hammer33 Flashcards
What is the treatment for neutropenic fever in COPD patient?
Cefepime for antipseudomonal coverage and only
What is th ebest treatment for achalasia? best iniital treatmetn?
Heller myotomy. Pneumatic dilation.
What is a classif finding of aortic dissection?
Decrescendo diastolic murmmur
What is the most common cause of meningitis even among immunocompromised patients?
Strep pneumo
What is used in treatment of treatment-resistant schizophrenia? Mechanism and sideeffects?
Clozapine with antagonistic effects on D1 and D4, histamine, seretonin, alpha adrenergic cholinergic. Agranulocytosis so monitor CBCs
What should you suspect when you see an upper GI bleed with normal endoscopy? Treatment?
Dieulafoy lesion. Band or sclerose it
What is the p/t of choledochal cysts?
fusiform dilation or saccular diverticula of the biliary tree. Surgical excision to reduce risk of cholangiocarcinoma
What is the most common cause of early deterioration in liver transplants?
Abnormalities in the vascular and biliary anastomosis via ultrasound check
What is the initial development in puberty in boys and girls
Testicular development and thelarche. Followed by adrenarche and growth rate.
What meds should you use in Heparin induced thrombocytoenia?
Fondaparinaux, argatroban, danaparoid. Warfarin contraindicated if plt count is < 150000
What is on top of the differential in persistent headache with breast cancer? Diagnostic modality
Mets to the brain , CT with contrast to identify lesions
What is the hormone situation in Turner’s syndrome?
High FSH and LH aand low Estradiol
What is the treatment for patients with acute gout and chronic renal failure?
Corticosteroids
What is the radiologic findings of uric acid stones and treatment?
Radiolucent. Hydration, NSAIDS and Potassium citrate or potassium bicarbonate to alkalinize the urine and dissolve the stone
What is the renal presentation of Wegner’s granulomatosis?
RBCs and RBC casts
What is the cause of adrenal insufficiency 2/2 stopping corticosteroid meds?
Iatrogenic.
What is the presentation of Jervell- Lange-Neilsen syndrome?
Prolonged QT, deafness ,AR, family history
What does the abdomen look like in esophageal atresia?
GASLESS
What is the side effect of pyrazinamide in TB treatment?
GI discomfort
What is a 2nd line treatment for acute pulmonary edema when furosemide, nitrates and morphine don’t work?
Hydralazine which is a smooth muscle relaxant working on arteries and arterioles
What is the presentation of hairy cell leukemia?
Dry bone tap, CD11c and CD22 antigens, fatigue, splenomegaly and abdominal pain
What is the orders of the drugs of coice to treat acromegaly when surgery is not possible?
- Octreotide 2. Bromocriptine/cabergoline and Pegvisomant (GHR antagonist)
What is the best treatment for prostate cancer?
Radical prostectomy
What is the treatment for BPH?
TURP and cryotherapy
What should u suspect in normal lab, benign PE, unilateral lower abdominal pain in a young woman?
Corpus luteum cyst formation
What should you give a child showing signs of intracrnaial HTN by vomiting and seizing?
Normal saline plus corticosteroids to reduce edema
What is the difference between TTP and HUS?
TTP has more altered mental symptoms and HUS has more anuric renal symptoms
What is the management of pediatric patients < 5 who have been exposed to a TB patient but have negative PPD test?
Isonazid PPX to prevent latent TB and redo PPD test 8-12 weeks and d/c treatment if negative
What are the symptoms of maternal diabetes in an infant?
VSD, TGA, dextrocardia, Open neural tube defects, kidney and skeleton dysfunction
What signs and markers are seen in Hodgkin lymphoma?
CD15 and CD30. Palpable non tender neck mass or mediastinal lymphadenopathy on CXR.
What is the platelet count in HIT type 1? Which one is more severe? Tx for type 2 HIT?
Bout 100000. Type II is more severe with plts 30000 - 50 000 and thrombosis. Danaparoid, Lepirudin or Argatroban
What is the presentation of tellogen effuvium?
Hair loss or thining after a stressful event such as surgery or infection. ALmost completely reversible.
What is the best way to reduce hypovolemc shock in pelvic fractures?
External fixation
What is best initial management of colovesical fistula?
CT abdomen and pelvis WITH contrast
What is the pathophysiology of Glanzmann thrombocytopenia?
Deficiency in glycoprotein IIb/IIIa. Decreased response to ADP, Epinephrine and collagen. Normal response to risocetin. Prolonged bleeding time.
What is the pathophysiology of Bernard Soulier?
Thrombocytopenia, large platelets. No response to risocetin, but normal reponse to ADP, Epinephrine and collagen.
What is the treatment for panic disorder?
Benzodiazepine for acute settings and SSRIs, TCA or MAOi for 6 months.
What is the w/u of polydipsia and polyuria?
Urine osmolarity and water deprivation test
What length of time is allowed to administer thrombolytic therapy?
3 hours of symptom onset if PCI is more than an hour away
What is the presentation of non occlusive mesenteric ischmeia?
Seen in eldery atherosclerotic patients with acute hypoperfusion or vasoconstriction. Diffuse abdominal pain after phenylephrine. CT showing small bowel thickening and foci of intramural gas. Irregular areas of narrowing and dilation of arterial branches without arterial or venous filling defets
What is the treatment for hereditary spherocytosis?
FOlic acid to sustain erythropoiesis,
What is the pathophysiology of SSSS similar to? How is it different from TEN and SJS?
Bullous impetigo as both cleave desmogelin. SSSS spares the mucosal surface because of higher desmoglein concetration in these surfaces while TEN and SJS go full thickness.
What is the pathophysiology of SJS and TEN?
CD8+ cytotoxic T lymphocyte mediated induction of cell death through Fas/FasL dependent mechanism
What should you suspect if observe a mass infront of the ear? Mgmt?
Parotid tumor. Superficial parotidectomy with facial nerve sparing
When do you screen for glaucoma?
If positive risk factors (diabetes, aa, family hx, elevated iop), every year after 40. Otherwise every 3-5 years between 40 - 60 and every 1-2 years after 60.
What is the treatment of mastitis?
Diclocacillin because it is S. aureus mediated in 40%
What is the desirec tidal volume in COPD patients?
5-7 ml/kg
What is the most ommon location and common site of metastasis of carcinoid syndrome?
Small bowel (ileum) and hepatic mets
When is Rhogam administered?
At 28 weeks, at delivery and if there are any procudeures
What is the recommendation for a mother with a history of Herpes who is now pregnant?
Acyclovir from 36 weeks till delivery
How does water toxicity occur?
Water moves passively into brain cells following the tonic gradient
What is the characteristic of NSAID/H.pylori induced gastritis?
Smooth ulceration in the antrum and thick rugal folds
What is borderline personality disorder associated with?
Mood disorders, anxiety, eating disorders and substance abuse
What should you suspect in HIV patients who do not improve with empiric treatment for toxoplasmosis?
B cell lymphoma. Do biopsy
What should you suspect in a third cranial nerve palsy?
Intracranial aneurysm. Do CT and angiogram followed by neurosurgery consult
Which malaria drugs are used in central america, mexico, argenitan, paraguay, caribbean?
Chloriquine
