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Medicine > Residency > Flashcards

Residency Flashcards

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1
Q

GERD

Treatment

A
  1. Proton Pump Inhibitor - compliance.
  2. Lifestyle modifications.
  3. H2 Receptor blocker added at night.
  4. Double dose of PPI or switch to another PPI.
  5. Baclofen.
  6. Endoluminal gastroplication.
  7. Antireflux surgery.
  8. Pro motility drugs.
  9. Pain Modulators - SSRIs, TCAs, Trazadone.
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2
Q

GERD

Evaluation

A
  1. Upper endoscopy.
  2. pH testing.
  3. Bilitec 2000 - DGER, bilirubin as a surrogate marker.
  4. Esophageal Impedance and pH Monitoring.
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3
Q

Occult Gastrointestinal Bleeding

Manifestations

A
  1. Fecal occult blood.
  2. Iron deficiency anemia.

Extremely common. Can be caused by virtually any lesion in the GI tract.

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4
Q

Iron deficiency anemia in men and post menopausal women.

Cause?

A

It should be considered to be gastrointestinal blood loss and evaluation by EGD and colonoscopy is required in this setting

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5
Q

Obscure gastrointestinal bleeding.

Location?
Evaluation?

A

Obscure GI bleeding is by definition recurrent and accounts for approximately 5 % of all cases of GI bleeding.

It usually occurs from a lesion in the small intestine.

Capsule endoscopy and deep enteroscopy (double balloon enteroscopy, single balloon enteroscopy and spiral enteroscopy) are the investigative procedures of choice.

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6
Q

Hepatic Encephalopathy: Long-term treatment

Drugs approved by the FDA

A
  1. Lactulose: 15 - 30 ml three times a day. Titrate to achieve 2 - 3 bowel movements a day.
  2. Rifaximin: 550 mg twice a day.
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7
Q

Hepatic Encephalopathy

Classification

A

Type A: Associated with acute liver failure.
Type B: Portosystemic bypass with no intrinsic hepatocellular disease.
Type C: Cirrhosis, portal hypertension, portosystemic shunts.
- Episodic HE: precipitated, spontaneous, recurrent.
- Persistent HE: mild, severe, treatment dependent.
- Minimal HE

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8
Q

Patient presenting with iron deficiency anemia and high eosinophils on differential white blood cell count…

Diagnosis?

A

Hookworm…

Ancyclostoma duodenale
Necator americanus

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9
Q

Inpatient type 2 diabetics.

Target blood sugars…

A

No hypoglycemic episodes

Pre-meal: less than 140 mg/dl

Random: less than 180 mg/dl

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10
Q

Which type of premeal insulin is preferred in gastroparesis patients and why?

A

Regular insulin, which is short acting instead of rapid acting, because patients with gastroparesis empty out their stomach slower and glucose takes longer to be absorbed and reach the blood stream.

Duration of action of regular insulin is 4 - 8 hours.

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11
Q

Types of basal insulin.

A

Lantus/glargine - 24 hours action.
Levemir/detemir - 12 to 24 hours action.
NPH (intermediate-acting) - always dose twice a day. Sometimes type 1 diabetics do better with NPH.

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12
Q

Insulin dosing based on fasting blood sugars, weight, age and renal function.

A

Fasting Blood Sugar 140 - 200 mg/dl, then 0.4 units/kg body weight.
Fasting Blood Sugar 201 - 400 mg/dl, then 0.5 units/kg body weight.
If age more than 70 years or GFR less than 60 ml/min, then 0.2 - 0.3 units/kg.

Give half of the calculated dose as basal and the other half in divided doses as pre-meal.

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13
Q

A diabetic patient on steroids has high blood sugars.

Would you increase the basal or pre-meal insulin?

A

Typically the pre-meal insulin needs to be increased.

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14
Q

A diabetic patient is on an insulin drip in the ICU for blood sugar control.

What range should the blood sugars be maintained at?

A

Between 140 - 180 mg/dl.

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15
Q

What adjustments should you make to the insulin regimen when a patient has overnight and morning hypoglycemia?

A

Always go and assess the patient.
Decrease the basal insulin by 25 - 50%.
After hypoglycemic episode patient is at risk for further episodes until it is time for the next dose of long acting insulin, so blood sugar so be checked every 2 hours for the next 24 hours.

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16
Q

How long does it take for Dilantin/Phenytoin to reach steady state in the blood stream when given as oral medication?

A

7 days

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17
Q

How do you treat phlebitis from a peripheral intravenous line?

A

Warm compresses.

It can give you fevers.

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18
Q

Sometimes vancomycin and clindamycin are used together in infections such as cellulitis.

Why?

A

Vancomycin and penicillins act on the cell wall and are bacteri-cidal. When the bacteria die then they release toxins that can increase the erythema and make the infection appear worse. Clindamycin is bacteri-static and prevents this effect.

It is called the Eagle effect.

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19
Q

What is the most likely cause of nephrotic syndrome in a patient with a history of cancer?

A

Membranous glomerulonephritis.

Cancer is associated with membranous glomerulonephritis. If a patient with a history of cancer develops nephrotic syndrome then this may indicate reactivation of the cancer.

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20
Q

Diabetes Mellitus type 2

Does surgery have a role?

A

New research indicates that bariatric surgery coupled with optimal medical management provides better glycemic control than optimal medical management for type 2 diabetics alone.

The mean BMI was 37 and these patients had already failed medical therapy. Unclear whether surgical benefits extends to patients who are not as overweight.

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21
Q

Which formula estimates GFR more accurately?

CKD-EPI or MDRD?

(And what do they stand for?)

A

The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation more accurately estimates GFR, and more accurately categorizes the risk for mortality and ESRD when compared with the MDRD (Modification of Diet in Renal Disease) study equation.

22
Q

What’s the diagnosis?

Hypersexuality
Neurological changes and behavioral changes
Hypermethamorphosis
Hyperphagia
Memory changes
A

Kluver-Bucy Syndrome

23
Q

What drug would you add in addition to Vancomycin in a patient with infected hardware?

A

Rifampin.

In cases of infected hardware where there is a layer of slime over the bone, Rifampin increases the penetration of Vancomycin to the bone, treating osteomyelitis better.

24
Q

What is the treatment of Helicobacter Pylori?

A

Triple therapy: PPI (twice a day), amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d for 10 - 14 days. If penicillin allergic then instead of amoxicillin give metronidazole 500 mg b.i.d.

Quadruple therapy: PPI (twice a day), bismuth 525 mg q.i.d. and two antibiotics, metronidazole 250 mg q.i.d. and tetracycline 500 mg q.i.d. for 10 - 14 days.

25
Q

How long do you have to wait after a CT scan with contrast before you can get an accurate radioactive iodine uptake scan?

A

3 months.

26
Q

What is fulminant hepatic failure?

A

New coagualopathy with hepatic encephalopathy of less than 2 weeks duration.

27
Q

Most common cause of fulminant hepatic failure.

A

Acetaminophen toxicity.

28
Q

Management of patient over 50 years of age with hemoptysis.

A

Bronchoscopy.

29
Q

When do you order an MRI brain with contrast?

A

When you are looking for things that affect the blood brain barrier.

30
Q

What is the significance of first degree AV block in acute endocarditis?

A

It detects aortic peri-valvular involvement, which is associated with increased mortality.

31
Q

What is the time frame for all patients who meet criteria for IV tPA?

A

Less than 3 hours.

32
Q

What is the time frame for all patients who meet criteria and who are less than 80 years old, do not use oral antcoagulants, have an NIHSS score of less than 25, and do not have a history of both previous stroke with diabetes?

A

Less than 4.5 hours.

33
Q

What is the time frame for IA tPA in an anterior circulation stroke?

A

Less than 6 hours.

34
Q

What is the time frame for IA tPA in a posterior circulation stroke?

A

Less than 12 hours.

35
Q

What is the time frame for mechanical clot retrieval in an anterior circulation stroke?

A

Less than 9 hours.

36
Q

What is the time frame for mechanical clot retrieval in a posterior circulation stroke?

A

Less than 24 hours.

37
Q

What is the treatment of erythema nodosum in Behcet’s disease?

A

NSAIDS.

If NSAIDs don’t work then prednisone.

38
Q

Which lipid lowering drug worsens glycemic control?

A

Niacin.

39
Q

What happens to the serum sodium in pregnancy?

A

It decreases.

40
Q

What are active cardiac conditions for which patient should undergo evaluation and treatment before non-cardiac surgery?

A
  1. Unstable coronary syndrome (unstable or severe angina).
  2. Decompensated heart failure (NYHA functional class IV; worsening or new-onset heart failure).
  3. Significant arrhythmias (high-grade AV block, Mobitz II AV block, 3rd degree AV block, symptomatic ventricular arrhythmias, supraventricular arrhythmias (including atrial fibrillation) with uncontrolled ventricular rate (HR greater than 100 beats/min), symptomatic bradycardia.
  4. Severe valvular disease (severe aortic stenosis; symptomatic mitral stenosis).
41
Q

What are the independent clinical risk factors for perioperative cardiovascular complications?

A
  1. History of ischemic heart disease.
  2. History of compensated or prior heart failure.
  3. History of cerebrovascular disease.
  4. Diabetes mellitus.
  5. Renal insufficiency.
42
Q

What is the most common kidney disease associated with hepatitis C and mixed cryoglobulins?

A

Membranoproliferative glomerulonephritis.

43
Q

What percentage of patients with hepatitis B have polyarteritis nodosa?

A

1 - 5 %

44
Q

What percentage of patients with polyarteritis nodosa have hepatitis B?

A

30%

45
Q

How do you diagnose polycystic kidney disease?

A

Renal ultrasound.

46
Q

What percentage of polycystic kidney disease patients have kidney stones?

A

25%

47
Q

What kind of kidney stones are present in polycystic kidney disease?

A

Uric acid stones.

48
Q

After how many weeks of gestation does pre-eclampsia occur?

A

20 weeks.

49
Q

Do you treat asymptomatic bacteriuria in pregnant women?

A

Yes.

50
Q

Treatment of vaginal candidiasis?

A

Fluconazole 150 mg once.

51
Q

What do you do in a new left bundle branch block?

A

It’s a STEMI equivalent - so go to cath lab

53
Q

Can iron deficiency anemia cause essential thrombocythemia?

A

Yes

Medicine (11 decks)

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