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Medicine Boards > GIM > Flashcards

GIM Flashcards

1
Q

When should you start statin based on LDL number?

A

> 20yo with LDL >190

high-intensity statin

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2
Q

How long to continue lovenox after orthopedic surgery?

A
  • 35 days if no increased bleeding risk

- 10-14 days if increased bleeding risk (minimum)

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3
Q

Tx of bacterial conjunctivitis

A
  • none, will go away in 2 weeks
  • if treating – topical trimethoprim–polymyxin B or erythromycin
  • if uses contacts can use topical fluoroquinolone, but otherwise not first line
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4
Q

Tx and duration of acute bacterial prostatitis after urologic procedure

A

bactrim or cipro

6 weeks –> use bactrim b/c cipro can prolong QT

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5
Q

Drug of choice for enuresis

A

impiramine (TCA)

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6
Q

How long to continue SSRI for 1st episode of depression?

A

4-9 months

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7
Q

SSRI and Bupropion (DNRI) should be avoided in which condition?

A

anorexia

Bupropion should also be avoided in bullemia b/c decreases seizure threshold, whereas SSRIs are used to treat bullemia.

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8
Q

Patient on SSRI and with cloudy urine

A

retrograde ejaculation

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9
Q

Meds that can increase blood glucose

A 
olanzapine
statins
betablockers (Except carvedilol)
HCTZ
niacin 
PI (HIV managment)
steroids
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10
Q

Treatment of acute dystonic reaction (as SE Of typical antipsychotics)

A

diphenhydramine/benztropine

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11
Q

Serotonin Syndrome

  • describe vitals/presentations
  • key meds
  • treatment
A
  • hyperthermia, change MS, tremor, autonomic instability (high HR, low BP), N/V/D, HYPERreflexia
  • SSRI, linezolid, tramadol
  • Tx - benzos +/- cyproheptadine (H1B)
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12
Q

Describe NMS (neurolopetic malignant syndrome) and its treatment

A
  • hyperthermia, change MS, autonomic dysfunction (high BP, high HR), LEAD PIPE RIGIDITY with rhabdomyolysis and HYPOreflexia.
  • Tx: Dantroline or bromocriptine
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13
Q

Describe malignant hyperthermia and treatment

A
  • hyperthermia, sustained muscle contraction (high HR high BP), HYPOreflexia, history of inhalation anesthetics
  • Tx: RAPID COOLING +/- dantrolene
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14
Q

Treatment of CCB overdose?

A

IVF, atpropine and slow IV CALCIUM CHLORIDE to counteract peripheral vasodilitory effects of CCV

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15
Q

Organophosphate poisoning

  • presentation
  • what to measure to confirm?
  • treatment
A
  • wet - increase secretions (ie. salivation), sweating, N/V, shortness of breath, tremors, fasiculations, pupils CONSTRICTED, low HR
  • RBC acetylcholinesterase level
  • TX;
    1. remove contaminated clothes
    2. activated charcoal (if <4hr)
    3. IV atroprine**
    4. IV pralidoxime** (after atropine if needed)
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16
Q

Treatment of non-displaced vs. displaced femur fracture

A
  1. nondisplaced – surgery + 3 parallel pins
  2. displaced – total hip arthroplasty (femur + ball + socket) … not hemiarthroplasty
  3. inter-trocaneteric fractgure –> hip compression screws
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17
Q

What can you use to treat bone pain from compression fracture? (after tylenol, nsaids)

A

Calcitonin (helps with bone pain 2/2 osteoporosis)

18
Q

Hallmarks of Optic Neuritis

A

acute vision loss, eye pain with movement, color perception change, and afferent pupillary defect; results of a funduscopic examination may be normal.

19
Q

Which immune globulins should you give to a pregnant woman that was expososed?

A

Hep A, Hep B, Measles, Varicella

20
Q

At what area is surgical treatment indicated for MS? what time of surgery

A

<1.0 sq. cm

Valvuloplasty (opening valve) - even in pregnancy if symptoms severe

21
Q

Pt with ASD wants to get pregnant when can she get pregnant vs needing to undergo surgery first?

A

If ASD shunt is..
<2:1 == can get pregnant
>2:1 == surgery first

22
Q

Cardiac contraindications to pregnancy?

A 
pulmonary HTN
Eisenmenger syndrome
Marfans with dilated aortic root
Dilated cardiomyopathy with CHF
Severe AoS
23
Q

What heart sounds are normal during pregnancy?

A

S3
II/VI systolic murmur at apex

functional 2/2 normal volume overload in pregnancy

24
Q

What heart sounds do you hear with ASD?

A

1 - FIXED SPLIT 2nd heart sound (S2) *** 2/2 increased volume in right heart at all times
2 - mid diastolic rumble @ LLSB 2/2 large blood volume from RA –> RV
3 - mid systolic ruble @ LSB 2/2 large blood volume RV –> pulm valve
4. Partial or full RBBB from ASD (LA–>RA)

25
Q

Difference between AFLP vs HELLP?

A

in AFLP you have increased PT, ammonia, and direct bilirubin

26
Q

When to stop OCP prior to surgery?

A

1 month prior 2/2 increase renin substrate which can cause HTN

27
Q

When to stop anti-TNF meds prior to major surgery? When to restart?

A

2 weeks prior to surgery, resume 2-4 weeks after surgery, otherwise risk for wound dehiscence

28
Q

What is the name of plan B? Has to be used within ___ post coitus. Whats MOA?

A

Levonorgestrel
within 72hrs of sex
inhibits ovulation and implantation of zygote

29
Q

Complications of OCP

A
  • HTN 2/2 increased renin substrate
  • Theophylline level inc and toxicity –> MAT
  • Euthyroid thyroxenemia (inc total T3 and T4 but nl TSH)
  • Hepatic adenoma (peliosis hepatis)– if ruptures –> pain > shock > CT abd > surgery
  • Erythema Nodosum
  • PCT (porphoria cutanea tarda)
  • PE/DVT/CVA
  • budd chiari (hepatic v. thrombus) - abd pain, acites, pedal edema
30
Q

Difference in smoking cessation treatment in person with quit date vs. no quit date

A
  1. Quit date = f/u 2 weeks post quit date > start 2 forms of NRT (gum/patch/inhaler)&raquo_space; if fail then start wellbutrin or chantix
  2. No quit date = start wellbutrin or chantix right away
31
Q

Unilateral R sided varicocele – thoughts?

A
  • uncommon and may be associated with a significant underlying abnormality ….
  • IVC obstruction due to tumor or thrombosis because the right gonadal vein directly empties into the inferior vena cava.
  • Experts recommend advanced imaging with CT for patients with right-sided varicoceles.
32
Q

Describe presentation of SCLERITIS

A
  • severe eye pain that radiates to the periorbital region
  • watery discharge
  • Pain may occur with eye movement (inflammation of the extraocular muscles)
  • Sclera appears violaceous with notable edema
  • severe local tenderness can be elicited by exerting pressure on the overlying closed eyelid.
  • In approximately half of scleritis cases, an associated systemic rheumatic or inflammatory disorder is present.
33
Q

When to stop Warfarin vs. NOACs before surgery? when to resume?

A

Warfarin - 5 days – 12 - 24 hr (pending bleeding risk and need for bridging)

NOAC s - 2-3 days – 48-72 hr

34
Q

How to treat patient with BPH and erectile dysfunction?

A

tadalafil (a phosphodiesterase-5 inhibitor) has been shown to be effective and is the only FDA-approved option to treat both conditions.

35
Q

What is cyclic mastalgia? treatment?

A
  • severe breast pain (+/- lumps) around menstrual cycle
  • Tx - conservative measures (ie. well fitting bra) and if still pain can use Danazol (FDA approved) but limited by androgenic side effects
36
Q

When to screen for AAA?

A

All men aged 65 to 75 years who have ever smoked should undergo one-time abdominal ultrasonography to screen for abdominal aortic aneurysm.

37
Q

How to diagnose bacterial vaginosis

A

3 of the following 4 features

  • vaginal pH > 4.5
  • thin and homogenous vaginal discharge
  • positive whiff test result
  • clue cells comprising at least 20% of all squamous cells on saline microscopy
38
Q

How do you treat cancer related pain in a patient with CKD or ESKD?

A

Hydromorphone (dilaudid) - opioid naiive

Fentanyl patch – opioid tolerant

39
Q

How do diagnose SEID? (systemic exertion intolerance disease)

A

Fatigue x 6 months +

  • substantial reduction in preillness activities
  • postexertional malaise
  • unrefreshing sleep
  • either cognitive impairment or orthostatic intolerance.
40
Q

Schizophrenia

A

At least TWO of following (1 month):
- delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms

Plus ONE area of functional impairment (6 months)
- occupation, social interactions, or self-care

Typical age of onset is early adulthood.

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