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Medicine > step 3 4 > Flashcards

step 3 4 Flashcards

1
Q

Hypomagnesium differential

A

medication side effect (Diuretics, gentamicin, amphotericin, cisplatin), alcohol withdrawal, pancreatitis, parathyroid surgery

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2
Q

metabolic alkalosis differential

A 
Primary: contraction alkalosis, cushing/conn syndromes, hypokalemia, milk-alkali syndrome, vomiting
CLEVER PD
C – contraction (dehydration)
L – liquorice (diuretic), laxative abuse
E – endocrine (Conn’s, Cushing’s)
V – vomiting, GI loss (villous adenoma)
E – excess alkali (antacids)
R – renal (Bartter’s), severe K depletion
P – post hypercapnia
D – diuretics
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3
Q

hypokalemia metabolic alkalosis pathophys

A

potassium ions shift out to correct hypokalemia, which causes hydrogen ions to shift into the cell

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4
Q

episodic HTN think

A

pheochromocytoma

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5
Q

screening intervention that has the biggest effect on mortality

A

mammography

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6
Q

ER, PR postive breast cancer needs…

A

tamoxifen

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7
Q

when you need adjuvant chemo for breast cancer

A

positive axillary nodes or tumor is greater than 1 cm in size
patient is still menstruating

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8
Q

tamoxifen SEs

A

DVT
Hot flashes
Endometrial cancer

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9
Q

aromatase inhibitors mechanism-side effects

A

estrogen antagonist, osteoporosis

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10
Q

use of trastuzumab in breast cancer

A

HER-2/NEU positive metastatic disease

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11
Q

screening for single family member with colon cancer

A

at age 40 or 10 years earlier than age at which family member contracted cancer

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12
Q

screening for HNPCC, three family members, two generations, one premature

A

colonoscopy at age 25, then every 1-2 years

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13
Q

screening for FAP, Gardner’s syndrome, Peutz-Jeghers, Turcot’s syndrome

A

screening sigmoidoscopy at age 12, then every 1-2 years

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14
Q

lung cancer screening indication

A

30 pack year plus + age 55-75 + has not quite in past 15 years

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15
Q

contraindications to lung cancer resection

A 
bilateral disease
mets
malignant pleural effusion
involvement of aorta, vena cava, heart
lesions within 1-2 cm of carina
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16
Q

cervical cancer screening

A

21-29, q3 years until 29, then pap + HPV (cotesting) q5 years until 65

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17
Q

pap smear results management

A

abnormal pap with low-grade or high grade dysplasia → colposcopy and biopsy
pap with atypical squamous cells of undetermined significance → HPV testing
HPV-positive pap → colposcopy

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18
Q

official recommendation for PSA

A

don’t offer, but if asked and patient is under 75, PSA + DRE

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19
Q

prostate cancer management

A

if localized – surgery + external radiation or implanted radioactive pellets
if metastatic – hormonal, not chemo, andogen blockade with flutamide and leuprolide or goserelin

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20
Q

management of cord compression in prostate cancer patient

A

flutamide

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21
Q

ovarian cancer treatment

A

surgical debulking then chemo

22
Q

step 3 answer to scrotal lump

A

inguinal orchiectomy of affected testicle

23
Q

testicular cancer treatment and staging

A

Stage with CT abdomen-pelvis

Treat local disease with radiation and metastatic with chemo

24
Q

rocephin generic name

A

CTX

25
Q

severe sepsis management

A

If still hypotensive after first pressor add vasopressin at 0.4 kg/hr
If still hypotensive → add stress-dose steroids, hydrocortisone 500 mg q6h, increase to 2g
monitor response to pressors with flow track or CVP monitoring

26
Q

AC abbreviation

A

before meals

27
Q

septic shock criteria

A

Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg, and
Lactate greater than or equal to 2 mmol/L

28
Q

when to be concerned about pseudomonas

A

1) nosocomial bacteremia,
2) wound
3) urinary tract infections
4) recent hospitalization
5) ventilator

29
Q

drugs covering anaerobes

A

Beta-lactam/beta-lactamase inhibitors such as ampicillin/sulbactam and piperacillin/tazobactam have excellent anaerobic coverage. When treating suspected or proven anaerobic infections with these drugs, addition of other agents such as metronidazole and clindamycin.

30
Q

e coli features

A

E. coli is a Gram-negative, facultative anaerobic (that makes ATP by aerobic respiration if oxygen is present, but is capable of switching to fermentation or anaerobic respiration if oxygen is absent)

31
Q

qSOFA criteria and interpretation

A

AMS
RR greater than 22
SBP less than 100
- positive if 2 or greater

32
Q

solumedrol generic name

A

methylprednisolone

33
Q

retroperitoneal structures

A 
urinary
adrenal glands
kidneys
ureter
circulatory
aorta
inferior vena cava
pancreas
rectum and anal canal
Secondarily retroperitoneal, meaning the structures initially were suspended in mesentery and later migrated behind the peritoneum during development[3]
the duodenum, except for the proximal first segment, which is intraperitoneal[4]
ascending and descending portions of the colon
34
Q

top 5 causes of chronic caugh

A

postnasal drip
asthma
gastroesophageal reflux disease (GERD) chronic bronchitis,
treatment with ACE inhibitors

35
Q

three key features of PTSD

A

1) re-experiencing of the traumatic event (dreams, flashbacks, or intrusive recollections)
2) avoidance of stimuli
3) increased arousal (anxiety, sleep disturbances, hypervigilance, emotional lability, or impulsiveness)

36
Q

other causes of depression

A

hypothyroidism, Parkinson’s, meds (beta blockers, steroids, antipsychotics, substance abuse

37
Q

rapid cycling bipolar diagnosis

A

bipolar with at least 4 episodes of mania per year

38
Q

rapid cycling bipolar treatment

A

stop all antidepressants, stimulants, caffeine, benzos, and alcohol

39
Q

first line for bipolar

A

lithium, lamotrigine, risperidone

40
Q

cyclothymia treatment

A

psychotherapy, if impaired function then start divalproex

41
Q

postpartum psychosis symptoms

A

psychotic symptoms, severe depressive symptoms

42
Q

suicide management

A

PEC and hospitalize → get sitter to accompany patient and do not leave unsupervised
psychotherapy + SSRI
security tray
IF acute severe risk of self-harm → ECT

43
Q

ECT indications

A

MDD unresponsive to meds
High risk for immediate suicide
Contraindications to using antidepressants
Good response to ECT in the past

44
Q

SSRI system

A

switch to another SSRI if no response within 8 weeks
IF single episode → treat for 6 months, then taper and discontinue
IF multiple episodes → long term therapy

45
Q

how to tailor antidepressants

A

IF poor appetite, weight loss, or insomnia → mirtazapine
IF weight gain or concern for sexual side effects → bupropion
IF severe insomnia → trazodone
IF chronic neuropathic pain → amitriptyline

46
Q

lithium toxicity presentation

A

disorientation, tremors, nausea, vomiting

47
Q

NMS management

A

discontinue antipsychotic → ICU transfer → give bromocriptine + dantrolene or diazepam

48
Q

serotonin syndrome management

A

IVF
Cyproheptadine
Benzodiazepine

49
Q

causes of MAOI-induced hypertensive crisis

A

MAOI + antihistamines, nasal decongestants, consumption of tyramine-rich foods

50
Q

depression system

A

Diagnose → Rule out other causes (hypothyroidism, Parkinson’s, meds (beta blockers, steroids, antipsychotics, substance abuse)) → determine risk factors for suicide → tailor antidepressant

51
Q

other somatic symptom disorder

A

Maintain a single physician as primary caretaker.
Individual psychotherapy.
Do not hospitalize.

Medicine (71 decks)

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