Step Up To Medicine Quick Hits Flashcards
(98 cards)
1
Q
Workup of Myasthenia Gravis ?
A
AcH Ab test: If positive
EMG: decremental response to repetitive stim
CT: of Thorax to rule out thymoma
Edrophonium ( Tensilon Test ): Trial of Ach Medication.
2
Q
Treatment of Myasthenia Gravis
A
- Pyridostigmine: Ach Inhibitor
- Thymectomy: Can be beneficial even if no adenoma. If there is an adenoma it is an indication for surgery
- Immuno-supression: Corticosteroids azoth
- IVIG and Plasmapheresis
3
Q
Vertigo tinnitus and hearing loss
A
Meniere’s Disease.
Treatment: Na restriction and diuretics
4
Q
Vertigo with head movements
A
BPV
Treat with Mezclizine.
5
Q
Focal neurologic exam, Bidirectional Nystagmus, Responds to tilt test every time without refractory period.
A
Central Vertigo, Get brainstem MRI, Eval for CV risk factors.
6
Q
Syncope, you suspect vasovagal. Best Test ?
A
ECG / RO structural heart disease + Tilt Table Test.
Treat with Beta blockers or Disopyramide.
7
Q
How can you differentiate syncope from seizures ?
A
In syncopal episodes bowel and bladder fx will be retained. Also the LOC will be very brief.
8
Q
Syncope with exertion
A
Hypertrophic Cardiomyopathy or Aortic Stenosis.
9
Q
Main goal with working up syncope ?
A
Rule out cardiac cause.
10
Q
Simple vs generalized seizures
A
Simple originate in one area of the brain.
11
Q
Simple Partial
A
Consciousness remains intact, originates in a focal area of the brain
12
Q
Simple complex
A
Origionates in a focal area of the brain, consciousness is lost.
13
Q
Generalized
A
Electrical activity to the entire brain is interrupted.
14
Q
Petite Mal
A
Absence Seizure
15
Q
Grand Mal
A
Tonic-Clonic
16
Q
Status Epilepticus Treatment
A
Airway, IV Diazepam, IV Phenytoin, 50g Dextrose
17
Q
Tonic Clonic and partial seizures
A
Phenytoin and Carbamazepine
18
Q
Absence Seizures
A
Ethosuxamide and Valproic Acid.
19
Q
MCC aphasia
A
cerebrovascular disease. If speech is fluent lesion is posterior to central sulcus. If speech is not fluent lesion is anterior to central sulcus.
20
Q
DD of facial Palsy
A
Trauma: Temporal bone / Forceps Delivery Lyme Disease: NO STEROIDS Tumor: Acoustic Neuroma Guillain-Barre: Bilateral Herpes Zoster
21
Q
Workup of Trigeminal Neuralgia
A
Clinical, bursts of intense pain. MRI to rule out CP angle tumor
Treat with Carbamazepine.
22
Q
Lung tumor that presents with horners syndrome ?
A
Pancoast Tumor
23
Q
Facial Fullness, Facial and arm edema
A
Superior Vena Cava syndrome
24
Q
Pleural Fluid with elevated amylase
A
Esophageal rupture, pancreatitis, malignancy
25
Pleural Fluid milky, opaque,
Chylothorax: Lymph fluid in pleural space.
26
Pleural fluid with frank pus
Empyema
27
Pleural Fluid with pH
Parapneumonic effusion / empyema
28
Pleural Fluid is transadate or exudate ?
One Criteria must me met to be exudative.
Protein (Pleural) / Protein (serous) = > 0.5
LDH (Pleural) / LDH (serum) = > 0.6
LDH is greater than upper 2/3 of serum LDH.
29
Workup of Sarcoid ?
| Treatment?
CXR: Hilar Adenopathy
Transbronchial Bx: Noncaseating Granuloma
Treat with systemic corticosteroids or mtx.
30
pANCA
Churgg Strauss (asthma) / Goodpasteurs (Anti-GBM)
31
Pleural Plaques
Asbestos, risk of bronchogenic carcinoma
32
Egg shell calcifications
Silicosis.
33
Hypoxia
PaO2 50
34
Hypercapnea
PaCO@ >50
35
Pathophysiology of ARDS
Massive intrapulmonary shunting (Widespread atelectus)`
36
Currant Jelly Sputum or thick mucoid capsule.
Klibsella Pneumonia.
37
Bleeding esophageal varicies in an alcoholic
ABC's then stabilize the patient, Check for clotting deficiencies, (FFP + Vit K)
If no bleeding history use Beta Blockers.
38
Prospective study will show you ?
Incidence and Relative Risk
39
Retrospective Study will show you ?
Odds Ratio
40
Type 1 error
Claiming a difference when none exists. P value gives you the chance of this.
41
Heparin is monitored with
PT
42
Warfarin is monitored with
PTT
43
Atrial Fibrillation. How does management change when the condition is chronic?
Rate control with Beta/CCB/digoxin and rhythm control with amiodarone/procainamide/DC cardioversion.
If chronic start with anticoagulation
44
WPW
procainamide or quinidine
45
V-Tach
Immediate defibrillation.
46
PVC's
If asymptomatic do not treat. If symptomatic Beta Block or use Amidarone.
47
How do you recognize 1st degree AV block ?
PR interval more than 0.2 sec.
48
When do you treat Hypercholesterol with no risk factors ?
- 2 Risk Factors
- CHD equivalent
- Very High Risk
> 190
> 130
> 100
> 70
49
What is the pneumonic for statin strength ?
```
First Lets Pray Some Are Religious
Fluvastatin
Lovastatin
Pravastatin
Simvastatin
Arorvastatin (High Strength)
Riuvastatin (High Strength)
```
50
Hypertension, Bradycardia, Respiratory Depression
Cushings Reflex. In trauma an epidural hematoma can be augmented by fluid resuscitation.
51
Progression of Uncal Herniation
1. Crus Cerebri --> Ipsilateral hemiparesis
2. Ipsilateral occulomotor --> Midrasis (Early) and down and out gaze
3. Posterior Cerebral Artery: Homonymous Hemianopsia
4. Reticular Formation: Altered Consciousness.
52
Conjugated chronic hyperbilirubinemia with black hepatocytes
Dubin Johnson Syndrome. Black sand in Dubai
| Diagnose with urine Coproporphyrin
53
Defect in hepatic storage of conjugated bilirubin. Direct hyperbilirubinemia. Liver is not black
Rotor syndrome. Differentiated from Dubin- Johnson in that the liver is not stained black.
54
Significant unconjugated hyperbilirubinemia
Criagler Najar, phototherapy and plasmapheresis can help for a while but liver transplant is the only cure.
55
Still Birth Delivery Options
2nd Trimester: D&C Induction and Spontaneous Vaginal Delivery
3rd Trimester: Induction, C-Section,
56
Best screening test for chylamida and gonnorrhea ?
Nucleic Acid Amplification Test.
57
Universal dyslipidemia screening
9 - 11 and 17 - 21 Lipids right before and after puberty are the best intervals to screen at.
58
Management options for miscarriage
Expectant- Outpatient, not good for a patient who is bleeding or who has unstable vitals.
Medical- Oxytocin, good in the first and second trimester.
Surgical- Hemodynamic Instability.
59
Polyarthritis, erythema marginatum, fever, elevated CRP and ESR
Jones Criteria are met for acute rheumatic fever.
60
Coombs Negative hemolytic Anemia, Jaundice, Splenomegaly. spherocyosis. Next test ?
Acidified glycerol test for spherocytosis.
61
Kawasaki disease vs scarlett fever.
Scarlet Fever presents with exudative pharyngitis and a sandpaper like rash.
62
Mononucleosis reaction after amoxicillin vs Type 1 drug hypersensitivity after amoxicillin.
After administration of amoxicillin a rash will generally develop within 24 hours. The patient will also have fatigue, exudative pharyngitis, and posterior cervical lymphadenopathy.
Drug reaction the rash will be immediate following the administration. Give an antihistamine.
63
AIDS patient with retinal necrosis, eye pain, and vision loss ?
VZV and HSV.
64
Severe unrelenting ear pain, purulant discharge, drainage and sense of fullness in an elderly diabetic ?
Bug and drug ?
Malignant otitis externa, Pseudomonas, IV Cipro
65
Cholesteatoma
Chronic granulamatous growth in the external ear canal.
66
What differentiates malignant otitis external from otitis externa ?
Extreme Pain, Granulation Tissue, ESR.
Topical neomycin and corticosteroids can treat OE, but MOE needs IV Cipro
67
Immune defect in bullious phemphegoid ?
IgG and C3 deposits at the dermal epidermal junction.
68
Pemphigus
IgG to the desmogelin which hold epithelial cells together.
69
Blurred vision in a patient with nonketotic hyperosmolar state
Myopic increase in lens length and intraoccular hypotension secondary to hyperosmolarity.
70
High yield survalence in patients with ulcerative colitis
Colorectal carcinoma screening. There is not method to screen for toxic megacolon.
71
Difference in adenopathy between strep and mono.
Mono will be diffuse cervical, strep will be anterior cervical.
72
Hyperpigmented nodule on the lower extremity
Dermatofibroma.
73
Baby born with nail and digit hypoplasia, dysmorphic facies, and mental retardation.
Fetal Hyandation Syndrome. Exposure to Phenytoin.
74
Difference between cardia equine syndrome and conus medularis syndrome .
Conus
75
What INR is the threshold for transfusing FFP ?
1.6 or so.
76
PRBC transfusion threshold for a stable patient
77
PRBC transfusion threshold for an unstable patient
78
Bladder pain relieved with voiding. Anterior vaginal pain. . Normal urinalysis.
Interstital cystitis.
79
Edema of the face mouth lips tongue and glottis.
Angioedema. ACE Inhibitor side affect.
80
Bradycardio, AV Block, Bronchoconstriction.
Beta Blocker Tox.
81
Preysbopia
Nearsightedness caused by loss of elasticity in the lens.
82
With the classical clinical and lab findings in appendicitis, do you need to confirm with imaging before you take them to the OR ?
No, they can go right to surgery.
83
Vasa Previa vs Placenta Previa
Vasa Previa will have rapid deterioration of the fetal tracing.
84
How do you work up and treat hereditary angioedema ?
C3 esterase inhibitor
85
Recurrent lung and sinus infections in a 7 month old with encapsulated bacteria.
Burtons Agammaglobinemia, X-Linked Recessive, little or absent B cells.
86
What causes SCID
Adenosine Deaminase Deficiency --> B and T cell defects
87
Do CCB or thrombolytics help in unstable angina ?
NO.
88
Essence trial proved ?
In unstable angina LMWH is superior to unfractionated.
89
Long term medical management of CAD
Asprin, B Block, and Nitrates.
90
Agents that reduce mortality in MI
Asprin, B-Block, ACE-Inh.
91
Is Heparin used for stable angina ?
NO
92
What test do patients get after MI before leaving the hospital ?
Stress Test to see if they need angio.
93
What reduces mortality more, PTCA or Thrombolytic ?
PTCA.
94
Anti Coag after bare metal stent ?
| After drug eluting stent ?
30 Days
| 6mo
95
Standard Treatment of CHF
Loop Diuretic
ACE INH.
B-Block.
96
What decreases mortality in post MI CHF
Beta Bloker.
97
Difference in treatment of L-CHF and R-CHF
In right sided failure you will not use spironolactone
98
Most important treatment of flash CHF ?
Lasix.
