general questions Flashcards
what drug should every diabetic patient be on
either an ACE or an ARB
what is the goal A1C for a diabetic patietn
<7%
what is the goal LDL for a patient with hypercolesterol
<100
what are the diabetic five?
1) smoking cessation, 2) blood pressure control, 3) lipid control, 4) aspirin/metformin, 5) glucose control.
what is the BP goal for a patient with diabetes
<130
what is the best imaging technique for an acute head bleed?
CT without contrast.
when do migraines typically occur?
usually present in adolescence. To have the first incidence of migraine occur when an adult is uncommon.
what are the symptoms of a migraine?
photophobia, auras, extremely painful headache that can localize in 60-70% patients. nausea and vomiting are not uncommon.
what are some treatments for migraines
NSAIDs, sumatriptans, ergot alkaloids.
why do we order a CT with contrast?
this would be to identify a space-occupying lesion, such as a tumor. Bleeds are foiund withiout contrast.
what is first line treatment for a tension headache
NSAIDs
what is first line treatment for a mild-to-moderate migraine
NSAIDs with combination analgesics like acetominiophen, caffeine.
what is first line treatment for a moderate to severe migraine
triptans. also use this for mild to moderate that are refractory
how do the kidneys reabsorb acid
by losing potassium
what are the labs for excessive vomiting
metabolic alkalosis (increased HCO3), hypochloremia, hypokalemia.
why do we not schedule mammagraphy for women under 35. what test is better to confirm breast lumps in women under 35
density of breast tissue.
ultrasound.
what is the indication for BRCA testing
significant family history. multiple first degree relatives (mother, daughter, sisters) who have had breast cancer at young ages (<40-50)
what is pinworm and its presentation
enterobiasis. most commonly presents as perianal itching, abdominal pain/fullness, nausea and vomiting. diagnosed with the scotch tape test that results in white eggs.
first line therapy for pin worm
menbendazole or albendazole. these are teratogenic,. watch out for others in the house! these are teratogeni
what is secdond line therapy for pinworm
pyrantel pamoate
how do we evaluate acute coronary syndrome
ECG and serial troponins
what are the symptoms of acute coronary syndrome
diaphoresis, chest pain –can radiate to the jaw, squeezing sensation in the chest.
what is the gold standard for diagnosing aortic aneurysm
aortogram.
what if a suspected acute coronary patient does not have elevated troponins
then its most likely stable angina
what do troponins measure
infarcted cardiac tissue
what do we use stress echos for
to stratify risky patients with medically stable, low-risk patients with coronary syndrome
what is the test pulmonary embolism
pulmonary angiogram
what should you think of when you see euvolemic hyponatremia?
SIADH!
what are the diagnostic criteria for SIADH
euvolemic hyponatremia, hypotonicity (osmolality <280), inappropriately concentrated urine with normal renal function
what is the treatment for vaginal candidiasis
oral fluconazole, or vaginal creams such as miconazole or clotrimazole
what is the most common cause of primary glomerulonehritis and the presentation
IgA nephropathy. episodes of gross hematuria that occur 5 days after a respiratory infection.
what is postinfectious glomerulonephritis and its presentation
after infection with streptococcal. <7 years of age, dark brown urine, periorbital and peripheral edema, there is latent period of 10 post pharyngitis, (antistreptolysin O titer would be expected to be elevated), need RBC casts for glomerular disease.
what is the most indicative finding of glomerular disease
dysmorphic RBCs. Normal morphology tends to indicate lower urinary tract syndromes
how do we treat emergent hyperkalemia and why
with IV calcium gluconate or calcium. this does nothing to the potassium levels, but does reduce cardiac membrane depolarization and thus protects the cardiac muscle.
what is emergent hyperkalemia
hyperkalemia that is causing EKG changes.
what drugs can cause retention of potassium
ACEi and spironolactone (potassium sparing diuretic).
what are treatments for hyperkalemia?
sodium bicarb, insulin + glucose, hemodialysis –last line effort.
what causes renal artery stenosis
fibromuscular dysplasia of the vessel wall. usually occurs in females under 50.
what to look for to diagnose wolfe-parkinson-white on EKG
widened QRS complex with a delta wave.
what is the treatment for WPW
ablation of the accessory pathway.
how do we treat a positive gonnorrhea test
with ceftriaxone and azithromycin. you must treat for both G and Chlamydia as they are commonly coinfected.
what are alternative treatments for gonorrhea
fluoroquinolones orally are acceptable
what is the best treatment for gonorrhea
one time injection in office with ceftriaxone.
what is the best treatment for chlamydia
oral one week doxycycline or one time dose azirthromycin
what is the presentation of myastenia gravis
ptosis, fatigue, muscle weakness, dysarthria, difficulty chewing, double vision. abdnomality of the thymus is highly likely many will have thymoma or hyperplasia of the thymus.
what is the treatment for myastenia
edrophonium. IV. this is an achetylcholine esterase inhibitor and will immediately improve the patient’s symptoms.
what causes myastenia gravis
autoantibodies to the ach receptors.
what does split s2 usually indicate?
atrial septal defect.
what do we give patients with exacerbations of COPD?
patients are typically given steroids and empirically treatd with antibiotics.
what antibiotics are used to empirically treat acute exacerbations of COPD?
amoxicillin, trimethoprim, doxycycline.
these will cover the strep and atypicals.
microcytic anemia in a male is what until proven otherwise
colorectal cancer. patients with mircocytic anemia need upper and lower endoscopy.
what is G6PD deficiency
X-LINKED RECESSIVE DISEASE that mainly effectbs meditaranean and african descent. this makes red blood cells sensitive to oxidative stress.
what is the presentation of G6PD deficiency
when there is an inciting agent that causes increased oxidative radicals there will be red blood cell lysis, anemia, jaundice without hepatomegaly.
what are some things that increase acute G6PD deficiency symptoms
viruses, bacterial infections, sulfonamides, dapsone, quinine, nitrofurantoin, fava beans.
what are diabetic patients assumed to have immediately
coronary artery disease. this governs their lipid goals
what measure of LDL should diabetic patients have?
low as possible. patients with known coronary artery disease, diabetes, previous MI, angina, need an LDL lower than 100.
what is the typical goal for LDL in low risk patients
<130
what is a common finding for turner’s syndrome
coartation of the aorta.
what is coarctation of the aorta and how does it present
this is a congenital heart defect that causes secondary hypertension. colateral vessels typically form and this causes notching of the ribs in the chest. there is usually a murmur.
polymyalgia rheumatica presentation and labs
diffuse arthralgia, fatigue, stiffness which usually resides within hours, occasional fevers. usually present with elevated ESR. usually occurs in the elderly, with the stiffness being localized to the shoulders and the hips.
what is the treatment of polymyalgia rheumatica
prednisone usually makes them feel much bette.
what is the best choice of birth control for young women with dysmenorrhea and a risk for ovarian cancer
oral contraceptives. these will reduce the risk of ovarian cancer and are effective at stopping pregnancy. IUD are only recommended for parous woman in committed relationships –apparently IUD increase the risk for infections as they are foreign body.
who should be hospitalized for pneumonia?
elderly, mental status changes, decreased vitals, medical comorbidities.
what is used to treat community acquired pneumonia and what bugs are the likely causes?
azithromycin is first line therapy. erythromycin and tetracyclines both work, azithromycin has better coverage for h flu.
what is the most common hereditary bleeding disorder
von willebrand
what is the presentation of von willebrands
family history, personal history of bruising or excessive bleeding with surgeries or menses. labs for PT and PTT will be normal, but bleeding time will be lengthened.
what is the treatment for von willebrands
desmopressin
what is hydroxurea used to treat?
sickle cell
what is splenectomy treatment for
refractory ITP
how does desmopressin help von willebrands
it increases the production and release of von willebrand factor.
solitary pulmonary nodule workup
if the patient is low-risk for cancer then observation is okay and repeat imaging in several months.
what size pulmonary nodules are low risk
<2cm
what age group is low risk for pulmonary nodules
<35
what size makes lesions more likely to be malignant
> 3cm
what do malignant nodules look like
bigger than 3 cm, with irregular borders. they will also grow more rapidly.
what is the work up for a patient that is thought to be short stature
look at growth velocity, if less than 5% then this is low. the next best thing to do is measure the bone age. bone age should match chronological age.
what is the bone age for constitutional delay?
bone age will be behind chronological age.
what does growth hormone deficiency look like?
short stature with overweight.
do we treat asymptomatic bacteremia in pregnancy and with what
yes, must treat. cephalexin is an option.
adjustment disorder
shows up within 3 months of stressor and is gone by 6 months. can present as depressed mood.
bereavement disorder
depressive symptoms, some times psychotic-like symptoms, hearing the voice of loved one. severe impairment of functioning suggests something else, though.
what are the presentations of major depressive disorder
SIG E CAPS: sleep disturbance, loss of interest, guilt, decreased energy, decreased concentration, appetite disturbance, psychomotor retardation. symptoms must be present for up to 2 weeks and there must be five to make diagnosis.
what is the necessary followup test for gouty flare?
24 hour urine collection and analysis for uric acid.
this has to be done in order to determine if the person is an overproducer or an undersecretor. if undersecreter, the 24 hour urine collection will be lower than 600 and probenecid should be started.
allopurinol is for people who are overproducing uric acid.
what can cause erythema multiforme
hepatitis viruses, HSV, bacterial infections such as mycoplasma or yersinia, and drugs such as antibiotics and NSAIDs.
what does erythema multiforme look like>
target lesion. outer ring of red, with a clear circle, then a red inner circle, usually with a erythematous interior.
what is the presentation of idiopathic thrombocytopenic purpura ITP?
this is an antibody mediated destruction of platelets. after a seemingly benign illness purpura will show up. patient is typically well.
when there is blood on dipstick but no RBCs in the urine what are you thinking?
hemoglobinuria.
what is a common source of rhabdomyolysis
crush injury.
what are the two things to consider with rhabdomyolysis?
release of electrolytes from the crushed cells and acute renal failure due to the myoglobinuria. must be treated with IV fluids to dilute this through the kidneys.
what is the presentation for tinea capis
occasional puritis and hair loss. spores on KOH prep
what is the treatment for tinea capis
griseovulvin, tertbinafine or itraconazole.
what do permethrin and lindane shampoo treat/
scabies
what are the most causes of cough for greater than 3 weeks
postnasal drip, asthma and GERD.
what does heparin administration effect
PTT time
what is hypertensive urgency
when there is BP > 200/120 but no symptoms of end organ damage
how to treat hypertensive urgency
with oral slow acting reducers of BP, such as beta blockers
what is hypertensive emeregency
when there is BP> 200/120 and there i ssigns of organ involvement
how to treat hypertensive emergency
with nitroprusside. this requires hospital admit and BP monitoring
what are some causes of congestive heart failure acute exacerbation
salt intake, medical noncompliance, new arrhythmia, anemia, myocardial ischemia or infarction.
what is the most important causes to rule out in acute congestive heart failure exacerbation
new ischemia or infarct. need echo.
what are the criteria for anorexia nervosa
amenorrhea, body weight less than 85% of expected ideal weight, intense fear of gaining weight or being fat. binging and purging are also associated with anorexia
if a person has both anorexia and bulimia what is the diagnosis
anorexia is a superordinate diagnosis to bulimia
what is the ultrasound finding of intussusception
coild-spring or bulls eye lesion
what is the first line therapy for intussusception
air contrast enema for diagnosis and reduction. if left too long, then use colonscopy or surgery.
what is the classic presentation of intussusception
sausage like mass, vomiting, currant jelly stool,
what do you do if you find gallstones in an otherwise asymptomatic person
nothing. reassurance
what is a common side effect of lithium treatment
hypothyroidism
what do we do for an AIDs patient with a CD4 count lower than 200?
prophylaxis for pneumocystis carinii, which means trimethaprim-sulfamethoxazole.
what vaccines do AIDS patients get?
pneumococcal, influenza.
what are the typical prophylaxis regimens for AIDS patietns
depends on CD4 count. if <200, then prophylaxis for pneumocystis, if < 100 then prophylaxis for toxoplasma (trimethaprim). if < 50, then prophylaxis for mycobacterium with azithromycin or clarithromycin.
what is PPD positive reading?
> 5mm induration in a high-risk patient –someone with exposures. >10mm in a moderate risk patient –homeless, comes from endemic region. >15mm in low risk.
what is the first line intervention for shoulder dysocia
suprapubic pressure.
what is the presentation of congenital syphilis
rash on the palms and soles, bloody nasal discharge, lymphadenopathy and organomegaly.
congenital toxoplasmosis triad
intracranial calcifications, hydrocephalus, chorioretinitis
congenital rubella presentatino
deafness, cataracts, pururitic skin lesions, and blueberry muffin baby.. can also occur when the mother contracts rubella during pregnancy
when is the risk of rubella very low
aftre 20 weeks
what is the next step after finding isolated elevated calcium
parathyroid level
what is charcot’s triad?
for the diagnosis of cholangitis. it is composed of fever, jaundice, right upper quadrant pain.
what is the treatment for isolated clamydia
azithromycin
how to treat tardive dystonia from antipsychotics
diphenhydramine or benztropine
what is the presentation for lumbar spinal stenosis
back pain that is worse while standing but improves while sitting or in hyperflexion. this is neurogenic claudication because the symptoms occur during ambulation and under increase in metabolic demand. flexing the spine increases the canal size and relieves the stenosis.
what causes early pregnancy loss
usually genetic anomalies
what causes second trimester losses
usually anatomical anomalies, such as a cervix that is incompetent.
what is the difference between DVT and superficial venous thrombophelbitis
they both have almost identical presentations, but the thrombitis will have a cord-like feeling and is superficial.
what is the treatment for thrombophelbitis
rest, NSAIDs, heat, elevation.
what is the treatment for DVT
heparin or enoxaparin
what are anti-mitochondrial antibodies indicative of
primary billiary cirrhosis.
what is the presentation of primary billiary cirrhosis
itching, jaundice, fatigue. anti-mitochondrial antibodies. typically females (6:1), 40-60. freqwuntly assocaited with other autoimmune diseases.
what is the ultimate treatment for primary billiary cirrhosis
liver transplant. but cholestyramine reduces the itching by binding bile salts. immunomodulators can reduce the progression of the disease.
what is associated with primary sclerosing cholangitis
ulcerative colitis –upwards of 80% of psc patients have ulcerative colitis.
what is an autoimmnune test for psc?
p-anca
acute labryrinthitis
inflammation of the VIII cranial nerve post viral illness. very common, but makes patients quite miserable. usually presents with peripheral nystagmus, hearing loss, abnormal head thrust test. hours long vertigo
what is a treatment for labrynthitis
steroids can reduce the inflammaiton and course.
what is white pupillary reflex and what is it indicative of
should be red…not white. this is the white retina of retinoblastoma. requires followup immediately.
what is the best treatment for mild comdone acne?
topical retinoid
what is the treatment for severe acne?
oral isoretinoin
Can avoiding greasy food be a treatment for acne?
no. there is no evidence to suggest that this is an effective treatment
pseudotumor cerebri is what
idiopathic intracranial hypertension. classically presents as a young fat female taking oral contraceptives. who eventually present with headaches and papilladema. headaches that are woprse in the morning or accompanend by nausea and vomiting are usually of intracranial origin.
what is the clinical presentation of addisons disease
fatigue, weight loss, hyponatremia, hypotension, hypoglycemia. hyperpigmentation is a classic sign of addisons.
how do we diagnose addisons
use the synthetic ACTH (cosyntropin) test. cortisol should rise with the administration of ACTH.
what causes addison’s
autoimmune distruction of the adrenal glands.
what other disorders do we watch out for in addisons
other immune disorders, such as vitiligo, thyroid diseases, type 1 diabetes, pernicious anemia.
what causes the hyperpigmentation in addisons
the adrenals do not respond to pituitary secretion of ACTH, so the pituitary keeps secreting more and this stimulates melanocytes to overproduce melanin.
what is the treatment for RSV
supportive with humidified oxygen, bronchodilators, corticosteroids
what is the normal BUN/creatinine ratio
10-15:1
what does prerenal failure look like>?
there is more BUN than creatinine, leading to an increase in the ratio. The kidney is still functioning so it is able to retain BUN…
what does acute tubular necrosis look liek
the BUN and Creatinine ratio doesnt change. they are retained at the same rate. can’t do its job so BUN is lost through the kidney at the same rate as the creatinine
when is it appropriate to screen for cancers due to smoking history
in adults 55-80yo who have a 30 pack-year history and are currently smoking or have quit within the last 15 years.
when and why do we screen men for abdominal aneurysm
between the ages of 65 and 75 in men that have ever smoked. one time with ultrasound
how do we test for C difficile
ELISA for C difficile toxins A and B
what is the presentation of cat-scratch disease
low grade fever, erythematous, painful cutaneous papules and pustules as well as lympadenopathy
what is the causal organism for cat scratch
bartonella henselae
what is the causal agent of cellulitis after a bite from an animal
typically pasteurella multicida
what is the most feared complication of ulcerative colitis
toxic megacolon
how do we approach a patient with a murmur and a history of IV drug use
they have infectious endocarditis until proven otherwise
what is the CSF analysis of bacterial meningitis
leukocytosis (neutrophilic predominance), low glucose and elevated protein
what does herpes encephalitis CSF look like
increased leukocytes of lymphitic predominance, increased protein and normal glucose.
how do we characterize diabetic ketoacidosis
you must have an elevated anion gap
how to calculate anion gap
sodium - (chloride + bicarb)
what is normal anion gap
8-16
which diabetics get DKA?
type I diabetics. the body has the fuel it needs (glucose) but acts as if its starving because there is no insulin to use it. thus the body tries to use ketone bodies
what is hyperosmolar hyperglycemia nonketotic syndrome
when high blood sugar causes the kidneys to try and get rid of it through the urine, but this also causes water and electrolytes. the removal of the water and electrolytes causes hemoconcentration of the sugars and an exacerbation of this blood sugars.
if you see a patient in an acute asthmatic attack and their CO2 continues to rise, while sustaining tachypnea what do you do?
this is not improvement, this is impending collapse. Need intubation and mechanical ventilation. this person is about have pulmonary failure
what are the first steps for fungal nail infections
KOH of the nail scrapings. itraconazole and terbinafine have higher have higher efficacy than griseofulvin
what is the management for grade I-II VUR
antibacterial prophylaxis and surveillance cultures every 3-4 months. low dose TMP/SMZ or nitrofurantoin is appropriate until VUR has disappeared. the antibiotic therapy is required to prevent recurrent UTIs and renal damage
what is the serum-ascites albumin gradient
serum albumin - ascites albumin; if greater than 1.1 then portal hypertension is the cause of the ascites, from cirrhosis, CHF, or budd-chiari syndrome; if lower than 1.1 then it is caused by pancreatitis, peritonitis, or peritoneal carcinomatosis.
SAAG of 1.1 or greater is due to what?
portal hypertension is the cause of the ascites, from cirrhosis, CHF, or budd-chiari syndrome
SAAG of 1.1 or less is due to what?
pancreatitis, peritonitis or peritoneal carcinomatosis
what is sister mary josephs node
indicative of gastric carcinoma, it is a firm nodule by the umbilicus usually red.
what is the indication of a female that was having normal menses and then all the sudden it stops and she becomes amenorrheic?
this indicates secondary amenorrhea, since she was normal until recently. Most likely due to pituitary function. test TSH and Prolactin levels.
what is legg-calves-perth disease
avascular necrosis of the femoral head that is idiopathic
what is the etiology of non-anion gap acidosis
renal tubular acidosis and GI bicarbonate loss.
how do you diagnose anion gap acidosis
MUDPILES –methanol, uremia, diabetic ketoacidosis, paracetamol/propylene glycol, isoniazid/infection, lactic acidosis, ethylene glycol, salicylates.
when you see a patient that has pH reading, what do you do?
if acidotic then calculate anion gap
when can we use amantidine for influenza a
only effective if it is started 48 hours after the onset of symptoms. afterward supportive therapy will work, such as acetominophen and peudophendrine
what is another name for guillain-barre syndrome
acute inflammatory demyelinating polyneuropathy. lack of deep tendon reflexes, symmetrical ascending weakness and paralysis.
what is the key to controlling asthma?
rules of 2. if controlled then use rescue inhaler less than 2 times per week in the day and less than 2 times per month at night
what is first line therapy for seasonal allergies
decongestants and antihistamines. the most effective treatment is inhaled nasal corticosteroids
what are common decongestant and antihistamine
pseudophedrine and chlorpheniramine
what is the treatment for impetigo
trimethaprim sulfamethoxazole
what is the most likely cause of elevated liver enzymes in a patient with diabetes, overweight and otherwise asymptomatic
fatty liver disease, or steatohepatitis
what are some of the prophylactic medications for migraines
tricyclic antidepressants (amitriptyline), beta blockers like propanolol or timolol.
what are the triptans and the ergot alkaloids
these are abortives. remember that if you have someone that is well-controlled on abortives, maybe a prophylactic is better
how do we diagnose appendicitis?
clinically.
what are the two most frequent causes of acute pancreatitis
gallstones and alcohol abuse
what is the presentation of normal pressure hydrocephalus
forgetfulness or dementia, wobbly gait, incontinence urine
presents as ventricular enlargement without cerebral atrophy
what does DKA look like on labs?
acidotic, low bicarb, low CO2.
do we stop breast feeding with mastitis
no. in fact it can help prevent abscess formation
what is minimal change disease?
this is a nephrotic syndrome. proteinuria, hyperlipidemia, edema, ans hypoalbuminemia. fusion of the foot processes of epithelial cells on electron microscopy.
what is first line therapy for GERD
lifestyle modifications
what is the firstline medical therapy for GERD
PPIs
what is second line therapy for GERD
H2 antagonists
what is the medical treatment for divericulitis
bowel rest, metrinidazole and ciprofloxacin
what is C-peptide and what does it have to do with factitious disorder
C-peptide is the peptide that is produced with insulin and is cleaved off of the nascent protein. you will see that in factitious disorder of insulin injection, the C-peptide will be physiological or low and that insulin will be raised and glucose will be low.
what is the treatment for bacterial prostatitis
antibiotic treatment consists of either fluoroquinolone (ciprofloxacin, levofloxacin) or trimethoprim/sulfamethoxazole.
what is the presentation of bacterial prostatitis
fever, dysuria, boggy and tender prostate.
