Flashcards in UWOrld Facts 4 Deck (94):
What are contraindications to the MMR vaccine?
1) anaphylaxis to neomycin
2) anaphylaxis to gelatin (eg marshmallows)
4) immunodeficient state (congenital immunodeficiencies, long-term immunosuppressive therapy, hematologic or solid tumors, severe HIV infection)
**in patients with personal or family history of epilepsy, MMR and varicella vaccines should be given separately
If a TG level is >500 mg/dL, what should be used to treat?
fibrate = gemfibrozil (if
How do you calculate MELD?
bilirubin, INR, creatinine. 95% survival rate among patients with score
TIPS is avoided in patients with a score greater than __
How is a relapse of C diff treated?
first = metronidazole for non-severe (WBC
What is the post-exposure prophylaxis for HIV exposure?
2 NRTIs for 4 weeks; if high viral load in source patient, PI should be added
What type of squamous cell skin cancer is treated by 5-FU?
squamous cell in situ; NOT invasive
What are the treatments for invasive squamous cell skin cancer?
surgery, cryotherapy, electrosurgery, and radiation therapy
Surgical removal during pregnancy is indicated for adnexal cysts that are larger than ___ cm
Surgery should be delayed to the 2nd trimester
Hypertension up to a BP of _____ mm Hg is permitted in patietns who did NOT receive thrombolytic therapy.
In those who did, ____ must be maintained.
NO tpa: 220/120
How should you treat septic abortion?
zosyn; imipenem; or triple therapy with clinda + gent + ampicillin
Patients with ocular melanoma can be monitored every 3-6 months as long as its dimensions remain
Choroidal melanomas can be treated with radiotherapy, as long as the tumors aren't too large and/or __________
don't extend past the sclera
Pseudomonas is the most common cause of CF-related pneumonia in adults, but ________ is the most common cause in CF children
Median nerve entrapment between teh two heads of pronator teres manifests as
pain in the volar forearm along with pain/numbness in right wrist and palmar surface of the first three fingers
T/F: Lobular carcinoma in situ (LCIS) has no malignant potential.
TRUE. But it does increase the risk of developing invasive lobular ductal carcinoma in EITHER breast
What is the treatment of LCIS?
Excisional biopsy. Follow up with surveillance (yearly mammogram); chemoprevention with tamoxifen or raloxifene; or prophylactic bilateral mastectomy
What other tests should be performed in a patient with central hypothyroidism?
MRI to assess pituitary
Also prompt assessment of other pituitary hormones (ACTH). Levothyroxine treatment in patients with uncorrected adrenal insufficiency may trigger adrenal crisis
The tick that transmits Lyme disease is _________, while the one that transmits RMSF is _________
Lyme = brown (Ixodes scapularis' deer tick). Also transmits Anaplasma, Babesia
RMSF = black (Dermacentor)
T/F: If a tick is found on a person and not engorged with blood, there is no risk of contracting Lyme disease.
True! Ticks take at least 24 hours to firmly attach to their victims; transmission takes place at least 36-48 hours after the tick has started suctioning the patient's blood
A history of preeclampsia in the first pregnancy increases the possibility of a second episode in the following pregnancy, especially if the preeclampsia presented before ___ weeks of pregnancy.
How do you calculate ATTRIBUTABLE RISK PERCENT?
ARP = (risk in exposed - risk in unexposed) / risk in exposed
How do you calculate population attributable risk percent?
(risk in total population - risk in unexposed) / risk in total population
**also (prevalence) (RR - 1) / [(prevalence) (RR - 1) + 1]
Which medications should be discontinued before surgery?
1) Raloxifene and tamoxifen (discontinue 4 weeks prior to surgical procedures with moderate to high risk of VTE)
2) ACE/ARBs night before (unless patient has heart failure)
Target-specific oral anticoagualnts (like dabigatran, rivaroxaban, apixaban, edoxaban) are renally excreted and are approved for patients with
NON VALVULAR atrial fibrillation (mild AS is ok)
What is Bezold abscess?
A neck abscess resulting from an erosion thorugh the medial aspect of the mastoid tip
What happens to PaCO2 during pregnancy?
Increase in respiratory drive cause a resting alkalosis with PaCO2 from 27-32
What is the firstline treatment for juvenile myoclonic epilepsy?
What are the firstline treatments for complex partial seizures?
valproate, lamotrigrine, levetiracetam
What are the first line treatmetns for absence seizure?
What is the first line treatmetn for tonic clonic seizure?
valproate, lamotrigine, levetiracetam
What is the first line agent for treatmetn of simple partial seizure?
carbamazepine, lamotrigine, oxcarbazepine, and levetiracetam
Which seizure meds do not affect OCP?
T/F: Gabapentin is contraindicated in patients with JME
True! IT can exacerbate seizures
What is the difference between Type 1 and Type 2 HIT?
Type 1 = nonimmune direct effect of heparin on platelet activation; plt count normalized with continued hep tx
Type 2: antibodies to PF4; occurs 5-10 days after initiation of hep tx with >50% drop in plt count
How can you confirm HIT?
1) serotonin release assay (should be high)
2) heparin-inudced platelet aggregation assay
3) heparing pf4 antibody elisa
What are direct thrombin inhibitors?
argatroban, lepirudin, etc
Warfarin can be started in a patient with HIT once the plt count is above _______
What is POEMS?
polyneuropathy, organomegaly (spleen, liver), endocrinopathy (type 2 diabetes, hypothyroidism, amenorrhea/gynecomastia, adrenal insufficency) M proteins (M spike), and skin changes
Treatment with vit B12 in patients with moderate to severe megaloblastic anemia can cause
hypokalemia (from uptake of potassium by newly forming red cells)
Patients with inferior wall myocardial infarctio nand bradycardia with hypotension should be treated how?
1) atropine for bradycardia; if persistently hypotensive, then
How do you treat Hep C?
in patients without renal dysfunction, alpha-interferon and ribavirin
In patients with impaired renal function, only alpha-interferon
What is meralgia paresthetica?
common syndrome caused by entrapment of lateral femoral cutaneous nerve. Decreased sensation over anterolateral thigh without muscle weakness or DTR abnormalities
How do you treat meralgia paresthetica?
reassurance, weight loss, and avoidance of tight-fitting garments.
If not responsive, local corticosteroid injection and the use of anticonvulsants
Upon refeeding anorexics, what are potential cardiac complications?
CHF (can develop from weak, atrophic heart that cannot handle fluid and electrolyte shifts)
What is the treatment for RMSF? In pregnant women?
In pregannt women (or patients who can't tolerate tetracyclines), chloramphenicol
What is teh treatment of condylomata acuminata?
1. Trichloroacetic acid application (destroys the lesion by protein coagulation). Podophyllin does the same, but is contraindicated during pregnancy and should not be applied to mucosal surfaces
2. ablative or surgical procedures in patients in whom medical therapy is not effective
When can you diagnose DM?
1) HbA1c > 6.5%
2) fasting blood sugar >126
3) glucose > 200 after OGTT
4) random glucose > 200 in symptomatic patients
T/F: Asymptomatic patients with an abnormal screening test for diabetes require a repeat measurement with the same test to confirm the diagnosis.
Symptomatic patients, however, do not require confirmatory testing
What are clues that suggest renovascular hypertension?
elevated Cr, unilateral renal atrophy, recurrent flash pulmonary edema, abdominal bruit on physical exam, atherosclerotic disease, resistance to multiple medications, young age of onset (
What is seen in 21-hydroxylase deficiency?
1) decreased cortisol and aldosterone (low Na, high K; hypotension)
2) increased testosterone (ambiguous genitalia in girls)
3) increased 17-hydroxyprogesterone
What is seen in 11B-hydroxylase deficiency?
1) decreased cortisol and aldosterone
2) increased 11-deoxycorticosteone (weak mineralocorticoid; fluid and salt retention; HYPERtension) and 11-deoxycortisol
3) increased testosterone (ambiguous genitalia in girls)
What is seen in 17a-hydroxylase deficiency?
1) decreased cortisol and testosterone (all patients phenotypically female)
2) increased mineralocorticoids and increased corticosterone (fluid and salt retention, HYPERtension)
What are the antibiotic treatments for cholangitis?
1) ampicillin and gentamicin; OR
2) imipenem; OR
What is the difference between precocious puberty and precocious pseudo-puberty? How can you distinguish between them?
Precocious puberty = premature activation of the HPG axis
precocious pseudo-puberty = gonadotropin-independent process, like an excess of sex steroids
Precocious pseudopuberty is more dramatic; precocious puberty has sequential development
How does HRT affect lipids?
decreases LDL, increases HDL, increases TG modestly (but not effective for primary/secondary prevention of CAD; it actually INCREASES nonfatal MIs)
What are the only two indications for combined HRT?
preventino of osteoporsis and control of vasomotor symptoms
How is dementia related to HRT?
women receiving HRT had 2x risk of dementia or mild cognitive impairment
Disappearance of spinal pain when a patient sits is characteristic of
lumbar spinal stenosis
What is lumbago?
lower back pain; usually self limited, lasts for approximately 2 months
What is the treatment of lumbar spinal stenosis?
2) lumbar epidural block
3) surgical decompression through a laminectomy
The diagnosis of spinal stenosis in a patient with symptoms is best confirmed with
MRI of the spine
What is Cushing's triad?
bradycardia, hypertension, and respiraotry depression (in ICP)
Why is hyperventilation to lower ICP CONTRAINDICATED in patients with TBI and acute stroke? What level of CO2 do you go to?
PaCO2 to 25-30 mm Hg
Contraindicated in patients with TBI and acute stroke because a decrease in cerebral blood flow caused by vasoconstriction can lead to worsening of neurological injury in those patients
Patients with Colles fracture with angulation >___ degrees may require urgent orthopedic consultation.
What is a Smith's fracture?
A fall with the wrist in flexion which leads to hyperflexion in addition to a ventrally displaced distal radius fracture (vs dorsal displacement in Colles fracture)
What is a boxer's fracture?
fractures of the 4th and 5th metacarpals caused by punching with a closed fist
What is pylephlebitis?
Infectious thrombosis of the portal veins
What is the most common complication of appendicits in the pregnant woman?
First trimester: abortion
Second trimester: premature delivery
Third trimester: appendix perforation with peritonitis and pylephlebitis
Which is more common in young patients: indirect or direct inguinal hernias?
What is the gold standard of treatment with endometritis?
clindamycin and gentamicin
Why can't flagyl be used in postpartum endometritis?
it is contraindicated in breastfeeding mothers
Which ITP patients should be treated with corticosteroids AND IVIG?
symptomatic with plts
Why isn't a bruit seen with scleroderma with the kidneys?
because only the small arterioles are affected; atherosclerotic disease causes bruits because it involves the renal arteries
What is the treatment of choice in scleroderma renal crisis?
Captopril! ACE inhibitors reverse the angiotensin-induced vasoconstriction, and captopril has a short time to onset. Goal is to reduce to baseline in 72 hours
**IF CNS MANIFESTATIONS or papilledema is present, IV nitroprusside should be added
What are the three factors used to calculate MELD score to gauge severity of liver disease?
bilirubin, INR, and creatinine
In Bells palsy, forehead muscle sparing suggests
a CENTRAL (vs peripheral) lesion; requires brain imaging to evaluate for ischemia or tumors
What is thought to cause most cases of Bells palsy?
reactivation of HSV
T/F: Sarcoidosis can also cause Bells palsy.
Children should not have cholesterol measured until age 2, since before htat, diet is high in fat and cholesterol.
What test should be performed at age 2?
1) if family member has TC >240, then random cholesterol. If >170, then order FLP
2) if family member has history of premature CAD, order FLP directly
**high random cholesterol in a child requires confirmation by repeating the test 1-2 weeks later
Patients with Celiac sprue are at increased risk of developing _______. Suspect this in patients with celiac disease who present with GI symptoms despite adherence to a gluten-free diet.
intestinal T cell lymphomas (jejunum commonly affected)
Why is right-sided ovarian torsion more common than left-sided?
the right utero-ovarian ligament is longer and the rectosigmoid colon occupies the space around the left ovary
Only treat patients with influenza A antiviral therapies (like oseltamivir) if they present within ___ hours of symptom onset
Early amniocentesis (performed before __ weeks) is associated with a greater risk of fetal loss, equinovarus foot, and amniotic fluid loss.
The majority of patients with myelomeningocele also have which malformations?
hydrocephalus, Chiari II malformations
T/F: MRI should be performed before surgical correction of myelomeningocele.
FALSE. Although it is performed for most spinal conditions, myelomeningoceles must be corrected during the first 24-48 hours
How do you distinguish between prerenal azotemia nad ATN clinically?
response to fluid challenge! THe first responds well, the second does not
What is plugging of the posterior canal?
A surgical procedure used in patients with intractable symptoms of BPPV
T/F: Thiazides are sulfonfamides.
The earliest a serum or urine test can detect a preganncy is _____
1-2 weeks after ovulation
WHat is the most effective emergency oral contraceptive?
ulipristal (effective for up to 5 days after unrpotected intercourse; efficacy does nto decrease with time, vs levonorgestrel and combined contraceptives)
Ulipristal inhibits and delays ovulation; levonorgestrel primarily just delays ovulation
What is the treatment of HCM with symptoms of heart failure and increased LVOT gradient?
negative inotropic agents.
1) beta blockers are the first monotherapy;
2) verapamil or disopyramide should be added if the first does not suffice
**Alcohol septal ablation should be used for patients that have symptoms refractory to medical therapy
What are the indications for ICD therapy?
1) prior MI AND LVEF