ITE 2020 Flashcards by Halley Flammer

NH resident tests positive for flu. How do you manage all the other residents?

All aysx residents should get chemoprophylaxis

Only do it if there are two lab confirmed cases on the unit

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How do you decide if you should tx for PID?

If there is enough of a clinical suspicion
Don’t wait for testing
Exam: CMT, uterine tenderness
Often WBCs on wet mount
only need TVUS if you are concerned for tubo-ovarian abscess

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Gender affirming tx for F to M

testosterone

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FTT pt, while checking BP you see capo pedal spasms. What electrolyte disturbance?

HypoCalcemia

Trousseau sign - spasmodic contraction of muscles caused by pressure on the nerves that control them

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Hypercalcemia would present with

Hyperrreflexia

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Pt with non Hodgkins lymphoma presents with SOB and CXR shows large mass around SVC. Now what?

This is SVC syndrome
Seen in lung CA and lymphoma
Admit pt to hospital and start steroids, chemo, radiation
NOT Bronchoscopy

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Most likely complication of HIT

Thrombosis (NOT BLEEDING OR DIC!)
This is different than other causes of thrombocytopenia
DVT and PE are most common
Tx - stop heparin, start argatroban/danaparoid/fondaparinux/bivalirudin (non heparin AC)

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Class I HF

heart dz with no syx or limitations in activity

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Class II HF

Mild syx with normal physical activity

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Clas III HF

Significant limitation of activity incl symptoms with less than normal activities

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Class IV HF

Syx at rest, unable to carry on activity w/o discomfort

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pt presents for her 2nd bartholian abscess. Tx?

marsupialization - doesn’t matter how long ago the last one was

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IBD syx with perianal fistual

Crohn’s

UC doesn’t NOT have perianal lesions

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abortive migraine tx in pregnancy

Tyl
Reglan
NOT Triptan (not safe after 1st trimester) or Dihydroergotomine (too similar to oxytocin)

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Longest acting insulin

Tresiba

42 h

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what is an instrumental ADL

Activities necessary to live independently (telephone, doing housework, preparing meals, taking meds, finances)
others are self are ADLs and don’t require independent living

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significant risk of anorexia that is regulated by HPA axis?

Bone loss

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ways to remove impacted cerumen

irrigate with warm water

or carbide peroxide ear drops

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young patient has pain of finger x days. No injury. erythema on tip of affected finger w/ several vesicles that have an opaque fluid. Distal digest pup is soft but tender. Dx and Tx

Herpetic whitlow - HSV
self-limited
tx - pain control and dressings to prevent spread

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fluid filled bump on distal surface of distal finger

Digital mucos cyst (aka cutaneous myxoid cyst)

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when should pts be on ASA?

If + h/o CVA or MI

Otherwise, it should be stopped. Even if ACSVD >10%

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what med can give false + for amphetamines?

bupropion
labetalol
ranitidine
trazodone

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false positive for opioids

levofloxacin

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false positive for cannabinoids

PPIs

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False positive for benzos

Sertraline

When do you give O2 to a pt with CP?

If pulse ox <90% | Low utility with normal pulse ox

Pt wants to focus on exercise for weight loss, how do you counsel?

exercise alone does improve insulin, glycemic control. Better or BP and CV risks and maintaining weight - Only moderately beneficial for weight loss - need diet changes too

In which pts are DOACs contraindicated?

Mechanical heart valves | Need Warfarin

most common syx of EtOH w/d in elderly?

Confusion | NOT tremor or tachycardia

Most common cause of SBO

``` Intestinal adhesions (60-75%0 Neoplasm (13-20%) Hernia (2-15%) Volvulous (<5%) Constipation is rare ```

Auscultation finding in aortic regurgitation

"blowing" decrescendo diastolic murmur at rUSB, loudest at LLSB

which iron supplement is preferred in CKD pts?

Ferric citrate | similar to IV Iron

medicare part A

Covers hospital and hospice

Medicare part B

covers outpatient services and labs

Medicare part D

Prescriptions

Polymyalgia reumatica is associated with what other chronic inflammatory condition?

Giant cell arteritis

What surveillance labs do CRC survivors need?

CEA | NOT CBC or LFTs

Effects of smoking on pregnancy

Fetal growth restriction and lower birth weight Quitting smoking - increases birth weight and reduces risk of preterm delivery NO effect o if woman develops pree

At what age should girls have primary amenorrhea w/u?

What combo therapy should you consider for pt with T2DM and HTN for BP control?

CCB + ACEI | Better outcomes than HCTZ + ACEI

Pt has frostbite and undergoing rewarming, what do you give in addition?

NSAIDs | rewarming causes and inflammatory response

Non atopic asthma (ie negative skin testing, low IgE) ASA sensitivity Associated with?

``` Nasal polyps ("intrinsic asthma") ```

T2DM pt is on insulins while pregnant. Now s/p sVD, what do you do?

restart metformin/oral agents

Tx for HFrEF and LBB and h/o angiodema to ACEI

SA node ablation | Entresto would be contraindicated

if you suspect septic arthritis in kiddo w/ nl xray get?

CBC ESR CRP | If positive get US to look for effusion to tap

medications that cause hypercalcemia

Lithium | Thiazide diuretics

Increase in Cr after starting ACEI suggests?

renovascular HTN | Get MRA of renal arteries

how to decide COPD tx based on Gold group

A - SABA or LABA monotherapy B - LAMA or LABA mono therapy C - LAMA (itratropium) D LAMA, OR ICS/LABA

Anal fissure not improving with sits baths or TOP nifedipine

Botox

COPD pt should be on oxygen if SPO2 is

<88%

Pt has anaphylaxis to eggs. How do you counsel about flu vax?

Can receive any version of the flu vax in the office.

While working pt up for cirrhosis, what medicine should they avoid?

NSAIDs NOT Tylenol D/t risk of renal insufficiency Tyl and Statins are safe in cirrhosis

type of hallucinations associated with Parkinson's?

Visual | NOT auditory

Tx of scaphoid fx with displacement?

Surgery high risk of AVN if non displaced - thumb spica

Pt has hirtruism with regular menses. Next?

OCPs x 6 months | c/f idiopathic hirsutism

pt ran out of BP meds, no SBP >180 and had a HA. What to do?

po labetalol (or clonidine, captopril, prazosin) until SBP <180 then restart home meds

USPTF screening recs for mammogram?

biennial mammo for women 50-75

benefit of low salt diet in CKD?

Lowers BP | NOT - change in mortality of time to HD

When do you offer daily hydroxyurea to SCD pt?

When pts have 3 or more vast-occlusive pain crisis/year or if they have daily pain Can be offered to as young as 9 m/o Goal is to reduce incidence of acute chest (NNT 6) PCN ppx to prevent pneumococcal sepsis is recommended in kiddos until age 5

Only type of contraception that does not require back up method immediately after placement regardless of where she is in her menses?

Paraguard

How do you confirm clearance of H pylori?

breath or stool Ag test 1 month s/p tx | d/c PPI prior to test

Pt has SLE syx, ANA +, what other tests confirm dx?

Low complement

Anti CCP ab

Rhematoid Arthritis

Anti smooth muscle Ab

autoimmune hepatitis

anti-centromere ab

systemic sclerosis

HLA-B27

seronegative spondyloarthropathy (psoriatic arthritis)

Tx for Etoh and opioid abuse?

Naltrexone

how long do you keep teen out of sport for heat cramps?

Until syx resolve

``` Pt with fatigue weight loss patches of non pigmented skin on hands Na 132 K 5.3 Next step? ```

ACTH stim test w/u for Addison's (adrenal insufficiency) suspect autoimmune etiology d/t vitiligo

pt uses heating pad on back. Now has reticular brown hyper pigmented skin changes. Dx?

Erythema ab igne | d/t heating pad eppsoure

4 priniciples of medical ethics

autonomy beneficence nonmaleficence justice

middle aged man has meniscal tear w/o OA. Tx that will have the best long term outcomes?

PT | arthorscopy hasn't shown significant benefit for long term pain or function

which abx can increase INR for pts on warfarin?

Bactrim, flatly, fluconazole (increase warfarin by 25%) | Rifampin DECREASES INR

dude has grown rash with red/brown macula's. Pink under woods lamp. Dx?

Erythrasma (Corynebacterium minutissima) | Tx erythromycin TOP BID until rash resolves

Pathophys of achalasia?

Aperstalsis in distal 2/3s of esophagus w/ incomplete lower esophageal sphincter relaxation Associated with loss of ganglion cells in esophageal wall --> loss of peristalsis and failure of relaxation of lower esophageal sphincter. Incomplete LES relaxation is highly specific for achalasia

what medicines can increase risk of dementia?

anticholinergic's and other sedatives

what do you do for preggo exposed to flu?

vax and Tamiflu

Tx for recurrent c. diff after course of vanc?

Fidaxomicin 299mg BID x 10 days | Can offer flatly if diaxomicin not available

when do you start statins in T2DM?

> 40 y/o

IVDU progressive DOE CXR b/l perihilar shadowing bronch bx would reveal?

Foreign body granulomas | caused by injection of crushed pills, talc etc

non infectious cause of injected clear?

Episcleritis Self limited idiopathic w/ mild discomfort and focal hyperemia NO discharge

ITE 2020 Flashcards

(81 cards)