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Medicine Clerkship > Last Minute > Flashcards

Last Minute Flashcards

1
Q

PE Work-up?

A

Wells criteria

0-1 low
2-6 intermediate
7+ high

> 4 likely
<4 unlikely

If low risk -> PERC

  • If 0 - stop
  • If 1+ - D-Dimer

If intermediate - D-Dimer
-If positive - CT-PE

If high - CT-PE

If CT-PE is negative with high pre-test probability, get another study (LE doppler or VQ scan)

Use VQ scan in high or intermediate risk with contraindication to CT

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2
Q

Wells criteria?

A 
Symptoms +3
P# #1 on DDx +3
Tachycardic +1.5
Immobilization +1.5
Previous DVT/PE +1.5
Hemoptysis +1
Malignancy
\+1
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3
Q

PERC?

A

0 points if:

<50
HR <100
OT sat >94% on RA
No unilateral leg swelling
No hemoptysis
No surgery/trauma within 4 weeks 
No hx VTE
No estrogen
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4
Q

Rx options for VTE?

A

Heparin drip
LMWH
Warfarin
NOACs

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5
Q

Rx VTE?

A

NOACs (dabigatran, rivaroxaban, apixaban, edoxaban)

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6
Q

Rx VTE + cancer?

A

LMWH

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7
Q

Rx VTE if once daily oral therapy preferred?

A

NOAC or Warfarin

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8
Q

Rx VTE with liver disease causing coagulopathy?

A

LMWH

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9
Q

Rx VTE with renal disease?

A

Warfarin (NOAC, LMWH contraindicated)

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10
Q

Rx VTE with CAD?

A

NOAC (NOT dabigatran) or Warfarin

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11
Q

Rx VTE if pregnant?

A

LMWH

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12
Q

When is thrombolysis indicated in DVT/PE?

A

Patients who are hemodynamically unstable and at risk for death

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13
Q

Indications for IVC filter?

A

Major contraindication to anticoagulation
Recurrent VTE despite therapeutic anticoagulation
Chronic reucrrent VTE with pulmonary HTN

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14
Q

Most common cause of major upper GI bleed?

A

PUD

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15
Q

Most common cause of major lower GI bleed?

A

Diverticulosis

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16
Q

Manage pt with GI bleed?

A

Protect the airway
2 large bore IVsIV fluids
Order blood/transfuse if needed
Consult GI for upper endoscopy

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17
Q

Dx HIV?

A
  1. ELISA - screens for Ab. If positive ->
  2. Western plot
  3. Quantitative PCR
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18
Q

In HIV, what i the best indicator of the status of the immune system/risk of OI and disease progression?

A

CD4 count

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19
Q

Risks of OI at 200-500 CD4?

A 
Zoster
TB
Lymphoma
Bacterial pneumonia
Kaposi
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20
Q

OI at CD4 <200

A

PJP

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21
Q

OI at CD4<100

A

Candidiasis
CMV
HSV

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22
Q

OI at CD4 <50

A

CM

MAC

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23
Q

What is used to assess response to therapy in HIV?

A

Viral load

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24
Q

Rx HIV?

A

Triple HAART therapy:

2 NRTs + EITHER a NNRT or Protease inhibitor

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25
Q

Prophylaxis/timing for PJP in HIV?

A

<200

TMP/SMX

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26
Q

Prophylaxis for TB in HIV?

A

Yearly screening with PPD

If positive, isoniazid + pyridoxine

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27
Q

Prophylaxis/timing for MAC in HIV?

A

<200

Clarithro and azithro

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28
Q

Prophylaxis/timing for Toxo in HIV?

A

<100

TMP/SMX

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29
Q

Rx PJP in HIV?

A

TMP-SMX for 3 weeks, steroids if hypoxic or elevated A-a graident

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30
Q

Rx candidiasis in HIV?

A

Oral/esophageal - nystatin swish and spit
Local - azoles
Disseminated - amphotericin

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31
Q

Dx cryptococcus neoformans?

A

CSF cryptotococcal antigen

India ink

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32
Q

Rx cryptococcus neofrmans?

A

Amphotericin B for 10-14 days

Oral fluconazole 8-10 weeks + forever

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33
Q

Rx CMV in HIV?

A

Ganciclovir or foscarnet

34
Q

Rx Toxo in HIV?

A

Sulfadiazone + pyrimethamine

35
Q

Dx autoimmune hepatitis

A

Anti-smooth muscle antibodies, liver/kidney microsomal antibodies

36
Q

Rx autoimmune hepatitis

A

Steroids

37
Q

What is PBC?

A

Autoimmune disease seen in middle-aged women, destruction of bile ducts with portal inflammation and scaring

Elevated alk phos
+AMA

38
Q

Rx PBC?

A

Symptomatic with ursodeoxycholic acid to slow progression

39
Q

What is PSC?

A

Men
Thickening of bile duct walls, narrows lumen

Dx - ERCP/PTC (beading)

40
Q

Rx PSC?

A

Symptomatic with cholestyramine (itching)

41
Q

Dx cholecystitis?

A

1 RUQ U/S

CT - as accurate as U/S, more sensitive for complications

HIDA if U/S inconclusive
If normal, rule out cholecystitis. + means gallbladder not visualized. If not visualized after 4 hours, dx confirmed

42
Q

DDx - conjugated hyperbilirubinemia?

A
  1. Decreased intrahepatic excretion of bilirubin (hepatocellular disease, DJ/Rotor, drug-induced, PBC, PSC)
  2. Extrahepatic biliary obstruction (gallstones, cholangiocarinoma, etc.)
43
Q

DDx - unconjugated hyperbilirubinemia

A
  1. Excess bilirubin production (hemolytic anemia)
  2. Reduced hepatic uptake of bilirubin or impaired conjugation (Gilbert’s, drugs, Crigler-Najjar, diffuse liver disease - hepatitis, cirrhosis)
44
Q

If unconjugated what labs?

A

CBC, reticulocyte count, haptoglobin, LDH, peripheral smear (hemolysis?)

45
Q

If conjugated what labs?

A

LFTs

46
Q

Work-up for lung nodule?

A
  1. Compare with past imaging

Options:

  • Observation (serial imaging with CT)
  • Biopsy (FNA)
  • Removal (gold standard/definitive Rx for malignant)
47
Q

Paraneoplastic syndrome - ACTH/SIADH/Lambert Eaton - what type of cancer?

A

Small cell carcinoma

48
Q

Paraneoplastic syndrome - Hypercalcemia via PTHrP - what type of cancer?

A

Squamous cell carcinoma

49
Q

Paraneoplastic syndrome - carcinoid syndrome - what type of cancer?

A

Bronchial carcinoid tumor

50
Q

Rx NSCLC

A

Surgery (gold standard)
Radiation very good
Chemo bad

51
Q

Rx small cell lung cancer

A

Chemo + radiation

Surgery bad

52
Q

Minimum PFT requirement for lung cancer resection

A

Pre-op

FEV1 >2 L or >1.5 L if lobectomy

53
Q

Walk through acid-base disorders

A
  1. [H+] = 24 x (pCO2/HCO3)
    7.10 -> 70, 7.20 -> 60 etc
  2. pH?
    >7.4 - alkalosis
    <7.4 - acidosis
  3. pCO2?
    If alkalosis, pCO2 <40 - respiratory, pCO2>40 - metabolic
  4. If acidosis, pCO2 <40 - metabolic, pCO2 >40 - respiratory
  5. Primary metabolic:
    -Alkalosis - pCO2 should be 40-55
    -Acidosis - calculate predicted pCO2 (1.5 x HCO3) + 8 +/-2
    -If actual too high - resp acidosis
    -Ifa ctual too low -a ddl resp alk
  6. AG?
  7. Correct the bicarb (AG - 12 + HCO3)
    If >30 - addl metabolic alk
    If <23 - addl non-AG metabolic acidosis
54
Q

DDx - AG metabolic acidosis

A 
Methanol/metformin
Uremia
DKA/alcoholic ketoacidosis
Paraldehyde
Isoniazid/Iron
Lactic acidosis
EtOH/Ethylene glcyol
Rhabdo/renal failure
Salicylates
55
Q

DDx - non-AG metabolic acidosis

A 
Hyperalimentation (TPN)
Acetaloamide
RTA
Diarrhea
Uretero-pelvic shunt
Post-hypocapnia
Spironolactone
56
Q

DDx - metabolic alkalosis?

A 
Contraction
Licorice
Endocrine (Conn's, Cushing's, Bartter's)
Vomiting/NG suction
Excess alkali
Refeeding
Post-hypercapnea
Diuretics
57
Q

Which alkalosis acidosis have high urine chloride?

A 
Licorice
Endo
Excess alkali
Refeeding
Diureitcs
58
Q

DDx - acute respiratory acidosis?

A

Hypoventilation

59
Q

Chronic respiratory acidosis?

A

COPD/Restrcitve lung dsiease

60
Q

Ddx - resp alkalosis?

A

Hyperventilation

61
Q

Calculate the osmolar gap?

A

Predicted osmolality = Na + (glucose/18) + BUN/2.8

Compare with serum osm

Indicates toxic ingestion

62
Q

Walk through hyponatremia

A
  1. Plasma osmolality
    (Calculate effective = measured - BUN/2.8)
    If low (<280) - true hyponatremia
    if normal (280-285) - pseduohyponatremia
    if high (>285) - hypertonic (hyperglycemia, mannitol, sorbitol, contrast)
  2. If hypotonic, assess volume status
    -Low - hypovolemic
    -Normal - euvolemic
    -High - hypervolemic
  3. Urine Na
    -Expected to be low
    -If >20, this indicates salt-wasting nephropathy, diuretics, hypoaldosteronism
  4. Urine Osm
    <100 - indicates appropriate dilution of urine
    >100 - SIADH, CHF, hypothyroidism, adrenal insufficiency
63
Q

DDx - euvolemic hypotonic hypernatremia

A

SIADH
Psychogenic polydipsia
Post-op
Hypothyroidism

64
Q

DDx - hypervolemic hypotonic hypernatremia

A

CHF, nephrotic, liver disease

65
Q

Joints NOT seen in OA?

A

Wrists and ankles

66
Q

Rx acute gout?

A

NSAIDs
2nd line - colchicine (contra in renal insufficiency)
3rd line - steroids

67
Q

Long term gout rx?

A

Allopurinol/febuxostat if increased production

Probenecid if decreased excretion

68
Q

Prevention for gout?

A

Colchcine, low dose pred, NSAIDs

69
Q

Key findings in joint fluid analysis?

A

WBC >50000 = septic
PMNs >75% = septic
WBC >2000 = inflammatory

70
Q

Correct ESR for age/gender?

A 
M = age/2
F = age+10/2
71
Q

Correct CRP for age/ggender?

A 
M = age/5
F = age+30/5
72
Q

Ab for RA?

A

+RF (sensitive, not specific)

anti-CCP (sensitive/specific, poor prognostic factor)

73
Q

Rx RA: short-term, mild, mod/severe

A

Short-term: prednisone
Mild: NSAIDs or hydroxychloroquine or sulfasalazine
Mod/Severe: oral weekly MTX (#1)

Leflunomide
Anti-TNF alpha
other biologics

74
Q

Rx spondylos?

A

Similar to RA, but no hydroxychloroquine in psoriasis (can worsen), use TNF-alpha if axial involvement

75
Q

Dx SLE?

A

4+

Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood disorders (penias)
Renal involvement
ANA
Immunological phenomena (Ab)
Neurologic
Malar rash
Discoid rash
76
Q

Ab in SLE?

A

ANA (sensitive)
anti-ds-DNA (specific)
anti-smith (specifiic)

77
Q

SLE Ab to monitor flares?

A

anti-dsDNA

78
Q

Rx SLE?

A

Short-term - prednisone
Mild/cutaneous - hydroxychloroquine
Mod/severe - azathioprine/MMF
Severe - MMF/ritoximab, cyclophos

79
Q

Ab in systemic sclerosis?

A

CREST - anti-centromere

Diffuse - anti-scl70

80
Q

Ab in Sjogren’s?

A

SS-A
SS-B
Often ANA, RF

81
Q

Ab in polymyositis?

A

Anti-Jo-1

82
Q

Rx COPD Stages 1-4

A

1 - SABA
2 - + LABA or LACA
3 - + inhaled cort
4 + O2

Medicine Clerkship (15 decks)

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