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Step 3 > March Deck > Flashcards

March Deck Flashcards

1
Q

Treatment for CML

A

tyrosine kinase inhibitor

Consider if severely elevated WBC
Philadelphia chromosone (9/22)

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2
Q

Who needs prophylaxis treatment for meningococcal meningitis?

A

Close contacts: ppl >8 hrs w/in 3ft of him or his oral secretions

Medical staff in close contact w/ saliva

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3
Q

How are OCP’s metabolized?

A

CYP P-450, therefore can be effected by other meds

Ex: anti-seizure meds may induce, therefore decrease OCP effectiveness –> pregnancy

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4
Q

On warfarin but sub-theraputic INR but with new signs of clots.
Management?

A

Increase Warfarin dose
Heparin to bridge inpt, enoxaparin to bridge outpt

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5
Q

Bronchiectasis sx

A

Daily cough
Mucopurulent sputum
recurrent pulmonary infections
hemoptesis (2/2 mucosal inflammation)

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6
Q

Functional vs. absolute iron deficiency anemia

A

F: normal/high ferritin, low Transferrin sat
(CKD, anemia chronic disease)

A: Low ferritin, low transferrin sat

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7
Q

Bicusped aortic valve may be related to ____ further cardiac complication

A

Aortic dilation

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8
Q

diagnostic test for pneumothorax

A

Lung US

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9
Q

Clinical signs of Aortic Stenosis

A

Soft, single heart sounds
delayed and diminished carotid pulse (parvus et tardus)
Loud, late-peaking systolic murmur

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10
Q

Tourette syndrome: Dx and management

A

multiple motor and at least one verbal tic >1 year (don’t have to be same tic whole time)

Antipsychotic (ideal 2nd gen: risperidone, aripripizol)

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11
Q

Which diuretic should be used in pts with gout?

A

Losartan (can help lower uric acid)

Most others (hydrochlorothiazide and loops) decrease uric acid excretion, risking gout

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12
Q

Sx ITP

A

Immune thrombocytopenia

asymptomatic petichia
mucosal bleeding
Preceeding viral illness

Child!

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13
Q

HIV lipodystrophy sx

A

Wasting of face and limb fat
Buffalo hump, increased abdominal fat

associated with:
abnormal lipid and glucose metabolism –> insulin resistance and dyslipodemia

(2/2 anti-retroviral therapy)

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14
Q

How do you diagnose (suspected active) TB?

A

3 sputum samples each submitted in 8-12 hr intervals, one must be early morning
- acid fast smear
- mycobacterial culture
- nucleic acid amplification

(bronchoscopy and lavage reserved for pt with clear sx but negative sputum cx)
Skin testing or interferon gamma release assay can’t differentiate active or latent TB, therefore not truly diagnostic

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14
Q

Initial management of Raynaud’s?

A

Nifedipine, amlodipine, diltiazem

NOT verapamil

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15
Q

How to prevent C diff infection?

A

Avoid Abx
Avoid gastric acid suppression (alters microbiome, increases risk of C diff proliferation)

Probiotic yogurt doesn’t help

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16
Q

Pleural effusion w/ elevated adenosine deaminase indicates?

A

TB

Often pt with HIV has disseminated or lobar or pleural TB infection (not cavitary b/c not enough immune response)

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17
Q

management of tinea capitis?

A

oral terbinafine or oral grisofulvin

Topical won’t penetrate hair follicles well enough

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18
Q

Transient synovitis

A

Hip pain
Can bear weight (unlike septic arthritis)
Pain w/ internal rotation
Normal CRP and WBC (unlike septic arthritis)

child, usually after virus
2/2 transient inflammation of synovitis

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19
Q

work up upon finding solitary pulmonary nodule on CXR?

A

chest CT

(not repeat cxr 2-3 mo)

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20
Q

if solitary pulmonary nodule thought to be malignant, then what?

A

referral to surgery for biopsy or excision

If lesion is centrally located, may be able to use bronchoscopy to obtain tissue for biopsy, but would not solve excision

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21
Q

preferred medication for awake fiberoptic nasotraceal intubation?

A

ketamine

(want him to be outta it, but still protecting his own airway)

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22
Q

Intubation fails, what is your emergency airway?

A

Cricothyrotomy
(not tracheostomy which takes longer)

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23
Q

Management of n/v in pregnancy:

A

First line: B6 and H1 antihistamine

Oral dopamine and seratonine agonist
IV fluids and anti-emetics
Steroids
TPN

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24
Q

Lab work in addison’s disease

A

Hyponatremia
hyperkalemia
mild hyperchloremic metabolic acidosis

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25
Q

Lab work in hypoaldosteronism

A

Hyperkalemia (asymptomatic)
Metabolic acidosis

(no hyponatremia unlike addison’s disease)

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26
Q

Work up of possible foot osteomyelitis

A

Prob-to-bone test
MRI (XR often ordered first b/c cheaper, but gold-standard is MRI)

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27
Q

How does Rhogam dose change if maternal hemorrhag?

A

increases
(otherwise risk not adequately immunizing)

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28
Q

Types of pharmacologic stress testing?

A
  1. dobutamine echo
  2. Adenosine myocardial perfusion imaging
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29
Q

How do you differentiate pre-renal AKI and HRS?

A

HRS won’t respond to fluids

(the renal vasoconstriction is 2/2 hormonal cascade, not volume depletion)

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30
Q

what type of fungus causes crazy high intracranial pressure and LP opening pressure?

treatment?

A

Cryptococcus
(cryptococcal meningoencephalitis)

serial LP’s to releive pressure
1. Amphotercin B and flucytosine >2 wks
2. THEN high dose fluconazol 8 weeks
3. THEN low dose fluconazol >1 yr

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31
Q

Polymyalgia rheumatica sx & labs

A

Pain in groin and shoulders
Negative CK

(statin would have +CK)

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32
Q

what meds effect levothyroxine absorption?

A

iron and calcium (and many others)

33
Q

what arrhythmia does prolonged QT lead to?

what precipitates it?

A

torsades de points

Brady arrhythmias or PVCs

34
Q

how do you manage torsades de points?

A

IV magnesium

35
Q

Management of ischemic priaprism

A

warm compress, urination

if >4 hrs
aspiration
injection alpha agonist (phenylephrine) - dec blood flow to penis

36
Q

What electrolyte disturbance do you expect after long surgery with multiple transfusions?

Manifestations?

A

hypocalcemia

Asymptomatic OR
hyperactive deep tendon reflexes, muscle cramps, convulsions

All because citrate in tranfused blood (to keep from coagulating) chelates w/ calcium

37
Q

Management of dumping syndrome?

A

high protein, low carb diet
small portions

38
Q

Medication management of SLE?

A

low dose prednisone for mild disease, high-dose for severe disease involving CNS or kidney

Hydrochloroquine - good for arthralgias, serositis, cutaneous sx
Cyclophosphomide or methotrexate may be added for severe illness

39
Q

Management of TTP?

A

Thrombotic thrombocytopenic purpura

plasma exchange (remove anti-ADAMTS-13 Ab’s)
Steroids
Rituximab (stops B cells making more abs)
Caplacizumab

40
Q

B6

A

pyridoxine

41
Q

Surgical cardiac risk factors

A

For NON-cardiac surgery

  1. High risk surgery (vascular, intrathoracic)
  2. ISCHEMIC heart disease
  3. CHD
  4. CVA
  5. DM on insulin
  6. Pre-op creat >2

> 2, elevated risk

42
Q

Subacute thyroiditis MOA

A

Post-virus release of PRE-MADE thyroid hormone

Therefore low iodine uptake
(also seen in silent (painless) thyroiditis and post-partum thyroiditis)

43
Q

Anemia caused by chronic lead ingestion is:

A

normocytic, hemolytic anemia

44
Q

First line management grief?

A

Grief education/counseling and sleep routine

only need psychologist or meds if grief continues longer than expected or if develop suicidal thoughts

45
Q

Liver lesion:
Hydrated disease vs. protozoal infection

A

H: Echincoccus granulosus: slower growing, usually don’t have a fever unless cyst ruptured, no sx til >10 cm

P: Entamobia histolytica: Fever, RUQ pain, dark brown fluid aspiration w/ no organizms visible

45
Q

Man with dysuria, fever, frequency and pyuria. Consider what dx?

A

UTI vs. acute bacterial prostatitis

Differentiate with DRE

46
Q

Trachea is ______ the esophagus

A

Trachea is IN FRONT OF the esophagus

47
Q

Most common cause hypercalcemia?

Management?

A

primary hyperparathyroidism

If asymptomatic and <50, serial dexa scans
If symptomatic/osteoperosis or >50, surgery

48
Q

breast mass work up?

A

> 40: mammogram, if indeterminant then US

Then CORE NEEDLE biopsy (excision biopsy only if core needle not possible)

49
Q

Pulmonary infarct 2/2 PE vs. metastasis on imaging?

A

Would expect multiple leasions for mets

Pulm infarct looks like: hemispheric consolidation abutting pleura

50
Q

Management of inguinal hernia infant?

A

Surgical repair 1-2 weeks

(don’t wait, >2 weeks doubles risk incarceration)

51
Q

New recurrent UTI’s
diarrhea, bloating, wt loss. Dx?

A

Crohn’s w/ fistula

52
Q

tachycardia/hypotension
severe lower quadrant abdominal pain
+psoas sign

A

retroperitoneal bleed

If on warfarin, INR could be within normal range

53
Q

Sx hypercalcemia

A

too much extracell Ca –> over-stablizes neuronal membrane –> slows neuronal function

  • dec reflexes
  • weakness
  • constipation
  • confusion
  • dehydration (from Ca dumping in urine)
  • kidney stones
54
Q

Sx Multiple Myeloma?

A

Ca elevated
Renal insufficiency
Anemia
Bone pain

55
Q

When do you not use metformin?

A

GFR <30

56
Q

Management of blephritis?

A

first line: supportive (warm compresses)
if fail: topical bx

Inflammation of eye margin

57
Q

Management of acute aortic dissection

A

IV Beta blocker (decrease shearing stress)
Morphine (pain)
Surgery

(can add sodium nitroprusside to BB if sBP >120, but not alone)

AVOID hydralazine and nitroprusside - can cause reflex sympathetic response, worsening shearing

58
Q

Management of bone density while on steroids

A

prior to osteoperosis, calcium and vit d supplementation

once dx, then add bisphosphonate (alendronate)

59
Q

how to diagnose acute cholangitis?

A

clinical sx: fever, RUQ pain, jaundice +/- hypotension and AMS

AND:

biliary dilation on imaging (RUQ US)

doesn’t have to be due to gallstones

60
Q

treatment of tinea versicolor?

A

topical ketoconazole
(orals are ineffective)

61
Q

most common cause of cellulitis?
Management?

A

strep pyogenes
Cephalexin

NOT Staph! think staph if abscess or pus, but less common in pure cellulitis

62
Q

Wolfe-Parkinson-White Syndrome sx

Most common arrhythmia?

A

asymptomatic –> palpetations, syncope
ECG delta wave, short PR, widened QRS

SVT

63
Q

Common causes bradyarrythmia

A

AV nodal heart block
SA node dysfunction

64
Q

signs of obstruction with air in distal colon. Dx?

A

PARTIAL sm bowel obstruction - admit, observe.

if not improved 24-48 hrs –> surgery

65
Q

When to treat subclinical hypothyroidism?

A
  1. presence of anti-thyroid abs
  2. abnormal lipid panel
  3. ovulatory and menstrual dysfunction
  4. hypothyroid sx (obvi lol)
66
Q

how to reverse warfarin?

A

prothrombin complex concentrate (contains vit K clotting factors, normalizes INR <10 min)

IV vit K (but takes 12-24 hrs to reach full effect)

67
Q

Young man w/ infective urethritis.
Bug? Management?

A

Ghonorrhea - profuce thick white discharge
Gram stain: intra-cellular gram neg diplococci
Tx: CTX

Non-ghonnoccocal (chlamydia) - scant, white, watery discharge
Gram stain: no orgs on gram stain
Tx: azithro or doxy

NOTE: Can treat non-ghonnoccocal monotherapy, but canNOT treat ghonorrhea monotherapy b/c can’t totally rule out chlamydia

68
Q

Management of mastitis?

A

Cephalexin or dicloxacillin

69
Q

Dementia + decreased vibratory sense in legs + hyperreflexia and spastic paresis

A

vitamin B12 deficiency
(subacute combined degeneration)

70
Q

Induration vs. fluctuance

A

induration: skin thickening from inflammation, may indicate abscess OR cellulitis

Fluctuance: wavelike motion on palpetation, indicates abscess

Differentiate w/ US

71
Q

anticoagulation in pregnancy

A

Best: LMWH (does not cross placenta)
If mechanical valve, then heprin 2nd and 3rd trimester
ASA okay (often prevents pre-E)

NO warfarin

72
Q

how to screen for Cushing syndrome

A

dexamethasone suppression test
or
24 hr urinary free cortisol level

73
Q

management of pheocromocytoma

A

Alpha blockaid
surgical removal

no beta blockers until AFTER alpha blockers in place

74
Q

tx restless leg syndrome

A

firsy line gabapenting/pregabilin

carbidopa-levodopa

75
Q

presentation hemochromocytosis

A

bronze diabetes
hepatomegally + elevated LFTs

2ndary hypogonadism & hypothyroidism
dilated or restricted cardiomyopathy

management: theraputic phlebotomy

76
Q

meningitis abx (by age)

A

<1 yr: amp + gent

1-50: ctx + vanc

> 50: ctx + vanc + amp

77
Q

Work up unconscious pt

A

BG
ABG
HCT
ECG, cardiac monitor
UA
UTox, Blood Tox
Acetaminophen, aspirin level
Ethanol level

Other:
CK, TSH,

78
Q

Overdose management (TCA)

A

NG tube w/ suction vs. activated charcoal
Oxygen/intubation
Narcan
NS
Sodium bicarb (acidotic and stablize cardaic)
Diazepam (sz)

79
Q

The 4 general tests I ALWAYS forget

A

BG
TSH
Troponin

Beta HCG

80
Q
A

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