Screening and Preventive Medicine Flashcards

(203 cards)

1
Q

Breast Cancer screening

A

Mammography starting at age 50 q2years

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2
Q

Lung cancer screening

A

Age >55 with a >30 pack year history and quitting <15 years ago

Test: Low dose CT scan q1y

Quit at 80 years old or when they have quit smoking >15 years ago

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3
Q

AAA screening

A

Men >65 and who have EVER smoked

Test: Abdominal US

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4
Q

Calcium oxalate crystals in gout

A

Seen in end stage renal disease Pts

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5
Q

Acute PolyArticular arthritis

A

Suspect underlying endocarditis or disseminated Gonococcal infxn

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6
Q

Prenatal labs

A

CBC

HBsAg

Hiv testing

Rpr

Urinalysis

Urine cx

Rubella antibody

Type and screen

Pap smear

Cervical Swab for chlamydia and gonorrhea e

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7
Q

Asymptomatic bacteruria risks in pregnant ladies

A

Preterm labor

Acute pyelonephritis

Low birth weight

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8
Q

6 month shots

A

DtAP

Hep b

Hib

Pneumococcal

Rotavirus

Influenza

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9
Q

Six month milestones

A

Six strangers switch sitting at 6 months

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10
Q

Drug used to treat public speaking phobias

A

BBs

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11
Q

Panic attack treatment

A

Control= SSRIs

Abortive=Benzos

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12
Q

MDD symptoms

A
Sleep
Interest
Guilt
Energy
Concentration
Appetite 
Pyschomotor 
Suicidal thoughts 

Need 5/8

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13
Q

Post partum psychosis tx

A

Antipsychotics

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14
Q

Diagnostic criteria for diabetes

A

Fasting blood glucose of >126

HbA1C >6.5

Plasma glucose of 200mg/dl or greater 2 hours after a 75g glucose challenge

Random plasma glucose of 200 or greater with hyperglycemic symptoms

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15
Q

Antihypertensive to use in black people

A

Thiazides OR amlodipine

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16
Q

Guidelines for starting statins

A
  1. Anyone under the age of 75 with atherosclerotic CV disease
  2. LDL >190
  3. Anyone older than 40 w/ a 10-year CVD risk of >7.5%
  4. Diabetics with an LDL of greater than 70
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17
Q

Thyroid nodule workup

A

TSH

Ultrasound

Biopsy; especially if it is >1cm or has normal/reduced functioning

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18
Q

Vaccine that cannot be administered after 15 weeks

A

Rotavirus

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19
Q

PCOS diagnostic criteria

A

Hyperandrogenism, evidenced by hirsutism or elevated serum androgen levels

Oligomenorrhea with cycle length greater than or equal to 35 days

Multifollicular ovaries on pelvic US (12 or greater)

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20
Q

Patient with suspected SAH

A

Refer to ER immediately; do not even get CT if you are in outpatient

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21
Q

Diabetic medications that help to lose weight

A

Metformin and Incretins (Exenatide)

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22
Q

Treatment for IBS with diarrhea

A

Peppermint oil

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23
Q

Frozen shoulder

A

Idiopathic condition that causes loss of active and passive shoulder rotation and severe pain, especially at night

Commonly happens in DM Type II patients

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24
Q

Erythema toxicum neonatorum

A

“Flea bitten” rash on the upper body of a newborn; infant is otherwise in no significant distress

Rash looks like small pustules surrounded by an erythematous base

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25
Croup tx
Mild- Mist Moderate- Racemic epi, steroids, O2 Severe- -Patient is 3months-3 years old and has barking cough with stridor
26
Croup that does not improve w/ racemic epinephrine
Probably dealing with bacterial tracheitis; give antibiotics and get tracheal culture Will probably see purulence in the back of the throat as well
27
<2 year old presenting w/ asthma like symptoms in the winter
Think bronchiolitis
28
Acne rosacea
Patient presents with central facial erythema and telangectasia that can progress to rhinophyma, flushing triggered by food or emotions, ocular problems, and pustules Tx: Sunscreen use, oral metronidaozle or tetracycline
29
Posterior tibialis tendinopathy
Patient will have pain and swelling behind their medial malleolus but will not recall spraining their ankle Tx: Immobilization in a boot or cast for 2-3 weeks
30
Restless leg syndrome treatment
Pramiprexole, ropirinole Also try iron supplementation if there ferritin is low
31
TST result interpretation
High risk? =>> >5mm is positive Low risk? =>> >15mm is positive
32
Testing to get for pyloric stenosis
Abdominal x ray to rule out a perforation
33
Indications for battery removal
Hasn't progressed in 3 days Flat button battery
34
Lewy body dementia
Presents with vivid hallucinations, fluctuation in cognition, and parkinsonian Extrapyramidal signs with postural instability Tremor may not be present
35
Metabolic syndrome
Constellation of symptoms including 3 of the following Waist circumference >102 cm Triglycerides > 150 HDL < 40 if male, <50 if female Blood pressure >130/85 Fasting plasma glucose >100 Or if a patient is being treated for any of these Increased risk of CVD and DM
36
Antiepileptics to use in pregnancy if you have to
Lamotrigine, leviteracetam (L-drugs)
37
Uterine rupture
Usually occurs at the site of a c-section scar; occurs with contractions, is painful, and regression of fetal station Tx: Crash c-sec
38
Prepubertal labial adhesions
Idiopathic condition in which pediatric patients have adhesions near the introitus of the vagina that may interrupt urination, create a pulling sensation, or cause recurrent UTIs Tx: Topical estrogen
39
Pallidotomy
Surgery for disabling unilateral tremor and dyskinesia from Parkinson's disease
40
Monteggia fracture
Distal fracture of the ulnar with dislocation of the radius Due to someone blocking something with their backarm
41
Galezzia Fracture
Radius break with ulnar dislocation
42
Fracture of the femoral head
Needs a prosthesis for repair Often presents in an old lady with a shortened and externally rotated leg
43
Antibiotics that are CYP inhibitors
Macrolides (erythromycin, Clarithromycin) Statins and other drugs metabolized in the liver are CI'd while using these abs
44
Tx for HELLP
Delivery Make sure to be observant of lab values
45
Child with Glomerulonephritis following a uri
Probably an IgA nephropathy
46
Other sites for herpes
Butt and sacrum
47
Pregnant lady with cervical trauma
Keep her in the supine position with the uterus deflected laterally
48
Surgery for an AAA
Tender mass Back pain >5.5 cm
49
Non opioid that can provide pain relief from compression fractures
Calcitonin
50
Surgery for an AAA
Tender mass Back pain >5.5 cm
51
Non opioid that can provide pain relief from compression fractures
Calcitonin
52
MCC of tracheitis
S. Aureus
53
LCP Tx
Conservative, brace the hip while maintaining some motion
54
SCFE Tx
Surgical pinning of the femoral head If not, can lead to Avascular necrosis
55
Aspirin OD
Early: Tinnitus, N/V, vertigo, Respiratory alkalosis Late: Anion gap acidosis, obtunded, coma, hyperpyrexia, Metabolic acidosis Dx: Salicylate level Tx: Alkalinize the urine
56
Cyanide OD
Causes: Smoke inhalation, nitroprusside OD Pt: Sick w/ cherry red skin and blood Tx: Thiosulfate
57
Organophosphate poisoning tx
Atropine and Pralidoxime (if you have to choose, pick pralidoxime) ``` Signs: Salivation Lacrimation Urination Diarrhea GI upset Emesis ```
58
Best tx for nocturnal enuresis
Bed wetting alarm
59
Common deficiency after gastric bypass surgery
Iron and B12
60
DRESS syndrome
Drug Reaction with Eosinophilia and Systemic Symptoms Erythroderma accompanied by fever, lymphadenopathy, elevated liver enzymes, and eosinophilia -Typically caused by a medication such as antiepileptics or allopurinol Tx: Corticosteroids and stop offending drug
61
Preventing post op atelectasis
Deep inspiration, coughing, incentive spirometry, and pain control
62
Postimplantation syndrome
Self-limited fever, elevated CRP, and leukocytosis w/ negative blood cx Usually follows an aortic aneurysm repair
63
Recurrent wheezing differential in children
Bronchomalacia Vascular rings GERD
64
Indications for palivizumab
Child with... Chronic lung disease Prematurity Congenital heart disease
65
Antispasmodics for IBS
Dicyclomine, hyoscyamine Used as need when pain is mild and infrequent
66
IBS tx for frequent and severe pain
TCAs
67
Diarrhea-predominant IBS tx
Loperamide Rifaximin
68
Constipation-predominant IBS tx
Fiber (like psyllium) Polyethylene glycol Lubiprostone (activates intestinal chloride channels) Linaclotide (increases gut motility) and secretions)
69
Jersey Finger
Tearing of the flexor tendons Occurs after a ripping motion when someone is trying to hold on it Tx: NSAIDs, splinting, surgery last resort
70
Mallet finger
Tearing of the extensor tendon Occurs when a ball hits someones finger tip Tx: NSAIDs, splinting, steroids, surgery last resort
71
Trigger Finger
Stenosing tenosynovitis (not a sports injury), patient when forcing finger into extension will see a pop Tx: Splinting, NSAIDs, Steroids, Surgery last resort
72
Dequervain's Tenosynovitis
Mom holding a baby and guy lifting weights Patient complains of thumb pain Patient can't make a fist and then deviate towards the ulna Tx: NSAIDs, splinting, steroids, NO SURGERY
73
Felon
Abscess on the pulp of the finger; patient will have a lot of pain, fever, and leukocytosis Is a product of penetrating injury Tx: High lateral I and D; sometimes antibiotics if severe
74
Colon cancer screening in patients with a positive family history
Start 10 years before the onset in their family member
75
Main action of metformin
Inhibition of glucose production in the liver
76
Child who is mildly dehydrated during illness at home
Start kid on an oral rehydration solution (not just water)
77
Treatment of infantile gonococcal ocular infxn
Single dose of ceftriaxone intramuscularly
78
Only drug that can intranasally reduce cold sx
Ipratropium
79
Bisphosphonates risks
Osteonecrosis of the jaw Anemia Burning while swallowin CIs: Decreased renal fnxn, hypocalcemia
80
Hypersensitivity pneumonitis
Patient is exposed to irritant and develops chills, cough, SOB CXR will be normal, PFTs show restrictive changes
81
Onion skinning in the midshaft of the femur
Ewing's sarcoma
82
Sunburst pattern on the distal femur
Osteosarcoma
83
Childhood Obstructive Sleep Apnea tx
Adenotonsillectomy
84
Calcaneal apophysitis
"Sever Disease" Heel pain that occurs when the bones grow faster than the muscles and tendons; the Achilles tendon pulls with repetitive running or jumping causing microtrauma Tx: NSAIDs, ice, stretching, orthotics
85
Child with apneic episode
Admit for observation but don't treat right away
86
Treatment for a GBS pos pregnant lady who is allergic ato penicillin
Cefazolin
87
Pain relief in hepatic cirrhosis patient
Anything but NSAIDS, even acetaminophen
88
Red rash with Coal red luminescence under a woods lamp
Indicates a corynebacterium infxn, treat with erythromycin instead of an antifungals
89
Abnormal ABI
>1.4 Indicates arterial calcification and mandates a CT follow up
90
Ottawa Rules for radiography
Pain in the malleolus or mid foot zone with tenderness over the distal tibia or fibula, lateral or medial malleolus, the base of the fifth metatarsal, or at the navicular bone OR Inability to bear weight immediately after the injury AND when evaluated by the physician
91
CI'd drug in hypertensive cardiomyopathy
CCB These drugs have a negative inotropic effect
92
️Chronic Antihypertensive to use in pregnancy
Labetalol
93
Tx for hypoactive sexual desire disorder
️Topical testosterone, for males and females
94
Indications for hospital admission due to upper GI bleed
Age >60 Systolic pressure <100 Heart rate >100 Shock Major comorbidities
95
Rotavirus vaccine deadline
15 WEEKS
96
Persistent occiput posterior delivery position
Assoc with higher risk of c-sec, assisted vaginal delivery, and lower likelihood of spontaneous delivery
97
Parkland fluid for burn
50% of fluid in 1st 8 hrs, 50% in next 16
98
Rubella in an infant
Prodrome: Tender Lymphadenopathy Later: Fever and rash (a lot like measles) There are no koplik spots like in measles
99
Workup of secondary amenorrhea
1. Progesterone withdrawal challenge 2. Estrogen 3. FSH, LH 4. MRI of anterior pituitary 5. Hypothalamus = diagnosis of exclusion
100
Tx for prolactinoma
Dopamine agonists
101
Pre or post exposure prophylaxis for HIV
Emtiricitabine and Tenofovir
102
HIV prophylaxis
CD4 <200 : PCP (Bactrim or Dapsone) CD4 <100 : Toxoplasmosis (Bactrim or Pyrimethamine) CD4 <50 : MAC (Azithromycin weekly)
103
Treatment for SVT
Radiofrequency ablation
104
Ventilator tx for ARDS
Decreased tidal volumes with increased PEEP
105
First line tx for diabetic peripheral neuropathy
TCAs
106
Surgery for asymptomatic gallstones
Only if they have a hemoglobinopathy since they have an increased risk for pigmented gallstones
107
Thessaly test
Positive test indicates a meniscal tear Patient bends knee to 20 degrees and then internally and externally rotates it
108
Acute rectal fissure pain relief
Botox
109
Indication for adenosine administration in cardiac cases
Symptomatic bradycardia
110
Stages of syphilis
1: Painless ulcer with nontender lymphadenopathy 2: Fever, rash on palms and soles of the feet, usually targetoid as well 3: Neurosyphilis (can be any neuro symptom but usually tabes dorsalis with a loss of proprioception), Argyll-Robertson pupil, aortic regurgitation
111
Lymphogranuloma Venereum
Painless ulcer like syphilis BUT there is TENDER lymphadenopathy and usually draining pus Pt is probably IC as well Tx: Doxycycline
112
Gestational hypertension
>140/>80 that begins after 20 weeks; there is no proteinurea or edema though Has a potential to progress to preeclampsia
113
Preeclampsia management
Weekly followups with frequent screenings until Week 34 Be on the lookout for alarm symptoms, in that case, you deliver no matter what week it is Alarm features: Increased creatinine, low platelets, RUQ pain, pulmonary edema, elevated LFTs, headaches, visual changes
114
Pain with passive stretching of the muscles and excessive pain out of proportion to a recent injury
Most reliable indicators of compartment syndrome
115
DVT assessment
Low risk= D dimer High risk= Go straight to ultrasound
116
Croup tx
Single dose of corticosteroids Epinephrine as well if it is severe
117
Lyme disease prophylaxis
Single 200 mg dose of doxycycline
118
Prolonged phases of labor
Latent phase: >20 hrs (nulli) >14 hrs (multi) Active phase: >1.2 cm/hr (nulli) >1.5 (multi) Stage II: >3hrs (nulli) >2 hrs (multi) Stage III: >30 mins
119
Baby in breech presentation
Try external inversion If it doesn't work, c section
120
Indications for surgery in diverticulitis
Generalized peritonitis Unconfined perforation Uncontrolled sepsis Undrainable abscess Failure of conservative management
121
Exercise for elderly people in nursing homes
Resistance training
122
Lichen planus is associated with what disease?
HCV
123
HbA1c goals in patients with significant comorbidities and are old
<8.5
124
Likelihood ratio of 1
Means the test is fuckin useless
125
Cardiac pre op eval
EF <35% =>> needs to be better MI =>> Wait 6 months Workup: EKG, Echo, Stress if indicated for a CAD patient Tx: MI= Stent/CABG CHF= Diuresis
126
Pulmonary pre op eval
Workup: PFTs, maybe ABG on the day of Tx: O2 Inhalers to control underlying disease *********SMOKING CESSATION 8 WEEKS IN ADVANCE
127
Liver pre op eval
Work-up: Albumin, PT, PTT, total bilirubin, check for ascites and encephalopathy Any of these positive, don't go to surgery Tx: Liver transplant
128
Nutrition pre op eval
Loss of 20% of body weight in less than 3 months, albumin <3, and anergic skin test Work up: Prealbumin, CRP, Tx: 10 days of nutrition
129
Patients who have gotten the BCG vaccine get screened for TB how?
INF-y assay
130
Brugada syndrome
Ion channel disorder common in Asian people that presents as a RBBB with an elevation of the J point and flat or negative t wave Can cause deadly arrhythmias
131
Secondary prevention
Screening and intervention
132
Stop screening for colon cancer at what age?
75 or 85 if there has been a positive one recently
133
AAA Screening
MEN >65 who have EVER smoked -Only have to screen once
134
Hep C screening
Baby boomers get screened once (1945-1965) Test for Hep C ab
135
People who HTN should be screen for what disease?
Diabetes; perform an A1C
136
HLD screening
>35 or >20 with risk factors in men >45 or >30 with risk factors in women
137
Max doses of epinephrine for anaphylaxis
0. 3-0.5 mL in adults | 0. 01 mg/kg with a max dose of .3 mg/kg in kids
138
Cat bite treatment
10-14 days of Augmentin High risk for Pasteurella multocida
139
Next step in therapy after confirming a stroke
Determine if thrombolytic therapy can be used If it has been >3 hrs since onset, they are not a candidate **CTs rule out hemorrhage, tumors, or abscess but do not always show ischemia right away
140
Anosognosia
Unawareness of a disability; common feature of strokes
141
Drugs to give after a stroke
Aspirin within 48 hours! Could also use clopidogrel Also start DVT prophylaxis with heparin Long term anticoagulation is not indicated after this acute period unless they have arterial disease that can cause clots
142
Stroke in a child
Suspect SCD
143
Severe high blood pressure after a stroke
Could be hypertensive encephalopathy or intracranial hemorrhage
144
BP goal in a 60 year old w. HTN
150/90
145
CKD and ARBS
THEY HAVE TO GET ACEIS OR ARBS
146
Emergency hypertension crisis tx q
IV BBs, CCBs or nitrates
147
BB to use in CKD
Labetalol
148
Drug to use if spironolactone causes gynecomastia
Eplerenone
149
HSV positive pregnant woman
Place them on therapy to reduce risk of viral shedding at time of delivery and breastfeeding
150
TdaP in pregnant women
Give between 27 and 36 weeks due to increasing incidence of pertussis
151
Uveitis
Assoc. w/ a sluggishly reactive pupil, photophobia, and conjunctival injection Assoc. w/ Ankylosing spondylitis and other HLA-b27 conditions Tx: Ocular corticosteroids
152
Dysplasia seen in esophagus with chronic GERD management
Local ablative therapies; doesn't really matter what Follow up with surveillance EGDs
153
Alarm symptoms with GERD and management
N/V Anemia Weight Loss Progressive dysphagia Recurrent vomiting Jaundice Management: EGD with biopsy
154
Patient who is on BBs, is hypotensive, and not responding to epinephrine
Give glucagon; their adrenergic receptors are blocked
155
Labs to monitor on Lithium patients
Lithium drug levels Renal fnxn TSH
156
H pylori serologic tests
Do not differentiate between active and past infxn
157
Increased bilirubin in the urine
Sign of Conjugated bilirubinemia
158
H pylori workup
Serological test to screen Stool test to work up Urea breath test if inconclusive, save this one because it is the most expensive
159
Erythema marginatum
Erythematous, serpinginous macules with pale centers Caused by group a strep
160
Medicine to give patients with diabetic nephropathy
ACEIs or arbs These drugs reduce the progression of disease to ESRD as well as decreasing their cardiovascular risk
161
Treatment of acute COPD exacerbation
Steroids, beta agonists, and antibiotics!
162
Scleroderma S&s
Thickening of the skin Raynauds Esophageal dis motility Interstitial lung disease ⭐️ anti- centromere antibodies!
163
Gout work up
24 hour urine for Uric acid If ️Decreased ➡️ prescribe probenecid which blocks resporption of Uric acid in the renal tubules If increased/normal ➡️ allopurinol which ️Decreases the breakdown of purines
164
Hypertensive urgency Tx
Labetalol Nitroprusside if it's an EMERGENCY
165
Congenital syphilis
Baby presents with rash involving the palms and soles of the feet, bloody nasal drainage, Hepatosplenomegaly, and lymhadenopathy ⭐️Blood nasal drainage = SNUFFLES
166
What follow should occur after confirmed Zollinger-Ellison
Men 1
167
Treatment of superficial thrombophlebitis
Symptomatic: RICE - Presents with a hardened, red, and inflamed vessel; typically not like a regular DVT - Typically DVTs cannot be palpated; if you do have a DVT, treat with heparin and long term coumadin
168
What should you check before starting a TCA?
QT interval =>> Get an EKG
169
MAOis
Selegline, Phenylzine, Tranylcyramine
170
Management of inevitable or missed abortion
Oxtocin to expel remaining tissue; D and C if there is still some left
171
Pramlinitide
️Inhibits inappropriately high glucagon secretion during episodes of hyperglycemia
172
Insulin secretagogue classes
Sulfonylureas, Meglitinides (Nateglinide), and glp-1 agonists (Exenatide) Glp-1 agonists also cause early satiety
173
Spinal stenosis causes
Degenerative arthritis Spondylolisthesis
174
Anti-mitochondrial antibodies
Primary biliary cirrhosis
175
Labyrinthitis
Vestibular neuritis Post-viral inflammation of CN VIII that is benign and will resolve on its own; patients have peripheral nystagmus, balance issues, and hearing loss
176
Classic patient for pseudotumor cerebri
Young, obese female on OCPs
177
Testing for Addison's
ACTH or Cosyntropin stimulation test
178
Ischemic tubular necrosis
Increased BUN:Cr (meaning there it is 15:1 ish instead of 10:1 ish) and ENa -In pre-renal failure, these are typically increased
179
Pasteurella multocida infxn
Simply shows up as cellulitis; if you see lymphadenopathy, think Bartonella henslae
180
Management of possible septic endocarditis
Echocardiogram to eval for vegetations
181
pCO2 that has risen after an asthma attack
Indicator of impending respiratory failure, Even if they appear stable! -It indicates that the airways are so constricted that the patient can no longer get rid of CO 2 "Silent chest" of a severe attack Tx: Admit and intubate
182
Onchomcosis
Presents as a yellow, somewhat tender nail F/U: KOH examination of nail scrapings Tx: Oral terbinafine, itraconazole
183
Vesicoureteral reflux
Antibiotic prophylaxis until it resolves; if it is severe and does not resolve, possible intervention
184
Causes of non-anion gap metabolic acidosis
Type I Renal Tubular Acidosis (decreased secretion of h+; can be caused by stones GI bicarbonate loss
185
Dexamethasone suppression test
Suppresses cortisol levels if there is a pituitary adenoma If there is an adrenal tumor or ectopic ACTH producing mass, it will not be suppressed
186
Patient with COPD who presents with acute bronchitis like symptoms
Go ahead and give antibiotics even tho you wouldnt do that for a normal person
187
Albuminocytologic dissociation
Increased WBC and normal WBC in a spinal tap Found in Guillan-Barre; don't need to do this usually to diagnose but just in case
188
Outpatient treatment of MRSA
Bactrim Think MRSA if a gram pos infxn, such as a skin infxn, did not go away with a normal B-lactam drug
189
Patient with ASCUS cells and a high risk HPV strain on testing
Colposcopy
190
Otitis media with effusion remaining for a long time after an acute infxn
Possible tube placement if it is affecting their hearing
191
Woman presenting with signs of appendicitis
Still get a pregnancy test
192
Alprostadil
Prostaglandin analogue that can be used for erectile dysnfnxn when there is a CI for tadalafil (such as nitrate use)
193
Elements of minimal change disease
Proteinuria Edema Hypoalbuminemia Hyperlipidemia
194
Thyroid Nodule workup
1. TSH (if hyper, don't worry about it) Euthyroid? =>>2. FNA
195
4-2-1 rule for kids
First 10kg =>> 40ml/kg/hr Next 10 =>> 20/ml/kg/hr After 20 =>> 1/ml/kg/hr
196
First step in management of GERD
Lifestyle modifications 2. H2 blockers; antacids 3. PPIs; H2 blockers 4. Nissen fundoplication
197
Cardiac pre op clearance
IF they have had coronary angiography or vessel grafting in the past couple years, they good If they have stable CHF, diabetes, uncontrolled HTN, or other mild risk factors, get a stress test before echo
198
Pregnant diabetic drug changes
Switch any oral drugs to insulin
199
Universal recommendation for menopausal women
1200mg/day of calcium Vitamin d of 800IU/day
200
Consider using what drugs in conjunction with opioids?
Bisacodyl or any other stool softener
201
Lymphedema management options
Support, pneumatic compression, drainage, and surgery
202
Squaring appearance of the foot with lower extremity swelling
Kaposi-Stemmer sign Seen with lymphedema
203
Tx for organophosphate poisoning
Atropine Pralidoxime