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61

First-line therapy for nausea and vomiting of pregnancy

Vitamin B6


Scopolamine is effective for nausea and vomiting of pregnancy but should be avoided in the first trimester
due to the possibility of causing trunk and limb deformities. Likewise, methylprednisolone is also effective
but should be avoided in the first trimester as it is associated with an increased risk of cleft palate if used
before 10 weeks of gestation.

62

Who should get antibiotics before dental work?

According to the American Heart Association’s 2007 guidelines, prophylaxis to prevent bacterial
endocarditis associated with dental, gastrointestinal, or genitourinary procedures is now indicated only for
high-risk patients with prosthetic valves, a previous history of endocarditis, unrepaired cyanotic congenital
heart disease (CHD), or CHD repaired with prosthetic material, and for cardiac transplant recipients who
develop valvular disease.

Based on a risk-benefit analysis in light of available evidence for and against antibiotic prophylaxis, these
recommendations specifically exclude mitral valve prolapse and acquired valvular disease, even if they are
associated with mitral regurgitation. The American Dental Association has endorsed this guideline.

63

Side effect of methimazole

AGRANULOCYTOSIS

Other rare complications of methimazole include serum sickness, cholestatic
jaundice, alopecia, nephrotic syndrome, hypoglycemia, and loss of taste. It is associated with an increased
risk of fetal anomalies, so propylthiouracil (PTU) is preferred in pregnancy.

64

Target LDL for diabetes

<100 (but lower is better, so <70 ideally!)
Patients with DM are considered to have known CAD, so 100 is target.

65

Apart from diabetic medications, what should all DM patients be on?

ACE-inhibitor or ARB for cardiovascular and renal protection

Microalbuminuria is a RF for CVD and progression of renal disease to ESRD and dialysis. ACE-Is/ARBs have been shown to decrease risk EVEN IN NORMOTENSIVE PATIENTS

66

If new-onset migraine with nuchal rigidity, think...

SUBARACHNOID HEMORRHAGE

Get LP

(If there was a similar headache a few weeks before, think SENTINEL BLEED from an aneurysm)

67

3-6 week old infant with projectile vomiting, visible peristaltic wave, and olive-like mass

PYLORIC STENOSIS

Hypochloremic, hypokalemic metabolic alkalosis

68

Acid-base status in pyloric stenosis

Hypochloremic, hypokalemic metabolic alkalosis

69

Best breast screening for concerning mass in:
<35
>35

<35: Ultrasound (since breast tissue is too dense for mammogram)

>35: Mammography

70

Treatment of enterobiasis (pinworm)

Albendazole or mebendazole in ALL HOUSEHOLD MEMBERS

(pyrantel pamoate if pregnant since azoles are teratogenic)

Also wash clothes and bedding, and trim nails (since under nails is most common place for eggs to hide out)

71

What things are needed to evaluate acute coronary syndrome?

EKG and serial troponins

(Unstable angina, NSTEMI, STEMI)

72

Treatment of vulvar candidiasis

Single dose of oral fluconazole or several days of miconazole or clotrimazole vaginal creams

73

Presentation of vulvar candidiasis

-vulvar pruritis [dominant sx]
-discharge: white with curd-like consistency ("cottage cheese")
-low vaginal pH (<4.5)
-KOH: budding yeast and hyphae

Other symptoms could include:
-dysuria
-vulvovaginal irritation
-dyspareunia

74

Alport syndrome

Glomerular hematuria along sensorineural deafness and ocular abnormalities (can't see, can't pee, can't hear). Since this is an inherited disease, there should also be a family history of renal failure and deafness. The primary defect is a genetic mutation in collagen type IV.

75

Immediate treatment of hyperkalemia

IV calcium gluconate

(even if very high and need dialysis, start with IV calcium as a temporizing measure to stabilize the myocardium)

76

Hyperkalemia on EKG

Peaked T waves

Medical emergency: IV calcium to stabilize myocardium

77

If HTN <30 y.o., think...

secondary HTN (as opposed to essential HTN), such as fibromuscular dysplasia

78

Drugs for uterine atony

-Carboprost (Hemabate) [contraindicated in asthma]
-Methylergonovine [contraindicated in HTN]
-Misoprostol (Cytotec)
-Oxytocin (Pitocin)

79

Treatment of acute parotitis

Amoxicillin/clavulanate (Augmentin)

Staphylococcus most common pathogen

80

Fever in child under 29 days old

Any child younger than 29 days old with a fever and any child who appears toxic, regardless of age,
should undergo a complete sepsis workup and be admitted to the hospital for observation until culture
results are known or the source of the fever is found and treated

81

Ottawa ankle rules

X-ray only needed if one or more of the following are positive:
1. Tenderness of the distal 6 cm POSTERIOR edge of tibia (medial malleolus)
2. Tenderness of the distal 6 cm POSTERIOR edge of fibula (lateral malleolus)
3. Tenderness of the navicular
4. Tenderness of the proximal 5th metatarsal
5. Inability to bear weight for four steps immediately after the injury or at examination

82

Finklestein test

De Quervain tenosynovitis

Place thumb in palm, close fingers around it; maximally deviate in ulnar direction.

+ is pain when maximally ulnar deviated

83

Phalen test

Carpal tunnel syndrome

Dorsum of hands together with wrists in forced flexion for 30-60 sec

+ is numbness of palmar thumb, index finger, and middle finger

84

Tinel test

Carpal tunnel syndrome

Lightly tap median nerve at palmar wrist

+ is electric jolt down middle finger

85

Spurling maneuver

Cervical nerve root pain

Turn head toward affected side with neck extended; exert downward pressure

+ is pain, numbness, weakness down arm

86

Speed's test

Tendinitis of long head of the biceps

Arm supinated, elbow extended, resist forward flexion at shoulder

+ is pain in biceps groove

87

Empty can test

Supaspinatus tendon

Arms extended at 30 degrees, thumbs pointing down, resist upward motion

+ is weakness or pain

88

Drop arm test

Supraspinatus tendon tear

Passively hold arm extended at shoulder level and release; allow patient to slowly lower arm to waist

+ is instability to control maneuver to waist

89

Lift off test

Subscapularis

Dorsum of hands in lumbar area, resist straight lift off

+ is pain or weakness

90

External rotation test (arm)

Infraspinatus and teres minor

Arm against ribs, elbows flexed at 90 degrees, resist external rotation

+ is pain or weakness