ITE 2020 Flashcards
NH resident tests positive for flu. How do you manage all the other residents?
All aysx residents should get chemoprophylaxis
Only do it if there are two lab confirmed cases on the unit
How do you decide if you should tx for PID?
If there is enough of a clinical suspicion
Don’t wait for testing
Exam: CMT, uterine tenderness
Often WBCs on wet mount
only need TVUS if you are concerned for tubo-ovarian abscess
Gender affirming tx for F to M
testosterone
FTT pt, while checking BP you see capo pedal spasms. What electrolyte disturbance?
HypoCalcemia
Trousseau sign - spasmodic contraction of muscles caused by pressure on the nerves that control them
Hypercalcemia would present with
Hyperrreflexia
Pt with non Hodgkins lymphoma presents with SOB and CXR shows large mass around SVC. Now what?
This is SVC syndrome
Seen in lung CA and lymphoma
Admit pt to hospital and start steroids, chemo, radiation
NOT Bronchoscopy
Most likely complication of HIT
Thrombosis (NOT BLEEDING OR DIC!)
This is different than other causes of thrombocytopenia
DVT and PE are most common
Tx - stop heparin, start argatroban/danaparoid/fondaparinux/bivalirudin (non heparin AC)
Class I HF
heart dz with no syx or limitations in activity
Class II HF
Mild syx with normal physical activity
Clas III HF
Significant limitation of activity incl symptoms with less than normal activities
Class IV HF
Syx at rest, unable to carry on activity w/o discomfort
pt presents for her 2nd bartholian abscess. Tx?
marsupialization - doesn’t matter how long ago the last one was
IBD syx with perianal fistual
Crohn’s
UC doesn’t NOT have perianal lesions
abortive migraine tx in pregnancy
Tyl
Reglan
NOT Triptan (not safe after 1st trimester) or Dihydroergotomine (too similar to oxytocin)
Longest acting insulin
Tresiba
42 h
what is an instrumental ADL
Activities necessary to live independently (telephone, doing housework, preparing meals, taking meds, finances)
others are self are ADLs and don’t require independent living
significant risk of anorexia that is regulated by HPA axis?
Bone loss
ways to remove impacted cerumen
irrigate with warm water
or carbide peroxide ear drops
young patient has pain of finger x days. No injury. erythema on tip of affected finger w/ several vesicles that have an opaque fluid. Distal digest pup is soft but tender. Dx and Tx
Herpetic whitlow - HSV
self-limited
tx - pain control and dressings to prevent spread
fluid filled bump on distal surface of distal finger
Digital mucos cyst (aka cutaneous myxoid cyst)
when should pts be on ASA?
If + h/o CVA or MI
Otherwise, it should be stopped. Even if ACSVD >10%
what med can give false + for amphetamines?
bupropion
labetalol
ranitidine
trazodone
false positive for opioids
levofloxacin
false positive for cannabinoids
PPIs
False positive for benzos
Sertraline
When do you give O2 to a pt with CP?
If pulse ox <90%
Low utility with normal pulse ox
Pt wants to focus on exercise for weight loss, how do you counsel?
exercise alone does improve insulin, glycemic control. Better or BP and CV risks and maintaining weight
- Only moderately beneficial for weight loss - need diet changes too
In which pts are DOACs contraindicated?
Mechanical heart valves
Need Warfarin
most common syx of EtOH w/d in elderly?
Confusion
NOT tremor or tachycardia
Most common cause of SBO
Intestinal adhesions (60-75%0 Neoplasm (13-20%) Hernia (2-15%) Volvulous (<5%) Constipation is rare
Auscultation finding in aortic regurgitation
“blowing” decrescendo diastolic murmur at rUSB, loudest at LLSB
which iron supplement is preferred in CKD pts?
Ferric citrate
similar to IV Iron
medicare part A
Covers hospital and hospice
Medicare part B
covers outpatient services and labs
Medicare part D
Prescriptions
Polymyalgia reumatica is associated with what other chronic inflammatory condition?
Giant cell arteritis
What surveillance labs do CRC survivors need?
CEA
NOT CBC or LFTs
Effects of smoking on pregnancy
Fetal growth restriction and lower birth weight
Quitting smoking - increases birth weight and reduces risk of preterm delivery
NO effect o if woman develops pree
At what age should girls have primary amenorrhea w/u?
15
What combo therapy should you consider for pt with T2DM and HTN for BP control?
CCB + ACEI
Better outcomes than HCTZ + ACEI
Pt has frostbite and undergoing rewarming, what do you give in addition?
NSAIDs
rewarming causes and inflammatory response
Non atopic asthma (ie negative skin testing, low IgE)
ASA sensitivity
Associated with?
Nasal polyps
("intrinsic asthma")T2DM pt is on insulins while pregnant. Now s/p sVD, what do you do?
restart metformin/oral agents
Tx for HFrEF and LBB and h/o angiodema to ACEI
SA node ablation
Entresto would be contraindicated
if you suspect septic arthritis in kiddo w/ nl xray get?
CBC ESR CRP
If positive get US to look for effusion to tap
medications that cause hypercalcemia
Lithium
Thiazide diuretics
Increase in Cr after starting ACEI suggests?
renovascular HTN
Get MRA of renal arteries
how to decide COPD tx based on Gold group
A - SABA or LABA monotherapy
B - LAMA or LABA mono therapy
C - LAMA (itratropium)
D LAMA, OR ICS/LABA
Anal fissure not improving with sits baths or TOP nifedipine
Botox
COPD pt should be on oxygen if SPO2 is
<88%
Pt has anaphylaxis to eggs. How do you counsel about flu vax?
Can receive any version of the flu vax in the office.
While working pt up for cirrhosis, what medicine should they avoid?
NSAIDs NOT Tylenol
D/t risk of renal insufficiency
Tyl and Statins are safe in cirrhosis
type of hallucinations associated with Parkinson’s?
Visual
NOT auditory
Tx of scaphoid fx with displacement?
Surgery
high risk of AVN
if non displaced - thumb spica
Pt has hirtruism with regular menses. Next?
OCPs x 6 months
c/f idiopathic hirsutism
pt ran out of BP meds, no SBP >180 and had a HA. What to do?
po labetalol (or clonidine, captopril, prazosin) until SBP <180 then restart home meds
USPTF screening recs for mammogram?
biennial mammo for women 50-75
benefit of low salt diet in CKD?
Lowers BP
NOT - change in mortality of time to HD
When do you offer daily hydroxyurea to SCD pt?
When pts have 3 or more vast-occlusive pain crisis/year or if they have daily pain
Can be offered to as young as 9 m/o
Goal is to reduce incidence of acute chest (NNT 6)
PCN ppx to prevent pneumococcal sepsis is recommended in kiddos until age 5
Only type of contraception that does not require back up method immediately after placement regardless of where she is in her menses?
Paraguard
How do you confirm clearance of H pylori?
breath or stool Ag test 1 month s/p tx
d/c PPI prior to test
Pt has SLE syx, ANA +, what other tests confirm dx?
Low complement
Anti CCP ab
Rhematoid Arthritis
Anti smooth muscle Ab
autoimmune hepatitis
anti-centromere ab
systemic sclerosis
HLA-B27
seronegative spondyloarthropathy (psoriatic arthritis)
Tx for Etoh and opioid abuse?
Naltrexone
how long do you keep teen out of sport for heat cramps?
Until syx resolve
Pt with fatigue weight loss patches of non pigmented skin on hands Na 132 K 5.3 Next step?
ACTH stim test
w/u for Addison’s (adrenal insufficiency)
suspect autoimmune etiology d/t vitiligo
pt uses heating pad on back. Now has reticular brown hyper pigmented skin changes. Dx?
Erythema ab igne
d/t heating pad eppsoure
4 priniciples of medical ethics
autonomy
beneficence
nonmaleficence
justice
middle aged man has meniscal tear w/o OA. Tx that will have the best long term outcomes?
PT
arthorscopy hasn’t shown significant benefit for long term pain or function
which abx can increase INR for pts on warfarin?
Bactrim, flatly, fluconazole (increase warfarin by 25%)
Rifampin DECREASES INR
dude has grown rash with red/brown macula’s. Pink under woods lamp. Dx?
Erythrasma (Corynebacterium minutissima)
Tx erythromycin TOP BID until rash resolves
Pathophys of achalasia?
Aperstalsis in distal 2/3s of esophagus w/ incomplete lower esophageal sphincter relaxation
Associated with loss of ganglion cells in esophageal wall –> loss of peristalsis and failure of relaxation of lower esophageal sphincter. Incomplete LES relaxation is highly specific for achalasia
what medicines can increase risk of dementia?
anticholinergic’s and other sedatives
what do you do for preggo exposed to flu?
vax and Tamiflu
Tx for recurrent c. diff after course of vanc?
Fidaxomicin 299mg BID x 10 days
Can offer flatly if diaxomicin not available
when do you start statins in T2DM?
> 40 y/o
IVDU
progressive DOE
CXR b/l perihilar shadowing
bronch bx would reveal?
Foreign body granulomas
caused by injection of crushed pills, talc etc
non infectious cause of injected clear?
Episcleritis
Self limited idiopathic w/ mild discomfort and focal hyperemia
NO discharge
