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Medicine 5 Flashcards

1
Q

Major depressive or manic episode and then pyschotic/shizophrenic features outside of mood disturbance

A

schizoaffective disorder

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2
Q

Pyschotic symptoms that occur exclusively in setting of mood episodes

A

Major depressive bipolar disorder with psychotic features

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3
Q

New onset dementia, patient has macrocytic anemia, disordered gait.
What to test for?

A

Both B12 deficiency and hypothyroidism

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4
Q

Pioglitazone or a PPAR-Y agonist has the side effect of:

A

heart failure and fluid retention

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5
Q

Gingko biloba is a supplement to boost memory and can cause

A

bleeding and platelet dysfnx

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6
Q

SJS is a bad side effect of which drugs

A

antiBx; sulfonamides, aminopenicillins, quinolnes, cephalosporins and anticonvulsants

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7
Q

Pt in 20s with intermittent heart palpitations and dyspnea with exercise, hear mid systolic murmur in the LUSB and wide, fixed splitting of second heart sound. Echo shows Rt atrial and ventricular dilation and now pt has atrial arrhythmia

A

ASD; 2nd most common congenital heart defect in adults (after bicuspic aortic valve)

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8
Q

Pt with dilated cardiomyopathy can devo atrial or ventricular arrhythmia and who what on echo

A

dilated LV and reduced LV function

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9
Q

Pt has harsh crescendo-descresendo systolic murmur at the apex of LLSB; gets louder with Valsalva and when rising from sitting to squatting. Echo w/ LV hypertrophy

A

Hypertrophic cardiomyopathy; see asymmetric hypertrophy of septum

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10
Q

Pt with harsh holosystolic murmur, best heard over left 3/4th intercostal space with thrill.

A

VSD; if large can get R–> L shunt with ventricle dilation and pulmonary over circulation

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11
Q

undescended testicle by 6 months requires what treatment

A

orchipexy; optimize fertility and testicular growth

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12
Q

When do we defibrilate?

A

Ventricular tachycardia or v fib. not helpful in asystole or PEA

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13
Q

____ used for patients that are stable with regular wide complex tachycardia or consider in pt with pulseless VT or VF not responding to defibrillation

A

Amiodarone

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14
Q

Pt has symptomatic bradycardia. Tx?

A

Atropine

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15
Q

How does lyme arthritis present?

What labs need to be obtained?

A

hx of tick bite, get joint patin and swelling several months later. synovial fluid shows WBC ~20-50,000 count and usually is knee involvement. Kids are afebrile, can bear weight.
Need to get enzyme linked immunosorbent assay and confirm with Western Blot. IgG + for B burgdorferi
Tx 28 day of doxycycline or amoxicillin with good recover

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16
Q

Man with watery discharge from penis, itchy and burning with pee. Urethral stain is aseptic with lots of leukocytes.
Likely dx and tx

A

Nongonococcal urethrithis
LIkely chlamydia (or mycoplamsa genitaleium or trich)
Tx 1g Azithro

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17
Q

Pt with green discharge from penis, itchy. unprotected sex. stain + gram neg diplococci

A

Gonogoccal or neisseria gonorrhea

Tx CTX and Azithro

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18
Q

Patient has TSH < 0.1 with normal T3/4 and asymptomatic.

What is recommended for management

A

Subclinical thyrotoxicosis

Need treatment IF: >65, heart disease, OA, nodular thyroid disease

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19
Q

Pt has TSH of 0.2, normal T3/4, no symptoms.

A

Pt with mildly suppressed TSH from 0.1 to 0.5 often have spontaneous recovery from subclincal thyrotoxocosis, monitor their levels

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20
Q

Pt comes in with presentation and PE consistent with guillain Barre. What quick bedside measurement should be obtained quickly on these patients?

A

Vital capacity or negative inspiratory pressure (NIF) d/t high risk of respiratory failure; get every 4 hours

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21
Q

What is tx for Guillain Barre?

A

IVIG or plasma exchange (don’t need both) and supportive cares
- do this if nonambulatory OR present w/i 4 weeks of onset

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22
Q

Definition of symptomatic carotid artery disease?

A

Pt with TIA or nondisabling stroke with high grade (70-99%) stenosis.
These pts should get carotid stenting done if life expectancy >5 years and are surgical canditates

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23
Q

Pt is in 30s, presents with acute chest pain, SOB, diaphoresis. He is hypoT, tachy. PE notable for systolic decrescendo murmur at apex, S1 is barely audible and S2 normal. with crackles in lungs.
ECG with PVC and tachycardia.
PE notable for velvety skin and hypermobile joints

A

Acute mitral regurg 2/2 to MVP; has chordae tendon rupture and is NON- MI related; pt had ehlers danlos
Tx: echo and surgery

*You get acute mitral regurn 2/2 to papillary msl rupture but thats from MI and seen in older pt with CAD

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24
Q

Meds that DECREASE metabolism of warfarin.

Should DECREASE warfarin dosing if started on thesea

A

Amiodarone, Azoles, Metronidazole, qunolones, tylenol

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25
Q

Meds that INCREASE metabolism of warfarin

Should INCREASE dosing of warfarin if started on this

A

OCP, rifampin, phenytoin

st. johns wart, green leafy veggies

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26
Q

Pregnant, in 2nd trimester. Increased white smelly discahrge. Wet mount with epithelial cells with stippled appearance.
Dx and Tx

A

Clue cells== Bacterial vaginosis
Tx in pregnancy!
Clindamycin or can do metronidazole after 1st trimester

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27
Q

Tx of choice for patients with bipolar who are severely depressed with SI and need urgent tx.

A

Electronic shock therapy

safe in pregnancy

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28
Q

Duration of anticoagulation therapy for patient with provoked (surgery) DVT?

A

3 months minimum but doesn’t need to longer than 6

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29
Q

Tx for heart fail class one

A

No limits of PE. Start an ACE inhibtor or ARB if not tolerated

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30
Q

Tx for Class II heart failure; slight limitation on PE with acitvity causing symptoms

A

ACE inhibitor + Diuretic thearpy
+B blocker if EF <40% once euvolemic
Spironolactone if EF <35% if stable renal fnx and K
Defibrilator if EF <30%
***consider isosorbide dinitrate/hydralazine if african american

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31
Q

Tx for heart fail class IV; can’t do shit w/o symptoms and even at rest

A

Need transplant and a VAD evaluation

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32
Q

Major issue in difficulty finding cross matched blood in pt with hx of multiple transufions is

A

alloantiB

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33
Q

Tx for localized herpes zoster (shingles) when diagnosed w/in 72 hrs of symptoms
what about >72 hrs after symptoms start

A

Oral antiviral; valcyclovir, acyclovir, Famciclovir
for SEVEN days
if present >72 hrs dont get antivirals; just zinc ointment and pain management

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34
Q

health care worker exposed to varicella in patient. They don’t have hx of varicella vaccine, next stps?

A

If they had prior hx of varicella infection; they’re good

If NO hx of VZV illness or vaccine; get varicella vaccine w/i 5 days of exposure

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35
Q

Management of pregnant person exposed to varicella w/o hx of getting vaccine or prior vzv illness?

A

DONT give vaccine, they get VZV immune globulin or antiviral therapy if thats not available

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36
Q

Tx for post herpetic neuralgia

A

Gabapentin, TCA or pregabalin

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37
Q

tamoxifen is associated with increased risk of…

A

uterine sarcoma

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38
Q

Initial phase of stroke management presenting AFTER 4.5 hrs symptoms includes

A

ASA, high dose statins, low dose subQ heparin (to prevent PE/DVT complication) and permissive hypertension and then manage BP after acute phase has passed
*get swallow study to make sure its safe

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39
Q

Pt comes in with weight loss, lethargy, N/V. Pale, thin. TSH is 0.3 (nml >1.0) and T4 and T3 are low. AM serum cortisol is low.
Concerning for?

A

low T4, low TSH as well as low cortisol concernign for central hypothyroidism as well as other pituitary invovlement
Get ACTH stim test

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40
Q

Are helpful in assessing for goiter and primary hypothyroidism (hashimotos/chronic autoimmune)

A

Antithryoid antibodies

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41
Q

Useful in follow up management of pt with differentiated thyroid cancer and to eval pt with suspected factitious thyrotoxicosis

A

Thyroglobulin levels

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42
Q

Head and neck cancers are locally advanced 60% of time at diagnosis and often inoperable. Tx is

A

chemo and radiation

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43
Q

Pt with fluelike illness, fever, horrible myalgias and bone and with retoortibal pain.
Increased vascular permeability, thrombocytopenia and increased risk of spont bleeding and shock
Travel

A

Dengue fever; viral infection cases increased capillary permeability and then hemoconcentration with thrombocytopenia and long fever with resp/circulatory fail

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44
Q

How long do we wait to give a live vaccine in a patient that receives IVIG for DK

A

11 months!

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45
Q

What is considered anemia for pregnant people?

A

<11.0 bc have increased blood volume

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46
Q

Electrophoresis showing 4 gamma chains

A

Alpha thal; 4 gamma = Hb Barts

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47
Q

Pt with palpitations, and narrow complex tachyarrythmia, vitals otherwise normal and pt is awake and stable
Pt NOT awake or NOT stable

A

Vagal/Adenosine

Sedate and synchronized cardioversion

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48
Q

MCC postpartum hemorrhage is uterine atony (uterus is soft after delivery).
Tx

A

uterine massage and oxytocine

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49
Q

What is a potential SE of isoniazid that occurs w/i first 2 months of therapy

A

hepatotoxicity adn be mild up to hepatitis; need baseline and monitoring of LFTs
Also can get B6 deficiency; but should be Rx pyridoxine (B6) with treatment to prevent this

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50
Q

HIV with CD4 <250 = risk for:
HIV with CD4 <200 = risk for:
HIV with CD4 <150 = risk for:
HIV with CD4 <50 = risk for:

A

HIV with CD4 <250 = risk for: Coccidiomycosis
HIV with CD4 <200 = risk for: Pneumocystasis
HIV with CD4 <150 = risk for: Histoplasmosis
HIV with CD4 <100 = risk for : Toxo and Cyprtococcus
HIV with CD4 <50 = risk for: Mycobacterium avium

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51
Q

Kava kava increases risk for

A

hepatic injury

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52
Q

Ginseng and Gingko increase risk for

A

bleeding

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53
Q

St Johns wark can cause what issues

A

Drug interactions: antidepressiants (get seratonin syndrome, OCP decreased effectiveness, anticoags (decrease INR) adn digoxin
Can cause hypertensive crisis

54
Q

Ephedra used for performance/memory or cold/flu can cause

A

HTN, arrythmia/MI/sudden death, stroke and seizure

55
Q

Pt with fever, malaise, myalgias and arthralgias with serositis (pleural effusions, cardiac effusions) was recently started on many meds for heart failure and test is positive for ANA

A

Drug induced Lupus
Drugs: hydralazine, procainamide, minocycline, antiTNF alpha like etanercept or infliximab
Tx symptomatic and stoping drug
+ ANA and anti-histone antiB

56
Q

Pt with hematochezia comes in. you suspect lower GI bleed,what needs to be looked at before you proceed with colonoscopy

A

Make sure stable; should have normal BUN/Cr ratio, bilious fluid w/o blood should be aspirated on NG exam
Then can do colonscopy
IF negative then do EGD
If thats negative and pt contiues to bleed angiography

57
Q

In pt who are hemodynamically unstable OR in whom UGIB is suspected you should do..

A

EGD first`

58
Q

____ is common cause of brisk painless hematochezia in old people.
____ presents with LLQ pain, fever ans often not bleeding and should NOT have colonscopy

A

Diverticulosis

Diverticulitis; may perf

59
Q

Patients at risk of contrast induced nephropathy (pt with CKD, >75 years old, reduced renal perfusion or high contrast load) should have what steps taken prior to Constrast infusion?

A

IV saline or sodium bicarb hydration prior and after infusion and hold NSAIDs
And avoid metformin!

60
Q

Pt comes in with submandibular unilateral mass. Hx of reurrent cavities, and muslce aches/pains. She gets frequent bl ocular symptoms of gritty inflamed dry eyes.
PE and vitals are otherwise nml

A

Sjogrens; cornic autimmuen inflammation; lacrimal and alaivary glands affected
Anti-ro and la antiBodies should be tested and optho exam

61
Q

Pt with Sjogrens are at increased risk for what type of malignancy?

A

non-hodkins B cell lymphoma

from chronic activation of inflammation

62
Q

Tetanus/diptheria toxoid vaccines should be given to pt with severe or dirty woulds who got most recent vaccine more than ___ years ago and more than ____years if minor wound
Who gets the tetanus immune globulin?

A

> 5 years with dirty wound
10 years with minor wound

People with severe wound who is unimmunized, unsure of immunization hx or incomplete (<3 doses) of tetanus vaccine

63
Q

Common organisms in human bites

AntiBx

A

Eikenella corrodens, Alpha hemolytic strep (viridians) Staph aureus or fusobacterium
Tx is clean, keep open and give Amox-Clavulanate for anaerob and aerobic coverage

64
Q

First line tx for gout flare

A

NSAIDS

can do colchicine if contraindicated for NSAIDS or if tow or more jts involved

65
Q

Acute anemia in SS patient with decreased reticulocytes and PE notable for fatigue but neg abdominal and lung exam, no pain or swelling

A

Aplastic crisis; acute anemia w/o reticulocyte response; often from Parvo B19

66
Q

Women with primary ovarian insufficiency (<40, hypoestrogenic symtpoms~ hot flashes, elevated FSH and low estrogen) should be treated with…

A

Estrogen AND progestin replacement if uterus is intact to reduce risk endometrial cancer
POST menopausal shouldn’t be on progesterone/estrogen dt increased risk of thromboembolism/CAD

67
Q

first line agent for post menopausal osteoporosis

A

Bisphosphonates like risedronate

68
Q

autoimmune disorder; prodrome of itching and uticaria then tense bullae with ertyematous uticarial lesions.
Dx
Tx for mild casesq

A

Dx with skin biopsy; look for basement membrane antiB

Tx: topical high potency glucocorticoids

69
Q

Young pt with diabetes, osteoporisis, hypertension, hypoK and metabolic alkalosis with mood swings raises concern for..
screen?

A

Cushings

Get overnight dexamethasone suppression test

70
Q

Young man comes in for routine exam, find a 2/6 midsystolic murmur at LUSB. Nothing else on PE, completely asymptomatic with exercise.
Echo confirms bicuspid aortic valve.
Next steps?

A

Auto. Dominant;more in males and 30% Turner pts
Dx echo and screen all first degree relatives
Complications: infective endocarditis, regurg or stenosis, aortic root or ascending aortic dilation, dissection
Management: echo q1-2 years

71
Q

What body fluids have low rate of HIV transmission and do not require 3 antiviral PEP?

A

urine, feces, tears and vomit are NONinfectious

High risk = blood, semen , vaginal secreations

72
Q

Pt has fetal growth restriction on routine US at 20 weeks. What is recommended management?
What is a concerning sign that requires emergent delivery?

A

US with EFW <10% for GA
Weekly umbilical artery doppler and q3 week growth measurements
Absent or reversed umbilcal artery end-diastolic flow sign of impending fetal hypoxia–> deliver!

73
Q

Pt in 60s, pain and stiffness in pelvic girdle muscles with intermittent fever and decreased ROM.
ESR >40 and otherwise normal labs.

A

Polymyalgia rheumatica
Can have pain or focal tenderness in girdle muscle groups
Tx is steroids which often quickly resolves pain

74
Q

Good prognostic features of schizophrenia

A

acute onset (lack prodrome), older age at onset, positive pyschotic symptoms

75
Q

Good drug for patients with obesity and diabetes; can decrease BS by 20% and help with weight loss and NASH and lowers TGs

A

Metformin

76
Q

Good for patients with elevated BS and T2DM and NASH but bad bc can cause weight gain

A

Thiazolidinediones; pioglitazone

77
Q

During pap you have pt with HSIL (high grade sq intraepitheralial lesion). next step management…

A

Colposcopy or diagnosic excisional procedure; high risk of premalignant/malignant cervical dx regardless of HPV results

78
Q

Tx of febrile neonate <28 days (w/o concern HSV)

Tx of febrile nenoate >28 days (w/ concerns SBI)

A

Amp and Gent OR Cefotax; e.coli, GBS

Ceftraixone or Cefotax (consider vanc if c/f CSF); strep pneumo or neisseria men

79
Q

monoclonal B cell leukemia causing: lymphadenopathy, organomegaly, lymphocytosis and anemia/thrombocytopenia
Median Survival:
Dx or confirmed by:

A

Chronic lymphocytic leukemia
thromboycyopenia/anemia/organomegaly worse pronosis
Dx with Severe lymphocytosis + smudge cells flow cytometry and can get LN bx but not often needed

80
Q

First line tx for uncomplicated acute cystitis in non-pregnant woman
Do we need to culture?
Do they need to be formally assesseed?

A

Often from E.Coli

Tx Bactrim 3-5 days or Nitrofurantoin 5 days or Fosfmycin

81
Q

Newborn with neonatal polycythemia or HCT >65% with symptoms should be treated with IV hydration; if not getting better next step?

A

Partial exchange transfusion

82
Q

Tx for mild inflammatory acne
For moderate inflammatory acne
For severe

A

Mild: topical retinoids + benzoyl
Moderate: Add topical antiBx
Severe: Add oral antiB

83
Q

Tx for Cystic acne
Moderate:
Severe:
Unresponsive:

A

Moderate: Topical retinoid + benzoyl + topical antiBx
Severe: Add oral antiBx
Unresponsive: oral isotretinoin

84
Q

Jones criteria
Major
Minor

A

Major JONES:
Joints, carditis, Nodules (subQ) Erythema marginatm, sydenham chorea
Minor: fever, arthralgias, elevated ESR/CRP, prolong PR
Late: Mitral regurg/stenosis
Start on Penicillin for GAS (pyogenes) and continue til adulthood

85
Q

Preferred tx option for low and high risk invasive sq cell skin cancer (SCSC)

A

Surgery or MOHS

Radiation, cyrotherapy and electrosurgery are options if inoperable, low risk or don’t want surgery

86
Q

Pt presents after episode of forceful retching, small amt of hematemesis, know has acute retrosternal chest pain, PE with mild epigastric tenderness, flat neck veins and pt is pale and diaphoretic.
CXR with small left sided pleural effusion.
Dx
Tx

A

Esophageal perf or Boerrhaave
Dx: Contrast esophagram with water soluble contrast
Tx emergent surgery; high mortality when associated w/ mediastinitis

87
Q

Licorice supplement can have what neg side effects?

A

Hypertension

Hypokalemia

88
Q

Infection with TB is very likely if induraiton is >___mm at 48 hours.
If CXR is negative this is indicative of ____
Next steps?

A

> 10 mm
Latent TB if normal CXR
Latent = noninfectious; go about daily activities. If work in healthcare, immunocompromized, prison, should be offered isoniazid

89
Q

How do we confirm pt previously active TB is no longer infectious?

A

Once done w/ tx need 3 consecutive acid fast bacilli sputum cx that are negative

90
Q

Pt with cocaine induced MI should be treated with standard MI therapy except_____
When do they get PCI or coronary angiography intervention?

A

No beta blockers= unopposed alpha 1 receptor mediated vasoCx; can do IV benzos to reduce sympathetic outflow and coronary vasoCx and give ASA early
Get PCI if persistant ST elevation not getting better with initial medical therapy

91
Q

Ingesiton with this leads to severe anion gap MA, rapid and deep breathing as well as n/v, ataxia, nystagmus, lethargy–> get worse with pulm edema, AMS and progressive coma. More common in little kids; accident

A

Antifreeze or ethylene glycol.

Tx with Fomepizole STAT

92
Q

High suspicion for Subarachnoid hemmorage.
First step Dx?
What if its inconclusive?

A

CT non contrast

Next step is LP

93
Q

Bone pain that is at night, not better with NSAIDs. PE is normal; increases concern for

A

mets in setting of other primary cancer

If PE normal or you are w/u other source of cancer get radionucleotide bone scan

94
Q

chronic nonproductive cough, worse at night, triggered by exercise, forced expiration, allergen exposure; typically lack wheeze or SOB

A

cough variant asthma

95
Q

Pt on steroids for prolonged duration should be on..

A

Ca and Vit D supplementation

Also may need bone densitometry every year

96
Q 
Hyponatremia
Serum Osm <275 (hypotonic)
Urine Osm >100
Urine Na >40
Pt with PNA
A

SIADH
can also be from other lung dx like small cell
Meds: carbamazepine, SSRI or NSAID
CNS distrubance: stroke, trauma

97
Q

Calcitonin is elevated in Medullar thyroid cancer; after removal of thyroid, we recheck calcitonin levels at least 2 months later. Should US neck and PE including levels of CTN, CEA, TFT/TSH every 6-12 months
Calcitonin Level elevated but <150; next step?
Level undetectable, next step?

A

CT or MRI of neck/check and abdomen or bone scan if c/f skeletal mets
Not detected; eval q6 mo for a year then annually

98
Q

Pt presenting with hypertension and hypoKalemia; increased thrist/urination
Concerning for….
Screen with…

A

Primary hyperaldosteronims or Conns syndrome

Screen with plasma aldosterone to plasma renin activity

99
Q

Child with adominal mass, symptoms of weight loss and periodic flushing and sweating. Has HTN.

A

Neuroblasoma; can compress renal artery–> activate RAS = HTN and you see elevatd urine or serum catecholamines
N-mcy gene amplification

100
Q

Painless hematochezia in pt with hx of diverticular disease

A

diverticular bleed; stems from vasa recta or exposed small artery of the colon

101
Q

These drugs all cause a common side effect:

trimethoprim, methotrexate and phenytoin

A

all interfere with folate metabolis; can get folic acid deficiency anemia which is macrocytic

102
Q

Prevention or treatment of macrocytic anemia in patients taking methotrexate?

A

Leucovorin or folinic acid

103
Q

inherited disorder with multiple bilateral renal cysts, usually asymptomatic and develop hypertension, hematuria, protenuria, renal insufficiency and flank pain.

A

Autosomal dominant polycystic kidney disease
Dx made with Ultrasound; if inconclusive may need CT or MRI
genetics not necessary unless inconclusive dx

104
Q

Tx or management for autosomal dominant polycystic kidney disease
Associated risks

A

Aggressive BP control with ACE inhibitors for HTN
Control risk factors for CV and CKD; consider hemodialysis, renal transplant for ESRD
Extrarenal features: cerebral aneurysms, hepatic/pancreatic cyst, MVP or AR, diverticulosis, hernias

105
Q

Preterm labor 34 to 36 6/7 weeks management

A

+/- Betamethasone and Penicillin if GBS + or unknown

106
Q

Preterm labor 32 to 33 6/7 weeks management

A

Betamethasone, tocolytic, PCN if GBS +

107
Q

<32 wks preterm labor managment

A

Betamethasone, tocolytics, Magnesium and PCN

108
Q

Bacteria infection causing gram negative, free living marine environment; can get from ingestion (oysters) or wound infection, increased risk in those with liver dx
Rapidly progressive (<12 hrs), septicemia (shock), cellulitis
*hemorrhagic bullae, necrotizing fascitiitis

A

Dx vibrio vulnificus

Tx CTX plus Doxycycline

109
Q

subacute or chronic infection from skin inoculation w/ contaminated organ material (soil/moss) and devo uclerative papule with legions along proximal lymph chain

A

Sporotrichosis

110
Q

Most frequent complication of transurethral resection of the prostate

A

Retrograde ejaculation

111
Q

First line tx for essential tremor of hands/forearms

–worsens w/ activity

A

propranolol, primadone

112
Q

Pt with cranial III palsy; ptosis and anisocoria; location of likely aneurysm

A

Posterior communicating artery anerusym

113
Q

Best thing to prevent death in pt with HCM

A

cardioverter/defibrillator

114
Q

Newborn with sensorineural hearing loss, blueberry rash, low birth weight with microcephaly, PDA and cataracts

A

Rubella

115
Q

Newborn with later findings of hepatomegaly, jaundice, rhinitis

A

congenital syphillis

116
Q

Newborn with hepatosplenomegaly, purpuric lesions, sensorineural hearing loss. Imaging showing periventricular calcifications
What about intracerebral calcifications

A

CMV

117
Q

Tx for catatonia in pt with pyschosis or mood disorders

A

benzos for catatonia

118
Q

Seond stage of labor arrest occurs when…

A

no fetal descent (change in station) after nulliparous puses for 3 hours w/o epidurial (4 hrs w/ epidural) management is C-section
*can only do operative vaginal delivery if station 0 or less

119
Q

Pain in numbness in wrist and plamr surface of first three digits (thumb/pointer/middle) …

A

carpal tunnel syndrome

D/T pinched median nerve

120
Q

PT with progressive eosphagus and colonic dilation. Also has ventricular apical aneurysm of heart with heart fail.
From Mexico

A

Chagas
Trypanosoma curzi; mexico or S/C america
see dilated CM as well as conduction anamolies

121
Q 
Pt with EtOH abuse... 
Encephalopathy/confused
Oculomotor dysnfx; lateral rectal palsy
Gait ataxia
Dx and tx
A

Wernickes; thiamine deficiency
Tx with IV thiamine
Can devo over time to Korsocoff = chronic; mammilary body atrophy

122
Q

Pt comes in with hand flapping, jaundice, hx of alcoholic cirrhosis and altered mentation
elevated bili, hypoK, coags elevated, elevated ammonia.. Dx and treatment

A

hepatic encephalopathy
Correct hypoK which can make hyperammonemia worse, tx hypovolemia; stop diuretics!
Give lactulose and if not responsive then give rifampin

123
Q

Causes of hepatic encepholapthy

A

Drugs (sedatives, narcotis) hypovolemia (diarrhea), hypoK, GI bleeds, infection (UTI or SBP) and TIPS procedure can increase risk

124
Q

Pt with incidental well demarcated lesion in lobe of liver, shows periopheral enhancement on CT, <5 cm
Pt on OCP

A

hepatic adenoma
<5cm and no symptoms can stop ocp; if symptoms resect
Complication: rupture with low chance of malignant transformation

125
Q

Key for antibacterial coverage in CF pneumonia

A

Need Staph coverage
PLUS
2 anti-pseudomonal drgs

126
Q

AntiBx that cover pseudomonas

A 
Flouroquinolones: cipro or levofloxicin
Meropenum/impenem
Ceftaz, cefepime
Pip/tazo
Tobi, amikacin, colistin
127
Q

Triad of dizziness, vertigo and hearing loss; not necessarily all at the same time

A

Menieres disease
Tx: diet modification; low salt/caffiene
may trial as needed vasodialator or diuretic

128
Q

Who gets started on bisphophonate therapy?
Osteoporosis =
Osteopenia =

A

osteoporosis = T score < -2.5 on DXA

osteopenia: T score btwn -1 to -2.5 AND a 10 year probability for major osteoporotic fracture >20% or hip frx >3%

129
Q

Low pitched diastolic rumble at the left lower mid clavicular region preceded by opening snap

A

mitral stenosi

MCC rheumatic fever and occurs in 90% ppl with this dx

130
Q

potent acetycholinesterase inhibitors; get excess buildup of acetylcholine in synapses–> cholinergic toxicity
Diarrhea, urination, miosis, bradycardia, emesis, tearing and salivation

A

Organophosphate poisoning
see on farms
Need atropine and pralidoxime to reverse

131
Q

What type of enema do we use for intussusepction treatment?

A 
AIR ENEMA
(don't use barium as much bc of risk for peritonitis)

Step 3 Prep (7 decks)

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