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MKSAP hannah > Facts > Flashcards

Facts Flashcards

1
Q

DM treatment options with weight negative effect

A

metformin
GLP-1 (liraglutide, exenatide)
SGLT2 (-flozins)

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2
Q

Which DM medication should be avoided with history of genital mycotic infections

A

SGLT2 (-glflozin)’s

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3
Q

colon cancer screening in UC

A

start 8-10 years after UC diagnosis and repeat every 1-2 years

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4
Q

treatment of pulmonary arterial HTN

A

If + response to vasoactivity test –> CCB FIRST

no symptoms at rest, only activity – then start with oral meds
(PDE-5 inhibitors = sildenafil, viagra) or
(enothelian receptor antag = bosentan, ambristan)

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5
Q

treatment of rising PSA after prostate cancer in past

A

radiation and leuprolide (androgen deprivation)

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6
Q

pyoderma gangrenosum

A

non healing ulcer, culture neg
assoc with UC/ IBD
tx: prednisolone, cyclosporine

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7
Q

goal BP for intracerebral hemorrhage?

A

<140 systolic

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8
Q

ethylene glycol overdose clinical features and tx

A

CNS depression
inc anion gap metabolic acidosis
inc plasma osmolar gap (>10 difference bw measured and calculated serum osm)
renal failure

tx: fomepazole, HD IV bicarb (if pH <7.3)

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9
Q

DM medications to lower cardiac risk

A

liraglutide

empagliflozin (dc all cause mortality, death by CVD and HF hospitalizations)

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10
Q

BMI cut off for bariatric surg

A

> 40 or >35 with obesity related comorbidities

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11
Q

lower incidence of statin induced myopathy with…

A

pravastatin, rosuvastatin

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12
Q

criteria for lung transplant referral

A

FEV1 <25%, PaO2 <60, CO2 >50

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13
Q

hidradenitis suppurativa tx

A

clindamycin-rifampin
infliximab
surgical excision

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14
Q

normal ABI

PAD ABI

A

nl: 0.9 -1.4
PAD: <0.9
ischemic rest pain < 0.4

if borderline nl and symptomatic–do EXERCISE abi

if > 1.4 it indicates the presence of calcified, noncompressible arteries in the lower extremities and is considered uninterpretable.— do toe brachial index instead

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15
Q

treatment of glioblastoma (IV)

A

surgical resection

followed by chemo (Temozolomide) + RT

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16
Q

acute Wegners treatment to induce remission

A

steroids and rituxmab or cyclophosphamide

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17
Q

DEXA score cut offs

A

osteoporosis < -2.5
osteopenia (-1 to -2.5

normal -0.9 to 1+

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18
Q

Indications for antiresporptive treatment (ex: bisphosphonates, denosumab, raloxifene, teriparatide)

A

osteoporosis
osteopenia with FRAX > 20% major and >3% hip
fragility fracture
vertebral or hip fracture

moderate or high 10-year risk for a major osteoporotic fracture taking at least 2.5 mg of prednisone daily for 3 months

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19
Q

risk of DKA with which diabetes med

A

SGLT-2 inhibitors (-flozins)

** DKA with normal glucose

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20
Q

anti-HTN to lower serum urate

A

losartan

HCTZ and salicylates elevate it and predisposes to gout

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21
Q

acute gout flare tx

A

NSAIDS (CI in PUD, CKD, HF, old, post op)
colchicine (CI in kidney failure)
glucocorticoids (oral vis intra-articular)

** do not change dose of allopurinol during acute flare

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22
Q

indications for long term urate lowering therapy

A

2 attacks of gout
1 attack with CKD
uric acid nephrolithiasis
visible tophi

tx options: allopurinol, febuxostat (for non tolerance allopurinol), IV pegloticase (severe refractory)

**give NSAID/Colchine with when initiation and continue flare prophylaxis if active disease or tophi for 3-6 months

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23
Q

tx for refractory gout

A

IV peglocticase

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24
Q

tx of status epilecpticus

A

IV lorazepam then phenytoin or fosphyenytonin (not keppra)

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25
Q

meineres triad

A

senisuronal hearing loss, vertigo, tinnitus

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26
Q

Rhinne vs. Weber (tuning fork to forehead)

A

normal is air >bone.
conductive loss is bone >air

Sensorinural– Weber louder in good ear (Ipsilateral)
Conductive– Weber louder in affected ear

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27
Q

time cut off for tpa in acute stroke

A

4.5 hours (asa okay 24 hours after TPA given)
3 hours is <80yo, DM with prior infarct, on anticoagulation

(must get to PCI center in 2 hours for acute MI or get TPA)
door to balloon is 90 mins in STEMI

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28
Q

age for cc screening

A

50 -75 (if prior screening and up to date)

if no prior screen can start up to age 85

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29
Q

when to FNAB a thyroid nodule

A

> 1cm with normal TSH and suspicious features
<1cm with high risk features (calcifications, etc)

  • after two negative FNAB can just follow clinically

** if suspect thyroid cancer/MEN check calcitonin (elevated in medullary thyroid cancer)

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30
Q

GFR cut off for metformin contraindication

A

<30

don’t start with GRF <45

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31
Q

Pioglitazone C/I in?

A

chronic liver disease and HF

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32
Q

drug of choice for coccidiodies

A

fluconazole

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33
Q

best anti-seizure meds for older people

A

lamotrigine, levetiracem, gabapentin

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34
Q

low potency steroids for face

A

1% hydrocortisone validate

can use 0.1% triamcinolone for other body parts

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35
Q

indications for surgery in primary hyperPTH?

A 
age <50
CKD with GFR <60
nephrolithiasis
T score < -2.5
Ca greater than 1 above the ULN
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36
Q

treatment of ILD in systemic sclerosis

A

mycophenolate

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37
Q

criteria for adequate stress testing

A

85% of age predicted maximum HR

atleast 4 METs

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38
Q

H pylori Tx

A

triple therapy: PPI, amox, clarithromycin

Quad therapy in clarity resistant areas (asia, australia) or pcn allergy: PPI, bismuth, flagyl + tetracycline!
prior exposure to macrolides: amox, levaquin, PPI

** test for clearance at least 4 weeks after completing therapy

** do not test for H pylori until off PPI for 2 weeks and abx for 28 days

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39
Q

Tx of NON-small cell lung cancer based on mutations
EGFR –>
ALK/ROS1 –>
PD-L1 –>

A

EGFR –> erlotinib
ALK/ROS1 –> crizotinib
PD-L1 –> pembrolizumab

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40
Q

indications for airborne contact precautions

A

TB
disseminated varicella zoster
localized zoster in an immunocompromised
measles

** neisseria meningitis only needs droplet

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41
Q

characteristic of AVNRT on EKG

A

SVT–Narrow QSR tachycardia
RP < PR
P wave buried in QRS
pseudo R in V1

tx:
hemodynamically stable: vagal maneuver/carotid massage, adenosine (C/I in asthma exac bc risk of bronchospasm)

unstable: sync cardioversion

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42
Q

DM med assoc with risk of cholestasis, cholelithiasis, choleycystecomy

A

GLP-1 (eventide, liraglutide)

  • bc rapid weight loss it causes saturation of cholesterol in bile and delayed release of bile
  • also inc risk pancreatitis
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43
Q

reversal of dabigatran (direct thrombin inhibitor)

A

idarucizumab

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44
Q

AAA screening US age group

A

age 65-75 who smoked more than 100 cig

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45
Q

tx of DM caused by chronic pancreatitis

A

INSULIN only bc pancreatic beta cell destruction

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46
Q

hemolytic anemia, hypocellular bone marrow/ pancytopenia, and lack of CD55 and CD59.
portal vein thrombosis

A

Paroxysmal Noctural Hematuria

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47
Q

timeline for radiation pneumonitis vs. radiation fibrosis of lungs

A

radiation pneumonitits–typically 6-12 weeks

radiation fibrosis—typically 6- 24 months

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48
Q

treatment for essential tremor

A

primidone or propanolol

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49
Q

interpretation of FeUrea

A

<35% = pre-renal

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50
Q

pre-renal findings

A

BUN: Cr >20:1
FENA <1%
U sodium <20 **
hyaline casts

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51
Q

ATN findings

A

BUN:Cr 10:1
FENA >2%
Urine sodium >40
muddy brown casts, tubular epithelial cells

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52
Q

AIN urine microscopy findings

A

leukocyte casts, eosinophilliura

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53
Q

mononeuritis multiplex assoc with

A

polyarteritis nodosum

  • medium vessel vasculitis–mesenteric and renal vessels
  • assoc with hep B
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54
Q

best seizure med for women on OCP/ reproductive age

A

Keppra

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55
Q

testing for lyme disease

A

TWO-tiered:

Enzyme assy (Lyme Ab EIA)
- if positive --> Western blot IgM and IgG (after 30 days will be present)
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56
Q

treatment after thyroidectomy for thyroid cancer?

A

if high risk – > radioactive iodine

high risk:
size of the primary tumor (between 2 and 4 cm), the presence of vascular invasion and extrathyroidal extension and the number of involved lymph nodes (>5).

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57
Q

mitral regurg—indications for mitral valve repair

A

asymptomatic and LV dysfunction (EF <60%)
symptomatic and EF >30%
Pulm HTN
new onset Afib

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58
Q

dx west nile via

A

IgM ab

fever, meningitis signs
+ FOCAL neuro deficit

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59
Q

tx of PID in hospitalized patient

A

cefoxitin (IV cephalosporin) + doxycycline

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60
Q

OD with increased anion gap acidosis, and an elevated osmolal gap.

A

methanol (wood alcohol)
ethylene glycol (antifreeze)
Tx: fomepizole, HD( if severe)

isopropyl or ethanol OD have elevated osmolar gap but NOT elevation anion gap and no metabolic acidosis

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61
Q

tx of RA

A

Methotrexate then DMARD/TNF-a inhibitor (if that doesn’t work then rituximab)

prednisone only for acute flares

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62
Q

how to prevent stroke after carotid a. dissection

A

aspirin

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63
Q

tx of partial seizure

tx of generalized seizure

A

partial–carbamazepine

generalized epilepsy– valproic acid

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64
Q

safest anti epileptic in preg

A

levetiracetam (or lamotrigine)

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65
Q

reasons to treat after FIRST unprovoked seizure

A 
age >65
h/o head trauma
focal findings on imaging/EEG
h/o partial seziure
h/o postictal weakness/paralysis

otherwise treat after 2 unprovoked

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66
Q

tx of relapsing-remitting MS

A 
interferon B (C/I in liver disease or depression) or glatiramer
vit D supplementation

refractory –> Natalizumab (C/I with pos JC virus Ab)

IV methypred (high dose steroids) for acute exac
Interferon C/I in depression/liver disease
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67
Q

Travel
episodes of fever, polyserositis, arthritis, erysipeloid rash around the ankles, and elevated acute phase reactants
dx?
tx?

A

Familial Mediterranean fever

colchicine

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68
Q

DM medication assoc with medullary thyroid cancer

A

liraglutide (GLP-1)

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69
Q

permissive HTN goals

  • after ischemic stroke
  • after/ before TPA
  • after ICH
A

after ischemic stroke <220/120

before TPA <185/110
after TPA <180/105 (for at least 24 hours)

ICH – <140

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70
Q

treatment of poison ivy

A

high potency topical steroid

Type IV hypersensitivity

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71
Q

Chicungunya distinction from Dengue

A

fever recurrent + migratory polyarthralgias (small joints of the hands, wrists, and ankles) and much less thrombocytopenia.

Dengue has more myalgia, arthralgia, back pain (bone break fever)

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72
Q

Pneumocystis jirovecii prophylaxis after solid organ transplant

A

bactrim for 6-12 months

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73
Q

pusles paradoxus

A

systolic drop by >10 with inspiration

  • seen in tamponade, constrictive pericarditis, asthma, COPD
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74
Q

Four statin benefit groups

A
  1. Clinical ASCVD (ACS, MI, Angina, CVA, TIA, PAD, aortic aneurysm, Coronary a. calcium score >100) —goal LDL <70 (add ezetimibe, then PCSK9)
  2. LDL >190 (high int)
  3. DM (mod inten) unless ascvd>20 then high
  4. ASCVD >7.5% (mod int), ASCVD >20% (high int)
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75
Q

preferred SSRI in preg

A

sertraline, fluoxetine

paroxetine is worse for preg

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76
Q

risky meds in preg

A

isotretitonin (X), warfarin (X), statins (X), bisphosphonates, ACE/ARB, valproic acid, SSRI, quinolone, tetracyclines

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77
Q

tx of alcoholic hepatitis to decrease mortality

indications?

A

prednisolone

Maddrey > 32, MELD >18
or encephalopathy + ascites

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78
Q

indication for MRI with headaches…red flags?

A 
first/worst  headache
change in pattern of headaches
aura lasting >1hr
focal deficit 
new HA in age <5 or >50
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79
Q

psychiatric symptoms, seizures, autonomic instability, and choreoathetoid movements.

A

anti-NMDAR encephalitis
** strong assoc with ovarian teratoma

treatment can include tumor removal (if present), intravenous glucocorticoids, intravenous immune globulin, plasmapheresis, and rituximab

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80
Q

Differences between types of RTA

A

nl anion gap metabolic acidosis w/ positive urine anion gap: (Na+K) - Cl

Type 1– distal

  • urine pH»6, low bicarb, hyperK
  • ass cat phos stones, SLE, Sjogerns

Type 2— proximal

  • urine pH <5.5, glycosuria
  • assoc MM

Type 4–

  • urine pH < 5.5 low renin, low aldo, Hyper K
  • assoc DM, develop severe HyperK with ace/arb
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81
Q

afferent pupillary defect, pain with eye mvmt, central scotoma

A

Optic neuritis, think MS

Get MRI brain

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82
Q

when to use vit K for supratherapeutic INR

A

oral vit K for INR >9
5-9 hold warfarin

IV vit K for life threatening bleeding only

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83
Q

Elevated LFTs, hemolytic anemia, unconjugated hyperbili

+neuro dysfunction

A

Liver biopsy to confirm Wilson’s disease

  • unexplained acute liver failure in <40yo.
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84
Q

Indications for ICD

indications for ICD post-MI?

A

EF <35% and NYHA class 2 or 3 symptoms
Not class 4 unless patient is transplant candidate
inherited long QT
Brugada
high risk HOCM
VT/VFib arrest
sustained VT with syncope or structural heart disease

at least 40 days post MI - EF <30%

  • at least 3 months since PCI/CABG
  • life expectancy at least 1 year
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85
Q

Murmur of HOCM

A

Increases with valsalva, change from squatting to standing (dec preload)

decreases with hand grip or squatting
(inc after load)

** murmur improves/decreases with volume in heart.
Increased risk of death with dehydration

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86
Q

timing of pneumococcal vaccine

A

23 valent age 19-64 with COPD/asthma

repeat 23 valent (polysaccharide) at age 65 if 5 years has lapsed

everyone gets 13 valent (conjugated) at age 65 [ 1 year after 23 valent]

PSV23 and PCV13 are also indicated in patients with functional or anatomic asplenia, cochlear implants, persistent cerebrospinal fluid leak, and significant immunocompromising conditions. Preferably, these patients should receive PCV13 first followed by PPSV23 at least 8 weeks later. This patient will require another dose of PPSV23 at the age of 65 years.

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87
Q

broad vs. narrow anti-epileptics

A

broad: topiramate, lamotrigine, levetiracetam, valproic acid, and zonisamide
- for both generalized and partial epilepsy or if unknown

narrow: Carbamazepine, gabapentin, and phenytoin
- used to treat partial-onset epilepsies(specific auras (déjà vu or a rising epigastric sensation) and unilateral clonic shaking before onset.)

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88
Q

nephrotic syndrome with risk of thromboemobolism

A

membranous glomerulopathy

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89
Q

when to administer TDAP during preg

A

b/w 27-36 weeks with every pregnancy

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90
Q

treatment for cluster headache (acute and prevention)

A

oxygen
subQ sumatriptan

for prevention: verapamil

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91
Q

when to screen for diabetes

A

adults age 40-70 who are overweight or obese

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92
Q

surgery vs. medical management of aortic dissections

A

surgery with Type A (ascending or aortic arch) or complicated Type B

medical mgt with type B–IV BB to decrease HR below 60 then IV nitro

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93
Q

which MELD score to send for transplant

A

> 15

TIPS c/i for >20

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94
Q

follow up colonoscopy timing for sessile serrated polyp vs. adenomatous

A

serrated:
<10mm — 5 years**
>10mm — 3 years **

adenomatous:
1-2 that are <10mm — 5-10 years
3-10, >10mm, villous, high grade dysplasia– 3 years
>10 polyps – < 3 years and eval for genetic cause

hyperplastic
if small and distal, regular 10 year interval

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95
Q

tests to screen for cushing’s disease

A

24 hour urinary cortisol
1mg (low dose) dexamethasone test
evening salivary cortisol

  • *NEED TWO ABNORMAL TO DIAGNOSE
  • **NOT AM cortisol, bc it fluctuates
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96
Q

how to diagnosis CTEPH

A

VQ scan

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97
Q

diagnosis of sarcoidosis

A

bronch biopsy

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98
Q

biliary disease assoc with UC

A

Primary sclerosisng cholangitis (intra and extra hepatic ducts)

Primary Biliary cirrhosis is assoc with anti-Mitochrondrial ab.

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99
Q

treatment of rosacea

A

rosacea – topical metronidazole

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100
Q

anterior knee pain that is slow in onset and typically made worse with running, climbing stairs, and prolonged sitting.

A

patellofemoral pain syndrome

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101
Q

lateral knee pain that is worsened by walking down an incline. On examination, there is frequently tenderness to palpation of the lateral femoral epicondyle,

A

illiotibial band syndrome

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102
Q

treatment of babesiosis

A

atovaquone + azithromycin

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103
Q

MEN syndromes

A

MEN1 – diamond (pituitary (prolactinoma), parathyroid, pancreas(insulinoma) )

MEN2A — square (parathyroid, pheo)

MEN2B — triangle (neuroma, pheo)

2A and 2B assoc with medullary thyroid cancer

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104
Q

treatment of secondary hyperPTH due to CKD

A

calcitriol

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105
Q

agent for pharmacologic stress ECHO with COPD/Asthma

A

dobuatmine

  • vasodilators, such as dipyridamole, adenosine, and regadenoson, can cause bronchospasm during cardiac stress testing; these agents can be used with caution in a patient with a history of COPD but are contraindicated in a patient who is actively wheezing.
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106
Q

size to warrant aortic aneurysm repair in men/women

A

5.5 cm in men and 5.0 cm in women

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107
Q

screening with annual low-dose CT in patients with

A

age 55 to 80 with at least 30 pack years and current smoker or quit within 15 years

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108
Q

treatment of lupus nephritis

A 
class III and IV
- prednisone AND mycophenolate or cyclophosphomide

V
- prednisone AND mycophenolate

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109
Q

Treatment of ITP

A

Platelets > 30,000 and no bleeding
- clinical observation , repeat CBC in 1-2 days

PLT<30K—- prednisone.
2nd line = IVIG
3rd =rituximab/splenectomy

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110
Q

Colonoscopy follow up timeline after cancer

A

Follow up colonoscopy at 1year and 3year and if normal then every 5 years

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111
Q

Hip pain with FABER (flexion, abduction,external rotation) plus tenderness of SI

A

Sacroillitis

FABER causes–posterior hip pain in the presence of sacroiliac joint dysfunction, groin pain from an intra-articular cause, and lateral hip pain from greater trochanteric pain syndrome.

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112
Q

critera for extubation

A

RR <35 and O2 sat of at least 90%

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113
Q

indications and treatment of Essential thrombocytopenia

A

> 60yo, h/o thrombus, PLT >1million
tx: hydroxyurea + asa

low risk patients– asa only

stroke/TIA–platetletpharesis

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114
Q

time to get to PCI center for STEMI

A

<120 mins otherwise give TPA
(symptom onset within last 12 hours for giving TPA)

c/i if history of brain bleed, known AVM in brain, active bleeding, ischemic cva within 3 months, closed head/facial trauma within 3 month

door to balloon goal 90 minutes

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115
Q

vasculitis assoc with HepC and ear infarctios

A

cryoglobulinemia

-low C4, normal C3

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116
Q

small R wave and deep S wave in V1 lead

EKG with wide QRS and “W” in V1 and “M” in V6

A

LBBB

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117
Q

diagnosis of parkinson’s

A

presence of bradykinesia and at least one of the other cardinal features of resting tremor, rigidity, or postural instability.

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118
Q

c-ANCA

p-ANCA

A

cANCA (anti-protinease Ab)
- Wegners (granulomatosis w/ polyangitis)

pANCA (anti-myeloperoxidase)

  • *MPA– microscopic polangitis**
  • Churg Strauss (eosinophillic granulamtosis)
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119
Q

pneumonia vaccine time line

A

13 (conjugate)
23 (polysaccaride)
*see pic

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120
Q

treatment of myasthenia crisis

A

plasmapheresis
IVIG

** stop pyridostigmine during acute crisis due to it causing inc in resp secretions

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121
Q

treatment of status migraineous

A

intravenous infusions of dihydroergotamine

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122
Q

when to screen for HCC in HepB carriers

A 
asian men >40, asian women >50
cirrhosis
famHx of HCC
persistant LFT elevation
african descent age 20
DNA levels > 10K

tx if ALT elevated and HBV DNA > 10,000

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123
Q

ICD vs. CRT placement (biventricular pacemaker)

A

ICD– EF <35% and class 2-3 HF on GDMT

Cardiac resync therpy– EF < 35% , class 2-4 symptoms on guideline-directed medical therapy, and LBBB with wide QRS*

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124
Q

dif b/w folate and b12 def

A

folate – elevated homocysteine

B12– elevate homocysteine and MMA

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125
Q

pap smear screening guidelines

A

21 to 65 q3 years with cytology (Pap smear)
30 to 65yo- pap + HPV q5years

can stop at 65 if two neg HPV+pap in last 10 years

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126
Q

nephrotic syn assoc with HepB

A

membranous

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127
Q

treatment of sever or symptomatic Mitral stenosis

**rheumatic heart dz = MCC

A

Percutaneous balloon mitral valvuloplasty is treatment of choice.

MV replacement if mod-severe mitral regur or LA thrombus

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128
Q

complement levels in lupus nephritits

A

low C3

low C4

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129
Q

biliary disease assoc with UC

A

Primary sclerosis cholangitis
( beads on screen)
(diagnose with cholangiography)

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130
Q

compressive spinal cord lesion

A

steroids for anything compressive
imed RT– if plasmacytoma or myeloma, leukemia, lymphoma, myeloma, and germ cell tumors

surgery–all other causes

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131
Q

ADAMSTS13 testing indication

A

suspicion of TTP (hemolytic anemia + low PLTS)
- treat with plasma exchange

ITP only has low platelets but no hemolytic anemia

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132
Q

positive direct antiglobulin (coombs) test

A

warm-Ab autoimmune hemolytic anemia

tx= steroids

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133
Q

+flow cytometry for CD55 and CD59

and how to treat?

A

PNH
no hemolysis—no treatment
tx for severe disease is eculizumab or HSCT

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134
Q

spherocytes

A

Autoimune hemolytic anemia (+coombs) or hereditary spherocytosis

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135
Q

anthrax tx

A

mild cutaneous– PO cipro
inhlational–IV cipro + 2 other abx

painless ulcer with black eschar
Gram pos bacilli
widen mediastinum– inhalation anthrax

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136
Q

small-vessel vasculitis affecting the skin, joints, kidneys, and gastrointestinal tract. Deposition of IgA

A

Henoch schonloin pupura

treat with steroids

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137
Q

Kleinfelter (XXY)

A

he extra sex chromosome results in malformation of the seminiferous tubules and typically of the Leydig cells. Physical examination is likely to reveal small, firm testes and decreased virilization. Additional manifestations include oligospermia and infertility.

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138
Q

low testosterone

    • with high FSH/LH
    • with low or normal FSH/LH
A

high fsh/LH = testicular failure
**Klinefelter (check karyotype), mumps orchitis, prior pelvic RT

low or normal = secondary hypogonadism

    • OSA, hyper Prolactin, hypothalamus or pit disorders, use of opiates/anabolic steroids, glucocorticoids
  • –> always eval prolactin, iron studies (hemochromatosis), pituitary MRI
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139
Q

what depth of melanoma requires sentinel LN biopsy

A

> 1mm– get LN biopsy and 2cm surgical margin
<1mm- get 1cm surgical margin

if greater than >4mm deep or LN involvement–immunotherapy with interferon alpha

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140
Q

treatment of melanoma with BRAF mutation

A

vemurafenib preferred over immunotherapy

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141
Q

treatment of anal cancer

A

squamous cell assoc with HPV

–radiation with concurrent chemo

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142
Q

diagnosis of preeclampsia

A

HTN after 20th week gestation
PLUS
proteinuria or END ORGAN DAMAGE
low PLT <100K, Cr elevation, elevated LFTs, pulm edema, cerebral or visual symptoms

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143
Q

cardiac/pulm side effect of limited cutaneous systemic sclerosis

A

pulmonary HTN (pulmonary arterial pressure > 25)
–eval with ECHO
THEN maybe right heart cath

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144
Q

alternatives to colon cancer screening

A

age 50-75

  • FIT Or high sens FOBT (gFOBT) yearly
  • flex sig q5
  • CT colonography q5
  • flex sig q10 +FIT/gFOBT
  • fecal DNA q3yr
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145
Q

how to determine surreptitious thyroid use

A

low thyroglobulin levels

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146
Q

treatment of hyperthyroidism in 1st trimester pregnancy and with thyroid storm

A

PTU

other wise treatment is methamizole

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147
Q

when is radioactive iodine c/i for hyperthyroidism treatment?

A

pregnancy

concurrent graves opthalamopathy

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148
Q

biggest side effect of hyperthyroidism tx

A

methamizole and PTU can cause agranulocytosis (severe neutropenia)

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149
Q

pre-op treatment of pheochromocytoma

A

IV phenoxybenazamine

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150
Q

first thing to do when evaluating hyper PROLACTIN

A

r/o hypothyroidism!!

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151
Q

dix hallpike differentiation b/w peripheral and central disease

A

peripheral

  • latency bw maneuver and symptoms
  • lasts <1min
  • fatiguability
  • horizontal w/ rotational

central (brainstem or cerebellar stroke)–get MRI

  • no latency,
  • Lasts >1
  • not fatiguable
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152
Q

indications to monitor pericarditis as inpatient

A

high-risk features (fever, leukocytosis, acute trauma, abnormal cardiac biomarkers, immunocompromise, oral anticoagulant use, large pericardial effusions, or evidence of cardiac tamponade)

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153
Q

indications for BRACA testing

A
  • breast cancer before age 45 years
  • breast cancer at any age and a family history of breast and/or ovarian cancer
  • triple-negative breast cancers diagnosed before age 60 year
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154
Q

treatment of burkett lymphoma

A

R-CVAD immediately bc it is aggressive

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155
Q

reasons for early surgical intervention in infective endocarditis (before 6 weeks)

A 
heart block
veg >10mm
HF
left sided w/ staph aureus/fungal/resistent
persistant bacteremia >7 days
annular or aortic abscess
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156
Q

episcleritits vs scleritis

uveitis

A

episcleritis

  • painless
  • no vision changes

scleritis

  • painful, assoc w/ systemic AI diseases
  • risk of vision loss, imed referral to optho

Uveitis

  • most dilation at corneal edge
  • Unitlateral
  • assoc with HLA-b27
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157
Q

b/l painless gradual peripheral vision loss

elevated IOP

A

open angle glaucoma

Macular degen causes central vision loss

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158
Q

initial evaluation of palpable breast mast

A

MMG (or US if <35yo)

then FNA or biopsy

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159
Q

c/i to combined OCPs

A 
uncontrolled hypertension
breast cancer
VTE
liver disease
migraine with aura.

Estrogen-containing preparations are contraindicated in women >35 years who smoke

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160
Q

treatment of menopause hotflashes + vaginal dryness

A

if have uterus— combined estrogen + progesterin

  • **younger than 60 and within 10 years of menopause
  • **max tx is 5 years

no uterus–can use estrogen alone

if just vasomotor hot flashes– SSRI
if just vaginal dryness – topical vaginal estradiol cream

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161
Q

indications for bridging

A

mechanical Mitral valve
mechanical aortic valve with afib or risk factors
recent VTE <3mos or afib and CVA <3 mos ago

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162
Q

time to wait for surgery after DES?

Bare metal

A

DES– atleast 6months, maybe 12

Bare metal- 30 days

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163
Q

treatment of ankylosis spondylitis if NSAIDs aren’t working

A

TNFa inhibitor for axial disease (adalimumab = humara)

MTX, sulfasalazine, HCQ for peripheral joint disease

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164
Q

initial tx of neutropenic fever

A 
MONOTHERAPY:
zosyn
or
cefepime
or 
meropenem/imipenem

**if signs of severe shock can add vanc simultaneously

no impvt in 4-5 days, add anti-fungal

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165
Q

ICD after MI

A

EF <35%
at least 40 days post MI

or 3 months post PCI

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166
Q

peripheral vertigo after URI

A

Vestibular neuronitis
- no hearing loss

Labrynthitis
- hearing loss

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167
Q

treatment of polycythemia vera (high Hgb, low EPO, +JAK2)

A

phlebotomy (goal HCT <45%)
asa 81

high risk– hydroxyurea

  • if EPO not low, consider a paraneoplastic syndrome, testosterone, chronic hypoxemia
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168
Q

treatment of ET

A

low dose asa (low risk)

high risk ( leukocytosis, >60yo, prior thrombi) —hydoxyurea

if need rapid PLT reduct (stroke, MI)—platelet pheresis

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169
Q

fever, hypoxia, pulm infiltrate after ATRA for APML

A

differentiation syndrom

- tx with dexamethasone

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170
Q

treatment of Afib when patient also has WPW

A

procainamide

not BB, CCB, dig–> can cause VF

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171
Q

treatment of WPW

A

asymptomt tachycaridia–procainamide

sympt tachy– ablation

unstable— cardioversion

WPW conduction w/o symptoms–no treatment or investigation

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172
Q

treatment of pericarditits

A

asa (esp after MI) or NSAIDS
+
colchicine – to prevent reoccurrence

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173
Q

topical vs. oral antifunal

A

oral terbinafine or itraconazole for onchomycosis, tinea capitus (head), extensive tinea corporis

topical clotrimazole or terbinafine for everything else

topical options:
imidazole, miconazole, clotrimazole, ketoconazole, ciclopirox, or terbinafine

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174
Q

tinea versicolor tx

A

topical treatment using ketoconazole 2% shampoo or selenium sulfide suspension is effective.

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175
Q

erythema multiforme

A

target with violaceous dark cente (multiple)

    • strong assoc with recurrent HSV or mycoplasma
    • also can be drug rxn
  • -> supportive care

NOT to be confused with erythema migranes of lyme which looks like bullseye

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176
Q

abrupt onset severe psoriasis assoc w/

A

HIV

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177
Q

HIV post exposure ppx

A

3 drug regimen: tenofivir, emtricitabine, dolutegavir
4 weeks of tx
within 72 hours of exposure
testing at 0,1,3 months

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178
Q

indications for coronary a. calcium score test

A

10–year ASCVD is borderline (5-7.5%) or intermediate (>7.5%) to determine need for statin for PRIMARY prevention

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179
Q

pneumonia assoc with livestock

A

Coxiella Burnetti
aka- Q fever
tx: doxycycline

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180
Q

formula for serum Osm

A

Serum Osmolality (mOsm/kg H2O) = (2 × Serum Sodium [mEq/L]) + Plasma Glucose (mg/dL)/18 + Blood Urea Nitrogen (mg/dL)/2.8

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181
Q

TB skin test cut offs

A 
>15mm =  normal population
>10mm =  IVDU, LTAC, healthcare, DM, homeless, recent arrival from prevalent country
>5mm =  HIV, contact with active TB, CXR with old TB, organ transplant
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182
Q

SBP antibiotic prophylaxis reasons

A
  1. ascites with GIB or variceal bleed– 7 day course
  2. chronic abx if hx of SBP
  3. hospitalized with ascites protein <1.5 with (Na <130, Cr >1.3, or bill > 3)

tx: fluoroquinoles

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183
Q

indication for carotid endartectomy

A

greater than 80% stenosis
asymptomatic infarcts on brain imaging
an abnormal transcranial Doppler ultrasound study
rapid progression.

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184
Q

oral lesions in bullous pemphigoid or pemphigus vulgaris

A

oral lesions in pemphigus vulgaris (easily ruptured)

bullous pemphigoid–subepidermal vesicles and blisters that are tense and do not rupture easily, chronic, autoimmune

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185
Q

LVH on EKG

A

large S in V1
large R in V5/6

(S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm).

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186
Q

treatment of Bechets ulcers

A

topical steroids

colchicine for preventing recurrent ulcers

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Not at all
2
3
4
5
Perfectly
187
Q

examples of PSK9 inhibitors

A

alirocumab or evolocumab

** add if LDL still >70 with statin + exzetimibe

188
Q

treating dermatitis herptiformis

A

gluten free diet

dapsone (make sure not g6pd deficient first)

189
Q

HTN on fundoscopy image looks like?

A

AV ratio <1 arterioles are very narrow compare to veins

flame-shaped hemorrhages; s
mall, white, superficial foci of retinal ischemia (cotton-wool spots);
yellow hard exudates
optic disk edema

190
Q

acid base findings of asa overdose

A

HAGMA + Resp alkalosis

tx: alkalize urine with sodium bicarb

191
Q

thin white vaginal discharge, fishy odor, no pain
+ wiff test
clue cells
pH >4.5

A

BV ( gardnerella)
tx: flagyl (clinda if preg)

candidas– painfull/itchy, pH <4.5

192
Q

what to give for lyme prophylaxis after tick bite and when?

A

doxycycline if tick has been attached 36 hours or longer and given within 72 hours of bite

otherwise just watchful waiting

193
Q

asthma treatment directed at IgE?

directed at high eosinophils?

A

IgE 30-700 – Omalizumab

Eospinophil count >150 — Mepolizumab/reslizumab

194
Q

hold long to hold NOAC pre-operatively

195
Q

indications for closure of ASD

A
  1. symptoms (dyspnea/embolism)
  2. L to R shunt
  3. RA or RV enlargement
196
Q

acute onset nephrotic syndrome (without hematuria, just proteinuria) most likely?

A

minimal change disease

197
Q

when to test for thrombophilla after unprovoked DVT?

A

NOT in acute setting

NOT while on AC— at least 2 weeks after discontinuation of anticoagulant therapy to minimize diagnostic error.

198
Q

anticoagulant treatment of valvular afib

A

warfarin (IF mod/severe rheumatic MS or mechanical valve)

otherwise– calc CHADS VASC and treat 2 or greater in men 3 or greater in women with NOAC

199
Q

stool osm gap

secretory vs. osmotic

A

290 - [ 2(stoolNa + stoolK)

gap >100 osmotic diarrhea ( low vol, improves with fasting)
*lactase def

<50 secretory diarrheal (large vol, no improvement with fasting)
* celiac, infectious, collagenous colitis, VIPoma

200
Q

old man with diarrhea, confusion (neurologic symptomatic), joint pains

A

Whipple disease
Dx: small bowel biopsy (foamy macrophages) and PCR from tropheryma whippelli

tx: 1 year abx (ceftriaxone then bactrim)

201
Q

classification of chronic diarrhea

A

> 4 weeks (1 month)

**first step is colonoscopy with biopsies

202
Q

when to do EGD with GERD

A

alarm symptoms ( anemia, dysphagia, vomiting, wt loss)

refractory to PPI (once daily then BID for 4-8 weeks)

male >50yo with symptoms for more than 5 years and inc risk factors (nocturnal symptoms, hernia, inc BMI, smoker)

203
Q

mgt of Barrett’s

A

no dysplasia – repeat EGD in 3-5 years

low grade– ablation OR repeat in 6-12 most if not choosing ablation

high grade– ablation

204
Q

treatment of eosinophilic esophagitis

A

young adult with acute food impaction
EGD– trachealization of esophagus (stacked rings)
tx: 8 week trial of PPI, if persistent diagnosis is confirmed and treat with swallowed fluticasone or budesonide

205
Q

Zollinger- Elison syndrome

A

chronic diarrhea, PUD, esop ulcers

dx: fasting serum gastrin after stopping PPI for 7 days

206
Q

first test to do with acute pancreatitis

A

RUQ US to rule out gallstones

CT only if severe, >48hours or complications suspected ( DO NOT routinely order)

207
Q

who to treat with Hep B

A
  1. compensated cirrhosis or acute liver failure
  2. immunosupressed
  3. polyarteris nodosum, membranous nephropathy, membranoprolifeerative
  4. HbeAg +, LFTS > 2x ULN, DNA > 20,000 U/mL
    IgG to core
  5. HgeAg neg but ALT >2 ULN and HBV DNA > 2000

tx: entecavir or tenofovir
if also HIV– emtricitabine-tenofivir

208
Q

hemochromatosis
dx:
tx:

A

iron overload in multiple organs bc increased intestinal absorption (liver, heart, pit, pancreases)

  • arthritis (destructive), ED, fatigue, DM, bronze skin
  • hooked osteophytes

dx: fasting transferrin/ iron saturation
tx: phlebotomy (if elevated ferritin) otherwise monitor

  • screen for HCC q6mos US
    • liver biopsy if elevated LFTs or ferritin >1000
209
Q

first thing to r/o with RLS symptoms

A

** check ferritan/iron def

210
Q

DAPT after stroke

A

asa + plavix for 21 days, then asa only

** only if initiated in first 24 hours (otherwise plavix only is more efficacious than asa only)

211
Q

UMN + LMN signs and NO SENSORY deficit

A

ALS

  • usually begins distally and asymmetrically
    tx: Riluzole

UMN (hyperreflexia, spasticity, and an extensor plantar response

LMN (atrophy and fasciculation)

212
Q 
triad:
 long standing RA
 splenomegaly
 neutropenia --> 
** risk of infections/LE ulcers/lymphoma/vasculitis
A

Felty syndrome

tx: agressive tx of RA

213
Q

which carbapenem does NOT cover pseuduomonas

214
Q

treatment of cyanide poisioning (house fire)

A

hydroxocobalamin

  • house fire, lactic acidosis
  • inappropriate high O2
  • late– hypoTN, heart block, arrythmia
215
Q

A-a gradiant

normal <20
elevated– causes?

A

normal (<20) – hypoventilation

elevated- VQ mismatch, shunt, diffusion problem (fibrosis/vasculitis), empysema

Calculating A-a gradient = PAO2-Pa02
PAO2 = 150- (PaCO2/0.8)

216
Q

vent strategy in ARDS

A

low TV (<6mL/kg ideal body wt)
high PEEP
allow for permissive hyperCapnia

217
Q

cryptogenic organizing pneumonia

A

cough, fever, and malaise for 6 to 8 weeks that does not respond to antibiotics
patchy opacities on chest radiograph; and ground-glass opacities on CT scan that are peripherally distributed
tx: glucocorticoids

218
Q

lung malignant assoc with hyponatremia

A

Small cell CA (bc SIADH)

219
Q

treatment of CO poisioning

A

supplemental O2

Hyperbaric O2 (if LOC, ischemic ACS, neuro deficits, carboxyHgb level >25%

220
Q

treatment of IPF

A

nintedanib or pirfenidone

221
Q

management of a parapneumonic pleural effusion

A

empiric abx (anaerobe coverage)

If complicated (pH <7.2, glucose <60) or empyema (frank pus---->
CT drainage and TPA into pleural space if not completely drained
222
Q

what therapies can decrease freq of COPD exac

A

roflumilast

long term macrolide (azithro) therapy

223
Q

lung + liver disease

empyema with bullous changes in lung bases

A

alpha1-antitrypsin

224
Q

causes of eosinophiluria

A 
AIN (NSAIDS, PPI, Sjorgrens, Sarcoidosis)
post infectious GN
atheroembolic ideas
septic emboli
small vessel vasculitis
225
Q

when to start 2 antiHTN at same time

A

BP >20/10 over goal

(>150/90) if goal is 130/80

226
Q

D- lactic acidosis

A

increased anion gap metabolic acidosis in patients with short-bowel syndrome or other forms of malabsorptio

227
Q

what kidney stone size cutoff is unlikely to pass spontaneously with supportive care/tamsulosin/nifedipine

A

urologic intervention for:

>10mm
any sign of infection
AKI
obstruction of solitary kidney
b/l obstruction
228
Q

acute onset of severe hypertension, kidney failure, and microangiopathic hemolytic anemia.

A

scleroderma renal crisis
tx: ACEI
assoc with diffuse cutaneous system sclerosis

229
Q

GFR when referral to kidney transplant center should be made

A

<20

**C/I if active malignancy, coronary ischemia, or active infections, no social support

230
Q

eval of hematuria (not dysmorphic erythrocytes suggestive of GN)

A
  1. exclude infection
  2. CT (non contrast helical to exclude stones, and contrast to exclude renal cell ca)
  3. IF >35, male, risk factors for malignant –> cystoscopy
    IF age <35, female, no risk factors –> urine cytology then stop eval if normal.
231
Q

mgt of renal a. stenosis

A 
medical mgt (FIRST)-- add ACE-I
optimize HLD, cardiac risk factors,  (if Cr rises >25% after addition of ACE it must be stopped)

Stenting –those who present with a short hypertension duration; fail medical therapy; or have severe hypertension or recurrent flash pulmonary edema, refractory heart failure, acute kidney injury following treatment with an ACE inhibitor or ARB, or progressive impaired kidney function

232
Q

HyperCa
hyperCalciuria—> nephrocalcinosis/nephrolithiasis

+ b/l hilar adenopathy or granulomas

A

sarcoidosis affect on kidney

Hypercalcemia occurs due to peripheral conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D by activated macrophages

tx: steroids

233
Q

which bicarb level to start oral bicarb supplement in CKD?

234
Q

when to give EPO in CKD?

A

If iron def r/o to maintain Hgb >10 (avoid Hgb >11.5)

goals with iron therapy in CKD:
maintaining transferrin saturation levels of >30% and serum ferritin levels of >500 ng/mL (500 µg/L).

235
Q

GFR cut off for thiazide (chlorthalidone/HCTZ)

A

don’t use with GFR <30

236
Q

type of IVF treamtment of alcoholic ketoacidosis

A

** thiamine before glucose

5% dextrose in 0.9% saline

237
Q

treatment of IgA nephropathy?

A

ACE-I (esp if have proteinuria)

asymptomatic hematuria 1-2 days after URI
nl complement levels

238
Q

skin findings in various forms of lupus

A

acute cutaneous – malaria rash –> develop SLE

subacute cutaneous – papulosquamous, annular or polygonal photosensitive rash that usually spares the face

chronic cutaneous lupus erythematosus—discoid lupus erythematosus, usually presenting as scaly infiltrative papules and plaques or atrophic red plaques on sun-exposed skin surfaces

239
Q

syndrome assoc with:
interstitial lung disease, myositis, Raynaud phenomenon, nonerosive inflammatory arthritis, constitutional findings such as low-grade fever, and mechanic’s hands

A

anti-synthatese syndrome

anti-aminoacyl-tRNA synthetases antibodies, such as anti–Jo-1

240
Q

tx of systemic sclerosis (scleroderma)

A

tx organ specific problems
** avoid steroids as them may precipitate a renal crisis

ILD– mycophenolate
PAH – treat similar to idiopathic PAH
renal crisis – ACE-I
Raynaud– avoid cold, CCB/ sildenafil/nitrogliycerin

241
Q

localized pain inferomedial to the knee join

medial knee pain worsened with climbing or descending stairs or rising from a seated position.

A

pes anserine bursitis.

242
Q

erythema nodosum +hilar adenopathy + inflam arthritis (usually ankles)

A 
Lofgren syndrome (form of sarcoidosis)
- does not require any lymph node biopsy
243
Q

spherocytes cause by

A 
Autoimmune hemolytic anemia (pos Coombs/DAT with IgG)
Herediatry spherocytosis (neg Coombs/DAT

positive test– shows agglutination
DAT = direct antiglobulin test

244
Q

best screening test for hemochromatosis

A

transferrin saturation

245
Q

treatment of MDS
low risk?
high risk?
-deletion of 5q?

A

low risk–no tx, infrequent transfustions

high risk– allogenic HSCT (young pts), azacytidine/decitabine

5q deletion– lenalidomide **
- favors good prognosis

246
Q

lymphadenopathy +protein spike + organomegaly + lymphocytes in bone marrow

A

Waldenstrom macroglobulinemia

*asso with hyper viscosity syndrome— needs emergently treated with plasmapheresis

247
Q

hook like osteophytes on MCP

A

hemochromatosis

248
Q

transfusing sickle cell patients

A

pre-op (surgery): simple transfusion to goal Hgb 10

if multi organ failure, ACS, CVA, retinal a. occlusion, fat embolism– exchange transfusion to HbS <30%

otherwise avoid blood transfusions with simple vasoclusion or otherwise

249
Q

reversal of dabigatran

A

idarucizumab (praxabind)

250
Q

PLT cut off for treating ITP

A

PLT <30K

  • steroids are 1st line
  • if resistant–> IVIG or anti-D-immune globulin (if RhD pos)
  • if still unresponsive to drugs or relapse after tapering steroids– splenectomy or rituximab
251
Q

mgt of Lobular carcinoma in situ (LCIS) on breast biopsy

A

no immediate mgt, consider high risk

** can consider anti-estrogen therapy like tamoxifen (risk of VTE, endometrial Ca), raloxifine (post menopausal only) or aromatase inhibitor (POST-menoupausal only, need DEXA q2 due to risk of osteoporosis)

252
Q

examples of aromatase inhibitors

A

anastrozole
letrozole
exemestane*

– only POST menopausal
risk of osteoporosis so need q2 year DEXA

253
Q

prophylactic cranial radiation with which lung cancer

A

small cell

limited stage– chemo & RT together
extensive stage– chemo

for both– prophylactic cranial irradiation

254
Q

mgt of SVC syndome

A

get tissue diagnosis (mediastinoscopy) and then treat.
Do not need urgent stent unless patient crashing

can use steroids and diuretic for symptomatic tx while awaiting

255
Q

tx of non- small cell lung ca (adeno, squamous, large)

A

I & II– surgical resection plus cisplatin based chemo if >4cm and RT if positive margins

III– (mediastinum or c/l mediastinal LN) – chemo + RT

IV– chemo, +/- immunotherapy

256
Q

rule for surgical resection of liver mets?

A

“three lesions or less”

unless they have one of three conditions: tumor involvement of the common artery or portal vein or common bile duct; more than 70% liver involvement, more than six involved segments, or involvement of all three hepatic veins;

257
Q

treatment of hairy cell leukemia

A

cladaribine

pancytopenia, splenomegaly, no LAD, “dry tap” bone marrow biopsy
thread-like projections off cells

258
Q

smudge cells

indications for tx?

A

CLL
dx confirmed by flow cytometry with CD5 and CD23

asymptomatic– observe
indications for tx: anemia, low PLT, symptoms, rapid doubling of WBC

tx: rituximab + chemo
older pts with late disease— ibrutinib, chlorambucil

259
Q

tx of renal cell cancer

A

early stage/localized– nephrectomy

metastaticc— debunking nephrectomy, immunotherapy with VEGF ( bevacizumab) or mTOR inhibitors (pemrolizumab, nivolumab)

** NO CHEMO is effective

260
Q

tx of bladder cancer

A

transurethral resection of the bladder tumor followed by intravesical chemotherapy (BCG) and periodic cystoscopy

261
Q

first thing to do for suspected testicular cancer

A

measures serum AFP and bHCG
CT A/P
inguinal orchiectomy – NOT NEEDLE BIOPSY

262
Q

seminoma vs. non seminoma testicular cancer

A 
Seminoma (only HCG, never produce AFP)
non seminoma (produces HCG &amp; AFP)

stage 1 (confined to scrotom)– observe

stage 2,3– cisplatin based chemo BEP

263
Q

target cells assoc with?

A

thalassemia

264
Q

EKG changes that make and exercise EKG stress test non reliable

A

LBBB, ST depressions, LVH, paced, WPW, digoxin use, prior CABG or PCI

265
Q

cannon a waves

A

3rd AV block, VT

266
Q

elevated RA pressure, PCWP and PA pressure with systemic hypotension

A

cardiogenic shock

nl PCWP <12
nl RA pressure <7
nl PA pressure 13-28/3-13

267
Q

tx of PAD

A

1st line– exercise training
med mgt– cilostazol (C/I in HF**)

still not responding– revascularlization

268
Q

screening for AAA?

tx cut offf>

A

MEN age 65-75 who have every smoked one time US

surgery if >5.5cm or >0.5cm/year

269
Q

when to take abx prophylaxis for infective endocarditits?

which surgery?

usually amoxicillin, cephalexin, clinda

A

prosthetic valve
h/o IE in past
congenital heart defect (unrepaired cyanotic or repaired with prosthesis)

procedures:
dental procedures
incidiosn/biopsy of respiratory mucosa
procedure with GU or GI infection at same time
procedure on infected skin
placing prosthetic valves/heart surgery
270
Q

paradoxical split of S2?
fixed?
persistent?

A

paradoxical– delayed closure of aortic valve (LBBB, severe AS, HOCM)

fixed splitting– ASD

persistant splitting– PS, RBBB

271
Q

treatment of afib development during with WPW

A

urgent cardioversion! can be life threatening

procainamide while awaiting

272
Q

which coronary after assoc with STEMI in
2,3,avF?
V1-V3?
1, avL, V4-V6?

A

2,3,avF? —- RCA (inferior MI)
V1-V3? — LAD ( anteroseptal MI)
1, avL, V4-V6? — left circumflex a. (Lateral MI)

273
Q

3 conditions with holosystolic murmur

A

VSD
Mitral regurg
TR

274
Q

DM meds to use with with cardiac disease

A

GLP-1 (liraglutide, extend)

SGLT2 (-flozins)— reduce risk of CHF exac

275
Q

indication for ASD closure

A

right heart enlargment or
large left to right shunt or
symptoms

percutaneous closure for ostium secundum (MC)
surgical closer for ostium primum

276
Q

hypocalcium effect on QT

A

hypocalcium – prolonged QT (>440 in men, > 460 women)

hypercalcium– shortened QT

277
Q

Anticoagulation of Afib with underlying HOCM?

A

Warfarin in everyone

(even with CHADSVASC not qualifying for anticoagulant

278
Q

TTE vs. TEE for endocarditits

A

TTE

  • 1st line
  • can rule out IE with low probability

TEE

  • for neg TTE in high probability patient
  • for perivalvular abscess concern (prolonged PR)
  • fungal or staph left sided IE
  • HF
  • congenital heart disease
  • papillary muscle rupture
  • AV block
279
Q

when to treat THORACIC aortic aneurysm

A

surgery once >5 (or >4.5 with other heart surgery), or rate of growth >0.5/yr.

**marfans – surgery >4.5

if >4.5 or rate of enlargement >0.5 per year then repeat US every 6 months other annual US

280
Q

anticoagulant with mechanical prosthetic valve

A

warfarin AND ASPIRIN!!

goal INR 2.5 - 3.5 for aortic
goal 3 for mechanical mitral valve or aortic with risk factors (afib, dec EF, prior VTE)

281
Q

GDMT for HF

A

ACE I
BB (metoprolol SUCCINATE, coreg, bisoprolol)

diuretics for vol OL

EF <40 + class 3-4 symptoms

  • aldactone/eplerenone
  • hydralazine + nitrates
ICD-- EF <35%, class 2-3 symptoms after minimum 3 pos GDMT
CRT- EF < 35%, class 2-4 symptoms, LBBB with QRS >105)

cardiac rehab

282
Q

critical limb ischemia

A

ABI < 0.5
ischemic rest pain and ulceration

tx: immediate invasive angiography

283
Q

congenital syndrom assoc with pulmonic stenosis

A

noonan syndrome

pulmonary stenosis, particularly those with short stature, variable intellectual impairment, unique facial features, neck webbing, hypertelorism, and other cardiac abnormalities, including hypertrophic cardiomyopathy, atrial septal defect, and ventricular septal defect.

284
Q

indications for migraine prophylaxis?

drug options for prophylaxis?

A

> 10 days/month
use of acute meds >8 days per month
disabling HA >4 days per month
not responding to therapy

tx?
propranolol, metoprolol, timolol, topiramate, valproic acid, effexor, amitriptyline,

285
Q

myoclonus, rapid progressive dementia at young age, periodic sharp waves on EEG, MRI with increased signal in cortex and basal ganglia

A

Creutzfeldt-Jakob

286
Q

who to treat for influenza

A

all inpatients

outpatient with high risk (immunocompromised, chronic lung disease, age >64, preg, DM, signifying comorbidities, BMI >40.

287
Q

treatment of PCP in HIV pts

indications for steroids?

A

oral bactrim if mild
IV bactrim is more severe
(pentamidine or clinda+primaquine if sulfa allergy)

+steroids IF paO2 <70, or A-a gradient >35

PAO2 = 150- (PaCO2/0.8)

288
Q

conjunctival suffusion

A

seen in Leptospirosis

exposure to animal urine or contaminated water/soil

dx: IgM serology
tx: doxycycline

289
Q

treatment of toxo with ring inenhanocing brain lesions

A

sulfadiazine, pyrimethamine, folic acid

290
Q

banana shaped gametocyte on peripheral smear

A

malaria (p. falciparum)

291
Q

treatmetn of cat scratch disease

A

azithromycin for GN coverage of fastidious gram-negative bacterium Bartonella henselae

Other agents that can be used include doxycycline, rifampin, clarithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.

292
Q

tx Yersina plague?

A

streptomycin/gentamycin

  • safety pin
    bipolar gram neg coccobacilli
    bioterrorism
293
Q

white painless plaques on side of tongue that cannot be scratched off in HIV patinet

A

oral hairy leukoplakia

** assoc with EBV in HIV/immunocompromissed

294
Q

treatment of ESBL organisms?

A

carbapenems

295
Q

brain lesion in AIDs patient

A

toxo or CNS lymphoma (EBV)

** need brain biopsy to differentiate

296
Q

treatment of cryptococcal meningitis

A

liposomal amphotericin B and flucytosine

297
Q

nonpurulent cellulitis tx

A

dicloxacillin, clindamycin, penicillin, cephalexin,

298
Q

when can you stop bactrim for PCP prophylaxis

A

CD4 cell counts greater than 200/µL for more than 3 months

299
Q

post transplant infection cause

A

first month— same as general population

> 1mos— infection often CMV or EBV, JC virus causing PML, or polyomavirus BK causing nephropathy/hemorrhagic cystitis

> 6 mos post transplant— back to normal community acquired things

300
Q

gram stain of neisseria

A

gram neg (pink) cocci

301
Q

what to do for exposure to small pox?

A

Vaccinia immunization within 7 days of exposure

302
Q

treatment of TB meningitis

A

RIPE + dexamethasone!

303
Q

ecthyma vs. pyoderma gangrenous

A

ecthyma

  • necrotic ulcers with tender erythematous border
  • typically pseudomonas

pyoderma gangrenosum

  • painful pustules or nodules become ulcers that progressively grow.
  • not infectious
  • assoc IBD, RA
304
Q

lyme disease rash

A

erythema migrans

bullseye— dark center with ring around it

305
Q

recurrent gonnochial/meningiococcal infection

testing?
tx?

A 
terminal complement deficiency
def of c5-c9
screen with CH50 assay

tx: standard antibiotics as needed, maintain currency of vaccinations (esp meningococcal)

306
Q

erythema migrans lyme disease rash with neuro symptoms (facial n. palsy, headache, nuchal rigidity)

A

**must do LP prior to tx to determine no Neuroborreliosis, which necessitates parenteral therapy with ceftriaxone, cefotaxime, or penicillin.

in acute disease with just erythema migrans, fever, ha, arthralgia, myalgia, etc– can just treat with empiric doxy without serologic confirmation first

307
Q

treatment of histoplasmosis

pulmonary?
disseminated?

A

asymptomatic– usually self resolves

subacute, chronic, pulmonary histo– itraconazle

disseminated (hypotensive, diaphoretic, hepatosplenomegaly)— liposomal amphotericin B

308
Q

diarrheal illness assoc with IgA deficiency

A

Giardia

tx: flagyl

309
Q

treatment of cyclospora water diarrhea

A

bactrim

stool with modified acid fast stain
high risk HIV patients
travel
parasite is endemic, such as Peru, Guatemala, Haiti, and Nepal.

310
Q

bloody diarrhea after solid organ transplant

311
Q

CAP tx:

  • outpatinet
  • inpatinet
  • ICU
A

outpatient
- macrolide OR doxy alone

inpatient

  • beta lactam + macrolide
  • fluroquinolne alone (levaquin/moxiflox)

ICU
-IV beta lactam + azithromycin/respir fluoroquinolone

if risk of pseudomonas– double coverage
if risk of MRSA– add Vanc or linezolid

312
Q

strep gallolyticus

A

new name for strep bovis

**check colonoscopy

313
Q

abx with biggest interaction on warfarin

A

Bactrim (also avoid with MTX therapy!)

also raise INR:
amio
erythomycin
metronidazole
-zoles
tylenol**
314
Q

treat of UTI while on warfarin

A

nitrofuratonin
pcn
cephalosporin

**caution with fluoroqunolones and AVOID bactrim!

315
Q

drugs that cause peripheral edema

A 
nifedipine, amlodipine, fedolapine
pioglitazone -- can trigger a HF exac
pramipexole
NSAIDS
estrogen
gabapentin/pregabalin
316
Q

side effects of tramadol

A

seizures
suicidal ideation
hyponatremia
hypoglycemia

317
Q

seizure med that causes non anion gap acidosis

A

topiramate

**can also cause calcium phosphate renal stones

318
Q

Side effects of SSRI

A

hyponatremia
increased GI bleeding risk
sexual dysfunction

319
Q

what percentage within 1 SD of mean?

2 SD?

A

68% within 1 SD
95% within two standard deviations

** see bell curve drawing

320
Q

if 95% CI crosses ___ for a treatment it is NOT significant

if 95% CI crosses ___ for a relative risk or odds ratio it is NOT significant

321
Q

NNT formula

ARR formula

A

NNT= 1/ARR

ARR= % risk in control group - % risk in treatment group

322
Q

positive LLR

negative LLR

A

+ LLR = sens (1-spec)

- LLR = (1-sens)/ spec

323
Q

what are the high intensity statins?

A

atorva 40-80

rosuva 20-40

324
Q

age to start cholesterol screening?

A

M – 35-65
F – 45 - 65

** if any risk factors can start at age 20

325
Q

low dose lung CT screening

AAA US screening

A

lung CT– YEARLY in age 55-80 with 30 pack years, current or quit within last 15 years

Abdominal US– ONE TIME ages 65-75 (MEN ONLY) who ever smoked

326
Q

drug interactions with lithium causing lithium tox

A

ACE-I ***
diuretics
NSAIDS

tx:

327
Q

drug overdose causing teeth grinding (bruxity) and hypoNa after a young kid going to a party

A

ecstasy/NMDA

328
Q

glaucoma on fundoxscopy

A

cup taking up most of the disc >2:1

329
Q

treatment of bulimia

A

CBT and SSRI (fluoxetine or imipramine)

anorexia– tx with CBT

330
Q

1st line therapy for insomnia

331
Q

when to give low dose asa

A

Low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and colorectal cancer is recommended for adults aged 50 to 59 years with a 10-year ASCVD risk of 10%

332
Q

labrynthitis vs. vestibular neuronitits

A

both are peripheral vertigos that are preceded by URI

hearing loss in labrynthitis due to inflammation of CN8

333
Q

treating combined ED and BPH

A

tadalafil**

334
Q

vertigo + vertical nystagmus with no fatiguability

A

consider brainstem/verterbrobasilar infarct

335
Q

Pre-operative measurement of serum electrolyte and creatinine levels necessary in?

A

patients with kidney disease and those who are taking medications that may affect kidney function or predispose them to electrolyte abnormalities.

336
Q

evaluation of palpable breast lump

A

age <30 – observere 1-2 menstural cycles, if persistant– US
age > 30 – Mammogram

337
Q

treatment of prostatitis

A

GN coverage (cipro, levaquim, or bactrim) for 4-6 weeks

** know how to treat epididymitits based on age
< 35– ceftriazone + doxy
>35 – ceftriaxone + fluroquinoloen

338
Q

preventing pressure sores

A

advanced static mattress or mattress overlay

339
Q

bridging with afib

A

ONLY IF:
mechanical valve or
high risk: ischemic stroke, TIA, or VTE within the past 3 months.

340
Q

low dose asa for primary prevention

A

primary prevention of ASCVD and colorectal cancer in adults aged 50 to 59 years with a 10-year ASCVD risk of 10% or higher

341
Q

drugs causing peripheral edema

A

gabapentin
vasodilators (minoxidil, hydralazine, calcium channel blockers, α-blockers)
amlodipine, etc.
pioglitazone and rosiglitazone,

342
Q

how to treat nephrogenic DI

A
    • if lithium induced: DC lithium, start amiloride

- - if not drug induced: thiazide diuretics and salt restriction

343
Q

PTH effect of Vit D def

A

Vit D deficiency causes SECONDARY hyperparathyroidism (high PTH, nl Ca, low phos, high alk phos due to bone turnover)

344
Q

diagnosis of DM

A

need TWO abnl:

fasting >126
random glucose >200 with symptoms
a1c > 6.5%
OGGT test– 2 hour post prandial >200

if disconcordance– repeat the abnl test

PRE-DIM
fasting 100-126
random 140 - 199
OGTT 140- 199
A1c 5.7 - 6.4%
345
Q

treatment of hyperthyroidism– 3 options

A
  1. methamizole (agranulocytosis/hepatoxic)
    PTU (preg 1st trimester and thyroid storm)
  2. radioactive iodine – for multi nodular goiter of hyperfunctioining nodule
    C/I in preg/ graves opthalmopathy
  3. thyroidectomy – if have opthalopathy
346
Q

treatment of subacute painful thyroiditis

A

NSAIDS and glucocorticoids
BB for symptoms
synthroid is symptomatic hypothyroid
thyroid studies will normalize by themselves

347
Q

treatment of myxedema coma (ams, hypoVent, hypothermic, hypoNa)

A

IV synthroid AND hydrocortisone

348
Q

indications for thyroid nodule biopsy

A

> 1cm and euthyroid (nl TSH)

<1 cm with suspicious features = calcifications, increased vascularity, ireg boarders)

349
Q

what to screen for incidentally adrenal adenoma discovery

A

Cushings– *1mg overnight dex suppression test (cortisol should be < 3 after)

Pheo– 24hr urine metanephrines

if HTN– aldo to renin ratio

350
Q

C/I for bisphosphonates (alendronate/risedronate)?

alternate therapy?

A

oral CI with esophogeal disorder
**can use IV zoledronic instead (C/I with GFR <35)

can instead use:
denosumab (safe in CKD), twice yearly
teriparatide– max tx is 2 years

351
Q

best test for serum vit d levels?

A

25- hydroxyvitamin D

352
Q

treatment of adrenal insuf

A

primary– hydrocortisone + fludrocortisone

secondary– hydrocortisone only

353
Q

rapidly progressive, or severe hyperandrogenism (hirsutism, frontal hair loss, etc)

A

consider androgen secreting ovarian tumor– check pelvic US

354
Q

MC cause of primary adrenal insufficiency (low cortisol, high ACTH)?

A

21-hydroxylase deficiency causing autoimmune adrenalitis

355
Q

drug causing sudden peripheral neuropathy

A

Quinolones

**also assoc with aortic dissection, tendon rupture

356
Q

drugs causing hypoNa

A 
HCTZ
SSRI
carbamazepine
NSAIDS
NMDA (excstasy)
357
Q

drug induced syncope in elderly

A

cholinesterase inhibitors

** donepizil

358
Q

opioid induced constipation treatment

A 
1st line-- stimulant +/- docusate (senna, biscodyl)
2nd line-- osmotic (miralax, lactulose
3rd line-- 
oral naldemedine 
subcutaneous methylnaltrexone
naloxegol
359
Q

Does IBD patient in hospital with acute flare and hematochezia need pharmacological dvt ppx?

A

YES!

regardless of bleeding status need subQ heparin because increased risk of VTE with UC/Chron’s

360
Q

indications for choley if gallbladder polyp found

A

> 1cm
any size assoc with gallstones
billiary collic
PSC

361
Q

confusion, ataxia, nystagmus, discongugate gaze post gastic bypass

A

thiamine def– wernikes

** give thiamine prior to glucose

362
Q

mgt of liver lesion

A

usually biopsy unnecessary
if no decomp cirrhosis and single small lesion– surgically resect

if cirrhosis and
up to 3 tumors <3cm or 1 tumor <5 cm – liver transplant

363
Q

IBS-C tx

A

fiber diet
hyoscyamine/dicyclomien short term
SSRI (for C predominant)
lupiprostone/linaclotide for IBS-C

IBS-D:
loperamide
TCA
eluxadoline
rifaximin
364
Q

HELLP vs. AFLP

A

HELLP- hemolysis, inc ALT, low put
AFLP – has encephalopathy and prolonged INR and hemolysis, low plt, elevated LFTs

tx of both is emergent deliver

365
Q

development of fever, diffuse capillary leak (pleural effusions, pericardial effusion, pulmonary edema) after starting ATRA for acute promyelocytic leukemia

A

differentiation syndrome

tx: prednisone

366
Q

determining readiness for extubation

A

RSBI < 105 = RR/ TV in Liters
few secretions
awake following commands
strong cough

367
Q

non-motor symptoms of early parkinsons

A

loss of smell/taste
REM sleep disorder
constipation
depression

368
Q

anti-UN-1RP (ribosomal Ab) assoc with?

A

MCTD

  • synovitis, Raynaud, hand edema, myositis
  • **pulmonary HTN
369
Q

Stress test for someone with LBBB or pacemaker?

A

must be adenosine/vasodilator nuclear perfusion

** cannot do exercise or dobutamine

370
Q

best test of unhealthy alcohol use?

A

single item screening test or

AUDIT-C

371
Q

hyperthyroid mgt in pregnancy

A

PTU 1st trimester
methamizole 2nd and 3rd
maintain mild hyperthyroid state
monitor thyroid studios every 4 weeks

372
Q

Fever
polyarthralgia
transient macular faint salmon colored rash
pericarditits/pleuritits

A

Adult onset Still’s

elevated WBC and ferritin

  • know difference between this and Felty syndrome
373
Q

drugs that can cause drug induced lupus

A 
HCTZ
procainamide
isoniazid
TNF-a inhibitors
minocycline

+anti-histone Ab

374
Q

abx with highest risk of cdiff

A 
fluoroquinoles
cipro, levaqin
clindamycin
3rd/4th gen cephalosprins
augmentin
375
Q

adverse effect of tamoxifen

A

VTE

increased risk endometrial Ca

376
Q

valvular abnormality assoc with GI bleeding due to AVM

A

aortic stenosis

377
Q

metabolic disorders assoc with pseudogout

A

recent parathryroidectomy
hyperPTH
hemochormotosis
hypothyroidism

378
Q

difference between myasthenia graves and lambert eaton

A

Lambert eaton– muscle weakness IMPROVES with repetitive stimulation and have hypo reflexes
anti–voltage-gated calcium channel antibodies
assoc with small cell lung ca

Myasthenia
fatiguabiliy
assoc with mediastinal mass (thymoma)– all need CT chest to screen for this
tx: pyridostigmine (if severe– steroids, IVIG)

379
Q

mgt of pituitary apoplexy (hemorrhage)

A

high dose IV steroids empirically until adrenal insufficiency rulled out
THEN surgical decompression

sudden HA, CN3 palsy, AMS, vision change

380
Q

erlichiosis vs. anaplasmosis

A

fever, elev AST/ALT, **leukopenia, ** thrombocytopenia

ehrlichiosis–
lymphopenia, clumps in monocyte

anaplasmosis–
neutropenia, clumps in granulocyte

tx: doxy

381
Q

acute onset HTN with flash pulmonary edema

A

renal a. stenosis

382
Q

thyroid storm

A

high fever, tachy, agitation, hyperTN, N/V, tremor, lid lag, goiter

trigger = infection, surgery, trauma, recent iodine load

tx: BB, PTU, steroids

383
Q

exudative pleural effusion with eosinophilic predom

384
Q

sensorineural hearing loss causes

A

meniere’s
acoustic neuroma
presbycusis
ototoxic drugs (ahminoglycosides)

385
Q

lymphadenopathy with leukocytosis

A

CLL if lmphocytosis
check peripheral smear and flow cytometry

(DONT BE TEMPTED TO BIOPSY LN)

386
Q

pH level with bacterial vaginosis

A

> 4.5

clue cell
thing grey discharge
+ wiff test

387
Q

allergic conjunctivitis
vs.
viral conjunctiivits

A

allergic– b/l, itchy, nasal congestion & sneezing
tx: topical antihistamine

viral – u/l then b/l
tx: supportive

388
Q

SAAG and protein eval of asities

A

SAAG < 1.1 – nephrotic syn

SAAG >1.1 – cirrhosis (protein <2.5) or HF (protein >2.5)

389
Q

Nephrotic syndrome + HF

A

restrictive cardiomyopathy + nephrotic syn = amyloidosis

390
Q

supine hypoxia

A

diaphragmatic paralysis

dx: sniff test using fluoroscopy

391
Q

daptomycin does not work for which infection

A

pneumonia! inactivated by pulmonary surfactant

392
Q

alopecia aerata

A

round non scaring hairloss
exclamation point! hairs on margins

tx: intra-lesional IV corticosteroids

393
Q

indication for CT or pleurodesis for pleural effusion

A

CT placement if > 2cm

pleurodesis if its the 2nd primary pneumo or any secondary pneumo

primary– tall, thin, marfan, normal lung or blebs/bullae
secondary– assoc COPD, CF, LAM, HIV and PCP pneumonia

394
Q

difference between GBS and transverse myelitits

A

TM has a sensory deficit line and affects bowel/bladder function
tx: iV steroids (2nd line = plasma exchange)

GBS is mostly motor (may have some mild paresthesias)
tx: plasmapheresis, IVIG

395
Q

C/I to NSAIDS for osteoarthritis

A

CAD, HF, CKD, Ulcer, h/o GIB, HTN, caution in >65

– use topical NSAIDS instead

396
Q

tx of myasthenic crisis

A

plasma exchange or IVIG

stop acetylcholinesterase inhibitors (pyridostigmine)

397
Q

obstructive vs. restrictive lung disease

A

Obstructive – Fev1/FVC <70%

restrictive– TLC < 80%

398
Q

what causes overdose with HAGMA + osmolar gap >10

tx?

A

Methanol
ethylene glycol

tx of both: fomepizole, dialysis if severe

399
Q

what pathogen causes bubonic plague (swollen lymph nodes, high fever, lethal)?

how to tx?

A

Yersinia pestis
(GN cocobacillus, transmitted by fleas on rodents)
** rats

tx: tetracycline or streptomycin

400
Q

when to give empiric antibiotics for a skin abscess after I&D

A 
>2cm
extensive surrounding cellulitis
systemic fever
neutropenia
extremes of age
401
Q

treatment of chronic urticaria (>6wks)

A

2nd gen H1 blocker – loratadine, certirizine, fexofendine

402
Q

what type of hypersensitivity is contact dermatitis

403
Q

what exacerbates psoriasis

A 
systemic steroids
anti-malarial
lithium
BB
NSAIDS
ACE-I
tetracyclines
404
Q

tx of rosacea

A

topical metronidazole if inflammatory pustules and papules

405
Q

drugs causing SJS (<10%) or TEN (>30%)

A

1-3 weeks after exposure

sulfa
allopurinol
anticonvulsants
NSAIDS

406
Q

type of ezxcema rash in flexure skin folds

A

atopic dermatitis

407
Q

extensive refractory seborrhagic dermatitis assoc with?

A

HIV

sebo keratosis assoc with GI malignancy

408
Q

Pityriasis rosea reactivation of?

A

HHV 6 or 7

mimics Syphillus except spares palms and soles so rule out by checking RPR

409
Q

effect of sarcoidosis on 1,25-vit D

A

elevated 1,25-vit d

410
Q

congenital adrenal hyperplasia

A

virilization, frontal balding
deficient of 21-hydroxylase

** diagnosis with elevated 17- hydroxprogesterone

411
Q

only lab required prior to giving TPA?

A

blood glucose level

412
Q

treatment of osteoporosis or bone mets with CKD?

A

denosumab

can’t use bisphosphonates if CrCl <35%

413
Q

difference between neuroleptic malignant syndrome and serotonin syndrome

A

both have fever, AMS, autonomic instability

NMS– muscle rigidity, no clonus, dec reflexes
precipitated by anti-psychotics, promethazine, reglan, infection, surgery or stopping dopamine agonists
tx: dantrolene

serotonin syn– agitation, rigidity, hyper-reflexia, myoclonus
tx: stop drugs, benzos

414
Q

malignancy assoc with Klinefelters?

415
Q

Sjogern syndrome increase risk which malignancy?

A

B cell lymphoma
(large B cell, MALT)

** increased risk heart block in neonates

416
Q

dx of gastroparesis

A

EGD 1st if acute symptoms then emptying study

if chronic symptoms–gastric emptying study

417
Q

avoid bupropion if…

A

seizure DO
eating disorder

avoid chantix if active psychosis or suicidal ideation

418
Q

treatment of toxoplasmossi

A

sulfadiazine + pyrimethamine + folic acid (or leucovorin)

419
Q

renal angiomyolipomas, renal cell carcinoma, and cysts

hypo pigmented macules

pulmonary LAM (cystic lung disease)

A

tuberous sclerosis

420
Q

1st line treatment of mitral stenosis?

C/I?

A

percutaneous mitral balloon valvotomy (to cut open valve)

C/I– concurrent MR or LA thrombus
- would require surgical MV repair

421
Q

first choice abx for non-purulent cellulitis

A

clindamycin
dicloxacillin
cephalexin

422
Q

persistently elevated lipase and abdominal fullness after episode of acute pancreatitis?

A

pancreatic pseudocyst

– most can just observe and spontaneously resolve

423
Q

which nephrotic syndrome assoc with thrombosis?

A

membranous (MCC of nephrotic syn too)

424
Q

DCM with left ventricular apical aneurysm– which infection?

A

T. cruzi– chagas disease

425
Q

recurrent acute abdominal pain
dark urine
hyponatremia

A

acute intermittent porphyria

426
Q

COPD tx based on FEV1

A

1st step— SABA only
FEV < 60% or symptoms – add LABA or LAMA
once having freq exacerbations– add LABA + ICS (budesonide/formetrol)

427
Q

gram positive rods meningitis

A

listeria

tx: ampicillin

428
Q

how long to continue anti-depressant once patient in remission

A

1st– 6 months
2nd episode – 1-2x the inter-episode interval
3rd– lifetime

429
Q 
flushing
secretory diarrhea
telangiectasisa
bronchospasm
Rt sided valvular disease-- TR
A

carcinoid syn

430
Q

secondary causes of ITP

A

drugs– heparin, antibiotics

diseases– HIV, HepC, hyperthyroid, SLE, CLL

  • need to rule these out
431
Q

C/I for triptans

A

CAD
cerebrovascular disease
hemiplegic migraine
brainstem aura (vertigo, aphasia, confusion, diplopia, tinnitus)

432
Q

brain aneurysm size cut offs for surgical intervention

A

> 12 mm anterior circulation

> 7 mm posterior circulation

433
Q

Bells Palsy tx?

A

prednisone if within 72 hours of onset

434
Q

GBS tx?

A

IVIG and plasma exchange

435
Q

c/i for donepizil for dementia

A

sick sinus syndrome, left bundle branch block, uncontrolled asthma, angle-closure glaucoma, and ulcer disease.

alternative is memantine

436
Q

parkinsons symptoms + orthostatic hypotension

A

multiple system atrophy

437
Q

screening test for hypogonadism?

A

am serum TOTAL testosterone

438
Q

relapse of Wegners treated with cyclophosphamide the first time?

A

tx relapse with Rituxmab

439
Q

treatment of aplastic anemia

A

cyclosporine + ATG (antithymocyte globulin)

<50yo allogenic HSCT

440
Q

BCR:ABL (9:22)

441
Q

acute leukemia assoc with DIC

A

APML
t(15:17)

tx: ATRA

442
Q

indications for long term hydroxyurea in sickle cell patients

A

> 2 pain crises per year

Acute chest syn

443
Q

c3 on Direct antigobulin (coombs) test?

A

cold agglutination dz

tx: avoid cold and rituximab

444
Q 
shistosytes
hemolytic anemia
low pLT
fever
AMS
renal dysfunction

tx?

A

TTP or TTP-HUS overlap

tx: plasma exchange once peripheral smear done (don’t wait for ADAMSTS13 deficiency confirmation)

445
Q

When to check D-dimer

A

wells DVT < 1

wells PE < 4

446
Q

which GN diseases have low complements?

A
  1. post infection GN (1-6 weeks post infection)
  2. membranoproliferative (assoc SLE, hepC/hepB)
  3. cryoglobulinemia
  4. lupus nephritis
447
Q

diagnosis of celiac disease

A

elevated anti-tTG IgA ab
AND
small bowel biopsy required for definitive diagnosis

448
Q

PFTs with pulmonary HTN

A

everything normal except decreased DLCO

449
Q

prophylaxis for travelers diarrhea

A

fluoroquinole (cipro, norfloxacin) or azithromycin

450
Q

indications to treat pagets disease (focal bone remodeling + elevated alk phos)

A

bone pain
radiculopathy
involvement of weight bearing bone/joint (ex: hip)

– need bone scan to determine extent of activity

tx: bisphosphonates

451
Q

diagnosis of CTEPH

A

pulmonary HTN without left sided heart disease

** diagnosis with V/Q scan with evidence of chronic thromboembolism

452
Q

center criteria for strep testing

A
  1. fever
  2. tender anterior cervical LAD
  3. tonsillar exudate
  4. no cough

3 or more should be tested with rapid strep test

all 4– empirically treat

453
Q

bicuspid aortic valve
aortic coarctation
and aortic aneurysm

A

Turners syn

*short, webbed neck, broad chest with wide spaced nipple

454
Q

diagnosis on esophageal rupture

A

water soluble contrast esophagogram (gastrografin)

455
Q

continuous murmur

femoral pulse delay

A

coarctation of aorta

** inc risk aortic dissection, intracranial aneurysm

456
Q

tx of rectovaginal fistula in Crohn;s

A

mild symptoms– abx

moder to severe– anti-TNF, (infliimab)

457
Q

protein cut off for nephrotic syn

A

> 3.5 g / day

>3500mg/24 hours

458
Q

uric acid stones

A

tx with potassium citrate

459
Q

lights criteria with active diuresis

A

** not reliable

Transudative if:
serum alb - pleural albumin > 1
or protein diff > 3

460
Q

young patient with chronic pancreatitis should be tested for?

A

sweat chloride testing for CF

in older adults check IgG4 to exclude type 1 autoimmune pancreatitis (tx: steroids)

461
Q

length of small bowel resection to empirically try cholestyramine

462
Q

curb65

A 
confusion
uremia
RR elevated
low BP
age > 65

2– inpatient
3– ICU

463
Q

coxiella assoc with

464
Q

treatment of latent TB

A

6 months izoniazid
or 4 months rifampin

9 mos isoniazid with HIV

465
Q

patient with vitiligo should be screened for

A

TSH

type 1 DM

466
Q

treatment cut offs of sub clinic thyroid disorders

A

subclinical hypothyroidism– treat TSH >10

subclinical hyperthyroidism– treat TSH < 0.1 or atrial arrhythmia

467
Q

warfarin mgt in preg

A

change to LMWH

unless mechanical valve- then keep on warfarin

MKSAP hannah (1 decks)

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