Deck 1 Flashcards
(119 cards)
1
Q
Osmotic stool gap calculation
A
290 - 2(Na +K)
2
Q
What does stool osmolal gap >125 indicate?
A
Osmotic diarrhea (ex sorbitol)
3
Q
What does stool osmolal gap <50 indicate?
A
Secretory diarrhea (crohns, celiac, neuroendocrine, etc)
4
Q
How do you treat neurosyphilis?
A
Penicillin G x14 days
5
Q
How do you treat neurosyphilis?
A
Penicillin G x14 days
6
Q
How do you treat early syphilis? (<100 days)
A
Penicillin B x 1
7
Q
How do you treat late syphilis? (>100 days)
A
Penicillin B x 3 (late includes tertiary syphilis)
8
Q
How do you diagnose ALS?
A
Electrodiagnostic tests, including electomyography (EMG) and nerve conduction velocity (NCV)
9
Q
Can lacunar strokes cause motor/sensory alone deficits?
A
YES!
10
Q
When should you use carotid endarterectomy?
A
70-99% occlusion
11
Q
What commonly causes lobar hemorrhagic strokes the elderly?
A
Amyloid
12
Q
How to treat acute MS?
A
IV steroids
13
Q
How to treat acute MS?
A
IV steroids
14
Q
How do you treat Guillain-Barre?
A
IVIG or plasmapheresis
15
Q
Besides iron replacement if low ferritin is present, what medication can be given for RLS?
A
Gabapentin/pregabalin
16
Q
Who should be screened for syphilis?
A
High risk sex, MSM, pregnant women
17
Q
When to screen for osteoporosis?
A
Women 65 and older
18
Q
Who should be screened for Cervical cancer
A
21-65
-HPV +/- cytology Q5y
OR
-Cytology Q3y
19
Q
Who to screen for breast cancer?
A
40-74 Q2yr
20
Q
Screening for BRCA?
A
If family history or ethnicity associated with BRCA, use risk tool to determine risk then make decision to send for testing
21
Q
Who should get screened for colon cancer?
A
45-85yo
If high risk, favor colonoscopy rather than other screening methods
22
Q
Who should get lung cancer screening?
A
50-80 (20py within last 15yr)
(20% chance of false positive)
23
Q
Who should get the pneumo vaccine?
A
65+ (OR immunosuppression, heart disease, lung disease, DM, and more!)
24
Q
What BUN:Cr suggests an upper GI bleed?
A
BUN:Cr >30
25
Indications for endoscopy for dyspepsia
-anemia
-gi bleeding
-weight loss
-dysphasia
-age >50
-nausea/vomiting
26
What is the treatment for hpylori
Clarithromycin/amoxicillin/PPI x14 days
27
How do you test for hpylori eradication?
Urea breath test or fecal antigen test
28
When do you screen for colon cancer? Interval?
45-85
Normal q10y
Tubular q5-7y
Serrated Q3y
29
What is HIDA used for?
Cholecystitis
Acalculous cholecystitis
30
How to treat hot flashes WITH a uterus?
Estrogen AND progesterone (prevent endometrial hyperplasia to cancer)
31
Be able to identify dry and wet macular degeneration
32
Characteristics of aortic stenosis (location, how the murmur sounds)
Best heard at RUSB
Has a late-peaking murmur with radiation into the carotids
Possible delayed/diminished carotid upstroke
33
What is treatment for AS?
-Asymptomatic: consider valve replacement, medical management
-Symptomatic AS +/- LV dysfunction: valve replacement (surgery vs TAVR)
34
Characteristics of HOCM (location, how the murmur sounds)
Can mimic AS!
-Murmur is loudest with preload-reducing maneuvers (valsalva, standing)
-softer with preload-increasing maneuvers (squatting, leg raise)
35
Treatment for HOCM
-Maintain volume!
-Nodal blockade (bb, CCB) to maintain preload and/or disopyramide
-Surgery
36
Characteristics of aortic insufficiency (location, how the murmur sounds)
Best heard at LSB
Early, high-pitched diastolic murmur
Head Bob/nodding
Bounding peripheral pulse
37
Characteristics of mitral stenosis (location, how the murmur sounds)
-Best heard at apex
-Diastolic low pitched rumbling murmur
-Opening snap after s2 of leaflets are mobile
38
Characteristics of mitral regurgitation (location, how the murmur sounds)
-best heard at apex
-Holo (mostly), mid, or late systolic murmur
39
When a woman with hypothyroid gets pregnant, what should you do with her levothyroxine? Why?
Increase dose
Pregnancy causes an increase in thyroid binding globulin and b-hcg increases TSH, both can cause fetal issues
40
How much is the ideal levothyroxine dosing for a patient? Should you do this with elderly patients or those with cardiac disease?
1.6mg/kg
No, ramp up slowly
41
What is the preferred antiarrhythmic for afib in 1) no CAD or structural heart disease? 2) LVH? 3) CAD w/o HF? 4) HF? 5) recurrent sxs refractory to meds?
1) Class I
2) Amio
3) Sotalol
4) Amio
5) ablation
42
When should you refer someone for prostate biopsy?
If PSA >7 and/or abnormal DRE
43
When to treat hypertriglyceridemia
>500
44
What microbe causes hot-tub lung
Nontuberculous mycobacterium (NTM)
45
What issues can cause compression of the CN II, III, IV, V?
Pituitary apoplexy
Cavernous sinus thrombosis
SAH
46
In the setting of presumed psuedoachalasia shown via barium swallow, what is the next test to perform?
Endoscopy
47
What should you do when you suspect a DVT but US is negative and D-dimer is high?
Repeat scan in a couple of days
48
Can chronic opioid use cause central hypogonadism?
Yes!
49
Which ingested alcohol does NOT cause a AGMA OR NAGMA ?
Isopropyl alcohol (rubbing alcohol, hand sanitizer)
50
What are the clinical features of primary ovarian insufficiency?
-Amenorrhea <40yo
-high FSH
-low estrogen
-hypoestrogenic symptoms
51
What are suspicious findings for a thyroid nodule that indicate FNA?
-microcalcifications
-hypoechoic
-increased vascularity
-infiltrative margins
52
What is the evaluation for a thyroid nodule?
53
If someone fails a statin, what should you do?
Try a different statin
54
What are the causes of hirsutism in women?
55
What is the treatment for h pylori?
56
If the clinical suspicion for giant cell arthritis is high but biopsy is negative, what should you do?
Repeat the biopsy as 40% of biopsies are negative
57
What is the treatment for digoxin toxicity?
Digoxin-specific antibody fragments
58
When should you screen someone with DEXA scan with celiac disease
At the time of diagnosis
59
What are the 3 causes of urinary incontinence?
1) Stress incontinence
2) Urge incontinence
3) Overflow incontinence
60
What is the etiology of stress incontinence? What are the common history findings? Treatment?
1) Decreased urethral sphincter toneUrethral hypermobility
2) leakage with coughing, sneezing, lifting
3) Pelvic floor training, pessaries, estrogen
61
What is the etiology of urge incontinence? What are the common history findings? Treatment?
1) detrusor overactivity
2) sudden, overwhelming urge to pee
3) bladder training, estrogen, anti-muscsrinic
62
What is the etiology of overflow incontinence? What are the common history findings? Treatment?
1) impaired detrusor activity, bladder outlet obstruction
2) incomplete emptying, involuntary dribbling
3) alpha blocker and/or 5alpha reductase inhibitor
63
What should be immediately done in pituitary apoplexy?
Give steroids THEN neurosurgery
64
How does pituitary apoplexy present?
Headache, CN III, IV, V deficits, visual deficits (optic chaism compression), and panhypopituitarism
65
A patient has thyroid nodules that look malignant. What are risk factors for thyroid malignancy? (Give 3)
Radiation exposure
Family history
High TSH
66
What is this?
Discoid lupus
Has hyperpigmented boarders
67
What is this?
Discoid lupus
Has hyperpigmented boarders
68
What is this?
Lichen planus
Commonly seen on flexor surfaces and are intensely pruritic
69
What is the best test for acromegaly? What is the confirmatory test?
1) Insulin growth factor one levels
2) Glucose suppression test (give glucose then check growth hormone level which should be elevated)
70
What is normal LV wall thickness?
<15mm
71
What medication should be used in conjunction with sulfadiazine/pyrimethamine for toxo treatment?
Leucovorin
(Pyrimethamine blocks folic acid pathway)
72
What are the light’s criteria? What is the serum-effusion protein difference? What is the serum-effusion albumin difference?
Pleural:serum protein >0.5
Pleural:serum LDH >0.6
serum-effusion protein difference >3.1
serum-effusion albumin difference >1.2
-suggestive of a transudative
73
What are the light’s criteria? What is the serum-effusion protein difference? What is the serum-effusion albumin difference?
Pleural:serum protein >0.5
Pleural:serum LDH >0.6
serum-effusion protein difference >3.1
serum-effusion albumin difference >1.2
-suggestive of a transudative
74
What is this?
Guttate psoriasis
Typically occurs following a strep infection
75
What is the management for dyspepsia?
Might have another card with answers
76
When do you treat sinusitis with antibiotics?
Symptoms >10 days and/or fever and/or facial pain
77
What is the preferred method to diagnose SBO? What if first method is negative and concern remains high?
1) Plain films
2) CT imaging
78
What medications are good for bony Mets? Which one can be given with renal disease?
1) Denosumab and Zolendronic acid (IV bisphosphonate)
2) Denosumab
79
What rare cancer can be seen in celiac disease?
Intestinal lymphoma
80
What T1DM antibody is a must know?
GAD
81
What is the prediabetes A1c?
5.7-6.4
82
Can you trust A1c in ESRD?
No, especially in those taking EPO
83
If a diabetic patient has unilateral retinopathy, what test should you order?
Carotid duplex as they likely have narrowing causing ischemia
84
What hounsfield unit and size adrenal lesion is concerning for malignancy?
HU >20 and >4cm
85
How do you treat pericarditis?
Colchicine and ASA (preferred after MI) or NSIAD
86
What are clinical features of idiopathic intracranial HTN? Diagnosis? Treatment?
1) Headache/nausea/vomiting, visual changes, CN VI palsy, tinnitus
2) papilledema, normal MRI (empty sella), LP with elevated opening pressure
3) weight loss, acetazolamide, topiramate
87
What are symptoms of retinal detachment?
Floaters, flashing lights, loss of vision
88
What are the next steps if a patient’s PT or PTT are elevated?
89
What are the characteristics of of lofgren’s syndrome?
Hilar adenopathy, erythema nodosum, arthritis (commonly ankles)
90
What is the treatment for microscopic colitis?
Stop possible offending medications (PPI, NSAID, SSRI), smoking cessation, oral budesonide, antidiarreal medications
91
What is the regimen for post-exposure prophylaxis (PEP) for HIV?
3 drug regimen
1)Tenofovir
2) Emtricitabine
3) Raltegravir OR Dolutegravir
92
What is the pre-exposure prophylaxis regimen for HIV?
2 drug regimen
1)Tenofovir
2) Emtricitabine
Check HBV status
93
What is the antibody for drug-induced lupus?
DNA-histone complex
94
What is the antibody for SLE?
Double-stranded DNA
Can see smith-ab
All SLE has positive ANA
95
What are the antibodies for systemic sclerosis?
RNA polymerase II and III
Scl-70/anti-topoisomerase type I
96
What is the antibody for MCTD?
Ribonucleoprotein (RNP)
97
What are the antibodies for Sjogren syndrome?
SS-A/Ro and SS-B/La
98
What is the antibody for limited scleroderma?
Anti-Centromere
99
What are the antibodies for polymyositis, dermatomyositis?
Aminoacyl-transfer RNA synthetases (ex Jo-1)
100
What is the antibody for microscopic polyangiitis?
MPO
101
What is the antibody for GPA?
Proteinase 3 (PR3)
102
What viruses belong to the polyoma virus family?
JC and BK viruses
103
What is the treatment for Paget’s disease?
Bisphosphonate
104
How to diagnose Cushing? (3 steps)
1. Confirm Cushing (2/3: low dose dex suppression, 24hr urine free cortisol, late night salivary cortisol)
2. Obtain ACTH
3. If elevated ACTH, high dose dex suppression test
105
Features of tricuspid regurgitation?
Holosystolic murmur at left sternal border that increases with inspiration
106
What vitamins are at risk for deficiency in a Roux-en-Y bypass?
Calcium
Iron
B12
Thiamine
Folate
Vit A, D, E, K
107
What is the preferred anti hypertensive agent for aortic dissection?
Beta blocker (ex esmolol, labetolol)
108
If osteoporosis is diagnosed, what lab should be obtained?
25 OH vit D
109
What medication is used to treat anorexia nervosa?
Olanzapine
110
How does BMI affect BNP levels?
High BMI can cause lower levels of BNP is heart failure
111
What are some findings of Behcet
Recurrent painful ulcers
Ocular manifestations (ex uveitis)
Skin lesions
Positive pathergy
112
What is the first line medication treatment for fibromyalgia?
TCA
113
What is the treatment for thyroid storm?
Beta blocker
PTU followed by iodine
Steroids
114
Can thyroid dysfunction cause myopathy?
Yes! Be sure to add it to the differential of elevated CK
115
What inhalers can/should be used in asthma in pregnancy?
Albuterol
ICS-LABA
Steroids okay for exacerbation
116
What two diseases is seborreic dermatitis seen? Obviously can be seen outside of this
HIV
Parkinson’s
117
What arthopathy disease causes chondrocalcinosis?
Calcium pyrophosphate dihydrate crystals (CPPD aka pseudogout)
118
What arthopathy disease causes chondrocalcinosis?
Calcium pyrophosphate dihydrate crystals (CPPD aka pseudogout)
119
What type of cardiac ischemic exam should be performed in those with a LBBB or ventricular over rhythm (ex pacer)?
Pharmacological radionuclide perfusion imaging
