February Deck Flashcards
(99 cards)
1
Q
Electrolyte disturbances w/ tumor lysis syndrome
A
Hyperkalemia
Hyperuremia
Hyperphosphatejmia (& hypocalcemia)
2
Q
TLS treatment of hyperuremia
A
rasburicase (urate oxidase analogue)
3
Q
locally aggressive benign tumor, may recur
A
Desmoid Tumor
4
Q
AVM bleeding more likely if pt also has…
A
ESRD
Aortic stenosis
vonWilabrand
5
Q
Daily Adult nutrition goal
A
30 kcal/kg per day
1 g/kg protein per day
6
Q
Precursor to skin cancer is called ______
Treatment
A
actinic keratosis
Liquid nitrogen (cryosurgery)
Surgery
5-fluoruricil cream, diclofinac cream, etc.
7
Q
Management of Stage 3 pressure ulcer is….
A
debridement of necrotic tissue
8
Q
How do IVC Filters effect PE risk and DVT risk?
A
1/2 PE risk
Double DVT risk
9
Q
Extrapyramidal Effects
A
Acute Dystonia
Akathesia (restlessness)
Parkinsonism
Tardive Dyskinesia
10
Q
Management acute dystonia
A
Benadryl or benztropine
11
Q
Management of akathesia
A
Beta blocker
Benzodiazapine
Benztropine
12
Q
Management parkinsonism
A
benztropine, amantadine
13
Q
Management tardive dyskinesia
A
Valbenazine, deutrabenzine
14
Q
Use defibrilation for which cardiac rhythms?
A
V fib
pulseless V tach
15
Q
Management of PEA?
A
CPR!!
(Pulseless electrical activity)
16
Q
Evaluation of carpal tunnel syndrome
A
- nothing, trial splinting
- nerve conduction studies and electromyography
17
Q
Normal physiologic changes of 3rd trimester pregnancy
(that can be confused for infection)
A
hypotension
mild resp alkalosis (2/2 progesterone)
Low bicarb (compensatory renal excretion)
Mild leukocytosis (15000)
18
Q
Lung complication of polymyositis?
A
Interstitial lung disease
19
Q
Polymyositis sx
vs.
polymyalgia rheumatica
A
Proximal muscle weakness, no/mild pain
Proximal muscle STIFFNESS
Gaint cell arteritis association
20
Q
What further infectious testing is usually done after new dx of HIV?
A
Hep B (b/c some anti-HIV meds target both)
Hep C
TB
STIs
21
Q
What is prognosis of Minimal Change disease?
A
Usually remission w/ steroids, but high risk relapse
usually achieve ultimate remission after age 5
usually no longterm kidney issues
22
Q
What is most irreversible SE of systemic steroids?
A
Cataracts
(therefore pts on longterm steroids require frequent optho monitoring)
23
Q
Bells palsey vs stroke
A
Bells Palsy effects eyebrow (CANNOT raise eyebrow)
Stroke does not effect eyebrow (can raise)
24
Q
2 most common causes of dilated cardiomyopathy is:
A
Idiopathic
CAD (ischemic cardiomyopathy)
25
All pts with unexplained new-onset CHF should undergo:
Echo
Stress testing or cardiac angiography (assess CAD as cause)
26
Endometriosis vs. genitopelvic pain/penetration disorder
Endometriosis is DEEP pelvic pain
penetration disorder is more superficial
27
What happens to TSH and Free T3/T4 in pregnancy?
TSH stays about the same but TOTAL T3 and T4 increase
hCG mimics TSH to produce more TH
AND estrogen causes increase T4-binding globulin
Therefore, total TH goes up
28
When is metformin NOT first line for DM?
Renal insufficiency
29
Medication management for Hot flashes?
1 Menopausal hormone therapy
2 SSRI (ex: if develop clot)
30
Sx parvovirus?
children: Slapped cheek
teens & adults: flu-like + rash, then 1 wk later symmetric joint pain +/- rash (lacy, reticular rash)
31
Sx of neuroleptic malignant syndrome
Fever
Rigidity
AMS
Autonomic Instability
32
Sx of Serotonin syndrome
Fever/hyperthermia
Myoclonus
Hyperreflexia
Tachycardia
AMS
33
Sx Lithium Toxicity
N/V, Diarrhea
Tremor
Slurred Speech
AMS
ATAXIA
RENAL excretion: sensitive to diuretics and vol depletion
34
Management of lower back pain is:
acutely: maintain normal levels of moderate activity
After recovery: exercise regimen to avoid recurrence
35
When and why does breast milk Jaundice develop?
starts 3-5 days, peaks 3 WOL
High beta-glucuronidase in BM deconjugates bilirubin, reabsorbed by gut
KERNICTEROUS IS RARE, KEEP EM FEEDING
36
What type of bilirubin causes jaundice in:
Biliary atresia
Breast milk jaundice
direct/conjugated
Indirect/Unconjugated
37
Typical anginal sx in older folks
not pain
dyspnea, lightheaded, fatigue
38
Patients w/ suspected stable CAD should undergo what test for confirmation?
Noninvasive stess testing
(then echo)
39
Which MI is most likely accompanied by bradycardia?
Inferior wall
II, III, aVF
(dec blood supply from RCA to SA node)
40
Management of distal esophageal spasm?
CCB
Tricyclic antidepressants
41
Meniere Disease sx
Vertigo 20min - 24hr
+/- N/V
Hearing loss/tinnitus
2/2 increased endolymph pressure
42
Benign Paroxysmal Positional Vertigo Sx
<1 min episodes vertigo
Trigger head movement
No HA
2/2 calcium debris in ear cannals
43
Vestibular Neuritis
Dizziness (?)
N/V, gait impairment
Sudden onset, self-limited (few days)
2/2 inflammation CN IIX after viral infx
44
Hyphema management
<50% - discharge home w/ close ophtho follow up
>50% - admit, bedrest, raise head of bed, serial IOP checks
45
What is unique about RV MI?
Inferior wall II, III, aVF
Failing RV relies on hydrostatic pressure from body to push blood through to lungs
If give nitrates, diuretics, opaites, decrease RV pre-load, worsen hypotension
--> give bolus
46
Sjogren's syndrome is associated with what cancer?
B cell lymphoma (non-hodgkins)
Bc chronic inflammation results in activation of polyclonal B cells
47
Who should get CT chest screening for lung cancer?
50 - 80 yo
>20 pack year hx
& currently smoking or quit <15 years ago
48
In gallstone pancreatitis, when should cholecystectomy occur?
Mild: "urgently" w/in 7 days
Severe: Wait for inflammation to go down/complications resolve
49
Pts w/ HIV and PCP often have increased inflammatory response as treatment starts. What do you do?
corticosteroids if ABG w/:
alveolar-arterial oxygen gradient >35
PaO2 <70
50
____ is one of most common causes acute aortic dissection in YA
HTN 2/2 cocain
Suspect if CP but normal HR and BP, normal ECG, and NEUROLOGIC findings (carotid involvement)
51
Sx Sarcoidosis
SOB, hilar lymphadenopathy
FATIGUE
Peripheral lymphadenopathy
Hepatomegaly
Facial nerve palsy
Arthritis
Skin plaques or erythema nodosum
52
Management of pts with acute decompensated HF
Decreased cardiac preload (diuretics)
Therefore decreases pulmonary capillary wedge pressure, reduces pulm edema
53
SE of Varenicline?
disrupted sleep, abnormal dreams
may use w/ nicotine replacement therapy with no added SE
54
Management of inhalation injury?
Signs of blistering/MM injry --> intubation
If nonspecific signs, may use flexible laryngoscopy first to assess for risk of airway obstruction
55
PICC complications vs. Centrally inserted central line complications?
PICCs - higher thrombotic risk
CICCs - higher infection risk
Higher procedural complications
Decreased pt comfort
56
What is the mechanism of sarcoidosis?
Infiltrative Noncaseating granulomas
Hypercalcemia 2/2 macrophage activation?
57
Liver labs in infiltrative liver disease
Alk phos and GGT > AST or ALT
Ex: Hepatic sarcoidosis
(vs hepatic steatosis in which AST/ALT > alk phos)
58
Salvating, sweaty, N/V, diarrhea, miosis ---> Sz, resp failure
What did he take?
Organophosphates
(acetylcholinesterase inhibitor --> increase ACh)
Result: Cholinergic toxicity
59
Treatment of cholinergic toxicity?
Atropine (competitive inhibitor of ACh)
Pralidoxime (reactivates ACh-E)
(Dumbells or wet wet wet)
60
Signs of cardiac chest pain?
1. Subcostal ??
2. Increases with exertion
3. Stops with rest/nitroglycerin
61
Dry Mucus membranes, heart block, midryasis, urinary retension.
what did she take?
Atropine
(Anticholinergic antagonist or anti-muscarinic)
Anticholinergic toxicity
62
Pruritis followed by bullae, erosions and erythema.
What is this?
Bullous pemphigoid
Skin biopsy, then steroids
## Footnote
Bullae w/ skin sloughing and mucosal involvement and pain (not itchy) is bullous vulgaris
63
Definition of pre-eclampsia?
management?
htn
protein in urine
1. Magnesium (sz)
2. Antihypertensives
3. w/o severe features deliver >37 weeks
w severe features deliver >34 weeks
64
when to discontinue aspirin prior to proceedures?
7 days prior IF bleeding risk
no need if low bleeding risk (cardiac cath)
65
when to discontinue metformin prior to proceedure?
if large iodine contrast (cardiac cath)
2 days prior?
66
Electrolyte disturbances by lots of vomiting?
Hypokalemic hypochaloric metabolic alkalosis
hyponatremia 2/2 water retension from hypovolemia
67
Management of post-MI pericarditis?
High dose aspirin
(as opposed to NSAID + colchicine as used for idiopathic or viral pericarditis)
68
During DKA, what is the goal BG while awaiting anion gap correction?
BG >200
Therefore, decrease the rate of IV insulin and add dextrose to fluids as needed to maintain BG and avoid hypoglycemia
69
How do you transition pt with now-resolved DKA off insulin drip?
Give SQ long-acting insulin, continue (bridge) IV insulin ~1-2 hrs (b/c delay uptake of SQ insulin)
Start short-acting insulin with meals
Start sliding-scale
70
what abx increase risk of c diff?
fluoroquinalones, cephalasporins, clindamycin
If C. diff dx, ideally stop instigating abx or change to a lower-risk one
(and start PO vanc or fidamoxacin for c diff)
71
ANY patient with syphilis w/ ____ sx requires LP
ANY patient with syphilis w/ NEURO sx requires LP
Blurry vision, HA, etc.
b/c early dissemination often seeds CSF. may be cleared on its own, but have to check esp if HIV+
72
Syphilis Tx by stage:
Primary, Secondary, Early latent
Late Latent or UNKNOWN duration
Neurosyphilis
Congenital syphilis
Benzathine Penicillin G
Primary, Secondary, Early latent: 1x IM dose
Late Latent or UKNOWN duration: IM for 3 weeks
Neurosyphilis: IV q4h 10-14 days
Congenital syphilis: IV q8-12h for 10 d
73
What lab work does ARNI (angiotensin-receptor-neprysilin-inhibitor ex: sacubitril-valsartan) effect?
Elevate BNP!
(don't trust it)
neprysilin usually breaks down BNP
74
<2 yo w/ unexplained fever but otherwise well appearing.
Work up?
UA for suspected UTI
If appears ILL, also BCx, LP, etc as needed
75
Nonmedication Management of OCD?
CBT (exposure and response prevention)
76
Management of borderline personality disorder?
Dialectical Behavior Therapy
77
How is viral conjunctivitis spread?
by eye discharge
ok to go to school after discharge resolves
78
Management of plantar wart?
Salicyclic acid (1-3 wks)
cryotherapy (liquid nitrogen)
look for thrombosed arteries
2/2 HPV
79
anticoagulation for patients with mechanical prosthetic valves?
WARFARIN only
(no doac)
80
Classification of PE and tx
(massive, submassive, low risk)
Massive: RV failure w/ obstructive shock (hypotension)
- TPA (if safe)
Submassive: RV dysfunction (echo findings or trop/BNP elevation) w/o shock (no hypotension)
- anticoag +/- catheter based stratagies
low risk: No RV dysfunction
- only anticoag
81
Repeat asthma exacerbations, brown mucus w/ cough, hemoptysis, transient consolidations on imaging.
Dx?
Allergic broncopulmonary aspergilosis
Exaggerated IgE response
Mangement: steroids and itraconazol
think for asthma or CF!!
82
management of acute hep B?
unlikely to become full liver failure, therefore, SUPPORTIVE care
If prolonged or does develop, admit and anti-virals
83
Meds to hold prior to surgery?
Metformin (lactic acidosis)
Raloxifine (clotting risk)
ACE/ARB (hypotension - hold night before unless for HF)
Diuretics (hypotension, hold day of)
84
Suspected slow gastric emptying work up?
1. EGD - assess for obstruction to gastric outlet
2. gastric emptying study (ex: gastroparesis)
85
acute interstitial nephritis sx and management
AKI +
Eosinophils
Rash
Pyuria
WBC casts
Cause: abx, NSAIDS, PPIs, rheum disease, infxns
Tx:
Stop offending agent
Serial kidney function studies
If no abrupt improvement, systemic glucocorticoids
86
ECG signs of R heart strain
R axis deviation
pre-cordial T wave inversion
S1Q3T3
87
Work up in suspected massive PE
1. Bedside Echo - looking for R heart strain
2. CT angiogram but only if hemodynamically stable
88
Management of LVOT obstruction?
Beta Blockers (increase filling time)
If not option: Verapamil (CBB)
Alcohol Septal ablation (only after pharm options exhausted)
89
Sx Salicylate toxicity
Aspirin
MIXED acid-base disorder
tachypnea (resp alkalosis)
Lactic acidosis
tachycardia
hyperthermia
N/V
AMS
90
Salicylate toxicity MANAGEMENT
1. SODIUM BICARB to alkalize urine and plasma to neutralize uncharged ASA molecules that can go through BBB and cell walls --> toxicity
2. glucose for neuroglycopenia
3. activated charcoal
4. HD
91
Rubeola
Measles disease
Cough
Coryza
Conjunctivitis
Koplik Spots
Cephelocaudal macular rash
92
Roseola
"sixth disease"
High fever
rash as fever breaks
93
Revised cardiac risk index
(Cardiovascular risk during non-cardiac surgery)
High risk surgery (vascular, intrathoracic)
Hx CHF
Ischemic heart disease
Hx Stroke/TIA
DM w/ insulin
Creatinine >2 pre-op
0-1: low risk
>2: elevated risk
94
Single-screening for risky alcohol use
How many times in past year have you had 5 or more drinks in one day? (men)
(4 for women)
95
management of scrotal injury?
If mild pain and normal PE, pain meds and outpt f/u
if abnormal PE (bruising, no cremasteric reflex) --> scrotal US and UA
96
Precipitators of hepatic encephalopathy
Drugs (sedatives, narcotics)
Hypovolemia
Electrolyte changes (hypoK)
Inc nitrogen load (GI bleed)
Infection
Portosystemic shunting (TIPS)
97
What is cardiac index?
Cardiac output (corrected per body SA)
98
management of cocaine MI
benzodiazepine (dec systematic outflow, tachycardia, htn)
nitroglycerine
if continues: PCI
(cocaine can stimulate thrombus formation)
99
