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My Step 3 > General > Flashcards

General Flashcards

1
Q

Treatment of Hepatorenal syndrome

A

First give volume to make sure not intravascular depletion. once confirmed, Midodrine and Octreotide

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2
Q

BM Biopsy findings in multiple myeloma

A

> 10% monoclonal plasma cells

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3
Q

T/F: Technetium-99m bone scans are used in patients with multiple myeloma

A

False, these are good for blastic lesions not lytic. Need a xray skeletal survey

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4
Q

Tx of hypercalcemia in MM

A

Hydration and dexamethasone; if severe, bisphosphonates

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5
Q

Hyperviscosity syndrome

A

MM patients p/w blurry vision, headache/confusion (neuro), nasal/oral bleeding, heart failure. Tx with plasmapharesis

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6
Q

Reversal of coumadin in patient with life-threatening hemorrhage

A

Need Prothrombin complex concentrate. This is a must, works in <10 minutes. need the vitamin k alongside but this takes 12-24 hours to work. Use FFP when PCC not available

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7
Q

lab test in smoker with polycythemia

A

carxboxyhemoglobin ; r/o carbon monoxide poisoning

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8
Q

____ can be used to follow SLE disease activity and predict lupus nephritis

A

anti-dsDNA

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9
Q

tx for Rayanuds

A

CCB - nifedipine or amlodipine

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10
Q

tx of gout in patients with renal failure or renal transplant

A

avoid nsaids because of renal flow; use intraarticular glucocorticoids

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11
Q

Next step when you suspect Ankylosing Spondylitis (progressive back pain which improves with exercise, limited chest expansion, reduced forward flexion lumbar spine)

A

Xray of SI joint - can’t make a dx of AS without sacroilitis . While HLA-B27 is frequently positive, its not specific

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12
Q

extraarticular manifestations of ankylosing spondylitis

A

acute anterior uveitis, aortic regurgitation, apical pulmonary fibrosis, IgA nephropathy, and restrictive lung disease

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13
Q

who needs a tetanus toxoid vaccine after cut?

A

last tetanus vaccine > 10ya (>5 for dirty/severe wound) or who have unimmunized, uncertain or incomplete vaccination status (<3 doses)

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14
Q

who needs tetanus immunoglobulin in addition to tetanus toxoid vaccine after cut?

A

IG if dirty severe wound + immunocompromised, uncertain or incomplete tetanus vacicnation status (<3 doses)

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15
Q

most common reaction to transfusion

A

febrile nonhemolytic reaction - 1-6 hours post - fevers/chills/malaise without hemolysis. prevent with leukoreduction

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16
Q

dermatomyositis is often associated with

A

malignancy. all patients with new dx need cancer screening

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17
Q

neck mass in Sjogren’s patient

A

B cell non-Hodgkin’s lymphoma

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18
Q

scoliosis eval: significant angle of rotation and cobb angle

A
  • angle of rotation (exam): >7 degrees = xray spine

- cobb angle (xray) <10 degrees is normal, f/u prn. >40 = surgical eval. in between, back brace/observation

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19
Q

side effects of Methotrexate

A

-hepatotoxicity
-stomatitis
-cytopenia
supplement with folate

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20
Q

what to check before starting TNF inhibitor (etanercept, infliximab)?

A

IFN gamma assay or TB skin test to screen for latent Tb

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21
Q

BP mgmt in gout patients

A 
Use ACE-I or ARB as they can lower uric acid
Avoid diuretics (HCTZ, lasix) and asa (all decrease uric acid excretion)
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22
Q

Treatment of choice for polymyalgia rheumatica

A

low dose prednisone. nsaids not v effective here

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23
Q

T/F: PMR has normal inflammatory markers

A

False, elevated ESR and CRP typically

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24
Q

scleroderma is an abnormal deposition of ________ in multiple organ systems

A

collagen

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25
Q

why do you need to monitor BP in patients with Raynauds?

A

Scleroderma renal crisis - can present with malignant hypertension. most scleroderma patients have some renal involvement. Tx with ACE-i

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26
Q

Spinal stenosis vs radiculopathy: pain decreases with flexion of spine and increases with extension

A

this is spinal stenosis. in contrast to radiculopathy.

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27
Q

post injury, pain out of proportion, temperature change, edema, abnormal skin color

A

Complex Regional Pain Syndrome. Dx by MRI or autonomic testing with increased resting sweat output; tx nerve block or iv anesthesia

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28
Q

c-peptide if excess insulin injection

A

low! C-peptide is from endogenous insulin…if abuse suspected and high c-peptide, oral hypoglycemic agents

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29
Q

thyroid nodule, when do you need iodine 123 scintography?

A

when low TSH –> hyperfunctioning nodule. will tell you hot or cold nodule

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30
Q

hot vs cold nodule thyroid

A

hot = hyperfunctional –> rarely malignant so just tx hyperthyroidism

cold = hypofunctional –>need FNA to eval malignancy

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31
Q

initial staging for differentiated thyroid cancer i.e. papillary or follicular

A

need US of neck and cervical LN before any surgery

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32
Q

MEN 1: 3 P’s

A 
Pituitary adenoma (prolactinoma)
Primary hyperparathyroidism (hypercalcemia, PT adenoma)
Pancreatic/GI neuroendocrine tumors (gastinoma i.e. recurrent peptic ulcers)
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33
Q

MEN 2

A 
Medullary thyroid cancer
Pheochromocytoma
----------------------------
Men2A: + primary hyperparathyroidism
Men 2B: +mucosal neuromas/marfanoid
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34
Q

How can 11 and 17 hydroxlase def be distinguished from 21?

A

11 and 17 have hypertension

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35
Q

Patients with Graves hyperthyroidism should be started on what alongside antithyroid drugs (PTU, methimazole)

A

a beta blocker to reduce hyperthyroid sxs, i.e. propranolol

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36
Q

Lab findings of adrenal insufficiency

A

hyponatremia, hyperkalemia, hyperchloremic metabolic acidosis.

vs hypoaldosteronism = asx hyperkalemia with mild metabolic acidosis, no hyponatremia.

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37
Q

how do you dx Addison’s dz

A

Primary adrenal insuff.

Low morning cortisol, high ACTH (ACTH stim test)

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38
Q

PTH affect on vit d

A

Stimulates conversion from 25-hydroxyvitd to 1,25 - dihydroxyvitamind in the kidneys

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39
Q

how does sarcoidosis affect calcium?

A

granulomatous disorders cause hypercalcemia d/t extra-renal production of 1,25 - hydroxyvitd

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40
Q

antithyroid peroxidase antibodies

A

Hashimoto’s (risk for thyroid lymphoma)

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41
Q

side effects to monitor of valproic acid

A

hepatoxicity

thrombocytopenia

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42
Q

T/F: ACE levels used to dx sarcoid

A

False; need bx showing noncaseating granuloma

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43
Q

first line pharm tx for cognitive impairment of dementia

A

acetylcholinesterase inhibitors = Rivastigmine/Donezapil/Galantamine. can also use memantine (NMDA receptor antagonist)

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44
Q

T/F: Can confirm suspected pulmonary TB with IFN gamma or skin test

A

false; those can’t differentiate latent vs active dz; need sputum acid-fast smear, mycobacterial cx, NAAT

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45
Q

tx for close contacts of neisseria meningitis

A

Rifampin, Ciproflaxocin or Ceftriaxone

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46
Q

polyarthralgias, rash, fever within 1-2 weeks of exposure to a responsible agent and stop when removed

A

serum sickness

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47
Q

which infection as a serum sickness like prodrome? define sxs

A

Hepatitis B. Rash, fever and polyarthralgia.

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48
Q

how is malaria dx?

A

peripheral smear

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49
Q

fever, headache and thrombocytopenia in a traveler

A

consider malaria

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50
Q

fever in a returning traveler <10 days

A

Typhoid fever, Dengue fever, Chikugunya, influenza, legionellosis

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51
Q

fever in a returning traveler 1-2 weeks

A

Malaria, Typhoid fever, schisto, ricketssial

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52
Q

fever a returning traveler > 3 weeks

A

TB, leishmann, enteric parasites

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53
Q

stepwise fever, rose spots, relative bradycardia in returning traveler

A

typhoid fever

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54
Q

Tx of fulminant C dif (shocky)

A

IV Flagyl + high dose vanco PO

55
Q

Tx of recurrent C dif

A
  • prolonged PO vanc course
  • fidaxomicin
  • Vanc PO followed by Rifaximin
56
Q

tx for cryptococcal meningitis (HIV)

A

initial: Amphotericin B + Flucytosine for 2 weeks til CSF sterilized
: Transition to PO Fluconazole for 8 weeks
Maintenance: lower dose Fluconazole for 1 year to prevent recurrence

57
Q

sxs of dengue fever

A

flulike febrile illness + joint pains and myalgia (BREAK-BONE FEVER), orbital pain. thrombocytopenia, spontaneous bleeding, vascular permeability. resp, circ failure

58
Q

travel diarrhea + pseudoappendicitis

A

campylobacter jejuni

59
Q

travel diarrhea > 2 weeks

A

Cryptosporidium (immunosuppressed), cyclospora, giardia (common in boonies)

60
Q

HIV PeP

A 
2 NNRTIs (Tenofovir, Emtricitabine, Lamivudine, Zidovudine) 
\+ Integrate-i (raltegravir), PI (Ritonavir), non-nrti (rilpivirine)
61
Q

triad for pulm aspergillus

A

hemoptysis, cough, pleuritic CP . serum markers galactomannan, beta d glucan. tx voriconazoleMOST

62
Q

Most common side effect of isoniazid

A

hepatotoxicity

63
Q

why do you give vitamin b6 (pyridoxine) with isoniazid?

A

prevent neurotoxicity (ataxia, neuropathy, weakness)

64
Q

DKA patient with periorbital swelling, black eschar/necrotic nasal turbinate, headache, nasal congestion

A

Mucormycosis. Need liposomal Amphotericin B + surgical debridement

65
Q

LV apical thrombus in south american

A

Chagas disease (protozoan)

66
Q

treatment of lyme in patients <8 years, pregnant/lactating women,

A

Amoxicillin (doxy causes teeth discoloration and skeletal deformities)

67
Q

nec fas

A

strep pyo

then staph aureus, c. perf (crepitus if gas producer)`

68
Q

chronic bacterial prostatitis and tx

A

> 3 months UTI, pain in genitourinary, pain with ejaculation. 6 wk cipro or bactrim

69
Q

3 criteria for acute liver failure

A

hepatic injury (LFTs), encephalopathy, INR>1.5

70
Q

treatment of lyme in patients <8 years, pregnant/lactating women,

A

Amoxicillin (doxy causes teeth discoloration and skeletal deformities)

71
Q

thyroid stimulating immunoglobulin

A

cause Graves dz

72
Q

thyroid nodule with normal tsh next step

A

straight to FNA to r/o malignancy despite sxs

73
Q

tx of hyperthyroidism

A

Graves: Methimazole > PTU (except pregnancy trimester uno); radioiodine ablation (I-131)
Toxic multinodular: I-131 radioiodine ablation only

74
Q

most common cause of hypothyroidism

A

Hashimoto (anti-TPO)

75
Q

when do you do I-123 scan?

A

if TSH is suppressed, to evaluate for a hot nodule

76
Q

thyroid nodule with normal tsh next step

A

straight to FNA to r/o malignancy despite sxs

77
Q

thyroid nodule with low/no tsh

A

I-123 scan. Hot nodule: meds. Cold nodule: FNA

78
Q

thyroid nodule with high tsh

A

normalize tsh with thyroxine; if nodule still palpable, get FNA

79
Q

first line treatment for toxic megacolon?

A

Steroids (medical management)! not surgery.

80
Q

management of esophageal variceal bleed

A

IV Octreotide + EGD (dx and tx)

81
Q

dx of chronic pancreatitis

A

usually on MRCP (pancreatic calcifications); labs are not typically elevated

82
Q

gallbladder wall calcifications on imaging

A

bad…porcelain gallbladder. increased risk for cancer, needs a chole

83
Q

treatment of intussusception for kids

A

air or water soluble (NOT barium b/c risk peritonitis with perf) enema

84
Q

tx of dematitis herpeteformis (celiac)

A

Dapsone + gluten-free diet

85
Q

management of patient with diverticular bleeding

A

IV fluids +/- transfusion. Patients should get a colonoscopy for tamponade or cauterization, could also do angiography with embolization

86
Q

Heyde’s syndrome

A

Angiodysplasia + aortic stenosis

87
Q

risk factors for angiodysplasia (common cause of hematochezia)

A

ESRD, Aortic stenosis, vWD

88
Q

dilation of submucosal venous plexus

A

hemorrhoids

89
Q

eroded small artery of the colon

A

diverticular bleed

90
Q

early complication of acute pancreatitis with fever, leukocytosis and recurrence of abdominal pain

A

pancreatic necrosis or peripancreatic fluid collection –>get a repeat CT

91
Q

abdominal pain + fat malabsoption

A

chronic pancreatitis (dx MRCP, or CT)

92
Q

metaplastic columnar epithelialization of esophagus

A

barret’s esophagus

93
Q

triple therapy if penicillin allergy

A

PPI + clarithromycin + metronidazole (instead of typical amoxicillin)

94
Q

chronic malabsorption + iron deficiency anemia. diarrhea not noted to be associated with specific foods

A

Celiac disease

95
Q

what should you monitor in celiac patients

A

iron/hgb, folate, calcium, vitamins (A, E, D, B12). Dexa to eval bone loss (vit d def) and receive pneumococcal vaccine (hyposplenism)

96
Q

cancer in upper esophagus vs lower esophagus

A

upper: SCC, tobacco and EtOH
lower: adenioCA, barretts and gerd

97
Q

dyspepsia age cutoff

A

<60: test and tx H pylori

>60: EGD

98
Q

when do you start colonoscopy for patients with first degree relative?

A

10 years before OR age 40 whichever comes first

if 1st degree was >60 just start at 50

99
Q

which age group do you worry about angiodysplasia and ischemic colitis?

A

> 60

100
Q

50% of patients with anal abscess will develop

A

fistula

101
Q

90-day mortality in patients with advanced liver disease

A

MELD score: Na, Cr, Bilirubin, INR

102
Q

tx hepatic hydrothorax

A

sodium restriction and diuretics; TIPS if refractory

103
Q

mgmt of delivery with HIV mom

A

viral load <1000: ART + vaginal delivery

>1000: ART + zidovudine + c-section

104
Q

dx/tx of latent tb

A

positive testing, neg cxr and neg sxs

9 months isoniazid (if allergic, rifampin)

105
Q

abdominal pain, fecal urgency, bloody diarrhea

A

colonic ischemia

106
Q

thyroid cancer with elevated calcitonin levels

A

Medullary thyroid cancer (MEN)

107
Q

first line therapy for persistent cluster headaches vs acure

A

Verapamil; 100% oxygen

108
Q

treatment of catatonia

A

benzos, ECT

109
Q

tx antipsychotic EPS: Acute dystonia

A

benztropine or benadryl

but NOT a benzo

110
Q

EPS: how do you treat anti-psychotic induced akathisia (restlessness, anxiety type)

A

try reducing the dose

use a beta blocker

111
Q

tx antipsychotic EPS: Parkinsonism

A

Benztropine

amantadine

112
Q

triad for fat embolism

A

neuro sxs (confusion), petechial rash, hypoxemia (normal cxr usually). vs pulmonary contusion after injury will be some irregular opacification and can be 24 hours later

113
Q

why don’t you use St John’s wort along with SSRI’s to treat depression?

A

risk of serotonin syndrome. also other drug interactions: induces p450

114
Q

what to screen for when starting varenicycline for smoking cessation?

A

neuropsychiatric history

115
Q

asthma PFT

A

no exacerbation: normal PFT, admin of methacholine reduced FEV1 >20%. negative methacholine challenge is reliable in ruling out dx.
active sxs: obstructive PFT; albuterol gives >15% improvement in FEV1

116
Q

how do you treat anti-psychotic induced akathisia (restlessness, anxiety type)

A

try reducing the dose

use a beta blocker

117
Q

when do you need to taper steroids?

A

when used for > 3 weeks (risk of adrenal insuff)

118
Q

actinic keratosis is a pre-malignant skin condition (SCC) caused by

A

sun exposure (UV light). of note, BCC is also associated with sun exposure but not AK and also has low metastatic potential (usually fleshy appearance for bcc vs scaly/rough etc for AK)

119
Q

when do you give antibiotics to patient with acute bronchitis?

A

COPD patient, with 2/3: increased sputum production, increased sputum purulence, increased dyspnea

120
Q

asthma PFT

A

no exacerbation: normal PFT, admin of methacholine reduced FEV1 >20%. negative methacholine challenge is reliable in ruling out dx.
active sxs: obstructive PFT; albuterol gives >15% improvement in FEV1

121
Q

postherpetic neuralgia timeline

A

4 months after initial shingles still having allodynia. tx with TCA/gabapentin/pregabalin

122
Q

risk factors for TTN (transient tachypnea of the newborn)

A

c/section, maternal diabetes, prematurity. resolves within 72 hours.

123
Q

actinic keratosis is a pre-malignant skin condition (SCC) caused by

A

sun exposure (UV light). of note, BCC is also associated with sun exposure but not AK and also has low metastatic potential (usually fleshy appearance for bcc vs scaly/rough etc for AK)

124
Q

patient develops bunch of muddy brown looking skin spots, can be pruritic or inflamed. what are the spots, whats the sign, what should you be worried about

A

seborhheic keratosis; Leser-Trelat sign; internal malignancy, most commonly GI adenoCA

125
Q

how long is shingles (zoster) transmissable to contacts?

A

until the lesion is completely crusted over, patients should keep lesions covered but they can do their activities without restriction

126
Q

postherpetic neuralgia timeline

A

4 months after initial shingles still having allodynia. tx with TCA/gabapentin/pregabalin

127
Q

options for skin SCC

A

surgical excision, radiotherapy, cryotherapy, electrosurgery

128
Q

next step in workup of normocytic anemia

A

RETICULOCYTE count
High: hemolysis
Low: hyproprolif state (renal dz, hypothyroid, aplastic anemia)

129
Q

mgmt of ITP

A

Platelets:
>30k: observe if no bleeding
<30K: steroids
IF bleeding/hemorrahge: IVIg + plt transfusion

130
Q

what does HiB vaccine help prevent?

A

epiglottitis

131
Q

most common cause of stroke in kids

A

sickle cell vaso-occlusive dz. dx with transcranial doppler

132
Q

buspirone vs buproprion for anxiety

A

buspirone: non benzo anxiolytic; can be used monotherapy in nondepressed patients
buproprion: antidepressant inhibits reuptake dopamine and norepinephrine. not effective in GAD and may worsen insomnia and anxiety

133
Q

tight glucose control in diabetics helps with _____ vascular complications

A

Micro i.e. retinopathy, nephropathy. unclear effect on macrovascular i.e. MI, stroke

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