Nuggets Flashcards
(217 cards)
1
Q
first line treatment of onychomycosis
A
terbinafine or itraconazole
2
Q
types of esophageal CA
A
adenocarcinoma - distal to mid *GERD
SCC - upper *alcohol, tobacco
3
Q
patients with late life depression are at greater risk for: ?
A
alzheimer disease and vascular dementia
4
Q
what medications are used acutely and for prevention for patients with cirrhosis and variceal hemorrhage?
A
acute - IV octreotide
chronic - BB
Both decrease elevated portal venous P
5
Q
treatment of ureterolithiasis associated with infection, AKI, or severe pain and has failed initial measures?
A
decompression with percutaneous nephrostomy or ureteral stent placement
6
Q
tick paralysis etiology
A
neurotoxins in the tick saliva are transmitted to host over 4-7 days of tick attachment
tx = tick removal
7
Q
iritis = ?
A
anterior uveitis
8
Q
modifiable risk factors for c diff (2)
A
recent abx
gastric acid suppression
9
Q
UTI abx contraindicated in pregnancy (3)
A
tetracyclines
fluoroquinolones
TMP-Sulfa
10
Q
meds that should be started at time of dx of peripheral artery disease (2)
A
ASA
statin
11
Q
chronic pancreatitis
A
sxs = abdominal pain (relieved by sitting up) + fat malabsorption dx = MRCP or abd CT showing pancreatic calcifications
12
Q
cluster HA
A
- men
- episodic HA 1-8x/day over period of weeks
- orbital, supraorbital, or temporal pain that is UNILATERAL
- autonomic sxs and restless agitation
13
Q
high potency steroids
A
flucinonide
betamethasone
14
Q
management of ADPKD
A
control of risk factors for CV and CKD - statins
ACE inhibitors
dialysis, kidney transplant
15
Q
screening for ADPKD
A
renal US for >18yo with family history
16
Q
MELD score
A
used to determine 90day mortality risk in advanced liver disease
uses: serum bili, INR, serum Cr, serum Na
17
Q
MVP physical exam findings
A
non ejection click with systolic murmur (from mitral regurg)
increases with standing/dec venous return
18
Q
Mentzer index
A
MCV/RBC
>13 - Fe deficiency likely
<13 - thalassemias
19
Q
complications of bicuspid aortic valve (4)
A
infective endocarditis aortic regurg or stenosis aortic root or ascending aortic dilation dissection **screening for dilation
20
Q
Sjogren syndrome - increased risk for what type of CA?
A
B cell lymphoma
21
Q
diagnosis of dermatomyositis
A
ANA screening
specific Ab (anti-Ro, Anti-La, anti-Sm, anti-RNP)
muscle or skin biopsy if Ab are negative/unclear dx
22
Q
when to use steroids in PCP
A
used in those with A-a gradient >35 mmHg or PaO2 <70
23
Q
dx of PCP
A
sputum testing
if sputum is negative -> BAL (more sensitive)
24
Q
lichen planus
A
discrete, itchy, polygonal violaceous papule or plaques on flexural surfaces, buccal mucosa, ext genitalia (sometimes lacy like pattern)
dx confirmed with biopsy
25
electrolyte risk of repeated RBC transfusion
symptomatic hypocalcemia
more common with massive transfusion or liver/renal failure, hypothermia, shock
serum Ca often normal, need ionized Ca level
26
prenatal screening at 24-28 wks
Hb/Hct
Ab screen if Rh(D) negative
50 g 1 hr GCT
27
treatment/workup for medullary thyroid CA
*MEN 2A syndrome
- serum calcitonin and carcinoembryonic Ag, neck U/S, genetic testing for germline RET mutation, eval for coexisting tumors (hyperparathyroidism, pheochromocytoma)
Pheo eval important before surgery
28
initial manifestation of hypoCa
hyperactive DTR
| HypoCa can occur during/immediately after major surgery or transfusions
29
glucagonoma
pancreatic tumor associated with mold diabetes and skin rash (necrolytic migratory erythema - scaling/crusting, central clearing)
30
sensitivity analysis
repeating primary analysis calculations by modifying certain criteria or variable ranges
31
treatment for ADHD in ages 3-5
1st line = behavior therapy
| meds if needed
32
rotator cuff tendonitis
lateral shoulder pain aggravated by abduction and ext rotation of shoulder
33
ETEC
most common cause of travelers diarrhea - contaminated water and food
manifests 1-3 days after exposure
watery diarrhea
34
treatment of hidradenitis suppurativa (acne inversa)
mild - topical abx
moderate (sinus tracts, scar formation) - oral abx
severe - TNF alpha inhibitors, wide surgical excision
35
treatment of lithium toxicity
Li level q2-4hr
IVF
bowel irrigation for asym acute overdose
hemodialysis for >4 or >2.5 + symptoms or increasing level despite IVF
36
Sydenham chorea
major manifestation of ARF
| emotional lability + jerking movements
37
treatment of bacterial vaginosis
metronidozole
| clindamycin
38
first line treatment of chronic bacterial prostatitis
6 weeks of fluoroquinolone or TMP-sulfa
39
pagets disease - sxs, labs, dx, tx
SXS- most pts are asym
skull deformity with enlargement, hearing loss, dizziness
bone pain, spinal stenosis, nerve compression
long bone bowing with fracture risk
bone tumors
LABS- elev AlkPhos, normal Ca and Phos, radiograph show lytic or mixed lesion
DX - bone scan/Xray & elev AlkPhos
TX- bisphosphonates
40
conditions that alter TBG [ ]
inc TBG - estrogens, acute hepatitis
| dec TBG - androgen hormones, high dose steroids, hypo protein, chronic liver disease
41
vaccines after IVIG
IVIG alters normal response to vaccine, so live vaccines should not be administered for 11 months after IVIG treatment
42
physical exam of scaphoid fracture
dec grip strength
dec ROM wrist
tenderness to palpation of anatomic snuffbox
43
actinic keratosis tx
excision or destruction of lesion - cryotherapy, topical 5FU cream
44
raloxifene
selective estrogen receptor modulators
| *D/C 4 wks prior to surgery with risk of VTE
45
side effect of Na-glucose cotransporter inhibitors used for DM
vulvovaginal candidiasis, UTI, polyuria
46
initial imaging for palpable breast mass
<30yo - US
| >30 - mammography
47
vit B12 deficiency in older populations
dementia + subacute combined degeneration (dorsal spinal column dysfunction, lateral spino tract abnorm)ineffective erythropoiesis -> anemia, intramedullary hemolysis
48
multifocal atrial tachycardia etiologies
COPD or pulm dz exacerbation
electrolyte disturbance *hypoK, hypoMg
catecholamine surge (sepsis)
49
Nelsons syndrome
pituitary enlargement and hyperpigmentation following bilateral adrenalectomy for bushings disease (older treatment option)
treated with surgery and/or radiation
50
phentolamine
used for HTN emergency during surgery of pheochromocytoma
51
urgency incontinence
sudden urges
caused by detrusor muscle overactivity
tx = bladder training, weight loss, smoking cessation, avoid caffeine and alcohol, antimuscarinic meds (tolterodine, solifenacin, oxybutynin)
52
trastuzumab side effect
reversible cardio toxicity (dec in LVEF), not dose related
53
saw palmetto
used by some to treat BPH though studies haven't shown usefulness
risk is bleeding, stomach discomfort
54
mycotic aneurysms
occur in cerebral or systemic circulation due to septic emboli and local vessel wall destruction
complication of infective endocarditis
intracerebral mycotic aneurysms can present its focal near findings or with rupture and subarachnoid hemorrhage
55
treatment of gout in renal failure/ post transplant
intraarticular steroids or increasing dose of systemic steroids
56
microbiology of human bite
eikenella corrodens (gram neg anaerobe)
strep viridans
anaerobes
57
routine lab testing in initial workup or suspected cognitive impairment
CBC
B12
TSH
CMP
58
most common causes of death in tuberous sclerosis
neurological impairment/epilepsy
59
which lung CA typically causes SIADH?
small cell
60
signs of acute salicylate toxicity
N/V *stimulates chemoreceptor trigger zone
tachypnea w. resp alka *stimulates medullary resp center
tinnitus
AMS
hyperthermia
lactic acidosis
61
treatment of acute salicylate toxicity
NaBicarb to alkalinizine urine and plasma
glucose
+/- activated charcoal if presentation within 2 hrs
+/- dialysis
62
causes of acquired long QT syndrome
```
meds
metabolic disorders
bradyarrhythmias
hypothermia
MI
intracranial disease
HIV
```
63
major drug interactions of levothyroxine
dec absorption: bile acid binding agents, Fe, Ca, alum hydroxide, PPI, sucralfate
inc TBG [ ]: estrogen, heroin, methadone
dec TBG [ ]: androgens, steroids,
inc thyroid hormone meta: rifampin, phenytoin, carbamezepine
64
interferon gamma release assay and benefits
TB test
no false + after BCG vaccine
doesn't require return visit
no 2 step confirmation test needed
65
porcelain bladder management
prophylactic cholecystectomy
66
how long are kids with viral conjunctivitis infectious?
until eye discharge resolves
67
TTP (thrombotic thrombocytopenia purpura)
etiology - dec ADAMTS13 activity -> microvascular thrombosis *can be precipitated by pregame's
SXS- petechial rash, neuro abnormalities, thrombocytopenia, MAHA/hemolytic anemia abdominal pain/N, fever, renal failure
TX - plasma exchange
68
complications for infants of diabetic mother
1st trimester: CHD, neural tube defect, small left colon, abortion
2nd/3rd trimester: fetal hyperglycemia and hyperinsulism -> polycythemia and viscosity , organomegaly,. neonatal hypoglycemia, macrosomia, shoulder dystocia, hypertrophic cardiomyopathy (glycogen disposition)
69
how many weeks = adequate trial of SSRI?
6 weeks
70
dementia with lewy bodies treatment
cholinesterase inhibitors for cognitive impairment
carbidopa-levadopa for Parkinsonism
melatonin for REM sleep d/o
+/- antipsychotics for visual hallucinations **2nd gen, low potency. Stronger antipsychotics can exacerbate confusion, Parkinsonism, and autonomic dysfunction
71
pelvis surgery during pregnancy - when and for what
for what: pelvic mass that is complex, persistent, and/or >10cm
best time is early 2nd trimester
72
pregnancy induced pruiritis - sxs and tx
benign
presents with localized, focal pruiritis over abdomen without rash, +/- mild transaminitis
tx = oatmeal bath, UW lights, antihistamines
73
pemphigoid gestationis - etiology, sxs, dx, tx
```
etiology - autoimmune to BM
sxs - prodromal pruritus, periumbilical papules and plaques, bullae, spares mucous membranes, occurs during 2nd or 3rd trimester
dx - clinical, biopsy
tx - topical steroids, antihistamines
resolves after delivery
```
74
candida endophthalmitis
at risk populations, neutropenia, TPN via central venous cath
sxs - fever, dec vision acuity, eye pain, white mound like lesion on retina into vitreous
tx - systemic and intravitreql anti fungal vitrectomy
75
treatment of endometriosis
NSAIDs and OCPs
medroxyprogesteron, leuprolide, danazol
surgery
76
chronic prostatitis/chronic pelvic pain syndrome vs chronic bacterial prostatitis
chronic prostatitis/chronic pelvic pain syndrome - leukocytes in UA but sterile culture
chronic bacterial prostatitis - leukocytes in UA + culture growth
77
seizure meds in pregnancy
AED inc risk of congenital anomalies
should switch to lowest possible dose of a single medication before conception to limit tetarogenicity
if conception has already occurred, no changes are made due to risk for seizure. Just add folic acid and screen for anomalies with alpha fetoprotein.
Valproate is worst teratogen
78
major cause of adverse drug reactions in elderly?
poly pharmacy
79
net clinical benefit of a medication = ?
measure of its possible benefit minus its possible harm
80
desmoid tumor
slow growing and locally aggressive benign neoplasm with high rate of local recurrence
deeply seated painless or painful masses
81
tuberculous meningitis - sxs, labs, imaging, tx
prodrome then signs of meningeal irritation, nerve palsies, coma, death can occur
choroidal tubercles (yellow white nodules near optic disk) can occur
CSF analysis: elevated protein, low glucose, lymphocytic pleocytosis, elevated adenosine deaminase
imaging: basilar meingeal enhancement
tx = 4 drug for 2 months then 2 drug for 9-12 months, steroids
82
threshold for transfusion in most stable patients?
Hb <7
83
abx therapy for postpartum endometritis
clindamycin + gentamicin
84
most important predictors of survival in COPD?
****FEV1
| age
85
management of opioid withdrawal
```
opioid agonis (methadone or buprenorphine - need supervised setting)
clonidine, antiemetics, antidiarrheals, Benzos
```
86
HTN drug of choice with lithium
CCB
| drugs that affect renal function or Na/K levels increase lithium levels
87
colonic diverticulosis
painless hematochezia from arterial erosion
dx = colonoscopy or tased RBC scan
tx = usually self limited, IVF, transfusion if necessary, +/- endoscopic theory or embolization
88
treatment for stress incontinence
lifestyle modification
pelvic floor exercises
pessary
urethral sling surgery
89
initial treatment of parkinson disease
```
levodopa
dopamine agonists (pramipexole) *preferred in younger patients
```
90
entacapone
COMT inhibitor, helps prolong effect of levadopa
| has no effect on PD by itself
91
Wallenberg syndrome = lateral medullary infarct
PICA or vertebral artery
loss of pain and T over ipsi face and contra body
ipsi bulbar weakness
vestibulocerebellar impairment
horners syndrome
motor function of face and body preserved
92
delayed puberty in boys
lack of testicular enlargement by age 14 and delayed growth spurt
initial workup = FSH, LH, T, TSH, prolactin, bone age
93
prostate CA screening
PSA screening considered for ages 55-59, but absolute benefit is small
most men with prostate CA die from other causes
No screening recommended for <55 or >70 or life expectancy <10 yrs
94
treatment for bacterial conjunctivitis
erythromycin ointment or polymyxin-trimethoprim drops
| topical fluoroquinolone for contact wearers (for anti-pseudomonas activity)
95
otitis-conjunctivitis syndrome pathogen
nontypeable H flu
96
treatment of AOM
first line = amox
| 2nd line = amox-clav (repeat infection within 1 month)
97
cardiac findings of massive PE
pulm HTN -> acute RV dysfunction, tricuspid annulus dilation and regurgitation
98
allergic bronchopulmonary aspergillosis - sxs, labs, imaging, tx
preexisting asthma or CF pt with recurrent episodes of fever, malaise, cough with brownish/blood tinged sputum, wheezing
dx = eosinophilia, positive skin test for aspergillum, positive aspergillus IgG, elevated aspergillum specific and total IgE
imaging = typical upper lobe opacities, atelectasis, bronchiectasis
tx= steroids, itraconazole, voriconazole
99
complication of cryptococcal meningoencephalitis
increased ICP
| requires serial LPs
100
most common cause of secondary dilated cardiomyopathy
CAD
*all patient presenting with unexplained heart failure due to LV sys dysfunction should be evaluated with stress testing or coronary angiography
101
most important modifiable risk factors of AAA formation, expansion, and rupture?
cigarette smoking
102
treatment of graves disease
BB for acute symptoms antithyroid drugs: mild hyperthyroidism, old age, prep for RAI or surgery, pregnancy (PTU in first trimester)
radioactive iodine: moder to sever hyperthyroidism, patient preference
surgery: CA, large goiter, severe ophthalmopathy, pregnancy that can't tolerate meds
103
best labs to assess response to antithyroid drugs (for graves)?
total T3 and free T4
| TSH may remain suppressed for several months after therapy is initiated
104
empiric treatment for osteomyelitis
coverage against staph *clinda or vanc if high likelihood of MRSA
*Add ceftriaxone for SCD its to cover salmonella
105
constitutional delay of growth and puberty
delayed puberty + short stature
normal growth velocity
delayed bone age
+/- family history of late bloomers
106
parvovirus B19
young children: flu like symptoms followed by slapped cheek rash (rarely arthralgias)
adolescents/adults: flue like sxs followed by acute onset symmetric joint pain, swelling, and stiffness *small joints (rarely faint reticular rash)
107
laryngeal edema
typically presents with post extubation stridor
consider early reintubation
IV steroids prior to extubation reduce risk
108
conduct disorder
repetitive and persistent pattern of behavior violating rights of others and major societal norms
cruelty towards people and animals
<18yo version of antisocial PD
109
oppositional defiant disorder
pattern of angry/irritable moof and argumentative behavior towards authority figures, stealing, destruction of property likes CD does
doesn't involved cruelty toward people or animal
110
when are abx indicated for acute rhino sinusitis?
if infection doesn't improve in 7-10 days or worsens after initial improvement
111
Hb and BP goal for elderly
HbA1c 7-8% because high risk of hypoglycemia
| BP <150/90
112
int vs ext validity
int validity = describes causality (inc as study is more tightly controlled)
ext validity = generalizability to real world
113
maternal and fetal risk for mother with SLE
* greater with active disease
* requires close monitoring
fetal: fetal demise, congenital complete heart block, anti-SAA and SSB Ab cross placenta, hepatic, term, hematologic, neonatal lupus
maternal: thrombosis with antiphospholipid syndrome, preeclampsia *ASA starting at 12wks
114
central hypothyroidism management
levothyroxine, monitor T4 not TSH
| ACTH stim test before treatment to r/o adrenal insufficiency
115
major risk factors for rapid progression of CKD? (3)
HTN
proteinuria
hyperglycemia
116
strongyloides - sxs, dx, tx
sxs - linear itchy rash, GI and pulm issues *often mild and recurrent
dx = serology, eosinophilia
tx = ivermectin or albendazole, recheck titers at 3-6 months
117
types of clinical trials
```
explanatory = test efficacy under optimal and controlled situations
pragmatic = test effectiveness in real life conditions
```
118
first line treatment for menopausal hot flashes
mild - behavioral modifications
| mod to severe - estrogen (+P if intact uterus) OR SSRI if contraindication to estrogen (thromboembolism, breast CA)
119
causes of AIN
drugs : abx, NSAIDs, PPI, diuretics
infections: legionella, strep
autoimmune: lupus, sarcoidosis, Sjogren syndrome
120
lung CA and AAA screening
AAA screening for any smoking history men age 65-75 *U/S, one time
lung CA screening for ages 55-80 with >30pack year smoking historians currently smoke or quit in last 15 years *CT, annual
121
treatment of Hirschsprung disease
surgical resection of ganglionic bowel
122
transient synovitis
hip pain + limp in otherwise well appearing child *able to bear weight, afebrile, labs normal/mild elev
often preceding viral illness
tx = NSAIDs
123
physiologic leukorrhea
increase in amount of normal vaginal discharge due to increased E levels
presents without other associated symptoms
124
tx for hyperCa 2* to malignancy
Ca >14 or severe sxs
short term: IVF and calcitonin
long term: bisphosphonates (e.g. zoledronic acid)
125
common meds that can raise BP (6)
```
NSAIDs
decongestant
antidepressants
OCPs
steroids
stimulants
```
126
HSV in pregnancy
antiviral therapy started at 36 wks for suppression
| C/S if active lesion at time of delivery
127
immune thrombocytopenic purpura (ITP) - cause, sxs, labs, tx
cause = acquired Ab to platelet Ag
often preceding viral illness or medical problem
sxs = mucous bleeding,(menorrhagia, epistaxis), petechia
labs = thrombocytopenia with normal platelet morphology (may have anemia due to bleeding), other labs normal
tx = observation, steroids if plt <30,000, IVIG and transfusion if hemorrhage
128
military TB - epi, sxs, dx, tx
epi: inc risk with immunosuppression, hematogenous dissemination from lungs
sxs: subacute/chronic fever, night sweats, weight loss, malaise, pulm, liver, CNS, adrenal sxs
dx = cytopenias, diffuse nodular pulm infiltrate, biopsy and culture
tx = 4 drug tx (same as for pulm tb)
129
tx of PTSD
trauma focused CBT
| SSRI/SNRI
130
initial management of postmenopausal bleeding
transvaginal US or endometrial biopsy
131
screening test for risk fo stroke in SCD pts
Transcranial doppler US for ages 2-16
132
common CV complications of OSA (4)
resistent HTN
CAD
arrhythmias
heart failure
133
thyroid function in elderly
TSH levels rise with age, TSH<7 in elderly doesn't need treatment if T4 is normal
134
HIT 1 vs 2 (heparin induced thrombocytopenia)
HIT 1- mild, non immune mediated, <2days after heparin initiation, lowest plt 100,000 typically , no treatment needed
HIT 2 - plts decline >30-50%, 5-10 days after heparin initiation (<1 day if prior exposure), thrombosis, tx = stop heparin, switch to other anticoagulant, plt factor 4 Ab testing
135
mucormycosis
invasive fungal infection in immunocompromised patient (DM, malignancy)
fever + nasal congestion + purulent nasal discharge + HA + sinus pain + necrotic invasion of plate, orbit, brain
dx/tx = sinus endoscopy with debridement, amp B
136
tx for splenic sequestration
IVF
pRBC
+/- splenectomy
137
when is imaging required in c diff?
```
evidence of sever or fulminenat disease
WBC>15
Cr >1.5
septic shock
apparent ileum
severe abdominal pain
```
138
treatment of acalculous cholecystitis
percutaneous cholecystomy and drainage + IV abs
| cholecystectomy for perf or necrosis
139
what is anti CCP specific for?
RA
140
treatment of uterine inversion
d/c uterotonics + manual uterine replacement
| *sometimes uterine relaxants are needed for replacement
141
management of neonatal polycythemia
monitor glucose and bili
| IVF if symptomatic (resp distress, tachy, apnea, lethargic)
142
complications of sickle cell trait
```
hematuria/papillary necrosis, hyposthenuria
splenic infarction (*high altitudes), venous thromboembolism, priapism
external rhabdomyolysis
```
143
Frailty
characteristics - fatigue, weakness, impaired ambulation, weight loss
labs - check TSH, CBC, Vit D, B12, metabolic panel
tx = structured exercise program, d/c necessary meds, nutrition and Vitamins D
144
chronic alcohol use then IVF with dextrose --> risk of ?
hypophosphatemia 12-36 hr later (because depleted intracellular P stores and then insulin drive P into cells)
145
what is the risk of waiting for spontaneous labor for intrauterine demise?
increase risk of DIC
| *still an option for patients however
146
EKG findings of LVH
high voltage QRD + inverted T waves
| *should get echo if sxs to determine cause - e.g. athletes heart or hypertrophic cardiomyopathy
147
workup of lower urinary tract symptoms in male?
```
*urinary frequency, nocturne, hesitancy
UA
PSA
+/- Cr
neuro and digital rectal exam
```
148
synovial fluid analysis in reactive arthritis
high WBC but culture negative
149
IgA nephropathy
gross hematuria following acute URI, no definitive tx
| *can be distinguished from post strep GN b/c in PSGN there is a gap of 10+ days between throat infection and onset
150
relationship between specificity and PPV
as specificity increases, PPV increases
151
symptoms of ACL injury
popping then hemarthrosis/effusion
| joint instability
152
chronic mesenteric ischemia
crampy epigastric pain that worsens after meal and workup otherwise negative
look for CAD risk factors
dx with angiography
153
recommendation re: future heparin use for patients with HIT?
avoid all forms of heparin for life
| "heparin allergy"
154
3 clinical criteria for dx of ankylosing spondylitits
1. low back pain/stiffness for 3+ month, improves with exercise/activity
2. lumbar spine ROM limited
3. chest expansion limited
* *Eval with Xray initially
155
px for ankylosing spondyilitis
no functional or employment disabilities, no increased mortality
156
preeclampsia: define, sxs, tx
new onset HTN >140/90 at >20wks + proteinuria or end organ damage
severe features: >160/110, thromobcytopenia, inc Cr, inc LFTs, pulm edeam, visual or cerebral sxs
tx = Mag, BP control, +/-delivery (>34 wks for sever features, >37 without sever features)
157
hyperthyroidism in pregnancy
treat with PTU in first trimester and methimazol din 2nd and 3rd trimester
treatment should be titrated to mild hyperthyroid state (similar to physiologic changes in pregnancy)
158
treatment of prolactinoma
dopamine receptor agonist (bromocriptine, cabergoline)
159
microbiology of nec fasc
GAS most common
clostridium *crepitus
staph
polymicrobial in those with underlying DM or PVD
160
cutaneous cryptococcosis
widespread skin papule with umbiliication *head and neck most common, small area of central hemorrhage or necrosis
in severe immunocompromise
usually a sign of disseminated cryptococcus
161
pan coast tumor presentation
shoulder pain
Horner syndrome
C8-T2 involvement - weakness of hand muscles, pain/parasthesias of 4tha nd 5th digits, medial arm, and forearm
tumor can spread to spinal cord causing asym LE DTR *needs immediate tx
162
NNT
1/ARR
| ARR = R1-R2
163
disseminated gonoccal infection
arthritis +/- dermatitis (pustules) + tenosynovitis
| dx = NAAT of urogenital sample
164
treatment for uncomplicated urogenital gonorrhea urogenital infection
1 IM ceftriaxone + 1 PO azithro
165
how to adjust warfarin when starting amiodarone?
decrease warfarin by 25-50% (amiodarone is CYP inhibitor)
166
most common complication of compartment syndrome?
rhabdo and AKT/renal failure
167
primary biliary cholangitis - patho, sxs, labs, tx
autoimmune disease
causes fibrosis and obliteration of intrahepatic bile duct
sxs = fatigue, pruritus most common +/- hyperpigmentation, inflam arthritis, RUQ discomfort, xanthelasmata and xanthomata
increased risk for osteopenia/porosis
labs = sig elev alk phos, +AMA
tx = ursodeox acid
168
when is exchange transfusion indicated for hyperbili?
>20-25, worsening hyperbili on phototherapy, or signs of near dysfunction
169
what does tight glycemic control in DM decrease risk of?
microvascular complications (retinopathy, nephropathy)
170
pituitary adenoma
increased serum alpha unit, low FSH, LH
sxs related to mass effect
tx = transsphenoidal surgery
171
adrenal mass workup
```
lytes & hormone workup:
dexameth suppression testing
24hr urine catecholamine
metanephrine
vanillylmandelic acid
17-ketosteroid
```
172
treatment of cocaine intoxication
Benzos + nitro +/- CCB, phentolamine for persistant HTN
NO BB!!
+percutaneous coronary intervention with persistent ST elevation after medical therapy
173
reversal of warfarin
prothrombin complex [ ] (FFP if not available)
| Vit K
174
endometriosis physical exam and complications
exam: nodularity, ovarian mass (endometrioma), immobile uterus, cervical motion tenderness
complications: infertility, chronic pain
175
prognosis in febrile seizure
30% risk fo recurrence
inc risk of epilepsy (<5%)
normal development
176
rabies ppx guidelines
pre exposure: 3 series vaccine
post exposure, unvaccinated: 4 series vaccine + Ig
post exposure, previous vaccination: 2 series vaccine
177
pt with syphilis + neuro sx workup?
LP to eval for neurosyphilis
* even if just HA, blurry vision
* greater risk in HIV
178
treatment of syphilis by stage
1*, 2*, early latent (<12 mths): 1 IM penicillin
late latent, unknown duration, gumma/CV syph: 3 wks IM weekly penicillin
neuro: IV penicillin for 10-14 days
congenital: IV penicillin 10 days
** treatment can cause Jarisch Herxheimer reaction - febrile syndrome within 24hrs after initial treatment, self limited
179
clinical manifestations of hereditary hemochromatosis
hyperpigmentation *bronze diabetes
arthropathy & chondrocalcinosis
elev LFTs
DM, secondary hypogonadism and hypothyroidism
restrictive or dilated cardiomyopathy, conduction abnormalities
inc susceptibility of Listeria, vibrio, yersinia
180
population attributable risk percent
proportion of disease in the population that is attributed to exposure
= (risk in total population - risk in unexposed) / risk in total population
= (prevalence x (RR-1)) / [(Prevalence x (RR-1) + 1 ]
181
pseudohypoparathyroidism
```
end organ resistance to PTH
chronic hypoCa
hyperPh
elevated PTH
sxs are related to low Ca - seizures, cramping, hyperreflexia, basal ganglia calcifications, cataracts
```
182
colles' fracture
distal radius fracture (+/- concurrent ulnar styloid fracture, scaphoid fracture, actor carpel tunnel syndrome)
FOOSH injury
183
contact precautions for localized shingles - outpatient treatment
cover the area until lesion are completely crusted
184
alopecia areata
smooth and discrete areas of complete hair loss w/o scaling, scarring, inflammation.
tx = topical or intralesional steroids
Recurring but hair regrows
185
IVF and insulin for DKA
start with NS IVF and IV insulin infusion
Add dextrose to fluids when glucose <200
Switch from IV to subQ insulin when glucose <200, AG <12, bicarb>15 *must be able to eat
*continue IV insulin for 1-2 hours after 1st subQ is given
186
imaging for possible bony metastasis
osteolytic (multiple myeloma): plain x ray and PET scan
osteblastic (prostate): bone scan
mixed (breast): bone scan, PET
187
what Ab can be used to follow disease severity in SLE?
anti-dsDNA
| -also associated with development of lupus nephritis
188
pulmonary contusion
from blunt chest trauma, presentation can be delayed 24 hrs after injury
chest pain + resp distress/hypoxemia
CXR shows irregular localized lung opacification
189
complication of subclinical hypothyroidism?
increased risk for pregnancy complications, including recurrent miscarriage
190
indications for ppx antiD Ig for Rh(D) negative patients
```
**not indicated if father is Rh(d) negative too
28-32 wks gestation
<72 hrs after delivery of RhD+ infant
<72 hrs after spontaneous abortion
ectopic or threatened pregnancy
hydatidiform mole
chorionic villus smapling, amniocentesis
abdominal trauma
2nd and 3rd trimester bleeding
external cephalic version
```
191
treatment of large pneumothorax
needle decompression in tension pneumo, unstable
| chest if tension pneumo hasn't developed yet and patient is stable
192
what do you monitor resp status with in Guillain barre syndrome?
tidal volume and negative inspiratory force
193
Guillain barre syndrome treatment
plasma exchange or IVIG if:
-nonambulatory
-within4 wks of sxs onset
speeds recovery and decreases need for mechanical ventilation
194
when should carotid endarterectomy be done?
high grade stenosis (70-99%) and symptomatic and life expectancy 5+ years
195
types of transfusion reactions
anaphylaxis: immediate, think IgA deficiency, prevent with washed RBC
acute hemolytic rxn: w/in 1 hr, fever, chills, flank pain, hemoglobinuria, can progress to DIC and renal failure, positive direct Coombs, prevent with cross matching
febrile nonhemolytic: 1-6hrs, fever, chills, malaise from leukocyte debris released cytokines, prevent with leukoreduction
TRALI: 1-6hr
delayed hemolytic: 2-10days
196
thyroid and sodium connection?
moderate to severe hypothyroidism can be associated with mild euvolemic hyponatremia
Levothyroxine corrects the sodium
197
iodine induced hyoperthyroidism
risk factors: nodular thyroid disease, chronic iodine deficiency
sxs - hyperthyroid sx onset following iodine exposure, temporary
labs = suppressed TSH, negative thyrotropin receptor Ab
tx - BB for sxs, antithyroid meds if needed
198
seborrheic dermatitis tx
topical antifungals
topical steroids
topical calcineurin inhibitor
Weekly retreatment may be necessary
199
lung CA screening effectiveness
25% will have nodule identified, 95% of which are false +
200
orthostatic proteinuria
most common cause of proteinuria in adolescents
mild proteinuria, but otherwise normal and asymptomatic
dx = split day and night 24hr urine collection or UPC when standing and supine
*elevated protein during day/standing, but not at night/supine
resolves spontaneously
201
target glucose levels in pregnancy
fasting <95
1hr postprandial <140
2hr postprandial <120
202
SGLT2 inhibitors (-flozins) side effects
```
euglycemic ketoacidosis
hyperK
hyperlipidemia
fluid loss (hypoBP, AKI)
vulvovaginal candiasis
UTI
low trauma fracture, amputation
```
203
medical contraindications to pregnancy
```
LVEF <40%
class III-IV HF
prior peripartum cardiomyopathy
severe obstructive cardiac lesions
severe pHTN
unstable aortic dilation
> 40mm
```
204
imaging that should be performed after diagnosis of multiple myeloma?
skeletal survey
205
hyper viscosity syndrome sxs
```
nasal or oral bleeding
blurry visions
neuro ses - confusion ,HA
heart failure
*complication of Waldenstrom macroglobulenemia or MM
tx = plasmapharesis
```
206
verification bias
occurs when a study uses a gold standard test selectively in order to confirm a positive or negative result of preliminary testing
207
workup of dyspepsia
>60 upper endoscopy
| <60 H pylori testing (upper endoscopy if alarm sxs/high risk)
208
treatment of infant botulism
IV botulism Ig
209
anomalous aortic origin of coronary artery
common cause of sudden cardiac death in young athlete
patients usually have premonitory sxs of exertion angina, lightheadedness, or syncope
dx = coronary angiography, ECG and echo can be normal
210
treatment of expanding neck hematoma
secure airway immediately due to risk of upper airway obstruction
211
carpal tunnel dx
nerve conduction studies to confirm dx or assess severity
| only used for those with chronic or refractory sxs
212
primary ovarian insufficiency sxs and tx
sxs: amenorrhea at <40, hypoE sxs (hot flashes), inc FHS, dec E
tx: estrogen therapy (with P if intact uterus)
213
treatment of malignant otitis externa
IV anti-pseudomonas abx, switch to PO when ESR/CRP normalize
| total therapy 6-8wks
214
hepatic encephalopathy
precipitating factors: drugs, hypoV, electrolyte changes, inc N load (diarrhea), infection, TIPS
tx = current underlying factor, dec blood ammonia (lactulose, rifaximin)
215
papillary renal necrosis
chronic nephropathy
can present acutely as hematuria, pyuria, proteinuria, and renal colic
occurs with heavy long term use of analgesics
216
CKD and its affect on P, Ca, PTH
CKD -> P retention, dec Ca, dec Vit D -> inc PTH (2* hyperparathryoidism) -> autonomous PTH secretion (3* hyperparathyroidism)
tx = parathyroidectomy in cases of persistent HyperCa or hyperPh, very high PTH, soft tissue calcification, or intractable bone pain
217
BP control after ischemic stroke
<185/105 >140/90
| *if no thrombolytic therapy received, <220/120
