Deck 1 Flashcards
Osmotic stool gap calculation
290 - 2(Na +K)
What does stool osmolal gap >125 indicate?
Osmotic diarrhea (ex sorbitol)
What does stool osmolal gap <50 indicate?
Secretory diarrhea (crohns, celiac, neuroendocrine, etc)
How do you treat neurosyphilis?
Penicillin G x14 days
How do you treat neurosyphilis?
Penicillin G x14 days
How do you treat early syphilis? (<100 days)
Penicillin B x 1
How do you treat late syphilis? (>100 days)
Penicillin B x 3 (late includes tertiary syphilis)
How do you diagnose ALS?
Electrodiagnostic tests, including electomyography (EMG) and nerve conduction velocity (NCV)
Can lacunar strokes cause motor/sensory alone deficits?
YES!
When should you use carotid endarterectomy?
70-99% occlusion
What commonly causes lobar hemorrhagic strokes the elderly?
Amyloid
How to treat acute MS?
IV steroids
How to treat acute MS?
IV steroids
How do you treat Guillain-Barre?
IVIG or plasmapheresis
Besides iron replacement if low ferritin is present, what medication can be given for RLS?
Gabapentin/pregabalin
Who should be screened for syphilis?
High risk sex, MSM, pregnant women
When to screen for osteoporosis?
Women 65 and older
Who should be screened for Cervical cancer
21-65
-HPV +/- cytology Q5y
OR
-Cytology Q3y
Who to screen for breast cancer?
40-74 Q2yr
Screening for BRCA?
If family history or ethnicity associated with BRCA, use risk tool to determine risk then make decision to send for testing
Who should get screened for colon cancer?
45-85yo
If high risk, favor colonoscopy rather than other screening methods
Who should get lung cancer screening?
50-80 (20py within last 15yr)
(20% chance of false positive)
Who should get the pneumo vaccine?
65+ (OR immunosuppression, heart disease, lung disease, DM, and more!)
What BUN:Cr suggests an upper GI bleed?
BUN:Cr >30
Indications for endoscopy for dyspepsia
-anemia
-gi bleeding
-weight loss
-dysphasia
-age >50
-nausea/vomiting
What is the treatment for hpylori
Clarithromycin/amoxicillin/PPI x14 days
How do you test for hpylori eradication?
Urea breath test or fecal antigen test
When do you screen for colon cancer? Interval?
45-85
Normal q10y
Tubular q5-7y
Serrated Q3y
What is HIDA used for?
Cholecystitis
Acalculous cholecystitis
How to treat hot flashes WITH a uterus?
Estrogen AND progesterone (prevent endometrial hyperplasia to cancer)
Be able to identify dry and wet macular degeneration
Characteristics of aortic stenosis (location, how the murmur sounds)
Best heard at RUSB
Has a late-peaking murmur with radiation into the carotids
Possible delayed/diminished carotid upstroke
What is treatment for AS?
-Asymptomatic: consider valve replacement, medical management
-Symptomatic AS +/- LV dysfunction: valve replacement (surgery vs TAVR)
Characteristics of HOCM (location, how the murmur sounds)
Can mimic AS!
-Murmur is loudest with preload-reducing maneuvers (valsalva, standing)
-softer with preload-increasing maneuvers (squatting, leg raise)
Treatment for HOCM
-Maintain volume!
-Nodal blockade (bb, CCB) to maintain preload and/or disopyramide
-Surgery
Characteristics of aortic insufficiency (location, how the murmur sounds)
Best heard at LSB
Early, high-pitched diastolic murmur
Head Bob/nodding
Bounding peripheral pulse
Characteristics of mitral stenosis (location, how the murmur sounds)
-Best heard at apex
-Diastolic low pitched rumbling murmur
-Opening snap after s2 of leaflets are mobile
Characteristics of mitral regurgitation (location, how the murmur sounds)
-best heard at apex
-Holo (mostly), mid, or late systolic murmur
When a woman with hypothyroid gets pregnant, what should you do with her levothyroxine? Why?
Increase dose
Pregnancy causes an increase in thyroid binding globulin and b-hcg increases TSH, both can cause fetal issues
How much is the ideal levothyroxine dosing for a patient? Should you do this with elderly patients or those with cardiac disease?
1.6mg/kg
No, ramp up slowly
What is the preferred antiarrhythmic for afib in 1) no CAD or structural heart disease? 2) LVH? 3) CAD w/o HF? 4) HF? 5) recurrent sxs refractory to meds?
1) Class I
2) Amio
3) Sotalol
4) Amio
5) ablation
When should you refer someone for prostate biopsy?
If PSA >7 and/or abnormal DRE
When to treat hypertriglyceridemia
> 500
What microbe causes hot-tub lung
Nontuberculous mycobacterium (NTM)
What issues can cause compression of the CN II, III, IV, V?
Pituitary apoplexy
Cavernous sinus thrombosis
SAH
In the setting of presumed psuedoachalasia shown via barium swallow, what is the next test to perform?
Endoscopy
What should you do when you suspect a DVT but US is negative and D-dimer is high?
Repeat scan in a couple of days
Can chronic opioid use cause central hypogonadism?
Yes!
Which ingested alcohol does NOT cause a AGMA OR NAGMA ?
Isopropyl alcohol (rubbing alcohol, hand sanitizer)
What are the clinical features of primary ovarian insufficiency?
-Amenorrhea <40yo
-high FSH
-low estrogen
-hypoestrogenic symptoms
What are suspicious findings for a thyroid nodule that indicate FNA?
-microcalcifications
-hypoechoic
-increased vascularity
-infiltrative margins
What is the evaluation for a thyroid nodule?
If someone fails a statin, what should you do?
Try a different statin
What are the causes of hirsutism in women?
What is the treatment for h pylori?
If the clinical suspicion for giant cell arthritis is high but biopsy is negative, what should you do?
Repeat the biopsy as 40% of biopsies are negative
What is the treatment for digoxin toxicity?
Digoxin-specific antibody fragments
When should you screen someone with DEXA scan with celiac disease
At the time of diagnosis
What are the 3 causes of urinary incontinence?
1) Stress incontinence
2) Urge incontinence
3) Overflow incontinence
What is the etiology of stress incontinence? What are the common history findings? Treatment?
1) Decreased urethral sphincter toneUrethral hypermobility
2) leakage with coughing, sneezing, lifting
3) Pelvic floor training, pessaries, estrogen
What is the etiology of urge incontinence? What are the common history findings? Treatment?
1) detrusor overactivity
2) sudden, overwhelming urge to pee
3) bladder training, estrogen, anti-muscsrinic
What is the etiology of overflow incontinence? What are the common history findings? Treatment?
1) impaired detrusor activity, bladder outlet obstruction
2) incomplete emptying, involuntary dribbling
3) alpha blocker and/or 5alpha reductase inhibitor
What should be immediately done in pituitary apoplexy?
Give steroids THEN neurosurgery
How does pituitary apoplexy present?
Headache, CN III, IV, V deficits, visual deficits (optic chaism compression), and panhypopituitarism
A patient has thyroid nodules that look malignant. What are risk factors for thyroid malignancy? (Give 3)
Radiation exposure
Family history
High TSH
What is this?
Discoid lupus
Has hyperpigmented boarders
What is this?
Discoid lupus
Has hyperpigmented boarders
What is this?
Lichen planus
Commonly seen on flexor surfaces and are intensely pruritic
What is the best test for acromegaly? What is the confirmatory test?
1) Insulin growth factor one levels
2) Glucose suppression test (give glucose then check growth hormone level which should be elevated)
What is normal LV wall thickness?
<15mm
What medication should be used in conjunction with sulfadiazine/pyrimethamine for toxo treatment?
Leucovorin
(Pyrimethamine blocks folic acid pathway)
What are the light’s criteria? What is the serum-effusion protein difference? What is the serum-effusion albumin difference?
Pleural:serum protein >0.5
Pleural:serum LDH >0.6
serum-effusion protein difference >3.1
serum-effusion albumin difference >1.2
-suggestive of a transudative
What are the light’s criteria? What is the serum-effusion protein difference? What is the serum-effusion albumin difference?
Pleural:serum protein >0.5
Pleural:serum LDH >0.6
serum-effusion protein difference >3.1
serum-effusion albumin difference >1.2
-suggestive of a transudative
What is this?
Guttate psoriasis
Typically occurs following a strep infection
What is the management for dyspepsia?
Might have another card with answers
When do you treat sinusitis with antibiotics?
Symptoms >10 days and/or fever and/or facial pain
What is the preferred method to diagnose SBO? What if first method is negative and concern remains high?
1) Plain films
2) CT imaging
What medications are good for bony Mets? Which one can be given with renal disease?
1) Denosumab and Zolendronic acid (IV bisphosphonate)
2) Denosumab
What rare cancer can be seen in celiac disease?
Intestinal lymphoma
What T1DM antibody is a must know?
GAD
What is the prediabetes A1c?
5.7-6.4
Can you trust A1c in ESRD?
No, especially in those taking EPO
If a diabetic patient has unilateral retinopathy, what test should you order?
Carotid duplex as they likely have narrowing causing ischemia
What hounsfield unit and size adrenal lesion is concerning for malignancy?
HU >20 and >4cm
How do you treat pericarditis?
Colchicine and ASA (preferred after MI) or NSIAD
What are clinical features of idiopathic intracranial HTN? Diagnosis? Treatment?
1) Headache/nausea/vomiting, visual changes, CN VI palsy, tinnitus
2) papilledema, normal MRI (empty sella), LP with elevated opening pressure
3) weight loss, acetazolamide, topiramate
What are symptoms of retinal detachment?
Floaters, flashing lights, loss of vision
What are the next steps if a patient’s PT or PTT are elevated?
What are the characteristics of of lofgren’s syndrome?
Hilar adenopathy, erythema nodosum, arthritis (commonly ankles)
What is the treatment for microscopic colitis?
Stop possible offending medications (PPI, NSAID, SSRI), smoking cessation, oral budesonide, antidiarreal medications
What is the regimen for post-exposure prophylaxis (PEP) for HIV?
3 drug regimen
1)Tenofovir
2) Emtricitabine
3) Raltegravir OR Dolutegravir
What is the pre-exposure prophylaxis regimen for HIV?
2 drug regimen
1)Tenofovir
2) Emtricitabine
Check HBV status
What is the antibody for drug-induced lupus?
DNA-histone complex
What is the antibody for SLE?
Double-stranded DNA
Can see smith-ab
All SLE has positive ANA
What are the antibodies for systemic sclerosis?
RNA polymerase II and III
Scl-70/anti-topoisomerase type I
What is the antibody for MCTD?
Ribonucleoprotein (RNP)
What are the antibodies for Sjogren syndrome?
SS-A/Ro and SS-B/La
What is the antibody for limited scleroderma?
Anti-Centromere
What are the antibodies for polymyositis, dermatomyositis?
Aminoacyl-transfer RNA synthetases (ex Jo-1)
What is the antibody for microscopic polyangiitis?
MPO
What is the antibody for GPA?
Proteinase 3 (PR3)
What viruses belong to the polyoma virus family?
JC and BK viruses
What is the treatment for Paget’s disease?
Bisphosphonate
How to diagnose Cushing? (3 steps)
- Confirm Cushing (2/3: low dose dex suppression, 24hr urine free cortisol, late night salivary cortisol)
- Obtain ACTH
- If elevated ACTH, high dose dex suppression test
Features of tricuspid regurgitation?
Holosystolic murmur at left sternal border that increases with inspiration
What vitamins are at risk for deficiency in a Roux-en-Y bypass?
Calcium
Iron
B12
Thiamine
Folate
Vit A, D, E, K
What is the preferred anti hypertensive agent for aortic dissection?
Beta blocker (ex esmolol, labetolol)
If osteoporosis is diagnosed, what lab should be obtained?
25 OH vit D
What medication is used to treat anorexia nervosa?
Olanzapine
How does BMI affect BNP levels?
High BMI can cause lower levels of BNP is heart failure
What are some findings of Behcet
Recurrent painful ulcers
Ocular manifestations (ex uveitis)
Skin lesions
Positive pathergy
What is the first line medication treatment for fibromyalgia?
TCA
What is the treatment for thyroid storm?
Beta blocker
PTU followed by iodine
Steroids
Can thyroid dysfunction cause myopathy?
Yes! Be sure to add it to the differential of elevated CK
What inhalers can/should be used in asthma in pregnancy?
Albuterol
ICS-LABA
Steroids okay for exacerbation
What two diseases is seborreic dermatitis seen? Obviously can be seen outside of this
HIV
Parkinson’s
What arthopathy disease causes chondrocalcinosis?
Calcium pyrophosphate dihydrate crystals (CPPD aka pseudogout)
What arthopathy disease causes chondrocalcinosis?
Calcium pyrophosphate dihydrate crystals (CPPD aka pseudogout)
What type of cardiac ischemic exam should be performed in those with a LBBB or ventricular over rhythm (ex pacer)?
Pharmacological radionuclide perfusion imaging
