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hammer12 Flashcards

1
Q

What is the first line treatment for psychosis? What is used for patients who have failed at least 2 trials?

A

Second gen antipsychotics like risperidone, quetiapine, olanzapine, aripiprazole. Clozapine

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2
Q

What is the cause of war magglutin autoimmune hemolytic anemia? How does it present? Treatment?

A

Drugs (penicillin), viral infections, autoimmune, immunodeficiency, CLL. Positve Coombs test with anti-IgG, anti C3 or both, splenomegaly, jaundice, decreased haptoglobin. Corticosteroids, splenectomy

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3
Q

Which one is the most common cause of macrocytic anemia?

A

FOlic acid deficiency

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4
Q

What is the treatment for hepatic encephalopathy when patients cannot clear toxins and have poor CNS function?

A

Lactulose, rifaximin and laxatives

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5
Q

What is the etiology and presentation of chronic mesenteric ischemia?

A

Atherosclerosis. Crampy, post prandial epigastric pain, food aversion adn weight loss

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6
Q

Which anti arrhythmic drugs cause progressive decrease in impulse conduction and increase in QRS duration? How?

A

Flecainide, propafenone and Calcium channel blockers. Use dependece 2/2 prolonged blockage of Na channels at initial depolarization phase

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7
Q

How is magnesium sulfate excreted?

A

Renally, so can have toxicity in renal patients

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8
Q

What is the presentation of eczema herpeticum and which disease does it present with?

A

Primary herpes simplex virus infection associated with atopic dermatitis. Painful vesicles, punched out erosions, hemorrhagic crusting. Fever, LAD

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9
Q

What is the presentation of polymyalgia rheumatica? Treatment?

A

Affects patients > 50. Characterized by pain and stiffness in neck, shoulders and pelvic girdle. Low dose prednisone

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10
Q

What is the clinical presentation of CLL? Complications?

A

LAD, Hepatosplenomegaly, severe lymphocytosis, flow cytometry. Infection, autoimmune hemolytic anemia nd secondary malignancies are complications.

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11
Q

What is the presentation of fibrocystic changes of the breast? Fibroadenoma?

A

Fibrocystic changes - multiple diffuse nodulocystic (cord like) masses, cyclic premenstrual tenderness. Fibroadenoma - solitary well circumscribed movile mass, cyclic premenstrual tenderness

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12
Q

What causes Graves disease in infannts? How is it treated?

A

Transplacental TSH receptor antibodies. Methomazole plus a beta blocker

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13
Q

What is the exception to giving the first HepB vaccine?

A

> 2kg infant

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14
Q

What are most common cause of urinary tract obstruction in newborn boys? What are ultrasound findings in prenatal ultrasonography?

A

Posterior urethral valves. Bladder distension, b/l hydroureters and b/l hydronephrosis.

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15
Q

What is the presentation of polycythemia vera? PE? Labs?

A

High blood viscosity with HTN, burning hands and feet (erythromelalgia), transient visual disturbances. Increased RBC turnover (gouty arthritis), aquagenic pruritis and bleeding. PE- facial plethora, splenomegaly.

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16
Q

Complications and treatment of polycythemia vera?

A

Elevated hemoglobin, low erythropoietin, JAK2 mutation, leuckocytosis and thrombocytosis. Tx - phlebotomy, hydroxyurea

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17
Q

What is treatment for severe symptomatic hyponatremia?

A

Hypertonic 3% saline

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18
Q

What are risk factors for preterm delivery?

A

Prior spontaneous preterm delivery, multiple gestation, short cervical length, cervical surgery, cigarette use

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19
Q

At what age is mammography indicated?

A

50

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20
Q

When do you do breast ultrasound ?

A

When the lesion is painful and or varies in size or pain eith menstruation.

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21
Q

What cancers if BRCA associated with?

A

Ovarian cancer and breast cancer

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22
Q

What procedure is avoided with q negative sentinel lymph node?

A

Axillary lymph node dissection

23
Q

What treatment should ER or PR positive patients get? What are the side effects?

A

Tamoxifen , raloxifen, or aromatase inhibitors (anastrazole, letrozole, exemestane). Tamoxifen cause endometrial cancer and clots while aromatase inhibitors give osteoporosis.

24
Q

What are the sideeffects of prostatectomy? Of radiation?

A

Erectile dysfunction and urinary incontinence. Diarrhea.

25
Q

What is the workup of elevated PSA?

A

If there is a palpable mass, biopsy. No palpable mass, do a transrectal ultrasound and if w mass is seen, biopsy the mass and if no mass is seen, do multiple blind biopsies.

26
Q

Which patients are screened for lung cancer?

A

30 year smoking history , age 55-80 with low dose annual Chest CT.

27
Q

Which testicular cancer secretes only HCG? Both HCG and AFP? What is the treatment for each

A

Seminoma is sensitive to both chemotherapy and radiation. Nonseminomatous cancer only sensitive to chemotherapy .

28
Q

What is the workup if ASCUs is found?

A

Do HPV testing and if positive do colposcopy.

29
Q

What is the treatment of achalasia?

A

Pneumatic dilation, surgical section or botulinum injection. Inability of lower esophageal sphincter to relax.

30
Q

What is treatment for esophageal spasms?

A

Calcium channel blockers

31
Q

What is the workup of an HIV patient with CD4 count presenting with oral trush?

A

Empirically start flucanozole. If no improvement then do endoscopy with biopsy. If the ulcerations are large, it is CMV. If small, HSV

32
Q

What is Schatzki ring associated with and where is it located? Treatment?

A

Acid reflux and is associated with a hiatal hernia, found at distal esophagus. Pneumatic dilation. Steakhouse syndrome has intermittent dysphagia.

33
Q

What is Plummervinson associated with and where is it located? Treatment ?

A

Iron deficiency anemia, squamous cell cancer, proximal esophagus. Replace iron

34
Q

What muscles are responsible for Zenker diverticulum and what are patients at increased risk for?

A

Posterior pharyngeal constrictors and aspiration pneumonia.

35
Q

What is Boooerhave syndrome?

A

Full penetration of the esophagus secondary to vomiting.

36
Q

What is the treatment for GERd with persistent symptoms or erosive esophagitis? What about for those not responsive to medical therapy?

A

Nissen fundoplication, endocinch, local heat or radiation

37
Q

What is the management for Barrett’s (columnar met aplasia with intestinal features)? Low grade dysplasia? High grade dysplasia?

A

PPIs and rescope every 2-3 years
PPIs and rescope every 6-12 months
Ablation with endoscopy, photodynamic therapy, radio frequency ablation, endoscopic mucosal resection.

38
Q

What are two tests used for H.pylori detection?

A

Urea C13 and C14 breath testing and H pylori stool antigen which tells if active infection is present.

39
Q

What is the only method for detecting gastric cancer? Which ulcers can cause it?

A

Endoscopy. Gastric ulcers. Repeating endoscopy to confirm healing is standard.

40
Q

What is the treatment for H pylori confirmed patients with and without a penicillin allergy? What if disease does not respond to treatment?

A

PPIs plus clarithromycin plus ampicillin. If allergic, PPIs plus clarithromycin plus metronidazole. Then recheck 30-60 days for eradication. Antibiotic resistance so confirm with a test.

41
Q

When do you scope patients in non ulcer dyspepsia?

A

If they are over 55 and or if alarm symptoms are present

42
Q

What is the most appropriate management of diabetic gastroparesis?

A

Erythromycin , metoclopromide

43
Q

What is the most common cause of upper GI bleeding? Lower GI bleeding?

A

Ulcer disease. Diverticulosis.

44
Q

What is the management of GI bleeding?

A

Fluid replacement, packed red cells if hematocrit is below 30, FFP, platelets if below 50000, Octreotide for varicella bleeding, endoscopy, IV PPI, surgery to remove the site of bleeding if fluids, blood, platelets and plasma will not control bleeding.

45
Q

What is done in addition to fluids,vblood, platelets and plasma in esophageal and gastric varices?

A

Octreotide to decrease portal pressure, banding to obliterate esophageal varices, a TIPS to decrease portal pressure in those who are not controlled by octreotide and banding, propranolol to prevent subsequent bleeding.

46
Q

How is recurrent case of C diff treated?

A

Retreat with Metronidazole. If that fails again, switch to oral vancomycin of fidaxomicin

47
Q

What is the presentation and treatment for Whipple disease? Treatment for topical sprue?

A

Arthralgia, ocular findings, neurological seizures, fever, LAD. Ceftriaxone followed by TMP SMX. TMP SMX or tetracycline.

48
Q

What is the most specific test for chronic pancreatitis?

A

Secretin stimulating test which won’t release bicarbonate rich fluids in an abnormal pancreas.

49
Q

What is the treatment of IBS?

A

Fiber, antispasmodic agents such as hyoscyamine or dicyclomine. TCAs, anti motility agents such as Loperamide, lubiorostone

50
Q

What are features of Crohn’s disease? Antibody and treatment?

A

Skip lesions, trans mural granulomas, fistulas (antiTNF agents such as infliximab) and absences, masses and obstruction, perianal disease (Ciprofloxacin and metronidazole), antisaccharomyces cerevesiae antibody. Budesonide

51
Q

What are features of ulcerative colitis? Antibody and treatment?

A

Curable by surgery, entirely mucosal, sclerosing cholangitis, no perianal disease. ANCA. Budesonide

52
Q

What is the presentation and treatment for DIVERTICULITIS?

A

LLQ tenderness, fever, leukocytosis. Initial CT scan. Antibiotics that target ecoli and anerobes. Treat with Ciprofloxacin plus metronidazole or amoxicillin /clavulanate.

53
Q

When should screening for IBD occur?

A

After 8-10 years of colonic involvement,with colonoscopy every 1-2 years.

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