7 Flashcards
SSRI + MAOI (phenelzine)
treatment of serotonin syndrome
Washout period of 14 days
Fluoxetine-washout period of 5 weeks
give benzos->cyproheptadine
Acute MR
Rupture of papillary muscle (in MI) or chordae tendinae (MVP, connective tissue disease)
velvety skin, atrophic scars, easily bruised, recurrent joint dislocations, scoliosis, hernias
Ehlers-Danlos
transmission of lyme from tick
attached >36 hours, engorged tick
precautions for patients on long term opioids
monitor on database, RANDOM drug screening, frequent follow up
ASD, secundum type
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
> 30 yo with breast mass
mammogram
in anyone, core biopsies only, no FNAs only aspirate simple cysts
Healthy adolescents with upper extremity morning myoclonus and subsequent generalized seizures
treatment
juvenile myoclonic epilepsy
EEG- bilateral polyspike and slow wave discharges
Valproic acid (side effects: hepatotoxicity, thrombocytopenia, NTDs, pancreatitis)
Digital injuries
tendons (run on anterior surface)
nerves, veins and arteries run on sides of digits
overflow fecal incontinence
treatment
impacted stool
disimpaction ffed by enemas
Hydatidiform mole management
complication
suction curettage, then contraception and serial b-hcg till undetectable for 6 months
gestational trophoblastic neoplasia->pelvic u/s and cxr->methotrexate to treat
Stone <1cm with no complications
alpha blocker, pain control, hydrate, d/c
Bell’s palsy
peripheral facial nerve palsy->steroids and artificial tears, eye patching
- central: forehead is spared
- bilateral facial palsy->sarcoidosis*
antidepressant induced mania
severe or refractory mania meds
discontinue antidepressant
if persistent, start mood stabilizer/ antipsychotic
mood stabilizer + antipsychotic
ear pain+ external auditory vesicles+ ipsilateral facial paralysis
ramsay hunt syndrome, vzv
malignant external otitis treatment
IV pseudomonal (fluroquinolones) until ESR, CRP normalize, then PO
Adolescent preg, increased risk of
fetal complications, preterm, postpartum depression, preeclampsia
Calcitonin elevation after thyroidectomy for MTC
Metastatic, obtain CT head and neck->CT abdomen
treated lyme disease in pregnancy
treatment
benign
oral amoxicillin, cefuroxime
non preggo-doxycycline
hypothyroidism labs
hyponatremia, macrocytosis, bradypsychia
STEMI ECG
> 1mm ST elevation in contiguous leads, left bundle branch block
1.5mm ST elevation in V2, V3
tetracycline side effect
phototoxicity
isotretinoin precautions
2 pregnancy tests, 2 forms of contraception before starting
discontinue all other anti-acne meds
warfarin preggo
switch to lovenox in first trimester, continue warfarin in 2nd and third trimesters, unfractionated heparin in last weeks
organophosphate poisoning treatment
atropine, pralidoxime->reactivates acetylcholinesterase
pyrostigmine->anticholinesterase for treatment of myasthenia gravis
multifollicular ovaries
polycystic ovaries
PCOS treatment: OCPs/ progestin IUD
(women with anovulation-estrogen excess)
COPD prognosis
FEV1 <40%, age
diabetes, hypertension, hypokalemia, metabolic alkalosis
diagnosis
cushing’s
dexamethasone suppression test
small rough papules
fleshy nodule with ulceration
actinic keratosis->squamous cell carcinoma
basal cell carcinoma
UTI diagnosis
treatment
physical exam and labs needed
history alone is sufficient
Bactrim/nitrofurantoin (Cipro for pyelo)
pregnant, pyelo, vaginal infection
SBO: air in distal colon
no air
partial obstruction, conservative management, surgery in a day if no improvement
complete obstruction->surgery
Marked increase in creatinine after ACEI
renal artery stenosis
diffuse esophageal spasm treatment
systemic sclerosis manometry
CCBs
hypomotility
naltrexone
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
post op hypercapnic and hypoxic respiratory failure, somnolent with decreased resp rate and hypoventilation
residual anesthesia effect
Postop atelectasis
treatment
low lung volumes, linear opacifications
CPAP if no secretions, secretions: chest PT and suctioning
Choking, >1 yo with complete airway obstruction
<1 yo
unconscious
abdominal thrusts
back blows and chest thrusts
CPR
dysuria, itching at urethral meatus, urethral discharge
gono vs chlamydia
gono: orgs in discharge
chlamydia: no orgs in discharge->azithromycin
can be m. genitalium->moxifloxacin
Untreated celiac disease cancer
enteropathy associated T cell lymphoma
abdominal pain, B symptoms, GI bleeding
median survival of 10 months