MKSAP Flashcards
(279 cards)
1
Q
in the tx of chronic stable angina, the BB dose should be titrated to achieve a resting HR of ___ and approximately ___% of the HR that produces angina with exertion
A
resting HR 55-60
75% of HR that produces angina with exertion
2
Q
what is ranolazine
A
novel anti angina agent that can be used in add’n to baseline tx with BB, CCB, and a long acting nitrate
3
Q
in the setting of continued angina despite maximal medical therapy, consider _______
A
coronary angiography
4
Q
what finding on echo during chest pain excludes coronary ischemia
A
normal wall motion
5
Q
chest pain, dyspnea, asymmetric leg edema, elevated central venous pressure, tachypnea, tachycardia
A
PE
6
Q
best test to look for PE
A
CT pulmonary angiography
7
Q
QRS tachycardia in setting of known structural heart disease (esp prior MI)
A
consider v tach until proven otherwise
8
Q
supra ventricular tachycardia with aberrancy
A
WPW
9
Q
an ____________ is indicated for an acute coronary syndrome with cardiogenic shock that is unresponsive to medical therapy, acute mitral regurgitation 2/2 papillary muscle dysf, ventricular septal rupture, or refractory angina
A
intra aortic balloon pump
10
Q
in patients with MI, early IV ____ tx reduces infarct size, decreases frequency of recurrent myocardial ischemia, and improves short and long term survival
A
BB
11
Q
an adenosine nuclear perfusion stress test is contraindicated in patients with significant ______ disease
A
bronchospastic (don’t give to patients with asthma)
12
Q
______ stress echo is an appropriate choice in patients who are unable to exercise and are not hypertensive at rest
A
dobutamine
13
Q
the presence of a new systolic murmur and respiratory distress several days after an acute MI indicates the possibility of either ______ or ______
A
ventricular septal rupture or mitral regurgitation 2/2 papillary muscle rupture
14
Q
ventricular free wall rupture usually occurs ___ days after acute MI and leads to pericardial tamponade > sudden hypotension and death
A
1-4 days
15
Q
right ventricular infarction occurs in 20% of patients with ______ wall STEMI
A
inferior
16
Q
hypotension, clear lung fields, and jugular venous distension in setting of inferior wall STEMI
A
right ventricular infarction
17
Q
________ following STEMI results in respiratory distress, hypotension, new systolic murmur, and a palpable thrill
A
ventricular septal defect
18
Q
mechanical complications (such as ventricular septal defect) occur ____ days after STEMI
A
2-7 days
19
Q
(early/late) complications following STEMI: cardiogenic shock, ventricular septal defect, mitral regurgitation, free wall rupture, left ventricular thrombosis
A
late
20
Q
how to treat A fib with RVR in a patient who is hemodynamically unstable
A
shock (any arrhythmia with hemodynamic instability)
21
Q
how do you treat cardiac arrest occurring within 48 hours of an acute transmural MI?
A
standard post MI care (do not need to shock a rhythm)
22
Q
treat NY heart assoc class IV heart failure with _____
A
digoxin (alleviates symptoms and decreases hospitalizations, but provides no survival benefit)
23
Q
patients with new onset heart failure and angina should be evaluated with:
A
cardiac cath and angiography (if they are possible candidates for CABG)
24
Q
all patients with new onset heart failure should be evaluated with
A
echo
25
treat all systolic heart failure with ___ and ____
ACEi and BB
26
treat NY heart assoc functional class III or IV heart failure patients (symptoms develop with mild activity) with:
spironolactone (reduces mortality)
27
fixed splitting of S2 and a right ventricular heave
atrial septal defect
28
failure of a prosthetic aortic valve often leads to:
aortic insufficiency
29
transthoracic echo is indicated when a grade __/VI systolic murmur is heard on exam, in presence of any diastolic or continuous murmur, or if a new murmur is diagnosed in the interval since a normal physical
III
30
best test for evaluating patients with suspected asthma who have episodic symptoms and normal baseline spirometry
methacoline challenge test
31
what is the PC 20
the methacoline dose that leads to a 20% decrease in the FEV1.
32
a PC 20 less than __ is consistent with asthma
4
33
a PC 20 of ___ to ___ suggests some bronchial hyperactivity and is less specific for asthma
4-16
34
normal PC 20
above 16
35
increased residual volume/total lung capacity ratio, normal FEV1/FVC ratio, low maximum respiratory pressures, normal DLCO
neuromuscular respiratory failure
36
what test can you use to dx vocal cord dysf
laryngoscopy
37
patient with throat or neck discomfort, wheezing, stridor, anxiety, does not respond to asthma therapy, decreased lung volumes, normal oxygen sat
vocal cord dysf
38
patient with systemic sclerosis, worsening fatigue, DOE, clear lung fields on exam
pulmonary arterial hypertension
39
what does laryngoscopy show in vocal cord dysf during inspiration
adduction of vocal cords during inspiration
40
PFTs in patients with pulmonary arterial hypertension
isolated decreased DLCO in setting of normal air flow and lung volumes
41
loud P2, fixed split S2, pulmonic flow murmur, tricuspid regurgitation
physical signs of elevated pulmonary artery pressure
42
treat a complicated pleural effusion with:
chest tube drainage (antibiotics not enough)
43
what makes a pleural effusion complicated?
assoc with PNA, presence of located pleural fluid, pleural fluid with pH less than 7.2, glucose level less than 60, LDH greater than 1000, positive Gram stain or culture, or presence of gross pus in the pleural space
44
dullness to percussion and absent or decreased tactile fremitus and breath sounds over the affected area
pleural effusion
45
a patient with tuberculous pleural effusion typically presents with a _____ (cell type) predominant exudative effusion
lymphocyte
46
test to evaluate a tuberculous pleural effusion
pleural biopsy
47
manage persistent asthma during pregnancy with:
inhaled corticosteroids
48
treat inadequately controlled (by inhaled corticosteroids) persistent asthma with:
long acting beta agonist (salmetrol or formoterol)
49
abx for moderate to severe exacerbation of COPD
3rd gen cephalosporin + macrolide OR just a fluoroquinolone
50
patients in COPD exacerbation who have mod-severe dyspnea, use of accessory muscles, RR>25, and PH<7.35 with PCO2>45 would benefit from what type of treatment?
noninvasive positive pressure ventilation
51
subacute disease progression and bilateral alveolar filling opacities on CXR without environmental exposure or smoking history
cryptogenic organizing PNA
52
DVT ppx in hospitalized, medically ill patients
unfractionated heparin, LMWH, fondaparinux
53
noninvasive test to dx acute PE (esp in presence of CKD)
VQ scan
54
evaluate low probability DVT with:
D dimer test (rule out with a negative test)
55
test to evaluate for nephrolithiasis
helical CT scan
56
initial screening for acute abdomen
supine and upright abdominal X rays (look for bowel obstruction or perf)
57
severe abdominal pain less than 24 hours in duration
acute abdomen
58
abd pain, back pain, syncope
AAA rupture
59
dx AAA rupture
CT scan
60
elderly pt with atherosclerosis, crampy abdominal pain and bloody stool
ischemic colitis
61
finding on colonoscopy of patchy segmental ulcerations
ischemic colitis
62
test to evaluate for diverticulitis
contrast enhanced CT scan
63
LLQ pain, fever, elevated WBC
diverticulitis
64
dx of HUS
peripheral blood smear
65
tx of HUS
no abx, plt transfusion is controversial
66
diarrhea and tenesmus within 6 weeks of radiation therapy
radiation proctitis
67
dx radiation proctitis
flexible sigmoidoscopy
68
dx chronic pancreatitis (ab pain, malabsorption, endocrine insufficiency)
abdominal CT
69
management of diarrhea predominant IBS
high fiber diet is initial recommendation
70
tx salmonella gastritis
it is self limited in healthy people
71
elevation of ALT and AST, direct hyperbilirubinemia
hepatocellular injury
72
elevation of alk phos and minimal elevations of AST and ALT
cholestatic injury
73
definitive tx for patients with symptomatic gallstone disease
cholecystectomy
74
pattern of liver enzyme findings in primary sclerosing cholangitis
cholestatic pattern
75
pattern of liver enzyme findings in acute hepatitis
marked elevation of aminotransferases
76
how to evaluate GERG alarm symptoms
upper endoscopy
77
tx erosive esophagitis
PPI
78
linear gastric ulcers or erosions in the hiatal hernia sac
Cameron lesions
79
in GI bleed of obscure origin (i.e., initial work up already completed), how do you identify a bleeding source?
repeat upper endoscopy--will identify lesions that are difficult to see or bleed intermittently
80
pt older than 60, LLQ pain, urgent defecation, red or maroon rectal bleeding, abdominal pain out of proportion to exam
ischemic colitis, does not require transfusion
81
cause of painful hemtochezia, rectal outlet bleeding, pt with constipation
anal fissures
82
screen for HCC in patient with Hep B with what test?
liver u/s
83
anti smooth muscle antibody
autoimmune hepatitis
84
cirrhosis in patients with obesity, metabolic syndrome
non alcoholic steatohepatitis
85
pruritus, jaundice, autoimmune disorders, women older than 25 years, antimitochondrial antibodies
primary biliary cirrhosis (B for babe-women, m for mama-mitochondrial)
86
elevated alk phos, modest elevations of aminotransferases, chronic condition that presents in 4th or 5th decade of life, associated with UC
primary sclerosing cholangitis (more common in men than women)
87
first line therapy for hepatic encephalopathy
lactulose
88
management of new onset ascites
paracentesis
89
saag calculation
serum albumin level - ascitic fluid albumin level
90
saag greater than 1.1
portal HTN
91
saag less than 1.1
assoc with infection, inflammation, or low serum oncotic pressure (such as nephrotic syndrome, malignancy, tb)
92
causes of portal HTN
cirrhosis, constrictive pericarditis, right sided heart failure, budd chiari syndrome
93
development of kidney failure in patients with portal HTN and normal renal tubular function. intense renal vasoconstriction leads to a syndrome of AKI
hepatorenal syndrome (after exclusion of pre renal azotemia, renal parenchymal disease, or obstruction)
94
most effective tx for hepatorenal syndrome
liver transplant
95
skin finding assoc with inflammatory bowel disease which manifests as small, tender nodules on the anterior tibial surface
erythema nodosum
96
first line tx for induction and maintenance of remission in mild to moderate UC is
mesalamine or another 5-aminosalicylate agent (sulfasalazine)
97
when do you use oral prednisone in UC
when sxs do not respond to 5-aminosalicylates
98
when do you use azathioprine or 6-mercaptopurine in UC
patients who have incomplete disease remission while on corticosteroids
99
chronic watery diarrhea without bleeding, dx made by histologic examination of colonoscopic bx specimen
microscopic colitis
100
initial tx for microscopic colitis
loperamide, diphenoxylate, bismuth subsalicylate
101
for what age COPD patients would you recommend the flu vaccine
all ages
102
who should get screened for AAA and when?
one time between ages 65-75, men who have smoked
103
at what age would you recommend the zoster vaccine
60 years, regardless of h/o prior infection
104
when can you omit the tetanus booster in a patient with an injury
received tetanus booster within 5 years and in patients with clean minor wounds who received the vaccination within 10 years
105
how often should you do sigmoidoscopy for colon cancer screening
q5y
106
how often should you do FOBT
q3y
107
syncopal episode in patient with advanced systolic heart failure and underlying ischemic heart disease
vtach
108
defn of orthostatic hypoTN
systolic drops by 20 or diastolic drops by 10 within 3 minutes of standing
109
sudden loss of consciousness irrespective of body position and lack of preceding symptoms
consider intermittent complete heart block as a cause of recurrent syncope
110
initial tx in management of patient with cocaine induced agitation
benzos
111
how to tx spinal stenosis
surgery
112
how to test for vertebral osteomyelitis (red flags include history of IV drug use, fever, elevated ESR)
urgent spine MRI
113
tx acute nonspecific back pain
acetaminophen (not bed rest!)
114
back pain, muscle weakness, loss of bowel/bladder control
spinal cord compression
115
how to dx spinal cord compression due to bone metastases
MRI
116
how to dx cough variant asthma (chronic cough not due to GERD, post nasal drip)
trial of inhaled albuterol (cough resolves)
117
all patients with hemoptysis should have a:
CXR
118
patients with hemoptysis and at high risk for lung cancer should have a:
Chest CT and fiberoptic bronchoscopy, even in CXR is normal
119
tx acute bronchitis
symptomatic measures, no abx
120
at what BMI do you consider bariatric surgery
35 with obesity related morbidities or 40 without morbidities if medical management has been unsuccessful
121
in all patients with a BMI greater than __, obtain a blood glucose level, serum creatinine level, fasting lipid profile to assess for comorbidities
25
122
manage a patient with involuntary weight loss, no focal sxs, no abnormal labs, negative CXR
reevaluate in 6 months (then search for malignancy if no cause can be found for weight loss)
123
well demarcated, rapidly spreading area of warmth, swelling, tenderness, and erythema that may be accompanied by fever
cellulitis
124
screening for hearing impairment
whispered voice test or handheld audioscopy
125
anticholinergic agents that are effective for treating urge urinary incontinence
oxybutynin and tolterodine
126
elderly patient with HTN
add a thiazide diuretic (more effective than ACEi/ARB)
127
defn of stage 2 HTN
160/100
128
tx stage 2 HTN
2 drug therapy
129
pancytopenia, low retic count, hypo plastic bone marrow
aplastic anemia
130
in _____, accumulated oxidized hemoglobin remains adherent to the erythrocyte membrane, which creates an adjacent membrane-bound clear zone
G6PD deficiency (bite cells)
131
low mean cellular volume, target cells, normal results on iron studies
thalassemia
132
peripheral blood smear finding in patient with prosthetic valve
schistocytes
133
spherocytes on blood smear, complication of lymphoid malignancies
warm antibody mediated hemolytic anemia
134
prolonged PT, PTT, high D dimer, reduced serum fibrinogen and plt count, microangiopathic hemolytic anemia
dic
135
personal and family h/o bleeding, prolonged bleeding time, borderline elevated activated partial thromboplastin time, low factor 8 level
von willebrand disease
136
right sided heart failure and peripheral edema, abnormal venous waveforms, fixed splitting of S2, loud or palpable pulmonic valve closure, tricuspid regurgitation, right ventricular heave, clear lungs (in patient with sickle cell)
pulmonary HTN
137
management of acute chest syndrome in patient with sickle cell
exchange transfusion
138
how to dx osteonecrosis of the hip if x rays are normal
MRI
139
when does HIT occur
5-10 days after starting heparin therapy (t1/2 of coag factors)
140
first line tx ITP
corticosteroids
141
for how long should you anticoagulate a patient with antiphospholipid syndrome after a first DVT?
lifelong
142
h/o thrombotic event (including recurrent fetal loss), assoc with lupus anticoagulant or persistently elevated levels of anticardiolipin or beta 2 glycoprotein I antibodies
antiphospholipid syndrome
143
decreased anion gap in the presence of anemia, proteinuria, hypercalcemia, and renal failure
multiple myeloma
144
monoclonal gammopathy of undetermined significance is characterized by a serum monoclonal protein level less than __g/dL with the overt clinical features of myeloma and less than __% plasma cells in the bone marrow
3g/dL, 10%
145
myeloblasts that contain Auer rods
AML
146
presence of BCR/ABL oncogene, smear showing increased granulocytes with marked left shift, hyper cellular bone marrow with marked myeloid proliferation
CML
147
worsening sore throat despite abx tx, fever, dysphagia, pooling of saliva, muffled voice
peritonsillar abscess complication of Group A beta hemolytic strep
148
abx of choice for tx acute otitis media in adults
amoxicillin
149
tx asx bacteriuria in pregnant patients with
ampicillin, amoxicillin, or nitrofurantoin
150
outpt management for pyelo
oral fluoroquinolone
151
tx PJP w/ hypoxia (arterial PO2 < 70)
bactrim and corticosteroids
152
most sensitive test for dx HIV in acute stage
HIV RNA viral load
153
how can you reduce the risk of ventilator assoc PNA
semi erect positioning
154
severe, rapidly progressive PNA, esp during flu season, in those with cavitary infiltrates on CXR
consider MRSA--add vancomycin or linezolid to CAP regimen of cefotaxime and levofloxacin
155
tx CAP in pt with no comorbidities with
azithro
156
long term outcome of Meniere disease
resolution of vertigo, continued hearing loss
157
most specific autoantibody for SLE
anti smith (anti-Sm)
158
tx raynaud
nifedipine (vessel specific)
159
how do you correct the serum sodium in a diabetic?
(glucose creates osmotic force that pulls water out of cells and into intravascular space) measured sodium + (glucose - 100)/100 x 1.6
160
management in patients older than 45 with increase in heartburn sxs and ab pain
EGD
161
Hep A follow up
report to public health dept
162
a cause of hyper coagulability and hemolytic anemia that is intermittent, caused by a defect in hemopoietic cells that renders them vulnerable to complement mediated lysis
paroxysmal nocturnal hemoglobinuria (sleep causes a mild acidosis)
163
test to evaluate for paroxysmal nocturnal hemoglobinuria
Ham's acidification test
164
treatment for a stable, supra ventricular tachycardia
1. vagal maneuver, 2. small bolus of adenosine (can use digoxin as chronic treatment)
165
dermatitis, dementia, diarrhea
pellagra (niacin def)
166
1st line tx COPD together with smoking cessation and pulmonary rehab
inhaled anticholinergics (ipratropium)
167
tx infectious arthritis in a 25 year old
ceftriaxone
168
ceruloplasmin levels in Wilson
decreased
169
urinary copper levels in Wilson
increased
170
treatment of choice for CNS toxoplasmosis
pyrimethamine, sulfadiazine, leucovorin
171
affect of edrophonium in patient with MG
transient increase in strength of handgrip, upward gaze (quick on/off)
172
ppx tx for portal HTN
beta blockers (block mesenteric artery dilatation, resulting in reduced portal inflow)
173
drug in elderly that can cause a hypokalemia that manifests as weakness and muscle cramps, or a hyponatremia that presents as lethargy/confusion/weakness (also, increased uric acid, increased LDL, hyperglycemia)
HCTZ
174
first line tx for ITP
trial of oral corticosteroids
175
dysfunctional collagen results in capillary fragility, poor wound healing, abnormal hair development, gum disease
Vit C def
176
tx of neurosyphilis
penicillin G, 3 million units, q4h for 10-14 days
177
management of progressive, unstable angina
cardiac cath and coronary angiogram
178
tx GBS
plasmapheresis or IVIG
179
bacterial meningitis of gram positive cocci in pairs in a 20 year old
strep pneumo
180
tx for acute MI with ST segment elevations of more than 2mm in two contiguous leads or a new LBBB
immediate repercussion with IV thrombolytics or coronary balloon angioplasty
181
how to reduce duration of flu if they have been sick for less than 2 days
amantadine and inhaled oseltamivir (do not base off viral antibody titers as they do not rise during acute phase of the illness)
182
type _ RTA is assoc with sjogren, SLE
I-distal
183
type _ RTA is assoc with diabetic nephropathy
IV-hyporenin, hypoaldosterone
184
type _ RTA is assoc with nephrolithiasis
I-distal
185
type _ RTA is assoc with bone disease
II-proximal
186
type _ RTA is assoc with hyperkalemia
IV
187
type _ RTA has urine pH > 5.5
I-distal
188
urine pH in hyperchloremic metab acidosis due to diarrhea (GI bicarb loss)
urine pH <5.5
189
RTA type _ assoc with multiple myeloma
II
190
effect of handgrip on afterload and volume of regurgitation murmurs and VSD
increases afterload, increases murmur volume in regurg murmurs and VSD
191
valsalva (increases/decreases) venous return
decreases
192
drug to treat vfib and vtach
amiodarone
193
drug to treat torsades
mag
194
drug to treat 1st degree AV block and 2nd Degree type I
atropine
195
most common bacterial cause of diarrhea
campylobacter
196
travel diarrhea
ETEC
197
AEIOU mnemonic
when to give dialysis: acidosis, electrolytes (na/k), ingestion (toxins), overload (chf, edema), uremia (pericarditis)
198
rbc urine casts
glomerulonephritis
199
wbc urine casts
acute interstitial nephritis, pyelo, interactions with drugs (Bactrim, pcn, cephalosporins)
200
muddy brown urine casts
ATN
201
waxy urine casts
CKD
202
plt disorder, glycol IIb-IIIa
Glanzmann's
203
plt disorder, glycoprotein Ib
Bernard Soulier
204
meds (2) for prolactinoma (first line tx)
cabergoline, bromocriptine
205
indications for CABG
L main dz, 3 vessel dz (2 vessel dz + DM), >70% occlusion, pain despite maximum medical tx, or post-infarction angina
206
can't do EKG stress test if:
old LBBB or baseline ST elevation OR on digoxin. do exercise echo instead
207
avoid what before MUGA nuclear medicine test that shows perfusion of heart
theophylline, caffeine
208
new systolic murmur 5-7 days post MI
papillary muscle rupture
209
cannon A waves post MI
AV dissociation, either V fib or 3rd degree block
210
step up in O2 concentration from RA to RV after MI
ventricular septal rupture
211
acute severe hypoTN post MI
ventricular free wall rupture
212
5-10 weeks post MI, pleuritic CP, low grade temp
Dresslers, autoimmune pericarditiis, tx with NSAIDs and ASA
213
CP that occurs with rest, worse at night, migraine headaches, worse with ergonovine stimulation test
prinzmetal's angina, tx with CCB or nitrates
214
SEM cresc/decresc, louder w/ squatting, softer w/ valsalva. + parvus et tardus
aortic stenosis
215
SEM louder w/ valsalva, softer w/ squatting or handgrip.
HOCM
216
Late systolic murmur w/ click louder w/ valsalva and handgrip, softer w/ squatting
MVP
217
holosystolic murmur radiates to axilla w/ LAE
mitral regurg
218
Holosystolic murmur w/ late diastolic rumble in kids
VSD
219
Continuous machine like murmur-
PDA
220
wide and fixed split S2
ASD
221
Rumbling diastolic murmur with an opening snap, LAE and A-fib
mitral stenosis
222
Blowing diastolic murmur with widened pulse pressure and eponym parade.
aortic regurg
223
if patient is young, comes in with SOB, no cardiomegaly on CXR, consider ___
primary pulmonary HTN
224
young pt with SOB with sxs of CHF w/ prior h/o viral infection
myocarditis, coxsackie B
225
PCWP in CHF
elevated (estimates the pressure of the left atrium)
226
Pulmonary artery pressure in pulmonary HTN
elevated
227
CHF: EF < __%
55%
228
digoxin's role in CHF
decreases sxs and hospitalization, does not improve survival
229
transudative pleural effusion
CHF, nephrotic, cirrhotic
230
low pleural glucose, transudative pleural effusion
rheumatoid arthritis
231
high lymphocytes in transudative pleural effusion
TB
232
bloody transudative pleural effusion
malignant or PE
233
exudative pleural effusion
cancer, parapneumonic
234
light's criteria for transudative pleural effusion
LDH<200, LDH eff/serum
235
first step if you suspect PE
give heparin first, then VQ scan or spiral CT, pulmonary angiography is gold standard
236
tx ARDS
mechanical ventilation with PEEp
237
1. ) PaO2/FiO2 < 200 (<300 means acute lung injury) 2.) Bilateral alveolar infiltrates on CXR
3. ) PCWP is <18 (means pulmonary edema is non cardiogenic
ARDS
238
new clubbing in a COPDer
hypertrophic osteoarthropathy, get a CXR bc likely lung cancer
239
1cm nodues in upper lobes w/ eggshell calcifications.
silicosis
240
important preventative measure in silicosis
yearly TB test
241
Reticulonodular process in lower lobes w/ pleural plaques.
asbestosis
242
Patchy lower lobe infiltrates, thermophilic actinomyces.
hypersensitivity pneumonitis (farmer's lung)
243
Hilar lymphadenopathy, ↑ACE erythema nodosum
sarcoidosis
244
MC lung cancer in non smokers
adenocarcinoma--in scars of old PNA
245
patient with kidney stones, constipation, malaise, low PTH and central lung mass
squamous cell carcinoma, paraneoplastic syndrome 2/2 PTH-rp
246
CXR showing peripheral cavitation and
| CT showing distant mets?
large cell carcinoma
247
patient with shoulder pain, ptosis, constricted pupil, facial edema
superior sulcus syndrome from small cell carcinoma
248
SIADH paraneoplastic
from small cell
249
lambert eaton paraneoplastic
from small cell
250
AST and ALT in 1000s after surgery or hemorrhage
shock liver ischemic hepatitis
251
causes of elevated D bilirubin
obstructive, dubins-j, rotor
252
causes of elevated I-bilirubin
hemolysis, gilbert, criggler-najjar
253
elevated alk phos, normal GGT, normal Ca
page's disease (tx with bisphosphonates)
254
HIV drug with SE GI, leukopenia, microcytic anemia
ziduvodine
255
post exposure ppx HIV
AZT, lamivudine, nelfinavir for four weeks
256
tx pcp in sulfa allergic patient
trim-dapsone or primaquine-clinda
257
pcp ppx in pt who is allergic to sulfa
dapsone, or atovaquone
258
never do a ___ on a neutropenic fever patient
Digital rectal exam
259
Tick bite, no rash, myalgia, fever, HA,
| ↓plts and WBC, ↑ALT
Ehrlichiosis! Can dx w/ morulae
260
(hypo/hyper) Ca: prolonged QT
hypo (also Chvostek, Trousseau)
261
(hypo/hyper) Ca: shortened QT
hyper
262
paralysis, ileus, ST depression, U waves
hypokalemia
263
BUN/Cr ratioif >20/1
pre-renal azotemia
264
#1 cause of death in CKD
CVD so keep LDL<100
265
tx normochromic normocytic anemia in CKD
give EPO
266
dx DM2
fasting over 126, random over 200, 2hr glucose tolerance test over 200, or venous HbA1c over 6.5%
267
how to manage hyperglycemia in a hospitalized patient
basal and rapid acting preprandial insulin administration
268
tx diabetic retinopathy
pan retinal photocoagulation
269
tests to dx DKA
blood glucose less than 250, arterial pH<7.3, serum CO2<15, positive serum or urine ketones
270
tx hyperglycemic hyperosmolar syndrome
IV fluids and tx predisposing factor such as infection, MI, new kidney insufficiency
271
tx DKA
insulin drip
272
LDL goal in patient with zero or one risk factor
160 or below
273
when is fibrate therapy indicated
triglycerides over 200 in setting of elevated non HDL cholesterol levels
274
how to confirm dx of hashimoto
look for TPO antibodies (but not necessary if you're merely diagnosing hypothyroidism, then you just do the T4 and TSH)
275
when do you do an FNA on a thyroid nodule
when it is greater than 1cm or if the patient has cancer risk factors
276
management of pregnant woman with hypothyroidism
recheck TSH, keep it in the lower range of normal. pregnancy increases levothyroxine requirements by 30-50% in the first trimester
277
medical tx graves dz
atenolol and methimazole
278
when would you pursue further testing of an incidentaloma
hyper secretion of glucocorticoids and catecholamines
279
best screening test for hyperaldosteronism
ratio of serum aldo to plasma renin activity (ratio greater than 20 is consistent with the disease)
