deck 23

Question 1

problem with thyroid sonograms

Answer 1

pick up a ton of incidentalomas (small thyroid nodules with low risk of malignancy)
- If TSH is normal, repeat US in 6-12 months

Question 2

anemia with normal RDW

Answer 2

beta-thalassemia

Question 3

TMJ disorder

Answer 3

Temporomandibular joint (TMJ) disorders occur in a large number of adults. The etiology is varied, but includes dental malocclusion, bruxism (teeth grinding), anxiety, stress disorders, and, rarely, rheumatoid arthritis. Dental occlusion problems, once thought to be the primary etiology, are not more common in persons with TMJ disorder. While dental splints have been commonly recommended, the evidence for and against their use is insufficient to make a recommendation either way. Physical therapy modalities such as iontophoresis or phonophoresis may benefit some patients, but there is no clearly preferred treatment. Radiologic imaging is unnecessary in the vast majority of patients, and should therefore be reserved for chronic or severe cases. In fact, the majority of patients with TMJ disorders have spontaneous resolution of symptoms, so noninvasive symptomatic treatments and tincture of time are the best approach for most.

Question 4

AIN natural course

Answer 4

With discontinuation of med, most patients recover normal renal function.

Question 5

AIN mes

Answer 5

all NSAIDs are known to be associated with AIN. Development of AIN usually becomes evident approximately 2 weeks after starting a medication and is not dose-related. Other medications strongly associated with AIN include various antibiotics (particularly cephalosporins, penicillins, sulfonamides, aminoglycosides, and rifampin), diuretics, and miscellaneous medications such as allopurinol.

Question 6

preferred pressors when fluid resuscitation is inadequate

Answer 6

NE + dopamine

Question 7

treatment of chronic orthostatic hypotension

Answer 7

fludrocortisone, midodrine, physostigmine

Question 8

recommended med to reduce mortality in symptomatic patients with HF

Answer 8

beta-blockers

Question 9

catch about PTH with hyperparathyroidism

Answer 9

normal PTH + hypercalcemia in a patient is diagnostic for hyperparathyroidism since PTH should be suppressed in the presence of elevated calcium

Question 10

renal failure affect on calcium

Answer 10

causes hypocalcemia

Question 11

milk alkali syndrome

Answer 11

hypercalcemia resulting from a chronic overdose of calcium carbonate

Question 12

antivirals for hep B?

Answer 12

Now available ($20/day)
- some AIDS drugs are also active against hep B

Question 13

hemoglobin level in patients with kidney failure

Answer 13

10-12 (levels in normal range associated with death and serious CV events)

Question 14

characteristic lab finding in pt with intrahepatic cholestasis of pregnancy

Answer 14

elevated serum total bile acids

Question 15

other conservative treatment for plantar fasciitis

Answer 15

stretching exercises for the achilles tendon

Question 16

microscopic hematuria management

Answer 16

Ultrasonography of the kidneys, urine cytology, and cystoscopy

Question 17

valvular abnormalities most common in marfan’s

Answer 17

MVP + aortic insufficiency

Question 18

long term PPI effects

Answer 18

• The three main concerns regarding the long-term safety of proton pump inhibitors (PPIs) include the effects of prolonged hypochlorhydria and hypergastrinemia, and the possible association of PPIs with gastric atrophy. In particular, hypochlorhydria is of concern since it may predispose to infections and malabsorption.
• studies subsequent to that guideline continue to raise concerns about possible infectious complications, electrolyte disturbances, and metabolic bone disease associated with PPI use

Question 19

Chads O and 2

Answer 19

CHADS of 2 –> oral anticoagulant

CHADS O –> nothing

Question 20

BP management/HTN goals

Answer 20

Goal blood pressure is <140/90 mmHg for the general hypertensive population under the age of 60 years, and for patients with diabetes or chronic kidney disease, regardless of age.
•Goal blood pressure is <150/90 mmHg for the general hypertensive population aged 80 years and older.

•Goal blood pressure is <150/90 mmHg for most of the general hypertensive population aged 60 to 79 years, but a goal of <140/90 mmHg may be appropriate for some patients. The choice between these two goal blood pressures depends upon the patient’s general health, comorbid conditions, postural blood pressure changes, the number of medications needed to reach the goal, and upon individual values and preferences.

Question 21

most common cause of hearing loss in newborns

Answer 21

genetic disorders

Question 22

side effects of testosterone

Answer 22

• increases hematocrit and can cause polycythemia
• need to monitor hematocrit q 6 months
• may increase bone density

Question 23

to know about oral iron replacement

Answer 23

1) absorbed better in acidic environment so can give vitamin C and need to avoid PPIs/H2 blockers
2) improved if taken on empty stomach but commonly irritates gastric lining
3) causes constipation

Question 24

APA treatment during pregnancy

Answer 24

aspirin + heparin

Question 25

dizziness most concerning when associated with…

Answer 25

diplopia, which suggests a central cause

Question 26

use of amylase for pancreatitis

Answer 26

less likely to be elevated in alcoholics

Question 27

lab pattern of hemolytic anemia

Answer 27

reticulocytosis, increased unconjugated bilirubin, elevated lactate dehydrogenase (LDH), decreased haptoglobin

Question 28

management of nipple pain with feeding

Answer 28

education on positioning

Question 29

Rome criteria for IBS

Answer 29

3 days per month of abdominal pain for the past 3 months, a change in the frequency of stool, and improvement with defecation

Question 30

management of diarrheal symptoms in IBS

Answer 30

loperamide

Question 31

ankle sprain management

Answer 31

semi-rigid stirrup brace (Air-Stirrup, “Aircast”)

Question 32

standrad therapy for meth dependence

Answer 32

outpatient behavioral therapies, especially with case management included

Question 33

what confounds B12 testing

Answer 33

renal failure. patients with renal failure often have normal B12 despite actual deficiency. this is when you need to order a MMA level to confirm the diagnosis

Question 34

patellofemoral pain complaints

Answer 34

Patients complain of popping, catching, stiffness, and giving way. On examination there will be a positive J sign, with the patella moving from a medial to a lateral location when the knee is fully extended from the 90° position. This is caused by an imbalance in the medial and lateral forces acting on the patella. Locking is not characteristic of patellofemoral pain syndrome, so a loose body or meniscal tear should be considered if this is reported.

Question 35

med dosing in CKD

Answer 35

A reduction of dose, an increase in dosing interval, or both may be necessary

Question 36

management of rotator cuff tears/any tendon tears

Answer 36

surgical management quickly

Question 37

preferred cervical cancer screening for women 30-64

Answer 37

Pap test + cotesting for HPV. This is because despite negative cytology, women with oncogenic HPV are at higher risk for later CIN 3+ than women with negative HPV tests. So if pap negative but HPV positive, need o return for cotesting in 1 year.

Question 38

imiquimod (aldara) used for…

Answer 38

genital warts

Question 39

severe hyperkalemia

Answer 39

greater than 7.0

Question 40

hyperkalemia acute management

Answer 40

1) give calcium chloride or gluconate (no effect on plasma potassium but should be given first since it stabilizes the membranes of cardiac myocytes)
2) then give sodium bicarb + glucose with insulin + albuterol. These will translocate potassium from serum to intracellular space.
3) hemodialysis for most severe cases

Question 41

when to combine NRT

Answer 41

relapsed smoker on next quit attempt

Question 42

efficacy of NRT for quitting smoking

Answer 42

usually doubles a smokers chance of quitting