Comprehensive step 3 Flashcards
(500 cards)
1
Q
Infectious Disease
A
…
2
Q
MSSA Abx (IV)
A
nafcillin/oxacillin or cefazolin
3
Q
MSSA Abx (PO)
A
Dicloxacillin or cephalexin
4
Q
MRSA (IV)
A
Vanc, tigecycline,linezolid, daptomycin, ceftaroline
5
Q
MRSA (minor infection)
A
Clindamycin, TMP/SMX, doxycycline
6
Q
Strep Abx (that don’t cover staph)
A
PCN, amox, amp
7
Q
SE of (A) linezolid (B) Daptomycin (C) imipenem
A
(A) low plt (B) myopathy (C) sz
8
Q
Anaerobic Strep Abx
A
Clindamycin
9
Q
Antiviral for longterm therapy for CMV retinitis
A
Valganciclovir
10
Q
Antivirals for CMV
A
valganciclovir, ganciclovir, foscarnet
11
Q
Antivirals for herpes simplex, varicella zoster
A
acyclovir, valacyclovir, famiclovir
12
Q
SE (A) Valganciclovir and ganciclovir (B) Foscarnet)
A
(A) neutropenia and bone marrow suppression (B) renal toxicity
13
Q
Antiviral for Hep C
A
ribavarin in combo with interferon
14
Q
Ribavarin uses
A
Hep C, RSV
15
Q
Chronic Hep B
A
lamiduvane, interferon, adefovir, tenofovir, entecavir, tebivudine
16
Q
Fluconazole uses
A
candida, cryptococcus, candidiasis as an alternative to topical agents
17
Q
Tx for aspergillus
A
Voriconazole
18
Q
Voriconazole SE
A
visual disturbance
19
Q
Best antifungal for neutropenic fever
A
echinocandins (caspofungin, micafungin, anidulafungin)
20
Q
SE Amphotericin
A
renal toxicity, hypokalemia, metabolic acidosis, fever/shakes/chills
21
Q
Osteomyelitis (A) first line test (B) second line (C) most accurate
A
(A) XR (B) MR (C) bone bx
22
Q
Earliest XR finding in osteomyelitis
A
Periosteal elevation
23
Q
Osteomyelitis: How do you monitor response to therapy?
A
trend ESR
24
Q
Most common cause of osteo?
A
Staphylococcus
25
MSSA osteo tx
IV oxacillin of nafcillin 4-6wks
26
MRSA osteo tx
IV vanc, linezolid, daptomycin
27
Otitis Externa: presentation
itching and drainage from the external auditory canal, difficult to visualize the tympanic membrane bc of swelling, manipulation of tragus is painful; associated w swimming, foreign bodies
28
Otits Externa: treatment
Topical abx (ofloxacin or polymyxin/neomicin)+hydrocortisone +acetic acid and water solution to reacidify the ear
29
Malignant Otitis Externa: presentation
osteo of the skull from pseudomonas in patient w diabetes, can lead to brain abcess and skull destruction
30
Malignant Otitis Externa: diagnostics and tx
Skull XR or MRI, most accurate test is bx; tx with surg debridement and abx effective against pseudomonas cipro, piperacillin, cefepime, carbapenem, aztreonam
31
Otitis Media: presentation
redness, bulging, decreased hearing, loss of light reflex, immobility of tympanic membrane (most sensitive)
32
Otitis Media: therapy
Amox (7-10 days), Next step is tympanocentesis and aspirate of the tympanic membrane for cx
33
Otitis Media: abx if initial therapy fails
Amox-clavulanate, cefdinir, ceftibuten, cefuroxime, cefprozil, cefpodoxime
34
Sinusitis: (A) initial test (B) most accurate test
(A) XR (B) sinus aspirate for cx
35
Sinusitis: treatment
amox if fever and pain, persistence after 7day trial of decongestants, purulunt discharge; +inhaled steroids
36
Centor Criteria for strep pharygitis
Pain/Sore throat, exudate, adenopathy, NO cough/hoarseness
37
Strep Pharyngitis: diagnosis and tx
initial test- rapid strep most accurate-cx; PCN or Amox if allergic use azithro or clarithro
38
Flu: treatment in first 48hrs
Oseltamivir or zanamivir
39
Impetigo: presentation + infectious agent
weeping, crusting, oozing, honey-colored lesions; strep pyogenes or S aureus infecting epidermal layer of skin
40
Impetigo: therapy
Topical mupirocin or retapamulin; Severe: oral dicloxacillin of cephalexin; MRSA: TMP-SMZ, clinda
41
Erysipelas: presentation
GAS (step pyogenes) infection of skin; bright red and hot skin
42
Eryspelas: diagnosis and tx
Blood cx on CCS, treatment in MC; oral dicloxacillin or cephalexin; if cx confirms group A beta hemolytic strep switch to PCN VK
43
Cellulitis: next step if suspected in leg
Lower extremity doppler
44
Cellulitis: treatment
Minor: dicloxacillin or cephalexin PO; Severe: IV oxacillin, nafcillin, or cefazolin; If allergic use cefazolin of vanc
45
Fungal Infection of skin/nails: diagnostic testing
Initial: KOH prep of scraping
46
Fungal infection of skin/nails: treatment in no hair/nail involvement
topicals like clotrimazole, miconazole, ketoconazole, econazole, terconazole, nistatin, ciclopirox
47
Fungal infection of skin/nails: treatment if scalp/nail involvement
terbinafine, itraconazole, griseofulvin (for tinea capitus)
48
Disseminated gonorrhea presentation
polyarticular disease, petechial rash, tenosynovitis
49
PID treatment
Ceftriaxon (IM) and doxy (PO)
50
Epididymo-Orchitis (painful tender testicle) treatment (A) \<35 (B) \>35
(A) ceftriaxone and doxy (B) fluoroquinolones
51
Chancroid: dx and tx
swab for Gm stain (Gm- coccobacilli) and culture (nairobi medium or Mueller-Hinton agar) tx IM ceftriaxone or 1 dose of azithro
52
LGV: presentation
large tender nodes and ulcer, nodes called buboes may develop suppurting, draining sinus tract
53
LGV: dx and tx
serology for C trachomatis, aspirate bubo and tx with doxy and azithro
54
HSV2:dx and tx
if clear presentation, just treat; acyclovir, valacyclovir, or famciclovir for 7-10 days
55
Syphilis: most accurate test
Darkfield microscopic exam
56
Syphilis (1\*): tx
Single IM shot of PCN, doxy if allergic
57
Jarisch-Herxheimer reaction:
fever, HA, myalgia developing 24hrs after tx for early stage syphilis; self-limited tx with ASA and continue tx
58
Syphilis (2\*): symptoms and diagnostic
Rash, mucous patch, alopecia areata, condyomata lata; RPR and FTA
59
Syphilis (2\*): treatment
IM PCN, doxy if allergic
60
Syphilis (3\*): presentation and diagnostics
Tabes dorsalis, argyl-robertson pupil, general paresis; RPR and FTA; LP for neurosyphilis (VDRL and FTA)
61
Syphilis (3\*) treatment
IV PCN, if allergic sensitize
62
When do you densensitize to PCN to treat syphilis?
3\* syphillis, pregnant women
63
Granuloma Inguinale: presentation
beefy red genital lesion that ulcerates
64
Granuloma Inguinale: dx and tx
biopsy or touch prep, klebsiella granulomatis; doxy, TMP/SMX or azithro
65
Uncomplicated UTI: tx
TMP-SMX x3days, if E coli resistance is \>20% use cipro or levofloxacin
66
Complicated UTI: (A) define (B) tx
(A) anatomic abnormality present (B) TMP-SMX or cipro x7days
67
Asymptomatic Bacteriuria: treat?
Only if pregnant or urologic procedure planned
68
Pyelo: tx
Cipro if outpatient; Amp/Gen for inpatient
69
Perinephric abcess: dx
no response to pyelo tx after 5-7days; sono will show collection; biopsy will guide therapy
70
Perinephric abcess: tx
quinolone +staph coverage (oxacillin or nafcillin)
71
Prostitis: tests
UA, Urine WBCs after prostate massage
72
Prostitis: tx
extended course of cipro
73
Infective Endocarditis: at risk patients
prosthetic heart valve, IV drug user, dental procedures that cause bleeding, h/o cyanotic heart disease
74
Infective Endocarditis: fever and new murmur (next step?)
Blood Cx, if positive do echo
75
Infective Endocarditis: other findings
Roth spots (retina), Janeway lesions (flat, painless in hands and feet), Osler's nodes (raised and painful), splinter hemorrhages under nails
76
Infective Endocarditis: if TTE is negative...
proceed to TEE
77
Infective Endocarditis: therapy
Vanc and gent 4-6wks, surgery if anatomic defects
78
Infective Endocarditis: next step if S bovis is culprit
Colonoscopy to r/o GI CA (assoc w/ Grp D strep)
79
Endocarditis: when to ppx
prosthetic valves, unrepaired cyanotic heart disease, prev endocarditis, transplant recipients who develop valve disease
80
Endocarditis: which procedures need ppx
dental that cause bleeding(amox), resp tract surgery, surgery of infected skin
81
Which class are these meds: zidovudine, didansodine, stavudine, lamivudine, abacavir, emtricitabine, tenofovir
NRTIs (Nucleoside reverse-transcriptase inhibitors)
82
NRTIs: Class wide SFX & Individual SFX
Class SFX = Lactic Acidosis; zidovudane-anemia; didanosine+stavudine: pancreatitis and neuropathy; abacavir- rash
83
Which class are these meds: indinavir, ritonavir, lopinavir, -avir?
Protease Inhibitors
84
Adverse effects of Protease Inhibitors - Class SFX & Individula SFX?
Class SFX = Hyperglycemia and hyperlipidemia; indinavir- kidney stones
85
Which class are these meds? Efavirenz, nevirapine, atravirine, rilpivirine
NNRTIs
86
NNRTI: adverse effects
drowsiness (efavirenz)
87
Needlestick ppx (if HIV+ blood)
HAART x 1mos
88
CD4\<50: ppx?
for MAC, azithro weekly
89
CD4\<200 ppx?
PCP ppx with TMP-SMX (if allergic atovaquone or dapsone)
90
PCP: when to give steroids?
pO2\<70 or A-a gradient\>35
91
Toxoplasmosis: presentation and initial test
HA, N/V, focal neuro findings, head CT w/ contrast shows "ring" or contrast enhancing lesions
92
Toxoplasmosis: treatment:
pyrimethamine and sulfadiazine x2weeks, repeat CT to confirm lesions are smaller thus confirming toxo, if they don't improve brain bx
93
CMV in HIV
CD4\<50, blurry vision; perform dilated ophtho exam
94
CMV: tx
ganciclovir or foscarnet; lifelong maintenace w oral valganciclovir
95
Cryptococcus:
CD4 \<50 with fever, HA
96
Cryptococcus: dx
LP: \>lymphocytes, India Ink Stain, cryptococcal antigen test
97
Cryptococcus: tx
Amphotericin followed by fluconazole; fluconazole is continued until CD4 rises
98
PML (Progressive Multifocal Leukoencephalopathy)
CD4 \<50, focal neuro findings
99
PML: dx and tx
head CT or MRI, lesions DO NOT show ring enhancement, no mass effect; treat with HAART
100
MAC in setting of HIV:
CD4 \<50, wasting with fever and fatigue, anemia if invasion of bone marrow, inc AlkP
101
MAC: dx and tx
Bone marrow or liver Bx, incr LFT & GGTP; tx with clarithro and ethambutol, ppx w azithro
102
Lyme: (A) most common late manifestation (B) Cardiac (C) neuro
(A) Joint involvement (B) AV conduction block (C) Bell's palsy
103
Lyme tx (A) rash, joint, palsy (B) CNS or cardiac
(A) oral doxy or amox (B) IV ceftriaxone
104
Nocardia: presentation
resp disease in immunocompromised, branching Gm+ filaments that are weakly acid-fast
105
Nocardia: dx and tx
1) CXR & Cx 2) TMP-SMX
106
Actinomyces: Pathophys; Dx; Tx
hx of facial or dental trauma --\> innoculation of commensal actinomyces. dx with Gm stain and cx; Tx PCN
107
Histoplasmosis: endemic in...
Ohio and Mississippi River Valleys, associated with bat droppings
108
Histoplasmosis: Presentation, test, tx
Palate and oral ulcers, splenomegaly, pancytopenia; Histo Urine Antigen, bx w culture, only treat if disseminated (amphotericin)
109
Coccidoidomycosis: endemic in....presents...treat with..
Arizona, joint pain and erythema nodosum, itraconazole
110
Blastomycosis: endemic in....look for....treat with...
rural SE, broad budding yeast causing acute pulm disease also bone lesions, amphotericin or itraconazole
111
Allergy and Immunology
...
112
Anaphylaxis Treatment
SQ epi (1:1000), steroids, antihistamines
113
Heriditary Angioedema occurs from deficiency of...
C1 esterase inhibitor
114
Agioedema: (A) diagnostics (B) tx
(a) low C2 and C4 (B) infusion of FFP, chronic therapy includes ecallantide (inhibits kallikrein), androgens like danazol and stanazol
115
Common Variable Immunodeficiency (CVID)
men and women; recurrent sinopulmonary infections, spruelike abdominal disporder, malabsoprtion, steatorrhea, diarrhea, lymph nodes, adenoids and spleen are present may be enlarged
116
CVID: diagnosis and tx
low total IgG, IVIG
117
X-Linked Agammaglobulinemia (Bruton's)
male children w recurrent sinopulmonary infections; lymph nodes, adenoids, spleen are diminished in size or absent
118
Bruton's: diagnosis and tx
B-cells and Immunoglobulins missing; IVIG
119
IgA deficiency
many are asymptomatic; some w recurrent sinopulm infections, spruelike malabsorption, increased atopy, anaphalyxis when get blood from donors who are not IgA deficient
120
IgA deficiency: tx
treat infections as they arise, IVIG wont work since it has little IgA
121
Hyper IgE Syndrome: presentation and tx
recurrent skin infections caused by Staph, tx infections as they arise
122
Oncology
...
123
Which screening test lowers mortality rate the most?
Mammography \>50yrs
124
When is screening mammography done?
Age 50-75
125
Abnormal Mammogram, next step?
Biopsy, if cancer is present test for ER/PR receptors
126
Sentinal node biopsy: when is it done, what is it
follows abnormal mammo; dye placed into operative field and the first node it goes into gets biopsied
127
When should the sentinal node be dissected?
no dissection if node is free of cancer; axillary lymph node dissection if +cancer
128
BRCA is associated with:
increased risk of familial breast ca, increased risk of ovarian ca
129
(+)Breat Ca, treatment?
initial: lumpectomy w radiation of the site is equal to modified radical mastectomy
130
Preventive therapy for breast ca?
Tamoxifen if 2+ first-degree relatives w breast ca, start at age 40
131
Axillary nodes + or the cancer is \>1cm in size, additional tx?
Adjuvant chemo
132
Which drugs are used if breast ca is Estrogen and/or progesterone +?
Tamoxifen or raloxifene
133
Adverse effects of Tamoxifen?
DVT, hot flashes, endometrial ca
134
Hormonal inhibition in breast ca, drugs?
tamoxifen, raloxifene, aromatase inhibitors
135
Name the aromatase inhibitors (which are pure estrogen anatagonists):
anastrazole, letrozole, exemestane
136
SE of aromatase inhibitors
can lead to osteoporosis (no DVTs)
137
When is adjuvant chemo used in breast ca? (A)(B)(C)
(A) Cancer in axilla (B) \>1cm (C) more efficacious in menstruating women since tamoxifen and aromatase inhibitors will not work in these women
138
What is trastuzumab and when is it used?
Monoclonal antibody against the breast ca gene HER-2/NEU, useful in metastatic disease
139
How is colon ca treated?
Resection of colon and chemo (5-FU)
140
Pt refuses colonscopy, other screening option?
occult blood testing starting age 50 then yearly
141
Screening if family member with colon ca
colonscopy at age 40 or 10yrs before age relative contracted ca, then q 10yrs
142
Screening for colon ca if: HNPCC, 3 family members, family \<50
colonoscopy at age 25 then q 1-2yrs
143
Screening if familial Adenomatous polyposis?
sigmoidoscopy at age 12 then q1-2 yrs
144
Screening if juvenile polyposis, peurtz-jeghers, turgot's syndrome, garner's?
no additional screening
145
When should you do an excisional bx on a solitary lung nodule?
\>1cm in patients who are smokers
146
Name instances where surgery cannot be performed for Lung Ca.
b/l disease, meastases, malignant pleural effusion, involvement of aorta vena cava or heart, lesions within 1-2cm of carina
147
Is small cell ca resectable?
No, almost always present with a contraindication to surgery
148
Next Step: abnormal pap w low-grade or high grade dysplasia.
colposcopy and bx
149
Next Step: atypical squamous cells of undetermined significance
HPV testive
150
Next Step: ASCUS, +HPV
colposcopy
151
Next Step: ASCUS, -HPV
repeat Pap in 6-12 mos
152
Pap smear: start at age (a) and do every (b) and stop at age (c)
(a) 21 (b) 2-3 yrs (c) 65 unless there has been no previous screening
153
Treatment of localized prostate cancer
surgery and either external radiation or implanted radioactive pellets
154
Treatment of metastatic prostate ca
Androgen blockage (flutamide and leuprolide)
155
What does finastride treat?
BPH and male pattern hair loss
156
Cord compression 2/2 prostate cancer, what do you do?
Start flutamide (testosterone receptor blocker), do not start leuprolide (GnRH agonist) since it can worsen compression
157
Ovarian Ca: marker of progression?
CA125
158
Ovarian Ca: treatment?
surgical debulking followed by chemo
159
Man \<35 with painless scrotal lump
testicular ca
160
Testicular Ca: diagnostics
NO NEEDLE Biopsy! Inguinal orchiectomy of affected testicle
161
Testicular Ca: labs?
AFP, LDH, beta-hCG, CT abdomen and pelvis
162
Testicular Ca: treatment
local disease: radiation, widespread: chemo
163
Preventative Medicine
...
164
Pnumococcal vaccine is indicated in all patients \>--
\>65
165
Meningococcal Vaccine: routine at age (a); who should get it earlers (b)
(a) 11 (b) functional asplenia, complement deficiency
166
HPV vaccine given to women ages:
13-26
167
What age group gets varicella-zoster vaccine?
\>60
168
Most effective method of achieving smoking cessation?
Oral meds like bupropion and varencline; nicotine patches and gum are less effective but can be tried first
169
What age should women get bone density screen?
65
170
AAA screening
men \>65 who were ever smokers should be screened with ultrasound
171
When is diabetes screening routine?
in pt with HTN
172
HTN screening
all \>18 should have BP checked at every office visit
173
Hyperlipidemia screening
men\>35 women \>45
174
Endocrinology
...
175
Diagnosis of Diabetes may be made with one of the following: Two fasting glucose \>(a); One random glucose \>(b) w symptoms; Abnormal GTT; HgA1c \> (c)
(a) 126 (b) 200 (c) 6.5%
176
Best initial therapy for T2DM
diet, exercise, weight loss
177
Best initial medical therapy for T2DM
Metformen
178
Which class of diabetes meds can lead to weight gain?
Sulfonureas
179
Mechanism of metformin
blocks gluconeogenesis
180
Metformin contraindications
Renal insufficiency (-\>lactic acidosis); use of contrast agents
181
Name some sulfonureas
glyburide, glimepiride, glipizide
182
Mechanism of sulfonureas
increase release of insulin from the pancreas
183
Adverse effects of sulfonureas
Hypoglycemia, SIADH
184
DPP-IV inhibitors (stigaliptin, saxagliptin): mechanism
block metabolism or incretins like glucagon-like peptide; i.e. increase insulin release and block glucagon
185
Thiazolidinediones (rosiglitazone, pioglitazone): mechanism and contraindication
increase peripheral insulin sensitivity, CHF
186
Alpha-glucosidase inhibitors (acarbose, miglitol): mechanism and SE
block absorption of glucose at the intestinal lining; diarrha, abdominal pain, bloating, flatulence
187
Insulin secretagogues (nateglinide and repaglinide): mechanism and SE
cause increased release of insulin (short-acting), hypoglycemia
188
Insulin: Long-Acting or Short? Glargine
Long (aka Lantis)
189
Insulin: Long-Acting or Short? Aspart
short
190
Insulin: Long-Acting or Short? Lispro
short
191
Insulin: Long-Acting or Short? NPH
long (2x/day)
192
Insulin: Long-Acting or Short? Glulisine
short
193
Insulin: Long-Acting or Short? Detemir
long
194
How long does short-acting insulin last? When is it given?
2 hours, given at mealtime
195
GLP analongs (exenitide) mechanism?
slow gastric emptying and promote weight-loss
196
DKA presentation
hyperventilation to compensate for metabolic acidosis (low bicarb), fruity breath and confusion 2/2 hyperosmolar state
197
DKA: diagnosis
Initial test: serum bicarb if low implies an elevated anion gap
198
Why is sodium level low in DKA?
high glucose artificially drops sodium level
199
DKA Labs: (a) glucose (b) K (c) bicarb (d) pH (e) anion gap (beta hydroxybutyrate
(a) \>250 (b) hyperkalemia (c) low (d) low with low pCO2 as resp compensation (e) elevated, high
200
DKA: treatment
bolus while getting labs, then IV insulin...K level will drop so add potassium to IVF
201
Diabetes: BP goal
\<130/80
202
Diabetes: LDL goal , goal if CAD+diabetes
\<100, \< 70
203
Diabetes: urine microalbumin abnormal, next step?
ACEinhibitor even if BP is normal
204
Diabetes: +neuropathy, next step?
gabapentin or pregabalin
205
Diabetes: gastroparesis tx
metoclopramide or erythromycin
206
Hypothyroid: initial tests
T4 (decreased), TSH (increased)
207
Hypothyroid: tx
T4 or thyroxine replacement
208
Hyperthyroid: labs?
T4 (increased) TSH (low)
209
Disease? Eye, skin, nail findings with elevated RAIU
Graves
210
Disease? Low RAIU, no PE findings
Silent hyperthyroidism
211
Disease? Tender thyroid, low RAIU
Subacute hyperthyroidism
212
Disease? No PE findings, high RAIU
pituitary adenoma
213
Graves' Disease: tx
PTU or methimazole acutely, then radioactive iodine to ablate gland; propranolol to tx sympathetic sx
214
Subacute thyroiditis: tx?
ASA for pain relief
215
Disease? High t4, high tsh
pituitary adenoma
216
Pituitary Adenoma: tx?
MRI of brain, surgical resection
217
Thyroid Storm
acute, severe life threatening hyperthyroidism
218
Thyroid Storm: tx?
iodine, PTU or methimazole, dexamethasone (to block peripheral conversion of T4-\>T3), propranolol
219
Can you determine the etiology of a goiter?
Nope, it can be 2/2 hyperT, hypoT or normal function
220
Solitary thyroid nodule: next step?
FNA, if its cancer needs to be surgically removed
221
Most common cause of hypercalcemia? How can we test for this?
Primary hyperparathyroidism, increased parathyroid hormone levels
222
Name other causes of hypercalcemia.
Malignancy, granulomatous disease (sarcoid makes vitD), Vit D intocixation, thiazide diuretics (increase reabsorption of Ca), TB, histoplasmosis, berylliosis
223
Hyperparathyroidism: which organs damaged?
Kidney (stones), osteoporosis/osteomalacia/fx, confusion, constipation and abd pain
224
Hyperparathyroidism: treatment?
Surgical removal (remember it may be part of multiple endocrine neoplasia aka MEN)
225
Issue? Confusion, constipation, polyuria/polydipsia, short QT, renal insufficiency, ATN, renal stones
Hypercalcemia (stones, bones, psychic moans, GI groans)
226
Acute Hypercalcemia: tx
IVF, furosemida after hydration (loop diuretics increase Ca excretion), bisphosphonate (potent but slow); calcitonin if above don't work; +steroids if etiology is granulomatous disease
227
Issue? Sz, neural twitching, arrhythmia-prolonged QT
Hypocalcemia
228
Chvostek's Sign? Trousseau's sign?
area of facial nerve tapped, muscles on that side of the face will contract; inflate BP cuff and after a few min patient's hand will contract
229
HypoC: caused by hypo/hyper Mg? Hypo/hyper Phos?
hypoMag, hyperPhos
230
HypoC: treatment
replace Ca; if VitD def or hypoparathyroid give VitD + Ca
231
Cushing Syndrome: describe
fat redistribution, easy bruising and striae (loss of collegen from cortisol), HTN, muscle wasting, hirsutism (2/2 increased adrenal androgen levels)
232
Cushing Syndrome Cause: High ACTH, suppression of highdose dexamethasone
Pituitary tumor --\>remove
233
Cushing Syndrome Cause: High ACTH, NO suppression of highdose dexamethasone
ectopic ACTH Production, or CA (cxr)
234
Cushing Syndrome Cause: low ACTH, NO suppression of highdose dexamethasone
adrenal adenoma --\> remove
235
Cushing Syndrome: initial test
1mg overnight dexamethasone suppression test , positive if 8am level is not suppressed after taking 11pm dose; 24-hour urine cortisol (do if abnormal dexamethasone suppression)
236
Overnight Dexamethasone Suppression Test: what gives false positives?
depression, alcoholism, emotional or physical stress
237
Cushings: low ACTH level, next step?
CT or MRI of Adrenals
238
Cushings: high ACTH level, next step?
High-dose dexaM suppression test; if high scan chest, if low scan brain
239
Cushings: if you suspect pituitary cause but MRI is negative, next step?
petrosal venous sinus sampling used to localize the lesion and see which part of pituitary should be removed
240
Disease? Hyperpigmented skin with fatigue, anorexia, weight loss, weakness, hypotension
Addison's Disease
241
Addison's: Lab values K? Na? Glu?
HyperK, HyoNa, Hypoglycemia, neutropenia (glucocorticoids increase glucose and WBCs)
242
Addison's: most accurate diagnostic tests?
Cosyntropin stimulation test: no rise in cortisol level after administration of this synthetic ACTH; CT scan adrenal
243
Addison's: tx?
steroid replacement; prednisone, fludocortisone in refractory patients
244
Disease? HTN, low renin, low K
HyperAldosteronism
245
Hyperaldosteronism: confirm dx with?
CT of adrenals
246
HyperAldosteronism: Tx?
surgical resection if solitary adenoma; if hyperplasia use spironolactone
247
Pheochromocytoma:best initial tests?
High plasma and urinary catecholamine levels, plasma-free metanephrine and VMA levels
248
Pheochromocytoma: most accurate tests?
CT or MRI of adrenals, metastatic disease is detected with an MIBG scan
249
Pheochromocytoma: tx?
\*Phenoxybenzamine for alpha blockate, then propranolol, then resection
250
CAH: ACTH? Aldo? Cortisol? Tx?
high ACTH, low aldo, low cortisol; Tx with prednisone (inhibits pituitary)
251
21, 17, or 11? HTN with low adrenal androgen levels
17-hydroxylase deficiency (no virilization)
252
21, 17, or 11? Hirsutism, hypotension
21-hydroxylase deficiency \*elevated 17-hydroxyprogesterone level
253
21, 17, or 11? Hirsutism, HTN
11-hydroxylase deficiency
254
Prolactinoma: presentation in men
impotence, decreased libido, gynecomastia, headache and visual disturbance
255
Prolactinoma: presentation in women
amenorrhea and galactorrhea in absence of pregnancy; prolactin inhibits GNRH so if no GNRH no LH/FSH release!
256
Other causes of high prolactin levels: drugs and other
metoclopramide, phonthiazines, TCAs, hypothyroid (high TRH stimulate prolactin release), stress, exercise
257
Prolactinoma: diagnostic testing
MRI brain
258
Prolactinoma: tx?
dopamine agonist (bromocriptine or cabergoline), if this doesn't work then surgical removal
259
Acromegaly: diagnostic testing
Initial Test: Insulin-like growth factor (IGF), not GH! Most Accurate: suppression of GH by glucose rules-out acrogmegaly then MRI
260
Acromegaly: tx?
surgical resection w transphenoidal removal, octreotide (somatostatin prevents GH release), cargoline or bromocriptine (also prevent release), pegvisomant (GH receptor antagonist)
261
Testicular Feminization
girl who does not menstruate, +breasts no cervix ovaries and missing top 1/3 of vagina; no penis prostate or scrotum
262
Klinefelter's Syndrome: describe
Tall men, XXY, high FSH/LH but no testosterone is produced from testicles since there are no receptors! Tx with testosterone
263
Kallman's Syndrome: describe
anosmia with hypogonadism 2/2 problem at hypothalmus; low GnRH, FSH, LH
264
Nephrology
...
265
3 effects of chronic renal failure
smaller kidneys, Hct will drop 2/2 loss of EPO production, Ca levels drop 2/2 loss of VitD hydroxylation
266
Prerenal azotemia: BUN/Cr? Ur Sodium? Fractional Excretion of Na? UrOsm?
BUN/Cr\>15:1; low urine Na (\<20); Fractional Excretion \<1%; UrOsm \>500
267
Which tests should you order if you suspect renal problem?
UA, chemistries, Renal U/S
268
Can unilateral obstruction cause renal failure?
Nope
269
Post-renal Azotema: BUN/Cr?
\>15:1 (like in prerenal)
270
Intrarenal Renal Failure: BUN/Cr? UrNa? UrOsm?
BUN/Cr 10:1, Urine Na \>40, UrOsm \<350
271
Which test should you order if you suspect contrast-induced renal failure?
Magnesium level
272
Aminoglycosides (gen, tobra, amikacin) can cause renal insufficiency. What lab supports this?
Hypomagnesemia
273
Toxin-induced Renal Insufficiency: UA reveals
muddy brown or granular casts
274
Cyclophosphamide effect on kidney?
Hemorrhagic cystitis NOT renal failure
275
Rhabdo: best initial test?
UA showing + dipstick for blood with no cells seen on micropscopic evaluation
276
Rhabdo: most accurate test
urine myoglobin
277
Rhabdo: labs
UA, CPK, Chemistry (hyperK, hypoC, low bicarb)
278
Rhabdo: tx
NS bolus, mannitol and diuresis to decrease contact time of myoglobin with tubule, alkalinize the urine
279
HyperK with peaked T-waves: tx?
Calcium gluconate, insulin, glucose
280
Antifreeze ingestion (ethylene glycol): best initial test, tx
UA shows envelope-shaped oxalate crystals, ethanol or fomepizole with immediate dialysis
281
Tumor Lysis Syndrome effect on kidney, tx
uric acid crystals, tx with hydration and allopurinol
282
If renal disease but patient NEEDS contrast
hydration with NS, +bicarb NAC or both
283
RBCs, RBC casts, proteinuria (mild, \<2g/24hrs), edema
Glomerulonephritis
284
Goodpasture Syndrome: presentation
cough, hemoptysis, SOB, lung findings
285
Goodpasture Syndrome: dx
Initial: anti-basement membrane antibodies Most accurate: Renal bx shows "linear deposits"
286
Goodpasture Syndrome: tx
plasmapheresis and steroids
287
Churg-Strauss Syndrome: presentation
asthma, cough, eosinophilia in addition to renal abnormalities
288
Churg-Strauss Syndrome: dx
Initial: CBC for eos Accurate: Biopsy
289
Churg-Strauss Syndrome: tx
Glucocorticoids, if no response add cyclophosphamide
290
Wegener's Granulomatosis: presentation
upper respiratory problems like sinusitis and otitis, lung issues (cough, hemoptysis, abnormal CXR), also systemic vasculitis (join, skin, eye, brain, GI)
291
Wegener's Granulomatosis: diagnosis
Initial: c-ANCA Accurate: renal biopsy
292
Wegener's Granulomatosis: tx
steroids and cyclophosphamide
293
Polyarteritis Nodosa (PAN): describe
systemic vasculitis involving every organ EXCEPT lung, +fever, weight loss, multiple motor and sensory neuropathy with pain
294
Polyarteritis Nodosa (PAN): dx
initial: ESR and inflammatory markers accurate: bc of sural nerve or kidney ALSO tst for HepB and Hep C , angiography showing "beading" can spare need for bx
295
Polyarteritis Nodosa (PAN): tx
cyclophosphamide and steroids
296
IgA Nephropathy (Berger's Disease): presentation
painless recurrent hematuria, usually Asian pt after recent viral resp tract infection; proteinuria and red cells (as will all glomerular disease)
297
IgA Nephropathy (Berger's Disease): diagnosis
Intial: no specific blood test, most accurate is Renal Biopsy esp as complement levels are normal
298
IgA Nephropathy (Berger's Disease): treatment
Steroids used in boluses when sudden worsening of proteinuria; ACEi used in all patients with proteinuria, Fish oil may have some effect in delaying progression
299
HSP: presentation
adolescent or child with purpuric lesions, abdom pain, joint pain, renal involvement
300
HSP: diagnostics
Initial: clinical Accurate: renal bx shows IgA deposition but it is not necessary
301
HSP: treatment
supportive
302
Post-Strep Glomerulonephritis: presentation
cola colored urine, periorbital edema, HTN; both throat and skin infections can lead to this
303
Post-strep Glomerulonephritis: diagnostics
Initial: ASLO, anti-Dnase, antihyaluronidase in blood, low complement; Accurate: Biopsy shows subepithelial deposits of IgG and C3 (but don't do!)
304
Post-strep Glomerulonephritis: tx
PCN and other abx for infection, although they don't reverse disease; control HTN and fluid overload w diuretics
305
Cryoglobulinemia: presentation
Hep C with renal involvement; joint pain and purpuric skin lesions
306
Cryoglobulinemia: diagnosis
Initial: serum cryoglobulin component levels (immunoglobulins, light chains, IgM), low C4; Accurate: Bx
307
Cryoglobulinemia: tx
treat Hep C with interferon, ribavarin, boceprevir or telaprevir
308
Lupus Nephritis: diagnostics
ANA and anti-dsDNA Accurate: Renal Bx can determine extent of disease and guide therapy
309
Lupus Nephritis: tx
Sclerosis only: none; Mild disease: steroids; Severed: Mycophenolate mofetil and steroids
310
Kidney, Eye+Ear problems (+deafness)
Alport's, no specific therapy
311
Hemolytic Uremic Syndrome triad, also look for
Intravascular hemolysis, elevated Cr, thrombocytopenia; history of E. coli 0157:H7
312
Thrombotic Thrombocytopenic Purpura (TTP): 5 findings
fever, neuro symptoms, intravascular hemolysis, elevated Cr, thrombocytopenia
313
HUS and TTP: tx
plasmapheresis in severe case; NO platelets, no abx
314
Nephrotic Syndrome: (a) grams of protein in urine (b) other findings
\>3.5g/day; edema, low albumin in blood, hyperlipidemia, thrombosis (bc of loss of antithrombin III, protein C, and Protein S in urine)
315
Define Nephrotic Syndrome
Hyperproteinuria, hypoproteinemia, hyperlipidemia, edema
316
Nephrotic Syndrome: diagnostics
Initia: UA with elevated protein; next: spot urine for prot:cr ratio \>3.5:1, 24-hr urine \>3.5g protein; Accurate: renal bx
317
Nephrotic syndrome in kids:
Minimal Change Disease
318
Nephrotic syndrome in adults w cancer
membranous
319
Nephrotic syndrome in Hep C patients
membranoproliferative
320
Nephrotic syndrome in HIV, heroin use
focal segmental
321
Treatment of nephrotic syndrome:
steroids, if no response add cyclophosphamide
322
When is dialysis indicated?
HyperK, metabolic acidosis, uremia w/ encephalopathy, fluid overload, uremia w/ pericarditis, no renal failure but toxicity with drug (lithium, ethylene glycol, ASA)
323
Causes of DI
Central (failure to produce ADH in brain), Nephrogenic (insensitivity of the kidney)
324
Causes of Nephrogenic DI
hypoK, hyperCa, lithium toxicity
325
DI: urine Osm? Urine Na? Urine Volume? Change in UrOsm with water deprivation?
urine Osm? LOW Urine Na? LOW Urine Volume? HighChange in UrOsm with water deprivation? NO
326
Central or Nephrogenic DI? Decrease in urine volume w DDAVP (vasopressin)
Central
327
Central or Nephrogenic DI? Increase in urine osmolality with DDAVP
Central
328
Central DI: tx
vasopressin/DDAVP
329
Nephrogenic DI: tx
correct underlying cause, thiazide diuretics
330
Hypervolemic Hyponatremia: causes
CHF, nephrotic syndrome, cirrhosis
331
Hypovolemic Hyponatremia: causes
diuretics, GI loss of fluids, skin loss of fluids (burns, sweating)
332
Which endocrine disease causes hyponatremia with hyperK and mild metabolic acidosis? Tx?
Addison's Disease, aldosterone replacement like fludrocortisone
333
Euvolemic Hyponatremia: causes
SIADH, hypothyroid, psychogenic polydipsia, hyperglycemia
334
Which medications can cause SIADH?
sulfonureas, SSRIs
335
SIADH: urine sodium? Urine Osm? Serum Osm? BUN/Cr? Bicarb?
Urine sodium: \>20mEq/L; UrOsm \>100mOsm/kg; Low serum Osm \<290; normal BUN/Cr, bicarb
336
How do you treat mild hyponatremia?
fluid restriction
337
Severe Hyponatremia: tx?
saline infusion with loop diuretics, hypertonic saline, ADH blockers (conivaptan, tolvaptan)
338
Central pontine myelinosis occurs when sodium is corrected more than:
10-12mEq/L in first 24 hours; or more than 18 in first 48hrs
339
Which meds can be used for chronic SIADH 2/2 malignancy?
Demeclocycline, conivaptan, tolvaptan
340
Severe HyperK on EKG shows? Tx
peaked T waves; calcium gluconate IV to protect heart then insulin and glucose
341
Moderate HyperK (no EKG findings): tx
insulin+glucose; bicarb to shift K into cells if acidosis is the cause or if there is rhabdo/hemolysis/or other reason you need to alkalinize urine; kayexalate takes several hours
342
Hypokalemia: EKG findings
U-waves (extra wave after T-wave showing purkinje fiber repolarization); also muscular weakness from its ability to inhibit contraction
343
metabolic acidosis w anion gap--\>Aspirin overdose: type of metabolic disturbance, tx?
resp alkalosis from hyperventilation, over a short period metabolic acidosis develops--\> lactic acidosis; bicarb
344
Metabolic Acidosis w Anion Gap--\>Methanol intoxication: diagnostic, tx
methanol level, +fomepizole or ethanol to block formic acid production until patient can be dialyzed
345
Metabolic Acidosis w Anion Gap--\>Isoniazid toxicity: tx
stop meds, move clock forward on CCS
346
Metabolic Acidoses w/o Gap: distal RTA (Type I) urine pH? Serum K? stones? Test?
high pH, low K, +stones, give acid and urine pH continues to be basic
347
distal RTA (type 1): tx
bicarb
348
Metabolic Acidoses w/o Gap: proximal RTA (Type II): urine pH? Serum K? stones? Test? Tx?
low pH, low K, -stones, bicarb since pt cant absorb it pH rises, thiazide diuretics or high dose bicarb
349
Metabolic Acidoses w/o Gap: hyporeninemic hypoaldosteronism (Type IV): diabetic patients; urine pH? Serum K? stones? Test? Tx?
low pH, high K, no stones, urine sodium loss, aldosterone in form of fludrocortisone
350
Metabolic Alkalosis: Conn Syndrome
hyperaldo from primary causes urianry acid loss, usually with hypoK
351
How to diagnose HTN?
Repeat abnormal measurement in 1-2weeks, may take 3-6 measurements to get an accurate assessment of BP
352
Most effective lifestyle modification for HTN?
weight loss
353
First line treatment for htn?
lifestyle modifications, 3-6mos
354
Second line treatment for HTN? In Diabetics?
thiazides (hydrochlorothiazide or chlothalidone); ACEi/ARB
355
If BP not controlled with diuretic add:
beta blocker (atenolol, metorprolol), ACEi, ARB, CCB
356
Gastroenterology
...
357
Young nonsmoker who has dysphagia to both solids and liquids, may be regurgitation of food particles and aspiration of previously eaten material
Achalasia
358
Achalasia: best initial test? Most accurate test?
Initial: Barium Swallow Accurate: Esophageal Manometer
359
Achalasia: tx?
Initial: pneumatic dilation or surgical myotomoy; if pt refuses above, try botulinum toxin injection
360
Esophageal Cancer: dysphagia to solids or liquids first?
Solids first, liquids later
361
Esophageal Cancer: treatment?
surgical resection if there are no local or distant mets; follow with chemo based on 5-FU
362
Peptic Strictures: diagnostic testing
intial: barium study
363
Plummer-Vinson Syndrome
proximal stricture found in association with iron deficiency anemia, more common in middle-aged women; tx: iron replacement
364
Schatzki's Ring: describe, best therapy?
distal ring of the esophagus which presents w intermittent dysphagia; pneumatic dilation
365
Zenker's Diverticulum: describe, initial test? Initial therapy?
dysphagia w horrible bad breath; barium study; surgical resection
366
Diffuse Esophageal Spasm: presentation
severe chest pain, often without risk factors for ischemic heart disease, can occur after drinking a cold beverage +/-dysphagia
367
Diffuse Esophageal Spasm: dx? Tx?
Manometry, barium studies may show corkscrew pattern during episode of spasm; Ca-channel blocker, nitrates
368
Scleroderma presenting w symptoms of reflux: tx?
PPIs
369
Barret's Esophagus: tx?
PPI and repeat endoscopy q2-3yrs
370
Low-grade dysplasia: tx?
PPI and repeat endoscopy in 3-6mos
371
High-grade dysplasia: tx?
Endoscopic mucosal resection, ablative removal or distal esophagectomy
372
Most common cause of peptic ulcer disease?
Helicobacter, NSAIDs, head trauma, burns, intubation, Crohn's, Zollinger-Ellison Syndrome
373
Gastric cancer occurs in \_\_% of patients with gastric ulcer.
4%
374
Patient \>45 with epigastric pain, next step?
Scope to exclude gastric cancer
375
Atrophic gastritis cause:
pernicious anemia and associated with vitB12 deficiency
376
Gastritis: diagnostics
Most accurate: Endoscopy w biopsy; Serology: sensitive not specific; breath testing and stool antigen can distinguish between old and new disease
377
H. Pylori: tx
PPI+ clarithromycin and amoxicillin
378
Zollinger-Ellison Syndrome: findings
elevated gastrin level and elevated gastric acid output
379
ZES: diagnostics
Endoscopic Ultrasound, nuclear somatostatin scan, secretin stimulation (no change of gastrin secretion or gastric acid output when secretin is transfused)
380
ZES: tx?
local disease: surgical resection metastatic disease: lifelong PPIs
381
ZES+hypercalcemia
think MEN syndrome
382
Crohn's Disease: ASCA? ANCA?
ASCA+, ANCA-
383
Ulcerative Colitis: ASCA? ANCA?
ASCA-ANCA+
384
IBD: intial therapy
Mesalamine
385
IBD: acute exacerbation tx
Budesonide (steroid that has extensive first-pass metabolism in liver)
386
IBD: severe disease therapy
Azathioprine, 6MP, Infliximab (remember to plant PPD)
387
IBD: colonoscopy
q1-2yrs after 8-10yrs of colonic involvement
388
Severe Infectious Diarrhea: Tx
fluoroquinolones, like cipro
389
Nonbloody Diarrhea: MSM, hikers, bloating, flatus, steatorrhea
Giardia, tx with flagyl
390
Nonbloody Diarrhea: refried chinese rice, vomiting
B. cereus, self-resolves
391
Carcinoid Syndrome
diarrhea, flushing, episodes of hypotension
392
Carcinoid Syndrome: diagnoses, treatment
urinary 5-HIAAl octreotide (somatostatin analog)
393
Skin lesion associated with celiac disease
dermatitis herpetiformis: vesicular skin lesion not present on mucosal surfaces
394
Tropical Sprue treatment
tetracycline or TMP/SMX for 3-6mos
395
Whipple's Disease: malabsorption plus....
arthralgia, neuro abnormalities, ocular findings
396
Whipple's Disease: Diagnosis? Treatment?
Accurate: Small bowel bx shows PAS+ organisms, PCR stool for T whippelii;Tx: tetracycline or TMP/SMX for 12 mos
397
Chronic Pancreatitis: intial test? Most accurate?
Initial: Abd XR to detect pancreatic calcification, Abd CT w/o contrast (better) Accurate: Secretin stimulation test (normal person should release a large volume of bicarb-rich pancreatic fluid in response to IV secretin
398
Chronic Pacreatitis: Tx?
Replace enzymes PO (amylase, lipase, trypsin)
399
Gardner's Syndrome
benign bone tumors (osteomas)+other soft tissue tumors
400
Peutz-Jeghers Syndrome
melanotic spots on the lips, hamartomatous polyps through small bowel and colon; no extra colon ca screening
401
Juvenile Polyposis
multiple hamartomas in bowel, no extra screening
402
Dysplastic Polyp Found: next step?
repeat colonoscopy 3-5yrs after the polyp was found
403
Diverticulosis: presentation
older individual, LLQ abdominal pain, lower GI bleeding
404
Diverticulosis: diagnostics
Accurate: Colonoscopy Best: Abd CT
405
Diverticulitis: presentation
complication of diverticulosis, LLQ pain, tenderness, fever, elev WBCs
406
Diverticulitis: diagnostics
Abdominal CT..colonoscopy is contraindicated!
407
Diverticulitis: treatment
Abx: cipro and flagyl
408
Define orthostatic HTN
drop in systolic \>20mmHg or rise in pulse \>10bpm
409
When to transfuse pRBCs?
Hct \<30 in old pt; Hct\<20-25 in younger pt
410
When to tranfuse FFP?
elevated PTT/INR and vit K is too slow
411
When to transfuse plts?
\<50k if pt is bleeding or surgery
412
What is the most common cause of death in GI bleeding?
myocardial ischemia
413
When is NG tube the answer?
if unsure if bleeding is upper or lower, iced saline lavage is always the wrong answer
414
Most common complication of transjugular intrahepatic portosystemic shunt (TIPS) procedure?
hepatic encephalopathy
415
Acute Mesenteric Ischemia: most accurate test
Angiography
416
Acute Mesenteric Ischemia: treatment
surgical resection of the bowel, SURGICAL EMERGENCY
417
Diabetic Gastroparesis: treatment
Erythromycin (increases motilin in the gut) or metoclopramide
418
Acute pancreatitis: Initial Test? Most Accurate?
Amylase/Lipase; Abd CT, MRCP detects causes of biliary and pancreatic duct obstruction not found on CT scan
419
If there is dilation of the common bile duct without a pancreatic head mass, cosider this test:
ERCP which can detect the presence of stones or strictures, can also remove stones and dilate strictures
420
Hep B or C: polyarteritis nodosa
Hep B
421
Hep B or C: cryoglobulinemia
Hep C
422
ALT or AST: viral Hepatitis
ALT elevated
423
ALT or AST: drug-induced hepatitis
AST elevated
424
Hep B: first test to become abnormal?
surface antigen
425
Hep B: vaccinated patients labs show positive....
surface Ab
426
Hep B: acute disease labs show...
surface Ag, e-Ag, core Ab
427
Hep B: healed/recovering patient labs show...
core Ab, surface Ab
428
Hep C: initial test? Most accurate?
Hep C Ab; Hep C pcr for RNA, liver bx
429
Ascities: serum to ascitis albumin gradient (SAAG): \<1.1
portal HTN is NOT present
430
SBP diagnosed with cell count \> __ neutrophils
250
431
SBP: treatment
cefotaxime
432
Primary Biliary Cirrhosis: findings
middle-aged woman c/o itching; xanthelasmas (cholesterol deposits) on exam, usually with history of other autoimmune disorders
433
Primary Biliary Cirrhosis: best initial test? Most accurate?
Initial: Elevated AlkP with nl bilirubin, IgM elevated Accurate: Antimitochondrial Ab, liver bx
434
Primary Biliary Cirrhosis: tx
ursodeoxycholic acid
435
Primary Sclerosis Cholangitis (PSC): presentation
IBD, itching, elevated bili, elevated AlkP
436
Primary Sclerosis Cholangitis (PSC): diagnostics? Tx?
ERCP shows beading of biliary system, Antismooth muscle Ab, ANCA+; ursodeoxycholic acid
437
Wilson's Disease
cirrhosis, liver disease, choreiform movement disorder, neuropsych issues, hemolysis
438
Wilson's Disease: diagnosis
Initial: slit lamp for Kayser Fleischer rings, ceruloplasmin levels (low) Most Accurate: Liver Bx
439
Wilson's Disease: tx
pencillamine
440
Most common cause of death from hemochromatosis?
cirrhosis
441
Hemochromatosis: diagnosis
Initial: elevated serum iron and ferritin with low iron-binding capacity Most Accurate: liver bx, can alternatively do MRI and genetic test for Hfe mutation
442
Hemochromatosis: tx
phlebotomy
443
Autoimmune Hepatitis: labs
ANA, Anti-smooth muscle Ab, SPEP shows hypergammaglobulinemia, liver/kidney microsomal Ab; Most accurate: liver bx
444
Autoimmune Hepatitis: tx
prednisode, can use other immunosuppressants (azathioprine) if you want to wean off of steroids
445
NASH: AST vs ALT?
ALT\>AST
446
Pulmonary
...
447
Asthma and reactive airway disease are confirmed with an increase in the FEV1 of \_\_\_% during pulmonary function testing after inhaled bronchodilators
\>12%
448
Methacholine stimulation testing
decreased FEV1 if patient has asthma
449
Asthma Exacerbation: therapies to order
Inhaled bronchodilators, bolus of steroids, inhaled ipatropium, O2, Magnesium
450
How long do steroids take to be effective in asthma exacerbation? (PO/IV)
4-6hours
451
Best initial therapy for asthma
Inhaled Bronchodilator (albuterol)
452
If pt not controlled on albuterol, add a chronic controller such as...
inhaled steroid
453
If inhaled steroid and albuterol don't control asthma add:
LABA (sameterol or formeterol)
454
Long term controller for asthma: Hay Fever
Cromolyn or nedocromil
455
Long term controller for asthma: Atopic disease
Montelukast
456
Long term controller for asthma: COPD
tiotropim, ipratropium
457
High IgE levels, no control w cromolyn
Omalizumab (anti-IgE antibody)
458
COPD: acute SOB management (tests and tx)
ABG, CXR, Albuterol, ipratropium, bolus steroids, CV, Resp, neuro exams
459
COPD: fever, sputum, or infilitrate with exacerbation. Management?
Ceftriaxone and Azithro for community acquired pneumonia
460
COPD: EKG findings
R-axis deviation, RVH, R atrial hypertrophy
461
COPD: (a) FEV1 (b) FVC (c) FEV1/FVC ration (d) DLCO
(a) down (b) down (c) down (d) decrease in diffusion capacity lung carbon monoxide
462
COPD: when do you give long-term home oxygen?
pO2\<55 or O2 sat \<88%
463
COPD: chronic therapy
ipratropium inhaler, albuterol inhaler, pneumococcal vaccine, influenza vaccine, smoking cessation
464
COPD age\<40 in a nonsmoker who has bullae at the lung bases
Alpha-1-antitrypsin deficiency
465
Alpha-1-antitrypsin deficiency: diagnostics
CXR, Labs (low albumin, elevated PT), alpha-1-antitrypsin
466
Alpha-1-antitrypsin deficiency: treatment
infusion of alpha-1-antitrypsin
467
Bronchiectasis: anatomic defect and presentation
profound dilation of bronchi; chronic resolving and recurring episodes of lung infections that give a very high volume of sputum that can be measured by the cupful! +hemoptysis +fever
468
Bronchiectasis: testing
CXR with "tram tracking", most accurate is chest CT
469
Bronchiectasis: treatment
no curative therapy, treat infections as they occur; chest physiotherapy, rotate abx to avoid the development of resistence
470
Interstitial Lung Disease: glass workers, mining, sandblasting, brickyards
Silicosis
471
Interstitial Lung Disease: coal workers
coal worker's pneumoconiosos
472
Intersitial Lung Disease: cotton
byssinosis
473
Interstitial Lung Disease: electronics, ceramics, fluorescent light bulbs
beryliosis
474
Interstitial Lung Disease: mercury
pulmonary fibrosis
475
Interstial Lung disease: fever? Clubbing?
NOPE
476
Interstitial Lung Disease: diagnostics
CXR (interstitial fibrosis), CT, Lung Bx, PFTs
477
Interstitial Lung Disease: FEV1? FVC? FEV1/FVC? Total Lung Capacity? DLCO?
low FEV1, low FVC, nl-high FEV1/FVC, low total lung capacity, low DLCO
478
Interstitial Lung Disease: which type respnds to steroids?
berylliosis because it's a granulomatuc disease
479
What is BOOP?
Bronchiolitis obliterans organizing pneumonia. Bronchiolitis/inflammation of small airways with chronic alveolitis of unknow origin
480
BOOP: presentation
Cough, rales, SOB, fever, malaise, myalgias
481
BOOP: diagnosis
CXR (patchy bilateral infiltrates), chest CT Most accurate: open lung bx
482
BOOP: treatment
steroids! No response to abx
483
Loud P2, Tricuspid Regurg, R ventricular heave, Reynaud's. Diagnosis?
Pulmonary HTN
484
Pulmonary HTN: tx
bosentan (endothelin inhibitor), epoprostenol and treprostinil (pulm vasodilators), Ca-channel blockers, sildenifil
485
PE: when is D-dimer testing helpful
if its negative; use in patient with a low probability of PE in whom you want a single test to exclude PE
486
PE: how long should warfarin be used after the use of heparin?
6 mos
487
Pleural Effusion: initial test? Most accurate?
CXR with decubitus films; most accurate is thoracentesis
488
Pleural Effusion: exudate or transudate? Pleural protein \> 50% of serum
exudate
489
Pleural Effusion: exudate or transudate? Pleural LDH \> 60% of serum
exudate
490
What is pleurodesis and when is it performed?
large effusion and recurrent from a cause that cant be corrected; infusion of an irritative agen like bleomycin or talcum into pleural space which inflames pleura and causes fibrosis so lung will stick to wall and pleural space will be eliminated
491
Asthmatic with worseing asthma symptoms, coughs up brownish mucous plugs with recurrent infiltrates, peripheral eosinophilia
Allergic Bronchopulmonary Aspergillosis
492
Allergic Bronchopulmonary Aspergillosis: diagnostics
Aspergillus skin testing, IgE levels, circulating precipitins, A. fumigatus-specific antibodies
493
Aspergillosis treatment
Steroids, itraconazole if refractory
494
Hypovolema: CO? Wedge pressure? SVR?
low, low, high
495
Cardogenic Shock: CO? Wedge pressure? SVR?
low, high, high
496
Septic Shock: CO? Wedge pressure? SVR?
high, low, low
497
Pathogen in Community-Acquired Pneumonia
Pneumococcus
498
Pathogen in Hospital-Acquired Pneumonia
Gm- Bacilli
499
Outpatient PNA: treatment?
macrolides (azithro, doxy, clarithro) or respiratory fluoroquinolone (levo, moxi)
500
Inpatient PNA: treatment?
Ceftriaxone and azithro, or fluroquinolone
