growth restriction, intrauterine fetal demise

77
Q

borderline sodium, hyperkalemia, mild acidosis, prerenal, weight loss, eosinophilia, asthenia

A

adrenal failure

78
Q

Sickle cell osteo treatment

A

cover staph and salmonella: (clinda/vanc (covers MRSA) + ceftriaxone)

79
Q

Rh incompatibility

A

RH- mum may form anti + antibodies when exposed to Rh+ baby. In any subsequent Rh+ preggos, attacks baby. Mum herself remains Rh-
not possible in Rh + mum, will never form antibodies

80
Q

Paps

A

21-30: no HPV

>30: + HPV if desired

81
Q

Phenytoin toxicity

A

horizontal nystagmus, blurred vision, ataxia, slurred speech, lethargy
decrease dose

82
Q

Massive PE can cause hypotension.

right bundle branch block

A

RV strain, tricuspid regurg

83
Q

Stress incontinence due to

treatment

A

urethral hypermobility

conservative measures->urethral sling

84
Q

gono conjunctivitis
treatment
prevention

A

profuse, purulent eye drainage and swelling at 2-5 days
IM cefotaxime
topical erythromycin for baby

85
Q

Post-extubation stridor

A

laryngeal edema, reintubate

86
Q

HELLP treatment

A

mag sulfate

plasma exchange if AST>2000/ LDH >3000

87
Q

palpable purpura+ fatigue+ arthralgia+ hypocomplementemia+ glomerulonephritis

diagnosis
treatment

A

mixed cryoglobulinemia

serum cryoglobulin
steroids and rituximab

88
Q

toxic thyroid nodule

A

methimazole, then surgery

89
Q

Adults with intellectual disability decision making

A

must involve guardian if exists

90
Q

causality

A

association increases with exposure (dose-response relationship)

91
Q

porphyria cutanea tarda

diagnosis
treatment

A

painless blisters, hyperpigmentation, hypertrichosis
associated with hep c
triggered by ethanol, estrogen

urinary uroporphyrins
phlebotomy/ hydroxychloroquine/ interferon alpha

92
Q

Hematemesis, left pleural effusion

A

Esophageal perf, may not find pneumomediastinum

Mallory-Weiss would not have fever, chest pain or pleural effusion

93
Q

harsh holosystolic murmur over left sternal border with palpable thrill

PDA shunting

wide and fixed splitting of S2

A

VSD

Aorta to main pulm artery: increased oxygenated blood in pulm artery

ASD

94
Q

labile glucose levels, post prandial fullness, early satiety, autonomic symptoms

diagnosis
treatment

A

diabetic gastroparesis

emptying study
dietary changes, metoclopramide, erythromycin

95
Q

GBS symptoms + sensory level+ bowel/bladder dysfunction
diagnosis
treatment

A

transverse myelitis

MRI
high dose steroids

96
Q

incidentaloma management

A

measure hormones/metanephrines

if functional/ >4 cm/ malignant features->remove

97
Q

Inflammatory acne refractory to topical retinoid and benzoyl peroxide

A

add antibiotic

98
Q

photoaging treatment

rosacea antibiotic

A

tretinoin

metronidazole

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