hammer29 Flashcards
What are electrolyte abnormalities in Barrter syndrome?
High renin and aldosterone, low potassium and chloride
For how long is anticoagulation used after PE?
For 3-6 months. Start with Heparin and Warfarin until INR reaches 2 -3 then use Warfarin only.
At which time lines is post exposure PPX testing done for HIV needle stick?
6 weeks, 12 weeks and 6 months Post exposure
What is the treatment of community acquired PNA in an alcoholic?
Fluroroquinolone or beta lactam + macrolide or doxicycline
What coagulation values are normal in TTP? How does it present?
PT, PTT, D-dimer. Fever, thrombocytopenia, miha, neurologic symptoms, renal failure
Which two drugs are common causes of sideroblastic anemia?
Isonazid and chloramphenicol
What is the presentation of chronic arsenic exposure?
Wart like palmar and solar keratones leading to squamous cell carcinoma in non exposed areas
At what Na serum level should you consider hypernatremic sodium replacement?
< 110 or CNS abnormalities
How is hypernatremic dehydration (Na > 150 corrected)?
Corrected over 48 hours. Maintenance and solute deficit corrected within the first 24 hours and half of free water deficit corrected over first 24 hours and the other half over the next 24 hours
What are risk factors for developmental dysplasia of the hip?
Female, Breech, Family history, First born
Which patients with MDS are considered high risk and receive hydroxyurea?
Age > 60, prior thrombosis, CV risk factors
What are the benefits and side effects of Dong quai?
Benefits- Relieves pain, muscle relaxant, uterine stimulant
Side effects - increases bleeding
How is hemorrhagic cystitis from cyclophsphamide prevented?
Give MESNA which binds acrolein which creates a friable surface
What are symptoms and treatment for Giardiasis? Which part of the body does it affect? Which is the most infective form?
Foul smelling diarrhea and malabsotrption. Metronidazole for 5 to 7 days. Small intestine and billiary tract. Cyst form not trophozite
What meds besides Rifampin can be used for prophylaxis in Neisseria meningitidis?
Ciplrofloxacin or third gen cephalosporin
What is the presentation of reflex sympathetic dystrophy (causalgia)?
Pain with slight touching. Use anesthetics or surgical sympathectomy.
What are the normal and abnormal inflammation markers in polymyalgia rhEumatica?
Elevated ESR with normal CPK
How does an infant with cocaine intoxication present after being delivered?
Irritable, inconsolable, High pitched cry
What imaging modality do you use in acute cholecystitis when renal US fails?
HIDA scan (cholescintigraphy)
What meds are used to treat PCP intoxication?
Benzodiazepines (Diazepam, Midazolam and Lorazepam)
How is peritonitis diagnosed and treated?
Abdominal pain or tenderness, cloudy dialysate (>100 WBC mostly neutrophils) . Cefazolin and ceftazidime because mostly due to Staph epidermidis and staph aureus.
What is the presentation and treatment of Oglive syndrome?
Non mechaical obstruction of large bowel post op and caused by sympathetic/parasympathetic . Constipation, abdominal distension, diffusely dilated large bowel on xray. IV Neostigmine (Peripheral acetylcholinesterase inhibitor)
Which teeth erupt first?
Mandibular central incsiors, maxillary central incisors, mandibular lateral incisors, maxillary lateral incisors, first molars, second molars
When should you measure plasma acetaminophen levels in toxicity? When can you give N acetylcysteine?
After 4 hours. Till then charcoal. Upto 16 - 36 hours in worse poisoning.
What are findings in right sided parietal lobe lesion?
Left sided neglect, left sided weakness, left sided homonymous hemianopsia
What is the managment of Corneal ulcer?
Slit lamp exam, scrape and culture, treat with fluoroquinolones topical no STEROIDS
What are the side effects of ACEi, hint Captopril?
CAPTOPRIL
Cough Angioedema / Agranulocystosis Proteinuria / Potassium excess Taste changes Orthostatic hypotension Pregnancy contraindication / Pancreatitis/ Pressure drop (first dose hypertension) Renal failure (and renal artery stenosis contraindication) / Rash Indomethacin inhibition Leukopenia / Liver toxicity
What maneuvers reduce mortality in ARDS? What other vent setting help?
Low tidal volume. High PEEP and permissive hypercapnia
What are the findings in Bernard-Soulier syndrome?
Giant platelets, thrombocytopenia, doesn’t respond to Risocetin assay
What should Type 1 diabetes patients be screened for and what are the next steps?
Celiac disease. Tissue transglutaminase IgA (TTG). If positive do biopsy to confirm.
What is the management of post herpetic neuralgia?
TCAs, gabapentin
What is the treatment for severe lead poisoning?
BAL + EDTA
What is the initial diagnostic steps in a HOCM patient who has syncope?
TTE + Holter monitoring for fatal arrhythmias
What are the three characteristics of acute respiratory distress syndrome?
- Bilateral radiographic infiltrates 2. PaO2/FiO2 <=200 3. No evidence of elevated left atrial pressure. (PCWP < 18mm Hg)
What gas abnormalities are found in COPD?
Compensated respiratory acidosis with hypercapnia and hypoxemia
Which parameter informs you to extubate a patient?
Rapid shallow breathing index (Ratio of Respiratory rate to tidal volume < 100)
What should you suspect in chronic constipation in a neonate? Treatment?
Hirschprung, barium enema
Blood pressure, LDL and triglyceride after hypothyroidism treatment?
All decrease
Where does adenoid cystic carcinoma occur? Benign or malignant?
Malignant. In eccrine glands such as salivary glands and lacrimal glands
What are the features of atrial septal defect?
- Fixed split S2
- Midsystolic pulmonary flow or ejection murmmur
- RA and RV enlargement
- RV impulse present
What is presentation and what can lichen sclerosis turn into?Treatment?
Chronic vulvular itching, burining, pain. SCC. Topical corticosteroids such as Clabetasol or Halbetasol
What is the next step after seeing a pulmonary mass > 3 cm?
Diagnosis and staging simultaneously via PET CT
When do you add steroids when treating Pneumocystis jivercii with TMP SMX?
PaO2 < 70 and A a gradient >35. Steroids are helpful in decreasing the need for mechanical ventilation and reduce mortality in severe hypoxia
What determines the conversion from IV to SubQ insulin in a DKA patient?
Anion gap
What is the treatmetn for head lice (pediculus humanus capitis)?
Lindane, pyrethrin, malathion, permethrin,
What is the EKG finding in hypothermia?
Osborn (J wave) which is the upward deflection after the R wave in Lead II
Treatment for Hep C?
PEG interferon and ribavirin combo
What is needed to make diagnosis of TTP?
Blood smear showing schistocytes from microangiopathic hemolytic anemia
What are the two phases of treating cryptococcal meningitis?
Induction (amphoterocin plus flucytosine for 14 days plus fluconazole for two months) Maintenance phase (fluconazole until CD4 >100)
What is the treatment for gonorrhea if patient is allergic to ceftriaxone or betalactams?
Azithromycin and gemofloxacin or gentamicin
Which part of the eye is affected in acute close angle closure glaucoma?
IRIS
What is the washout period before starting an MAOi after an SSRI or viceversa?
Stop MAOi for 14 days
Stop SSRI for 5 weeks
What are the CT findings of Glioblastoma Multiforme?
Poorly differentiated, ring enhancing, both lobes, hemorrhagic, extensive edema, patients have less than a year survivial
What is the presentation and treatment of bacterial conjunctivitis?
Purulent discharge and uni/bi lateral redness. Sulfa eye drops or erythromycin ointments
What is the most sensitive test for detecting pituitary adenomas (which are also most common)?
MRI scan with gadollinum. CT has advantage of showing calcifications though
