Panda fam med: 1 Flashcards
(58 cards)
1
Q
Two Type 2 diabetic treatments allowed in children?
A
- Insulin
2. Metformin
2
Q
What beta blocker is best in CHF treatment?
A
Carveidolol (Comet Trial)
3
Q
What are max doses of Lasix / ACE-I?
A
- Lasix = 80 mg
- ACE-I = 40 mg
4
Q
If CHF patient is symptomatic on max doses of all meds, next step?
A
Biventricular Pacing
5
Q
3 Beta Blockers for CHF Patients
A
Metoprolol (b1 specific)
Bisoprolol (b1 specific)
Carveidolol (nonspecific with alpha antagonist properties)
6
Q
Omega 3 Fatty Acids
- Mechanism of Protection
- Long Term Benefits (3)
- Use in high risk patients, esp allergic to ____
A
- Mechanism: increase eicosonoid production = decrease platelets/increase vasodilation
- 3 Longterm Benefits: decrease stroke, non-fatal MI and arrhythmias
- Good for people allergic to fish
7
Q
Management for Descending Aortic Dissection:
- Rx (2)
- When to Operate?
A
Rx:
- Beta Blocker IV
- Nitroprusside: always give BB first b/c this will cause reflex SNS activity which will increase LV output and shear stress on aorta
Operate:
- If ascending component
- If major branches are involved
8
Q
Recommendations for AAA Screening
A
All males between 65-75 who have ever smoked. One time screening is recommended unless pathology is found.
9
Q
LDL Goal for Diabetics
A
<100
10
Q
Benign Childhood Murmurs (3)
What components of murmur will NEVER include it in benign murmurs of childhood (3).
A
- Still’s Murmur: S = S, still’s best heard when supine; musical
- Peripheral Pulmonic Stenosis: systolic murmur radiating to b/l axilla
- Venous Hum: 2/2 fluttering open/close of jugular veins; best heard when UPRIGHT (vs. Still’s) and on INSPIRATION (b/c venous)
NON-BENIGN FEATURES
- Diastolic
- Extra sound
- > 2/6 on Levine Scale
11
Q
Management of Stable Angina (2)
A
- Beta Blocker
2. ASA
12
Q
Indications for thrombolytic therapy in AMI? (2)
A
Both are on EKG
- Ensure STEMI
- ≥1mm elevation in 2x limb leads
- ≥2 mm elevation in 2x precordial leads - Look for New onset LBBB which is c/w complete occlusion
13
Q
You suspect secondary HTN in a patient. Knowing one of the MCC, what is the best test to order?
A
AM Aldosterone/Renin Ratio looking for primary hyperaldosteronism. If ratio >20 = Dx!
Note: Renovascular HTN (with RAS is MCC 2/2 HTN)
14
Q
Plantar Fasciitis (Etiology, Presentation, Treatment)
A
- Etiology: 2/2 overuse (repetitive micro trauma) = obese/always on feet
- Presentation: heel pain with “First step phenomenon”, gets better throughout day
- Treatment: OTC Heel Inserts / Achilles Tendon Stretching / NSAID –> Steroid Shot –> Surgery
15
Q
- Tarsal Tunnel (Etiology, Presentation)
A
- Etiology: compression of post tibial nerve deep to med malleoulus
- Presentation: medial foot / plantar paresthesias with pain on tapping tarsal tunnel
16
Q
- Fat Pad Atrophy (Etiology, Presentation)
A
- Etiology: atrophy of fat pad over heel
- Presentation: pain worsens throughout the day
17
Q
Best anticoagulation for patient undergoing hip repair who has history of previous post-op DVT?
A
SubQ Lovenox before and after surgery
18
Q
Recommendations for Patients with HCM (2)
(T/F) HCM Patients have decrease lifespan
A
Recs:
- No strenuous activity
- Screen all first degree with ECHO
False. Risk of SCD 1-5%
19
Q
3 CIs to using Beta Blockers in CHF?
A
- Bradycardia
- Heart Block
- Severe Asthma
20
Q
Pre-Op Cardiac Risk
- Protocol
- Classify procedures into High / Int / Low Risk
A
- Protocol: 12 Lead –> Stress Test if + –> Cath if +
- Classification
1. HIGH RISK: anything vascular / emergency
2. INT RISK: head/neck, thoracic/abdominal, prostate
3. LOW RISK: Breast, Cataract, Endoscopic
21
Q
Marelgia Paresthetica
A
Compression of LFCN –> sensory loss of ant/lat thigh without motor deficits
22
Q
Pt with fatigue, adenopathy and pharyngitis is giving ampicillin / PCN. They develop a morbilliform rash. If this patient is then admitted to the ED with respiratory distress, what is the next best step?
A
Add steroids. Patient has MONO; airway obstruction 2/2 inflammation. Give steroids.
23
Q
5 Malignancies associated with EBV?
A
- Nasopharyngeal Carcinoma
- Primary CNS Lymphoma
- Burkitt’s
- Hodgkins
- (HIV) Hairy Leukoplakia
24
Q
HyperCa of Malignancy
- 3 Etiologies
- Management Protocol
A
- 3 Etiologies: PTHrP»_space;> Mets with Release of Local Factors»_space;> Ectopic PTH Secretion
- Management:
1. IVF
2. +/- Lasix to avoid IVF overload
3. Calcitonin (Acute management) vs. Bisophosphonate (chronic management)
25
Treatment of Torsades?
Mg
26
10 y/o has older sibling who died suddenly in a soccer game. His parents have had recurrent syncopal episodes.
- What do you suspect?
- Next best diagnostic step?
- Management?
- Suspect Long QT Syndrome
- Diagnostic Step: RESTING (≠Stress EKG) for long QT interval
- Management: beta blockers and NO competitive sports
27
WPW
- EKG Findings (3)
- Treatment
EKG Findings in WPW
- Short PR Interval
- Narrow QRS
- Delta wave
Treatment: Procainamide
28
You are considering starting a RA / AI patient on TNF-alpha blocker. What 3 diseases do you screen for?
1. Hep B
2. Hep C
3. TB
29
Lab Test to W/U Suspected HCV (3 Components)
1. ELISA for HCV Antibody
+: Proceed to 2nd Immuno Based Assay (#2 below)
-: Not infected or very early infection
2. Immunobased Assay for HCV Antibody
+: Proceed to test for active / resolved infection (#3 below)
-: Original ELISA was a false+
3. HCV RNA PCR
+: Active Disease
-: Resolved disease
30
OCD:
- First Line Treatment (2)
- Alternative to First Line Rx Treatment
- First Line Treatment
1. SSRI
2. Exposure-Response Therapy
- Alternative
1. Clomipramine
31
NHAP
- Why to think about different bugs?
- Inpatient vs. Outpatient Management
NHAP: increase colonization of oropharynx with GNR
Management
1. Inpatient: Cover MRSA (Vanc/Linezolid) and 2x Anti-Psuedomonal (Resp Fluoroquinolone and Cephalosporin)
2. Outpatient: Resp Fluoroquinolone
32
Standard Management of Osteoporosis (3 components)
- Lifestyle Change (no smoking, exercise)
- Supplements: 800 VitD + 1200 Ca
- Rx: Bisphosphanate (≠Calcitonin b/c this is more acute management) --> Teriparatide
33
Rx that Decrease Hip Fractures (3)
All Bisphosophnate: Alendronate, risedronate, zolendronate
34
Rx for Post-menopausal women with Osteoporosis and FMH of Breast Cancer
Raloxifine: agonist in bone / antagonist in breast
35
Rx for Men with Osteoporosis (2)
- Alendronate
| - Teriparatide
36
Rx for osteoporosis in Patients on Chronic Steroids
- Supplements (VitD + Ca) and Bisphosphonate
37
Rx that increase risk for osteoporosis (5)
- Steroids
- Heparin
- Phenytoin (or any CYP - increase Vit D metabolism)
- Thyroid replacement
- Cyclosporin
38
Influenza
- Microbiology Name
- Management
Orthomyxovirus A/B
Management
48 + Hospitalizations = NA-inhibitors
>48 and NO Hospitalization = no treatment
39
ASA PPx Men vs. Female
Men: 45-79 where risk of MI > GI Bleed
Women: 55-79 where risk of Ischemic CVA > GI Bleed
40
Benign NB Rash (4)
1. Erythema Toxicum: ERYTHEMA surrounding macules/papules/pustules. +Eosinophils on smear
2. Acne Neonatorum: macules/papules/pustules without surrounding erythema on face.
3. Staph Pyoderma: vesicular rash with g+cocci in clusters
4. Milia: pearly keratin plugs without surrounding erythema
41
Patient has symptomatic MVP.
- What are the symptoms?
- Treatment?
```
Symptoms = palpitations
Treatment = Beta Blockers
```
42
Subclinical Hypothyroidism
- Clinical Features
- Labs
- Risks (vs. Subclinical Hyperthyroidism)
- Clinical Features: ASYMPTOMATIC (thus "Subclinical")
- Labs: HIGH TSH (hypothyroid) but NORMAL FT4 (thus Asx)
- Risk: increase LDL / cholesterol
Don't confuse with subclinical hyperthyroidism = associated with increase sCHF / arrhythmia / decrease bone density
43
Lithium ADE
What other common Rx causes increase Li levels?
```
LMNOPP
Lithium...
Movement Disorder (Tremors)
Neph DI
hypOthyroidism
Pregnancy (Ebstein)
High PTH = High Ca
```
NSAIDs; recall Li is cleared in the kidneys, so anything that simulates AKI or increase resorption (dehydration) will cause increase Li levels.
44
CI to Breast Feeding (7)
4 Common Misconceptions of CI to Breast Feeding
CI:
1. Active HIV
2. Active HSV over breast
3. Active TB (≠TB Rx)
4. Radioactive Iodine
5. PO Antifunglas/Antimalarials/Antiparasitics
6. Lithium
7. Chemotherapeutics
Not CI:
1. HepB/C
2. CMV
3. Warfarin
4. Active Mastitis
45
3 MC Fish Toxicities
1. Scombroid: eating poorly stored fish where bacterial infection converts histidine --> histamine = anaphylaxis
2. Ciguatera: eating reef fish; manage symptoms
3. Shellfish: eating shellfish; manage symptoms
46
POTS vs. Orthostatic Hypotension
- Criteria
- Underlying pathophysiology for both
POTS
- +30BPM or HR >120 within 10 minutes
Orthostatic Hypotension
- Drop in SBP by 20 or DBP by 10 with increase in HR by 20
Paph
- Loss of baroreceptor responsiveness
- Loss of myocardial contractility
47
JNC 7 Guidlines for Post-CVA HTN Rx
ACE-I + HCTZ
48
6 Features of Solitary Thyroid Nodule s/o Malignancy
1. H/o Neck Radiation (Papillary)
2. >4.0 cm
3. Fixed / Firm
4. Signs of Spread (Adenopathy, Dysphagia, Hoarseness)
5. Male Gender
6. Non-functioning
49
Approach to Incidentaloma In Thyroid
If:
1. <1.0 cm
2. Asymptomatic
3. Normal TFTs
F/u with Serial USG q6-12 months
50
(T/F) In growth issues in hypothyroidism, bone age = chronologic age.
False, bone age < chronologic age.
51
4 Indications for PT-ectomy in HyperPTH
SCAB
- Stones
- Serum Ca >1.0 mg/dL above normal
- Age <50
- Decrease Bone density
52
Presbycusis
- What type of hearing loss?
- What frequency is affected?
- Consonants vs. Vowels
```
Sensorineural
High frequency (=consonants)
```
53
Known Cirrhotic p/w new onset fevers and diffuse abdominal pain.
- Next Best Step
- What will confirm the diagnosis?
- MC Bugs (3)?
- Best treatment
Diagnostic Paracentesis for SBP
Findings on Paracentesis confirming diagnosis:
- PMN >250
- +Fluid Culture
- MC BUg = EColi > Kelb > Strep Pneumo
- Best Treatment = Cefotaxime
54
At prenatal visit mother is found to be HBsAg+. What actions should be taken to decrease transmission to baby?
At the TIME OF BIRTH, baby should receive:
1. HBIg
2. HBV Vaccine (normally occurs anyway)
55
What 4 bugs survive in chlorinated water?
Entamoeba Histolytica
Giardia
Cryptosporidium
HAV
56
4 Groups of Patients needing screening for HCV?
1. IVDU (needles)
2. Accidental needle stick
3. Transfusions <1987
4. Persistent Elevations in LFT***
57
IBS
- Diagnostic Criteria (3)
- Supplement that helps
- Most consistent finding
Rome Criteria
- Abdominal Pain / Distention (abd pain = MC finding)
- Change in consistency / frequency of stool
- Relief with defecation
Supplement that Helps: Daily Peppermint Oil
58
In ___(3 diseases)__ correct anemia to ______(value)____.
CHD, CKD and EPO Replacement Patients = 3 Disease
Anemia Correction: 10-12
*Patients who were corrected all the way did worse from CV-related events
