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medicine Clerkship > IM Essentials > Flashcards

IM Essentials Flashcards

1
Q

What are the sx of serotonin syndrome? unique features?

A

high fever, muscle rigidity, cognitive changes

unique feat: shivering, hyperreflexia, myoclonus, ataxia

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2
Q

What are the sx of malignant hyperthermia?

A

severe muscle rigidity, masseter spasm, hyperthermia, tachyarrhythmia, rhabdomyolysis

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3
Q

What drugs cause malignant hyperthermia?

A

inhaled anesthetics (halothane) and depolarizing NM blockers (succinylcholine, decamethonium)

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4
Q

What are the sx of neuroleptic malignant syndrome?

A

muscle rigidity, hyperthermia, autonomic dysregulation, commonly delirium, extrapyramidal sx (tremors/parkinsonism/dystonia, high muscle enzyme [CK])

(vs 5HT s/o has hyperreflexia and myoclonus)

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5
Q

What are indications for starting abx in pt with URI/sinus infection?

A
  • 3-4 days of severe sx: fever > 39, purulent drainage, facial pain
  • worsening sx that were initially improving after typical URI
  • sx that do not resolve in 10 days
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6
Q

What are the centor criteria?

A
  1. t > 38.1 (100.5)
  2. tonsil exudate
  3. tender cervical lymphadenopathy
  4. absence of cough

if 4 –> > 40% changce of strep pharyngitis
2-3 –> intermediate –> do RADT

may empirically treat 3/4 which wait for test results

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7
Q

What should you suspect/next test in someone w/ pharyngitis, persistent fever, neck pain, septic pulmonary emboli?

A

lemierre syndrome = septic thrombosis of jugular vein

do CT of neck w/ contrast

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8
Q

When do you need to cover for psuedomonal pneumonia? what is abx of choice?

A
  • hx of smoking, hx COPD, broad spectrum abx use in previous month, recent hospitalization, malnutrition, neutropenia, steroid use
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9
Q

What is/are abx of choice for pseudomonas pna?

A

B lactam + aminoglycoside (ex. piperacillin tazobactam + amikacin)

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10
Q

What is curb-65?

A

confusion, BUN > 19.6, RR > 30, SBP 65

if 2 or more, admit to hospital
if 3-4 to ICU

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11
Q

What is the outpatient treatment for CAP?

A

azithromycin

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12
Q

What are risk factors for drug resistant strep pneumo?

A
  • age > 65
  • B lactam use in last 3 mo
  • medical comorbidities
  • immunocompromised
  • alcoholism
  • exposure to child in day care
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13
Q

What is the most appropriate test for pt who has received BCG vaccine to test for TB?

A

interferon-y-releasing assay

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14
Q

What is the next step if +PPD and negative CXR?

A

latent TB –> give INH for 9 mo

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15
Q

Who should receive abx prophylaxis to prevent infective endocarditis?

A

only pts w/ underlying heart conditions w/ high risk of adverse outcome from infective endocarditis –> prosthetic heart valve, hx of prior infective endocarditis, unrepaired cyanotic heart disease or repaired congesnital heart disease for 6 mo following repair, cardiac transplant recipieitns with cardiac valvulopathy

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16
Q

What are 2 abx treatments for endocarditis 2/2 MRSA?

A

IV vancomycin or daptomycin

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17
Q

What is the initial therapy for pericarditis?

A

NSAID or ASA

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18
Q

What are characteristics of pericarditis chest pain?

A

pleuritic, worse with lying down (better when sitting forward)

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19
Q

What is next step in dx GERD in pt with CP where cardiac etiology has been ruled out?

A

trial of PPI for 8-10 wks

if successful –> continue
if unsuccessful –> do endoscopy or manometry

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20
Q

When do you increase dose of B blocker vs add on CCB?

A

optimal B blockade = resting HR of 55-60

if HR is higher, you can increase dose

if HR in optimal range, add on CCB

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21
Q

What is next line medication if pt’s angina not controlled on BBlockers?

A

add CCB

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22
Q

What are contraindications to giving B Blockers in pts with ACS?

A

heart failure, systolic

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23
Q

What are contraindications to LMWH instead of regular heparin?

A

obese, CKD

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24
Q

What is preferred treatment for pts presenting with many hours of STEMI?

A

1st = PCI = benefit up to 12 hrs from onset sx and possibly even longer

no benefit for thrombolytic therapy more than 12 hrs after sx onset = 2nd line

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25
Q

What are the sx of postinfarct VSD?

A

new holosystolic murmur at L sternal border, acute resp distress, thrill

–> leads to cardiogenic shock from acute volume overload to R ventricle

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26
Q

What are sx of LV free wall rupture postinfarct?

A

hemopericardium w/ electromechanical dissociation and death

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27
Q

What is first line tx for pt with ACS?

A

dual antiplatelet (ASA + tienopyridine [clopidogrel]), B Blocker, nitrates, heparin

morphine if active CP
if BBlocker CI –> CCB [not nifedipine]

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28
Q

What are sx of sixk sinus syndomre?

A

episodes of sinus bradycarida with dizziness

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29
Q

What do you see on KEG with LBBB?

A

absent Q waves in leads 1, aVL, V6
large wide positive R in leads 1, aVL, V6
prolonged QRS to > 0.12 s

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30
Q

What is the acute treatment for AFib if hemodynamically stable?

A 
rate control = 
IV BBlocker (metoprolol, esmolol) or CB (diltiazem, verapamil)
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31
Q

When do you do cardioversion for AFib?

A

adverse hemodynamic status of acute coronary ischemia 2/2 afib

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32
Q

What do you see on EKG with atrial flutter?

A

saw tooth pattern, regularly irregular, 2:1 AV conduction = typical

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33
Q

Who is at risk for multifocal atrial tachycardia?

A

acutely ill pts in setitng of pulm dz (COPD, electrolyte abnormalities)

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34
Q

What is EKG in MAT?

A

presence of at least 3 different P wave morphologies with varying P-R intervals

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35
Q

What is EKG of AVNRT?

A

RP interval so short that P wave buried in QRS, narrow QRS

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36
Q

What is the treatment for atrial tachycardia?

A

B blocekrs and CCB (verapamil/diltiazem)

  • adenosine/cardioversion not very effective
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37
Q

What is treatment for AVNRT?

A

IV adenosine

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38
Q

What is treatment for AVRT?

A

if narrow QRS –> adenosine

if wide complex –> 2/2 accessory path, don’t use AV node blocking drugs –> procainamide

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39
Q

What is treatment for MAT?

A

treat underlying pulm disease, discontinue B agonists

if doesnt resolve, give metoprolol or high dose MG

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40
Q

What is treatment for HCM if risk factors for sudden death?

A

implantable cardioverter-defibrillator

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41
Q

What is treatment for ventricular tachycardia?

A

if stable –> amiodarone [or procainamide or sotalol]

if unstable –> cardioversion

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42
Q

What is the treatment for suppression of premature ventricular complexes?

A

B blockers (metoprolol) if symptomatic

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43
Q

Who should get spironolactone in heart faulire?

A

class III-IV symptoms, serum K

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44
Q

What are some factors that increase and decrease BNP?

A

increase: ventricular wall stress, kidney failure, older age, F
decrease: obesity

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45
Q

What are some clinical situations in which BNP is elevated?

A

CHF exacerbation, PE, acute MI, acute tachycardia

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46
Q

When should you do coronary angiography to evaluate new HF?

A

angina or new onset LV dysfunction in the setting of risks for silent ischemia (ex. DM)

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47
Q

What meds should everyone wtih HF get?

A

B Blocker, ACEI

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48
Q

What meds should you give to patient with HF with preserved EF?

A

CCB or BBlocker AND
ARBs (candesartan) or ACEI

avoid nitrates and nondihydropyridine CCBs b/c decrease preload/filling even further

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49
Q

What is optimal medical therapy for severe systolic HF?

A

ACE inhibitor + BB + spironolactone

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50
Q

When is cardiac resynchronization indicated in pt with HF?

A

persisitnet moderate to severe sx despite optimal medical therapy and QRS > 120

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51
Q

What med should you give a patient with resistant htn and HF receiving optimal lisinopril/carvedilol/chlorthalidone?

A

add 2nd gen dihydropyridine CCB (amlodipine)

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52
Q

What does it mean if a murmur increases in intensity with inspiration?

A

R sided murmur

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53
Q

What type of murmur is seen with aortic regurg?

A

soft blowing diastolic murmur best at 3rd L or 2nd R intercostal space
does no radiate
best leaning fwd in end-expiration

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54
Q

When is echo indicated for a murmur?

A
  • grade 3+
  • diastolic or holosystolic or late systolic, or with ejection click
  • radiation to back
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55
Q

What is treatment for patients with severe aortic stenosis?

A

surgical aortic valve replacement

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56
Q

What murmur is diastolic with opening snap, accentuated wtih atrial contraction. loud S1, variable S2?

A

mitral stenosis

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57
Q

What murmur is associated wtih wide pulse pressure?

A

aortic regurg

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58
Q

What systolic murmur presents with click? Where does it radiate? what happens with valsalva/standing?

A

mitral valve prolapse

radiates to axilla

click-murmur moves closer to S1 with valsalva/standing

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59
Q

What is the tx of choice for fibromuscular dysplasia?

A

revascularization with kidney angioplasty

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60
Q

What is goal for bridging/INR for DVT anticoagulation?

A

5 days LMWH until INR 2 for more than 24 hours

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61
Q

What is initial treatment for acute DVT in pt with kidney disease?

A

IV unfractionated heparin (don’t use LMWH)

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62
Q

What is the next diagnostic step in patient with low probability of DVT?

A

D Dimer to exclude DVT

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63
Q

What is wells score?

A

1 point each for: cancer, paralysis, immobilization or surgery, tenderness along deep veins, sweelnig of leg, calf circumference differential of 3, pitting edema, collateral superficial veins, -2 pts for clinical suspicion that another dx is likely

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64
Q

What happens to lung volumes, PFTs in respiratory muscle weakness?

A

restrictive pattern –> decreased TLC, but with increased RV b/c unable to exhale fully
decreased FEV1 and FVC, but preserved ratio

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65
Q

What etiology of chronic dyspnea in setting of hx of multiple intubations? What is next diagnostic step?

A

at risk for tracheolmalacia or tracheal stenosis

dx by PFTs = see flattening of curve on insp/exp

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66
Q

What does it mean if jugular vein distends/fills during inspiration?

A

kussmaul sign = suspicious for constrictive pericarditis

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67
Q

What do you see on echo in constrictive pericarditis?

A

restrictive filling and ventricular itnerdependence (diastolic filling of one V impedes the other = to and fro diastolic motion of ventricular septum)

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68
Q

What are characteristics of pleural effusions associated w/ malignancies?

A

exudative, predominantly lymphocytes, unilateral

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69
Q

When do you tap a parapneumonic effusion?

A

only if complicated (empyema)–> do chest tube

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70
Q

What kind of pleural effusion in PE?

A

exudative, small and unilateral

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71
Q

How do you distinguish lobar consolidation vs pleural effusion on physical exam?

A

both have decreased breath sounds, only decreased tactile fremitus with effusion, consolidation will have increased fremitus

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72
Q

When should you order a1 antitrypsin levels in pt with COPD?

A
  • dx younger than 45
  • non-smoker
  • predominantly basilar lung disease
  • concurrent liver disease
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73
Q

When is O2 therapy indicated in COPD?

A
  • arterial PO2
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74
Q

What are indications for admission in COPD exacerbation?

A
  • severe disease
  • advanced age
  • significant comorbidities
  • marked increase in intesnity of sx
  • newly occuring arrhythmias
  • diagnositc uncertainty
  • insufficient home support
  • onsent new physical sx
  • poor response to inital medical management
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75
Q

When should you give noninvasive positive pressure ventilation in COPD (BIPAP/CPAP)? when intubate?

A

acute hypercapnic resp failure, acidosis, RR> 25

intubate if RR> 35

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76
Q

How do you dx OSA?

A

polysomnography

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77
Q

What is first line treatment for OSA?

A

CPAP

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78
Q

What diagnosis should you think of when pt presents with CAP sx but does not improve with treatment?

A

cryptogenic organiziaing pneumonitis

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79
Q

What 3 ILDs are known to be in basal lobes?

A

IPF
asbestos
NSIP

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80
Q

What 3 ILDs are known to go to upper lobes?

A

hypersensitivity pneumonitis
sarcoid
silicosis

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81
Q

When do you do ventilation perfusion scan vs CTA for pulm embolism?

A

ventilation perfusion in kidney failure or other contraindication to contrast CTA

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82
Q

What is next step if you suspect diverticulitis? What tests should you avoid?

A

if uncomplicated –> start PO abx if can tolerate oral intake (cipro + metronidazole for anaerobes + gram neg rods)

if complicated –> surgery

avoidcolonoscopy and barium enema 2/2 risk of perforation

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83
Q

What are the 3 classic findings in chronic pancreatitis?

A

abdominal pain (mid-epigastric), postprandial diarrhea, DM 2/2 pancreatic endocrine insufficiency

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84
Q

What is next step for confirming dx of GERD in pt that fails to respond to PPIs?

A

gold standard dx = 24 hr esophageal pH impedance monitoring

85
Q

What is the next dx step if suspect HCC on US?

A

triple phase contrast enhanced CT or gadolinium enhanced MRI of abdomen

[no need for bx, radiologic criteria are specific]

86
Q

What is DASH diet? What is effect of DASH diet on BP?

A

diet high in fruits + veggies, low is sat fat and total fat

SBP down by 8-14

87
Q

What is effect of wt loss on BP?

A

5-20 SBP per 10kg loss

88
Q

In order which are most effective at decreasing BP?

wt loss, alcohol, dietary Na, DASH, exercise

A

wt loss > DASH > exercise > dietary Na > alcohol

89
Q

What are the most common tumors to met to liver?

A

GI tract, lung, breast

90
Q

What is the geo location of blastomycosis?

A

great lakes, Mississippi and ohio river basins

91
Q

What are sx of systemic blastomycosis?

A

ulcerated skin lesions, lytic bone lesions, pulm/cxr findings similar to TB/histo

92
Q

How do you dx blasto?

A

broad based budding yeast in sputum

93
Q

What is treatment of systemic blasto?

A

itraconazole or amphotericin b

94
Q

What are sx of systemic coccidioidomycosis?

A

fever, cough, night sweats, extrapulm manifestations –> skin,meninges, skeleton

95
Q

What is location of coccidiomycosis?

A

southwestern US

96
Q

What is best dx test for HCC?

A

triple phase contrast CT

97
Q

What is the definition of hepatorenal syndrome?

A

development of kidney failure in patients with portal hypertension and normal renal tubular function

presents w/ AKI, increased renal Na avidity, normal urine sediment, and sometimes oliguria

98
Q

What is the treatment for large esophageal varices (>5mm)?

A

use nonselective B Blocker

if CI, do endoscopic variceal band ligation

as PPX to prevent hemorrhage

99
Q

What is the indication for TIPS?

A

recurrent or refractory variceal hemorrhage

100
Q

What is the next step if you find asymptomatic gallstones?

A

observation

101
Q

What is the next step if you suspect cholecystitis?

A

ultrasound

102
Q

What do you see on US with cholecystitis?

A

pericholecystic fluid, thickened gallbladder wall 3-4 mm

103
Q

What do you see in acute cholecystitis on HIDA scan?

A

non visualization of gallbladder

104
Q

When is ERCP indicated?

A
  • remove stones/help drainage in pts with cholangitis or with gallstone pancreatitis complicated by cholangitis
105
Q

What are poor prognostic factors in acute pancreatitis?

A

hemo-concentration –> elevated BUN, cr, hematocrit

106
Q

What is next step if find asymptomatic pancreatic pseudocyst after acute pancreatitis?

A

if asymptomatic, no further testing, will resolve on its own in ~ 4 wks

drain only if pain/fever/anorexia

107
Q

What is the tx for severe or relapsed CDiff?

A

oral vanco OR oral vanco + IV metro

108
Q

What is tx for CDiff with ileus or obstruction?

A

vancomycin per rectum combined with oral vancomycin and intravenous metro

109
Q

What is a late complication of gastric bypass?

A

SIBO –> diarrhea, bloating, and features of malabsorption

110
Q

What are alarm sx that should make you work up chronic diarrhea rather than just assuming its IBS?

A

weight loss, anemia, fever, chronic severe diarrhea, family history of gastrointestinal disease

111
Q

What is treatment for IBS?

A

supportive, can give anti-spasmodic

112
Q

What are recommendations for colonoscopy in UC?

A

disease extending beyond the rectum should undergo routine surveillance colonoscopy with biopsies every 1 to 2 years beginning 8 to 10 years after diagnosis.

113
Q

What medical treatment should you give to patient w/ acute UGI bleed from ulcer?

A

proton pump inhibitors can decrease the potential need for intervention during upper endoscopy and can reduce the risk of recurrent hemorrhage (omeprazole, pantoprazole, etc)

114
Q

What is the MCC obscure small intestine bleeding in elderly?

A

angiectasia

115
Q

When should you work up rectal bleeding further that you suspect is from hemorrhoids?

A
  • if > 40 with typical hemorrhoidal symptoms but at low risk for colon cancer, do colonoscopy or at least sigmoidoscopy
  • if > 50 do colonoscopy
116
Q

MCC severe hematochezia?

A

bleeding from colon –> diverticulosis

117
Q

What are symptoms/ findings in exogenous glucocorticoid induced 2ndary adrenal insufficiency?

A

N/V/ab pain, hypotension, hypoNa, +/- hypoK

118
Q

What should you do if pt with well controlled hypothyroid becomes pregnant?

A

increase levothyroxine by ~30% with goal TSH 0.1-2.5

119
Q

What is next step if TSH greater than the reference range, with serum free thyroxine (T4) level in the reference range and only mild fatigue?

A

subclinical hypothyroid
repeat testing of thyroid function in 6 mo

unless: marked symptoms, goiter, pregnant, TSH > 10

120
Q

What is acute treatment for hyperthyroid?

A

β-blocker and methimazole (or PTU)

121
Q

What tests should you do when someone presents with adrenal incidentaloma?

A
  • o/n dexamethasone suppression
  • 24 hr urine metanephrines
  • measure plasma renin and aldosterone [if hypertension or hypokalemia]
122
Q

What signs of hyper and hypo cortisol do you look for to decide if you need to change dose of steroids in person w/ adrenal insufficiency?

A

increase dose if hypo = N/V, malaise, hypotension, wt loss, hypo Na, hypoglycemia

decrease dose if hyper = cushing = wt gain, hyperglycemia, htn, striae, ab fat

123
Q

What clinical characteristics distinguish cushing disease from other causes of cushing syndrome?

A

hyperpigmentation = in cushing disease b/c of high ACTH

vs no hyperpigmentation if primary hypercortisolism

124
Q

What are symptoms of carcinoid syndrome?

A

episodes of flushing lasting up to 30 min, accompanies by fall in BP and rise in HR

125
Q

What are screening recommendations for DM1?

A

fasting lipid panel after puberty or at dx if dx is after puberty

  • nephropathy screening > 5 yrs after dx
  • dilated fundoscopic exam > 3-5 years after dx
126
Q

When do you need to repeat testing in DM diagnosis?

A

dx must be confirmed on subsequent day by repeating the same test suggestive of DM

if results of 2 different dx tests available and both diagnostic for DM, additional testing is not needed

127
Q

What electrolyte abnormalities in DKA?

A
  • hyperosmolar
  • hyponatremia
  • hyperkalemia (although total body K is low, as give insulin shifts into cells –> hypokalemia)
128
Q

is hyperK associated with acidosis or alkalosis?

A

acidosis

129
Q

What type of insulin should you give in pt with hyperglycemic emergency?

A

regular insulin by IV infusion [b/c immediate onset of action]

130
Q

What is the most appropriate tx for pt with osteoporisis and GERD?

A

IV bisphosphonate (zoledronic acid) [vs oral = alendronate, risedronate] b/c of risk of esophagitis

131
Q

What are screening recommendations for lung cancer?

A

low-dose spiral chest CT scans for 55 to 79 yo with >30-pack-year history as current smokers or quit in past 15 years.

132
Q

What is the treatment for ER+ DCIS?

A

breast-conserving treatment (lumpectomy plus radiation therapy) or mastectomy followed by tamoxifen therapy for 5 years.

133
Q

What is next step if pt has 1/6 FOBT test positive?

A

colonoscopy now

134
Q

What are colonoscopy recs for patients with a relative with colorectal carcinoma?

A

if fam member w/ ca

135
Q

What is f/u treatment for completely resected colorectal ca?

A

adjuvant chemo (not radiation)

136
Q

If ascus with positive HPV dna what is next step?

A

colposcopy

137
Q

What is next step if find nodule/asymmetry on transrectal prostate exam?

A

do biopsy even if normal PSA

138
Q

What is the treatment for metastatic prostate cancer?

A

androgen deprivation therapy [GnRH agonists or bilateral orchiectomy]

139
Q

What is follow up for pts in remission from prostate cancer?

A

serial digital rectal examinations and serum PSA measurement every 6 to 12 months.

140
Q

What is treatment for early stage diffuse large B cell NHL?

A

chemotherapy and rituximab followed by radiation

141
Q

What is the next step when a pt presents with SVC syndrome?

A

mediastinoscopy and biopsy to confirm what type of cancer before treating

142
Q

What is pathogenesis/tx of warm autoimmune hemolytic anemia?

A

IgG antibodies against RBCs, at warm temps

  • facilitate destruction by splenic macrophages.
  • dx by direct antiglobulin (Coombs) test
  • see Spherocytes are seen on the peripheral blood smear

tx: Glucocorticoids

143
Q

What are sx of ITP? how do you dx?

A

sx: asx OR petechiae/echymoses
dx: platelets often

144
Q

What are diagnostic criteria of MGUS?

A

IgG spike

145
Q

What are the two lab tests necessary for diagnosing multiple myeloma?

A
  • serum protein electrophoresis
  • urine protein electrophoresis

combined with immunofixation for whichever is positive for a monoclonal protein to confirm what it is

146
Q

What should you work up if pt presents with first unprovoked DVT?

A

make sure patient’s age- and sex-appropriate cancer screening is up to date.

147
Q

When should you work up a pt for inherited thrombophilia with VTE?

A
  • avoid during acute phase of VTE or while on anticoagulation
  • do it 2 wks after stop anticoagulation
148
Q

What are recommendations for anticoagulation w/ antiphospholipid syndrome?

A

life long anticoagulation to prevent DVT

149
Q

what special type of blood products for pt with IgA deficiency to prevent anaphylaxis?

A

washed RBCs and platelets

150
Q

WHat is the universal donor blood?

A

O negative

151
Q

What is presentation of adult onset stills disease?

A

daily fever, evanescent salmon-colored rash, arthritis, and markedly elevated serum ferritin

152
Q

What is presentation of patellofemoral pain syndrome?

A

anterior knee pain that is made worse with prolonged sitting and with going up and down stairs

153
Q

What findings suggest meniscal tear on exam?

A
  • pain along the joint line is 76% sensitive
  • audible pop/snap on McMurray test is 97% specific (Maximally flexing the hip and knee and applying abduction (valgus) force to the knee while externally rotating the foot and passively extending the knee)
154
Q

what kind of knee injury presents w/

  • pain along anteromedial proximal tibia distal to the joint line of the knee
  • worse w/ climbing stairs
  • worse at night
A

pes anserine bursitis

path: pt w/ osteoarthritis or from overuse

155
Q

What is presentation of rotator cuff impingement? specific test?

A

pain w/ abduction, no decrease ROM

  • Hawkins test: quickly internally rotate pt’s arm, assess for pain
156
Q

What is next step if suspect rotator cuff tear?

A
  • get MRI

if complete –> surgery
if incomplete –> physical therapy

157
Q

What is next step for pt w/ OA who has pain in one or a few joints that is disproportionately painful to other joints?

A
  • intra-articular glucocorticoid injection to decrease pain and improve function
158
Q

What are criteria for OA?

A

meet 3 of the following:

  • age greater than 50 years
  • stiffness lasting less than 30 minutes
  • crepitus
  • bone tenderness
  • bone enlargement
  • no palpable warmth
159
Q

What is likely dx if xray shows joint space narrowing w/ osteophytes and cartilaginous calcification, negative RF?

A

Calcium pyrophosphate dihydrate deposition disease = osteoarthritis-like arthritis in atypical joints, such as the metacarpophalangeal joints, along with the presence of chondrocalcinosis.

160
Q

What is mnemonic for the 11 characteristics of SLE (4 required to make dx)?

A

MD SOAP BRAIN

  • Malar
  • Discoid
  • Serositis
  • Orla ulcer
  • Arthritis
  • Photosensitivity
  • Blood –> los Plt, anemia
  • Renal failure
  • ANA
  • immuno
  • Neuro
161
Q

What is next step if pt’s RA is not well controlled on methotrexate?

A

add a TNFa inhibitor [etanercept, infliximab, adalimumab]

162
Q

What is tx for pt with SLE and early lupus nephritis?

A

high dose steroid

163
Q

What are earliest imaging findings in ankylosing spondylitis?

A

MRI changes in sacroiliac joints before XR changes

164
Q

What is tx for raynaud?

A

dihydropyridine calcium channel blocker [amlodipine, nifedipine]

165
Q

What is tx for fibromyalgia?

A

1st = lifestyle: regular aerobic exercise, CBT

SNRI (duloxetine and milnacipran), TCA, pregabalin

166
Q

What is next step if pt w/ isolated proteinuria?

A

split urine collection –> split urine collection during day vs night, if orthostatic proteinuria will have high protein during day not night

167
Q

What is the tx for rhabdo?

A

IV NS

168
Q

What are presenting sx of rhabdo?

A

serum creatine kinase level above 5000 U/L

blood on urine dipstick in absence significant hematuria.

169
Q

What are complications of rhabdo?

A

hypocalcemia, hyperphosphatemia, hyperuricemia, metabolic acidosis, acute muscle compartment syndrome, and limb ischemia

170
Q

What lab values in refeeding syndrome?

A

intracellular shift of phosphorus –> cells previously starved now stimulated to grow, consume phosphorous for ATP

171
Q

What type of RTA characterized by normal AG, low K, urine pH > 6.0?

A

RTA type 1 (distal)

172
Q

What are some etiologies of RTA type 1?

A

Sjögren syndrome, systemic lupus erythematosus, or rheumatoid arthritis; drugs such as lithium or amphotericin B; hypercalciuria; and hyperglobulinemia.

173
Q

What lab abnormality in gitelman?

A

inactivating mutations in the gene for the thiazide-sensitive sodium chloride cotransporter

hypokalemic metabolic alkalosis

174
Q

What lab values in RTA type 2?

A

normal AG met acidosis, low K, glucose in urine in setting of a normal BG, low-molecular-weight proteinuria, phosphate wasting, Uph

175
Q

What is next step if pt w/ metabolic alkalosis?

A

get urine chloride

if volume responsive 2/2 dehydration/emesis
if > 10 –> volume non-responsive –> then if htn think hyperaldo

176
Q

What is next step if someone w/ recurent Ca oxalate stones and hyperoxaluria

A
  • decrease foods w/ oxalate –> low protein

- increased Calcium intake

177
Q

When do you use hctz for ca oxalate stones?

A

if hypercalciuria

178
Q

What is the corresponding increase in disease probability with a +LR of 2, 5, or 10?

A

15%, 30%, and 45%, respectively

179
Q

What is the corresponding decrease in disease probability w/ a -LR of 0.5, 0.2, 0.1?

A

15%, 30%, and 45%, respectively

180
Q

What are hypertension drugs of choice in pergnancy?

A

labetolol, hydralazine

181
Q

What is definition of metabolic syndrome?

A

3 of the following 5:

(1) waist circumference >40 in M and >35 in F
(2) SBP≥130 DBP ≥85
(3) HDL

182
Q

What test if you suspect vertebral fracture?

A

plain XR film

183
Q

What initial imaging test to diagnose ankylosing spondylitis?

A

AP xray of the pelvis to view sacroiliac joints and the hips.

184
Q

What is the tx for upper airway cough syndrome?

A

first gen antihistamine (like diphenhydramine) and a decongestant

185
Q

What are sx of upper airway cough syndrome?

A

cough, nasal discharge, sesnation of postnasal drip, frequent throat clearing, cobblestoning of posterior pharyngeal mucosa

186
Q

What is next step in pt w/ hemoptysis and hx of smoking?

A

get CXR –> then chest CT and fiberoptic bronchoscopy even if radiograph is negative

187
Q

Which pts w/ influenza should get oseltamavir/zanamivir?

A
  • within first 2 days of sx
  • hospitalized pts w/ influenza
  • severe complicated illness
  • CKD, cardiovascular risk, active cacner, liver dz, hemoglobinopathies, immune compromise
188
Q

What meds can you give w/ pt trying to quit smoking to prevent weight gain?

A

burpoprion

189
Q

What is next step if pt w/ depression on SSRI for 8 wks and no response?

A
  • switch to different antidepressant in same or different class
  • add a second agent [usually do this after has 2 failed trials of medication monotherapy]
  • do psychotherapy
190
Q

What is tx for cocaine associated chest pain?

A

CCB and benzo

191
Q

What is tx for pt w/ menorrhagia 2/2 fibroids?

A
  • medroxyprogesterone acetate for 10-21 days

- or can use monophasic oral contraception 4x day for 5-7 days then daily for 3 wks

192
Q

What is next step if pt with syncope w/ no diagnosis after using 30 day loop recorder?

A

implantable loop recorder –> lasts ~ 3 yrs

193
Q

What is the biggest risk factor for pt w/ lymphadenopathy to be pathologic?

A

age > 40

194
Q

What are risks for pathologic etiology of lymphadenopathy?

A

age > 40
sustained over > 2wks
size > 2cm

195
Q

What is presentation of open angle glaucoma?

A

painless, gradual loss of peripheral vision in both eyes,
often asymmetric
clinical: increased optic cup to disc ratio (>0.5), disc hemorrhages, and vertical extension of the central cup

196
Q

What is presentation of dry macular degeneration?

A 
soft drusen (deposits of extracellular material) form in the area of the macula
gradual loss of central vision
197
Q

What is presentation of wet macular degeneration?

A

neovascularization of the macula with subsequent bleeding or scar formation. Visual loss may be more sudden (over a period of weeks) and is often more severe.

198
Q

How do cataracts present? risk factors?

A

risks: older age, ultraviolet B radiation exposure, smoking, diabetes mellitus, a family history of cataracts, and systemic corticosteroid use.
present: difficulty with night vision.

199
Q

What is the tx for acute urticaria?

A

H1 antihistamines (ceterizine)

200
Q

What is preferred therapy for episodic tension HA?

A

NSAIDS

201
Q

What is preferred imaging for dx subacute or chronic HA?

A

MRI (vs CT)

202
Q

What is tx for carpal tunnel?

A

wrist splinting

203
Q

What is tx of drug induced dystonia?

A

benzo, anticholonergic (diphenhydramine), or botulinum toxin shot

204
Q

What is tx for essential tremor

A

lifestyl mod: getting enough sleep and reduction of caffeine

if that doesnt work start propanolol

205
Q

What is next step in dx if pt w/ suspected MS but neuroimaging inconclusive?

A

LP –> oligoclonal bands or elevation of the IgG index

206
Q

When should you do valve replacement in infective endocarditis?

A

heart failure; abscess or fistula formation; severe left-sided valvular regurgitation; refractory infection despite appropriate antibiotic therapy; or recurrent embolic events, especially with residual vegetation larger than 1.0 cm

207
Q

WHat is presentation? mcc? tx? of acute epidydimitis?

A

unilateral pain and tenderness in the epididymis and testis, spermatic cord is enlarged and tender on palpation

mcc = chlamydia, can also be 2/2 gonorrhea
tx: ceftriaxone and doxycycline (or azithromycin)

208
Q

How do you differentiate reactive arthritis from gonococcal arthritis?

A

reactive; symmetric, HLA B27, rash on palms and soles, conjunctivitis, urethritis, oral ulcers, balantitis

goococcal: asymmetric, migratory, tenosynovitis, skin lesions = vesico/pustules

medicine Clerkship (4 decks)

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