ITE 2018 Flashcards
What lessens the severity of OSA and reduces blood pressure and offers further benefit beyond that of traditional diuretics?
Aldosterone antagonist (Spironolactone). Resistant hypertension is common in OSA and is associated with higher levels of aldosterone, which can lead to secondary pharyngeal edema, increasing airway obstruction.
What is hypertensive emergency?
SBP >180 or DBP >110 with end organ damage.
symptomatic HCM, what drug to use?
BB. If they are unable to tolerate BB, use verapmil.
HTN medications in AA
Use Thiazides and CCB
Murmur increases with Valsalva
Think HCM
What needs to be considered when starting or adjusting the dosage of novel anticoagulants (NOACs)?
Renal Function novel anticoagulants include apixaban (eliquis), dabigatran (Pradaxa), edoxaban (Savaysa) and rivaroxaban (Xarelto).
What is used to adjust warfarin dosing and what is used to adjust heparin dosing?
INR for warfarin PTT for heparin
What should be initiated in patients with DM, HTN and microalbuminuria?
Ace inhibitors for renal protection Reduce decline in renal function.
In patients with marfan’s what would the cardiac examination reveal? What occurs in 80-100% of affected individuals
aortic regurgitation murmur or a murmur of mitral valve prolapse. Aortic root dilation
What should be obtained in patients presenting with acute atrial fibrillation?
TSH level Patients with hyperthyroidism have threefold risk of developing AFIB.
In patients undergoing or vascular or high risk surgeries such as joint replacement, what is recommended to decrease risk of CVD and perioperative mortality?
statins
The use of gadolinium contrast has been associated with? In what types of patients should we avoid this with?
development of nephrogenic systemic sclerosis. Avoid in patients with GFR <30, as well as patients with renal failure.
What is the most appropriate pharmacological therapy for anticoagulation in pregnant patients?
Enoxaparin (lovenox)
What antihypertensive drug may reduce the severity of sleep apnea?
Spironolactone OSA causes resistant HTN, which is associated with higher levels of aldosterone, which can lead to secondary pharyngeal edema, increasing airway obstruction.
In patients who with HTN that do not have DM, therapy may be started with?
ACEI, Thiazide, Diuretics, or CCB.
What is the preferred test to confirm legionnaire’s disease? What is the gold standard?
Urine test for legionella pneumophilia antigen. Rapid test. Gold standard is sputum cx. Takes 48-72 hours.
What should be avoided in patients with IBS?
Lactulose -Osmotic laxative, it should be avoided in patients with IBS because it is broken down by colonic flora and produces excessive gas.
What is FDA approved for short term treatment in adults and children with occasional constipation and in patients with IBS?
Polyethylene glycol (Miralax), a long-chain polymer of ethylene oxide, is a large molecule that causes water to be retained in the colon, which softens the stool and increases the number of bowel movement.
Test of choice for patients in patients with suspected distal biceps tendon rupture?
MRI
For DM patients, what is the goal HbA1c goal? What is recommended first line as long as there are no contradictions? What if goal is not met or HbA1c is > or = to 9?
7 Metformin Add another agent to metformin.
How do you recognize nephrotic syndrome?
peripheral edema, heavy proteinuria, and hypoalbuminemia, Hyperlipidemia
How do you diagnosis nephrotic syndrome?
protein/cr ratio >3.0-3.5mg OR 24 hour urine collection showing >3.0-3.5 of protein.
IV versus IM versus PO immediate release opioids peak time
morphine, oxycodone, hydromoprhine Oral takes one hour IV takes 10 minutes IM takes 20 mins
What is the only proven therapy for pulmonary hypertension related to COPD patients?
Supplemental oxygen Supplemental oxygen should be recommended when the PaO2 is <60 mmHg, because it has been shown to improve mortality by lowering pulmonary arterial pressures. Do not use PAH drugs such as nifedipine, sildenafil, bosentan because they cause V/Q mismatch.
NNT versus ARR
NNT = the number of people who wound need to receive an intervention in order for one person to benefit. It is the inverse of absolute risk reduction which is the difference in risk for a disease without and with an intervention. NNT = 1/ARR.
What is recommended as the first line medication for women diagnosed with PCOS who are experiencing irregular menses, acne and hirsutism who do not desire pregnancy? What about those who want to become pregnant
OCP Letrozole or clomiphene for those who want to become pregnant.
Treatment for Rocky Mountain Spotted fever
doxycycline is the only approved medication for RMSF for all ages, including children less than 8 years of age.
Symptoms or RMSF?
if you become ill after having been bitten by a tick or having been in the woods or in areas with high brush where ticks commonly live. •Fever •Headache •Rash •Nausea •Vomiting •Stomach pain •Muscle pain •Lack of appetite Rash is a common sign in people who are sick with RMSF. Rash usually develops 2-4 days after fever begins. Rash varies. Some rashes can look like red splotches and some look like pinpoint dots. While almost all patients with RMSF will develop a rash, it often does not appear early in illness, which can make RMSF difficult to diagnose.
What should be used as first line for patients with Type 2 DM? What is considered second line choice for patients who are intolerant of this mediation?
Empagliflozin, an SGLT2 inhibitor.
If a school personnel suspect that a child has head lice, what is the management?
The child should remain in class and should not be treated unless there is a clear diagnosis and live lice are seen.
What factors can increase hb A1c value?
Conditions that decrease erythropoiesis, such as iron deficiency anemia, increase the mean age of the RBC, thereby increasing hbA1c. Severe chronic kidney disease increase RBC glycation through lipid peroxidase of hemoglobin and by extending the erythrocyte lifespan due to decreased erythropoietin levels.
What factors can falsely lower the Hb A1c value in a patient with Type 2 DM?
Hemolytic Anemia Erythryocyte lifespan is decreased by conditions such as hemolytic anemia, HbA1c is decreased because of reduced RBC exposure time for glycation.
Patient has intermittent asthma that has become at moderate persistent. What medication do you need to add to her albuterol (Proventil, Ventolin) inhaler?
Moderate dose inhaled corticosteroid with a long acting bronchodilator such as Fluticasone/salmeterol (Advair)
Two most common causes for neonatal sepsis
Group B strep and E.coli
Screening for MDD in adolescents at what age?
12-18 years of age.
What is the most common cause of tinnitus?
sensorineural hearing loss
Patient comes into your office with this?
Pearly penile papules. Present as small skin colored, dome shaped papules in a circular pattern around the coronal sulcus.
Patient comes in with this?
Appear solely on the glands of the penis, but are also found on the scrotum, abdomen, thighs, groin and extremity. Treatment not necessary unless lesions are bleeding or extensive. **Angiokeratomas on the shaft of the penis, the suprapubic region or sacral region can be associated with fabry disease. Patients with this finding should be promptly referred.
Patient with a smooth circular area of complete hair loss on her scalp with no other skin changes
Alopecia areata Chronic, relapsing, immune-mediated inflammatory disorder affecting hair follicles that results in patchy hair loss. Treatment of choice is intralesional corticosteroid injections.
Patient sees you after injurying his right index finger while playing volleyball. He has pain and flexion defmority at the DIP joint.
What would be an indication for further evaluation before splinting?
Patient is unable to passively fully extend the joint.
Mallet finger, injury to the distal exsor tendor of the finger at the DIP, cuased by forceful flexion of the extended DIP joint.
The iniabilty to passively extend the DIP joint completely may be an indcation of trapped soft tissue or bone that may require surgery.
Pneumococcal vaccine timing for adults
Bells palsy versus stroke
A stroke is caused by a blood clot that stops blood flow to the brain or by a blood vessel that ruptures in the brain, while Bell’s palsy is linked to facial nerve damage.
The eyes and forehead receive innervation from both hemispheres, while the lower face only receives innervation from the contralateral hemisphere.
Acute ischemic strokes will result in contralateral facial weakness of the lower face only, with preservation of the muscles of the upper face on both sides, due to the dual innervation of the upper face. Patients will have a weak smile, but will be able to close their eye tightly and wrinkle their forehead symmetrically.
Lesions that damage the facial nerve in the brainstem, or after it exits the brainstem, result in ipsilateral facial weakness involving both the upper and lower face. It doesn’t matter where the innervation is coming from; if the nerve is damaged, all the muscles on that side of the face are weak. These lesions are referred to as “peripheral lesions” because they affect the facial nerve as it exits the brainstem. Patients will be unable to wrinkle their forehead, tightly close their eye, or smile on the affected side.
Plantar fasciitis clinical and physical findings
Most common cause of heel pain.
Throbbing heel pain that is worst in the mornings with the first step after rest. Palpation of the medial calcaneal tuberosity and dorsiflexion of the affected foot will elicit sharp pain.
Heel spurs are present in approx 50% of patients iwth plantar fasciitis, but can also be found in people without plantar fascitits.
Nonerythematous flesh colored dome shaped paupules with central indentation on the lower back and popliteal fossa
Molluscum contagiosum
Poxvirus
What findings would be most suggesitive for cerebral palsy
cross-legged posturing, neck stiffness, hyperreflexia, suggest a central cause of motor delay such as cerebral palsy.
