General Flashcards
(133 cards)
1
Q
Treatment of Hepatorenal syndrome
A
First give volume to make sure not intravascular depletion. once confirmed, Midodrine and Octreotide
2
Q
BM Biopsy findings in multiple myeloma
A
> 10% monoclonal plasma cells
3
Q
T/F: Technetium-99m bone scans are used in patients with multiple myeloma
A
False, these are good for blastic lesions not lytic. Need a xray skeletal survey
4
Q
Tx of hypercalcemia in MM
A
Hydration and dexamethasone; if severe, bisphosphonates
5
Q
Hyperviscosity syndrome
A
MM patients p/w blurry vision, headache/confusion (neuro), nasal/oral bleeding, heart failure. Tx with plasmapharesis
6
Q
Reversal of coumadin in patient with life-threatening hemorrhage
A
Need Prothrombin complex concentrate. This is a must, works in <10 minutes. need the vitamin k alongside but this takes 12-24 hours to work. Use FFP when PCC not available
7
Q
lab test in smoker with polycythemia
A
carxboxyhemoglobin ; r/o carbon monoxide poisoning
8
Q
____ can be used to follow SLE disease activity and predict lupus nephritis
A
anti-dsDNA
9
Q
tx for Rayanuds
A
CCB - nifedipine or amlodipine
10
Q
tx of gout in patients with renal failure or renal transplant
A
avoid nsaids because of renal flow; use intraarticular glucocorticoids
11
Q
Next step when you suspect Ankylosing Spondylitis (progressive back pain which improves with exercise, limited chest expansion, reduced forward flexion lumbar spine)
A
Xray of SI joint - can’t make a dx of AS without sacroilitis . While HLA-B27 is frequently positive, its not specific
12
Q
extraarticular manifestations of ankylosing spondylitis
A
acute anterior uveitis, aortic regurgitation, apical pulmonary fibrosis, IgA nephropathy, and restrictive lung disease
13
Q
who needs a tetanus toxoid vaccine after cut?
A
last tetanus vaccine > 10ya (>5 for dirty/severe wound) or who have unimmunized, uncertain or incomplete vaccination status (<3 doses)
14
Q
who needs tetanus immunoglobulin in addition to tetanus toxoid vaccine after cut?
A
IG if dirty severe wound + immunocompromised, uncertain or incomplete tetanus vacicnation status (<3 doses)
15
Q
most common reaction to transfusion
A
febrile nonhemolytic reaction - 1-6 hours post - fevers/chills/malaise without hemolysis. prevent with leukoreduction
16
Q
dermatomyositis is often associated with
A
malignancy. all patients with new dx need cancer screening
17
Q
neck mass in Sjogren’s patient
A
B cell non-Hodgkin’s lymphoma
18
Q
scoliosis eval: significant angle of rotation and cobb angle
A
- angle of rotation (exam): >7 degrees = xray spine
- cobb angle (xray) <10 degrees is normal, f/u prn. >40 = surgical eval. in between, back brace/observation
19
Q
side effects of Methotrexate
A
-hepatotoxicity
-stomatitis
-cytopenia
supplement with folate
20
Q
what to check before starting TNF inhibitor (etanercept, infliximab)?
A
IFN gamma assay or TB skin test to screen for latent Tb
21
Q
BP mgmt in gout patients
A
Use ACE-I or ARB as they can lower uric acid Avoid diuretics (HCTZ, lasix) and asa (all decrease uric acid excretion)
22
Q
Treatment of choice for polymyalgia rheumatica
A
low dose prednisone. nsaids not v effective here
23
Q
T/F: PMR has normal inflammatory markers
A
False, elevated ESR and CRP typically
24
Q
scleroderma is an abnormal deposition of ________ in multiple organ systems
A
collagen
25
why do you need to monitor BP in patients with Raynauds?
Scleroderma renal crisis - can present with malignant hypertension. most scleroderma patients have some renal involvement. Tx with ACE-i
26
Spinal stenosis vs radiculopathy: pain decreases with flexion of spine and increases with extension
this is spinal stenosis. in contrast to radiculopathy.
27
post injury, pain out of proportion, temperature change, edema, abnormal skin color
Complex Regional Pain Syndrome. Dx by MRI or autonomic testing with increased resting sweat output; tx nerve block or iv anesthesia
28
c-peptide if excess insulin injection
low! C-peptide is from endogenous insulin...if abuse suspected and high c-peptide, oral hypoglycemic agents
29
thyroid nodule, when do you need iodine 123 scintography?
when low TSH --> hyperfunctioning nodule. will tell you hot or cold nodule
30
hot vs cold nodule thyroid
hot = hyperfunctional --> rarely malignant so just tx hyperthyroidism
cold = hypofunctional -->need FNA to eval malignancy
31
initial staging for differentiated thyroid cancer i.e. papillary or follicular
need US of neck and cervical LN before any surgery
32
MEN 1: 3 P's
```
Pituitary adenoma (prolactinoma)
Primary hyperparathyroidism (hypercalcemia, PT adenoma)
Pancreatic/GI neuroendocrine tumors (gastinoma i.e. recurrent peptic ulcers)
```
33
MEN 2
```
Medullary thyroid cancer
Pheochromocytoma
----------------------------
Men2A: + primary hyperparathyroidism
Men 2B: +mucosal neuromas/marfanoid
```
34
How can 11 and 17 hydroxlase def be distinguished from 21?
11 and 17 have hypertension
35
Patients with Graves hyperthyroidism should be started on what alongside antithyroid drugs (PTU, methimazole)
a beta blocker to reduce hyperthyroid sxs, i.e. propranolol
36
Lab findings of adrenal insufficiency
hyponatremia, hyperkalemia, hyperchloremic metabolic acidosis.
vs hypoaldosteronism = asx hyperkalemia with mild metabolic acidosis, no hyponatremia.
37
how do you dx Addison's dz
Primary adrenal insuff.
| Low morning cortisol, high ACTH (ACTH stim test)
38
PTH affect on vit d
Stimulates conversion from 25-hydroxyvitd to 1,25 - dihydroxyvitamind in the kidneys
39
how does sarcoidosis affect calcium?
granulomatous disorders cause hypercalcemia d/t extra-renal production of 1,25 - hydroxyvitd
40
antithyroid peroxidase antibodies
Hashimoto's (risk for thyroid lymphoma)
41
side effects to monitor of valproic acid
hepatoxicity
| thrombocytopenia
42
T/F: ACE levels used to dx sarcoid
False; need bx showing noncaseating granuloma
43
first line pharm tx for cognitive impairment of dementia
acetylcholinesterase inhibitors = Rivastigmine/Donezapil/Galantamine. can also use memantine (NMDA receptor antagonist)
44
T/F: Can confirm suspected pulmonary TB with IFN gamma or skin test
false; those can't differentiate latent vs active dz; need sputum acid-fast smear, mycobacterial cx, NAAT
45
tx for close contacts of neisseria meningitis
Rifampin, Ciproflaxocin or Ceftriaxone
46
polyarthralgias, rash, fever within 1-2 weeks of exposure to a responsible agent and stop when removed
serum sickness
47
which infection as a serum sickness like prodrome? define sxs
Hepatitis B. Rash, fever and polyarthralgia.
48
how is malaria dx?
peripheral smear
49
fever, headache and thrombocytopenia in a traveler
consider malaria
50
fever in a returning traveler <10 days
Typhoid fever, Dengue fever, Chikugunya, influenza, legionellosis
51
fever in a returning traveler 1-2 weeks
Malaria, Typhoid fever, schisto, ricketssial
52
fever a returning traveler > 3 weeks
TB, leishmann, enteric parasites
53
stepwise fever, rose spots, relative bradycardia in returning traveler
typhoid fever
54
Tx of fulminant C dif (shocky)
IV Flagyl + high dose vanco PO
55
Tx of recurrent C dif
- prolonged PO vanc course
- fidaxomicin
- Vanc PO followed by Rifaximin
56
tx for cryptococcal meningitis (HIV)
initial: Amphotericin B + Flucytosine for 2 weeks til CSF sterilized
: Transition to PO Fluconazole for 8 weeks
Maintenance: lower dose Fluconazole for 1 year to prevent recurrence
57
sxs of dengue fever
flulike febrile illness + joint pains and myalgia (BREAK-BONE FEVER), orbital pain. thrombocytopenia, spontaneous bleeding, vascular permeability. resp, circ failure
58
travel diarrhea + pseudoappendicitis
campylobacter jejuni
59
travel diarrhea > 2 weeks
Cryptosporidium (immunosuppressed), cyclospora, giardia (common in boonies)
60
HIV PeP
```
2 NNRTIs (Tenofovir, Emtricitabine, Lamivudine, Zidovudine)
+ Integrate-i (raltegravir), PI (Ritonavir), non-nrti (rilpivirine)
```
61
triad for pulm aspergillus
hemoptysis, cough, pleuritic CP . serum markers galactomannan, beta d glucan. tx voriconazoleMOST
62
Most common side effect of isoniazid
hepatotoxicity
63
why do you give vitamin b6 (pyridoxine) with isoniazid?
prevent neurotoxicity (ataxia, neuropathy, weakness)
64
DKA patient with periorbital swelling, black eschar/necrotic nasal turbinate, headache, nasal congestion
Mucormycosis. Need liposomal Amphotericin B + surgical debridement
65
LV apical thrombus in south american
Chagas disease (protozoan)
66
treatment of lyme in patients <8 years, pregnant/lactating women,
Amoxicillin (doxy causes teeth discoloration and skeletal deformities)
67
nec fas
strep pyo
| then staph aureus, c. perf (crepitus if gas producer)`
68
chronic bacterial prostatitis and tx
>3 months UTI, pain in genitourinary, pain with ejaculation. 6 wk cipro or bactrim
69
3 criteria for acute liver failure
hepatic injury (LFTs), encephalopathy, INR>1.5
70
treatment of lyme in patients <8 years, pregnant/lactating women,
Amoxicillin (doxy causes teeth discoloration and skeletal deformities)
71
thyroid stimulating immunoglobulin
cause Graves dz
72
thyroid nodule with normal tsh next step
straight to FNA to r/o malignancy despite sxs
73
tx of hyperthyroidism
Graves: Methimazole > PTU (except pregnancy trimester uno); radioiodine ablation (I-131)
Toxic multinodular: I-131 radioiodine ablation only
74
most common cause of hypothyroidism
Hashimoto (anti-TPO)
75
when do you do I-123 scan?
if TSH is suppressed, to evaluate for a hot nodule
76
thyroid nodule with normal tsh next step
straight to FNA to r/o malignancy despite sxs
77
thyroid nodule with low/no tsh
I-123 scan. Hot nodule: meds. Cold nodule: FNA
78
thyroid nodule with high tsh
normalize tsh with thyroxine; if nodule still palpable, get FNA
79
first line treatment for toxic megacolon?
Steroids (medical management)! not surgery.
80
management of esophageal variceal bleed
IV Octreotide + EGD (dx and tx)
81
dx of chronic pancreatitis
usually on MRCP (pancreatic calcifications); labs are not typically elevated
82
gallbladder wall calcifications on imaging
bad...porcelain gallbladder. increased risk for cancer, needs a chole
83
treatment of intussusception for kids
air or water soluble (NOT barium b/c risk peritonitis with perf) enema
84
tx of dematitis herpeteformis (celiac)
Dapsone + gluten-free diet
85
management of patient with diverticular bleeding
IV fluids +/- transfusion. Patients should get a colonoscopy for tamponade or cauterization, could also do angiography with embolization
86
Heyde's syndrome
Angiodysplasia + aortic stenosis
87
risk factors for angiodysplasia (common cause of hematochezia)
ESRD, Aortic stenosis, vWD
88
dilation of submucosal venous plexus
hemorrhoids
89
eroded small artery of the colon
diverticular bleed
90
early complication of acute pancreatitis with fever, leukocytosis and recurrence of abdominal pain
pancreatic necrosis or peripancreatic fluid collection -->get a repeat CT
91
abdominal pain + fat malabsoption
chronic pancreatitis (dx MRCP, or CT)
92
metaplastic columnar epithelialization of esophagus
barret's esophagus
93
triple therapy if penicillin allergy
PPI + clarithromycin + metronidazole (instead of typical amoxicillin)
94
chronic malabsorption + iron deficiency anemia. diarrhea not noted to be associated with specific foods
Celiac disease
95
what should you monitor in celiac patients
iron/hgb, folate, calcium, vitamins (A, E, D, B12). Dexa to eval bone loss (vit d def) and receive pneumococcal vaccine (hyposplenism)
96
cancer in upper esophagus vs lower esophagus
upper: SCC, tobacco and EtOH
lower: adenioCA, barretts and gerd
97
dyspepsia age cutoff
<60: test and tx H pylori
| >60: EGD
98
when do you start colonoscopy for patients with first degree relative?
10 years before OR age 40 whichever comes first
| if 1st degree was >60 just start at 50
99
which age group do you worry about angiodysplasia and ischemic colitis?
>60
100
50% of patients with anal abscess will develop
fistula
101
90-day mortality in patients with advanced liver disease
MELD score: Na, Cr, Bilirubin, INR
102
tx hepatic hydrothorax
sodium restriction and diuretics; TIPS if refractory
103
mgmt of delivery with HIV mom
viral load <1000: ART + vaginal delivery
| >1000: ART + zidovudine + c-section
104
dx/tx of latent tb
positive testing, neg cxr and neg sxs
| 9 months isoniazid (if allergic, rifampin)
105
abdominal pain, fecal urgency, bloody diarrhea
colonic ischemia
106
thyroid cancer with elevated calcitonin levels
Medullary thyroid cancer (MEN)
107
first line therapy for persistent cluster headaches vs acure
Verapamil; 100% oxygen
108
treatment of catatonia
benzos, ECT
109
tx antipsychotic EPS: Acute dystonia
benztropine or benadryl
| but NOT a benzo
110
EPS: how do you treat anti-psychotic induced akathisia (restlessness, anxiety type)
try reducing the dose
| use a beta blocker
111
tx antipsychotic EPS: Parkinsonism
Benztropine
| amantadine
112
triad for fat embolism
neuro sxs (confusion), petechial rash, hypoxemia (normal cxr usually). vs pulmonary contusion after injury will be some irregular opacification and can be 24 hours later
113
why don't you use St John's wort along with SSRI's to treat depression?
risk of serotonin syndrome. also other drug interactions: induces p450
114
what to screen for when starting varenicycline for smoking cessation?
neuropsychiatric history
115
asthma PFT
no exacerbation: normal PFT, admin of methacholine reduced FEV1 >20%. negative methacholine challenge is reliable in ruling out dx.
active sxs: obstructive PFT; albuterol gives >15% improvement in FEV1
116
how do you treat anti-psychotic induced akathisia (restlessness, anxiety type)
try reducing the dose
| use a beta blocker
117
when do you need to taper steroids?
when used for > 3 weeks (risk of adrenal insuff)
118
actinic keratosis is a pre-malignant skin condition (SCC) caused by
sun exposure (UV light). of note, BCC is also associated with sun exposure but not AK and also has low metastatic potential (usually fleshy appearance for bcc vs scaly/rough etc for AK)
119
when do you give antibiotics to patient with acute bronchitis?
COPD patient, with 2/3: increased sputum production, increased sputum purulence, increased dyspnea
120
asthma PFT
no exacerbation: normal PFT, admin of methacholine reduced FEV1 >20%. negative methacholine challenge is reliable in ruling out dx.
active sxs: obstructive PFT; albuterol gives >15% improvement in FEV1
121
postherpetic neuralgia timeline
4 months after initial shingles still having allodynia. tx with TCA/gabapentin/pregabalin
122
risk factors for TTN (transient tachypnea of the newborn)
c/section, maternal diabetes, prematurity. resolves within 72 hours.
123
actinic keratosis is a pre-malignant skin condition (SCC) caused by
sun exposure (UV light). of note, BCC is also associated with sun exposure but not AK and also has low metastatic potential (usually fleshy appearance for bcc vs scaly/rough etc for AK)
124
patient develops bunch of muddy brown looking skin spots, can be pruritic or inflamed. what are the spots, whats the sign, what should you be worried about
seborhheic keratosis; Leser-Trelat sign; internal malignancy, most commonly GI adenoCA
125
how long is shingles (zoster) transmissable to contacts?
until the lesion is completely crusted over, patients should keep lesions covered but they can do their activities without restriction
126
postherpetic neuralgia timeline
4 months after initial shingles still having allodynia. tx with TCA/gabapentin/pregabalin
127
options for skin SCC
surgical excision, radiotherapy, cryotherapy, electrosurgery
128
next step in workup of normocytic anemia
RETICULOCYTE count
High: hemolysis
Low: hyproprolif state (renal dz, hypothyroid, aplastic anemia)
129
mgmt of ITP
Platelets:
>30k: observe if no bleeding
<30K: steroids
IF bleeding/hemorrahge: IVIg + plt transfusion
130
what does HiB vaccine help prevent?
epiglottitis
131
most common cause of stroke in kids
sickle cell vaso-occlusive dz. dx with transcranial doppler
132
buspirone vs buproprion for anxiety
buspirone: non benzo anxiolytic; can be used monotherapy in nondepressed patients
buproprion: antidepressant inhibits reuptake dopamine and norepinephrine. not effective in GAD and may worsen insomnia and anxiety
133
tight glucose control in diabetics helps with _____ vascular complications
Micro i.e. retinopathy, nephropathy. unclear effect on macrovascular i.e. MI, stroke
