Medicine 1 Flashcards
1
Q
Lyme transmitted by Ixodes tick after ___ hrs of attatchment and are at ___ risk for Lyme.
How many days does it take for erythema migrans to devo?
A
Lyme = B Burgdorferi 36-48 hrs LOW at least 3 days for rash to devo; mostly 7-14 days Serology not positive for about 2 weeks
2
Q
Derm side effects of:
Furosemide
Lisinopril:
Amlodipine
A
Furosemide: SJS and uticaria NOT photo
Lisinopril: Angioedema, uticaria, maybe aggravation of psoriasis
Amlodipine: see significant fluid retention and uticaria
3
Q
Derm SE of these antiHTN
Metoprolol
Hydrochlorothiazides
A
Metoprolol: uticaria and CAN cause photosensitivity
HCTZ: photosensitivity (they are sulfa containing drugs)
4
Q
Electrolyte imbalance resulting in HYPERactive DTR, muscle cramps –> convulsions
A
HYPOcalcemia
5
Q
Why does hypoCa occur after major surgery/trauma? How does it manifest
A
often massive blood transfusions–> large amounts citrate use to anticoag teh blood. Citrate–Ca chelation–> low Ca
ALSO can get volume resuscitation leading to low Ca and low Albumin (generally Asymptomatic)
Sx: HYPERactive DTR, muscle cramps, convulsions
6
Q
What are GI, CV changes we see with HYPERkalemia?
A
N/V and ECG: peaked T waves,short QT–> lengthening of PR interval and QRS –> P wave disappears–> sine wave
7
Q
What happens to DTR in HYPERmag?
A
high Mag = LOSS Of DTR and can lead to flaccid quad, apnea, decreased respiration
mild elevation mag = increased DTR
8
Q
Patient with stroke has these symptoms:
Vertigo, difficulty standing (vestibulocerebellar) and falling TOWARDS lesion and nystagmus (horizontal/vertical) + ipsilateral limbataxia
Abnormal facial sensation and loss of Pain/temp IPSILAT face and CONTRA trunk (sensory)
Dysphagia, dysarthria, hoarsness (CONT VC paralysis)= IPSI bulbar msl weakness
Ipsi Horners (miosis/ptosis/anhidrosis), hiccups, no respirations
A
Wallenberg syndrome
= LATERAL MEDULLARY stroke
9
Q
Patient with lesions in the lateral cerebral hemisphere present with
A
IPSILATEARL ataxia, not dizzy and no change in sensation or temp
10
Q
What vessel most commonly implicated in Wallenberg syndrome (lateral medullary stroke)
A
Intracranial vertebral artery
See vesibulocerebellar findings; can’t feed and overshoot targets bc of ipslateral limb ataxia.
Sensory changes; loss pain/temp in IPSIlateral face adn CONTRA trunk/limbs
Dx MRI and Tx stat thrombolytics (TPA)
11
Q
PT presents with weakness in chewing (msl of mastication), diminished jaw jerk reflex, impaired tactile and position sense. Most likely location of lesion
A
Lateral mid-pontine
12
Q
Patient presents with CONT paralysis of arm and leg, tongue deviation towards the lesions.
CONT loss of tactile and position sense
A
Medial Medullary Syndrome (vertebral or anterior spinal artery)
13
Q
Difference btwn TIA and stroke, time/symptoms
A
TIA = < 24hrs symptoms resolve, from emboli or thrombus (the opthalmic artery is 1st branch of the ICA) and NEVER from hemorrhage
Stroke symptoms >24 hrs, 80% ischemia (thrombus/emboli) and 20% hemorrhage
14
Q
How do you triage a stroke? Imaging and medications?
A
STAT head CT WITHOUT contrast (to assess for hemorrhage)
if not hemorrhage–> thrombolytics (TPA) if w/in 3 hr
15
Q
Locate the lesion
LE weakness, mild upper ex weakness, personality change/pysch disturbance, urinary incontinance
A
Anterior cerebral artery (if one sided symptoms are CONtralateral)
16
Q
Locate lesions
Profound UE weakness, aphasia, apraxia/neglect of CONT
Eyes deviate TOWARDS lesion
CONT homonymous hemianopsia (only see one side of vision field) + macular sparing
A
MIddle cerebral artery
17
Q
Locate lesion
Patient cannot recognize anyones face (prosopagnosia)
A
Posterior cerebral artery
18
Q
Locate lesion
Vertigo,N/V
Drop attack or LOC
sensory changes in face/scalp with ataxia and bilateral findings
A
Vertebrobasilar artery
19
Q
Locate lesion
Ipsilateral face
Contralateral body
Vertigo/Hordners
A
Post inferior cerebral artery
20
Q
Locate lesion:
ABSENCE of cortical deficits
Ataxia, Parkinsonian signs, Sensory deficits, hemiparesis (mostly in face), possible bulbar signs (CN IX-XII; swallowing, tongue fasciculations, emotional lability, brisk jaw)
A
Lacunar infarct
21
Q
Patient with SOB, wt gain and hx of HTN, obesity. PE Notable for LE edema, S3 heard on exam.
Echo with LV hypertrophy, impaired diastolic filing and preserved EF
A
Heart fail with preserved EF
22
Q
Phenomenon seen in patients with COPD which includes loss of lean muscle mass dt energy imbalance and systemic inflammation: BMI <20 and wt loss >5%
A
Pulmonary Cachexia Syndrome (PCS)
23
Q
Viral gasto most commonly caused by:
To treat gastro outpatient…
A
Noro, rotavirus
resume normal diet as tolerated, not BRAT diet (low protein) and nothing high in sugar (juice causes more osmotic diarrhea) not high in fats (more gastric acid secreation)
24
Q
Contraindications to DTaP?
A
Anaphylaxis or encephalopathy w/i 7 days of prior vaccine.
Encephalopathyd/t pertussis parts so they can still get Td
Relative contraindications are extremely high fevers >105 or seizures
25
Management of HIV antepartum
HIV RNA viral load every visit; 2-4 wk check until undetectable, monthly once undetactable then q3m, CD4 every 3-6, resistance testing, ART initiation STAT no amniocentisis unless viral load <1,000 copies
26
Management of HIV mom during delivery
avoid ROM, scalp electrode, operative VD
goal viral load <1,000: ART + vaginal
IF >1,000: ART + zidovudine +CS
27
Management of HIV mom and baby after delivery
Mom: cont ART
Baby if Mom <1,000 viral load: zidovudine
if mom >1,000: multidrug ART
28
Breast feeding contraindications:
```
Active untreated TB
HIV infection (unless in resource scarce area)
Herpetic breast lesion
Active varicella infection
Chemo or radiation
Active substance abuse
Baby with galactosemia/PKU
```
29
Protective factors against suicide:
social support, family connectedness, pregnancy, parenthood, religion/participation in religion
30
Woman is 35 wks pregnant, presents with painless vaginal bleeding. FHR is normal with normal fetal HR tracing. Most concerning is ____
Next step____
Placental Previa
Get transvaginal US; this does not invade the endocervical canal thus okay. Digital cervical exam is contraindicated bc can cause hemorrhage while speculum and transvag doesn't.
31
When do we obtain a biophysical profile?
BPP is US of fetal movement, tone, breathing, amniotic fluid volume and evals for fetal hypoxia after abnormal nonstress test (decels or no accelerations)
32
Woman just has baby, now in cardiogenic shock, hypoexmic resp fail with DIC and in a coma
Dx?
RF?
Tx?
amniotic fluid embolism
RF: AMA, gravida 5, CS or instrumented delivery, placenta previa/ abruption, preE
Tx: Supportive cares and consider transfusion
33
Placenta ____ direct attachment of placenta to myometrium, see difficulty separating placenta from uterus after delivery + postpartum hemorrhage
Accreta
34
What is definition of subclinical hypothyroidism?
| Who gets treated?
Elevated TSH with normal free T4
You can observe in asymptomatic patients BUT should tx with Levothyroxine IF: having thyroid symptoms, pregnant, infertility or ovulatory dysfunx, goiter, positive antithyroid antiB titers and if TSH >10
High TSH and antiB titers is very likely progression to overt hypoT
35
Patient with elevated free T4, low TSH, elevated radioactiveiodine uptake, hyper T features plus opthalmopathy
Graves
| Tx is radioactive iodine ablation
36
Clinical features of..
pain/swelling and morning stiffness in multiple joints, usually symmetric. small jts (MCP, MTP, PIP) spares DIP with somesystemic signs and Cspine can be subluxed or see cord compression
Rhuematoid arthritis
37
What labs are notable for rheumatoid arthritis
rhumatoid factors presenting in 75-85% pts but present in other dx, non-specific
anti-cyclic citrulinated peptide or anti-CCP is most accurte and present 95% time earlier in course.
Nothing helpful w/ joint aspiration
38
Boutonneire deformity: flexion of PIP with hyperextension of DIP
Swan neck: extension PIP with flexion of DIP
both findings in RA
39
Dx criteria for RA
synovitis (single going is enough)
RF or antiCCP
elevated ESR or CRP
lasts >6 weeks
40
What does it mean if pt highly suspisious of RA has neg RF adn anti-CCP?
Patients with RA don't necessarily have to have + RF or anti-CCP
41
What pts with RA should start a disease modifying antirheumatic drug (DMARD?)
Pts with active RA should be started on DMARD (if they have bony erosions and cartilage loss on xray) then methotrexate (1st line)should be initiated. YOu can stop NSAIDs f symptoms improve
42
What are tx for RA?
Symptoms: NSAIDS
1st line DMARD: MTX
if fail that... start tissue necrosis factor inhibitor; etanercept or infliximab
43
How does MTX work? What should all pts be on that are taking it?
folate antimetabolite, targets rapid proliferating cells, Blocks dihydrofolate reductase.. blocks purine synthesis and blocks DNA repair, SE are hepatotoxicity, stomatitis, BM suppression is seen in HIGH dose
TAKE FOLIC ACID
44
What supplement should you take before starting isoniazid?
Vitamin B6 or pyridoxine to prevent neuropathy
45
Most all patients with SLE screen positive for ___, however this is nonspecific and seen in healthy ppl and in pts wit CT disease
____ and ___ are associated with SLE but one is more sensitiv
anti-dsDNA and anti-Smith (both specific)
| anti-dsDNA are 66-95% sensitive, smith is about 20% sensitive
46
anti Ro/SSA are seen in some pts with SLE but more sensitive for_____
Sjogrens
47
Anti-centromere antiB are most sensitive for
detection of CREST variant of scleroderma
48
anti-mitochondiral antiB are sensitive for...
Primary biliary cirrhosis
49
Elevation of this titer and decreasing of this can correlate with flair and progression of Lupus
increasing or elevated anti-dsDNA
| decreasing complement levels
50
How many critera are needed for Lupus dx?
```
4 criteria (Skin/Arthralgias/blood (leukopenia, thrombocyotpenia or hemolysis)/renal (proteinuria or ESRD)/cerebral (menigitis,stroke,behaviors)/ Serositis (pleuritic,mycarditis,pericarditis,pna)/ serology (ana, dsDNA, smith)
Rash + joint pain + fatigue generally = lupus
```
51
Anti-Ro (SSA) is siginificant in pregnancy because?
baby is at risk for heart block
52
Tx of lupus flare ups
| Jt pain?
Prednisone and glucocorticoids
| NSAIDs
53
Tx for rash/jt pain in Lupus not responding to NSAIDs as well as tx for serositis and cutaneous symptoms?
hydroxychloriquine... great for pleural effusions/pleuritc chest pain or myo/pericarditis with steroids
Can also prevent nephritis
54
Tx for SLE dx relapse in setting of dc of steroids?
Belimumab, asathioprime or cyclophosphamide
55
Tx of Lupus nephritis?
Steroids + MFM or cyclophosphamide
56
Patient with SLE has failed steroid tx with significant organ involvement.. medication to try?
consider MTX
57
Renal dysfunciton and uremia are associated with platelte dysfnx... in pt that is actively bleeding, what can we give them?
IV desmopressin
| You would want to correct plt dysfnx before going into surgery
58
Patient with pleuritic chest pain (decreseases when sitting up) low grade fever. Hear a scratchy sound on CV exam. What is this likely?
What do you see on EKG and echo?
Tx?
acute pericarditis
EKG: diffuse ST seg elevation and PR depression (can be masked if recent MI)
Echo with pericardial effusion
59
RF for acute pericarditis?
| Tx?
RF: viral/idiopathic, autoimmune (SLE), uremia, Post MI (peri-infarct pericarditis... later is Dressler syndrome)
Tx: NSAIDS + colchicineif viral/idiopathic
60
immune mediated pericarditis occurs several weeks follwing MI, present w/ pleuritic chest pain worse inspiration, and typical PE findings
Dressler syndrome
61
Patient had MI in the LAD 3 months ago. Follow up EKG shows persistant ST elevation now with deep Q waves in same leads
Echo shows LV enlargement
pt having symptoms of angina, SOB
Ventricular aneurysm; complication of MI in following weeks to months
62
Tx for peri-infarct pericarditis (PIP)?
| Tx for viral/idiopathy pericarditis?
high dose ASA (NOT other NSAIDS, impair myocardial healing and increase risk of free wall rupture)
NSAIDs + colchicine
63
Elevated___ is a marker for medullary thyroid cancer or can be see in multiple endocrine neoplasia 2A or B.
Calcitonin
| MTC present as palbable nodule
64
MCC of hypercalcemia in o/p setting is ____
primary hyperPTH
| you can seen mild hyperCa in hyperThyroid 2/2 bone turnover
65
What can we see in the legs of patients with GRAVES
pretibial myxedema (thyroid dermopathy)
66
how does subclinical hyothyroidism affect women of childbearing age
recurrent miscarriage, severe preE, preterm delivery, low BW, placental abruption
67
Sudden, seere vision loss w/ temporal sparing, hx of amourosis fugax and see pale fundus w/ cherry spot on exam
Central retinal artery occlusion
68
Prolongued course of vision loss, asymptomatic to severe vision loss and on fundoscopic exam see retinal hemorrhages and optic disc edema (blood and thunder)
Central retinal vein occlusion
69
Increased frequency floaters, photopsias (flashing lights) and exam showing vitreous hemorrhage with elevated retina
retinal detachment, needs surgical repair
70
Visual haziness, floaters and dark streaks, decreased RLR, visible hemorrhage on fundoscopy
vitreous hemorrhage
| bed rest, elevate HOB 30-45 degrees
71
Patient is preganant and dx with asymptomatic strep. agalactiae. What is the next step? What about peripartum prophylaxsis
= GBS!
| Needs treatment now and PCN ppx during labor .
72
Indications for intrapartum prophylaxsis of GBS
GBS bacteriuria or GBS UTI in current pregnancy
GBS + rectovaginal swab
?GBS status if <37 wks gestation, intrapartum fever, ROM >18, prior infant with early onset GBS
73
All patients with new onset heart fail that is unexplained should have ____ done as ____ is second most common etiology
Cardiac stress
Ischemic cardiomyopathy
**these pt has chronic myocardial ischemia that MAY be reversed with cath or revasularization
74
___ is the most common cause of secondary dialated cardiomyopathy..
Next step in evaluation?
Coronary artery disease
| Cardiac stress test or coronary angiography
75
During 24-28 weeks GA, take 50g glucose load, test one hour later. If > ____ you failed and move on to glucose 3hr glucose tolerance test
140
Dx GDM if > 2 or more values
*HA1C not sensitve in pregnancy bc increase in red cell turnover and mass
76
Failed OGG 3 hour test numbers
> ____ @ 1 hr
>____ @ 2 hr
>____@3 hr
180
155
140
77
Pt dx with GDM, exercising regularly and still has elevated BS. What is the next step in management?
Anti-hyperglycemics: Insulin, metformin, glyburide are all safe agents
78
Who requires neisseria meningitis exposure prophylaxsis?
household members, roomates, intimate contacts, persona directly exposed to oral or respiratory secretions (kissing, mouth to mouth, intubation) person sitting next to affected person >8 hrs
79
What antiBx is recommended for N.Men chemoprophylaxsis?
Rifampin (4 doses)
CTX (1 dose IM)
Ciprofloxicin (one orally, not used for kiddos)
80
How do you reverse Warfarin in the setting that pt has active bleed?
Prothrombin complex concentrate (has Vit K dep clotting factors, normalizes INR <10 min after infusion)
Then IV Vit K for sustatined reversal effect but takes 12-24 hrs.
Can you FFP if PCC not available but has a LARGE volume
81
____ can increase levels of circulating factor VIII and von WB in pts with bleeding episodes that have vWB disease or in uremic platelte dysfunction
IV desmopressin (analogue of antidiuretic hormone)
82
______presents as constant dribbling and is from bladder distension with incomplete emptying. You can see neuropathy (decreased sensation) and post voids are usually >150cc. Tx is self cath, correct underlying cause
Overflow incontinence
83
_____and ______are associated with stress urinary intontinence (leakage with increased intraabdominal pressure like cough, sneeze, valsalva) with + bladder stress test (leak with cough
intrinsic sphincter deficiency and urethral hypermobility
84
presents with vulvovaginal atrophy, vulvar irritation, pelvic organ prolapse
GU syndrome of menopause
85
soft single S2
delatey or diminished carotid pulse (parvus et tardus)
Loud and late peaking systolic murmur
Are all significant for??
Signs of severe Aortic Stenosis
86
Pt goes out to eat for sushi.. gets headache,flushed, diarrhea and abdominal cramps with heart palpitations. Usually happens to all diners
Scromboid poisoning.. histatine in certain fishes--> histamine
87
Patient with perioral tingling, incoodination, weakness, neurologic signs ate this weird food
pufferfish
88
____ presents with >3 months dysuria, pelvic pain and pain w/during ejaculation. Should have UA and culture done before and after prostate massage
UA + massage reveals >20leuks
chronic prastatitis
89
What is the difference between chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome?
Same symptoms
bacterial: >20 leuks + culture with pathogen (>10 fold more after massage
CP/CPP with aseptic UA
90
What is the tx for Chronic prostatitis/chronic pelvic pain syndrome
Meds for prostate enlargement (alpha blockers), antiBx, anti-inflammatories, psychotherapy
91
Patient presents with + peritoneal signs, wants to lie flat and motionless, onset of symptoms were sudden. Has hx of severe GERD. What is most likely dx and what are next steps?
Peritonitis from perforation (hx of GERD and ulcer)
| Get upright CXR; if that's unclear then get CT scan
92
Sinus bradycardia and AV block are common and typically seen with_____ infarction.
Treatment is _____ and ____
acute inferior wall MI
| Tx IV atropine and temporary cardiac pacing
93
Elevation in leads II, III and aVF are significant for _____ MI
Complications are sinus bradycardia and AV block
Inferolateral
94
How do patients with cardiogenic syncope present?
LACK of autonomic prodrome (no nausea, pallor or diaphoresis), underlying structural heart disease (ischemic scarring from prior MI, low EF) often cardiogenic syncope due to VT.
95
Patient presents after episode of LOC x3 mins then back to baseline. Prior hx of MI, no neuro hx w/ normal neuro exam. ECG with evidence of prior MI. Likely dx?
Next steps if normal CXR, electrolytes and blood work?
cardiogenic syncope
| admit for telemetry adn echocardiogram
96
What is the treatment for acute coronary syndrome due to non-ST elevateed MI, or unstable angina?
Tx with dual antiplatelet therapy, anticoagulation, B blocker and high intensity statin
97
Patient presents with pulmonary edema, JVD and S3 heart sound. Concerning for?
acute decompensated heart failure
98
Patient presents in acute decompensated HF (JVD, crackles with S3). EKG shows ST depression in leads I, aVL adn V3-6. What is etiology of heart failure? What tx should you do? What do you avoid
Likely from acute coronary syndrome (see non-ST elevation MI, unstable angina)
Tx with dual antiplatelet therapy (asa adn P2Y12 receptor blocker), anticoagulate, high intensity statin and nitrates BUT you do NOT give B-blocker
B-Blockers are contraindicated in decompensated HF bc they can decrease contractility and HR. You can start once heart failure has stabilized.
99
Nitroglycerin decreases cardiac preload, its indicated for pt with angina with ACS as well as for pulmonary edema in pt with ADHF. Which patients should NOT recieve nitroglycerin?
Patients with right ventricular MI (V1-3 and V4R)... it can cause severe hypotension
100
EKG elevated in V2-4, II, III and aVF
STEMI in anterior location
101
What are the diagnostic criteria for Multilple Myeloma? CRAB
monoclonal protein in serum or urine
>10% clonal plasma cells in BM
End organ damage (CRAB)
Ca elevation, Renal insufficiency, Anemia (normocytic), Bone pain
102
70 yr old women presents with back pain, fatigue and difficulty with daily tasks, recently had hip fracture, feels she is getting worse. No focal neuro signs. CBC notable for mild elevation in Ca+, Cr to 2.1 and elevated monocytes. Most concerning for?
Next steps?
Multiple myeloma
Obtain serum and urine protein electrophoresis and BMBx which shows sheets and cluster of plasma cells >10% monoclonal plasma cells
103
When do we see elevated parathyroid hormone protein?
often with hypercalcemia of malignancy. more common in pulmonary malignancy (sq cell carcinoma) consider chest CT
104
_____ is often diagnostic for sarcoidosis
Serum angiotensin converting enzyme
105
You dx patient with multiple myeloma and they are worried about recurrence of bone fractures. What should you order to assist in addressing this concern?
Skeletal x ray series... identify lytic lesions
| Be careful of CT, pt likely has impaired renal function (contrast not good for beans)
106
Patient with mult myeloma presents with blurred vision, epistaxsis, confusion and gingival bleeding. Dx and Tx?
Hyper viscous syndrome
| Tx plasmapheresis
107
```
What are the tx for the following complications of mult myeloma?
HyperCalcemia (anorexia/nausea/constipation/weak)
REnal insufficiency (acute or gradual, cause normocytic anemia and 2/2 to light chain cast (Bence Jone) deposition)
Infections (PNA or UTI often 3-4 month into therapy)
Skeletal lesions (bone pain, frx)
Hypervisous syndrome (nasal/oral bleeds, neuro symptoms, heart fail)
```
1. HyperCa--> hydration and dexamethasone if mild and bisphosphates if severe
2. Renal insuff--> plasmapheresis or dialysis
3. Infection --> PPx antiBx during therapy, vaccines
4. Skeletal lesions--> bisphosphates
5. Hyperviscous syndrome--> plasmapheresis
108
Patient has HA, confusion, blurred vision. Inguinal and cervical LN. Hx of IV drug use and unprotected sex. There is a maculopapular rash on hands and palms. Dx?
Secondary syphilis and signs of early neurosyphilis as well as ocular syphilis.
Treponema palidum
109
Elevated ST in II, III and aVF
Inferior wall MI
| likely right coronary artery
110
When should patients with HIV go on prophylactc antiBx?
CD4 >200 at risk of pneumocystisis pneumonia, take bactrim
| risk of CMV reactivation <100
111
Immunocompromised patient (HIV/solid donar recipient/chemo pt) presents with SOB, hypoxia to 85%, dry cough and fever that has gotten worse over past week. States he hasn't been taking all meds. Which med not taking? What is likely pathogen?
Bactrim
Pneumocystis PNA
Imaging shows diffuse BL reticulonodular infiltrates
112
Patient presents with severe focal spinal pain with point tenderness, neurologic deficits (loss of DTR in LE) and fever.
Most likely dx and what are next diagnostic steps after blood work?
Spinal epidural abscess +/- cord compression
MRI of spine with gadolium (preferred) otherwise CT w/ IV contrast
Tx almost immediately with surgery for cord decompression
113
What electrolyte disturbances can occur 2/2 to loop diuretics?
HypoK, HypoNa
| The low K can lead to paralytic ileus
114
What is the AFI cutoff for oligohydramnios and what are the causes and complications?
AFI <5cm
Causes: preeclampsia, placental abruption, uteroplacental insufficiency, renal anoamlies, NSAID use
complications; MASyndrome, preterm, umbilical cord compression
115
What is the AFI for polyhydramios?
What are the causes?
Complications?
AFI >24
Causes: eso/duo atresia, ancephaly, multiples, congenital infection, mom with GDM
Complications: fetal malposition, umbilical cord prolapse, preterm, PPROM
116
Patient anxiety, agitation, insomnia, LOA. PE mild tachycardia, elevated SBP, idaphoretic and mydriasis. Acting different. Hx of ADHD and family hx bipolar.
Stimulant toxicity
117
____ first line pharmacotherapy for alcohol use disorder
Naltrexone
decreases craving and can be started in patients NOT on opiates that are still drinking
acomprosate is also an option
118
____ is option for alcoholics that can cause a very unpleasant physiologic reaction when EtOH is consumed. only for highly motivated individuals and ideally not if living alone
Disulfiram
| inhibits aldehydre deydrogenase
119
_____ tx depression and smoking cessation but does not help with EtOH use disorder. It does increase risk of seizures
Buproprion
120
_____to tx moderate to severe EtOH withdrawl.
Benzos (like chlordiazepoxide)
121
Woman with dysuria, postvoid dribbling, dysparenuian and an anteiror vaginal mass on pelvic exam
urethral diverticulum
122
Diagnosis of urethral diverticulum?
MRI of pelvis
consider transvaginal US
get a UA and UCx
Tx: surgery, manual decompression, needle aspiration
123
Patients with renal failure or those receiving prolonged infusion of Na nitorprusside are at increased risk for _____ toxicity.
Present with unexplained metabolic acidosis and altered mental status. Flushing (cherry red), cyanosis, arrythmia, tachypnea and pulmonary edema, n/v
Cyanide
124
Patient presents with hypertensive crisis. What are goals of therapy and complications of dropping BP too quickly?
Rapidly lower DBP to 100-105 in 2-6 hours; but total drop should not be more than 25% initial value
--can lead to excessive hypotensive response; cerebral ischemia, MI, seizures
125
Pt with scattered pustules on distal extremities, tenosynovitis; swelling and pain with passive extension in mult joints, polyarthrlagias with fevers. Sexually active
Disseminated gonococcal infection
| Dx NAAT of UG tract (+ N gonorrhea) try to get BCx and joint fluid but not as sensitive. Test and tx for other UTI
126
Tx for gonorrhea
CTX + Azithromycin (for cephalosporin resistant organisms)
127
male comes to office. Has several rows of painless papules on penis, flesh colored and are present on the penile corona or sulcus
Pearly penile papules
128
Patient presents with dyspepsia; abdominal pain, epigastric fullness, nausuea worse with eating. Patient is 70 years old, what is your next step?
Likely GERD, given age (>60) has increased risk of malignancy. Any pt >60 with dyspepsia should have upper endoscopy with Bx to r/o malignancy.
<60 w/o risk factors should test for H.pylori!
129
PT presents with dyspepsia. You test for H.pylori but what alarm features should you watch for that would push towards endoscopy?
progressive dysphagia, Fe deficiency anemia, odynophagia, palpable mass or LN, persistant vomit, FHx of GI malignancy
130
Patients should be started on a statin if LDL is >____
| OR patients that are over 40yeras with this diease
Start if LDL >190
| if >40 with Diabetes
131
How do you determine if a patient should be started on a statin?
You calculate their 10 year atherosclerotic cardiovascular disease risk.
132
What patients have established ASCVD?
```
Pt with Acute coronary syndrome
Stable angina
Arterial revascularization (CABG)
stroke, TIA, PAD
If <75; high intensity statin
If >75: moderate intensity statin
```
133
Patient with smoking hx, erythrocytosis, hematuria raises concern for
Renal cell carcinoma
134
Typical triad of RCC?
Labs?
Next step for workup?
Flank pain, hematuria, palable abdominal mass
erythrocytosis from paraneoplastic syndrome
Get CT of abdomen!
135
Pt with polycythemia, itchiness after shower, hypertension and venous thrombosis.
Dx?
Mutation?
Polycythemia vera
| JAK2 mutation
136
Pt has ehnancing mass of kidney with thickened irregular septa. Initially presented for flank pain and found to have hematuria.
Dx?
Tx?
RCC
Nephrectomy; will look for mets and remove them as well
See bilateral in inherited conditions: VHL, tuberous sclerosis)
137
Polycystic kidney disease inheritance?
Dx?
Treatment?
Autosomal dominant
CT showing BL multiple cystic kidneys; test for PKD gene
Tx ACE inhibitors to reduce chronic renal insufficiency, may eventually need nephrectomy
138
What are the signs and symptoms of nonfunctioning pit adenomas?
What is the best management?
Often from gonadotropin secreting cells of pituitary, have hypogonadism, low gonadotropin levels (low FSH, LH) adn serum alpha subunit elevated.
Tx is transphenoidal surgery
139
Pt presents with prolactin secreting tumor, what is tx?
Dopaminergic meds; like cabergoline
140
Predisposing features to gout?
| What do we see on microscopy for jt aspiration?
diuretics, low dose asa, sugery, trauma, DM, CKD, obesity, highprotien meals, EtOH
monosodium urate crystals; neg birefringent and needle shaped
141
What do we use to treat gout?
| Pt with renal fail?
NSAIDs and oral steroids and colchicine
Use intraarticular steroids in pts that cannot use NSAIDS (renal patients!)
To PREVENT gout flares use allopurinol
142
What pts cannot use colchicine
Pt on azathioprine cannot use this, causes leukopenia
143
What is a side effect of amiodarone?
Hypothyroidism
should check TSH periodicially; every 3-4 mo
pt will have wt gain, fatigue, bradycardia
144
Pt with CKD often devo normocytic anemia 2/2 underproduction of EPO. prior to starting this therapy what needs to be checked?
Iron stores as you can rapidly deplete Fe stores once you start therapy.
145
In tx naive HIV pts, what is expected viral load...
at 4 weeks
at 8-16 weeks
at 16-24 wks
4 wks: <5,000
8-15: <500
16-24: <50
146
Pt is on three antiHTN meds and still having elevated BPs. on exam has bruit on auscultation to left of umbilicus, elevated Cr. What may be going on?
Renovascular disease.
All pts on 3 or more antiHTNs with persistent elevated BPs should be evaluated for 2nd causes of HTN.
-Pt should have a renal duplex doppler US or CT or MRA done
147
Pt with pain, weakness in leg adduction, sensory loss of small area in medial thigh. Often 2/2 to pelvic trauma/surgery
obturator nerve damage
148
Pt with acute foot drop, weakness in foot dosiflexion and eversion as well as paresthesia and sensory loss over dorsum of foot and lateral shing.
Common peroneal nerve injury
| injury at knee, lateral aspect of fibular head
149
Inabilty to extend knee, loss of knee jerk reflex, sensory loss over anterior and medial part of thgh and media aspect of shin and arch of foot
femoral nerve injury
150
Weakness affection most of LE and hamstring. NORMAL hip flexion/adb/add adn knee extension.
Sensory loss over lower leg. Normal knee jerk, no ankle jerk
sciatic nerve injury
151
18 year old with pain in the right femur. Occurs at night, better with NSAIDs
osteoid osteoma
152
Recommended tx for pt with DVT or PE that DONT have cancer?
Factor Xa inhibitor (rivaroxaban)
| If malignancy use LMWH
153
Why don't we prescribe oral Vit K antagonist alone at time of dx of DVT?
Can have transient hypercoagulable state thus need several days of heparin bridging
154
Patient has menopausal hot flashes, on BC pill but needs to stop bc of increased risk for DVT. What is another valid option?
SSRI; citalopram or escitalopram. OR SNRIS like venlafaxine
155
Pt presenting with second episode of dizziness, visual aquity changes, numbness in legs and hyperreflexia. Last time got better w/in a week.
What test will help confirm your suspicions?
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T2 MRI (shows lesions disseminated in time and space); often have optic neuritis (monoccular vision loss, pain w/ eye movement) periventricular white matter lesions
Oligoclonal IgG bands on CSF
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156
Tx for acute flair of MS?
| Tx for chronic maintenance?
Steriods
| Beta interferon or glatiramer acetate
157
Rivastigmine is used for what disease?
mild to moderate Alzheimer dementia, cholinesterase inhibitor
158
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Medication manatement in MS for
Depression:
Spasticity:
Fatigue:
Neuropathic pain
Urge urinary incont:
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Depression: SSRIs
Spasticity: PT, stretch, massage, Baclofen
Fatigue: Amantadine, stimulants, sleep hygiene
Neuropathic pain: gabapentin or duloxetine
Urge urinary incont: Anticholingercis (oxybutynin, tolterodine) fluid restrict
