7 Flashcards
SSRI + MAOI (phenelzine)
treatment of serotonin syndrome
Washout period of 14 days
Fluoxetine-washout period of 5 weeks
give benzos->cyproheptadine
Acute MR
Rupture of papillary muscle (in MI) or chordae tendinae (MVP, connective tissue disease)
velvety skin, atrophic scars, easily bruised, recurrent joint dislocations, scoliosis, hernias
Ehlers-Danlos
transmission of lyme from tick
attached >36 hours, engorged tick
precautions for patients on long term opioids
monitor on database, RANDOM drug screening, frequent follow up
ASD, secundum type
R atrium and ventricular dilation
wide and fixed splitting of second heart sound, mid systolic ejection murmur over pulmonary valve, mid diastolic rumble
associated with a fib/flutter
> 30 yo with breast mass
mammogram
in anyone, core biopsies only, no FNAs only aspirate simple cysts
Healthy adolescents with upper extremity morning myoclonus and subsequent generalized seizures
treatment
juvenile myoclonic epilepsy
EEG- bilateral polyspike and slow wave discharges
Valproic acid (side effects: hepatotoxicity, thrombocytopenia, NTDs, pancreatitis)
Digital injuries
tendons (run on anterior surface)
nerves, veins and arteries run on sides of digits
overflow fecal incontinence
treatment
impacted stool
disimpaction ffed by enemas
Hydatidiform mole management
complication
suction curettage, then contraception and serial b-hcg till undetectable for 6 months
gestational trophoblastic neoplasia->pelvic u/s and cxr->methotrexate to treat
Stone <1cm with no complications
alpha blocker, pain control, hydrate, d/c
Bell’s palsy
peripheral facial nerve palsy->steroids and artificial tears, eye patching
- central: forehead is spared
- bilateral facial palsy->sarcoidosis*
antidepressant induced mania
severe or refractory mania meds
discontinue antidepressant
if persistent, start mood stabilizer/ antipsychotic
mood stabilizer + antipsychotic
ear pain+ external auditory vesicles+ ipsilateral facial paralysis
ramsay hunt syndrome, vzv
malignant external otitis treatment
IV pseudomonal (fluroquinolones) until ESR, CRP normalize, then PO
Adolescent preg, increased risk of
fetal complications, preterm, postpartum depression, preeclampsia
Calcitonin elevation after thyroidectomy for MTC
Metastatic, obtain CT head and neck->CT abdomen
treated lyme disease in pregnancy
treatment
benign
oral amoxicillin, cefuroxime
non preggo-doxycycline
hypothyroidism labs
hyponatremia, macrocytosis, bradypsychia
STEMI ECG
> 1mm ST elevation in contiguous leads, left bundle branch block
1.5mm ST elevation in V2, V3
tetracycline side effect
phototoxicity
isotretinoin precautions
2 pregnancy tests, 2 forms of contraception before starting
discontinue all other anti-acne meds
warfarin preggo
switch to lovenox in first trimester, continue warfarin in 2nd and third trimesters, unfractionated heparin in last weeks
organophosphate poisoning treatment
atropine, pralidoxime->reactivates acetylcholinesterase
pyrostigmine->anticholinesterase for treatment of myasthenia gravis
multifollicular ovaries
polycystic ovaries
PCOS treatment: OCPs/ progestin IUD
(women with anovulation-estrogen excess)
COPD prognosis
FEV1 <40%, age
diabetes, hypertension, hypokalemia, metabolic alkalosis
diagnosis
cushing’s
dexamethasone suppression test
small rough papules
fleshy nodule with ulceration
actinic keratosis->squamous cell carcinoma
basal cell carcinoma
UTI diagnosis
treatment
physical exam and labs needed
history alone is sufficient
Bactrim/nitrofurantoin (Cipro for pyelo)
pregnant, pyelo, vaginal infection
SBO: air in distal colon
no air
partial obstruction, conservative management, surgery in a day if no improvement
complete obstruction->surgery
Marked increase in creatinine after ACEI
renal artery stenosis
diffuse esophageal spasm treatment
systemic sclerosis manometry
CCBs
hypomotility
naltrexone
for moderate to severe alcohol use disorder
decreases cravings and heavy drinking
use in opioid free patients without hepatic dysfunction
disulfiram is for patients who are abstinent and highly motivated
post op hypercapnic and hypoxic respiratory failure, somnolent with decreased resp rate and hypoventilation
residual anesthesia effect
Postop atelectasis
treatment
low lung volumes, linear opacifications
CPAP if no secretions, secretions: chest PT and suctioning
Choking, >1 yo with complete airway obstruction
<1 yo
unconscious
abdominal thrusts
back blows and chest thrusts
CPR
dysuria, itching at urethral meatus, urethral discharge
gono vs chlamydia
gono: orgs in discharge
chlamydia: no orgs in discharge->azithromycin
can be m. genitalium->moxifloxacin
Untreated celiac disease cancer
enteropathy associated T cell lymphoma
abdominal pain, B symptoms, GI bleeding
median survival of 10 months
Untreated celiac disease cancer
enteropathy associated T cell lymphoma
abdominal pain, B symptoms, GI bleeding
median survival of 10 months
Strep agalactiae (GBS) bactiuria during pregnancy acute pyelo in pregnancy
amoxicillin now, penicillin prophylaxis during labor
daily antibiotic supression
tension headache vs migraine
non throbbing, bilateral, band-like vs throbbing, disabling, aura
lithium toxicity
causes
dialysis
confusion, ataxia, NM excitability
volume depletion, thiazides, ACEI, NSAIDs
lithium >4/ neurologic symptoms/ AKI
hydrate with isotonic saline
hyperbilirubinemia and anemia in infancy
hemolytic disease of newborn (ABO incompatibility)
G6PD deficiency (day 2-3) within 24 hours
Dementia labs
acetylcholinesterase inhibitors
NMDA antagonist
TSH, CBC, CMP, B12
RPR, Vitamin D, folate, CSF if appropriate
rivastigmine, donepezil, galantamine
memantine
Age 65 pneumo vaccine
prevnar first, then PPSV23 in 6-12 months
Preggo mania
If SI/HI, not eating
Haldol/ lithium
ECT
women who have sex with women at increased risk for
BV and cervical cancer
vasovagal syncope management
educate and reassure
only tilt table test if etiology is unclear
post bariatric surgery preggo
wait for a year
DVT anticoagulation length
If time-limited/ reversible risk factor: 3-6 months
hypokalemia ileus, cardiac/neuro complications
replete
pancoast tumor
complication
non small cell lung cancer
shoulder pain, horner’s syndrome, hand weakness
spinal cord compression
length-time bias vs lead time bias
detecting more benign cases vs detecting disease early
company sponsorship for conferences
lecturers can accept, attendees can’t
requests for euthanasia prompted by
loss of sense of autonomy, fear of future suffering
pioglitazone side effect
fluid retention
treat with spirinolactone
swinging fever and leukocytosis post abdominal surgery
subphrenic abscess->abd u/s
lead poisoning labs
CBC, iron, ferritin, rec count
lobular carcinoma in situ
nonmalignant->excisional biopsy
High fever and severe polyarthralgia
abdominal fever
fever+leukopenia+thrombocytopenia+elevated aminotransferases
chikungunya
typhoid
Ehrlichiosis
Corneal foreign bodies org
staph
Sjogren’s cancer
B cell non-Hodgkin’s lymphoma
B symptoms are associated with Hodgkin’s lymphoma
Trichomoniasis treatment
if breastfeeding
single dose flagyl
express and discard for 24 hours
chlamydia cervicitis treatment
doxycycline
GGT
elevated alk phos and GGT only
hepatic sarcoidosis treatment
liver
infiltrative disease
steroids
Alcoholic ketoacidosis labs
treatment
osmolal and anion gaps
IV dextrose, normal saline, thiamine, CIWA protocol
GBS management, first step
treatment
prognosis
frequent monitoring of TV and NIF
IVIG or plasma exchange if nonambulatory if <4 weeks
spontaneous recovery, treatment decreases duration
Gestational DM screening
24-28 weeks with 1 hour 50g glucose challenge
if positive (>140), 3 hour 100 g glucose tolerance test
fasting glucose <95, 2hour test <120
Strong correlation
close to -1 or 1.
Elevated c-peptide
endogenous insulin->from insulinoma/ oral hypoglycemic
serum assay for hypoglycemics, then ->imaging
Most effective non pharm antihypertensive
weight loss
DASH diet, sodium restriction, decrease alcohol, exercise, smoking cessation
lyme arthritis treatment
28 days of amoxicillin/ doxy, refrain from high impact activity
thin, homogenous d/c, stippled cells, clue cells, amine odor
treatment
BV
flagyl/clindamycin, treat to relieve symptoms
partial response to antidepressant
add second agent
subchorionic hematoma
increased risk of
expectant management
spontaneous abortion, abruption placentae, PPROM, preterm labor, preeclampsia, fetal growth restriction, intrauterine fetal demise
borderline sodium, hyperkalemia, mild acidosis, prerenal, weight loss, eosinophilia, asthenia
adrenal failure
Sickle cell osteo treatment
cover staph and salmonella: (clinda/vanc (covers MRSA) + ceftriaxone)
Rh incompatibility
RH- mum may form anti + antibodies when exposed to Rh+ baby. In any subsequent Rh+ preggos, attacks baby. Mum herself remains Rh-
not possible in Rh + mum, will never form antibodies
Paps
21-30: no HPV
>30: + HPV if desired
Phenytoin toxicity
horizontal nystagmus, blurred vision, ataxia, slurred speech, lethargy
decrease dose
Massive PE can cause hypotension.
right bundle branch block
RV strain, tricuspid regurg
Stress incontinence due to
treatment
urethral hypermobility
conservative measures->urethral sling
gono conjunctivitis
treatment
prevention
profuse, purulent eye drainage and swelling at 2-5 days
IM cefotaxime
topical erythromycin for baby
Post-extubation stridor
laryngeal edema, reintubate
HELLP treatment
mag sulfate
plasma exchange if AST>2000/ LDH >3000
palpable purpura+ fatigue+ arthralgia+ hypocomplementemia+ glomerulonephritis
diagnosis
treatment
mixed cryoglobulinemia
serum cryoglobulin
steroids and rituximab
toxic thyroid nodule
methimazole, then surgery
Adults with intellectual disability decision making
must involve guardian if exists
causality
association increases with exposure (dose-response relationship)
porphyria cutanea tarda
diagnosis
treatment
painless blisters, hyperpigmentation, hypertrichosis
associated with hep c
triggered by ethanol, estrogen
urinary uroporphyrins
phlebotomy/ hydroxychloroquine/ interferon alpha
Hematemesis, left pleural effusion
Esophageal perf, may not find pneumomediastinum
Mallory-Weiss would not have fever, chest pain or pleural effusion
harsh holosystolic murmur over left sternal border with palpable thrill
PDA shunting
wide and fixed splitting of S2
VSD
Aorta to main pulm artery: increased oxygenated blood in pulm artery
ASD
labile glucose levels, post prandial fullness, early satiety, autonomic symptoms
diagnosis
treatment
diabetic gastroparesis
emptying study
dietary changes, metoclopramide, erythromycin
GBS symptoms + sensory level+ bowel/bladder dysfunction
diagnosis
treatment
transverse myelitis
MRI
high dose steroids
incidentaloma management
measure hormones/metanephrines
if functional/ >4 cm/ malignant features->remove
Inflammatory acne refractory to topical retinoid and benzoyl peroxide
add antibiotic
photoaging treatment
rosacea antibiotic
tretinoin
metronidazole
