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MS3 > Step studying 7 > Flashcards

Step studying 7 Flashcards

1
Q

Diagnose and treat: vesicular lesions on the uvula and soft palate of a child

A

Herpangina caused by Coxsackie (hand foot and mouth

Tx = reassurance

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2
Q

Tx of Kawasaki

A
  • Aspirin - to prevent thrombosis of coronary arteries

- IVIG

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3
Q

What part of vision is first affected in macular degeneration

A

Central vision

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4
Q

What are the options for tocolytics

A

Indomethacin, Nifedipine (CCB), Beta agonists (Terbutaline), Magnesium sulfate

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5
Q

At what age do you give the following in preterm labor

  • Betamethasone
  • Penicillin
  • Tocolytics
  • Magnesium
A
  • Betamethasone = <37 weeks
  • Penicillin = always if GBS+ or unknown
  • Tocolytics = <34 weeks
  • Magnesium = <32 weeks
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6
Q

Tx of Mallory Weiss tear

A

♣ Superficial tear
♣ Tear of the gastroesophageal junction caused by excessive/forceful vomiting
♣ Self-limiting

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7
Q

Tx of Boerhaave syndrome

A

♣ Transmural (esophagus ruptured into the chest), usually distal esophageal rupture
♣ Due to violent retching (alcohol or bulimia)
♣ CXR may show air in the mediastinum
♣ Surgical emergency

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8
Q

Pentad of sx suggestive of ascending cholangitis

A
  • RUQ pain
  • Jaundice
  • Fever
  • AMS
  • Hypotension
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9
Q

Tx of ascending cholangitis

A
  • Emergent ERCP to remove the stone so bile can flow and clear the infection
  • IVF, IV abx, NPO
  • Urgent cholecystectomy
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10
Q

Tx of choledocholithiasis

A

o NPO, IVF, IV abx
o Urgent ERCP
o Elective cholecystectomy

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11
Q

What disease is associated with migratory thrombophlebitis

A

Pancreatic adenocarcinoma (Troussea’s syndrome)

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12
Q

Erythromycin eye drops in newborns is used for prophylaxis of what bug

A

Gonococcal conjunctivitis (does not work against Chlamydia)

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13
Q

What is the difference between S3 and S4 heart sound

A

S3 = volume overload (rapid flow of blood from atria to ventricles)

S4 = atria contracting against stiffened ventricles

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14
Q

MEN1

A

♣ Pituitary tumors (prolactin or GH)
♣ Pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas)
♣ Parathyroid adenomas

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15
Q

MEN2A

A

♣ Medullary thyroid carcinoma (neoplasm of parafollicular C cells which secrete calcitonin)
♣ Pheochromocytoma
♣ Parathyroid hyperplasia

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16
Q

MEN2B

A

♣ Medullary thyroid carcinoma
♣ Pheochromocytoma
♣ Mucosal neuromas (oral/intestinal ganglioneuromatosis) / Marfanoid habitus

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17
Q

Tx if someone presents with acute chest pain

A 
MONA BASH 
M = morphine
O = O2
N = nitro
A = ASA
B = BB
A = ACEi
S = Statin
H = Heparin
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18
Q

Medical tx of hypertrophic cardiomyopathy

A

Want increased blood in the heart to stretch the ventricle and prevent obstruction

  • avoid dehydration
  • Beta blockers or CCBs to prolong diastole/filling
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19
Q

Is constrictive pericarditis a problem of systole or diastole

A

• Constrictive pericarditis is a problem of diastole – ventricle cannot expand against rigid pericardium

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20
Q

Medical tx of fast and wide arrythmia

A

E.g. V-tach

Amiodorone

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21
Q

Medical tx of fast and narrow arrythmia

A

E.g. SVT

Adenosine

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22
Q

Medical tx of slow rhythm

23
Q

Why might you see bleeding/coagulopathy in renal failure

A
  • Uremic toxins are implicated in platelet dysfunction

- There will be normal platelet count but defect involving platelet-vessel wall and platelet-platelet interaction

24
Q

How does hypothyroidism cause amenorrhea

A

• Low T3/T4 increases TRH (produced by hypothalamus) = increased TRH stimulates the anterior pituitary to produce prolactin = high prolactin inhibits GnRH = low GnRH causes low FSH and LH

25
What maneuver is for MCL vs LCL
``` Valgus = MCL Varus = LCL ``` REMEMBER: G comes before R in the alphabet and M comes before L
26
What will you see on pulmonary artery catheter readings in cardiac tamponade
Equalization of intracardiac diastolic pressures (RA = RV = PCWP)
27
Does factor VIII deficiency affect PT or PTT
PTT
28
Which are the vitamin K dependent clotting factors
II, VII, IX, X, C, and S THINK: diSCo started in 1972
29
Does vitamin K deficiency affect PT or PTT
Both | - But mild disease will affect PT more (recall that PT measure extrinsic pathway - VII, X, and V)
30
How does von Willbrand disease affect BT, PT, and PTT
- Prolonged BT - Normal PT - May have prolonged PTT due to vWF stabilization of Factor VIII
31
What clotting factors are involved in intrinsic vs extrinsic pathway
Intrinsic = XII, XI, IX, X, VIII Extrinsic = VII, X Both = X, V, II, I
32
What form of anticoagulation is preferred in CKD
Warfarin
33
What part of the brain is affected in Huntingtons
Caudate nucleus ``` Remember disease of C's: • Cognitive decline • Caudate atrophy • Chorea • CAG repeat • Chromosome cuatro (4) • Cuarents (40 y/o) • Decreased AcetylCholine ```
34
Who should get low dose CT scan to screen for lung cancer
- Age 55-80 - 30 pack year smoking hx - Quit smoking <15 years ago
35
Order of tx for COPD
In order – continue to add the next step until you gain control • Short acting beta agonist (SABA) • Long acting muscarinic antagonist (Tiotropium) • Long acting beta agonist (LABA) • Inhaled corticosteroids • Phosphodiesterase 4 inhibitors • Oral steroids
36
What are the 2 things that improve mortality in COPD
O2 and smoking cessation
37
Describe the following associated with Asbestosis - Exposure - Imaging findings - Histology
- Exposure to shipbuilding, roofing, plumbing - Imaging shows pleural plaques - Can cause lung cancer and mesothelioma (cancer of lung pleura) - Histology shows fusiform rods (dumbbells)
38
What should you look for in the eyes in PCP intoxication
Nystagmus (vertical or horizontal)
39
What gene is affected in Fragile X
FMR1 (THINK: Fragile Mental Retardation)
40
What mutation is associated with Prader Willi vs Angelman syndrome (associated with maternal vs paternal loss of gene)
Prader Willi due to 15q 11-13 deletion or mutation on paternal allele (so both genes are from mom) Angelman due to maternal allele (so both genes are from dad)
41
What hormone is most responsible for sx of acromegaly
Insulin-like growth factor ♣ GH increases hepatic production of insulin-like growth factor-I (IGF-I), which causes excessive growth of bone and soft tissues
42
Describe work up for suspected acromegaly
Elevated IGF-1 levels --> inadequate GH suppression in oral glucose suppression test --> MRI of brain to determine if tumor is pituitary or extrapituitary
43
Medical tx of cancer-related anorexia syndrome (CACS)
Progesterone analogue (e.g. megestrol acetate)
44
Management following a recent cat bite that does not appear infected
Antibiotic prophylaxis for pasteurella (Amox-Clav)
45
What is a lacunar stroke
Small penetrating artery occlusion due to hypertensive arteriolar sclerosis Affected areas usually include basal ganglia, subcortical white matter, pons
46
Presentation of lacunar stroke
``` ♣ Absence of cortical signs (e.g. aphasia, agnosia, neglect, apraxia, hemianopia), seizure, or mental status change ♣ Common syndromes: • Pure motor hemiparesis • Pure sensory stroke • Ataxic hemiparesis • Dysarthria-clumsy hand ```
47
Most important risk factor for lacunar stroke
HTN - leads to arteriolar sclerosis and vessel occlusion (hypertensive vasculopathy)
48
Diagnosis of GERD
PPI + lifestyle modification x6 weeks with resolution/improvement of symptoms
49
Diagnosis and tx of eosinophilic esophagitis
♣ >15 eosinophiles per high powered field | ♣ Trial PPI to r/u GERD (because GERD often causes eosinophilia)
50
Tx of Barrett's esophagus
High dose PPIs + surveillance EGDs
51
Tx of H Pylori
• Triple therapy = PPI + clarithromycin (or metronidazole) + amoxicillin
52
Describe GI effect of diabetes
Gastroparesis (subtype of peripheral neuropathy)
53
How do you diagnose gastroparesis
Gastric emptying studying (radioactive eggs); positive if . . . o >60% gastric contents remaining after 2 hours o >10% gastric contents remaining after 4 hours o Pt must be off opiate and anticholinergics with good blood glucose control in order for test to be reliable
54
Tx of gastroparesis
``` Prokinetic agents o Metaclopramide (PO) in stable disease o Erythromycin (IV) in acute flare ``` * Avoid opiates * Blood glucose control * Low fiber, small volume meals

MS3 (88 decks)

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