Case Files Flashcards
Age for Colon Cancer Screening
Adults older than 50
Age for influenza vaccination
6 months of age & older
Age for Pneumococcal polysaccaride vaccination
65 years or older
Also 65 years or younger who are alcoholics or smokers; have chronic cardiovascular, pulmonary (including asthma), renal or hepatic disease; diabetes, immunodeficient or is asplenic.
One time revaccination after 5 years for those who are immunocompromised and is asplenic.
One time revaccination for those older than 65 if they were vaccinated longer than 5 years previously and were younger than 65 years at the time of initial vaccination.
Age for booster of Tdap
19 and 65 years of age
Recommended for all adults who have not had a Td booster within 10 years and have never had a Tdap vaccine as an adult.
In an adult with chronic lung disease, a one time vaccination with which vaccines is recommended?
Penumonoccal Influenza Tdap booster (if not within 10 years or never received one).
FEV1 ratio & treatment for Mild COPD (Stage 1)
less than 80%
short acting bronchodilators
- Albuterol
- ipratropium
FEV1 ratio & treatment for Moderate COPD (Stage 2)
less than 50-80%
Long acting bronchodilators
- Salmeterol
- Tiotropium
FEV1 ratio & treatment for Severe COPD (Stage 3)
30-50%
Inhaled Steroids
FEV1 ratio & treatment for Very severe COPD (Stage 4)
less than 30%
Long term oxygen therapy & consider surgical interventions.
Patient develops COPD at a young age, does not respond to bronchodilator.
Think alpha1 antitrypsin deficiency
Correlation with pulmonary function and smoking cessation
His current pulmonary function will be unchanged, but the rate of pulmonary function decline will slow.
JVD and lower extremity edema
Cor pulmonale (right sided heart failure due to chronic elevated pressures in the pulmonary circulation.
Radiation exposure greater than what number is associated with fetal harm?
How does X-ray fit into this?
5 rad.
Xrays exposes the fetus to a very small fraction of this amount of radiation (.00017)
Recommended amount of folic acid daily to reduce the risk of NTD
400 to 800 micrograms per day
Recommended amount of folic acid for a women who has had a child with NTD?
4 milligram per day
Recommended amount of folic acid for a omen with diabetes and epilepsy?
1 milligram per day
LMP calculation
First day of LMP, subtract 3 months and add 7 days.
Optimal time for trisomy screen
10-13 weeks for serum hCG and pregnancy associated plasma protein A (PAPP-A).
16-18 weeks triple (AFP, hCG, estriol) or quadruple (triple with inhibin A).
When should all women be offered GBS screening by vaginorectal culture?
35-37 weeks gestation
Proper method of collection of GBS screening by vaginorectal culture?
Swab the lower vagina, perineal area and rectum.
Mother is Rh negative. Next step?
Assess the antibody screen or indirect Coomb’s test. If the antibody screen is neg, there is no isoimmunization and RhoGAM is given at 28 weeks and again at delivery if the baby is confirmed as Rh (anti-D).
Recommended Immunization for a 6 month well child visit.
DTaP (diphtheria, tetanus, acellular pertussis).
Hepatitis B
Haemophilus Influenza Tybe B (HiB)
Rotavirus
inactivated polio vaccine can be given between 6-15 months of age.
Age by which a child should say mama and dada
nonspecifically between 6-9 months.
specific between 8-12 months.
A child should stay in a rear-facing seat until the child weighs at least how many pounds and at least how old?
at least 20 lbs & 1 year old.
All states require testing for congenital disease?
PKU & congenital hypothyroidism
When can a child use a forward facing seat?
between 20-40 lb
When can a booster type seat be used?
greater than 40lbs
True contradiction to providing a vaccination
History of anaphylactic reaction to a specific vaccine component or a severe illness.
Side effects of decongestants
rebound hyperemia and worsening of symptoms
First line therapy for long term management of mild to moderate allergic rhinitis
corticosteroid nasal spray
Indicated for both management of persistent asthma and chronic allergies
Leukotriene inhibitors
First generation antihistamine
diphenhydramine, chlorpheniramine, and hydroxyzine
S.E: sedation
Second generation antihistamine
Loratadine, Desloratadine, Fexofenadine and cetirizine
All have lower incidence of sedation & anticholinergic effects except cetirizine.
At first sign of anaphylaxis, what must be given?
Aqueous epinephrine 1:1000, in a dose of 0.2 to 0.5 ml (0.2 to 0.5 mg) is injected subcutaneously or intramuscularly
Repeated injections every 15-30 mins when necessary.
Treatment for Allergic conjunctivitis
Anti-histamine or anti-inflammatory eye drops
Treatment for bacterial conjunctivitis
Sulfonamide
Treatment for epidemic keratoconjunctivitis (pink eye)
Sulfonamide - prevents secondary bacterial infection
Hot compress to reduce discomfort of lid edema
weak topical steroids to treat corneal infiltrates
Approved non nicotine medications
Bupropion (brand name: Zyban)
Varnicline (brand name: Chantix)
Bupropion is contraindicated in patients with?
eating disorders
seizures
used MAO inhibitor in the last 2 weeks
Mechanism of Bupropion vs. Varenicline?
Bupropion blocks uptake of NE and/or dopamine.
Varenicline is a nicotinic receptor partial agonist
Side effects of Bupropion
insomnia and dry mouth
Side effects of Varenicline
nausea, trouble sleeping, abnormal vivid dreams
What can be used in combination with any of the nicotine supplements?
Bupropion
Nicotine products can also be used in combination with each other.
STD partner notification can occur by which methods?
patient referral or by health department staff.
Traveler’s Diarrhea - Common bacterias
Ecoli (all types) Salmonella Shigella Vibrio non-cholera Capylobacter
Traveler’s Diarrhea - Common viruses
Rotavirus
Norovirus
Traveler’s Diarrhea - Common parasites
Giardia Lamblia
E. Histolytica
Cryptosporidum parvum
Common etiology for traveler’s diarrhea
E. coli
Illness within 6 hours of eating a salad containing mayonnaise
S aureus
Within 8-12 hours of eating
Clostridium perfringens
Within 12-14 hours of eating
E. coli
Most patients with acute diarrhea have self limited processes and do not require much work. What are the exceptions?
Profuse diarrhea, dehydration, fever exceeding 100.4 F (38.0 C), bloody diarrhea, severe abdominal pain, duration of diarrhea for more than 48 hours, and children, elderly patients and immunocompromised patients.
When antibiotics is indicated for travelers’ diarrhea, what are the drugs commonly used?
Ciprofloxcin (500 mg 2x daily) is given for 1 or 3 days. TERATOGENIC.
Azithromycin (single 1000 mg dose in adults or 10 mg/kg daily for 3 days in children). CAN BE USED IN PREGNANT WOMEN.
RIFAXIMIN (200 mg 3x daily for 3 days) - used for noninvasive strains of E.Coli. Not effective against infections associated with fever or blood in stool
What drug can be used to treat C.difficile?
Metronidazole or oral vancomycin
What drug is contraindicated in any patient suspected with C. difficile colitis?
Loperamide - opioid drug, decreases frequency of bowel movements.
It increases the risk of toxin retention and precipitation of toxic megacolon.
National Osteoporosis Foundation recommendation for calcium & vit. D intake for all women over the age of 50.
1200 mg of calcium and 400 to 800 IU of vitamin D per day
Optimal age for Cervical Cancer Screening
21
How often should you get a pap smear?
annual pap smears until age 30, and then spacing out the interval to every 2-3 years
When to stop screening for pap smears?
USPSTF - after 65 both if no new risk factors have been identified (new partner) & if there has been adequate recent screening
American Cancer Society - stop at 70 if a women has 3 consecutive normal pap smears and no abnormal pap smears the last 10 years.
Ottawa Ankle Rules applies to?
Applies to:
(1) non pregnant adults who have normal mental status,
(2) no other significant concurrent injury,
(3) evaluated within 10 days of the injury.
When should X-rays be performed according to Ottawa Ankle Rules?
(1) bony tenderness of the posterior edge or tip of the distal 6 cm of either the medial or lateral malleolus OR
(2) if the patient is unable to bear weight immediately or when examined
What is the most commonly injured ligament?
ATFL, followed by CFL
What should be used in initial evaluation of the painful joint?
Plain film X-rays.
If the patient has normal x-rays and who have a suspected soft tissue (ligament, tendon, cartilage) injury, MRI scanning is usually the net most appropriate imaging study to perform.
Most common cause of a stiff or painful joint following a sprain is?
Inadequate rehabilitation.
When a patient is unable to adequately self-rehabilitate an injury, a physical therapy referral can be beneficial.
Ottawa Knee Rules recommendation for performing an X-ray in a knee injury
Any of the following criteria:
(1) Age 55 years or older
(2) isolated patella tenderness
(3) tenderness of the head of the fibula
(4) inability to flex the knee to 90 degrees
(5) inability to bear weight for four steps immediately and in the examination room (regardless of limping).
Most commonly occurring melanomas in both men and women
Superficial spreading melanomas
Melanoma that is most aggressive and usually invasive at the time of diagnosis?
Nodular Melanomas
Melanoma that is found on the palms of hands, sole of feet and under finger and toenails?
Population most common in?
Acral Lentiginous Melanoma
Asian & African
Melanoma most commonly found in the elderly
Lentigo Maligna
Least common out of the four types
Prognosis of Melanoma
Single most important piece of info for prognosis in melanoma is the thickness.
Melanomas less than 1-mm thick have a low rate of metastasis and a high cure rate with excision.
How does Basal cell carcinoma appear?
Pearly papules, often with central ulceration or with multiple telangiectasis.
Rarely metastasize but can grow large and be locally destructive.
How does Squamous Cell Carcinoma appear?
Irregularly shaped plaques or nodules with raised borders.
Freq. scaly, ulcerated and bleed easily.
Higher rate of metastasis than BCC.
Gross Hematuria
always deserve a full workup.
Urinalysis, urine culture and imaging of upper urinary tract by CT scanning.
Upper tract can be imaged by?
Intravenous pyelogram (IVP) or CT
IVP is xray imaging of the Upper UT after administration of IV contract dye. Widely available and low cost, but can miss small renal masses & does not solid from cystic lesions.
CT detects masses, renal stones, renal or perirenal infections and obstruction.
CT scan should be initially preformed.
Lower tract is commonly evaluated by?
cystoscopy
What is the treatment of choice for Graves disease in adult patients who are not pregnant?
Radioactive iodine
absolutely contraindicated in pregnancy.
What is the treatment of choice for Graves disease in adult patients who are pregnant?
PTU
Test to see if thyroid nodules are malignant
Fine needle aspiration
Thyroid cancer detected during pregnancy
Can be observed until after pregnancy is complete.
If needed, thyroid surgery can be performed safely in 2nd or 3rd trimesters.
Difference between Graves and Thyroiditis in Radionucleotide imaging?
Graves - diffuse hyperactivity with large amounts of uptake
Thyroiditis - patchy uptake with overall reduced activity (tells you it is releasing existing hormone rather than the overproducing new thyroxine).
What is a specific diagnostic test for Graves?
Detection of serum thyroid receptor antibodies.
What test do you do to tell the difference between Familial Hypocalciuric Hypercalcemia or primary hyperparathyroidism?
24 hour urinary calcium excretion.
Hyperparathyroidism - kidneys spill calcium in the urine at normal or elevated level.
FHH- the urinary calcium is low.
Primary Hyperparathyroidism
usually due to excessive production of the parathyroid glands, leading to hypercalcemia.
Secondary Hyperparathyroidism
Parathyroid glands overproduce PTH in response to low calcium levels (can be from dietary calcium or from def. of Vit. D)
Tertiary Hyperparathyroidism
Elevated PTH in patients with renal failure
What are the 3 stages of labor?
Stage 1. Onset of labor until the cervix is completely dilated.
Stage 2. complete cervical dilation (10cm) through the delivery of the fetus.
Stage 3. Begins after delivery and ends with the delivery of the placenta and membranes.
Stage 1 of labor is divided into what 2 phases?
Latent phase of labor - contracts become stronger, longer lasting & more coordinated.
Active phase - usually starts 3-4 cm of cervical dilation is the rate of cervical dilation at its maximum.
What are the three stages of decelerations from the fetal baseline heart rate that occurs?
early, late & variable
early coincides with a contraction in onset of the fetal heart rate decline
late = gradual reduction in fetal heart rate that starts at or after the peak of a contraction and has a gradual return to baseline.
variable = abrupt decrease in fetal heart rate, usually by an abrupt return to baseline that occurs variably in its timing, relative to an contraction
What is early deceleration thought to be caused by?
fetal head compression
What is late deceleration thought to be caused by?
uteroplacental insufficiency
What is variable deceleration caused by?
cord compression
What is the most common cause of blindness worldwide?
Cataract Disease
What is the leading cause of severe vision loss in the elderly?
Age related macular degeneration (AMD)
Presbycusis
high frequency hearing loss along with loss of speech discrimination
Leading cause of blindness in working age adults in the U.S
Diabetic retinopathy
Most common cause of hypertension in children under 6 years of age?
renal parenchymal disease
urinalysis, urine culture, and renal ultrasonography should be ordered for all children presenting with hypertension.
Other secondary causes, such as pheochromocytoma, hyperthyroidism, and excessive caffeine use, are less common, and further testing and/or investigation should be ordered as clinically indicated.
thiazolidinediones (TZDs) are associated
fluid retention, and their use can be complicated by the development of heart failure.
Optimal candidates for cardiac resynchronization therapy (CRT)
have a dilated cardiomyopathy on an ischemic or nonischemic basis, an LVEF ≤0.35, a QRS complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV despite maximal medical therapy for heart failure
The American Heart Association recommends a goal blood pressure of ≤130/80 mm Hg for patients with
hypertension in patients with diabetes mellitus, chronic kidney disease, or coronary artery disease.
According to the U.S. Preventive Services Task Force, which one of the following patients should be screened for an abdominal aortic aneurysm?
in men 65-75 years of age who have ever smoked.
Monotherapy for hypertension in African-American patients
is more likely to consist of diuretics or calcium channel blockers than β-blockers or ACE inhibitors.
Patient with severe renal disease presents with acute coronary syndrome. Which one of the following would most likely require a significant dosage adjustment from the standard protocol?
A. Enoxaparin (Lovenox) B. Metoprolol (Lopressor, Toprol) C. Carvedilol (Coreg) D. Clopidogrel (Plavix) E. Tissue plasminogen activator (tPA)
Enoxaparin is eliminated mostly by the kidneys. When it is used in patients with severe renal impairment the dosage must be significantly reduced. For some indications the dose normally given every 12 hours is given only every 24 hours.
Although some β-blockers require a dosage adjustment, metoprolol and carvedilol are metabolized by the liver and do not require dosage adjustment in patients with renal failure.
The most useful diagnostic tool for evaluating patients with heart failure
Two-dimensional echocardiography with Doppler.
Assesses left ventricular ejection fraction (LVEF), left ventricular size, ventricular compliance, wall thickness, and valve function.
Isolated systolic hypertension in the elderly responds best to
diuretics and to a lesser extent, β-blockers.
As the body ages, what happens to each of the following?
A. Maximum heart rate B. Heart rate variability C. Ejection fraction D. Arterial wall elasticity E. Blood pressure
HR trend- DECREASE
HR variability - DECREASE
Ejection Fraction - DECREASE
Arterial wall elasticity - STIFFENS
Blood Pressure - INCREASED
(stiff walls –> peripheral resistance –> increase in BP).
The use of what allows patients with acute deep vein thrombosis (DVT) to be managed as outpatients.
LMWH (Enoxaparin (Lovenox).
The dosage is 1 mg/kg subcutaneously 2x daily.
Oral anticoagulation with warfarin can be initiated on the first day of treatment after heparin loading is completed
Which procedures carries the highest risk for postoperative deep venous thrombosis?
Neurosurgical procedures & orthopedic surgeries.
Orthopedic surgeries - total knee replacement, hip fracture surgery, and total hip replacement.
The most common recommendation for surgical repair is when the aneurysm approaches what size in diameter.?
5.5 cm
What is preferred for treating hypertension in patients who also have diabetes mellitus?
ACE inhibitors
What is indicated for patients with symptomatic aortic stenosis?
Prompt correction of his mechanical obstruction with aortic valve replacement.
Contraindication to the use of beta-blockers for CHF?
Hemodynamic instability, heart block, bradycardia, and severe asthma.
Leading cause of death in women
Cardiovascular disease
A resting 12-lead EKG is recommended for?
Males over 45,
females over 55, and patients with diabetes, symptoms of chest pain, or a previous history of cardiac disease.
First line for Acute sinusitis?
Amoxicillin & Trimethoprim-Sulfamethoxazole for 10-14 day.
What should not be used for more than three days to avoid the risk of rebound vasodilation with resulting worsening of symptoms?
Topical decongestants.
Gold standard for diagnosis of GAS infections?
Throat cultures
can take 24-48 hours
What is the drug of choice for GAS pharyngitis?
Pencillin
Oral therapy requires 10 day course of penicillin V.
In penicillin allergic patients, you can use cephalosporins & macrolides.
Findings frequently associated with GAS infections?
Abrupt onset of sore throat and fever, tonsillar and/or palatal patchy, tender cervical adenopathy and absence of cough.
Findings frequently associated with EBV infections?
Exudative pharyngitis, retrocervical or generalized adenopahty and heaptosplenomegaly.
Atypical lymphocytes on peripheral blood smear.
The vast majority of pharyngitis is?
Viral
Treatment for mononucleosis?
Self limiting disease
Most accurate maneuver for detecting an ACL tear
Lachman test
Followed by the anterior drawer test and the pivot shift test.
McMurray’s test is used to detect meniscal tears.
How do you determine if Monoclonal gammopathy of undetermined significance (MGUS) has progressed to multiple myeloma?
Evidence of end organ damage
femoral neuropathy
decreased sensation to pinprick and light touch over the left anterior thigh, and reduced motor strength on hip flexion and knee extension. The straight leg raising test is normal.
straight leg test
If the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disc is likely to be the cause of the pain
Diabetic polyneuropathy
symmetric and distal limb sensory and motor deficits.
Meralgia paresthetica
a.k.a lateral femoral cutaneous neuropathy
numbness and paresthesia over the anterolateral thigh with no motor dysfunction.
Iliofemoral atherosclerosis
may produce intermittent claudication involving one or both calf muscles
Women who use low-dose estrogen oral contraceptives have a 50% lower risk of cancer of the?
epithelial ovarian cancer
Mainstay therapy for polymyalgia rheumatica.
Corticosteroids
Polymyalgia Rheumatica
What is it?
Who is most commonly affected?
ESR?
Clinical hallmarks?
Systemic symptoms?
inflammatory disorder that occurs in persons over the age of 50.
White women of European ancestry are most commonly affected.
One review found that 4%–13% of patients with clinical polymyalgia rheumatica have a normal erythrocyte sedimentation rate (ESR). As many as 5% of patients initially have a normal ESR that later rises.
Clinical hallmarks of polymyalgia rheumatica are pain and stiffness in the shoulder & pelvic girdle.
Variety of systemic symptoms. Fever is common, with temperatures as high as 39°C (102°F) along with night sweats. Additional symptoms include depression, fatigue, malaise, anorexia, and weight loss.
The hallmark biochemical feature of refeeding syndrome is
Hypophosphatemia
Refeeding syndrome = potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally).
When prescribing an inhaled corticosteroid for control of asthma, the risk of oral candidiasis can be decreased by?
Rinsing the mouth after each use & using a valved holding chamber to your metered-dose inhaler.
When is Laryngoscopy is recommended?
when hoarseness does not resolve within 3 months or when a serious underlying cause is suspected.
In adults, the most common cause of right heart failure is:
left heart failure
pericarditis
type of pain? Radiation? when the pain is exacerbated? when is the pain lessen? ECG findings?
Sharp Radiates to the trapezius Exacerbated by inspiration Decreased with sitting forward Global ST segment elevation
The goal of LDL cholesterol in anyone with a history of CAD and high risk for future cardiac events
Less than 70 mg/dL
What is contraindicated in myocardial ischemia?
Rapid release, short-acting dihydropyridines (nifedipine).
Increased mortality in multiple trials.
What are the agents of choice for MI?
Beta blockers
increases survival
All patients with MI should receive?
Aspirin and an antithrombotic treatment
ESRD is GFR of less than?
15 mL/min
Normal GFR is between 90-120 mL/min.
What is most important in the prevention of end stage renal disease?
Glycemic Control
Diabetes is a leading cause of end-stage renal disease.
What helps with hypertension and also protects renal function in diabetics and CKD?
ACE inhibitors
Vaginitis Discharges:
Fungal
Bacterial Vaginosis
Trichomonas
Fungal - thick discharge & can cause significant pruritus
Bacterial Vaginosis - thinner and has a fishy odor.
Trichomonas - discharge is frothy & green and patient cervix is frequently very erythematous.
pH of vulvovaginal candidiasis
4.0-5.0
Treatment of uncomplicated candidiasis?
short term intravaginal preparations (cream or vaginal suppositories)
OR
single dose oral fluconazole 150 mg.
Recommended treatment of trichomoniasis
Oral metronidazole, given in a single 2-g oral dose
OR
1-week regiment of 500 mg twice a day to BOTH the patient and her sexual partner.
What are the 4 clinical criteria for Bacterial Vaginosis?
Diagnosis can be based on the presence of 3 of 4 clinical criteria.
- thin homogenous vagina discharge.
- vaginal pH more than 4.5
- a positive KOH “whiff” test
- the presence of clue cells in a wet mount preparation.
Test of choice for determination of the source of lower GI bleeding
Colonoscopy
What helps rule out upper GI bleeding?
Nasogastric tube.
Upper GI - aspirate shows blood
Lower GI - aspirate shows bile
What patients must be evaluated for the presence of colon cancer?
Any patient older than age 50 years who has lower GI bleed
Inflammatory Bowel Diseases - How do you tell the difference between the two?
Ulcerative colitis - continous inflammation of the large bowel, starting from rectum and extending proximally.
Crohn Disease - areas of focal inflammation, but can occur anywhere in the GI tract.
Initial management of asymptotic diverticuli
high fiber diet
Management of severe or recurrent symptomatic cases of diverticuli
surgery
Patients with a heterophil antibody test is positive for infectious mononucleosis should avoid what?
All, or nearly all, patients with mononucleosis have splenomegaly.
Should be advised to avoid contact- or collision-type activities for 3–4 weeks because of the increased risk of rupture.
Initial treatment for a patient with malignancy of hypercalcemia
Fluid replacement with normal saline to correct the volume depletion & to enhance renal calcium excretion.
Restrict use of loop diuretics - danger of fluid overload (and are not very effective alone in promoting renal calcium excretion)
Once the hypercalcemic patient has become EUVOLEMIC by saline repletion then give pamidronate (mainstay treatment).
Uterine fibroid embolization
Procedure done by radiologist.
blocks blood flow to fibroids in the uterus.
Requires a shorter hospitalization and less time off work.
For women who are not planning a pregnancy in the future, UFE is a possible option in place of surgery for fibroids.
Myomectomy
surgical removal of fibroids from the uterus.
Recommended over fibroid embolization for patients who wish to become pregnant in the future.
The Valsalva maneuver will typically cause the intensity of a systolic murmur to increase in patients with which heart condition?
Maneuver decreases venous return to the heart, thereby decreasing cardiac output.
Increases in hypertrophic obstructive cardiomyopathy.
The murmur of mitral valve prolapse becomes longer, and may also become louder.
Melanosis coli
dark pigment is deposited in the lining of the colon.
The brown pigment is lipofuscin in macrophages, not melanin.
from chronic use of herbal laxatives that contain anthraquinones.
Condition can develop after just a few months of laxative use.
Benign
Slipped capital femoral epiphysis
most common hip disorder between ages 8 and 15
More common in boys and overweight or obese children
femoral head is being medially and posteriorly displaced
presents with limping and pain, and limited internal rotation of the hip.
Treatment: Surgery (surgically pinning the femoral head)
Legg–Calvé–Perthes Disease
usual onset of three to ten years of age
Thought to be caused by avascular necrosis of the femoral head, with resultant abnormal growth of the femoral head.
Treatment is conservative, protection of the joint and efforts to maintain range of motion.
Best test for the diagnosis of COPD
Spirometry
has FEV /FVC ratio of 70% or less.
A 30-year-old female asks you whether she should have a colonoscopy, as her father was diagnosed with colon cancer at the age of 58.
You recommend that she have her first screening colonoscopy:
At age 40, or 10 years before the earliest age at which an affected relative was diagnosed (whichever comes first) and be rescreened every 5 years.
Drug-induced lupus pleuritis
hydralazine, procainamide, and quinidine.
Drug-induced pleural disease
amiodarone, bleomycin, bromocriptine, cyclophosphamide, methotrexate, minoxidil, and mitomycin.
Treatment of choice for Wolff-Parkinson-White syndrome
Procainamide although amiodarone may also be used.
Which one of the following is contraindicated in the second and third trimesters of pregnancy? (check one) A. Amoxicillin B. Azithromycin (Zithromax) C. Ceftriaxone (Rocephin) D. Ciprofloxacin (Cipro) E. Doxycycline
Doxycycline is contraindicated in the second and third trimesters of pregnancy due to the risk of permanent discoloration of tooth enamel in the fetus.
Patients with rheumatoid arthritis should be screened for tuberculosis before starting which one of the following medications?
TNF inhibitors have been associated with an increased risk of infections, including tuberculosis.
infliximab, adalimumab, certolizumab pegol, and golimumab.
The most widely used initial assay for detecting hepatitis C virus (HCV) antibody is?
If positive, what should this test be followed by?
If this test is positive, what should it be followed by? What if it’s negative?
enzyme immunoassay.
Followed by a confirmatory test such as the recombinant immunoblot assay.
If positive, the quantitative HCV RNA polymerase chain reaction is used to measure the amount of virus in the blood to distinguish active from resolved HCV infection.
If negative, it indicates a false-positive antibody test.
Metformin (Glucophage) should be stopped prior to which one of the following, and withheld until 48 hours after completion of the test? A. An upper GI series B. Abdominal ultrasonography C. CT angiography D. MRI of the brain E. Colonoscopy
Since even a temporary reduction in renal function, such as occurs after pyelography or angiography, can cause lactic acidosis in patients taking metformin, the drug should be discontinued 48 hours before such procedures and restarted 48 hours after the procedure if renal function is normal.
The DSM-IV criteria for obsessive-compulsive disorder (OCD) indicate
patient recognizes that the obsessions or compulsions are excessive or unreasonable.
Nursing home–acquired pneumonia drug treatment
Need coverage for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa.
Combination therapy of Ceftazidime, levofloxacin, and vancomycin
Which one of the following has the best evidence that it is safe for use in pregnancy? A. Alprazolam (Xanax) B. Lithium C. Bupropion (Wellbutrin) D. Fluoxetine (Prozac) E. Paroxetine (Paxil)
Fluoxetine (Prozac)
Xanax - cleft lip/ palate
Lithum - terogenic
Wellbutrin - spontaneous abortions
Paroxetine - congential cardiac malformations
Intussusception
paroxysms of colicky abdominal pain.
A mass is palpable in about two-thirds of patients.
usually occurs in children under the age of 2 years
most occur at the ileocecal junction
current jelly stool (mixture of blood and mucus that has sloughed from the affected bowel wall)
Pyloric stenosis
presents with a palpable mass, but usually develops between 4 and 6 weeks of age
Most common cause of GI obstruction in infants.
choledochal cyst
presents with the classic triad of right upper quadrant pain, jaundice, and a palpable mass.
Intestinal malrotation
usually presents within the first 4 weeks of life and is characterized by bilious vomiting.
Meckel’s diverticulum
painless lower gastrointestinal bleeding.
Indicated for the treatment of severe osteoporosis, for patients with multiple osteoporosis risk factors, or for patients with failure of bisphosphonate therapy
Teriparatide
Describe the gait in each of these disorders
A. Visual impairment B. Cerebellar degeneration C. Frontal lobe degeneration D. Parkinson’s disease E. Motor neuropathy
Visual impairment - abducted arms and legs; slow, careful, “walking on ice” movements
Cerebellar degeneration - ataxic gait that is wide-based and staggering.
Frontal lobe degeneration - gait apraxia that is described as “magnetic,” with start and turn hesitation and freezing.
Parkinson’s disease - typical gait that is short-stepped and shuffling
Motor neuropathy - “steppage” gait resulting from foot drop, short strides, a slapping quality, and frequent tripping.
Which interventions is most likely to be successful for a patient with anorexia nervosa?
Family-based treatment
Provides superior results when compared with individual adolescent-focused therapy.
Antidepressants have not been successful.
Which Asthma medications should be used only as additive therapy and not as monotherapy
Long-acting β2-agonists
Because of the risk of asthma exacerbation or asthma-related death, the FDA has added a warning against the use of long-acting β2-agonists as monotherapy.
Erythema toxicum neonatorum
is a common harmless red rash in neonates.
not require any treatment, as it will spontaneously go away in 5–7 days.
macular erythema, papules, vesicles, and pustules, and it resolves without permanent sequelae.
Physicians should counsel all patients with CKD, as well as those at increased risk for CKD, to avoid what as it will increased their risk of deterioration in renal function.
NSAID.
NSAIDs induce renal injury by acutely reducing renal blood flow and, in some patients, by causing interstitial nephritis.
The primary treatment for symptomatic mitral valve prolapse
Beta blockers
Helps relieve symptoms of palpitations or chest pain that might happen with this condition.
Do not improve the functioning of the mitral valve.
prevention of altitude illness in a patient with sulfa allergy - what should be used?
Dexamethasone - it is not contraindicated for those with a sulfa allergy.
Acetazolamide is an effective prophylactic agent, but is contraindicated in patients with a sulfa allergy.
Most common drug-related cause of acute interstitial nephritis.
Antibiotics, especially penicillins, cephalosporins, and sulfonamides.
All patients with suspected pneumonia should have what test done?
a chest xray
Legionella often causes what along with pneumonia?
diarrhea
Bacterias that are classified as atypical pneumonia?
Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae
Drug of choice for pneumonias caused by Legionella or S. Aureus?
Erythromycin
Drug of choice for pneumonias caused by Streptococcus?
Pencillin
Drug of choice for pneumonias caused by Hemophilus influenza?
Cefuroxime
Common infection seen after influenza infection
Staph. Aureus
The use of antidepressants in bipolar disorder may precipitate?
acute manic behaviors
First line treatment for depression
SSRI
What is the most common cause of erythema multiforme, accounting for more than 50% of cases?
Herpes simplex virus (HSV)
accounting for more than 50% of cases.
Bereavement - when is the diagnosis of major depression made?
If the symptoms last longer than 2 months and involves suicide ideations, morbid preoccupations or psychosis.
Bipolar disorder
episodes must last longer than 1 week and should be abrupt, not continuous.
continuous suggest personality disorder or schizophrenia.
A single episode of mania is sufficient for diagnosis of bipolar disorder
All patients diagnosed with depression should be questioned about?
Mania as treatments are different.
Treated with mood stabilizers such as valproate, carbamazepine and lithium.
Trazodone
Atypical antidepressant
risk of priaprism (rare)
highly sedating and frequently used as a sleep aid
All antidepressants carry and FDA “black box’ warning that they increase the risk of?
suicidal thoughts and behaviors in children, adolescents and young adults, especially in the first few months of treatment.
Persons with depression have a greater chance of developing or dying from?
cardiovascular disease
What is given during or immediately after the third stage of labor to aid in producing increased uterine tone?
oxytocin (Pitocin)
In women who are not breast feeding, menstruation using restarts by?
third postpartum month
Most common cause of postpartum hemorrhage?
Uterine atony
Failure of uterus to contract adequately results in continued bleeding from uterine vasculature.
Treatment of uterine atony?
IV administration of oxytocin and initiation of bimanual uterine usage.
When these fail, give methylergonovine intramuscularly. This drug is contraindicated in patients with hypertension (may cause abrupt increase in blood pressure).
4 Ts of postpartum hemorrhage
Tone, Trauma, Tissue, Thrombin
Postpartum fever, especially associated with uterine tenderness and foul smelling loch
endometritis
Contradictions to breast feeding?
HIV infection
Acute active Hep. B infection
Recommended waiting time to start oral contraceptives in breast feeding women vs. non breast feeding women
breast feeding: 6 weeks postpartum
Non-breast feeding: 3 weeks
OCP in breast feeding vs. non breast feeding - what should be used?
Breast feeding: protesting-only pill (combination OCP may reduce lactation).
Non-breast feeding: combination OCP
Drug used to treat mastitis
Cephalexin or penicillin based antibiotic
IUD may be placed at which week of postpartum visit?
6 weeks postpartum as earlier placement is associated with increased rate of expulsion of the device.
Omeprazole therapy is associated with
Increased risk of community-acquired pneumonia & Clostridium difficile colitis.
Acutely decrease the absorption of vitamin B 12,
Decreases calcium absorption, leading to an increased risk of hip fracture.
Next step in management of patient over the age of 35 who experiences abnormal vaginal bleeding.
endometrial biopsy.
must have an endometrial assessment to exclude endometrial hyperplasia or cancer.
For patients with a history of previous stroke, JNC-7 recommends using
combination therapy with a diuretic and an ACE inhibitor to treat the hypertension, as this combination has been clinically shown to reduce the risk of recurrent stroke.
Most effective treatment for chronic plaque psoriasis and has fewer adverse effects?
topical corticosteroids.
The American Psychiatric Association and the Institute for Clinical Systems Improvement both recommend which drugs for patients who have an incomplete response to antidepressant therapy.
a trial of lithium or low-dose triiodothyronine (T3 )
Ehrlichiosis causes
thrombocytopenia
