QBank Review Flashcards
(144 cards)
1
Q
What is a MUGA scan used for?
A
asessing EF in CHF
2
Q
How do you dx Churg-Strauss syndrome?
A
p-ANCA is present
pthology of affected tissue
3
Q
How do you treat a diabetic pt with microalbumuria?
A
ACE inhibitor
4
Q
What side effects are associated with 5-flucytosine?
A
bone marrow suppression
5
Q
What are the indications for hyperbaric oxygen therapy in carbon monoxide poisoning?
A
loss of consciousness
age >50
metabolic acidosis
carboxyhemoglobin >25%
cerebellar findings on neuro exam
6
Q
What conditions make exercise stress tests useless bc the EKG is unreadable?
A
LBBB
digoxin effect
LVH
Pacemaker
any major baseline abnormality of the ST segment
*do a nuclear/checmical stress test instead
7
Q
What is a great antifungal medicine class for candida, but does not cover cryptococcus?
A
Echinocandins (caspofungin, micafungin, and anidulafungin)
8
Q
How do you dx Sjogren’s syndrome?
A
salivary gland biopsy - gold standard
most people ANA positive (95%)
some people will have anti-Roa nd -La present (50-65%)
9
Q
How to anticoagulate after non-hemorrhagic stroke?
A
aspirin, clopidogrel, or aspirin + dipyridamole
10
Q
How do you manage temporal (giant cell) arteritis?
A
Immediate IV steroids and admission! so that doesn’t progress to blindness or stroke
11
Q
What neuro findings if present when Wernicke’s area is affected?
A
word salad - fluent speech but meaningless
12
Q
What type of hepatitis is most likely transmitted through a blood transfusion?
A
Hep C, takes 5-10 wks to incubate
13
Q
What is the follow up management after MI?
A
- B-blockers, aspirin, ACE inhibitors, statins
- stop smoking
- exercise
- moderate alcohol comsumption
- low-fat, vegetarian, and mediterranean diets
- sex can be resumed after 1-2 weeks or after 6 wks in pts with residual symptoms
14
Q
What is a side effect of ticlopidine (anti-platelet)?
A
neutropenia
*switch to clopidogrel
15
Q
What fungus grows septated hyphae?
A
aspergillus - tx with voriconazole
16
Q
What are good topical antibiotics for otitis externa?
A
polymyxin, neomycin, ciprofloxacin, ofloxacin, gentamicin, tobramycin
17
Q
What physical exam findings are seen with anabolic steroid usage?
A
Testicular atrophy
gynecomastia
htn
tachycardia
18
Q
What bacteria causes pneumonia and is lancet-shaped, gram positive diplococci?
A
strep pneumo
19
Q
What neuro findings if present when Broca’s area is affected?
A
expressive aphasia
20
Q
How to w/u urethritis in men?
A
gram-stain for gonorrhea
21
Q
How do you manage an acute COPD exacerbation?
A
oxygen, albuterol, budesonide, ipratropium, steroids, and ABX (azithromycin)
22
Q
How do you dx hepatopulmonary syndrome?
A
liver disease
increased A-a gradient
evidence of intrapulmonary vascular abnormalities on conrast-enhanced ECHO, pulm arteriography, or Tech-99 labeled albumin scanning
23
Q
What is the best initial therapy for cryptococcus?
A
amphotericin and flucytosine
24
Q
Can GERD be caused by H pylori?
A
NO. if pt with GERD is foudn to have H pylori it is incidental unless they also have ulcer dz, gastritis, or mucosal associated lymphoid tissue
25
When should you start inhaled steroids when a pt is hospitalized for acute asthma exacerbation?
right away - takes 5-10 days to see an effect, so when you start tapering oral/IV steroids, they will be ready to go
26
Where does breast cancer metastasize to?
bone
27
What lifestyle modification will ahve teh greatest immediate impact on coronary artery disease?
smoking cessation
28
What is the most effective tx for aspergillus?
voriconazole
29
How do you assess the severity of DKA?
bicarb (low)
pH (low - acidosis!)
increased anion gap
30
What are teh 5 A's of smoking cessation?
Ask, advise, assess, assist, arrange (f/u)
31
What is the next step in management of Parksinon's disease if levodopa/carbidopa is not controlling symptoms?
Add a COMT inhibitor - tolcapone or entacapone
32
How do you test for legionella?
urine
33
What are the options for empiric tx of neutropenia and fever?
1. carbapenems (imipenem, meropenem, doripenem)
2. cefepime
3. pip/tazo
34
What parameters must be kept in mind when ventilating a pt with ARDS?
"lung tissue very non-compliant and prone to rupture \*limit tidal volume to 6 cc/kg or less \* limit PIP to 35 or less so you don't over extend the lung \*make sure PEEP is atleast 10 cm H2O to prevent full collapse of the lung"
35
What settings do you use to ventilate pts with asthma?
low ventilatory rate (allow time for expiration), small tidal volume (prevent damage - air trapping), high flow
36
How do you initially manage DKA?
IV Bolus NS and IV Insulin
37
What is the most common type of fistula formed as a complication from diverticulitis?
colovesical (colon to bladder)
if pneumaturia present - needs surgery right away!
38
How to tx impetigo?
mupirocin and retapamulin
39
What is acute rheumatic fever?
post-streptococcal disease complication that is diagnosed with the JONES criteria.
Migratory Arthritis, Carditis, Sydenham chorea, erythema marginatum, or subcutanous nodules
+
(2 of) arthralgia, fever, elevated ESR/CRP, prolonged PR interval, and positive ASO titers
40
How do you treat acute prostatitis?
10-14 days ciprofloxacin or TMP-SMZ
41
How do you tx a mallet finger (avulsion of distal phalanx)?
extension splinting for 4-5 weeks
42
How do you dx Wegner granulomatosis?
presence of c-ANCA
like churg-strauss w/o asthma or eosinophilia
presents with sinus problems or nasal septal perforation
43
What is a simple vs complicated UTI and how do you tx each?
simple - bactiuria (bladder infection)
complicated - UTI in male, diabetic, HIV +, or pregnant
tx:
simple 3 days abx (TMP-SMZ)
complicated 10-14 days abx
44
What is a side effect of hydroxychloroquine?
ocular or retinal toxicity
\*can be reversed if caught early and you stop the drug
45
What are symptoms of legionella?
viral prodrome, initial dry cough, confusion, diarrhea, hyponatremia, leukocytosis
46
How do you treat acute rheumatic fever?
penicillin V now
aspirin if fever or arthritis
prophylaxis with pencillin G for...
1. 10 yrs or until age 21 (whichever is longer) if you have carditis
2. 5 years or until age 21 (whichever is longer) if no carditis
3. forever if carditis with residual effects on ECHO
47
How do you treat herpes simplex encephalitis?
IV acyclovir
48
What is the MOST controllable risk factor for stroke?
hypertension
49
What is Churg-Stauss syndrome?
vasculitis associated with nephritic syndrome, eosinophilia, and asthma
50
After a pt is treated for diverticulitis, when should confirmatory imaging be done?
do a barium enema in 2-3 weeks (in acute period the risk for perforation is too high)
51
Shock States
52
How do you decide to anticoagulate a pt with a fib to prevent stroke?
CHAD 0-1 : aspirin
CHAD 2+ : warfarin or dabigatran
53
What do you check yealy at a diabetic pt's check up?
urine microalbumin
foot exam
LDL level
dilated eye exam
54
How do you treat esophageal spasm?
CCB like diltiazem
55
What side effects are associated with amphotericin?
renal toxicity (distal RTA and hypokalemia)
56
What EKG findings are associated with Brugada syndrome?
RRRB and ST segment elevation in V1-V3
57
What is a prolonged QT for men and women?
men \>450
women \>470
58
How to manage NSTEMI?
Dual antiplatelet therapy
Nitrates
beta blockers
statins
anticoagulant therapy
59
What is a common complication to look out for with bicuspid aortic valve?
aortic dilation (can lead to aortic aneurysm)
60
How do you treat symptomatic HOCM?
Beta-blocker
61
What are the features of CREST Sydnrome?
calcinosis cutis
Raynaud phenomenon
esophageal dysmotility
sclerodactyly (fatty puffy fingers)
telangiectasias
\*when there is lung involvement - it is usually pulmonary HTN
62
What are the features of systemic scleroderma?
skin, lung (interstitial lung dz), kidney, and IG involvement
63
What sreening tests should be done at time of dx for scleroderma?
PFTs to get baseline lung fx
64
What are the clinical manifestations of celiac disease?
GI - diarrhea, abd pain, bloating
Mucocutaneous - dermatitis herpetiformis, atrophic glossitis
Endocrine - Vit D deficiency and secondary hyperparathyroidism
Bone - rickets, osteomalacia/porosis
Heme - iron deficiency anemia
Neuro - depression/anxiety, peripheral neuropathy
65
What is diverticular bleeding?
arterial erosion due to colonic mucosal outcropping
\*can cause painless hematochezia
66
What causes the mitral chordae tendineae to rupture vs a papillary muscle to rupture?
chordae - mitral valve prolapse, infective endocarditis, rheumatic heart dz, trauma
muscle - MI or trauma
67
What are clinical features of Ehlers-Danlos?
skin - velvety w/ atrophy and scarring, poor healing, hyperextensible
MSK - joint hypermobile, pectus, scoliosis
cardiac - MV prolapse
Other - abdominal/inguinal hernias, uterine prolapse
68
What are clinical features of Marfan?
MSK - joint hypermobile, pectus, scoliosis, tall w/ long extremities
Heart - progressive aortic root dilation, MV prolapse
other - lens and retinal detachment, spon. pneumothorax
69
How do you dx and manage gastroparesis?
dx - nuclear gastric emptying study
dietary modification - frequent small meals w/ decr fat and fiber intake
\*can use erythromycin or metoclopramide for motility if needed
70
What conditions are pts with Down syndrome more likely to develop later in life?
acute leukemia, dementia, autism, ADHD, depression, seizures
71
How to tx acute decompensated heart failure?
IV furosemide (decr preload and get fluid off lungs)
IV nitroglycerin (decr preload)
EHO to figure otu cause
72
What heart findings are associated with ASD (in adulthood)?
wide and fixed splitting of S2, right atrial or ventricular dilation
73
First line tx for DVT?
factor Xa inhibitor - rivaroxaban for \>/= 3 months \*if pt doesn't have cancer
\*if has cancer - LMWH
74
What is an alternative non-hormonal treatment for hot flashes?
SSRIs (escitalopram) or SNRIs (venlafaxine)
75
What is the genetic mutation in marfan?
defect to fibrillin-1 (glycoprotein)
76
What is a common presentation of GERD?
chronic cough due to irritation of cough receptors in the Respiratory tract
77
What medications cause digoxin toxicity?
verapamil, quinidine, amiodarone, spironolactone
78
How do you manage peri-infarction pericarditis?
high dose aspirin
79
How do you determine the cause (or narrow the ddx) of ascites?
SAAG value = serum albumin - ascitis albumin
IF \>/= 1.1 - means portal htn (CHF, cirrhosis, alcoholic hepatitis)
IF \<1.1 - means not portal HTN (TB, nephrotic syndreom, pancreatitis, serositis, carcinomatosis)
80
how do you tx idopathic pulmonary arterial HTN?
endothelin receptor antagonists
81
How to dx STEMI?
\>1mm ST elevation in \>/= 2 contiguous leads except V2 and V3, which need \>2mm
or new LBBB
82
When can radiation proctitis occur?
anytime after radation tx (acute - years)
causes diarrhea, muscus discharge, feeling need to defecate and not being able to pass much
83
How to eval and treat blood in the stool?
If suggestive of upper bleeding - EGD, if don't find it - colonoscopy
84
How to treat type 2 heart block?
pacemaker
85
What can chronic gerd lead to that causes obstructive dysphagia?
esophageal stricture
86
What are the most significant risk factors for coronary heart disease?
noncoronary atherosclerotic dz (AAA, peripheral artery, carotid dz)
DM
chronic kidney dz
87
How do you manage a stable aortic aneursym?
smoking cessation
aspirin and statin therapy
elective repair is \>5.5cm, rapidly enlarging \>0.5 cm in 6 months or assoc with peripheral artery dz/aneurysm
88
What is the most important risk factor to stop for AAA?
smoking
89
How do you tx cocaine tintoxication wtih chest pain?
benzos and nitroglycerin
CCBs for perisistent chest pain
phentolamine for perisistent HTN
PCI for MI
90
What are the most common causes of acute pancreatitis in adults?
alcohol and gallstones (65% of time)
metabolic - hyperCa and hypertriglyceridemia
91
What is the standard reccommendation for enteral feeding formulas for adults?
30 kcal/day and 1 g/kg/day of protein
92
What are the best non=pharm managment strategies for decreasing BP?
weight loss to BMI \<25 \*best!
DASH diet (8-14 mm Hg decr)
exercise (4-9 decr)
decr Na in deit (2-8 decr)
93
What does afib look like on EKG and how to tx?
narrow QRS
no p waves
irregularly irregular rhythm
tx: beta blockers or CCB (unless hypotensive or in Heart failure)
94
What drug must you decrease warfarin dose to compensate for when starting?
amiodarone
95
How to decide if you can clear a patient with a CAD hx for surgery?
If minor surgery (eye, breast, amubulatory, endoscopy) - ok unless acutely active dz
If any bigger surgery - if they can do a full exercise stress test or equivalent by hx (walking up 2 flights of stairs, briskly walk)- good, if they can't, they need further w/u
96
Does antibodiy testing confirm active hep C dz?
no! could mean active, past infection, or false pos
need HCV RNA testing
97
Can you re-try a statin drug if a pt had myositis from exercise provoked by the statin but was previously asymptomatic on the statin?
yes - recheck CK and if normalized, can try again
98
What are complications of diptheria?
pharyngitis (pseudomembrane)
toxin-mediated myocarditis
99
How to tx diptheria?
erythromycin or penicillin G
diptheria antitoxin (if severe)
100
What are symptoms of congenital rubella?
hearing loss, cataracts, PDA
"blueberry muffin rash)
101
How to think about heart meds and continuing/discontinuing before surgery...
102
Way to think about how to step up therapy with heart failure meds,,,
103
What is the classic KUB finding for sigmoid volvulus?
A distended colonic loop in the RUQ and the tip ointing toward the left lower quadrant
104
How to manage a sigmoid volvulus?
if febrile and peritoneal signs - surgical detorsion
if stable without fever or peritoneal signs - flex sigmoidoscopy or colonoscopy for dx and tx
105
How to manage drug induced parkinson dz (tardive dyskinesia and other extrapyramidal symptoms)?
switch to clozapine or quetiapine
\*if s/sx continue, try an anti-cholinergic med like benztropine
106
What is the standard of care for dx chlamydial and gonorrheal infections?
NAAT on urine in man or self-urethral swab on woman
107
What childhood viral illness causes high fevers and then ?rose-pink" maculopapular rash afterwards?
Roseola infantum (HHV-6)
108
What childhood viral illness causes slapped cheek rash and mottled looking skin?
erythema infectiosum (Parvovirus B-19)
109
What childhood viral illness causes rash and fever with cough and Koplik spots?
Rubeola (measles virus)
110
What childhood viral illness causes pharyngitis, rash, and strawberry tongue?
scarlet fever (strep infection)
111
What preventative counseling/advice is most likely to prevent disability w/in 5-10 yrs in an adolescent?
don't drink and drive
MVA's one of highest causes of mortality in adolescent age group (10-24)
112
What are the most important risk factors for men and women in regards to osteoporosis?
women - being a woman!
men - caucasian
113
What criteria must be met to dx brain death?
no spontaneous movement
no response to painful stimuli
no seizure or decerebrate, decorticate, or dyskinetic movements
no cranial nerve reflexes
no central respiratory drive with apnea test
114
how to w/u abnormal PAP with ASCUS
115
How to deliver ventilator breaths to COPD pts?
slow breaths (8-12 bpm) with 6-10 cc/kg tidal volumes to prevent baro-trauma to blebs or bulla
116
How to dx Wernicke's encephalopathy?
clinical! (eye, confusion, and gait abnormalities in malnourished alcoholic)
no lab testing needed - just start tx with IV thiamine
117
How can you differentiate between spontanrous SLE and drug-induced SLE?
drug induced does NOT have renal or CNS involvement
\*otherwise identical
118
What is the medical w/u for panic attacks?
Thyroid function tests
CBC, CMP, fasting glucose, LFTs, urea, Cr, Ca, UA, Urine drug screen, EKG
119
What condition presents with painless juandice and elevation of conjugated bilirubin and alk phos and how do you image?
pancreatic adenocarcinoma - get an abd CT
120
What is the next step in T2DM management when metformin is not controlling blood glucose levels?
add an incretin (sitagliptin) or a sulfonylurea (glimepiride, glyburide, or glipizide)
don't go to insulin until fails 2-3 oral meds
121
What is the most common complication of placental abruption?
disseminated intravascular coagulopathy (DIC)
122
What antibodies are found in transfusion-assocaited acute lung injury (TRALI)?
antigranulocyte antibodies in the blood donor
123
What is a contraindiaction for a TIPS procedure?
hx of hepatic encephalopathy
(makes it worse, bc not all blood is being filtered through liver)
124
What is Legg-Calve-Perthes disease?
avascular necrosis of the femoral head in 4-8 yo
125
How do you tx vibrio septicemia (caused by ocean exposure to cut and making black bullous lesions over skin)?
cefotaxime and minocycline
126
What is the best treatment for hepatopulmonary syndrome?
liver transplant
127
What is the right to left shunt refering to that is seen in pulmonary syndrome?
arteriovenous shunting - blood moving fast pass the lung tissue and there is no time for oxygen exchange
128
How to calculate the Aa Gradient?
A-a Gradient = 150 - (1.2 \* PaCO2) - PaO2.
129
What are findings of adernal crisis and how do you manage it?
hypokalemia, hyoptension (dehydration), circulatory failure
tx: saline, steroids, Abx (if infection precipitated it)
130
What should be screened for in all pts with HTN?
diabetes!
HgA1c \>6.5%
or fasting glucoses x2 \>125 mg/dl
or serum glucose \>200 mg/dl w/ symptoms
131
What should you suspect in an newborn who hasn't urinated, has a hx of oligohydraminios, and has acute renal failure?
how to dx?
posterior urethral valves
voiding cystourethrogram
132
How to treat exacerbation of mild asthma in ED?
3 doses of albuterol in 1 hour
(add steroids if pt was on them recently)
133
What are indications for hemodialysis in lithium toxicity?
serum level \>4
signs of lithium toxicity (seizures, mental status changes)
134
What is paget disease and what are complications that it can cause?
osteitis deformans - increased bone turnover
complications: fractures, tumors, high-output heart failure (bc incr blood flow through bone), arthritis
135
How to classify types of asthma?
intermittent - less than 2 days per week
mild - symptoms 2+ days, but NOT daily
moderate - daily symptoms, limits activity
severe - daily and nightly, limits activity
136
What are the side effects of metformin?
lactic acidosis, contraindicated in renal insufficiency
137
What antibodies should be screened for in pregnant pts with lupus?
anti-phospholipid and anti-ro antibodies
\*put on LMWH and aspirin in pregnancy d/t risk for placental infarction)
\*anti-ro can indicate neonatal lupus and risk congenital heart block
138
How to manage Barrett esophagus?
PPI and endoscopy q3 years
139
How to tx allergic contact dermiatitis?
stop agent and apply topical steroids
140
What is the best test for seeing if a pt had a new MI within days of a previous one?
CK-MB bc it only stays around for 1-2 days, so if elevated, it will be a new rise.
(troponin sticks around a lot longer 1-2 wks)
141
What is the best early screening test for hemochromatosis?
transferrin saturation (fe/TIBC)
142
What are normal opening pressures on LP in an adult?
100-200 mm Hg
143
What electrolyte derrangement to consider in a DKA pt with new weakness, muscle apain, and SOB?
hypophosphatemia
144
