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2018 ITE > ITE 2018 > Flashcards

ITE 2018 Flashcards

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1
Q

What lessens the severity of OSA and reduces blood pressure and offers further benefit beyond that of traditional diuretics?

A

Aldosterone antagonist (Spironolactone). Resistant hypertension is common in OSA and is associated with higher levels of aldosterone, which can lead to secondary pharyngeal edema, increasing airway obstruction.

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2
Q

What is hypertensive emergency?

A

SBP >180 or DBP >110 with end organ damage.

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3
Q

symptomatic HCM, what drug to use?

A

BB. If they are unable to tolerate BB, use verapmil.

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4
Q

HTN medications in AA

A

Use Thiazides and CCB

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5
Q

Murmur increases with Valsalva

A

Think HCM

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6
Q

What needs to be considered when starting or adjusting the dosage of novel anticoagulants (NOACs)?

A

Renal Function novel anticoagulants include apixaban (eliquis), dabigatran (Pradaxa), edoxaban (Savaysa) and rivaroxaban (Xarelto).

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7
Q

What is used to adjust warfarin dosing and what is used to adjust heparin dosing?

A

INR for warfarin PTT for heparin

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8
Q

What should be initiated in patients with DM, HTN and microalbuminuria?

A

Ace inhibitors for renal protection Reduce decline in renal function.

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9
Q

In patients with marfan’s what would the cardiac examination reveal? What occurs in 80-100% of affected individuals

A

aortic regurgitation murmur or a murmur of mitral valve prolapse. Aortic root dilation

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10
Q

What should be obtained in patients presenting with acute atrial fibrillation?

A

TSH level Patients with hyperthyroidism have threefold risk of developing AFIB.

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11
Q

In patients undergoing or vascular or high risk surgeries such as joint replacement, what is recommended to decrease risk of CVD and perioperative mortality?

A

statins

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12
Q

The use of gadolinium contrast has been associated with? In what types of patients should we avoid this with?

A

development of nephrogenic systemic sclerosis. Avoid in patients with GFR <30, as well as patients with renal failure.

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13
Q

What is the most appropriate pharmacological therapy for anticoagulation in pregnant patients?

A

Enoxaparin (lovenox)

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14
Q

What antihypertensive drug may reduce the severity of sleep apnea?

A

Spironolactone OSA causes resistant HTN, which is associated with higher levels of aldosterone, which can lead to secondary pharyngeal edema, increasing airway obstruction.

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15
Q

In patients who with HTN that do not have DM, therapy may be started with?

A

ACEI, Thiazide, Diuretics, or CCB.

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16
Q

What is the preferred test to confirm legionnaire’s disease? What is the gold standard?

A

Urine test for legionella pneumophilia antigen. Rapid test. Gold standard is sputum cx. Takes 48-72 hours.

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17
Q

What should be avoided in patients with IBS?

A

Lactulose -Osmotic laxative, it should be avoided in patients with IBS because it is broken down by colonic flora and produces excessive gas.

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18
Q

What is FDA approved for short term treatment in adults and children with occasional constipation and in patients with IBS?

A

Polyethylene glycol (Miralax), a long-chain polymer of ethylene oxide, is a large molecule that causes water to be retained in the colon, which softens the stool and increases the number of bowel movement.

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19
Q

Test of choice for patients in patients with suspected distal biceps tendon rupture?

A

MRI

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20
Q

For DM patients, what is the goal HbA1c goal? What is recommended first line as long as there are no contradictions? What if goal is not met or HbA1c is > or = to 9?

A

7 Metformin Add another agent to metformin.

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21
Q

How do you recognize nephrotic syndrome?

A

peripheral edema, heavy proteinuria, and hypoalbuminemia, Hyperlipidemia

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22
Q

How do you diagnosis nephrotic syndrome?

A

protein/cr ratio >3.0-3.5mg OR 24 hour urine collection showing >3.0-3.5 of protein.

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23
Q

IV versus IM versus PO immediate release opioids peak time

A

morphine, oxycodone, hydromoprhine Oral takes one hour IV takes 10 minutes IM takes 20 mins

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24
Q

What is the only proven therapy for pulmonary hypertension related to COPD patients?

A

Supplemental oxygen Supplemental oxygen should be recommended when the PaO2 is <60 mmHg, because it has been shown to improve mortality by lowering pulmonary arterial pressures. Do not use PAH drugs such as nifedipine, sildenafil, bosentan because they cause V/Q mismatch.

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25
NNT versus ARR
NNT = the number of people who wound need to receive an intervention in order for one person to benefit. It is the inverse of absolute risk reduction which is the difference in risk for a disease without and with an intervention. NNT = 1/ARR.
26
What is recommended as the first line medication for women diagnosed with PCOS who are experiencing irregular menses, acne and hirsutism who do not desire pregnancy? What about those who want to become pregnant
OCP Letrozole or clomiphene for those who want to become pregnant.
27
Treatment for Rocky Mountain Spotted fever
doxycycline is the only approved medication for RMSF for all ages, including children less than 8 years of age.
28
Symptoms or RMSF?
if you become ill after having been bitten by a tick or having been in the woods or in areas with high brush where ticks commonly live. •Fever •Headache •Rash •Nausea •Vomiting •Stomach pain •Muscle pain •Lack of appetite Rash is a common sign in people who are sick with RMSF. Rash usually develops 2-4 days after fever begins. Rash varies. Some rashes can look like red splotches and some look like pinpoint dots. While almost all patients with RMSF will develop a rash, it often does not appear early in illness, which can make RMSF difficult to diagnose.
29
What should be used as first line for patients with Type 2 DM? What is considered second line choice for patients who are intolerant of this mediation?
Empagliflozin, an SGLT2 inhibitor.
30
If a school personnel suspect that a child has head lice, what is the management?
The child should remain in class and should not be treated unless there is a clear diagnosis and live lice are seen.
31
What factors can increase hb A1c value?
Conditions that decrease erythropoiesis, such as iron deficiency anemia, increase the mean age of the RBC, thereby increasing hbA1c. Severe chronic kidney disease increase RBC glycation through lipid peroxidase of hemoglobin and by extending the erythrocyte lifespan due to decreased erythropoietin levels.
32
What factors can falsely lower the Hb A1c value in a patient with Type 2 DM?
Hemolytic Anemia Erythryocyte lifespan is decreased by conditions such as hemolytic anemia, HbA1c is decreased because of reduced RBC exposure time for glycation.
33
Patient has intermittent asthma that has become at moderate persistent. What medication do you need to add to her albuterol (Proventil, Ventolin) inhaler?
Moderate dose inhaled corticosteroid with a long acting bronchodilator such as Fluticasone/salmeterol (Advair)
34
Two most common causes for neonatal sepsis
Group B strep and E.coli
35
Screening for MDD in adolescents at what age?
12-18 years of age.
36
What is the most common cause of tinnitus?
sensorineural hearing loss
37
Patient comes into your office with this?
Pearly penile papules. Present as small skin colored, dome shaped papules in a circular pattern around the coronal sulcus.
38
Patient comes in with this?
Appear solely on the glands of the penis, but are also found on the scrotum, abdomen, thighs, groin and extremity. Treatment not necessary unless lesions are bleeding or extensive. \*\*Angiokeratomas on the shaft of the penis, the suprapubic region or sacral region can be associated with fabry disease. Patients with this finding should be promptly referred.
39
Chronic daily tension type headaches treatment
Amitriptyline - helps reduce the severity and duration of chronic tension type headaches.
40
What helps reduce the frequency of migraine headaches?
Propanolol
41
What is considered first line therapy for painful diabetic peripheral neuropathy?
Pregabalin (Lyrica) - first line First line alternative is gabapentin.
42
Patient with a smooth circular area of complete hair loss on her scalp with no other skin changes
Alopecia areata Chronic, relapsing, immune-mediated inflammatory disorder affecting hair follicles that results in patchy hair loss. Treatment of choice is intralesional corticosteroid injections.
43
Patient has an elevated serum lacatate or hypotension receive isotonic IV fluids at an inital rate of? Calculate for patient who is weight 100kg.
30ml/kg in the first 3 hours using small boluses of approximately 500ml. 3000ml over 3 hours.
44
MRI of the breasts should be reserved for women with?
Very high risk for breast cancer such as those with genetic mutations, a history of breast irradiation, or a very high-risk family history.
45
Dosaging errors with medicine cups compared to oral syringe with parents.
40% of parents made dosing errors with medicine cups compared to a 17% error rate with an oral syringe. Use oral syringes for medicine and give dosages using millileters.
46
What is a common finding in patietns with celiac disease?
Iron deficiency anemia due to chronic blood loss.
47
Patient comes in with skin rash and chronic diarrhea. Previously diagnosed with eczema. CBC reveals mild microcyctic hypochromic anemia. Tissue transglutaminase antibody test is positive.
Celiac disease with both intestinal and extraintestinal manifestations (diarrhea and dermattis herpetiformis, respectively).
48
Patient with history of major depression and mania, what is contraindicated as monotherapy in treating the patient's depression?
History of major depression and mania = classified as having **bipolar I disorder.** **SSRI are insufficient as monotherapy** for controlling or preventing mania. They may even precipitate a manic episode in patients with bipolar I disorder and are contraindicated as monotherapy for these patients. Need to add **mood stabilizer** such as anticonvulsants (lamotrigine, divalproex), atypical antipsychotics (quetiapine) or litihium.
49
Takotsubo Cardiomyopathy
stressed induced cardiomyopathy. Presents with classic apical and midsegment LV hypokinesis, or apical ballooning, and a new T wave inversion with modest elevations in cardiac troponin.
50
Viral myocardiitis presentation
Fever, myalgia and signs and symptoms of heart failure following a viral syndrome.
51
What is the leading cause of cancer death in men in the US?
Lung cancer
52
A patient is being treated for opiod use disorder with buprenorphine. Which can be used as an adjuvant treatment to reduce stress related opiod cravings and increase abstience?
Clonidine (0.1-0.3mg Q6-8 hours)
53
What should be performed for all children \<6 months of age and for uncircumcised boys \<2 years of age who comes in with a fever. Uptodate on immunizations.
U/A and culture
54
Presence of RBC casts on microscopic examination of urine is pathognomic for?
Acute glomerulonephritis
55
How does acute pyelonephritis show on urine microscopy?
bacteriuria, pyuria, and possibly WBC casts
56
Acute tubular necrosis on urine microscopy?
Associated with hypotension, acute blood loss, sepsis or rhabdomyolysis. **Granular or epithelial casts** in the urine sediment (not RBC casts)
57
Patient sees you after injurying his right index finger while playing volleyball. He has pain and flexion defmority at the DIP joint. What would be an indication for further evaluation before splinting?
**Patient is unable to passively fully extend the joint.** Mallet finger, injury to the distal exsor tendor of the finger at the DIP, cuased by forceful flexion of the extended DIP joint. The iniabilty to passively extend the DIP joint completely may be an indcation of trapped soft tissue or bone that may require surgery.
58
Drug eluting stents - duration of dual antiplatelet therapy?
Drug-eluting stents. patient should be on dual antiiplatelet therapy with aspirin plus clopidogrel for a mininum of one year. Aspirin should be continued indefinitely.
59
PCV 13 and PPSV23 are recommended for patients with? Indications for PPSV23 alone is indicated for?
PCV 13 and PPSV23 are recommended for patients with chronic renal failure. Indications for PPSV23 alone in immunocompetent persons younger than 65 include chronic lung disease, DM, CHF, smoking and alcoholism.
60
Pneumococcal vaccine timing for adults
61
Bell's Palsy treatment
Valacyclovir and a tapering dose of prednisone
62
Bells palsy versus stroke
A stroke is caused by a blood clot that stops blood flow to the brain or by a blood vessel that ruptures in the brain, while Bell's palsy is linked to facial nerve damage. The eyes and forehead receive innervation from both hemispheres, while the lower face only receives innervation from the contralateral hemisphere. Acute ischemic strokes will result in contralateral facial weakness of the lower face only, with preservation of the muscles of the upper face on both sides, due to the dual innervation of the upper face. Patients will have a weak smile, but will be able to close their eye tightly and wrinkle their forehead symmetrically. Lesions that damage the facial nerve in the brainstem, or after it exits the brainstem, result in ipsilateral facial weakness involving both the upper and lower face. It doesn’t matter where the innervation is coming from; if the nerve is damaged, all the muscles on that side of the face are weak. These lesions are referred to as “peripheral lesions” because they affect the facial nerve as it exits the brainstem. Patients will be unable to wrinkle their forehead, tightly close their eye, or smile on the affected side.
63
What test is needed to confirm cushing syndrome?
Urinary free cortisol
64
Second degree Mobitz type I - how to identify on EKG
Wenckeback heart block progressive prolongation of PR interval until p wave is not followed by a QRS complex.
65
Treatment for asymptomatic second degree mobitz type I heart block
No treatment for asymptomatic. Treatment for sympomatic patients.
66
Obesity hypoventilation syndrome
Hypoventilation leading to CO retention \>45 mmHg in an individual with BMI \>30, when other causes of chronice alveolar hypoventilation hve been ruled out. The patients retain bicarbonate to compensate for the respiratory acidosis.
67
Plantar fasciitis clinical and physical findings
Most common cause of heel pain. Throbbing heel pain that is worst in the mornings with the first step after rest. Palpation of the medial calcaneal tuberosity and dorsiflexion of the affected foot will elicit sharp pain. Heel spurs are present in approx 50% of patients iwth plantar fasciitis, but can also be found in people without plantar fascitits.
68
Short duration laryngitis treatment whether viral or due to vocal overuse or abuse
No talking, whispering or throat clearning for 48 hours.
69
Treatment of anaphylais
IM epinephrine, 1:1000 dilution dosed at 0.01 mg/kg (max dose of 0.3 in children and 0.5 in adults).
70
Low dose aspirin therapy is recommended by the USPSTF for the primary prevention of cardiovascular disease in patients age 50-59 who have risk of CVD . or = to?
10% Daily aspirin use in those over 70 did not significally reduce the risk of CVD.
71
Referral of bariatric surgical evaluation is indicated for patients with a BMI of ?
BMI \> or =40 without coexisting medical problems or BMI \> or = 35 with one or more severe obesity related comorbidities such as DM.
72
Treatment for Pituitary microadenoma
Those \<10mm in size that are secretig prolactin may be treated iwth dopaminergic agent such as bromocriptine. This will lower the prolactin level and shrink the adenoma. Nonprolactin-secreting adenomas, especially those \>10 mm in size (macroadenomas), require neurosurgical intervention.
73
Indications for an adult with acute bronchitis to have a chest radiograph
Bloody sputum, rusty-colored sputum, or dyspnea, a pulse \>100, RR \>24, or a temp \>100.0. Abnormal findings on chest exam such as fremitus, egophony or focal oncoslidation.
74
Management of acute bronchitis that does not require CXR.
Dextromethorphan, guaifenesin or honey
75
Antibiotics ppx prior to dental procedures indications
Indicated for prosthetic cardiac valves, previous infective endocarditits, unrepaired cyanotic congenital heart disease or a repaired congenital defect with residendual shunt, and a cardiac transplant with valve tregurgitation due to structually abnormal valve.
76
Abx given for ppx prior to dental procedures
amoxicillin 2g
77
What is used to rule out septic arthritis?
Arthrocentesis.
78
Risk factors for septic arthritis
underlying joint disease such as RA or OA, and immunosuppresive states such as HIV infection, DM and taking immunosupressive medications.
79
What is the most appropriate psychotherapy for patients with OCD?
CBT
80
Long term PPI are associated with
Fractures, hypomagnesemia, Vitamin B12 deficiency, iron deficidenc y and acute interstitial nephritis with progression with CKD. Safe for short term use. use lowest doseage and shortest duration of therapy be used to control smptoms of gerd.
81
Nonerythematous flesh colored dome shaped paupules with central indentation on the lower back and popliteal fossa
Molluscum contagiosum Poxvirus
82
Treatment of pox virus
If lesions are asymptomatic and not inflamed, the inital treatement is observation only. If the lesions are inflammed or pruritic, then topical corticosteriod treatment can be used.
83
Treatment of acute rhinosinusitis
In the first 3-4 days, viral and bacterial rhinosinusiitis are indistinguable. Abx should not be used unless symptoms persist for 7 days or worsened after intial improvement. Use mometasone (nasonex) first. If symtpoms last more than 7 days, then use amoxicillin with or without clavulanate.
84
Age for Individualized approach for colon cancer
age 75.
85
Abnormal gross motor development findings that suggest muscular dystrophy in 18 year old
Head leg due to neck muscle weekaness in infants is a classic early finding of musclar dystrophies.
86
What findings would be most suggesitive for cerebral palsy
cross-legged posturing, neck stiffness, hyperreflexia, suggest a central cause of motor delay such as cerebral palsy.
87
What is most commonly associated with oliogohydramnios?
Posterior urethral valves Amnionitc fluid volume is regulated in part by fetal swallowing, inspiration, and urination. Some malformations of the urinary tract, including renal agenesis and persistent obstruction from posterior urethral valves lead to oliguria or anuria and are associated with oligohydramnios.
88
What are associated with polyhydramnios
Anecephaly (mcc), esophageal atreasia, intrauterine heart failure, alpha thalsemia
89
Abx for mild to moderate cellulitis to cover MRSA
Bactrim and cephalexin
90
iron deficiency anemia
low normal MCV lower serum ferritin Low reticulocyte index
91
High reticulocyte index would be seen in
hemolysis
92
In many normally developing infants, there may be imperfect coordination of eye movements and alignment during early days and weeks. When should you worry and give an ophthalmogic referral?
6 months.
93

2018 ITE (1 decks)

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