Practice question notes Flashcards
1
Q
Last-ditch treatment for left BBB
A
Cardioversion if have maxed out medical therapy
2
Q
Treatment of AAA
A
IV labetalol to get systemic BP <100-120
3
Q
SVT treatment
A
IV adenosine
4
Q
DOC HTN in AAs
A
CCB or diuretics over ACEi
5
Q
What is Still’s murmur?
A
Benign childhood systolic murmur best heart at lower precordium; low, short tone
6
Q
How is Lovenox eliminated?
A
Renal, do renal dosing
7
Q
When do you give thrombolytics for heart attacks?
A
If LBBB - bc occluded LAD
Give for STEMI but not ST depression
8
Q
What is ABI and what is a normal number
A
Systolic ankle/sys arm; 0.9-1.2
9
Q
After 1st DVT?
A
Warfarin 3 months + LMWH
10
Q
What is SMA syndrome?
A
- Vomiting, 2. Cardiac problems, 3. Leukocytosis
11
Q
DOC a fib
A
BB for rhythm and rate
12
Q
What do fibrates do
A
Lower TGs, inc. HDL
13
Q
Niacin is contraindicated in __
A
diabetics
14
Q
Treatment of WPW with SVT
A
Radiofrequency ablation, not digoxin
15
Q
DOC for acute delirium/AMS
A
Haldol q 30 and more doses q necessary
16
Q
High LDL found. Need to screen for:
A
Hypothyroid, DM, liver dz, CRF, meds
17
Q
Treating arrythmias 2/2 cocaine, do NOT:
A
Don’t use BBs–>vasospasm
18
Q
DOC intermittent claudication?
A
Cilostazol, a PDE5 inhibitor, C/I CHF
19
Q
Subclinical hypothyroidism lab pattern TSH Te
A
TSH>10, normal T3. Assoc w high LDL
20
Q
Lithium AEs
A
hypterthyroidism, renal impairment, congenital heart
21
Q
Byetta/exenatide MOA
A
Increases gastric emptying time and C/I gastroparesis
22
Q
DDx hot nodules thyroid
A
Grave’s, multinodular goiter, solitary hot nodule, TSH adenoma, molar pregnancy/choriocarcinoma
23
Q
DDx cold nodules thyroid
A
Subacute thyroiditis, PP lymphocytic thyroiditis, radiation-induced, struma ovarii, follicular cancer
24
Q
UC or Crohn’s which has an increased risk of colon cancer?
A
UC
25
Characteristics of Crohn's (vs. UC)
No rectal involvement, transmural, segmental, fistulas
26
S/S radiation proctitis
Pain with defecation, diarrhea, rectal bleeding
27
Tx of traveler's diarrhea
Cipro 3 days
28
MSM need this preventative service
HepA vaccine
29
Best test for hemochromatosis
Serum transferrin saturation (not Bx!)
30
Bilirubin over __ is always pathologic in neonates
17
31
Finding on peritoneocentesis dx of acute bacterial peritonitis
PMN>300/mL
32
Gilbert's increased direct or indirect bili?
Indirect
33
IBS symptoms worsen:
At night
34
DOC torsades
Magnesium
35
Erythema toxicum neonatorum rash appearance
Flea bitten
36
DOC preventing spread of pertussis
Azithromycin
37
Tarsal coalition?
Bone fusion in adolescents. Often bilateral, ankle pain with dec ROM and pain with inversion
38
Os trigonum?
Non-ossification of cartilage; unilateral and palpable with heel tenderness
39
Sever's apophysitis?
Heel pain from calcaneal inflammation
40
Navicular fractures
Tender over dorsomedial navicular
41
Bupropion weight gain?
NO
42
Delayed bone age as well as growth velocity suggest:
GH deficiency
43
What is xerosis?
Pathologic dryness, usually in the elderly, worst in winter
44
Test of choice hypogonadism in men
Total T
45
Treatment of hypercalcemia of pregnancy?
pamidronate
46
Valsalva maneuver and murmurs mechanism
Decreases venous return and CO
47
SCFE presentation
Overweight boys with limited internal rotation
48
Pts with immediate family member with colon cancer screening recommendations
Start at 40, q 5 years
49
These drugs act at the AV node and may worsen WPW by causing v fib
Adenosine, digoxin, and CCBs
50
DOC WPW
procainamide or amiodarone
51
SSRI DOC pregnancy
Prozac (fluoxetine)
52
Tx of severe BPP resistant osteoporosis?
Teriparatide (Teri is so strong) for up to 2 years
53
ASA recommendations
Men 45-79 to reduce MI risk
| Women 55-79 to reduce stroke risk
54
Erythema multiforme is the rash of:
HSV
55
ASCUS-->
3 options: 1) repeat at 6 and 12 mo 2) test for HPV 3) colposcopy
56
Omeprazole decreases __ absorption
B12
57
Treatment of atrial flutter with acute HF
Cardioversion
58
Treatment of atrial flutter if pt is stable
Digoxin or verapamil
59
Patellofemoral pain syndrome
Active teenagers with anterior knee pain that worsens with running -> get PT
60
TZDs mechanism
Act on PPARg to increase insulin sensitivity
61
Vacuum or forceps?
Vacuum worse bc more dystocia, cephalohematoma, retinal hemorrhage
62
Trazodone side effects
Sedation, orthostatic hypotension
63
This antidepressant can worsen insomnia
bupropion
64
Mirtazepine is great for:
appetite stimulation and weight gain
65
ACD iron study pattern
Low TIBC, low serum iron, high ferritin
66
Preventing recurrent calcium stones
Low sodium diet, increase fluids, take K citrate at mealtime to increase urinary pH, also HCTZ!
67
Metabolic acidosis plus acute renal failure suggests:
Methanol poisoning; check gap, look for hypocalcemia, check for fluorescent pee
68
Treatment of methanol poisoning
fomepizole
69
Is glipizide safe for CKD?
Yes
70
Therapies for essential tremor
Propanolol, primodone
71
Who should be screened for diabetes?
BMI>25, Inactive, HTN, HDL250, A1C>5.7, Hx of GDM or PCOS
72
Spinal stenosis pain is relived by:
Sitting
73
Herniated disc pain is made worse by:
Sitting
74
Pseudogout joint findings
Short, blunt, rhomboid and cuboid crystals with lots of PMNs
75
Cat bite what do you do?
Prophylax for pasturella
76
Methadone worrisome cardiac effect
torsades
77
A fib low risk DOC anticoag
ASA 325
78
A fib high risk DOC anticoag
Warfarin
79
Cat scratch DOC
Azithromycin
80
Nortryptilline and duloxetine AEs
Worsen arrhythmias, worsen urinary retention
81
Celexocib AE
reflux
82
Which NSAID is on Beers list?
Indomethacin
83
Pain after cholecystectomy plus jaundice?
Retained common duct stone
84
Recommendations for gastric bypass
BMI>40 or 35-40 with comorbidity with dietician and mental health eval first
85
First test in patients with abnormal renal function plus hypertension
Duplex Doppler USG
86
Who should be screened for osteoporosis
Women over 65, men over 70, men and women 50-69 with risk factors
87
DOC ascites?
Spironolactone over loops
88
V tach acute treatment
amiodarone
89
Bronchiolitis in ED best drug first?
Albuterol
90
Contraindications to zolendronate
Hypocalcemia, creatinine less than 35
91
ESRD associated with hypo or hyper pth?
hypoparathyroid
92
Common EKG finding in anorexia nervosa?
Sinus bradycardia
93
GC treatment?
Ceftriaxone 250 IM
94
Chlamydia tx?
Azithromycin
95
Zostavax is contraindicated in:
immunocompromised
96
Sevelamer MOA
Blocks intestinal absorption of phosphate, lowering PTH
97
Tx of acute otitis externa?
Cipro + dex
98
Which type of renal stone needs acidification of the urine?
CA phosphate
99
Calcaneal aphophysitis presents?
Heel pain in kids with tight Achilles, pain with dorsiflexion and activity
100
Tx of SCFE?
Surgery; more common in blacks that are fat
101
Length of thromboprhophylaxis for THA?
35 days
102
Phenytoin long-term side effect?
osteoporosis, by increasing hepatic metabolism of vitamin D
103
When to begin breastmilk supplementation and with what?
Vitamin D at 2 months
104
Does polymyalgia rheumatica have increased CPK?
Nope
105
In those on long-term prednisone, they also need to take:
BPP and vit D
106
What are some drug options for incomplete response to an antidepressant?
T3, lithium, or atypical antipsychotic
107
Pertussis phases
Prodrome 1-2 weeks similar to URI, then paroxysmal coughing fits
108
Baby has rash on perineum that's not diaper? What is the organism
GAS
109
What is an appropriate monotherapy for exercise induced asthma?
Pre-activity beta agonist
110
Posterior tibial tendonopathy presentation
women over 40 with no trauma, but pain with plantarflexion an worse with foot inversion
111
How are sulfonamides teratogenic?
Kernicterus in 3rd trimester
112
Rare side effect of dextromethorphan?
Serotonin syndrome
113
How do you interpret an AM cortisol test? High low etc
>13 excludes adrenal insufficiency; if <13, need to do ACTH stimulation test
114
All patients with HHT (OWR) need to be screened for:
Pulmonary venous malformations by contrast echo
115
Best way to image septic arthritis of hip?
USG
116
Treatment of Paget's bone?
BPP
117
Presentation of acute closed glaucoma
Severe pain, blurry vision, halos, increased extra-ocular pressure, red conjnctiva, dilated pupils, hazy cornea
118
What is Gottron's papules?
Flat violaceous papules on knuckles nearly pathognomonic for dermatomyositis
119
Which arrhythmia is adenosine used for?
SVT
120
How to check vit D levels?
25-OH, not D3
121
What is rifamixin used for?
Unabsorbed antibx that reduces ris kof traveler's diarrhea
122
Who should avoid zanamavir?
COPD
123
Clonidine is C/I in:
Depression
124
Working up an incidental adrenal mass (not imaging)
O/N dex test; if cortisol >5, indicates adrenal hyperfunctioning
125
Glucose goal for gDM
Fasting 95 or less
126
Do not use ziprasidone in combination with these drugs
Clarithromycin, TCAs, or antiarrhythmics bc of qt prolongation
127
Sjogren's antibodies to check
anti SSA and SSB
128
What is empiric therapy for suspected bacterial endocarditis?
Vanc + gent
129
Aricept increases risk for:
Cataracts
130
You find large parotid glands in someone. You should check to see if they have :
Diabetes
131
Drugs to reverse acute dystonia?
Diphenhydramine or benztropine
132
What is linagliptin?
DPP4 inhibitor
133
What is exenatide?
GLP analog
134
What is saxagliptin?
DPP4 inhibitor
135
What is sitagliptin?
DPP4 inhibitor
136
What is liraglutide?
GLP analog
137
What is glyburide?
Sulfonylurea
138
What is glimepizide?
Sulfonylurea
139
What is glipizide?
Sulfonylurea
140
What is pioglitazone
TZD
141
ST elevation in leads V1-V6, which artery is clogged?
LAD
142
ST elevation in leads II, III, aVF, which artery is clogged?
RAD
143
ST elevation in leads I, aVF, which artery?
Circumflex
144
Treatment for bullous impetigo?
Bactrim
145
Telogen effluxivum timeline
Hair loss 3 months after a stressful event that lasts 6 months after removal of the stressor
146
Iron anemia lab pattern TIBC ferritin reitulocytes
high TIBC, low ferritin, reticulocytosis 1 week after supp
147
ALT >3x UNL is specific for
gallstone pancreatitis
148
What is Behcet's disease?
Asians with eye problems, cutaneous sensitivity, esp needle pricks
149
Most sensitive 1st trimester option to screen for Down's?
Chorionic villus sampling
150
How do you monitor Lovenox?
Anti-Xa levels
151
How do you monitor LMWH?
PTT
152
Long-term use of H2 blockers or PPIs decreases __ absorption
Ca carb, so use Ca citrate
153
Where are the common fibromyalgia spots?
Medial scapula, back of neck, medial knee
154
Best SSRI for adolescents?
Fluoxetine
155
Tx of fungal toenail infection
Oral terbinafine 12 weeks
156
If PSA is >40, then:
Start 5 alpha reductase inhibitors
157
Otosclerosis presentation
Women in 20s-40s with progressive conductive hearling loss
158
Ottawa rules for X-raying ankles
Image if unable to take 4 steps, local navicular tenderness, local 5th MT tenderness, posterior or tip of malleolus is tender (Malleolus, Navicular, 4 steps, 5th metatarsal)
159
What is trifascicular block?
RBB + L anterior hemiblock inc risk of arrhythmia and bradycardia, so do heart monitoring
160
A 2nd PPD is + after a - one a few days before, what does that mean?
Long-standing latent infection
161
What is Hawkin's impingement test?
Pain w int rot while 90 flex and 90 elbow - indicates rotator cuff
162
What is granuloma annulare?
Self-limited , not congaeious, treat with steroids. Red bumps on skin arranged in rings, usually on hands or feet
163
DI urine findings
Uosm < 300
164
Pressors used for septic shock
NE and DA
165
Tx of orthostatic HTN
Fludrocortisone, midodrine, physostigmine
166
What is a J sign?
Patella moves medial to lateral when extended
167
BZDs for alcohol withdrawal?
Long-acting like chlordiazepoxide
168
SIADH UA
FeNa>1, Uosm high
169
Differences between Waldenstrom's, MM, and MGUS?
Waldenstrom's has kappa Igm with lymphocytes, MM has plasma cells instead, MGUS has no BJ proteins like the others
170
Varicocle - which side is worrisome
R. Usually they are on L and unilateral. On R should be susp for abdominal or intraperitoneal mass
171
Which SSRIs have the highest withdrawal symptoms?
Venlafaxine (Effexor)
172
Preventing contrast nephropathy before CT
Give N-acetylcysteine
173
Tx of SIADH in a stable patient
Water restriction
174
Marfan's suspected, need to do:
Echo
175
What is DRESS syndrome?
Drug reaction with eosinophilia and systemic symptoms; erythroderma plus fever, LAD, LFTs
176
Gonococcal conjunctivitis pres and tx
2-5 days life, tx ceftriaxone IM
177
Tx of dog and cat bites
5-7 days augmentin
178
Bacteria commonly associated with closed fist injuries?
Eikenella
179
What is amaurosis fugax?
Blockage of opthalmic artery leading to transient eye problems, assoc w strokes
180
What is the ABCD scoring system for people who have a TIA?
Age, BP, Clinical features, Duration/diabetes - identifies those at high risk of stroke within 7 days of TIA: BP >140/>90 1, Clinical 1, duration > 60 min 2 pt, less than 1 hr 1 point, diabetes 1 point
181
Aphasia during stroke indicates this artery is occluded or bleeding
MCA
182
Stroke work-up, acute
```
Head CT w/o contrast
EKG
MRI if symptoms have already resolved, w/in 24h
Non-hemorrhagic: ASA w/in 48h
tPA if w/in 3 hours
Watch for post-stroke brain edema
```
183
How long should PEP be given for HIV
4 weeks, with TMP-SMX, ideally within 2 hours
184
What are the stages of AIDS?
1 CD4 >500, 2 CD4 200-499, 3 (AIDS) CD4<200 plus AIDS-defining condition, 4 Unknown labs with AIDS-defining
185
Clinic follow-up for someone with AIDS
Measure CD4 count q 3-6 mo, with CBC, CMP, UA at baseline and periodically to monitor for complications of HIV and its drugs; serology for toxo and CMV, screen for other STDs, do PPD too; women need regular Pap smears with HPV dna
186
When do you begin PCP pneumonia prophylaxis in AIDS?
CD4<200 with TMP-SMX
187
When do you begin MAC prophylaxis?
CD4<50 with azithromycin or clarithromycin
188
What are some risk factors for hepatitis A?
International travel, contaminated foods (raw oysters esp)
189
Which form of bilirubin is excreted in the urine?
Conjugated, while unconjugated is albumin-bound
190
Mild unconjugated hyperbili off and on throughout a patient's life w/o symptoms...
Gilbert's
191
How is hep A transmitted?
Fecal-oral
192
What is the average incubation for hep A
25-50 days
193
How long does the hep A icteric phase usually last?
6-8 weeks
194
Who should get the hepatitis A vaccine? Besides just MSM
Children age 1, children 2-18 in high risk counties, traveler's to endemic areas, persons with chronic liver disease or clotting disorders, IV drug users, HIV+, high risk exposure workers, and anyone who desires immunity
195
What is the incubation time for hep B?
6 weeks to 6 mo., but only 50% are ever symptomatic
196
Risk of developing chronic hepatitis from the B virus is related to:
Age at infection; 90% of infants, but 5% of adults
197
This is responsible for 80% of HCC worldwide
hepatitis B
198
A patient is found to be anti-HBcAg IgM positive, with all other antibodies negative. What does that mean?
Window period
199
What percentage of those infected with hep C will develop chronic infection?
60-80%
200
What is the leading cause for liver transplant in the US?
Hep C
201
LFTs...viral hepatitis usually causes this one to be very high
ALT
202
What is the preferred non-invasive office test for H pylori now?
Stool antigen because of superior PPV, but must be off PPIs for at least 2 weeks
203
Drawback of H pylori serology
Cannot distinguish active vs treated infection
204
Roseola course
High fever and mild URI for up to 5 days, then exanthem of maculopapular eruption on face for 1-2 days
205
A new breast mass in women over 35 should undergo:
Triple assessment, with clinical exam, mammography, and either core biopsy or surgical excision
206
For women under 35, suspected lesions of fibroadenoma or fibrocystic change may be assed with:
USG, or rarely mammogram w/ FNA
207
DOC for breast pain
Danazol
208
Drugs that cause galactorrhea
SSRIs, TCAs, atenolol, verpamil, antipsychotics, H2 blockers, opiates, estrogens
209
What are Bouchard's and Heberden's nodes?
Bouchard: DIP
Heberden: PIP
Subluxed OA
210
Pseudogout
Pseudogout most often affects the elderly, and usually affects the knee, wrist, and ankle. Joint contains rhomboid-shaped, weakly POSITIVE birefringent calcium pyrophosphate
211
What are you worried about with premature closure of the fontanelles?
Craniosynostosis, if suspected get skull radiograph initially and if seen do CT
212
Tramadol should be used with caution in those with:
seizures esp older ppl
213
What are the approved treatments for men with osteoporosis?
Alendronate and PTH hormone
214
What is the treatment to reverse nerve gas (sarin)?
Atropine (anti-cholinergic)
215
What is the most effective drug for alcohol abuse?
Naltrexone
216
A post-traumatic air-fluid level in the sphenoid sinus is associated with:
A basal skull fracture
217
To test for median nerve inact after cut to hand ask them to:
Oppose thumb to pinky
218
What is autonomic hyperreflexia?
Sudden-onset sympathetic symptoms in those with spinal lesions above T6; fairly common; main concern is hypertension
219
This pain medication should be avoided in the elderly because of seizure risk
Meperidine (metabolite causes seizures sometimes)
