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Complex step 3 > COMLEX 3 (DIT, COMBANK, MTB) > Flashcards

COMLEX 3 (DIT, COMBANK, MTB) Flashcards

1
Q

MC microorganism in exogenous endopthalmitis

A

Staphylococcus epidermidis (eye infection)

Endophthalmitis is an inflammation of the interior of the eye

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2
Q

Sensitivity equation

A

TP / TP + FN

screening test positive in pts with a disease

likelihood that a test will detect all people with the disease
SN-OUT - negative test, rules out disease
ifits perfectly sensitive then no false negatives

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3
Q

Specificity equation

A

TN / TN + FP

probability test will be negative in pts w/o disease

likelihood that people without disease are correctly identified as disease free by a test

SP-in - specificity, positive test rules in disease

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4
Q

Positive Predictive Value (PPV)

A

TP / TP + FP

probability someone with positive test has disease

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5
Q

Attributable risk calculation

A

AR = (A/A+B) - (C/C+D)

difference in rates between exposed and unexposed populations

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6
Q

Incidence equation

A

New cases of dz / Population at risk

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7
Q

Prevalence equation

A

of people with disease currently / total population

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8
Q

Compares a group of people with a given disease to a group w/o the disease

A

Case control

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9
Q

Compares a group with a given risk factor or exposure to a group without that risk factor

A

Cohort

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10
Q

Relative risk calculation

A

(A/A+B)/(C/C+D)

probability of getting a disease in a group exposed to specific risk factor compared to probability of getting disease in unexposed group

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11
Q

Absolute risk reduction

A

(C/C+D) - (A/A+B)

Difference in rates of disease between exposed and unexposed populations

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12
Q

Number needed to treat

A

1/ARR

ARR = (C/C+D) - (A/A+B)

number of pts that have to be treated in order to prevent one negative outcme

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13
Q

Standard error of mean

A

“sigma / square root of sample size


“

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14
Q

Z-value for CI = 90%

A

1.645

CI = [(mean - Z(SEM) to (mean + Z(SEM)]

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15
Q

Z-value for CI = 95%

A

1.96

CI = [(mean - Z(SEM) to (mean + Z(SEM)]

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16
Q

Z-value for CI = 99%

A

2.57

CI = [(mean - Z(SEM) to (mean + Z(SEM)]

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17
Q

Chest Pain + Pleuritic Pain (changes with respiration) DDx

A

Pulmonary embolism
Pneumonia
Pleuritis
Pericarditis
Pneumothorax

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18
Q

Ages that make cardiac family hx significant

A

Female relatives < 65
Male relatives < 55

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19
Q

S3 gallop

A

“Dilated Left Ventricle

"”Rapid ventricular filling during diastole””

As soon as the mitral valve opens, blood rushes into the ventricle, causing a splash sound transmitted as an S3”

S3 or Ventricular Gallop

  • After S2
  • Failing left ventricle, increased blood volume in ventricles
  • Dilated CHF
  • Ken-tuck-y
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20
Q

S4 gallop

A

Left ventricular hypertrophy

The sound of atrial systole into a stiff or noncompliant ventricle

S4 or Atrial Gallop

  • Before S1
  • Blood being forced into hypertrophic left ventricle
  • Failing left ventricle, restrictive cardiomyopathy.
  • Tenn-ess-ee
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21
Q

Mitral regurgitation murmur

A

Holosystolic

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22
Q

Best initial test for ischemic-like pain

A

EKG

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23
Q

Most accurate test for ischemic-like pain

A

Troponin or CK-MB

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24
Q

Which cardiac enzyme will rise first with an MI?

A

Myoglobin (1-4 hours)

Troponin and CK-MB will rise 3-6 hours after

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25
Q

Most accurate method to evaluate ejection fraction

A

Nuclear ventriculogram

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26
Q

Medication that reduces mortality in ACS

A

Aspirin

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27
Q

Medication that inhibits ADP activation and only given if angioplasty is done

A

Prasugrel (Brilinta)

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28
Q

3 meds that block ADP-mediated activation of platelets

A

Clopidogrel
Ticagrelor
Prasugrel

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29
Q

_____________ activate plasminogen into plasmin

A

Thrombolytics

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30
Q

What medication will lower mortality in ACS if the EF is low?

A

ACE-inhibitors and ARBs

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31
Q

Therapy that ALWAYS lowers mortality in ACS

A

Aspirin
Thrombolytics
Primary angioplasty
Metoprolol
Statins
Clopidogrel, prasugrel, or ticagrelor

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32
Q

When do you use CCBs in ACS?

A

Patient has:

  • Intolerance to BBs (like asthma)
  • Cocaine induced CP
  • Coronary vasospasm (prinzmetal’s angina)
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33
Q

When is a pacemaker the answer for acute MI?

A

1) NEW LBBB
2) Symptomatic bradycardia
3) Bifasicular block
4) 2nd AV block, Mobitz II
5) 3rd degree AV block

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34
Q

Cardiogenic Shock (Diagnostic Test and Treatment)

A

Diagnostic Test: ECHO, Swan-Ganz catheter

Treatment: ACE-i, urgent revascularization

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35
Q

Valve Rupture (Diagnostic Test and Treatment)

A

Diagnostic Test: ECHO

Treatment: ACE-i, nitroprusside, intra-aortic balloon pump as bridge to surgery

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36
Q

Septal Rupture (Diagnostic Test and Treatment)

A

Diagnostic Test: ECHO

Treatment: Ace-i, nitroprusside, and urgent surgery

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37
Q

Myocardial wall rupture (Diagnostic Test and Treatment)

A

Diagnostic Test: ECHO

Treatment: Pericardiocentesis, urgent cardiac repair

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38
Q

Sinus bradycardia (Diagnostic Test and Treatment)

A

Diagnostic Test: EKG

Treatment: Atropine, followed by pacemaker if there are still symptoms

Sinus bradycardia can be the result of many things including good physical fitness, medications, and some forms of heart block.

“Sinus” refers to the sinus node, the heart’s natural pacemaker which creates the normal regular heartbeat.

“Bradycardia” means that the heart rate is slower than normal

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39
Q

3rd degree heart block (Diagnostic Test and Treatment)

A

“Diagnostic Test: EKG, cannon ““a”” waves

Treatment: Atropine and pacemaker EVEN if symptoms resolve”

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40
Q

“Cannon ““a”” waves”

A

“3rd degree heart block

Cannon A waves, or cannon atrial waves, are waves seen occasionally in the jugular vein of humans with certain cardiac arrhythmias. When the atria and ventricles contract simultaneously, the blood will be pushed against the AV valve, and a very large pressure wave runs up the vein.[1][2] It is associated with heart block, in particular third-degree (complete) heart block

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41
Q

Right ventricular infarction (Diagnostic Test and Treatment)

A

Diagnostic Test: EKG showing right ventricular leads

Treatment: Fluid loading

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42
Q

Electrolyte abnormality caused by ACE-i or ARBs

A

Hyperkalemia

With ACE inhibitor use, the production of ATII is decreased, which prevents aldosterone release from the adrenal cortex. This allows the kidney to excrete sodium ions along with obligate water, and retain potassium ions. This decreases blood volume, leading to decreased blood pressure.

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43
Q

Ranolazine

A

“Anti-angina med added if no other meds control pain

”

Ranolazine is used to treat chronic angina. It may be used concomitantly with β blockers, nitrates, calcium channel blockers, antiplatelet therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers.

Contraindications

Some contraindications for ranolazine are related to its metabolism and are described under Drug Interactions. Additionally, in clinical trials ranolazine slightly increased QT interval in some patients and the FDA label contains a warning for doctors to beware of this effect in their patients. The drug’s effect on the QT interval is increased in the setting of liver dysfunction; thus it is contraindicated in persons with mild to severe liver disease.

Ranolazine prolongs the action potential duration, with corresponding QT interval prolongation on electrocardiography, blocks the INa current, and prevents calcium overload caused by the hyperactive INa current, thus it stabilizes the membrane and reducing excitability.

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44
Q

LDL goal in a patient with CAD and Diabetes

A

LDL goal at least < 70

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45
Q

MC adverse effect of statin medications is _____ ________

A

Liver toxicity

LFTs should be routinely checked

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46
Q

Melanoma suspicion AND most appropriate NEXT step in management

A

“Excisional biopsy


“

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47
Q

Shingle/Herpes zoster AND most appropriate management

A

“1.) 7-day course of anti-viral drug within 72 hours
- Acyclovir, Valcyclovir, or Famciclovir

  1. ) Analgesics
  2. ) Herpes zoster vaccine (Recommended in ages > 60)


“

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48
Q

Pruritic, purple, polygonal papules

A

“Lichen planus

tx: topical corticosteroids


“

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49
Q

Scabies tx

A

“Topical permethrin or Oral ivermectin


“

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50
Q

Mongolian spot AND most appropriate next step in management

A

“Reassurance


“

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51
Q

Stevens-Johnson syndrome / Toxic epidermal necrolysis TX

A

“1.) Admit to ICU or burn unit

  1. ) Stop offending drug
  2. ) Wound care
  3. ) Supportive treatment (fluids, electrolytes, pain control)
  4. ) Monitor for bacterial superinfection


“

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52
Q

Vancomycin-induced RED MAN’s syndrome TX/management

A

“1.) Stop vancomycin infusion

  1. ) Give benadryl + ranitidine
  2. ) Restart infusion @ slower rate


“

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53
Q

What conditions are associated with erythema nodosum?

A

“1.) Streptococcus pharyngitis

  1. ) Sarcoidosis
  2. ) TB
  3. ) Fungal infections
    - Coccidiomycosis
    - Histoplasmosis
    - Blastomycosis
  4. ) Inflammatory bowel disease
  5. ) Pregnancy/OCP use
  6. ) Idiopathic


“

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54
Q

Post-infectious oral erosions and target lesions

A

Erythema multiforme

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55
Q

Stasis dermatitis tx

A

“1.) Leg elevation

  1. ) Compression stockings
  2. ) Treat underlying cause


“

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56
Q

Developmental mile-stones at 9 months of age

A

“Expected to begin to say ““dada/mama””
Understand the meaning of ““no””
Crawl
Pull to a stand
Use a 3-finger pincer grasp
Wave ““bye-bye””
Play pat-a-cake”

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57
Q

First line treatment for hyperosmolar coma

A

Fluid resuscitation with isotonic saline

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58
Q

6-day old male w/fever, irritability, and an erythematous rash around the mouth. One day later, the rash generalizes and flaccid blisters appear. The upper layer of the skin begins to slough off, especially when gentle lateral pressure is applied to skin. Dx, Organism, and Treatment:

A

Staphylococcus scalded skin syndrome

S. aureus

  1. ) IV Anti-staph abx
    - Nafcillin/oxacillin
  2. ) Supportive Care
    - Emollients
    - IV Fluids
    - Correct electrolytes
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59
Q

Staphylococcus scalded skin syndrome (characteristics)

A

“Flaccid blisters

+ Nikolsky

No mucous membranes

Tx: Nafcillin/oxacillin


“

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60
Q

What are the treatment options for actinic keratosis?

A

“1.) Cryotherapy

2.) Curettage

  1. ) Topical:
    - 5-fluorouracil
    - Imiquimod
    - Ingenol mebutate

4.) Photodynamic therapy


“

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61
Q

Pemphigus vulgaris vs. Bullous pemphigoid

A

Pemphigus vulgaris:
+ Nikolsky
+ oral involvement
Systemic corticosteroids
+/- immunosuppression

Bullous pemphigoid
Tense blisters
Rare oral involvement
Topical corticosteroids
+/- immunosuppression

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62
Q

Pemphigus vulgaris tx

A

“Flaccid blisters (+ Nikolsky)
Oral involvement

Treatment:
Systemic glucocorticoids
- Prednisone
- Prednisolone

+/- Immunosuppression
Azathioprine
Mycophenalate


“

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63
Q

Bullous pemphigoid tx

A

“Tense, sub-epidermal blisters
(-) Nikolsky
Oral involvement rare (10-30%)

Treatment:
Topical corticosteroids
- Clobetasol

+/- Immunosuppression
Azathioprine
Mycophenalate


“

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64
Q

Hep C + skin blisters in the sun (Dx and Tx)

A

Dx: Porphyria cutanea tarda

Treatment:

Avoid triggers (alcohol, estrogen, poly-hydrocarbons)

Phlebotomy (removing excess iron)

Chloroquine

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65
Q

“Herald patch + ““christmas tree pattern”” rash”

A

“Pityriasis rosea

Tx:
Reassurance
Topical Corticosteroids

IF SEVERE: acyclovir


“

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66
Q

What should be done prior to initiating isotretinoin therapy in a teenage girl?

A
  1. ) Counseling and education
  2. ) Pregnancy test x2 (and tests throughout)
  3. ) 2 forms of birth control
  4. ) Labs (Lipids, LFTs, CBC, preg)
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67
Q

Nodular basal cell carcinoma classic description

A

“Papular
Pearly
Translucent
Telangiectasia
Painless/raised


“

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68
Q

Lice tx

A

“1.) Permethrin cream (MC)

  1. ) Malathion
  2. ) Benzyl alcohol
  3. ) Spinosad
  4. ) Ivermectin
  5. ) Lindane (last resort/neurotoxic)


“

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69
Q

A 2-year old boy is brought to the office by his mother because of a 1-year history of dry skin despite frequent application of moisturizing lotion. She says that he constantly scratches skin. Physical examination shows erythematous patches and scaling on the: face, neck, and ANTECUBITAL/POPLITEAL fosse What is the most likely diagnosis? This patient is as increased risk for what condition later in life?

A

“Atopic dermatitis / eczema

ASTHMA


“

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70
Q

What is the classic description of a cutaneous squamous cell carcinoma lesion?

A

“Head/neck (MC location)
Plaque/papule/nodule
Ulceration
Crusting
Hyperkeratosis
““Non-healing ulcer””


“

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71
Q

WPW syndrome and digoxin

A

AVOIDED

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72
Q

Initial slurring of the QRS is called the _____ wave and is associated with ___ syndrome

A

Delta wave

WPW

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73
Q

What is a delta wave on EKG associated with?

A

“WPW syndrome


“

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74
Q

WPW syndrome tx

A

“Carotid massage
Procainamide
Valsava manneuver
Cardioversion if unstable


“

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75
Q

DEXA scan up to -1

A

normal range

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76
Q

DEXA scan -1 to -2.5

A

Osteopenia

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77
Q

DEXA scan < -2.5

A

Osteoporosis

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78
Q

When should a DEXA scan be ordered as preventative screening?

A

Hx of cigarette smoking
Chronic glucocorticoid therapy
BW less than 127 lbs
Previous fractures
Excessive alcohol intake

DEXA scanning should be performed in women:
> 65 as screening OR
in post-menopausal women < 65 with risk factors

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79
Q

Acute Pulmonary Edema tx

A

“Oxygen
Furosemide
Nitrates
Morphine


“

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80
Q

Carvedilol MOA

A

Beta 1, Beta 2, and Alpha 1 antagonist

Thus it is:
Anti-arrhythmic
Anti-ischemic
Anti-hypertensive

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81
Q

Milrinone and Inamrinone MOA

A

Phosphodiesterase inhibitors
Increase contractility
Decrease afterload
Vasodilators

(similar effect that dobutamine has)

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82
Q

Dopamine MOA

A

Alpha-1 agonist
Vasoconstriction
Increases afterload
Increases contractility

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83
Q

Hypoxia in CHF causes respiratory __________

A

Alkalosis

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84
Q

Further management in CHF/pulmonary edema when furosemide, oxygen, nitrates, and morphine are given and the patient is still SOB

A

Dobutamine
Inamrinone
Milrinone

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85
Q

Acute Pulmonary Edema + Ventricular Tachycardia. Next step?

A

Synchronized cardioversion

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86
Q

What is Nesiritide?

A

____________ is a synthetic version of atrial natriuretic peptide that is used for acute pulmonary edema as part of preload reduction

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87
Q

Pulmonary edema is associated with decrease in _______ ______ due to pump failure, which results in backup of blood into the left atrium causing ___________ wedge pressure

A

Cardiac Output

Increased

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88
Q

Wedge pressure =

A

Left Atrial Pressure

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89
Q

BB’s with evidence of lowering mortality in CHF

A

Metoprolol
Carvedilol
Bisoprolol

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90
Q

In CHF when ACE inhibitors and ARBs cannot be used

A

Hydralazine + Nitrates

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91
Q

ANY PATIENT originally presenting with pulmonary edema should get ______________

A

Spironolactone

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92
Q

SA nodal inhibitor used in systolic CHF when BB’s can’t be used

A

Ivabradine

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93
Q

Decreased mortality in CHF with these 3 drugs (drug/classes)

A

ACE/ARB
Beta blocker
Spironolactone

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94
Q

Systolic dysfunction drugs

A

ACE/ARB
Metoprolol, carvedilol, Bisoprolol
Spironolactone or eplerenone
Diuretics
Digoxin
Hydralazine/nitrates

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95
Q

Diastolic dysfunction drugs

A

Metoprolol, carvedilol, bisoprolol
Diuretic

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96
Q

______________________________ are indicated in dilated cardiomyopathy with an EF below 35%

A

Implantable cardioverter/defibrillator

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97
Q

Severe CHF with EF < 35% and wide QRS ( > 120 msec)

A

Biventricular pacemaker

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98
Q

“SOB, ““worse with exertion/exercise””, and young female”

A

Mitral valve prolapse

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99
Q

“SOB, ““worse with exertion/exercise””, and healthy, young athlete”

A

Hypertrophic obstructive cardiomyopathy

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100
Q

“SOB, ““worse with exertion/exercise””, and immigrant and/or pregnant”

A

Mitral stenosis

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101
Q

“SOB, ““worse with exertion/exercise””, and turner’s syndrome and/or coarctation of aorta”

A

Bicuspid aortic valve

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102
Q

“SOB, ““worse with exertion/exercise””, and palpitations w/atypical chest pain (no CP with exertion)”

A

Mitral valve prolapse

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103
Q

If a murmur INCREASES in intensity with EXHALATION think _______ side of heart

A

LEFT

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104
Q

If a murmur INCREASES with INHALATION think _______ side of heart

A

RIGHT

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105
Q

AS, AR, MS, MR, and VSD ALL _________ with increased venous return to heart (squat or leg raise)

A

INCREASE

They will DECREASE with decreased venous return to heart (stand or valsalva)

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106
Q

Which are the only two murmurs that DECREASE with increased venous return to heart (squat or leg raise)

A

MVP and HOCM

They will INCREASE with decreased venous return to heart (stand or valsalva)

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107
Q

Handgrip WORSENS which murmurs?

A

AR, MR, VSD

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108
Q

Amyl nitrate as a vasodilator ____________ AR and MR

A

improves

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109
Q

Amyl nitrate _____________ the murmurs of MVP, HOCM, and AS

A

worsens

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110
Q

Handgrip SOFTENS which murmurs?

A

MVP, HOCM, AS

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111
Q

BEST INITIAL test for valvular heart disease

A

ECHOCARDIOGRAM

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112
Q

Most accurate test for valvular heart disease

A

LEFT heart cath

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113
Q

“If ““handgrip”” makes a murmur worse, then use…”

A

ACE inhibitors (most effective medical therapy)

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114
Q

Regurgitant lesions tx

A

Vasodilator therapy

  • ACE
  • ARB
  • Nifedipine
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115
Q

Stenotic lesions are best treated with

A

Anatomic repair

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116
Q

”"”Valsava”” improves murmur = _____________ indicated”

A

Diuretics

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117
Q

Older patient with chest pain and hx of HTN Has a murmur: DECREASES with standing, valsalva, and handgrip INCREASES with leg-raising, squatting, and amyl nitrate

A

“Aortic stenosis


“

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118
Q

Mild, moderate, and severe disease in AS based on pressure gradient across the valve (criteria)

A

30 mm Hg: mild

30-70 mm Hg: moderate

> 70 mm Hg: severe

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119
Q

Best INITIAL treatment for AS vs. treatment of choice

A 
Diuretics (initial)
Valve replacement (treatment of choice)
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120
Q

Aortic regurgitation DDx

A

“Hypertension
Rheumatic heart disease
Endocarditis
Cystic medial necrosis

Rarer:
Marfan’s
Ankylosing spondylitis
Syphilis
Reactive arthritis


“

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121
Q

”"”Diastolic decrescendo murmur heard best at Left sternal border”” Increases in intensity with leg raising, squatting, and handgrip”

A

Aortic Regurgitation

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122
Q

Quincke pulse

A

“Aortic regurgitation

Arterial or capillary pulsations in fingernails


“

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123
Q

Corrigan’s pulse

A

“Aortic regurgitation

High bounding pulses (AKA water-hammer pulse)


“

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124
Q

Musset’s sign

A

Aortic regurgitation

Head bobbing up and down with each pulse

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125
Q

Duroziez’s sign

A

Aortic regurgitation

Murmur heard over the femoral artery

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126
Q

Hill sign

A

Aortic regurgitation

Blood pressure gradient much higher in lower extremities

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127
Q

Aortic regurgitation TESTING

A

Best initial: TTE
More accurate: TEE
Most accurate: Left heart cath

ADD in: EKG and CXR showing LVH

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128
Q

Aortic regurgitation

A

“Best initial therapy: ACE/ARBs and Nifedipine

ADD in Loop diuretic for CCS


“

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129
Q

AR treatment with EF < 55% OR Left ventricular end systolic diameter > 55mm

A

SURGERY, even if asymptomatic

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130
Q

Abscess tx

A

Warm compresses
Incision & Drainage
Abx:
- Clindamycin
- TMP-SMX

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131
Q

Antibiotics for abscess tx

A

Clindamycin & TMP-SMX

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132
Q

Impetigo tx (antibiotics)

A

“Topical Antibiotics

  • Mupurocin
  • Retapamulin

IF SEVERE: oral dicloxacillin or cephalexin


“

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133
Q

“Superficial infection, w/papules that progress to vesicles and pustules, and finally ““honey-colored crusts”””

A

“Impetigo


“

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134
Q

MC organism for Impetigo

A

S. aureus

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135
Q

MC organism for Erysipelas

A

Strep pyogenes

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136
Q

Microorganisms in Cellulitis

A

S. aureus
S. pyogenes
OTHERS

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137
Q

Depth of infection in erysipelas

A

Upper dermis

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138
Q

Depth of infection in cellulitis

A

Deeper dermis and sub Q fat

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139
Q

“Skin infection w/spreading warmth, edema, redness AND ““INDISTINCT borders”””

A

Cellulitus

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140
Q

Skin infection w/painful, red, raised lesions AND a clearly demarcated border

A

“Erysipelas


“

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141
Q

Erysipelas tx

A

Oral penicillin or amoxicillin

IF SEVERE: IV ceftriaxone or cefazolin

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142
Q

Cellulitis tx

A

Oral dicloxacillin or cephalexin

IF SEVERE: IV cefazolin or clindamycin

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143
Q

Cellulitis borders are _______________ (key word)

A

“Indistinct


“

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144
Q

What is the appropriate management of a necrotizing soft tissue infection?

A

Surgical debridement
IV broad spectrum abx
Supportive care (IV fluids and vasopressors)

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145
Q

IV broad spectrum abx for necrotizing soft tissue infection

A

Carbapenem or Beta-lactam/Beta-lactamase inhibitor (ex: zosyn)

Clindamycin

MRSA coverage (vancomycin)

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146
Q

What lab should you monitor when putting patients on terbinafine, itraconazole, or griseofulvin?

A

LFTs, these agents are hepatotoxic

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147
Q

Patient appears toxic w/fever, crepitus, and pain out of proportion to exam w/skin infection

A

“Necrotizing soft tissue infection


“

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148
Q

Tinea unguium tx

A

“Oral antifungals

  • Terbinafine
  • Itraconazole
  • Griseofulvin


“

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149
Q

Tinea pedis tx

A

“Topical antifungals

  • Terbinafine
  • Naftifine
  • Clotrimazole


“

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150
Q

Tinea corporis tx

A

“Topical antifungals

  • Terbinafine
  • Naftifine
  • Clotrimazole


“

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151
Q

Tinea capitis tx

A

“Oral antifungals

  • Terbinafine
  • Itraconazole
  • Griseofulvin


“

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152
Q

Potentially how long could a patient need anti-fungal treatment for dermatophyte infection?

A

12 weeks

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153
Q

Terbinafine, Itraconazole, & Griseofulvin in treating tinea capitis/unguium

A

Oral antifungals

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154
Q

“Warts with ““stuck-on”” appearance”

A

“Seborrheic keratosis


“

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155
Q

Seborrheic keratosis tx

A

“Curettage AFTER cryosurgery


“

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156
Q

Podophyllin, Trichloroacetic acid, or 5-fluorouracil

A

Topical agents for condyloma acuminata

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157
Q

19-year-old woman w/fever, hypotension, AMS, rash w/history of being on menstrual cycle recently

A

Toxic Shock Syndrome

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158
Q

Toxic Shock Syndrome tx

A

“1.) Remove source of infection (tampon)

  1. ) Supportive care (IV fluids/pressors)
  2. ) Abx: Clindamycin and Vancomycin


“

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159
Q

What are the treatment options for condyloma acuminata?

A
  1. ) Topical agents
  2. ) Immune modulators
  3. ) Surgical removal
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160
Q

Condyloma acuminata tx (immune modulators)

A

Imiquimod
IFN-alpha

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161
Q

Condyloma acuminata tx

A

“1.) Topical agents (podophyllin, acid, 5-fu)

  1. ) Immune modulators (Imiquimod, IFN-a)
  2. ) Cryosurgery
  3. ) Laser therapy
  4. ) Surgical excision


“

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162
Q

+ Nikolsky sign ddx

A

“Stevens-Johnson syndrome
Toxic epidermal necrolysis
SSSS
Pemphigus vulgaris


“

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163
Q

Psoariasis tx

A

“1.) Emollients

  1. ) Topical corticosteroids
  2. ) Topical calcineurin inhibitors
  3. ) Topical retinoids
  4. ) Topical vitamin D
  5. ) Phototherapy
  6. ) Biologic agents


“

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164
Q

Biologic agents in severe Psoariasis tx

A

Methotrexate
Cyclosporine
Adalimumab
Etanercept
Infliximab

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165
Q

Topical corticosteroids in Psoariasis tx

A

Hydrocortisone
Betamethasone
Clobetasol

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166
Q

Topical calcineurin inhibitor in Psoariasis tx

A

Tacrolimus

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167
Q

Seborrheic dermatitis tx

A

“1.) Anti-fungal shampoo

  • Selenium sulfide
  • Ketoconazole
  1. ) Topical corticosteroid
  2. ) Topical anti-fungal


“

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168
Q

Patients with severe injuries such as burns, short bowel syndrome, or those receiving TPN are at risk for _________ deficiency

A

Chromium

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169
Q

Chromium deficiency + Diabetes

A

Increased insulin requirements, supplementation with chromium can improve glucose tolerance

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170
Q

Patient with fragile-abnormal hair, depigmented skin, ataxia, neuropathy, cognitive defects, edema, and osteoporosis + microcytic anemia / neutropenia

A

Copper deficiency

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171
Q

Patient with microcytic anemia that gets worse with iron supplementation

A

Copper deficiency

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172
Q

Perioral/perianal rash + diarrhea + hair loss

A

Zinc deficiency

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173
Q

Skeletal muscle dysfunction, cardiomyopathy, mood disorders, impaired immunity, macrocytosis, and white nail beds

A

Selenium deficiency

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174
Q

Patient with suspected BPH and urinary retention. What do you need to evaluate next?

A

Renal function and r/o infection and hematuria with BMP and urinalysis

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175
Q

BPH + renal insufficiency (elevate Cr). Next step?

A

Renal ultrasound to evaluate for bladder outlet obstruction or hydronephrosis

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176
Q

What is the ACLS protocol for ventricular fibrillation?

A

“Shock FIRST then CPR immediately


“

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177
Q

What is the ACLS protocol for pulseless electrical activity or asystole?

A

“CPR FIRST, Drugs, Evaluate and treat H’s and T’s


“

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178
Q

H’s of PEA/aystole

A

Hypovolemia
Hypoxemia
H+ (acidosis)
Hyperkalemia
Hypokalemia
Hypoglycemia
Hypothermia

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179
Q

T’s of PEA/aystole

A

Tamponade
Tension pneumothorax
Thrombosis (MI or PE)
Trauma
Toxins or Tablets

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180
Q

Hypovelmia and PEA/aystole tx

A

Volume resucitation

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181
Q

Hypoxemia and PEA/aystole tx

A

Intubation, oxygen, chest tube

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182
Q

H+ (acidosis) and PEA/aystole tx

A

Bicarbonate

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183
Q

Hyperkalemia and PEA/aystole tx

A

Calcium chloride/gluconate
Bicarbonate
Insulin and glucose

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184
Q

Hypokalemia and PEA/aystole tx

A

Potassium chloride

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185
Q

Hypoglycemia and PEA/asytole tx

A

D50

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186
Q

Hypothermia and PEA/aystole tx

A

Warm

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187
Q

Tamponade and PEA/aystole tx

A

Pericardiocentesis

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188
Q

Tension pneumothorax and PEA/aystole tx

A

Needle decompression
Chest tube

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189
Q

Thrombosis (MI) and PEA/aystole tx

A

Cardiac cath
Thrombolytics

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190
Q

Thrombosis (PE) and PEA/aystole tx

A

Thrombolysis
Thrombectomy

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191
Q

Trauma patient with high-riding prostate OR blood at urethral meatus

A

Suspect urethral injury
- Do a retrograde cystourethrogram BEFORE foley

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192
Q

What study is used to diagnose injury to urethra or bladder following trauma?

A

Retrograde cystourethrogram

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193
Q

What type of IV nutrition is recommended for a patient with acute alcohol withdrawal?

A

Potassium
Magnesium
Phosphate
Thiamine
Glucose

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194
Q

Acute alcohol withdrawal tx

A

IV Fluids
IV nutrition
Benzodiazepines
Propofol (if severe)
Respiratory support

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195
Q

Benzo’s for acute alcohol withdrawal

A

Diazepam
Lorazepam
Chlordiazepoxide

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196
Q

What are the indications for emergent hemodialysis in acute renal failure?

A

”


“

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197
Q

What empiric antibiotic prophylaxis is used for cat and dog bites?

A

”


“

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198
Q

What empiric antibiotic treatment is used for an INFECTED cat or dog bite?

A

”


“

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199
Q

What is the treatment for carbon monoxide poisoning?

A

”


“

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200
Q

What is the treatment for acquired methemoglobinemia?

A

”


“

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201
Q

What substances are known to cause malignant hyperthermia?

A

”


“

202
Q

What is the initial, standard treatment for malignant hyperthermia?

A

”


“

203
Q

When do you need to cool a patient with malignant hyperthermia?

A

Temp above 39 celsius or 102.2 F

204
Q

Malignant hyperthermia AND hyperkalemia tx

A

Calcium chloride
Bicarbonate
Furosemide
Insulin and glucose

205
Q

Difference between heat EXHAUSTION and heat STROKE

A

Exhaustion: Temp 101-104 F and no CNS dysfunction

Stroke: Temp > 104 F w/CNS dysfunction

206
Q

Patient comes in with suspected heat-related injury and has temperature above 104 F with CNS dysfunction?

A

Heat stroke

207
Q

Patient comes in with suspected heat-related injury and has temperature between 101-104 F without CNS dysfunction? (may also mention difficulty with exercise)

A

Heat exhaustion

208
Q

Td should be given to every adult every _________________

A

10 years

209
Q

Tdap booster is recommended ONCE in place of the Td between ages ______________ years

A

19-64

210
Q

Nontetanus-prone wound (LE, clean, minor) + 3 or more prior tetanus shots. When is a Td indicated?

A

Td if it’s been more than 10 years since last dose

211
Q

Tetanus-prone wound (dirt, contamination, puncture, crush injury) + 3 or more prior tetanus shots. When is a Td indicated?

A

Td if it’s been more than 5 years since last dose

212
Q

Patient is uncertain of last dose or if they have had the complete series (3). When do you give Td in nontetanus and tetanus prone wounds?

A

Td to complete series
DT if <7 years

213
Q

When do you give tetanus immune globulin and how much?

A

When a patient is uncertain of vaccination history and has a tetanus-prone wound

250 units IM

214
Q

PAINLESS, progressive obstructive jaundice

A

Pancreatic cancer

215
Q

Atropine administration and EYES

A

“Fixed and dilated pupils (mydriatic) with no response to light stimulation or accommodation


“

216
Q

-TROPs (possible adverse effects)

A

Confusion
Constipation
Urinary retention
Fever
Flushing
Tachycardia
Blurry vision
Mydriasis

217
Q

MC cause of mitral stenosis

A

Rheumatic fever

218
Q

Why are pregnant patients at risk for mitral stenosis?

A

Large increase in plasma volume

(more volume with same valve diameter means more pressure, backflow, and symptoms)

219
Q

Diastolic rumble after an opening snap + increase in intensity with leg-raising, squatting, or expiration

A

Mitral Stenosis

220
Q

Best initial diagnostic test for mitral stenosis

A

TTE (best initial)
TEE (more accurate)

221
Q

Most accurate test for mitral stenosis

A

Left heart catheterization

222
Q

”"”straightening of the left heart border and elevation of the left mainstream bronchus”” on chest x-ray”

A

Mitral stenosis

223
Q

Best initial therapy for mitral stenosis

A

Diuretics

224
Q

Most effective therapy for mitral stenosis

A

Balloon valvuloplasty

225
Q

SPECIAL features of mitral stenosis

A

Dysphagia: LA pressing on esophagus

Hoarseness: pressure on recurrent laryngeal nerve

Atrial fibrillation: leading to stroke

226
Q

Causes of mitral regurgitation

A

Hypertension
Ischemic heart disease
Conditions leading to dilated heart

227
Q

MC symptoms of mitral regurgitation

A

Dyspnea on exertion

228
Q

___ gallop is associated with fluid overload states, such as congestive heart failure or mitral regurgitation

A

S3

229
Q

S3 gallop DDx

A

CHF or Mitral regurgitation

230
Q

Holosystolic murmur, best heard at apex, radiates to axilla, and increased with leg-raising, squatting, and handgrip

A

Mitral regurgitation

231
Q

Holosystolic murmur, best heard at apex, DECREASES with standing, valsalva, and amyl nitrate

A

Mitral regurgitation

232
Q

Best initial diagnostic test for mitral regurgitation

A

TTE (best initial)
TEE (more accurate)

233
Q

Best initial therapy for mitral regurgitation

A

ACE-i
ARBs
Nifedipine

234
Q

Patient with mitral regurgitation and EF drops below 60% OR LV volume > 40mm

A

SURGERY repair or replacement

235
Q

Holosystolic murmur at the lower left sternal border, SOB, and worsens with exhalation, squatting and leg raise

A

VSD

236
Q

Best initial diagnostic test for VSD

A

ECHO

237
Q

More precise test to determine degree of left-to-right shunting in VSD

A

Cath

238
Q

Fixed splitting of S2

A

ASD

239
Q

When is repair indicated in ASD?

A

When the shunt ratio exceeds 1.5 to 1

240
Q

Wide splitting of S2, P2 delayed

A

RBBB
Pulmonic stenosis
Right ventricular hypertrophy
Pulmonary hypertension

241
Q

Paradoxical splitting of S2, A2 delated

A

LBBB
Aortic stenosis
Left ventricular hypertrophy
Hypertension

242
Q

Best initial test for dilated cardiomyopathy

A

ECHO

243
Q

Most accurate method for determining ejection fraction in dilated cardiomyopathy

A

MUGA or nuclear ventriculography

244
Q

MC causes of dilated cardiomyopathy

A

Ischemia
Alcohol
Adriamycin
Radiation
Chaga’s disease

245
Q

Treatment for ALL forms off dilated cardiomyopathy

A

ACE-i
ARBs
Beta blockers
Spironolactone

246
Q

Spironolactone and eplerenone, mineralocorticoid or aldosterone antagonists are given in dilated cardiomyopathy to…

A

Decrease the work of the heart; they are NOT given for their diuretic effect

247
Q

What do you give a patient with dilated cardiomyopathy if the heart rate is > 70 after the use of beta blockers

A

Ivabradine, a Na+ channel blockers

248
Q

S4 gallop is a sign of…

A

Left ventricular hypertrophy and decreased compliance or stiffness of the ventricle

249
Q

SOB on exertion and S4 gallop

A

Hypertrophic cardiomyopathy

250
Q

Hypertrophic cardiomyopathy EF

A

Normal!

251
Q

Mainstay of therapy in hypertrophic cardiomyopathy

A

Beta blockers AND diuretics

252
Q

Causes of Restrictive cardiomyopathy

A

History of:

  • Sarcoidosis
  • Amyloidosis
  • Hemochromatosis
  • Cancer
  • Myocardial fibrosis
  • Glycogen storage diseases
253
Q

Kussmaul’s sign

A

an increase in jugular venous pressure on inhalation

254
Q

SOB is the main presenting complaint in ALL FORMS of…

A

Cardiomyopathy

255
Q

SOB + Kussmaul’s sign

A

Restrictive cardiomyopathy

256
Q

“Low voltage EKG, ““speckled pattern”” on ECHO, and SOB”

A

Amyloid Restrictive cardiomyopathy

257
Q

Mainstay of diagnosis in Restrictive cardiomyopathy

A

ECHO

258
Q

Single most accurate diagnostic test of the etiology of Restrictive cardiomyopathy

A

Endomyocardial biopsy

259
Q

Best treatment for Restrictive cardiomyopathy

A

Diuretics and correcting underlying cause

(sarcoidosis, amyloidosis, hemochromatosis, cancer, myocardial fibrosis, glycogen storage disease, etc)

260
Q

Rare, sudden systolic dysfunction brought on by extreme emotions

A

Takotsubo Cardiomyopathy

261
Q

Post-menopausal woman with sudden psychological stress, presents like an acute MI, normal coronary arteries

A

Takotsubo Cardiomyopathy

262
Q

Takotsubo Cardiomyopathy treatment

A

ACE-i, Beta-blockers, and Diuretics

263
Q

_____________ adds efficacy to NSAIDs and prevents recurrent episodes in pericardial disease

A

Colchicine

264
Q

Pleuritic CP that is positional, sharp, and brief with a friction rub on physical exam

A

Pericardial disease

265
Q

Best initial test for pericarditis

A

EKG

  • ST segment elevation everywhere
  • PR segment depression in lead II (not always present)
266
Q

PR segment depression in lead II

A

“Pericarditis


“

267
Q

Causes of pericarditis

A

MC: Cancer
Others: infection, collagen vascular disease, or trauma

268
Q

Best initial therapy in pericarditis

A

NSAID:

  • Indomethacin
  • Naproxen
  • Aspirin
  • Ibuprofen

NSAID + Colchicine

269
Q

Persistent symptoms in pericarditis after NSAID + colchicine therapy

A

Oral prednisone

270
Q

SOB + Hypotension + Jugular venous distension

A

Pericardial tamponade

271
Q

Unique features of tamponade (physical exam and EKG)

A

Pulsus paradoxus + Electrical alternans

272
Q

Electrical alternans

A

“Alterations of the axis of the QRS complex on EKG


“

273
Q

Pulsus paradoxus

A

“Decrease in BP > 10 mm Hg on inhalation


“

274
Q

Most accurate diagnostic test in cardiac tamponade

A

“ECHO: ““diastolic collapse of the right atrium and right ventricle”””

275
Q

EKG findings of cardiac tamponade

A

Low voltage and electrical alternans

276
Q

”"”Equalization”” of all pressures in heart during diastole on right heart catheterization”

A

Cardiac tamponade

277
Q

Best initial therapy for cardiac tamponade

A

Pericardiocentesis

278
Q

Most effective long-term therapy in cardiac tamponade

A

Pericardial window placement

279
Q

MOST DANGEROUS therapy in cardiac tamponade

A

Diuretics

280
Q

SOB + chronic right heart failure + positional, pleuritic pain

A

Constrictive pericarditis

281
Q

Signs of chronic RIGHT heart failure

A

Edema, JVD, Hepatosplenomegaly, Ascites

282
Q

Pericardial knock

A

EXTRA diastolic sound from the heart hitting a calcified, thickened pericardium

283
Q

Calcification surrounding the heart on CXR, low voltage on EKG, and thickened pericardium on CT/MRI

A

Constrictive pericarditis

284
Q

Best initial therapy for constrictive pericarditis

A

Diuretics

285
Q

Most effective therapy for constrictive pericarditis

A

Surgical removal of the pericardium (pericardial stripping)

286
Q

Abdominal aortic aneurysms are repaired when they are bigger than ____ cm

A

5

287
Q

“CP radiating to the back between the scapula, described as ““ripping””, and a difference in BP between right and left arms”

A

Aortic dissection

288
Q

Best initial test for aortic dissection

A

CXR showing widened mediastinum

289
Q

Most accurate test for aortic dissection

A

CT angiography

290
Q

Aortic dissection management

A
  1. ) Order beta blockers, EKG, and CXR
  2. ) Next: CT, TEE, or MRA (all equally accurate)
  3. ) Add nitroprusside to control BP
  4. ) ICU transfer + surgical consult
291
Q

Most effective therapy for aortic dissection

A

Surgical correction

292
Q

AAA screening guidelines

A

U/S in men 65-75 years old who are current or former smokers

293
Q

Pain + Pallor + Pulseless =

A

Arterial occlusion

294
Q

Acute loss of pulse, cold extremity, and pain with history of AS or a-fib

A

Acute arterial embolus

295
Q

Best initial test in PAD

A

Ankle-brachial index (ABI)

296
Q

Normal ABI

A

Equal to or greater than 0.9

297
Q

Greater than 10% difference in BP when comparing legs

A

Obstruction is present

298
Q

Most accurate test in PAD

A

Angiography

299
Q

Best initial therapy in PAD

A

Aspirin
BP control w/ACE-inhibitor
Exercise as tolerated
Cilostazol
Lipid control w/statins (LDL < 100 is goal)
Vorapaxar

300
Q

Vorapaxar

A

Anti-platelet drug given in PAD w/aspirin or clopidogrel

301
Q

Palpations and an irregular pulse in a person with a history of HTN, ischemia, or cardiomyopathy

A

A-fib

302
Q

A-fib patients who are hemodynamically STABLE should undergo _______ monitoring outpatient

A

Holter

303
Q

Other tests to order once A-fib is found on EKG

A

ECHO
Thyroid function testing (T4 and TSH)
Electrolytes (K+, mag, and Ca++)
Troponin or CK-MB levels

304
Q

Unstable a-fib patient (systolic < 90, confusion related to hemodynamic instability, CP, or CHF) and management

A

Immediate synchronized cardioversion

305
Q

Stable a-fib patient and HR > 100-110

A

Slow ventricular HR with beta blockers, CCBs, or digoxin

306
Q

CHADS-VASc

A

C: CHF
H: HTN
A: Age > 75
D: Diabetes
S: Stroke or TIA
V: vascular disease
A: Age between 65-74
S: sex (female)

307
Q

Score of 0-1 on CHADS-VASc

A

Aspirin therapy

308
Q

Score of 2 or more on CHADS-VASc

A

Control rate and anticoagulate

(Warfarin, Apixaban, Dabigatran, Edoxaban, or Rivaroxaban)

309
Q

Factor Xa inhibitors

A

Rivaroxaban
Apixaban
Edoxaban

310
Q

NOAC thrombin inhibitor

A

Dabigatran

311
Q

Severe bleeding with warfarin use

A

Reverse with FFP

312
Q

Severe bleeding with dabigatran

A

Reverse with Idacrucizumab

313
Q

Severe bleeding with Xa inhibitors

A

Reverse with Andexanet

314
Q

Benefits of NOACs (novel oral anticoagulants)

A
  1. ) Prevent more strokes than warfarin
  2. ) Cause less intracranial bleeding than warfarin
  3. ) Decrease mortality MORE than warfarin
  4. ) Treat DVT and PE
315
Q

The main indication for warfarin is a patient with atrial fibrillation who have…

A

Metallic heart valves

316
Q

Common BB used in ischemic heart disease + a-fib or a-flutter

A

Metoprolol

317
Q

Migraines + a-fib or a-flutter tx

A

Metoprolol and/or diltiazem

318
Q

Graves disease + a-fib or a-flutter tx

A

Metoprolol

319
Q

Pheochromocytoma + a-fib or a-flutter tx

A

Metoprolol

320
Q

Asthma + a-fib or a-flutter tx

A

CCB: Diltiazem

321
Q

Borderline hypotension in a patient with a-fib or a-flutter tx

A

Digoxin

322
Q

Patient with COPD/emphysema + atrial arrhythmia (polymorphic P waves, tachycardia)

A

Multifocal atrial tachycardia (MAT)

323
Q

Multifocal atrial tachycardia EKG finding

A

“Polymorphic P waves (different atrial foci for the QRS complexes)


“

324
Q

Irregular, chaotic rhythm on EKG showing polymorphic P waves in a patient with history of COPD/emphysema

A

Multifocal atrial tachycardia (MAT)

325
Q

Multifocal Atrial Tachycardia tx

A
  1. ) OXYGEN first
  2. ) Diltiazem second
  3. ) NEVER beta blockers
326
Q

Best initial management for UNSTABLE patients in SVT

A

Synchronized cardioversion

327
Q

Best initial management for STABLE patients in SVT

A

Vagal maneuvers

328
Q

NEXT best step in management of a stable patient in SVT when vagal maneuvers do not work

A

IV Adenosine

329
Q

Best long-term management of a patient with recurrent SVT

A

Radio frequency catheter ablation

330
Q

SVT that can alternate with Ventricular tachycardia

A

Wolff-Parkinson-White Syndrome

331
Q

”"”worsening of SVT AFTER the use of CCB or digoxin”””

A

WPW syndrome

332
Q

Delta wave on EKG

A

“WPW syndrome


“

333
Q

Most accurate test in WPW

A

Electrophysiologic studies

334
Q

WPW syndrome treatment

A

Procainamide

335
Q

Best initial therapy IF the patient is described as being in SVT or VT from WPW

A

Procainamide

336
Q

Best long-term therapy in WPW syndrome

A

Radio frequency catheter ablation

337
Q

If an EKG does not detect VT, then _______________________ should be ordered

A

Telemetry monitoring

338
Q

The most accurate diagnostic test for ventricular tachycardia

A

Electrophysiologic studies

339
Q

Hemodynamically stable patients in VT treatment

A

Amiodarone, Lidocaine, Procainamide, Magnesium

340
Q

Unstable patients in VT treatment

A

Synchronized cardioversion

341
Q

Treatment of V-fib

A

ALWAYS unsynchronized cardioversion

342
Q

Initial Syncope workup

A

Cardiac/neuro examination
EKG
Chemistries (glucose)
Oximeter
CBC
Cardiac enzymes

343
Q

Make sure to order these tests for syncope

A

EKG
Cardiac Enzymes
ECHO
Head CT

344
Q

A physician refuses to administer abx to a patient with a viral infection because of the high risk of dangerous side effects. Identify core ethical principle.

A

Non-maleficence (do no harm)

345
Q

A physician allows a cancer patient to choose between two acceptable and equally effective treatment plans. Identify core ethical principle.

A

Patient autonomy

346
Q

Paternalism definition

A

Opposite of patient autonomy; the attending physician chooses best treatment

347
Q

A competent patient refuses therapy for a life-threatening condition. Identify core ethical principle.

A

Patient autonomy

348
Q

A working-class patient with end-stage liver disease is given higher priority for a liver transplant than an internationally-renowned actor whose liver disease is less advanced. Identify core ethical principle.

A

Justice, all patients must be treated fairly

349
Q

Patient does not want blood products, has signed consent, and understands risk. During procedure a large artery was injured and the patient will die w/o transfusion. How is this patient handled in the OR under anesthesia?

A

No blood products given due to patient’s living will

350
Q

Under what circumstances may a physician share a patient’s confidential information?

A

“Danger/harm to self/others
Child/elder abuse
Reportable diseases
Patient grants permission
Those involved in direct care


“

351
Q

Suspicion of elder abuse. Next step?

A
  1. ) Report
  2. ) Speak to patient w/o caregiver
352
Q

A physician orders an invasive test for the wrong patient. What is the most appropriate ethical response?

A

Inform patient of mistake; always communicate mistakes to maintain patient trust

353
Q

A patient tells the physician that he/she finds the physician attractive and wants to start dating. What is the most appropriate ethical response?

A
  1. ) Maintain professionalism
  2. ) + Chaperone during encounters
354
Q

An elderly woman is found to have inoperable lung cancer, and her family asks the physician to tell the patient the biopsy is negative. What is the most appropriate ethical response?

A
  1. ) DO NOT lie
  2. ) Ask patient if they want to know results
  3. ) Ask family for motives
355
Q

You suspect another physician of practicing under the influence of alcohol. What is the most appropriate ethical response?

A

Notify physician’s superior

356
Q

Who should determine patient’s capacity in making decisions?

A

Attending physician

357
Q

Who should determine patient’s COMPETENCY in making decisions?

A

Judge

358
Q

What is required to determine if a patient has decision-making capacity?

A

“1.) Patient is 18+

  1. ) Understands and is informed
  2. ) Decision stable over time
  3. ) Can communicate appropriately
  4. ) Decision not influenced by psychiatric disorders


“

359
Q

When is parental consent not required?

A

“Emergency, Pregnancy, Alcohol-related, STI’s, contraception


“

360
Q

MC underlying cause of TIA

A

Atrial fibrillation

361
Q

Patient has bruit on exam. Next first step?

A

Carotid u/s

362
Q

Young patient with hyponatremia and hyperkalemia. Next step?

A

Order blood glucose. Looking for evidence of DKA

363
Q

Staphylococcus epidermidis is coagulase ___________

A

Negative

364
Q

MC organism that infects a hydrocephalus shunt

A

Staph epidermidis (coagulase negative)

365
Q

”"”NOLIP”” what mnemonic is this for?”

A

Treatment of acute pulmonary edema (CHF exacerbation)

Nitrates, oxygen, loop diuretic, inotropic drug, and position change (legs down)

366
Q

Acute pulmonary edema tx

A

”"”NOLIP””

N: Nitrates
O: Oxygen
L: Loop diuretic
I: Inotropic drug (dobutamine)
P: Position change (legs down)”

367
Q

What findings on cardiac catheterization would be indication for CABG?

A

1.) Left main coronary artery stenosis > 50%

or

2.) Severe 3-vessel coronary artery stenosis

368
Q

What precautions should be taken prior to cardioversion to prevent an embolic event in a patient with stable atrial fibrillation?

A

a-fib > 48 hours: TEE

369
Q

Thrombus found in atria in a patient with a-fib. Next step?

A

Anti-coagulate for 3 weeks then cardioversion

370
Q

Patient in acute a-fib for < 48 hours and unstable. Next step?

A

Cardioversion w/o the need for TEE. Then +/- anti-coagulation

371
Q

Bounding pulses, diastolic decrescendo murmur heard at left sternal border, ECHO w/early mitral valve closure and reverse blood flow across the aortic valve. Most likely diagnosis?

A

Aortic regurgitation

372
Q

What two classes of medication would be most likely to improve the symptoms of AR?

A

Ace-inhibitors and CCBs

373
Q

+ Troponin and EKG changes in V2-V5 (precordial leads)

A

Anterior wall MI

374
Q

+ Troponin and EKG changes in lead I and aVL

A

Lateral wall MI

375
Q

+ Troponin and EKG changes in lead II, III< and aVF

A

Inferior wall MI

376
Q

What is the most useful test in determining acute pericarditis?

A

EKG

  • diffuse ST elevations
  • PR depression
377
Q

Vasculitis of the kidney, upper airway, and lungs

A

Granulomatosis with polyangiitis (Wegener’s)

378
Q

Vasculitis of the kidney, GI tract, but spares the lungs

A

Polyarteritis nodosa

379
Q

Palpable purpura on the legs, associated with IgA nephropathy

A

Henoch-schönlein purpura

380
Q

Vasculitis in a young asthmatic

A

Eosinophilic granulomatosis w/polyangitis (Churg-strauss)

381
Q

Vasculitis in a young male smoker

A

Thrombosis obliterans (Buerger’s disease)

382
Q

Wegener’s granulomatosis

A

“Vasculitis of the kidney, upper airway, and lungs


“

383
Q

Polyarteritis nodosa

A

“Vasculitis of the kidney and GI tract, but spares the lungs


“

384
Q

Arteritis that spares the lungs and is associated with hep B

A

Polyarteritis nodosa

385
Q

2-year old Asian girl with strawberry tongue and desquamation of hands/feet

A

Kawasaki disease

386
Q

Eosinophilic granulmatosis w/polyangitis (Churg-strauss)

A

“Vasculitis in a young asthmatic


“

387
Q

20-year old Asian woman with weak pulses in the upper extremities

A

Takayasu arteritis (aka pulseless disease)

388
Q

Elderly woman with unilateral headache and jaw claudication

A

Giant cell arteritis (aka Temporal arteritis)

389
Q

Vasculitis associated with Hepatitis B

A

Polyarteritis nodosa (remember: usually spares the lungs)

390
Q

Vasculitis associated with perforation of the nasal septum

A

Granulomatosis with polyangiitis (Wegener’s)

391
Q

Vasculitis associated with polymyalgia rheumatica

A

Giant cell arteritis (aka Temporal arteritis)

392
Q

What medications are indicated to reduce mortality in patients with CHF?

A

Beta-blocker (Biso-, Carve-, or ER Meto-)
Ace-i/ARB
Aldosterone Antagonist (Spiro- or Eplerenone)

393
Q

Stanford A-type aortic dissection

A

“Any involvement of the ascending aorta
- Tx: surgery


“

394
Q

Standford B-type aortic dissection

A

“Confined to descending aorta
- Tx: medical management (usually)


“

395
Q

Swanz-Ganz pulmonary artery catheter reveals: decreased CO, increased SVR, and increased PCWP

A

Cardiogenic shock

396
Q

Swanz-Ganz pulmonary artery catheter reveals: increased CO, decreased SVR, and normal PCWP

A

Septic shock

397
Q

Septic shock treatment

A

IV Fluids and Norepinephrine

398
Q

Cardiogenic shock treatment

A

Dobutamine or Dopamine

399
Q

Medical management of aortic dissection (confined to ascending aorta)

A
  1. ) Transfer to ICU
  2. ) BETA-BLOCKERs
  3. ) Surgical consult
400
Q

Administering a beta-blocker in a patient with a murmur from hypertrophic cardiomyopathy with _________ the intensity of the murmur

A

DECREASE (beta blockers increase pre-load)

401
Q

Episodic frank hematuria that starts within a day of an upper respiratory tract infection

A

IgA nephropathy

402
Q

Frank hematuria which starts and resolves within days of an upper respiratory or GI infection with PERSISTENT microscopic hematuria

A

IgA nephropathy

403
Q

Oliguria, edema, HTN, and smokey-brown urine within 2 weeks of a group A beta-hemolytic strep infection

A

Post-infectious glomerulonephritis

404
Q

Low serum C3, increased ASO titer, and lumpy-bumpy immuno-fluorescence

A

Post-infectious glomerulonephritis

405
Q

Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea. What NYHA class is this?

A

Class III (Moderate)

406
Q

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea. What NYHA class is this?

A

Class II (Mild)

407
Q

Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased. What NYHA class is this?

A

Class IV (Severe)

408
Q

Telavancin is a _________ derivative with similar efficacy

A

Vancomycin

409
Q

IV abx for MSSA

A

Oxacillin/nafcillin or cefazolin

410
Q

Oral abx for MSSA

A

Dicloxacillin or cephalexin

411
Q

Severe MRSA abx

A

Vancomycin
Linezolid
Daptomycin
Ceftaroline
Tigecyline
Telavancin

412
Q

Minor MRSA abx

A

TMP/SMX
Clindamycin
Doxycycline

413
Q

Adverse effect of linezolid

A

Thrombocytopenia

and

Interferes with MAO inhibitors

414
Q

Abx that interferes with MAO inhibitors

A

Linezolid

415
Q

Abx used for severe MRSA infection that can cause thrombocytopenia

A

Linezolid

416
Q

Adverse effects of daptomycin

A

Myopathy and rising CPK

417
Q

If the organism is sensitive, _________, _________, or _________ is superior to vancomycin

A

Oxacillin
Nafcillin
Cefazolin

418
Q

3 antibiotics specific for streptococcus

A

Penicillin
Ampicillin
Amoxicillin

419
Q

Telavancin, dalbavancin, and oritavancin MOA

A

Bactericidal lipolysaccharides
Inhibit bacterial cell wall synthesis
Bind to D-Ala-D-Ala terminus of Pg cell wall

420
Q

Ceftaroline MOA

A

Inhibit cell wall growth by binding to penicillin-binding protein

421
Q

Linezolid MOA

A

Inhibits protein synthesis

422
Q

TMP-SMX MOA

A

Folate antagonist

423
Q

Gram-negative bacilli (list of microorganisms)

A

E. coli
Enterobacter
Citrobacter
Morganella
Pseudomonas
Serratia

424
Q

Quinolone for pneumonia

A

Gemifloxacin

425
Q

Cefepime and Ceftazadine (drug class and coverage)

A

Cephalosporins for gram-negative bacilli

426
Q

Piperacillin and Ticarcillin (drug class and coverage)

A

Penicillins for gram-negative bacilli

427
Q

Aztreonam (drug class and coverage)

A

Monobactam for gram-negative bacilli

428
Q

Quinolones for gram-negative bacilli

A

Ciprofloxacin
Levofloxacin
Moxifloxacin
Gemifloxacin

429
Q

Gentamicin, Tobramycin, and Amikacin (drug class and coverage)

A

Aminoglycosides for gram-negative bacilli

430
Q

Carbapenems for gram-negative bacilli

A

Imipenem
Meropenem
Ertapenem
Doripenem

431
Q

__________ is the only carbapenem that DOES NOT cover pseudomonas

A

Ertapenem

432
Q

Pipercillin and Ticarcillin coverage

A

Gram-negative bacilli
Streptococci
Anaerobes

433
Q

3 excellent pneumococcal drugs

A

Levofloxacin
Gemifloxacin
Moxifloxacin

434
Q

_________________ work synergistically with other agents to treat staph and enterococcus

A

Aminoglycosides

  • Gentamicin
  • Tobramycin
  • Amikacin
435
Q

Excellent anti-anaerobic medications that also cover streptococci and MSSA

A

Carbapenems

  • Imipenem
  • Meropenem
  • Ertapenem
  • Doripenem
436
Q

______________ covers MRSA and is broadly active against gram-negative bacilli. It is weaker than other anti-MRSA drugs

A

Tigecycline

437
Q

Why is polymyxin/colistin used last in multi-drug resistant gram negative rods?

A

Renal toxicity

438
Q

“What drug should be used in ““failed therapy for ventilator-associated pneumonia””?”

A

Polymyxin/colistin

439
Q

Beta-lactam antibiotics (4 classes)

A

Penicillin
Cephalosporins
Carbapenem
Monobactam

440
Q

Beta-lactam abx MOA

A

All inhibit cell wall by binding the penicillin-binding protein

4 classes:

  • Penicillin
  • Cephalosporins
  • Carbapenem
  • Monobactam
441
Q

Beta-lactamase inhibitors (4 drugs)

A

Clavulanate
Sulbactam
Tazobactam
Avibactam

442
Q

2 combined antibiotics that cover anaerobes

A

Piperacillin-tazobactam
Ticarcillin-clavulanate

443
Q

Imipenem adverse effect

A

Seizures

444
Q

Daptomycin adverse effect

A

Myopathy

445
Q

Linezolid adverse effect

A

Low platelets

446
Q

________________ is the best medication for abdominal anaerobes

A

Metronidazole

447
Q

Carbapenems, piperacillin, and ticarcillin are equal in efficacy for abdominal anaerobes compared to _____________________

A

Metronidazole

448
Q

The only 2 cephalosporins that cover anaerobes

A

Cefoxitin
Cefotetan

449
Q

______________ is the best drug for anaerobic strep

A

Clindamycin

450
Q

3 agents for herpes simplex or varicella zoster

A

Acyclovir
Valacyclovir
Famciclovir

451
Q

________________ is the best long-term therapy for CMV retinitis

A

Valganciclovir

452
Q

3 agents for CMV

A

Valganciclovir
Ganciclovir
Foscarnet

453
Q

Foscarnet adverse effect

A

Renal toxicity

454
Q

Valganciclovir and ganciclovir adverse effect

A

Neutropenia and bone marrow suppression

455
Q

Oral agents for Hep C

A

Sofosbuvir-ledipasvir
Elbasvir-grazoprevir
Daclatasvir-sofosbuvir
Ombitasvir-paritaprevir-dasabuvir
Sofosbuvir

456
Q

_______________ when combined with sofosbuvir will cover all genotypes of hepatitis C

A

Velpatasvir

457
Q

Neuraminidase inhibitors for influenza A and B

A

Oseltamivir, zanamivir, and peramivir

458
Q

””“-mivir”” drug class”

A

Neuraminidase inhibitors

459
Q

Ribavirin adverse effect

A

Anemia

460
Q

Ribavirin + Interferon treats

A

Hepatitis C (only used when other treatments have failed)

461
Q

Respiratory syncytial virus treatment

A

Ribavirin

462
Q

Chronic Hepatitis B treatment

A

Lamivudine
Interferon
Adefovir
Tenofovir
Entecavir
Telbivudine

463
Q

Sofosbuvir and Dasabuvir MOA

A

RNA polymerase inhibitors
- Treat Hep C

464
Q

Paritaprevir, simeprevir, daclatasvir, and ombitasvir MOA

A

Protease inhibitors that prevent viral maturation by inhibiting protein synthesis
- Treat Hep C

465
Q

Candidemia treatment

A

Fluconazole
Caspofungin

466
Q

ALL -azoles possible adverse effect

A

Liver toxicity (at high dose)

467
Q

Candida treatment

A

Fluconazole

468
Q

Cryptococcus treatment

A

Fluconazole

469
Q

BEST agent against Aspergillus

A

Voriconazole

470
Q

Voriconazole adverse effect

A

Visual disturbance

471
Q

Mucormycosis treatment

A

Posaconazole

472
Q

Echinocandins (3 of them)

A

Caspofungin
Micafungin
Anidulafungin

473
Q

””“-fungin”” class”

A

Echinocandins

474
Q

Excellent treatment for neutropenic patients

A

“Echinocandins
““-fungins”””

475
Q

______________ have NO significant human toxicity because they affect/inhibit the 1,3 gluten synthesis step, which does not exist in humans

A

Echinocandins

  • Caspofungin
  • Micafungin
  • Anidulafungin
476
Q

Efinaconazole and tavaborole

A

Topical anti-fungal agents against onychomycosis

477
Q

What class of antifungals inhibit conversion of lanosterol to ergosterol?

A

Azoles

478
Q

Powerhouse drug effective against ALL Candida, Cryptococcus, and Aspergillus

A

Amphotericin

479
Q

Aspergillus treatment superior to amphotericin

A

Voriconazole, isavuconazole, and caspofungin

480
Q

_______________ is superior to amphotericin in neutropenic fever

A

Caspofungin

481
Q

Amphotericin adverse effects

A

Renal toxicity (increased creatinine)
Hypokalemia
Metabolic acidosis from distal RTA
Fever, shakes, and chills

482
Q

When renal toxicity is described in a patient needing amphotericin… next step?

A

”"”Switch to liposomal amphotericin”””

483
Q

Osteomyelitis best initial test

A

Plain x-ray

484
Q

Best 2nd test for osteomyelitis

A

MRI (if clinical suspicion + X-ray is negative)

485
Q

Most accurate test for osteomyelitis

A

Bone biopsy and culture

486
Q

What is the earliest finding of osteomyelitis on x-ray?

A

Periosteal elevation

487
Q

What is the next best step in determining the diagnosis of osteomyelitis when the x-ray is normal

A

MRI

488
Q

How do you follow response to treatment in osteomyelitis?

A

Sedimentation rate

489
Q

MC cause of osteomyelitis (microorganism)

A

Staphylococcus

490
Q

Osteomyelitis abx treatment if the organism is sensitive

A

Oxacillin or nafcillin IV for 4-6 weeks

491
Q

MRSA Osteomyelitis tx

A

Vancomycin
Dalbavancin
Oritavancin
Linezolid
Ceftaroline
Daptomycin

492
Q

Gram negative bacilli in osteomyelitis

A

Salmonella and Pseudomonas

493
Q

Itching and drainage from the external auditory canal with history of swimming or foreign objects

A

Otitis Externa

494
Q

Otitis Externa tx

A

Topical antibiotics (ofloxacin, ciprofloxacin, or polymyxin/neomycin)

+ Topical hydrocortisone to decrease swelling/itching

+ Acetic acid and water solution to reacidify the ear

495
Q

Osteomyelitis of the skill from Pseudomonas in a patient with diabetes

A

Malignant Otitis Externa

496
Q

Malignant Otitis Externa best initial test

A

CT or MRI

497
Q

Most accurate test for Malignant Otitis Externa

A

Biopsy

498
Q

Malignant Otitis Externa tx

A

Surgical debridement and Antibiotics active against pseudomonas

Ciprofloxacin
Piperacillin
Cefepime
Carbapenem
Aztreonam

499
Q

Quinolone antibiotics MOA

A

Inhibit DNA gyrase

500
Q

Immobility of the tympanic membrane

A

Otitis Media

Complex step 3 (1 decks)

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