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DIT Level 3 > Clinical questions - Various IM Topics > Flashcards

Clinical questions - Various IM Topics Flashcards

1
Q

Management of angioedema associated with ACE-i

A

caused by accumulation of bradykinin

Stop the ACE and switch to ARB when stable
Monitor for airway compromise, intubate if needed

Antihistamines for quicker resolution - H1 (benadryl) + H2 (ranitidine)

Epi and glucocorticoids are NOT helpful, they do not lower bradykinin levels

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2
Q

Causes of pharyngitis

A

Viral: flu, EBV, common cold

Noninfectious: allergic rhinitis, post nasal drip

Bacterial: 
GAS, GCS, GGS
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Corynebacterium diphtheriae
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3
Q

Centor Criteria and treatment of Strep pharyngitis

A

Centor criteria:

  • tonsillar exudates
  • tender anterior cervical adenopathy
  • fever by history
  • absence of cough

3-4 of these test for strep

Abx:
PO amor or PCN V for 10 days
IM PCN G X1 dose

2nd line - cephalosporins - cephalexin
PCN all: macrolide - azithro or clarithro
If Macrolide resistant and PCN allg - Clinda

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4
Q

Contraindications to and side effects of phosphodiesterase -5 inhibitors

A

sildenafil, tadalafil (longest acting)

Contra:
Nitrates (NG, imdur) risk of severe hypotension
Caution in alpha blockers - terazosin or parazosyn for BPH due to risk of hypotension

Side effects:
Flushing
Headache
nasal congestion
Blue vision (sildenafil - blue pill)
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5
Q

Management of anaphylaxis

A 
IM epi
O2 +/- intubation
IVF
Antihistamine for itching/hives
Albuterol if not fully responding to episode
Monitor 8-10 hrs following tx
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6
Q

Vitamin deficiency associated with macrocytic anemia with hypersegmentated neutrophils

A

Folate (B9) or B12

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7
Q

Vitamin deficiency associated with swollen gums, poor wound healing, bleeding mucous membranes, spots on skin

A

Vit C

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8
Q

Vitamin deficiency associated with dermatitis, diarrhea, dementia

A

-Pellagra

Niacin B3

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9
Q

Vitamin deficiency associated with hemorrhagic disease

A

Vit K

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10
Q

Vitamin deficiency associated with neural tube defects

A

Folate B9

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11
Q

Vitamin deficiency associated with pernicious anemia

A

B12

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12
Q

Vitamin deficiency associated with kidney disease

A

Vit D

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13
Q

Vitamin deficiency associated with bitot spots, keratomalacia, xerophthalmia

A

vit A

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14
Q

Vitamin deficiency associated with cheilosis and glossitis

A

B vitamins - 2, 3, 9, 12

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15
Q

Vitamin deficiency associated with dilated cardiomyopathy, edema, polyneuropathy

A

Wet beriberi - Thiamin def B1

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16
Q

Vitamin deficiency associated with osteomalacia and rickets

A

Vit D

17
Q

Epistaxis management

A

Direct pressure continuously for 10-15 min
Oxymetazoline (afrin) nasal spray - alpha 1 agonist
Cautery - silver nitrate or electrical
Nasal packing - nasal tampon, gauze

18
Q

Presentation and treatment of otitis externa

A 
Hx of swimming, muffled hearing
Pain with manipulation of pinna
External ear canal edematous and erythematous
Scant purulent debris in canal
Normal TM
Tx: 
clean ear canal - irrigate with H2O2
Topical Abx gtt:
-Ofloxacin, ciproflox
-Polymixin B + neomycin
-Tobramycin, gentamicin
Topical steroids:
-Hydrocortisone
-Dexamethasone
Analgesics - NSAIDs, tylenol
19
Q

Allergic Rhinitis

A

Presentation: sneezing, nasal congestion, watery nasal discharge, itching eyes
PE: no cervical LAD, nasal congestion with non-purulent nasal discharge

Tx:
Glucocorticoid nasal spray
-Fluticasone (Flomax), mometasone, triamcinolone, budesonide
Nasal decongestant spray
-Oxymetazoline (afrin) no more than 2-3 days as mono therapy - risk rebound congestion
Antihistamines
-benadryl, loratadine (claritin), fexofenadine (allegra), cetirizine (zyrtec)
Montelukast (singulair)
second line: cromolyn (stabilize mast cells), ipratropium spray - anticholinergic

Nasal spray/saline rinse
SQ immunotherapy

20
Q

BPH - presentation, exam, treatment

A

urinary hesitancy, frequency, and weak urine stream gradually worsening over 3 months

PE: symmetrically enlarged, smooth, nontender
Labs: normal UA

Tx:
Alpha blockers: relaxation of sm.m. in capsule of prostate and urethra/bladder neck -> less compression of urethra
Nonselective: vasodilation -> BP effects
-doxazosin, terazosin, alfuzosin
Selective: tamsulosin, silodosin

5 alpha reductase inhibitors: block T conversion to DHT, leads to shrinkage of prostate

  • Side effects: decreased libido, ED
  • Finasteride, dutasteride
21
Q

Indication for antibiotics in rhinosinusitis

A

Majority caused by virus

Indications:
Sxs 7 or more days PLUS
-purulent nasal discharge
-Maxillary tooth or facial pain - esp unilateral
-unilateral maxillary sinus tenderness on exam
-Worsening sxs after initial improvement

Abx: 5-7 day course

  • Augmentin
  • Doxy
  • Levaquin or moxifloxicin

Clarithro, azithro, 2nd or 3rd gen celphalosporins not recommended given s. pneumonia resistance

Consider nasal steroid spray in addition to abx

DIT Level 3 (32 decks)

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