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Flashcards in Step 3 7 Deck (68):
1

valvular disease workup

echo
left heart cath
EKG
CXR

2

AS management

Diuretics
Consult cardiology for valve replacement

3

dilated cardiomyopathy management

ACEi/ARB
Betablocker
if HR > 70 still, add ivabradine
spironolactone

4

HOCM management

Betablocker
Diuretics

5

kussmaul sign

increase in JVP on inhalation

6

tamponade presentation

SOB + hypotension + JVD + clear lungs

7

what echo will show with tamponade

diastolic collapse of RA and RV

8

long-term therapy for pericardial tamponade

pericardial window placement

9

treatment of constrictive pericarditis

surgically remove pericardium

10

thoracic dissection management

EKG
CXR
CT angiography/MRA/TEE
ICU transfer
Consult surgery
Betablocker
then nitroprusside to control BP

11

PAD management

Aspirin
Cilostazol
Vorapaxar
BP control with ACEi
Statins to target LDL < 100
Exercise as tolerated
IF signs of gangrene OR pain at rest → surgical bypass
Consider:
Pentoxifylline (marginally effective)

12

hemodynamic instability on CCS

SBP less than 90, CHF, AMS, chest pain

13

rate control meds in AFib

BB (metoprolol, carvedilol) or Non-DHP CCB (diltiazem) or digoxin

14

reversal drug for dabigatran

idarucizumab

15

VASc in CHADS-VASc

Vascular disease
Age 65-74
Female sex

16

NOACs

Xa inhibitors (rivaroxiban, edoxaban, apixaban)
Direct thrombin inhibitor (dabigatran)

17

CHADS

CHF
HTN
Age over 75
DM
Stroke/TIA

18

treatment of bleeding for patient on warfarin

FFP

19

reversal drug for Xa inhibitors

andexanet

20

benefit of NOACs over warfarin

NOACs prevent more strokes, cause less intracranial bleeding, and decrease mortality more, and treat DVT/PE

21

drug selection in rate control for AF

if hyperthyroid/ischemic heart disease/migraines/Graves/pheochromocytoma → BB
if comorbid COPD/asthma → CCB
if borderline hypotension → Digoxin

22

MAT management

FIRST: Oxygen
Diltiazem
Palliative care consult

23

gamma gap meaning and definition

difference between total serum protein and serum albumin.
4 g/dL.

24

gamma gap differential

blood cell dyscrasias or viral infections, e.g., multiple myeloma, monoclonal gammopathy of unknown significance, or acute HIV infection

25

antiarrhythmics for VT

amiodarone, lidocaine, procainamide, magnesium

26

syncope orders

Chem 7
Telemetry
Oximeter
CBC
EKG
CT head
If ventricular dysrhythmia diagnosed, consult cardiology for ICD
If chest pain → CK-MB/troponin
If murmur on exam → TTE
If focal deficits on neuro exam OR seizure described → EEG

27

second set of workup for syncope if first negative

holter
repeat CK-MB and troponin
Urine and blood tox

28

third set of orders for syncope workup

tilt table testing
EP testing

29

MSSA oral options

cephalexin, dicloxacillin

30

MSSA IV options

oxacillin/nafcillin, cefazolin

31

daptomycin SE's

myopathy, rising CK

32

minor MRSA infection options

bacrim, clindamycin, doxycyline

33

MRSA infection in patient with penicillin alergy

RASH: cephalosporins
Anaphylaxis: clindamycin or linezolid
Severe infection: Vanc, linezolid, dapto
Minor infection: macrolides, clinda, bactrim

34

meds with activity against strep

penicillin, ampicillin, amoxicillin

35

big gun for pseudomonas coverage

polymyxin/colistin

36

beta lactamase inhibitors

clavulanate
sulbactam/tazobactam/avibactam

37

cephalosporins with anaerobe coverage

cefoxitin, cefotetan

38

best long-term therapy fo CMV retinitis

valganciclovir

39

Influenza meds

oseltamivir
zanamivir
peramivir

40

ribavirin use

refractory hep C (causes anemia)

41

aspergillus treatment

voriconazole

42

best antifungal in neutropenic fever

Echinocandins

43

OM clinical features

(DM + PAD) + (Ulcer or soft tissue infection)

44

osteomyelitis management

Bone biopsy/aspiration or culture (whether under CT guidance or during surgery (to guide treatment)
Ortho consult
ID consult (dispo, vascular access, OP antibiotic coordination)
Plastics consult if skin flap may be needed
ABX → base on cultures, thus wait until biopsy or specimens from I&D obtained.
IF SIRSY → blood culture
Monitor sed rate to guide antibiotic duration

45

otitis externa management

ofloxacin, ciprofloxacin, or polymyxin/neomycin
topical hydrocortisone
acetic acid and water solution

46

malignant otitis externa management

surgical debridement

47

treatment of refractory otitis media

cephalosporin or augmentin

48

most accurate test for sinusitis

sinus aspirate for culture

49

indications for influenza vaccination + approach

- COPD, CHF, dialysis, steroids, health care workers, everyone over 50
- inhaled live attenuated for anyone under 50

50

impetigo treatment

if mild --> mupirocin or retapamulin
if severe --> oral dicloxacillin or cephalexin

51

cellulitis management

If diabetic, venous insufficiency, or lymphedema, → consider X-ray, then possible MRI for OM.
If lower extremity → US for DVT
If persistent systemic symptoms after 48 hrs → consider X-ray, then possible MRI for OM PLUS US for abscess

52

size of hair follicle infections

folliculitis, furuncle, carbuncle, boil

53

workup of fungal infection of skin and nails

KOH prep

54

dysuria, discharge management

If dysuria or discharge or both:
→ NAAT on urine sample
if positive → CTX IM + azithromycin single dose PO.

55

epididymitis treatment

>35 → CTX + doxycyline
<35 → fluoroquinolone

56

genital herpes management

Treat empirically with acyclovir x 7 days
IF recurrent → daily suppressive therapy
IF refractory → foscarnet

57

treatment of primary/secondary syphilis if penicillin allergic

doxycycline

58

granuloma inguinale diagnosis

biopsy or touch prep

59

treatment of granuloma inguinale

doxy, TMP/SMX, azithromycin

60

pediculosis

mite that lives in hair-bearing areas, such as pubic hair or axilla

61

UTI SYSTEM

if positive for symptoms (dysuria, urinary frequency or urgency, suprapubic pain, hematuria, fevers, chills, flank pain) OR a man → UA + gram stain → assess for pyuria + bacteriuria → assess complicated/uncomplicated...
uncomplicated → fosfomycin or nitrofurantoin x 3 days (if resistance to e coli low, if high, then quinolone)
complicated → culture --> TMP/SMX or ciprofloxacin x 7 days

62

pyelo management

UA + culture
Outpatient → ciprofloxacin
Inpatient → CTX, quinolones, ampicillin, gentamicin

63

perinephric abscess

quinolone + oxacillin/nafcillin/vancomycin

64

prostatitis management

Cipro or TMP/SMX x 2 weeks (acute) or 6 (chronic)

65

HAART combinations

lamivudine + abacavir + integrase inhibitor
tenofovir + emtricitabine + integrase inhibitor
tenofovir + emtricitabine + atazanavir/darunavir

66

tenofovir AE's

RTA, fanconi syndrome, osteopenia

67

what to test for before starting abacavir

HLAB5701

68

drugs that constitute prep

tenofovir + emtricitabine