Step 3 Flashcards
(216 cards)
1
Q
What is the study of choice for lumbar stenosis?
A
MRI of the spine.
2
Q
A patient with supraventricular tachycardia who develops atrial fib relation with rapid conduction after adenosine has what underlying disorder?
A
Wolff Parkinson White syndrome
3
Q
What type of error is it if adenosine is given to a Wolf Parkinson White syndrome patient and result in atrial fibrillation with rapid ventricular conduction?
A
Non-preventable adverse event - any known adverse event of a treatment.
4
Q
What is another term for a negligent adverse event?
A
Preventable adverse event
5
Q
What is a save type of medical error?
A
A medical error that never reaches a patient.
6
Q
What is a near miss adverse event?
A
An error the reaches a patient because there’s no apparent harm.
7
Q
A high CSF red blood cell count WITHOUT xanthochromia suggests?
A
Traumatic tap.
8
Q
What is saw palmetto usually used as treatment for?
A
Benign prostatic hyperplasia
9
Q
What is St. John’s Wort?
A
Depression
10
Q
What is garlic used as treatment for?
A
Hypercholesterolemia
11
Q
What type of V/Q mismatch is present in COPD?
A
Low ventilation/perfusion because emphysema causes loss of elastic tissue which limits airflow and thereby results in poor ventilation which then leads to hypoxia vasoconstriction. Supplemental oxygen thereby improves ventilation and perfusion.
12
Q
When is a copper IUD contraindicated?
A
Cervicitis, PID, Wilson’s disease, undiagnosed vaginal bleeding
13
Q
What is the next preferred emergency contraception after Copper IUD?
A
Ulipristal (anti progrestin) inhibits or delays ovulation. Good for five days. Renal or hepatic impairment are contraindications.
14
Q
Patients who have experience sexual assault should be treated for?
A
Gonorrhea with ceftriaxone, chlamydia with azithromycin, trichomonas with metronidazole.
If not immunized against hepatitis B also give hepatitis B vaccine and immunoglobulin as needed. For HIV, treat with tenofivir-emtricitabine and raltegravir.
15
Q
Radioactive iodine alone in a patient with graves may worsen opthlalmopathy.
A
Yes
16
Q
What is the best test to assess a patient’s thyroid function after radioactive iodine uptake?
A
Free T4 and Total T3. Do not use TSH as it can be low for weeks to months after RAI.
17
Q
What alternative medications increase the risk of bleeding?
A
Saw palmetto, gingko, garlic, ginseng.
18
Q
What alternative medications increase the risk of bleeding?
A
Saw palmetto, gingko, garlic, ginseng.
19
Q
What anti-hypertensive medications have interactions with lithium?
A
Diuretics, ACE-inhibitors, ARBs. If a pt is on lithium, start with amlodipine. Any drug that decreases GFR or changes Na+, K+ levels will affect lithium levels. SSRIs also impact Li levels.
20
Q
What does undercooked meat expose a pregnant mom to?
A
Risk of congenital toxoplasmosis.
21
Q
What is the preferred management for obstructing ureteral stone with evidence of infection, AKI, or severe pain or hemodynamic instability?
A
Percutaneous nephrostomy or retograde ureteral stent.
22
Q
What is the preferred management for ureteral stone with no complications?
A
Shockwave lithotripsy.
23
Q
A patient with Type 1 diabetes who presents with hypotension, hyperkalemia, weight loss, tachycardia, and hypoglycemia is concerning for…
A
adrenal crisis
24
Q
What other auto-immune diseases are patients with Type 1 diabetes at risk for?
A
Hypothyroidism, pernicious anemia, autoimmune ovarian failiure (check FSH, estradiol)
25
What is the appropriate treatment for pregnant women with hyperthyroidism?
1st trimester - treat with PTU. Methimazole is a teratogen in 1st trimester.
2nd (after 12 wks) and 3rd trimester - treat with methimazole because of PTU liver failure risk.
Surgery is avoided in pregnancy unless no improvement.
26
What is an ocular manifestation of phenytoin toxicity?
Horizontal nystagmus on lateral gaze.
27
What is the most appropriate first test for a stable patient with evidence of perforated peptic ulcer or perforated bowel?
Upright Chest and abdominal x-ray to look for pneumoperitoneum.
28
What is appropriate management for a patient with a PERFORATED peptic ulcer?
Broad spectrum IV Fluids, IV antibiotics, IV PPI for acid protection and emergency surgery (lap or open).
29
When is it appropriate to use fibrinolytic therapy for a patient with pulmonary embolism?
Only in hemodynamically UNSTABLE patients with acute PE.
30
What is the target INR with Warfarin therapy for PE?
2.0-3.0
31
What is the definition for hospital acquired pneumonia?
Pneumonia that begins 48+ hours after admission with no prior evidence of infection.
32
In a patient with a known pulmonary embolus who mounts a low-grade fever, tachycardia, and has a mildly elevated WBC count what is the appropriate management?
Get a repeat CXR and obtain blood cultures. Even if there is evidence of pulmonary infarction on the CXR, that is not grounds for starting antibiotic therapy as low-grade fever, elevated WBC, mild tachycardia are all associated with pulmonary embolus. FYI streaky opacity on CXR can be infarction or atelectasis.
33
What are the criteria with regards to smoking and combined hormonal OCPs?
Women over 35 who are heavy smokers (15 or more cigarettes a day)
34
What are the absolute contraindications for combined hormonal OCPs?
Migraines WITH AURA, Stage 2 hypertension (160/100 or more), History of PE, DVT, Stroke, or MI, Breast Cancer, Cirrhosis/Liver Cancer, Surgery that will lead to prolonged immobilization, < 3 weeks post-partum.
35
What type of Oral contraceptives are the patch and vaginal ring?
Combined hormonal OCPs.
36
Estrogen increases the risk of thrombosis and is higher in pregnancy and OCPs.
Ok.
37
What is the presentation of NF2?
Bilateral acoustic neuromas/deafness, HYPOpigmented cafe au lait spots, autosomal dominant but half are spontaneous
38
What is the presentation of Sturge Weber?
Port-wine stain and leptomeningeal angiomatosis.
39
What are the clinical manifestations of tuberous sclerosis?
Ash-leaf spots (HYPOpigmented macules), organ harmatomas/cysts, Flat-red macular lesions on face, Shagreen patch (reddish nodule); 50-60% have cardiac lesion at birth
40
What are the manifestations of NF1?
HYPERpigmented cafe au lait lesions, cutaneous neurofibromas, axillary freckling.
41
What is a prolonged QT interval for men and women?
For men >450 ms; for women >470ms.
42
What is the most common cause of exertional chest pain or sudden cardiac death in a young athlete?
Anomalous coronary artery.
43
What is the characteristic EKG finding in Brugada?
RBBB and ST segment elevation in V1-V3.
44
How could hypertrophic cardiomyopathy be determined?
Echocardiogram or EKG.
45
Hypercalcemia due to paraproteinemia or malignancy does what to ionized calcium?
No change in the level of ionized calcium. Only increases total serum Calcium by increasing bound calcium
46
What is the first step with hypercalcemia?
Repeat Ca2+ levels and correct for albumin and get ionized calcium level to confirm hypercalcemia.
Then get PTH levels and if suppressed (PTH-independent), get Vit D levels (25 hydroxy and 1,25 OH2D).
47
Hypercalcemia that is characterized by low PTH, normal
Vit D levels and a high ionized calcium is consistent with ...
What is appropriate management?
Immobilization (bone breakdown); can also happen with Paget disease or adolescents
Management: Bisphosphonates
48
What is an important complication of blood transfusion that needs to be considered especially in patients with renal failure, hepatic failure, hypothermia or shock?
HYPOcalcemia due to citrate infusion. Excess Citrate binds calcium. Normally, it would be converted to lactate but if metabolism impaired, excess citrate builds up with blood transfusion.
Measured calcium levels will be NORMAL because it is IONIZED Ca2+ that is low.
**For these patients (shock, hypothermia, renal or hepatic failure), prophylactic administration of 10cc of Calcium glauconite for every 500ml RBCs is thus recommended.
49
Sodium bicarbonate infusion is only recommended if bicarbonate is less than 5 mEq/L or less in a normal patient because as circulation improves, you get rebound increase in alkali that may cause overshooting and the bicarbonate will then be converted to CO2 in the brain causing paradoxical acidification of CNS.
Ok
50
What drugs can cause Folate deficiency and a macrocytic anemia?
Trimethoprim, methotrexate, and phenytoin
51
What is the best treatment for folic acid anemia caused by methotrexate?
Folinic acid or Leucovorin is preferred over folic acid (used to prevent or treat too).
52
When is if best to administer 3 drug post exposure prophylaxis for HIV infection?
Up to 3 days though ideally in the first 1-2 hours after.
53
How should a patient with concern for Immediate HIV exposure be screened and when should it be repeated?
HIV p24 antigen and HIV-1/HIV-2 antibodies are needed for acute exposure screening. Repeat 4 weeks later due to chance for false negative as antigen levels and antibody titers low in first 4 weeks (referred to as the window period).
54
What is appropriate pre-screening prior to starting HIV anti retro oral treatment?
Screen for Hep B (some ARVs treat both). Also screen for STIs (G/C, syphilis), Hep C, TB.
55
What rash and other finding is characteristic of disseminated gonococcal infection?
Tenosynovitis of wrist, fingers, ankles, toes.
Also transient pustular rash present for a few days or vesiculo-pustular rash that is present for a few days.
56
What is one easy way of telling apart Marfan from Ehler's Danlos?
Only Ehler's Danlos has hyperextensible skin.
57
Thoracolumbar scoliosis, "velvety" skin with atrophic scars with joint hypermobility and frequent dislocations suggests
Ehlers-Danlos disease
58
What are AFP levels in Down's
| Syndrome?
Decreased
59
What is entacapone?
It is a COMT inhibitor that prolongs the presence of levodopa in Parkinson's by preventing its degradation but has no effect on Parkinson's disease on its own.
60
What is pramipexole and what are other similar drugs?
Dopamine agonist similar to levodopa and bromocriptine which are both used in Parkinson's Disease.
61
What are the drugs to treat essential tremor?
Propranolol and primidone
62
What is a primary prevention example?
Anything that prevents someone from even developing a disease. E.g. Treating to lower cholesterol so as to prevent heart disease.
63
What does secondary prevention do?
It halts or delays the progression of a disease at its initial stage.
64
What type of assay is a standard urine drug test?
It is an immunoassay.
65
What is the treatment for severe PID with evidence of sepsis?
IV cefoxitin and IV doxycycline or Ceftriaxone and doxycycline.
66
What are the treatments for mild to moderate PID?
IM ceftriaxone and oral azithromycin or doxycycline
67
What medication is used for tocolysis between 32 and 34 weeks?
Nifedipine.
68
What is the cut off for giving bethamethasone?
Less than 37 weeks since it decreases risk of respiratory distress, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal mortality
69
When is magnesium sulfate indicated to prevent neurotoxicity e.g risk of cerebral palsy?
Less than 32 weeks.
70
Patients with signs of C.diff colitis who test negative on enzyme immunoassay (EIA; only 73% sensitive) as opposed to PCR (97% sensitive) can have what test to confirm diagnosis if they are ill appearing?
Sigmoidoscopy or limited colonoscopy to see pseudomembranous colitis.
71
How does rabies present?
Fever and malaise for a few days, then followed by neurologic symptoms.
Hydrophobia occurs because water causes pharyngeal spasms that scare the patient from drinking because of the sense that throat is closing.
72
What sign with a pulmonary embolus is indicative of poorer prognosis?
Elevated troponin suggesting R heart strain, hemodynamic instability, or hypotension suggest a poorer prognosis in pulmonary embolism.
Pulmonary infarction DOES not necessarily suggest poorer prognosis.
73
When is the only appropriate time to use fibrinolytic therapy in patients with pulmonary embolism?
SBP less than 90.
74
When in pulmonary embolism management should warfarin be started?
Immediately after heparin. Same day or within a day preferred with target INR of greater than or equal to 2.0.
75
What is the definition of massive hemoptysis?
600mL in 24 hours. In the case of massive hemoptysis, bronchoscopy or angiographic embolization can be pursued.
76
In a patient with evidence of acute mastitis, what is the likely causative agent and even if she has fever and mild tachycardia, what is the preferred therapy?
Staph aureus (MSSA). Give oral dicloxacillin or cephalexin.
Fever, focal breast pain, erythema, and swelling.
77
For patients with a DVT with no evidence of pulmonary embolism and who do not have cancer, what is the preferred method of Anti-coagulation?
Oral anti-Xa inhibitor because it is active within 2-4 hours and requires no ongoing monitoring with at least 3 months of treatment.
78
In a menopausal woman who has had a DVT, what is a safe alternative therapy to manage hot flashes since estrogen-containing therapy has to be stopped?
SSRIs e.g. Escitalopram or SNRI
79
What is the standard enteric feeding regimen by G-tube for an adult patient?
30kcal/kg/day with 1g/kg protein.
80
What is the test of choice if a patient continues to have persistent symptoms after conservation management of carpal tunnel syndrome?
Nerve conduction studies.
81
What is the treatment for mucormycosis?
Surgical debridement and liposomal amphotericin B
82
Pregnant women undergoing active TB treatment should get what 3 three drugs as treatment?
RIE--Isoniazid, Rifampin, Ethambutol for 2 months followed by RI for another 7 months.
83
In a patient with signs concerning for dementia, what reversible causes should be ruled out first?
Screen for hypothyroidism, B12 deficiency and depression.
84
What is appropriate treatment for a UTI in pregnancy?
First or second generation cephalosporin (cephalexin), nitrofurantoin, amoxicillin or amoxicillin-clavulanate for 3-7 days. CONTRAINDICATED in pregnancy: ciprofloxacin is associated w/risk of tendon rupture in young children, tetracyclines, bactrim (avoid in 1st, 3rd trimester).
85
Treatment of pyelonephritis in a pregnant woman is with? For how long?
3rd generation cephalosporin (ceftriaxone) or ampicillin + gentamicin for a total 10-14 day course.
86
In constitutional growth delay, is the bone age also delayed?
Yes; absence of puberty by age 14 with a positive family history, bone age younger than patient age (retarded bone age) with no evidence of syndromic illness.
87
How does Klinefelter syndrome present?
47 XXY, they usually are males with on time puberty but Leydig cells atrophy over time and testes become small and firm.
88
What is Kallmann syndrome?
Hypogonadotrophic hypogonadism with failure of GnRH cells and olfactory cells to migrate to final location. Key is infertility with anosmia.
89
In acute decompensated heart failure, what medication is recommended against?
beta blocker
90
What medication are suggested in acute decompensated heart failure with pulmonary edema and severe hypertension?
1. IV diuretics
| 2. Nitroglycerin or nitroprusside
91
For hyperechoic, hyperfunctional thyroid nodules, is biopsy appropriate?
No! They are rarely cancerous.
92
Prior to surgery or radio-iodine ablation, patients with hyperfunctioning, toxic thyroid nodules or toxic adenomas must undergo...
PRE-TREATMENT with methimazole to optimize them for surgery by achieving chemical euthyroidism.
93
Where/how does dermatitis herpetiformis, which is associated with celiac present?
Intensely pruritic papules and vesicles on EXTENSOR surfaces of elbows buttocks, knees, and back.
94
The rash that occurs when infectious mononucleosis is treated with antibiotics is though to be mediated how?
Immune complex mediated
95
What are the indications for carotid endarterectomy?
Anyone symptomatic with stenosis > 70% should get a carotid endarterectomy. (FYI In men who are asymptomatic, 60% stenosis or more. in men who are symptomatic, 50% or more).
96
What is the ejection fraction cut off for systolic dysfunction?
Ejection fraction less than or equal to 40%.
97
Asymptomatic left ventricular systolic dysfunction is best treated with?
ACE-inhibitor (lisinopril) and beta blockers. They delay onset of heart failure symptoms and improve cardiac morbidity and mortality.
98
When is digoxin appropriate?
Digoxin is reduces rate of hospitalization and symptoms in SYMPTOMATIC patients with left ventricular systolic dysfunction.
99
A patient with evidence of subclinical thyrotoxicosis/hyperthyroidism with a low TSH but normal T4/T3 as well as normal heart rhythm and bone density ca have their thyroid levels re-checked in 6-8 weeks.
Repeat.
100
At what degree of angulation should structural kyphosis be referred to an orthopedist?
70-80 degrees of angulation.
101
How is the diagnosis of drug-induced lupus best made?
Anti-nuclear and anti-histone antibodies. Offending drugs include: procainamide, hydralazine, minocycline, TNF alpha inhibitors (etnarcept, infliximab). The initial presentation need not include rash but may be characterized by fever, malaise, myalgias, arthritis, serositis...
102
Dog bite injuries of the hand and puncture wounds...
SHOULD NOT BE closed primarily and instead should be irrigated well with saline and left open to drain with frequent checks for signs of infection.
103
What is the TSH target level after ablation and surgery?
depends on initial stage of the cancer and risk of recurrence. target: Low-normal level.
104
GERD Pain is usually described as a burning or squeezing sensation that can radiate to the back, neck or jaw and awaken from sleep that is worse with emotional stress and occurs post-prandially.
Ok
105
How is standardized incidence ratio calculated?
Observed / expected cases
106
What are the drugs for relapsing remitting multiple sclerosis?
Beta interferon or glatimer acetate.
107
In pregnancy women with multiple sclerosis can be
Treated with most disease modifying drugs. Steroids are also safe and they usually have fewer exacerbation in pregnancy
108
What is the most common cause of non-PTH dependent hypercalcemia?
PTH-related protein
109
Pregnant women undergoing active TB treatment should get what 3 three drugs as treatment?
RIE--Isoniazid, Rifampin, Ethambutol
110
In a patient with signs concerning for dementia, what reversible causes should be ruled out first?
Screen for TSH, B12 deficiency and depression.
111
What is appropriate treatment for a UTI in pregnancy?
First or second generation cephalosporin (cephalexin), nitrofurantoin, amoxicillin or amoxicillin-clavulanate. CONTRAINDICATED in pregnancy: ciprofloxacin is associated w/risk of tendon rupture in young children, tetracyclines, bactrim (avoid in 1st, 3rd trimester).
112
Treatment of pyelonephritis in a pregnant woman is with? For how long?
3rd generation cephalosporin (ceftriaxone) or ampicillin + gentamicin for a total 10-14 day course.
113
In constitutional growth delay, is the bone age also delayed?
Yes; absence of puberty by age 14 with a positive family history, bone age younger than patient age (retarded bone age) with no evidence of syndromic illness.
114
How does Klinefelter syndrome present?
47 XXY, they usually are males with on time puberty but Leydig cells atrophy over time and testes become small and firm.
115
What is Kallmann syndrome?
Hypogonadotrophic hypogonadism with failure of GnRH cells and olfactory cells to migrate to final location. Key is infertility with anosmia.
116
What are the levels of testosterone in a patient with androgen insensitivity?
HIGH!!!
117
What is appropriate management of a suspected CLABSI infection?
Catheter removal if there is hemodynamic instability, severe sepsis with organ hypoperfusion, endocarditis, suppurative thrombophlebitis, or persistent bacteremia after 72 hours.
Vancomycin should be used and cefepime should be added if the patient is septic or neutropenic.
118
Does tightened glycemic control have an effect on erectile dysfunction?
No
119
What is the drug of choice for treating erectile dysfunction in diabetics?
Phosphodiesterase inhibitors. When used in patients also using alpha blockers, it is important to use at least 4 hours apart to prevent hypotension.
120
What is a characteristic feature of tamponade?
It causes increase in right atrial and right ventricular pressure and it causes a characteristic equalization of right atrial, right ventricular end diastolic and pulmonary capillary wedge pressures.
121
What drugs are associated with orthostatic hypotension in the elderly?
Diuretics, nitrates, and alpha blockers.
Ace -inhibitors are much less associated and the above 3 classes should be addressed first.
122
What are the indications for infective endocarditis antibiotic prophylaxis of pts with history of high risk cardiac procedures?
Patients undergoing GI or GU procedures with active infection.
Also any gingival or respiratory tract manipulation.
123
What should occur at 24-28 weeks gestation?
Women should undergo CBC screening for anemia and get glucose tolerance test
Rh D negative women should get anybody screening
124
SLE is associated with premature coronary artherosclerosis so that MI or cardiac disease is a leading cause of death in SLE.
Repeat.
125
At what gestation point do you not use tocolysis if a patient is in pre-term labor?
At 34 weeks and above
126
What mood stabilizers should be avoided in pregnancy?
Carbamazepine, Valproic acid can cause neural tube defects.
127
What is the best drug to treat bipolar disorder in a pregnant woman?
Haloperidol is safe in pregnancy
128
What is a hallmark of B12 deficiency?
Ineffective erythropoiesis. There is intramedullary hemolysis due to defective DNA synthesis and megaloblastic transformation of bone marrow.
There is usually a low reticulocyte response.
129
What is the first step in diagnosing Duchenne or Becker muscular dystrophy?
Measure creative phosphokinase. After that, can get EMG and muscle biopsy.
130
Between ages 3 and 5, what is the appropriate treatment for ADHD?
It is appropriate to try behavioral therapy prior to pharmacological therapy.
Age 6 and above may receive pharmacologic treatment first.
131
How long is min required time to not overlap SSRI and MAOI
5 weeks
132
How long must a tick be attached for risk of Lyme disease to occur?
Ticks have to feed for at least 36 hours before risk of Lyme disease is present.
Patients who are bitten and have tick feeding for less than 36 hours are low risk for
Lyme disease. No specific treatment needed.
Also takes a few weeks for Lyme
Serologies to be positive.
133
What are the goals in ARDS?
PaO2 of 55-80 and oxygen saturation of 88-95%
Permissive hypercapnia and low tidal volumes is safe for everyone except those with increased ICP or seizure disorder
134
What are the two most important prognostic factors in COPD?
FEV1 and age. After age adjustment it is FEV1
135
Plasma glucose less than ____ mg/dL is suggestive of hypoglycemia.
60mg/dL. Target blood glucose in diabetes should be between 80 and 120mg/dL.
136
What is the preferred treatment for H.Pylori in most patients?
In patients with a penicillin allergy?
PPI, clarithromycin and amoxicillin for two weeks.
If has penicillin allergy, can use PPI, clarithromycin and metronidazole.
If a patient fails triple therapy, give quadruple therapy with PPI, bismuth, tetracycline, and metronidazole). Clarithromycin resistance occurs.
137
If a neonate' hematocrit is borderline high, it is important to remember to with a venous sample in 12-24 hours after because neonate hematocrit is highest ~2hours after birth.
Repeat. How do you treat? Hydration and partial exchange transfusion if symptomatic (irritability, hypoglycemia, jaundice, apnea, cardiac or respiratory compromise).
138
What is the best initial step in management of a patient with COPD exacerbation?
Chest X-Ray. Then if concerning signs, (weight loss, persistent cough, persistent hemoptysis) or depending on CXR findings can pursue more imaging.
139
What is the definition of chronic diarrhea? And what is the best first work up?
Chronic diarrhea is defined as loose stools for 4 weeks or more regardless of whether freq is increased or not.
First step in management is microscopic examination of stool for leukocytes, parasite, occult blood, osmotic gap, special staining for pH, fat electrolytes.
140
What is the initial treatment for mild to moderate psoriasis?
Topic high potency steroids like fluocinoide or augmented bethamethasone 0.05% for an initial 4 weeks. Can use a plastic wrap or occlusion tape to maximize effect of the topical steroid.
Systemic corticosteroids are contraindicated because of risk of causing pustular psoriasis.
141
Sudden onset headache with ptosis or miosis with head/neck pain or transient vision loss is concerning for ...
Carotid artery dissection.
It can be associated with TIA or stroke.
142
Anti-dsDNA antibodies correlates with lupus disease severity in addition to being most sensitive screener besides ANA.
Repeat.
143
What viruses are the most common cause of viral meningitis in children?
In adults?
Arboviruses and Enteroviruses are the most common cause of meningitis in children.
Herpes simplex is the most common cause of viral meningitis in adults.
144
Effects of botulinum toxin consumption via improperly canned food can be seen as quickly as 1 day later with bulbar weakness.
Ok
145
What are the features of organophosphate poisoning and how can it's activity be measured?
Confusion, lethargy, Bradycardia, miosis, skin flushing, wheezing, garlic odor.
Measure RBC cholinesterase
146
A sticking sensation in the throat accompanied by absence of peristalsis in the distal esophagus and decrease in lower esophageal sphincter tone is concerning for...
Scleroderma
147
Heavy alcohol drinking can cause hypoglycemia with sulfonylureas like glyburide by causing unsteady glucose levels.
Ok
148
The prostate should not be massaged in a patient with signs of acute prostatitis because you can spread the bacteria to the bloodstream, rather, if there is acute urinary obstruction they should get a suprapubic catheter
Repeat
149
What is the drug of choice in scleroderma induced renal crisis?
ACE inhibitors.
Nitro prudish can be added if there is CNS involvement.
150
The risk of type 1 diabetes in a child of a mom with type 1 is? Of a dad with type1?
3% for mom with Type 1, 6% if dad has type 1 DM
151
The drug of choice for alopecia areata is....
Topical
| Corticosteroids or intralesional corticosteroids.
152
Patients with severe mania should be managed with
Lithium or valproate
AND
Atypical anti-psychotic.
153
Most patients with ankylosis G spondylitis have no functional
Or employment disability and they do not have reduced life expectancy.
Ok
154
What is the treatment for sunburns?
NSAIDs
155
Isotretinoin should not be consumed with excessive alcohol due to risk of ____
Pancreatitis.
156
At what age should nighttime enuresis prompt a urinalysis?
Age 5
157
What is the most useful test is confirming a diagnosis of possible bronchogenic carcinoma causing recurrent pneumonias?
Flexible bronchoscopy as biopsy can be taken.
158
What is the best next step in treatment or management of a patient with bulbous pemphigoid?
Skin biopsy because many bullous skin diseases appear similar and depending of the severity of bullous pemphigoid you can use topical high potency steroids vs oral corticosteroids.
159
What medication class given for the Parkinsonism in Lewy Body Dementia can worsen visual hallucinations?
Dopamine agonist.
160
For a dirty dog bite in a patient with unclear immunization status what is the right approach?
Amoxicillin clavulanate for the dog or cat bite. Tetanus toxoid if has been 5 years for dirty wound or 10years for clean wound. Also give tetanus immunoglobulin if dirty wound and unsure of their prior immunization history.
161
Renal failure in a diabetic, characterized by a rise in serum creatinine the should be managed how?
Glyburide (sulfonylureas) and metformin both should be stopped due to metabolism by kidneys and regular insulin should be used instead. Oral Drugs like the -glitazone and acarbose and repaglinide can be continued.
162
Even for a patient with 90% stenosis of a peripheral artery who is on a station, what is the next intervention if not yet begun?
Exercise therapy, smoking cessation, diabetes control, and blood pressure control. Only if the patient is still having symptoms with these lifestyle and pharmacologic measure do you do surgery.
163
A patient who has hypoxemia immediately post op without stridor is usually due to
Residual anesthetic effect from poor respiratory drive.
164
What is the most common type of headache? Characterized by non-throbbing bilateral location and tends to happen on weekdays.
tension headache. migraine headaches would be associated with aura, n/v, photophobia.
165
A multiple myeloma patient that develops acute onset headache, dizziness, nystagmus, hearing loss, confusion, blurry vision, neurologic symptoms, heart failure is concerning for...
hyperviscocity syndrome; treatment is prompt plasmapheresis. Absence of peripheral edema and the blurry vision make renal failure unlikely.
166
Prior to perform a gastric outlet emptying study including for possible diabetic gastroparesis, what study should be performed?
Upper GI endoscopy should be performed to rule out obstruction.
167
What does a succussion splash mean?
Suggests retained gastric material.
168
Any rheumatoid arthritis patient who has erosions, should be started on what therapy?
Regardless of symptomatic relief, erosions on X-ray are by definition moderate disease and should receive DMARDs such as methotrexate, sulfasalazine, anti-malarial, leflunomide etc. No steroids to treat RF. They do not help.
169
What is the correct age for colonoscopy screening?
If colon cancer in family member over the age of 60, begin at 50; every 10 years.
If colon cancer/adenomatous polyps in any 1st degree family member below age 60 OR in 2 first degree relatives at any age, begin screening at AGE 40 and screen every 3-5 years or at 10 years below the youngest person with history whichever is more conservative.
170
What is the biggest predictor of a patient with occupational back pain's likelihood of returning to work.
The patient's recovery expectation; i.e. positive expectations regarding recovery.
171
When is smoking a major risk factor to CHD?
1 pack or more a day
172
In a woman, what is the greatest risk factor for CHD?
Diabetes
173
In a patient with MR over the age of 18, ask about guardianship.
Ok.
174
Classically, how many hands are involved in tinea manuum?
One and tinea pedis is usually present; causes annular erythema with trailing scale.
175
Only use upright tilt table test in a case of vasovagal syncope that is not a clear cut diagnosis.
ok
176
What are the indications for stress ulcer prophylaxis (with PPI preferred) in the ICU?
Coagulopathy, h/o GI bleeding in past year, mechanical ventilation for >48 hours, or 2 of following: Sepsis, ICU stay > 1 week, Occult GI bleed > 6 days, or glucorticoid therapy
177
Pain elicited while extending the knee and on gentle palpation of anterior patella. Pain also occurs with squatting or athletic activity in young adult suggestive of ...
What is the management?
Patellofemoral pain syndrome. Management: Stretching and strengthening thigh muscles.
178
What is the Q-tip test for?
Urinary stress incontinence
179
What is methylene blue instillation in bladder for?
To test for vesicovaginal fistula. If a tampon in vagina becomes blue after methylen blue instiled in bladder, then vesicovaginal fistula present.
180
How is a urethral diverticulum managed?
Urinalysis, urine culture, MRI pelvis, Transvaginal ultrasound
181
If a patient with a bleeding varix bleeds again, a few days after upper GI endoscopy, what is the appropriate management?
repeat upper GI endoscopy. Only after repeat can TIPS or surgical shunt intervention be considered.
182
A patient previously stabilized on an anti-depressant should be assessed for what if they no longer have response?
Substance abuse (alcohol, opiates, or stimulants).
183
How should akathisia from an anti-psychotic be managed?
Beta blocker or Benzodiazepine
184
How should acute dystonia like torticollis and oculogyric crisis from anti-psychotic be managed?
Benztropine or benadryl
185
How should antipsychotic induced EPS of Parkinsonism be treated?
Benztropine or amantadine.
186
When after cryptococcal meningitis should you start anti-retrovirals?
4-6 weeks
187
What are skin tags associated with?
Insulin resistance or GI malignancy.
188
What form of anti-coagulation is recommended for patients with mechanical valve replacement of an aortic valve? Of a mitral valve?
Aortic valve with no risk factors: aspirin and warfarin with INR 2.0-3.0
Mitral valve or an aortic valve with risk factors (atrial fibrillation, LVEF less than 30%, hyper coagulants state):Aspirin and warfarin with INR 2.5 to 3.5
189
What is the preferred medication to halt an opioid withdrawal outside of supervised inpatient or outpatient settings?
Clonidine alpha 2 agonist.
190
Skin Papule -- Nodular, ulcerative. Colorless drainage with associated cervical lymphadenopathy concerning for...
Sporothrix.
191
What is an example of a medication that should be given in the setting of sulfonylurea (glyburide) overdose causing hypoglycemia? Especially to prevent the rebound hypoglycemia that can occur with dextrose infusion as initial management?
Octreotide, a somatostatin analogue, inhibits insulin secretion.
192
What is exenatide?
GLP1 agonist
193
What is Pentazocine
Mixed opioid agonist-antagonist; avoid in opioid dependent patients to prevent withdrawal
194
What is sitagliptin?
A DPP-IV inhibitor which works by inhibiting glucagon release and increasing the level of incretins (GLP 1, GIP)
195
Even for large prolactinomas that cause visual defects or other compressive symptoms, what is 1st line treatment?
Dopamine receptor agonist (bromocriptine, cabergoline). Rarely ever is surgery used as even bad prolactinomas respond to oral agents within days.
196
What is the most common ocular manifestation of sarcoidosis?
Anterior uveitis - mild to moderate pain, red eye, blurry vision, photophobia
197
In the setting of hypercalcemia, at what level is PTH considered suppressed?
less than 20 pg/ml
198
How do bisphosphonates work?
Inhibiting osteoclastic activity.
199
How does cinacalcet work?
Calcium-sensing receptor agonist that works by decreasing PTH levels in hyperparathyroidism.
200
If a patient is intoxicated when expresses suicidal threat, appropriate course of action is to
Wait and observe and perform suicidal assessment again while sober.
201
If an adult Jehovah's witness patient declines transfusion, what is next best step?
IV Fluids and vasopressors as appropriate.
202
If a Jehovah's witness parent declines transfusion in an emergent situation for a child, what is the next step?
Transfuse blood. Clinicians must preserve children under consenting age's life.
203
What is the target 1 hour post prandial glucose value in the setting of testing for GDM? 2hr?
1hr: 140mg/dL or less
2hr: 120mg/dL or less
204
What are the 2 shockable rhythms by defibrillator?
Ventricular fibrillation and pulseless V-Tach
205
A healthy female with 2 UTIs that have occurred in the past 6 months or 3 UTIs in the past year should have what as the next step?
Antibiotic prophylaxis. There is no need for imaging as it is low yield unless there evidence of obstruction or nephrolithiasis (proteus UTI etc).
206
What is the preferred agent for treating cardiac arrhythmias in TCA overdose?
Sodium bicarbonate
207
How should hot flashes be managed?
No uterus and no contraindications to estrogen: Estrogen
Uterus intact & no contraindications to estrogen: Progesterone and Estrogen
Contraindications to Estrogen: SSRI
Contraindications to estrogen: Breast cancer, coronary heart disease, endometrial cancer, liver disease, thromboembolism
208
When do findings from a chlamydial pneumonia in a child occur and what are characteristic findings?
Occur between 2 and 19 weeks. Afebrile with stacco cough, current or history of conjunctivitis, radiologic or physical exam findings out of proportion to clinical appearance. Normal WBC count but eosinophilia.
209
What is a factorial study design?
One in which greater than to 2 intervention groups are selected and there is a combination group.
210
Sarcoidosis with hilar prominence and erythema nodosum but otherwise Asymptomatic requires what for treatment?
No corticosteroids or treatment needed. Usual spontaneous resolution. Just schedule frequent follow up
211
A patient between age 25-35 who has dysmenorrhea (painful periods) and develops pain on deep penetration with no evidence of cervicitis but mild deep pelvic pain on exam is concerning for
Endometriosis. NSAIDs and OCPs for initial management. Laparoscopy as needed for definitive diagnosis
212
Second stage arrest of labor is defined as
failure to progress after three hours with no epidural or after four hours with an epidural. For a woman who is nulliparous
213
What is the impact of a varicocele on the testicle?
Testicular atrophy. Seminiferous tubules are smaller.
214
What drugs are appropriate to treat a UTI in pregnancy?
Nitrofurantoin, Amoxicillin, Amoxicillin-Clavulanate, Cephalexin
Contraindicated: Floroquinolones, tetracyclines, Bactrim
215
Analgesic induced nephropathy can present with
Florid (e.g) 7g proteinuria, no hematuria, mild pyuria.
216
The light chain Bence jones proteins in multiple myeloma are not detected on urinalysis.
Ok.
