Awesome Review Index cards - finished Flashcards
Activated charcoal is not effective when the overdose is with what?
Caustics, cyanide, electrolyte overages, alcohols, hydrocarbons, heavy metal poisoning , lithium
Alkalinization of the urine to a pH of greater than 7 increases excretion of what?
Aspirin, tricyclics, phenobarbital.
Acidification of the urine with ammonium chloride increases excretion of what?
Amphetamines and PCP.
Hemodialysis is effective in removing drugs with low molecular weights that are not lipid soluble, protein bond, or tissue bound. What drugs are effectively removed by hemodialysis?
Lithium, chloral hydrate, salicylates, and alcohols (methanol and ethylene glycol).
What pain medications are associated with seizures in toxicated patients, especially those on dialysis?
Meperidine, tramadol, propoxyphene
How do you treat aspirin overdose?
Decontamination with activated charcoal with a cathartic (sorbitol or magnesium citrate) and serum/urine alkalinization using sodium bicarbonate and aggressive hydration
What is the treatment for acetaminophen overdose?
Activated charcoal is beneficial if given within 4 hours of ingestion. N-acetylcysteine which increases glutathione is effective of an 8 to 16 hours after overdose. even if it’s given late it’s yours to decrease mortality.
What is the mnemonic for anticholinergic overdose?What is the treatment?
Red as a beet (cutaneous vasodilation), hot as a hair (hyperthermia), blind as a bat (mydriasis), mad as a hatter (hallucinations) and full of flask (urinary retention) & tachycardia.Treatment is physostigmine which is an anticholinesterase.
How is a pure or dose of benzos seen? (Many times benzo overdose will present for the mixed picture)
Coma with normal vital signs.Treatment is with flumazenil, but can cause withdrawal seizures.
How do you treat tricyclic overdose?
Give activated charcoal within 2 hours. QRS prolongation correlates most closely with the degree of intoxication. Block this by keeping patient alkalemic via hyperventilation or IV bicarbonate: target pH is 7.5 to 7.55. if arrhythmias still persist give lidocaine (first line) or phenytoin as needed. Use benzos for seizures.
What is the clinical presentation of digoxin toxicity?
Nausea vomiting, abdominal pain, changes in color vision, scotoma, bradycardia with hypotension, anorexia.
What labs do you see with digoxin toxicity?
Acute toxicity will show hypokalemia and chronic toxicity will show hyperkalemia and you will see kidney injury which is usually the cause of toxicity
What does the EKG look like with digoxin toxicity?
Flattened or inverted t waves, shortened QT interval, and depressed lateral ST segments often referred to as the digit effect.
How do you treat digoxin overdose?
Give activated charcoal if patient presents with in 2 hours. Use Fab fragments to treat patients who have serious ventricular arrhythmias, k>5, renal failure or changes in mental status.
How do you treat cocaine overdose?
Nitroglycerin and calcium channel blockers for the chest pain, and benzodiazepines.
How do you treat PCP overdose?
IV benzos as needed and supportive care for complications such as rhabdomyolysis, hypertension
What treats iron overload?
Deferoxamine
What supplements affect Warfarin?
Gingko Balboa increase risk of hemorrhage.St. John’s Wort increase metabolism of Warfarin and hence cause under-anticoagulation.
Drugs that precipitate seizures in patients on hemodialysis when not dose-adjusted are.
Beta-lactam antibiotics, metoclopramide, toxic levels of theophylline, lithium, acyclovir, carbamazepine and meperidine.
Screening recommendations for patients with a history of colorectal cancer consist of follow-up colonoscopy at ___ year and ___ years after curative surgical resection; if results of these colonoscopies are normal, the surveillance interval can be extended to ___ years.
1 yr, 3 yr and then every 5 yrs
- Patients with large (≥10 mm) or dysplastic sessile serrated polyps or traditional serrated adenomas should undergo colonoscopy in ____ years.2. The recommended postpolypectomy interval for patients with sessile serrated polyps smaller than 10 mm is ____ years.
- 3 yrs2. Five yrs
Hydrophilic statins are less likely than lipophilic statins to cause statin-induced myopathy and can be used at low doses in patients with previous statin-related myalgia, myopathy, or mild rhabdomyolysis. Lisit both types.
Hydrophilic: Rosuvastatin (especially) but also pravastatin and fluvastatin.Lipophilic: Atorvastatin, simvastatin, and lovastatin.
- Patients with bite wounds should be vaccinated with Tetanus toxoid should be given to patients if they have not received a tetanus immunization within the past 5 years for “dirty wounds”. How do you define such wounds? For a clean and minor wound, a booster dose of tetanus toxoid would be given to prevent tetanus if more than ____ years have elapsed since immunization.2. ___ and ____ are given to pateints who have had <3 doses of Td during their lifetime or whose status is uncertain AND they have a dirty wound.
- Dirty wounds are those contaminated with soil, saliva, dirt, or feces; avulsions; puncture wounds; and wounds resulting from burns, frostbite, crushing, or missiles….10 yrs2. Tetanus Immunoglobulin + Td
The use of ______ is considered first-line treatment for lichen sclerosus: Patients with lichen sclerosus have inflammation in the skin, which leads to thinning, hypopigmentation, and scarring or sclerosus.Areas of long-standing lichen sclerosus are at risk of developing _____
high-potency topical glucocorticoids….squamous cell carcinoma
Women aged ____ and older and younger women who have a fracture risk of ______ higher should be screened for osteoporosis.
65 years ……9.3%
The USPSTF published a new statement recommending statin therapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults aged _____ with a 10-year ASCVD event risk of ______ or higher and one or more ASCVD risk factors (dyslipidemia, diabetes, hypertension, or smoking
40 to 75 years…..10%
According to the USPSTF, acceptable screening strategies include high-sensitivity ____ every year, ____ every 5 years, ____ every 5 years, combined flexible sigmoidoscopy every ____ with high-sensitivity fecal occult blood testing every year, or ____ every 10 years
Fecal occult blood testing (gFOBT or FIT)Flexible sigmoidoscopy CT colonography 10 yearsColonoscopy
- What is the treatment for severe menopausal vasomotor symptoms (e.g. night sweats, mood lability, vaginal dryness, dyspareunia, etc)in women?2.Treatment of severe menopausal vasomotor symptoms in a woman whose uterus has been removedis with what? Why?
- Tx is Hormone replacement therapy: Estradiol-progestin combination pill. The absolute risks for use of hormone therapy in healthy women younger than 60 years are low, as are the risks of adverse cardiovascular events if time since menopause is less than 10 years.2. Estrogen therapy alone w/o concurrent progesterone: these womendo not require the use of a progestin to oppose the proliferative effects of estrogen on the endometrium,
Pruritic, purple, polygonal papules are what? In what disease do you find these?
Lichen PlanusLP occurs with increased frequency in patients with liver disease, particularly hepatitis C, although the reasons for this remain unclear
The risk of ovarian cancer may be especially increased in women with what autoimmune disease, esp in the 1st 2 years after diagnosis. So what should you do in these patients?
Dermatomyositis….transvaginal US
The joints most commonly involved in osteoarthritis are weight-bearing joints. Affected non–weight-bearing joints in the hand typically include the ___, ___ & ___._____ &/or ____ nodes, or ossified growths at the medial and dorsolateral aspects of the DIP or PIP joints, respectively, may be present.
First carpometacarpal, distal interphalangeal (DIP), and proximal interphalangeal (PIP) joints.Heberden and/or Bouchard
Patient has Alzehimer’s disease with MMSE score of 22/30…you start a cholinesterase inhibitor (fyi donepezil is specifically approved for severe disease)….12 weeks later, pt. has serious GI SE’s: MMSE now is 20/30. What is the next step?
D/c the cholinesterase inhibitor…once GI sxs resolve, start with donepezil +/- memantine (NMDA-receptor antagonist
Patient has pain with eye movement, central scotoma, and an afferent pupillary defect. What is the dx? What is the next step?
Optic Neuritis….do MRI brain to check for MS lesions
Neurosyphilis classic pupillary abnormality is Argyll-Robertson pupil, in which pupils are ____.
Unreactive to light but constrict to accommodation
- ____ is recommended for those with elevated BP or stage 1 hypertension and a 10-year cardiovascular risk of 10%2. Nonpharmacologic and ____ is recommended for those with BP ≥130/80 mm Hg and clinical cardiovascular disease or a 10-year cardiovascular risk ≥10% to a BP goal of 130/80 mm Hg.3. ____ is recommended for those with no cardiovascular disease and a 10-year cardiovascular risk of 10% for BP of ≥140/90 mm Hg.4. Adults with stage 2 hypertension and an average BP of ____ above their BP target should be treated with ____.5. BP target of 130/80 is for what conditions?
- Nonpharmacologic therapy2. Drug treatment3. Nonpharmacologic and drug treatment 4. 20/10 mm Hg…a combination of two first-line antihypertensive drugs of different classes.5. Stable ischemic heart disease w/ HTN….HTN w/ HFrEF….HTN w/ PAD….CVA (after hospital d/c: Ischemic & hemorrhagic)….HTN & DM….HTN & CKD.
Guidelines recommend consideration of treatment with a bisphosphonate for low bone mass (osteopenia) only if there is 10-year fracture risk determined by the FRAX calculator of greater than or equal to ____ for a major osteoporotic fracture or greater than or equal to ____ for hip fracture.
20%…. 3%
Patients present with intense pain, photophobia, ciliary injection (redness at the junction between the cornea and sclera), an irregularly shaped pupil, and miosis: what is the diagnosis?
Iritis (or iridiocyclitis)
In patients with lung disease and sea-level oxygen saturation between 92% and 95%,____ testing can be used to determine the need for oxygen supplementation during air travel. If it’s <92% they will need ____ during their flight.If this test is not available, what test can you do? In this test, oxygen saturation < ___% means, the patient will need oxygen while flying and If greater than this number, refer them to the above test.
Hypoxia altitude simulation…..oxygen6 minute walk test: if <84%, then patient will need oxygen.
Women with____ typically have elevated resting luteinizing hormone (LH) levels, which may be mistaken on home urinary LH kits for ovulation (consistent false positive pregnancy tests)
Polycystic ovary syndrome
Preeclampsia is classically defined as new-onset hypertension after 20 weeks of pregnancy with ____ but can also be diagnosed in patients without this and if the hypertension is accompanied by ____.
Proteinuria….other end-organ damage (e.g. thrombocytopenia, crackles, etc)
Insomnia is divided into 3 types: sleep-onset, sleep-maintenance and early morning awakenings.If its due to a stressor, we can give short term-oral therapy: ___, zaleplon and ramelteon have a short duration of action and so are prescribed for _____ type of insomnia.For maintenance insomnia, give ____, as it has a longer half-life and a longer duration of action.
Zolpidem…sleep-onset insomniaTemazepam
For scabies, you can treat with topical ____ or ____. Third line is ____ but this can cause ____ and so should be avoided in infants and ____.
Permethrin 5%….oral ivermectin….lindane…pregnant women
Calcium channel blocker overdose is treated with ___
IV calcium gluconate
- Screening for lung cancer with annual low-dose chest CT is recommended for high-risk patients, defined as adults aged ____ years with a smoking history of ____or more, including former smokers who have quit in the last 15 years (meaning you must have quit within this time frame: if >15 yrs, and 30pack yrs, then no screening if asxs)2. The USPSTF recommends one-time screening for AAA with abdominal ultrasonography in all men aged ____ who have smoked at least ____cigarettes in their lifetime
- 55 to 80….30-pack-years2.65 to 75 years….100
____ are the mainstay of pharmacologic treatment for panic disorder
Selective serotonin reuptake inhibitors
- Treatment of high-altitude pulmonary edema (HAPE) is with supplemental oxygen, rest, and consideration of descent from altitude; vasodilators such as ____ can be used as adjunctive treatment.The mechanism of HAPE is believed to be a noncardiogenic exaggerated hypoxic vasoconstriction of the pulmonary vasculature2. ____ is the preferred drug for preventing acute mountain sickness and high-altitude cerebral edema, but it is not useful in preventing HAPE.3. ____ is the preferred drug (in addition to supplemental oxygen) for the treatment of severe acute mountain sickness and high-altitude cerebral edema.
- Nifedipine….or PED5 inhibitors (ie sildenafil)2.Acetazolamide3.Dexamethasone
___ may be a cause of acute kidney injury by triggering acute oxalate nephropathy, particularly in patients with volume depletion or chronic kidney disease.
Orlistat
Older patients, > ___with osteoarthritis who require NSAID therapy to control pain should be considered for____ therapy to manage gastrointestinal toxicity
75….topical NSAID
____painful inflammation of the fibrous layers of the eye underlying the episclera and conjunctiva, is often associated with systemic diseases including inflammatory connective tissue disorders and infections.Patients may present with severe, continuous, boring ocular pain that radiates to the surrounding facial areas, redness, photophobia, and tearing. Most commonly affects both eyes and is worst at ____ and has ____*Emergent referral to opthalmologist
Scleritis….night…photobia
___ classically presents with burning heel pain and stiffness that worsen with activity and improve with rest.On examination, there is frequently tenderness to palpation approximately 2 to 6 cm proximal to the Achilles tendon insertion on the calcaneus.
Achilles tendinopathy…
1.The ___l is a quality improvement method that focuses on eliminating non–value-added activities, or waste, within a system: ie improve waiting times2. This modeltends to focus more on quality control in each step of a process rather than on optimizing the overall efficiency of a system (used within the 6 sigma model)3. ___ tend to focus on specific points in a system and are not typically used for studying overall system function and efficiency4. ___ is a quality improvement model that is designed to reduce variation and drive a process toward near perfection; ie reduce infections in the ICU
1.Lean mode2.The Define, Measure, Analyze, Improve, Control (DMAIC)3.PDSA cycles4.Six Sigma
To give large volumes of crystalloid fluids what do you utilize?
Large-caliber short-length peripheral IVs (NOT triple lumen cathethers or PICC)Recall, flow of fluid through a catheter is inversely proportional to catheter length and proportional to the radius of the catheter to the fourth power.
___ in the form of either a patch or the less expensive cream has been shown in randomized controlled trials to be very effective in treating postherpetic neuralgia and diabetic peripheral neuropathy.Similarly, ___ is an effective topical therapy for neuropathic pain.
Topical lidocaineTopical capsaicin
- What are the long-term vitamin and mineral deficiencies seen post bariatric surgery?2. 40 yo femael s/p bariatric surgery 5 yrs ago p/w c/o fatigue and painless paraesthesias: PE = spasticity and hyperreflexia. Hgb 10, Plt 1000, WBC 2.4: BM biopsy = hypercellular marrow w/ some blasts and ring siderobalsts.MCV 75: dx?MCV 102 w/o the spasticity and hyperreflexia Dx?
- Vitamin B12, Vitamin D, Copper, and Iron2. Copper deficiency…..B12 deficiency
- Red eye w/ pain and photobia, (+) blurry vision2. (+) red eye w/ constricted irregular pupil, (+) ciliary flush.3. Red eye, slit-lamp shows WBC in aqueous humor on corneal epithelium4. Blurry vision, floaters and genital ulcers
- Anterior Uveitis (AU)2. AU3. AU4. Posterior-uveitis: pt. w/ Bechet’s syndrome
- Pt. w/ A. fib has painless loss of vision. Dx? What will optho exam show?2. Pt. w/ HTN or P. vera or waldenstrom macroglobulinemia p/w sudden painless loss of vision of one eye. Dx? What will optho exam show?3. Eldery pt. p/w blurry vision in the center, but peripheral vision is spared. Dx? What will optho exam show?
- Retinal artery occlusion: cherry red spot in macula.2. Retinal vein occlusion: multiple hemorrhages3. Macular degeneration: yellow spots (drusen)
- Young woman who has blurring of vision, especially after exercise and regains it gradually. What should you r/o?2. Optin nerve infarction is seen in ____. Tx is ___
- R/o MS: Do MRI head2. Temporal arteritis: high-dose steroids
Pt w/ long-standing DM presents w/ c/o of blurry vision1. Fundoscopy shows aneurysms w/ hemorrhages and exudates. Dx and Tx?2. Fundoscopy shows neovascularization. Dx and Tx?
- Non-proliferative diabetic retinopathy w/ macular edema: tx w/ tight glc control2. Proliferative DM retinopathy: Tx w/ laser of periphery and tight glc control
- Pt w/ right eye and facial pain w/ n/v/headache and blurry vision; PE mid-dilated pupil that’s sluggishly reactive: (+) ciliary flush. Hazy cornea. Dx?2. Decreased vision in left eye + paraesthesias3. Elderly man w/ progressive loss of central vision; edges of objects are blurry4. Elderly w/ difficulty driving at night time due to glare from oncoming veichles and has difficulty reading door signs of fine print: Dx?
- Glaucoma2. Optic neuritis3. Macular degeneration4. Cataracts
- Anterior uveitis has ___ color in eye, pain, photophobia, ___ pupil and ___ blurry vision
- Anterior uveitis has redness in the eye…mid-constrictive pupil +/- blurry vision. Posterior uveitis is normal except that it pt has blurry vision!
- Pt. w/ red eye has a corneal ulcer and pain: dx? tx?2. Pt. whose intubated develops red eye and whtie cornea: Dx?3. Pt. who wears contact lenses; must r/o what?4. AIDS pt w/ blurry vision; fundoscopy shows white cheese, ketchup apperaance. Dx? Tx?
- HSV-1 keratitis: tx w/ topical trifluridine or ganciclovir2. Psuedomonas keratitis3. Pseudomonas keratitis4. CMV retinitis: Ganciclovir or fosfovir (NOT acyclovir: won’t work)
- 45 yo female p/w c/o of severe right eye pain and temporal headache; exam shows conjunctival injection of right eye, 20/200 visionand a mid-dilated, fixed, non-reactive pupil. Dx? Next step?
- Closed-angle glaucoma: start Pilocarpine drops right away and refer to optho
- ___ is a pustule on eye lid margin; tx is ___2. ___ is a small nodule under tarsus (ie eyelid). Tx is ___
- Stye: warm compresses2. Chalazion: obstruction of meibomian glands. Tx: Warm compresses
- For surgical clearance, most cases on exam will be “clear for surgery”, except those who have ____; do further evaluation with ____2. Pt. on anti-TNF medication goes for majory surgery: when do you stop and when do you resume? Why?3. Pt. post CABG is confused and inattentive; what do you give? What medication is known to cause this?
- Peripheral vascular disease; likely have CAD; d/ dipyridamole thallium stress test or dobutamine stress test2. Stop before surgery and resume 2-4 weeks after; otherwise can get wound dehiscence3. Key here is attentive; pt is delerious, likely due to, most commonly, meperidine. Give haldol
A chronic alcoholic presents to the ER with1. Confusion, ataxia, nystagmus and diplopia. Dx? Tx?2. Anterograde and partial retrograde amnesia and has confabulatory speech. Dx?3. Pt. in ICU on TPN has nystagmus: what should you think?
- Wernicke’s encephalopathy: Tx w/ thiamine2. Korsakoff psychosis3. R/o Thiamine deficiency: TPN is deficient in it
Vitamins1. White-grey spots on the conjunctiva.2. Pt. p/w nausea, vomiting, severe constipation and dry mucous membranes: Ca is 11.3, and Phos is 5.2: Dx?3. Pt. presents w/ n/v, headache, dizziness and dry skin; has transaminitis and Ca is 10.7. Dx?4. Diarrhea, dementia, dermatitis, death5. Diarrhea w/ linear vertical whie lines on nails is due to what poisoning?6. Prolonged ICU on TPN has alopecia, heperkeratotic rash, anemia and loss of taste. Dx?
- Vitamin A deficiency2. Vitamin A toxicity3. Vitamin D toxicity4. Niacin B35. Arsenic poisoning6. Zinc deficiency
Best drug to tx alcohol addiction is what?Best screening test for dependce is called ___Best test to establish chronic alcholoism is ____
NaltrexoneBest screening test for dependce is called Screening, brief intervention and referral for treatment (SBRIT): 6 or more is severeBest test to establish chronic alcholoism is: increased carbohydrate free transferrin
Pt whose post-surgery and only on IV fluids now POD#3 has prolnoted PT and INR. Dx? Why?..7 days later ahs PTT 65, PT 2.8. Dx?
- Factor VII Def due to biliary stasis?2. Vitamin K def
- Pts. w/ Mitral Valve prolapse have increased incidence of what psychabnormality?2. Tx of OCD is what?3. Tx for PTSD?4. Young woman has multiple complaints w/ >8 organ systems involved w/ several negative evaluations. Dx and Tx?
- Panic disorders; best tx is Paroxetine (think Premenstrual d/o and premature ejaculation also)2. SSRI: fluoxetine or TCA cloimpramine + CBT3. CBT first…then SSRI4. Somatic sxs d/o: tx w/ regularly scheduled visits
- Pt. has multiple physical complaints that are non-sensical; doctor shops and needs q month appts. Dx?2. Pt. has weakness of one side of body but normal MRI and is unaware3. Pt. produces signs & sxs deliberately4. Same sxs as #3 but w/ secondary gain
- Somatic sxs d/o (Somatization)2. Conversion d/o3. Munchausen syndrome (if is a pathological liar about others; its MS by proxy);4. Malingering
Depression sxs after the death of a loved one that last <2 months is considered ____
Bereavement
Treatments of choice1. Eneuresis2. Panic d/o3. OCD4. Chronic pain +/- depression5. Smoking cessation6. Insomnia
- Imipramine (TCA)2. Alprazolam (short-term): SSR (long-term)3. Fluoxetine…clomipramine…fluvoxamine…CBT4. Amitryptyline5. Bupropion6. Amitryptyline
Tx for bulimia is ___ where as these must be avoided in anorexia
SSRIs
- Pt. has hyperthermia w/ mental status changes, tremors, tachycardia, BP, and hyperreflexia: dx? cause? tx?2. Pt. has above sxs w/ lead pipe rigidity and hyporeflexia. Increased CPK. Dx? Cause? Tx?3. Hyperthermia w/ sustained muscle contraction, HTN, hyporeflexia, increased CPK. Dx? Tx? Cause?
- Serotonin syndrome: due to SSRI + MAOI or SSRI + linezolid or SSRI + tramadol: d/c meds. Start benzo’s + cyproheptadine2. Neurleptic malignant syndrome: tx w/ dantrolene or bromocriptine. Due to antipsychotics/antidopamanergics3. Malignant hyperthermia: start rapid cooling then dantrolene. Due to inhalation anesthetics (esp if fam hx of fever or death on table during anesthesia)
Organophsophate poisoning (“Petite farmer on heroin = constricted pupils): what blood test do you do? Tx?
RBC acetylcholinesterase level…Tx w/ remove clothing, activated chorcoal, IV atropine and IV pralidoxime
Substance abuseFever, hypertension, tachycardia, mydriasis and hyperreflexia is seen in all of them1. Serotonergic and SIADH (causing hypoNa), and seizure. Drug?2. Aigtated, psychotic, violent, with hallucinations and delusions. Drug?3. Agitated, psychotic but alert with oral mucosa burns, poor dentition and skin pricking. Drug?
- MDMA: ecstasy2. Bath salts3. Methamphetamine
Timed up and go test has patient walk 10 ft turn around and return to sit in same chair. Longer than ____ seconds means pt is at high risk of falls
> 14 seconds
If an elderly pt has a non-displaced femoral fx then do surgery and ____ as opposed to a sustained displaced femoral neck fx, then do ____ and for intertrochanteric fx do ____
Three parallel pins….total hip arthroplasty (femur + ball + socket replacement)…hip compression screws
- Tx for this incontinence is Wt. loss first, then bladder training, pelvic muscle exercises (Kegels) and lastly oxybutynin or tolterodine2. Tx for this incontinence is Wt. loss first, then kegels (pelvic muscle exercises)3. Post void residual is >100ml, and tx for this is praxosin or finasteride4. Post void residual is >100ml, and tx for this is cholinergics (bethanechol)5. Pt. has urge to urinate very often and often leak urine on her dress and sometimes has small amount of urine loss with coughing or sneezing6. Pt. has incontinence secondary to patients’ inability to reach the bathroom due to a physical disability and atonic bladder from a stroke. What incontinence is this?
- Urge incontinence2. Stress incontinence3. Urethral obstruction4. Detrusor underactivity (overflow incontinence)5. Mixed incontinence6. Functional incontinence
Pt. has symptomatic BPH (causing incontinence: urgency, polyuria), but BP is 90/65mmHg. PSA is normal. Best tx?2. Above person w/ BP 140/85mmHg. Tx?3. Pt. w/ BPH + hematuria. Tx?
- Tamsulosin (Flomax): lowest effect on BP2. Terazosin3. Finasteride
TCA’s and anticholinergics (such as diphenhydramine) can cause what type of incontinence?
Overflow incontinence
- Pt. has non-blanchabel redness on the sacrum: Dx and Tx?2. Pt. has lossof skin and full thicknesstissue, subcutaneous fat is visible, not bone. Dx and Tx3. Pt. has a shallow ulcer that is red pink with a wound bed. Dx and Tx?4. Full thickness loss of tissue; can see bone, tendon or muscle. Dx and Tx?
- Stage 1 ulcer: Static foam or gel mattress2. Stage 3 Ulcer: debride + Abx prn3. Stage 2 ulcer:tx w/ occlusive or semipermeable dressings that will maintain a moist wound environment4. Stage 4 ulcer: Debridement + abx prn
- Drugs to avoid during pregnancy are ___ anti-epeleptic, ___ anti-BP medication, ___, ___ and ___ antibiotics, ___ immunosuppressant, most antihistamines (except hydroxyzine and chlorpheniramine), radio iodide I-131, methimazole (1st trimester only), and nitroprusside.2. Drugs safe in pregnanyc are Mg sulfate, ___ and ___ anti-epileptics, ___ (4) BP meds, __, ___, ___, and ___antibiotics, ___ antiarrythmic, CCB, clonidine, PTU, hydroxyzine and chlorpheniramine, ___ (3 anti-coagulants)
- Valproic acid, ACE inhibitors, ciprofloxacin, doxycycline/tetracyclines and most aminoglycosides, mycophenolate mofetil2. Carbamazepine and levitracetam…labetalol, furosimide, alpha methyl dopa and hydralazine, nitrofurantoin, amoxicillin/ampicillin, gentamycin and flagyl…procainamide…heparin, LMWH and warfarin =5mg (anytime).
Pregnant mother gets exposed to1. Hepatitis A2. Hepatitis B3. Measles4. VaricellaWhat do you give for each of the above and when?
- Immune globulin2. Hepatitis B immune globulin3. Immuneglobulin within 1 week4. Varicella immune globulin within 10 days
- Can you treat Latent or active TB during pregnancy?2. What vaccines to avoid during pregnancy?3. MMR, varicella and zoster (not the recombinant one) are contraindicated in HIV with CD4 count
- Yes2. MMR, Varicella, oral polio and yellow fever3. 200cells/uL
- Pt. who has anaphylactic reaction to eggs should be given what flu vaccine?2. Can you give the singles vaccine and pneumococcal vaccine at the same visit?3. Can you give digoxin or verapamil to a pregnancy woman?
- Flublok2. Yes; give in different arms3. Yes
- Pt. w/ Mitral stenosis w/ A. fib should be tx w/ ___, ___ and ___ medications2. MS valvular area of ___ requires no tx, ___ requires beta blocker therapy and ___ requires valvuloplasty
- Beta blocker, digoxin and anticoagulation2. >1.5sqcm…1-1.5sqcm…<1sqcm
- Pregnancy woman with ASD wants to get pregnant, what do you do ifShunt is < 2:1….. or >2:12. Can pt. w/ MV prolapse or HOCM get pregnant?
- <2:1: Can get pregnant….>2:1: surgery first2. Yes
- Pregnant pt. w/ S3 and II/VI systolic murmur at apex; W.t.d?2. Causes of DIC in pregnancy are pre-eclampsia, acute fatty liver of pregnancy, ____ embolism, ___ and ____.3. Pt. c/o itching during pregnancy, w.t.d?4. What two medication requirements increase during pregnancy?
- Functiona heart sound and murmur due to normal volume overload of pregnancy - do nothing2. Amniotic fluid embolism, dead fetus and abruptio placentae3. Can give hydroxyzine and chlorpheniramine4. Insulin (by 50%) and thyroxine
- What trimester is the best time to fly during pregnancy?2. Women with pulmonary HTN should avoid ____ only OCPs
- 2nd2. Progesterone
- When is hyperemesis gravidarum seen during pregnancy? Does it have AST/ALT elevation? Does it have itching?2. When is intrahepatic cholestasis seen during pregnancy; does it have increased AST/ALT? Does it have vomiting? What is the tx?3. Does pruritis gravidarum (called mild intrahepatic cholestasis of pregnancy)have vomiting or AST/ALT elevation? What about itching? What trimester is it seen?
- 1st trimester; Yes >2xULN. No itching2. 2nd or 3rd trimester: Yes but <200ULN: no vomiting; Tx/ w/ cholestyramine, ursodeoxycholate or early delivery if fetal distress (+)3. No AST/ALT elevation or vomiting: (+) itching. 2nd or 3rd trimester
- 40 yo female has dysfunctional uterine bleeding (abnormal uterine bleeding w/o a specific cause): what do you give?2. What do you give for post-coital contraception3. Pt. on OCPs missed 3 days of pills and had no sexual activity during that period: w.t.d?
- Mydroxyprogesterone acetate for 10-12 days2. Start Levonorgesterl within 72 hrs: this inhibits ovulation, but if already ovulated, blocks implantation.3. Take only the most recently missed pills and use another method of contraception for 1 week
- OCPs are contraindicated in patients w/ CAD, HTN, ___ headaches, breast cancer, chornic hepatitis, hx of DVT, and smokers >___ yo.2. What abx cause OCP failure? What anti-seizure meds cause OCP failure? What supplements? What immunocuppressants?
- Migraines w/ aura…>35 yo (use progesterone only)2. Rifampin….Topiramate, primidone (metabolized to phenobarb), hbarbiturates, carbamazepine and phenytoin….St. john’s wort…tocilizumab
Woman on fertility tx presents w/ SOB, and abdominal distension: US show sascites and enlarged ovaries w/ increased number of ovarian follicles. Dx?
Hyperstimulation syndrome (affects women taking injectable hormone medications to stimulate the development of eggs in the ovaries….happes due to too much hormone medication in the system)
- Covers hospitals, skilled nursin ghomes, home-health, and hospice services2. Covers some cost of prescription medications3. Covers healthcare personnell, and labs tests and durable medical equipment4. Covers benefits from part A, B, and D through medicare advantage plans (managed care plans)5. Supplemental insurance plans to help cover deductibles and co-insurance costs of Medicare Parts A and B, as well as preventive and other health-related services
- Medicare Part A2. Medicared Part D3. Medicare Part B4. Medicare Part C5. Medigap
- Pt w/ breast cancer makes an advanced directive and desires DNR; son moves in w/ her recently. She deteriorates and ends up in ER. Son says she told him that she doesn’t want to be DNR and wants you to intubate the mother. W.t.d?2. Pt. w/ hemiplegia after a stroke makes her son durable power of attorney; she wants colonoscopy. Son says, no wait for me and I will decide. W.t.d?3. Whom can overright an advanced directive if patient becomes incapacitated?4. Who takes presedence: living will or durable power of attorney for healthcare?
- Refer to ethics committee2. Tell the son, you will take consent from the mother and proceed accordingly3. Assigned surrogate or healthcare proxy (also known as durable power of attorney for healthcare)4. Durable power of attorney/healthcareproxy/surrogate
- Pt. w/ attempted suicide brought to the ER refuses treatment. Threatens to sue. W.t.d?2. Pt. w/ meningococcal meningitis and wants to leave AMA. What do you do?3. Pt. w/ AWMI, whose mentally competent, refuses admission even after you explain consequence. W.t.d?
- Treat: pt is in a pathological mental state2. Hold against will for public welfare3. Give nitrates, beta-blockers, ASA, ace inhibitor and arrange for home visiting RN
- Pt. w/ COPD from smoking comes for a visit; you advise quitting; he says, he wants to, but doesn’t have a quit date. W.t.d?2. Leading cause of mortality for age group 10-24 is what?3. Leading cause of preventable premature deaths in the US are due to waht?
Begin varenicline, a partial neuronal alpha-4, beta-2 nicotinic receptor agonist (know this)2. MVA>homicide>suicide3. Cigarette smoking
- Marathon runner collapses; on PE she’s ataxic (key), hypotensive, tachycardic, flushed with dry skin; Temp is 105F. Dx?Key differences btw heath exhaustion and stroke are what?
Heat stroke (NOT heat exhaustion): key is ataxia = mental status changeHeat exhaustion is opposite: pt is sweating, cool to touch, has a rapid weak pulse (strong pulse in heat stroke) - no altered mental status (no passing out, etc)
- No DM, 10yr ASCVD risk >/=10.5%: best stain therapy? (<75yo)2. DM + LDL 80-189; best statin therapy? (40-75yo)…LDL >190? Tx?3. LDL >190: best statin therapy? (>19yo)4. ASCVD: CAD, PAD, TIA or stroke: >75yo: Tx? <75yo: Tx?
- High intensity statin2. Moderate intensity statin….high intensity statin if >1903. High intensity statin4. >75yo: Moderate intensity…<75yo: High intensity
- A. High intensity statins are rosuvastatin and atorvastatin at ___ doses2. B. Moderate intensity statins are rosuvastatin and atorvastatin at ___ doses, and simvastatin and pravastatin at ___ doses3. 62 yo DM male and HTN has Chol 268 and LDL 190, HDL 142. Tx?4. 68 yo w/ DM and ESKD on HD has legpains on atorvastatin 40mg; next step?5. 76 yo w/ DM and CVA: Tx?6. CHF pt. on atorvastatin w/ muscle aches; normal CPK. Next step?7. 50 yo w/ DM and LDL 130. Tx?
- Rosuvastatin: 20-40mg…Atorvastatin: 40-80mg2. Rosuvastatin: 5-10mg…10-20mg…simvastatin: 20-40mg, prvastatin 40-80mg3. A (B/c LDL is >189: If less then choose B)4. D/c; no decrease in mortality in pts w/ DM or CHF5. B: age is 76yo!6. D/c7. B
The most common heritable hyperlipidemia is familial combined HLD. What is the best test for it?
Apoprotein B
- Decreased LDL receptors + tendon xanthomas2. Decreased LPL and familial CII…same + chylomicrons - eruptive xanthomas – all these can cause ____3. Abnormal ApoE + palmar xanthomas
- Type IIa LDL2. VLDL type I, IV….and V - also all cause pancreatitis.3. Type III IDL: palmar xanthomas***Type I, IV and V are the same; all have eruptive xanthomas
- Best tx for HLD in pregnancy?2. Pt. on statin c/o of myalgias; CPK 1900. You d/c; repeat in 3 mo, CPK 1925; muscle biopsy shows necrotizing muscle fibers w/ NO inflammation and NO vacuoles. Dx?3. When do you d/c a statin? vs. decrease its dose?
- Colesevelam: safe, but not most potent2. Statin induced myopathy 2/2 200/100: anti-3 hydroxy-methylglutaryl coenzyme A reductase HMGCR)3. D/c if LFT’s >5x ULN….Decrease dose if LFT’s are >3-5x ULN; otherwise, continue dose and monitor
For patients taking low doses of prednisone ____, stress dosing of glucocorticoids typically is not required, even before high-risk surgical procedures (such as intrathoracic surgery).
<10 mg/d
True or FalseScreening for cervical cancer can be stopped in women age 65 years and older who have had three consecutive negative Pap smears or two consecutive negative Pap smears plus human papillomavirus test results within the last 10 years, with the most recent test performed within 5 years.
True
Side effects of Isotretinoin?
In addition to teratogenicity, serious side effects include pseudotumor cerebri (especially if used with tetracyclines), depression and psychosis, pancreatitis, marked hypertriglyceridemia, hearing loss, night vision loss, and skeletal abnormalities.
Beefy red tongue is seen in what deficiencies?
• Beefy red tongue (glossitis) is seen in pernicious anemia and various B vitamin deficiencies. It can also be associated with glucagonomas.
Macroglossia is seen in what diseases?
Macroglossia (big tongue) is associated with multiple myeloma, primary amyloidosis, lymphoma, hemangioma, acromegaly, hypothyroidism, angioedema, and Down syndrome.
Geographic tongue, thought benign, is associated with what autoimmune disease?
Psoriasis
Oral hairy leukoplakia seen in patients with HIV / AIDS is usually benign itself, what virus causes it?
EBV
Bald tongue is atrophy of the lingual papillae associated with what diseases?
Pellagra, iron deficiency anemia, pernicious anemia
Treatment for Rosacea
Topical Flagyl, azelaic acid, or sulfur/sulfacetamide preparations, or if severe, oral tetracycline
Treatment for contact dermatitis
Topical corticosteroids, burrow’s solution; if severe, give po steroids
Treatment for intertrigo
Topical antifungals (ketoconazole, miconazole, etc), and drying agents (antifungal powders, aluminum sulfate powders, or corn starch).
Treatment for Seborrheic Dermatitis
Topical antifungals such as ketoconzazole +/- Low-potency topical corticosteroids; can use tacrolimus or sulfur/sulfacetamide cleansers/lotionsGo to tx is topical antifungal
Antibiotic to use for refractory moderate-to-severe acne?
Bactrim
Treatment for Hidradenitis Suppurativa
1% topical clindamycin and intralesional steroidsIf refractory, consider Adalimumab (TNF alpha inhibitor)
Hyperpigmented Gingiva is seen in what autoimmune disease?
Addison’s Disease
Oral Hairy leukoplakia, seen in HIV/AID patients as white plaques on side of tongue are caused by what Virus?
EBV
Strawberry tongue is associated with what diseases?
Scarlet Fever, Kawasaki Disease, and Toxic Shock Syndrome
What drugs are known to cause photosensitivity?___, ___ and ____ antibiotics, ____ anti-arrythmic, ____ cholesterol medication, ____ diuretic, and ____ heart medication
Tetracyclines, floroquinolones, sulfunoamides, amoidarone, statins, furosimide, and diltiazem.
This drug causes hypersensitivity syndrome (rash, lymphadenopathy, and hepatitis): also causes something with the gums?
Phenytoin: gum hyperplasia.
What drugs are known to cause Drug reaction w/ eosinophilia syndrome (DRESS)?
Allopurinol andanticonvulsants
All types of psoriasis can be worsened by what?
Beta Blockers, infections (virus and strep pharyngitis), sunburn, and lithium
What is a known trigger of Guttate psoriasis?
Streptococcal pharyngitis
Sudden withdrawal of what medication is known to cause pustular psoriasis?
Corticosteroids
Diffuse systemic sclerosis affects face, trunk, upper arms and thighs and is associated with what type of antibodies? What diseases do these people develop?
Anti-topoisomerase I antibody (Scl-70) or anti-polymerase RNA III antibodies. Develop scleroderma renal crisis and interstitial lung disease
Lofgren syndrome
Acute sarcoidosis that presents with EN, bilateral hilar adenopathy, fever, arthritis and uveitis; it is self-limiting
What is Lupus Perino? What is the treatment?
A type of sarcoidosis that has skin changes ranging from violaceous (purple) lesions on the tip of the nose and earlobes to large purple nodules/tumors on the face and fingers. It has a slow onset and almost never resolves! It is associated with chronic disease and extrapulmonary involvement.Treatment for cutaneous sarcoidosis: topical steroids, intralesional steroid injections, antimalarials and MTX.Tx of pulmonary sarcoidosis: Corticosteroids
Erythema nodosum is most commonly seen in what diseases? What is the MCC of EN in the world?
Sarcoidosis, inflammatory bowel diseases, drugs (sulfa and penicillins), infections (TB, strep anddeep fungal).MCC of EN in the world is: streptococcal infection
If you only see cutaneous dermatomyositis, what is it called?How is it treated?
Amyopathic dermatomyositis.Treatment: Hydroxychloroquine
Pyoderma gangrenosum is most commonly see in inflammatory bowel disease. What other diseases can you see this in?
RA, MM
Sweet syndrome aka acute febrile neutrophilic dermatosis: idiopathic or associated with underlying disease (e.g. AML). What is the treatment?
Corticosteroids, potassium iodide, dapsone or colchicine - all 1st line
Porphyria cutanea tarda is seen in patients with what? It is a hereditary or acquired blistering disease caused by excess circulating porphyrins. Up to 50% of patients with sporadic PCT have ____ infection. Clinically, patients present with vesicles and bullae on sun-exposed skin, most commonly on the face, dorsal hands, and scalp. Skin fragility (tearing with minimal trauma) is common. Other features include hyperpigmentation, milia (tiny inclusion cysts), hypertrichosis, and alopecia.
HIV, HCV and hereditary hemochromatosisHepatitis C
HSV resistant to acyclovir should be given what?
Foscarnet
For most fungal infections (candida), what should your prescribe: topical or oral treatment?
Topical treatment will treat almost all infections (clotrimazole, miconazole, andterbinafine (lamisil).
Tinea unguium (onychomycosis) can be treated with either topical or oral antifungal agents. How long is topical treatment?
48 weeks w/ eg: ciclopirox 8%
Can you treat tinea capitis w/ topical antifungals?
No: must always be treated with oral antifungals: griseofulvin, terbinafine, fluconazole, or itraconazole
KOH prep reveals spaghetti meatball appearance. What is it?What disease does it cause?
Malasezzia furfur or globosa.It causes tinea versicolor (hypo/hyperpigmented lesions depending on patient’s skin tone/color)
What is the treatment for head lice?
Spinosad (overexcites CNS of head lice), Malathoin (pesticide), topical ivermectin (strongest drug; one application)Benzyl alcohol lotion (has no neurotoxic pesticides; safe in children >6 months and; needs 2nd treatment 7 days later)OTC premetherin cream + lotion (<50% effective 2/2 to resistance)1% lindane shampoo (2nd line due to neurotoxicity)
Treatment for Scabies?____ topical cream, ___ oral medication___ and ___ are safe in pregnancy and young children
Treat with 5% permethrin applied to all areas of the body from the head down and washed off after 8–14 hours. A second dose in 7 days is recommended.Use oral ivermectin for severe or recalcitrant cases with a repeat dose in 2 weeks.Lindane has CNS toxicity, so do not use during pregnancy, in infants, or in young children.Permethrin (category B) can be used in pregnancy.Precipitated sulfur is also considered safe in pregnancy, but may be less effective.Wash all linens in hot water.
Glucagnomas (alpha-cell tumors) cause what?
secrete excessive amounts of glucagon and can cause a beefy red tongue (think GLucagonoma = GLossitis), angular cheilitis, and a necrolytic migratory erythematous rash. Patients with glucagonomas may develop the 4 Ds: diabetes, DVT, depression, and dermatitis. Weight loss is characteristic.
What cancers metastasize to the skin?
Lung, breast, GI & melanoma
Nikolsky sign: Slight lateral pressure on the skin causes sloughing of the epidermis. It is positive in what diseases?
Pemphigus vulgaris, toxic epidermal necrolysis (TEN), and staphylococcal scalded skin syndrome (SSSS). It is negative in bullous pemphigoid
How does bullous phemphigoid differ from pemphigus vulgaris?
Bullous phempigoid rarely involve the mucosa.
What drugs precipitate bullous pemphigoid? Treatment is what?
Furosemide, ibuprofen, captopril, and penicillamine. Therapy includes topical (mild disease) and systemic corticosteroids and immunosuppressants.
Dermatitis herpetiformis, seen in celiac’s, can be treated with what antibiotic?
Dapsone
When can a woman on isotrentoin become pregnant?What is required of them before they can use it?
When she stops taking it and waits at least 1 month.2 negative pregnancy tests and is on 2 forms of birth control prior to use. Shemust undergo a pregnancy test prior to obtaining a prescription, every time.
_____ is a safe and effective treatment for moderate-to-severe hidradenitis suppurativa, resulting in a significant decrease in abscesses and inflammatory nodules within the first 12 weeks of treatment.
Adalimumab
Scaling and redness, specifically on the eyebrows, nasolabial folds, and sides of the chin, are characteristic of _____. The redness and scaling are a response to commensal yeasts in the skin, and topical ____targets them.
Seborrheic dermatitis. Ketoconazole
_____ is a medical condition involving inflammatory cells in the anterior chamber of the eye. It is a leukocytic exudate, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera.Blood in the anterior chamber is ____
HypopyonHyphema
_____ consists of ongoing, slowly progressive, scaly infiltrative papules and plaques or atrophic red plaques on sun-exposed skin surfaces. Other chronic lesions may be____appearing. Most patients with this type of lupus, particularly those whose lesions are only on the head and neck, do not have systemic disease_____ may be associated with systemic lupus erythematosus but may also occur independently without systemic involvement. The rash is papulosquamous or annular, spares the ___, and usually ___.
Chronic cutaneous lupus erythematosus (also known as discoid lupus erythematosus)… hypertrophic or verrucousSubacute cutaneous lupus erythematosus….face, and usually does not scar.
____ which may develop from extensive alcohol use, ____ or _____ , presents with skin fragility and small, transient, easily ruptured vesicles in sun-exposed areas such as on the hands.
Porphyria cutanea tarda….Hemochromatosis, or hepatitis C virus infection
Most patients on stable doses of isotretinoin who have mild, expected changes in laboratory studies _____ monthly surveillance laboratory testing.
None! Do not need monthly surveillance.
Severe atopic dermatitis: Tx is what?
Medium-potency glucocorticoids: Triamcinolone ointment
___ and_____ are rated FDA pregnancy category B and is safe to use for mild comedonal and inflammatory acne during pregnancy
Azelaic acid cream and topical erythromycin
____ are benign firm brown or reddish papules that most commonly occur on the lower extremities. They extend deeper into the skin and exhibit the “dimple sign” when squeezed.
Dermatofibromas
____ are flat brown macules that occur on sun-exposed skin of older persons, particularly the face and dorsal hands rather than the trunk. They resemble large freckles
Solar lentigines (“liver spots”)
- This type of rash has the characteristic findings include erythematous papules coalescing into plaques, often with some pruritus, and no accompanying systemic symptoms after a drug.2. In ______,patients develop an exanthem rash on the face, trunk, and extremities, and they often have facial edema. Due to systemic inflammation, patients may have fever, lymphadenopathy, and, in severe reactions, hypotension. Tx with ____.
- Morbilliform Reaction2. Drug reaction with eosinophilia and systemic symptomsTx w/ steroids and d/c drug (MC allopurinol, sulfonamide abx and anticonvulsants)
- Erythema infectiosum is seen in2. Erythema marginatum is seen in3. Erythema migrans is seen in4. Erythema multiforme is most commonly seen in5. Erythema nodosum is seen in
- Parvovirus B19: “Fifth disease”2. Rheumatic fever3. Lyme disease4. HSV…also Mycoplasma5. Rheumatic fever, sarcoidosis, inflammatory bowel disease, etc.
Erythrasma is a scaly, reddish-brown rash that most frequently occurs in the inguinal or axillary areas caused byCorynebacterium minutissimum. The rash will fluoresce a ____ when illuminated with ultraviolet light from a Wood lamp.
Coral red color
- White flakes on chest, upper arms and scalp: cause? what should you work up in these patients? Dx? And Tx?2. Associated with asthma and rhinitis: Increased IgE; found on flexural surfaces: Dx and Tx?
- Seborrheic dermatitis; due to Pityrosporum; check HIV. tx w/ topical antifungal or topical steroids2. Atopic dermatitis; tx w/ hydrants, emollients….hydrocortisone
Female w/ severe acne wants accutane; what do you do prior to prescribing it?
Start OCP and another method of contraception during the treatment and 1 month after completing therapy
- Macroglossia is associated with amylodoisis, ____ cancer, acromegaly, and ___ syndrome, hypothyroidism, angioedema2. Erythema multiforme (‘targetoid lesions) is caused by ___ virus, ___ bacteria, ___ anti-epileptic, and ___ antibiotics and ___ pain medicaiton3. Pt. has recurrent erythema multiforme; what do you do?
- Multiple myeloma, down syndrome2. Recurrent HSV, Mycoplasma, phenytoin, PCN and sulfa abx, and NSAIDs3. R/o HSV: tx/ w/ prophylaxis acyclovir - lifetime
- Tx for SJS (<30%) and TEN (>30%)2. Pt. has generalized erythema, exfoliating dermatitis w/ bullae, you do punch biopsy and it shows a cleavage plane in the stratum corneum, this is due to ____….what if it shows in the stratum germinativum, then its due to ____
- IVIG and steroids.2. Infection….TEN due to drugs: start IVIG
- Rapid tapering of steroids can cause ____ psoriasis2. This psoriasis can be seen after a sore throat (usually due to group A strep: pyogenes)3. Pt on infliximab presents with erythrodermic itchy skin; cause? Tx?
- Pustular2. Guttate psoriasis3. Psoriasis 2/2 to anti-TNF therapy; d/c it.
Red painful nodules (erythema nodosum) on the shins +1. Genital ulcers. Dx2. Diarrhea. Dx3. Hilar adenopathy. Dx
- Bechet syndrome2. Ulcerate colitis3. Sarcoidosis
What is the vitamin deficiency?1. White spots on conjunctiva w/ night vision loss: Dx?2. Bleeding gums + perifollicular hemorrhages3. Angular cheilitis4. Atrophic glossitis w/ cheilitis and hyperpigmentation of skin5. Gum hypertrophy can be caused by ___ anti-epileptic, ___CCB, and ____ immunosuppressant.6. Eczematoid red rash on whole body + alopecia: pt. usually on TPN
- Vitamin A deficiency2. Vitamin C deficiency3. Riboflavin deficiency (B2)4. B12 deficiency5. Phenytoid, nifedipine, and cyclosporine6. Zinc deficiency
- Pt. has a while defined reddish lesion on axilla or groin or toe webs that lights up under wood’s lamp: turns red. Dx? and Tx?2. Erysipelas is caused by ____ and recurrent ____ infections. If fever, what should you r/o?3. For verrucuous warts on hands; tx is ____. In the genitals, the tx is ___4. Smooth umbilicated papules that are seen common in HIV patietns are due to ____ and usually located on the ____ and tx with ____
- Erythrasma; Gram + corynebacterium. Tx w/ oral erythromycin2. Strep and if recurrent its staph; if fever, do Echo to r/o endocarditis.3. Topical salicylic acid….topical imiquoid4. Poxvirus….eyelids….cryotherapy - molluscum contagiosum
- Pt. has an erythematous, annular, scaly rash with central cleaning AND an advancing red border: Next step? Dx? Tx?2. Pt. c/o of a bald patch; o/e you see black dots (broken hair follicles); Under wood’s lamp, it lights up bright green fluorescence. Dx? Tx?3. Pt. in summer, after tanning, finds untanned areas. Exam shows hypopigmented patches; next step? dx? tx?
- Do scraping w/ KOH, which will likely reveal septate branching hyphae = tinea. Tx w/ topical azole (terbinafine or ketoconazole)2. Tinea capitis…Tx w/ PO meds: griseofulvin or terbinafine or ketoconazole3. Scarping w/ KOH: will see yeast-like ball and sticks or meatball and spaghetti on microscopy: dx is tinea versicolor (caused by malassezia furfur). Tx is reassurance + topical antifungal cream or selenium sulfide
- The depth of this cancer determines prognosis; it’s seen in patients with multiple sunburns in childhood, especially those who are on immunosuppressants. What is it?2. This is seen usuallyafter age 60yo in sun-exposed areas and gradually, over years, becomes bigger and is pigmented. Dx? Tx?3. ___ is recommended for patients with melanomas of 1- to 4-mm thickness to provide accurate staging, as metastasis to regional lymph nodes is the most important prognostic factor in patients with early-stage melanoma.
- Melanoma: <0.76mm is a good prognosis: think ABCD2. Lentigo maligna; refer for biopsy - its a precursor to melanoma3.Sentinel lymph node biopsy
High SPF lotion/cream helps protects against which of the following:Solar (actinic)keratosis and squamous cell carcinoma, melanoma or basal cell carcinoma
Solar keratosis and squamous cell carcinoma!
AA male has patchy loss of hair on arms and legs, coalescing to discrete patches/plaquies/nodules on trunk and buttocks + severe pruritis.Biopsy shows clusters of atypical lymphocytes in the epidermisDx?What is this called if you see lymphocytes with hyperchromatic and convoluted nuclei (cerebriform nuclei) in the blood smear?What is the Tx?
Mycosis FungoidesSezary Cells/syndromeTx: Topical nitrogen mustard or psoralen PUVA
- Pt. has red to violet telangiectasias on lips, tongue and extremities. Dx? What should you r/o in this patient?2. Pt. has pigmented lesions on lip and mouth. What should you r/o?
- Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu Syndrome)2. Peutz-Jegher’s syndrome: colonoscopy = hamartomas = increased malignancy risk
- Pt. has beefy red tongue w/ skin rash w/ central clearing (necrolytic migratory erythema) on the perineum, perioral areas w/ chelitis: Dx?2. Pt. has multiple oral ulcers and large loose bullae and denuded skin: Dx? Abs will be positive to ___ proteins. Pt. has a positive ___ sign. These are intraepidermal3. >60 yo patient has tense bullae that don’t rupture easily: have IgG + C3 and eosinophil deposits at the ___ junction: Dx? Tx?4. Pt. has tense, nonpruritic blisters in sun exposed areas. Causes? Tx?
- Glucagonoma: islet cell tumor2. Pemphigus vulgaris…demoglein 1 & 3; Nikolsky sign - pressure applied on a blister results in its extension.3. Bullous pemphigoid: Dermal-epidermal junction. Tx w/ oral tetracycline or steroids4. Dx: Porphyrea cutanea Tarda: Hep C, Hemochromatosis, alcoholism, OCPs. Tx: Phlebotomy, anti-malarials (hydroxychloroquine)
- Pt w/ recurrent itching, wheezing, SOB, dizzines w/ hypotensive episodes, abdominal pain and diarrhea. O/E: +/- hepato-splenomeagly. Dx? Next step?2.An elevated eosinophil count (>1500/µL [1.5 × 109/L]) without a secondary cause and evidence of organ involvement are diagnostic of ___3. ___ is characterized by urticaria pigmentosa, a unique identifying clinical finding. Urticaria pigmentosa findings include pruritic yellow to red or brown macules, papules, plaques, and nodules; these pts key complaints are GI
- Systemic mastocytosis….Do serum tryptase2. Hypereosinophilic syndrome3.Systemic mastocytosis with eosinophilia
- Frost bite, when grade 1 (affects fingers) and grade II (blue finger tips) put in warm (100F) water (NOT hot), for grade III and IV, do ___, if abnormal, give ____.2. Day # 2: If blisters seen, what should you do? What to do if you see blisters w/ hemorrhagic fluid?
- Assess perfusion by doing technitium-99 bone scan: If decreased, give tPA + heparin then re-assess w/ scan.2. Drain and debride….drain only, do NOT debride
Hypersensitvity reactions:1. Allergic bronchopulmonary aspergillosis2. Hypersensitivity Pneumonitis3. Rh incompatibility and ABO incompatibility4. Arthus reaction and serum sickness5. SLE, PAN, RA, Hep B6. PPD, Poison ivy, nickel7. Latex8. Hyperacute graft rejection9. Acute or chronic graft rejection10. Allergic rhinitis/urticaria11. Wheal and flare
- Type 12. Type 33. Type 24. Type III5. Type III6. Type IV7. Type IV, but can be type I8. Type II9. Type IV10. Type 111. Type 1
- Best test for someone w/ allergic rhinitis, ocular itching exacerbated by pollen2. Best test for someone w/ latex allergy for dx?3. Pt has allergy to ASA. What NSAID can you use?4. What medications are contraindicated in patients with sulfa allergies? ____ type of NSAID, ___ BP med, ___ migraine med, and ___ anti-epileptic5. Pt. who develops itching and swelling in the mouth after eating avocado, or kiwii, or ____ have latex food allergy syndrome
- RAST (radioallergosorbent testis a blood test using radioimmunoassay test to detect specific IgE antibodies: quantitative)2. RAST3. Sodium or choline salicylate4. Celecoxib, Hctz, sumatriptan, zonisamide5. Pineapple
- Pt. gets urticaria when exposed to heat or hot shower. Dx?2. Pt. stung by bee/wasp = bronchospasm, urticaria, flushing; hypotension.What do you give: IV epi vs. subQ epi, vs. diphenhydramine vs. steroids?3. Can you give immunoglobulins (IVIG) to a patient with IgA deficiency?
- Cholinergic urticaria syndrome2. SubQ epinephrine3. No! IVIG has IgA antibodies = worsen the reaction!
- Patient has recurrent angioedema with each episode, lasting 1–3 days. Unlike angioedema/urticaria caused by immediate hypersensitivity reactions,this is not associated with urticaria or itching. Even minor trauma from dental procedures can precipitate attacks! Attacks may include laryngeal obstruction and very often affect the GI tract, causing severe abdominal pain. Dx? W/u? Tx? And long-term management?2. Patients are particularly susceptible to invasive infections with encapsulated bacteria (such as meningitis and septicemia): Deficiency is in what? These patients are at increased risk of what autoimmune disease?3.Pt has severe pyogenic bacterial infections: Deficiency is in what complex?4. Deficiency in this results in increased Neisseria meningococcal/gonococcal infections (especially meningitis or septicemia). Dx? Screen with what?5. What is the best screening test for complement deficiencies? Why?
Hereditary angioedema: check C4 (will be low) if so, check C1H-inhibitor functional assay: this is C1 esterase inhibitor deficiency. Tx isFFP (SubQ epi does not work in this situation). Best long-term management = Danazol (increasesC1-inhibitor levels)2. C1, C2 or C4 (MC is C2)– SLE3. C3 complement4. C5 to C9 complement deficiency: Screen with CH505.CH50…b/cCH50 assay measures the total complement hemolytic activity of the classical pathway
- Which hypersensitivity rx benefits from immunotherapy? How long does it take to have this effect? What medication should be avoided when patients are underoing this?What type of reaction is ABPA - can you give immunotherapy to those patients? Is hypersensitivity pneumonitis IgE mediated?
Only IgE-mediated reactions benefit from immunotherapy treatment. Avoid beta-blockers as they can interfere w/ epinephrine if tx is neededABPA is IgE mediated AND immune complex deposition : DO NOT give them immunotherapy - will worsenHyperesensitivity pneumonitis is NOT IgE mediated.
- Are there any contraindications for giving live or inactive vaccines to patiets w/ complement deficiencies?2. What vaccines can you not give in patients w/ phagocyte dysfunction?3. What vaccines can you not give in patients w/ a B-cell deficiency? (These are typically not given in the US)
- No contraindications: can give all vaccinations2. Do not give live oral typhoid vaccine and BCG: can give all other live vaccinations3. Live influenza, Yellow fever, smallpox, oral polio, oral typhoid and BCG - you can give other live vaccines such as MMR, varicella, zoster
When giving measles and varicella containing vaccinations, how long should you wait if patient has had:1. IVIG2. Whole Blood3. Plasma/Platelets/PRBCs4. Immunoglobulins of measles or varicella or hep A or Hep B or Tetanus
- 8-11 months2. 7 months3. 6 months4. Range from 3mo to 6mo
Theophylline levels are increased by what drugs?
ciprofloxacin, clarithromycin, zileuton, allopurinol, methotrexate, estrogens (OCPs), propranolol, and verapamil
Theophylline levels are decreased by what drugs?
Various antiepileptic drugs, rifampin, St. John’s wort, and smoking (which is more of an issue when patients stop smoking and theophylline levels subsequently increase on the same dose)
Theophylline decreases levels of these two drugs when co-administered. What are they?
Phenytoin andLithium
Silicosis is exposure to what occupations?
Making Brick, glass, ceramics, metal. Also sandblasting, and mining.
Asbestosis is exposure to what occupations?
Factory workers, industrial workers, insulators
Byssinosis (organic dust) exposure occurs in what occupations?
Cotton dust, hemp dust or flax dust
Beryllium exposure occurs in what occupations?
Worker’s in high-tech electronics, alloys, ceramics, nuclear industry and pre-1950 fluorescent light manufacturing
Long-term oxygen therapy is indicated if patients with COPD meet the following criteria: (1) chronic respiratory failure and/or severe resting hypoxemia, defined as an arterial PO2 less than or equal to ___ mm Hg (7.3 kPa) or oxygen saturation less than or equal to ___ breathing ambient air, with or without hypercapnia; and/or (2) if there is evidence of pulmonary hypertension, peripheral edema suggesting right-sided heart failure, or polycythemia, in combination with an arterial PO2 less than ____ mm Hg (8.0 kPa) or oxygen saturation less than ____ breathing ambient air.
- 55mmHg2. 88%3. 60mmHg4. 88%
_____ are the drug class of choice for treatment of non–neuropathic pain in critically ill patients, including mechanically ventilated adult patients in the ICU, and should be given in an interrupted fashion when needed.
Opioids
According to the referenced study, the most appropriate treatment for this patient with idiopathic pulmonary arterial hypertension (PAH) is to add oral ____ to the current regimen of ambrisentan and tadalafil.
Selexipag: it resulted in a significant reduction in the combined endpoint of death or complications in patients with pulmonary arterial hypertension, both in patients on other therapies and in patients who had not yet been treated.
For acutely ill patients who are hemodynamically unstable, supporting all respiratory effort with the ____ mandatory ventilation setting to minimize risk for ventilator-induced lung injury is recommended as the best strategy for initial mechanical ventilation. ____ ventilation, in which a breath is delivered according to a preset inspiratory pressure, has been associated with ventilator-induced lung injury; therefore, ____, in which ___ and ___flow are designated, is the preferred breath control method as the initial strategy for ventilation of critically ill patients.
Volume-controlled continuous…Pressure-controlled…Volume control…tidal volume and inspiratory flow
- A large (>2 cm), symptomatic, primary spontaneous pneumothorax may be initially managed with high-flow supplemental oxygen and ____2. Insertion of a ___-bore thoracostomy tube (<14 Fr [4.7 mm]) is indicated as initial treatment for larger (>2 cm) _____ pneumothoraces in patients who are symptomatic
- Needle aspiration2. Small…secondary
The combination of ____ with ____ has been shown to improve FEV1, alleviate symptoms, and reduce exacerbations in patients with moderate to severe COPD.
Long-acting muscarinic agents with long-acting β2-agonists (LAMA + LABA)LAMA + ICS is NOT superior - ICS = increased pneumonias
Obesity hypoventilation syndrome is characterized by fatigue and daytime somnolence in patients who are ____, and the diagnosis is confirmed by arterial blood gas testing showing ____ with an arterial PCO2 greater than ____ (in OSA this is normal; key difference between the two). Pulmonary function testing typically shows a ____ without ____, with a decreased FEV1 and FVC but preserved ____.
Obese (BMI >30)….daytime hypercapnia….45 mm Hg (6.0 kPa). Restrictive pattern….obstruction…FEV1/FVC ratio.
Congenital bilateral absence of the vas deferens is a common cause of obstructive azoospermia and is frequently associated with ____. Sperm production, however, is normal!
Cystic fibrosis
