Medicine 5 Flashcards
1
Q
Major depressive or manic episode and then pyschotic/shizophrenic features outside of mood disturbance
A
schizoaffective disorder
2
Q
Pyschotic symptoms that occur exclusively in setting of mood episodes
A
Major depressive bipolar disorder with psychotic features
3
Q
New onset dementia, patient has macrocytic anemia, disordered gait.
What to test for?
A
Both B12 deficiency and hypothyroidism
4
Q
Pioglitazone or a PPAR-Y agonist has the side effect of:
A
heart failure and fluid retention
5
Q
Gingko biloba is a supplement to boost memory and can cause
A
bleeding and platelet dysfnx
6
Q
SJS is a bad side effect of which drugs
A
antiBx; sulfonamides, aminopenicillins, quinolnes, cephalosporins and anticonvulsants
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)
8
Q
Pt with dilated cardiomyopathy can devo atrial or ventricular arrhythmia and who what on echo
A
dilated LV and reduced LV function
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
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
11
Q
undescended testicle by 6 months requires what treatment
A
orchipexy; optimize fertility and testicular growth
12
Q
When do we defibrilate?
A
Ventricular tachycardia or v fib. not helpful in asystole or PEA
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
14
Q
Pt has symptomatic bradycardia. Tx?
A
Atropine
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
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
17
Q
Pt with green discharge from penis, itchy. unprotected sex. stain + gram neg diplococci
A
Gonogoccal or neisseria gonorrhea
Tx CTX and Azithro
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
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
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
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
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
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
24
Q
Meds that DECREASE metabolism of warfarin.
Should DECREASE warfarin dosing if started on thesea
A
Amiodarone, Azoles, Metronidazole, qunolones, tylenol
25
Meds that INCREASE metabolism of warfarin
| Should INCREASE dosing of warfarin if started on this
OCP, rifampin, phenytoin
| st. johns wart, green leafy veggies
26
Pregnant, in 2nd trimester. Increased white smelly discahrge. Wet mount with epithelial cells with stippled appearance.
Dx and Tx
Clue cells== Bacterial vaginosis
Tx in pregnancy!
Clindamycin or can do metronidazole after 1st trimester
27
Tx of choice for patients with bipolar who are severely depressed with SI and need urgent tx.
Electronic shock therapy
| safe in pregnancy
28
Duration of anticoagulation therapy for patient with provoked (surgery) DVT?
3 months minimum but doesn't need to longer than 6
29
Tx for heart fail class one
No limits of PE. Start an ACE inhibtor or ARB if not tolerated
30
Tx for Class II heart failure; slight limitation on PE with acitvity causing symptoms
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
31
Tx for heart fail class IV; can't do shit w/o symptoms and even at rest
Need transplant and a VAD evaluation
32
Major issue in difficulty finding cross matched blood in pt with hx of multiple transufions is
alloantiB
33
Tx for localized herpes zoster (shingles) when diagnosed w/in 72 hrs of symptoms
what about >72 hrs after symptoms start
Oral antiviral; valcyclovir, acyclovir, Famciclovir
for SEVEN days
if present >72 hrs dont get antivirals; just zinc ointment and pain management
34
health care worker exposed to varicella in patient. They don't have hx of varicella vaccine, next stps?
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
35
Management of pregnant person exposed to varicella w/o hx of getting vaccine or prior vzv illness?
DONT give vaccine, they get VZV immune globulin or antiviral therapy if thats not available
36
Tx for post herpetic neuralgia
Gabapentin, TCA or pregabalin
37
tamoxifen is associated with increased risk of...
uterine sarcoma
38
Initial phase of stroke management presenting AFTER 4.5 hrs symptoms includes
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
39
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?
low T4, low TSH as well as low cortisol concernign for central hypothyroidism as well as other pituitary invovlement
Get ACTH stim test
40
Are helpful in assessing for goiter and primary hypothyroidism (hashimotos/chronic autoimmune)
Antithryoid antibodies
41
Useful in follow up management of pt with differentiated thyroid cancer and to eval pt with suspected factitious thyrotoxicosis
Thyroglobulin levels
42
Head and neck cancers are locally advanced 60% of time at diagnosis and often inoperable. Tx is
chemo and radiation
43
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
Dengue fever; viral infection cases increased capillary permeability and then hemoconcentration with thrombocytopenia and long fever with resp/circulatory fail
44
How long do we wait to give a live vaccine in a patient that receives IVIG for DK
11 months!
45
What is considered anemia for pregnant people?
<11.0 bc have increased blood volume
46
Electrophoresis showing 4 gamma chains
Alpha thal; 4 gamma = Hb Barts
47
Pt with palpitations, and narrow complex tachyarrythmia, vitals otherwise normal and pt is awake and stable
Pt NOT awake or NOT stable
Vagal/Adenosine
| Sedate and synchronized cardioversion
48
MCC postpartum hemorrhage is uterine atony (uterus is soft after delivery).
Tx
uterine massage and oxytocine
49
What is a potential SE of isoniazid that occurs w/i first 2 months of therapy
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
50
HIV with CD4 <250 = risk for:
HIV with CD4 <200 = risk for:
HIV with CD4 <150 = risk for:
HIV with CD4 <50 = risk for:
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
51
Kava kava increases risk for
hepatic injury
52
Ginseng and Gingko increase risk for
bleeding
53
St Johns wark can cause what issues
Drug interactions: antidepressiants (get seratonin syndrome, OCP decreased effectiveness, anticoags (decrease INR) adn digoxin
Can cause hypertensive crisis
54
Ephedra used for performance/memory or cold/flu can cause
HTN, arrythmia/MI/sudden death, stroke and seizure
55
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
Drug induced Lupus
Drugs: hydralazine, procainamide, minocycline, antiTNF alpha like etanercept or infliximab
Tx symptomatic and stoping drug
+ ANA and anti-histone antiB
56
Pt with hematochezia comes in. you suspect lower GI bleed,what needs to be looked at before you proceed with colonoscopy
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
In pt who are hemodynamically unstable OR in whom UGIB is suspected you should do..
EGD first`
58
____ is common cause of brisk painless hematochezia in old people.
____ presents with LLQ pain, fever ans often not bleeding and should NOT have colonscopy
Diverticulosis
Diverticulitis; may perf
59
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?
IV saline or sodium bicarb hydration prior and after infusion and hold NSAIDs
And avoid metformin!
60
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
Sjogrens; cornic autimmuen inflammation; lacrimal and alaivary glands affected
Anti-ro and la antiBodies should be tested and optho exam
61
Pt with Sjogrens are at increased risk for what type of malignancy?
non-hodkins B cell lymphoma
| from chronic activation of inflammation
62
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?
> 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
Common organisms in human bites
| AntiBx
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
First line tx for gout flare
NSAIDS
| can do colchicine if contraindicated for NSAIDS or if tow or more jts involved
65
Acute anemia in SS patient with decreased reticulocytes and PE notable for fatigue but neg abdominal and lung exam, no pain or swelling
Aplastic crisis; acute anemia w/o reticulocyte response; often from Parvo B19
66
Women with primary ovarian insufficiency (<40, hypoestrogenic symtpoms~ hot flashes, elevated FSH and low estrogen) should be treated with...
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
first line agent for post menopausal osteoporosis
Bisphosphonates like risedronate
68
autoimmune disorder; prodrome of itching and uticaria then tense bullae with ertyematous uticarial lesions.
Dx
Tx for mild casesq
Dx with skin biopsy; look for basement membrane antiB
| Tx: topical high potency glucocorticoids
69
Young pt with diabetes, osteoporisis, hypertension, hypoK and metabolic alkalosis with mood swings raises concern for..
screen?
Cushings
| Get overnight dexamethasone suppression test
70
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?
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
What body fluids have low rate of HIV transmission and do not require 3 antiviral PEP?
urine, feces, tears and vomit are NONinfectious
| High risk = blood, semen , vaginal secreations
72
Pt has fetal growth restriction on routine US at 20 weeks. What is recommended management?
What is a concerning sign that requires emergent delivery?
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
Pt in 60s, pain and stiffness in pelvic girdle muscles with intermittent fever and decreased ROM.
ESR >40 and otherwise normal labs.
Polymyalgia rheumatica
Can have pain or focal tenderness in girdle muscle groups
Tx is steroids which often quickly resolves pain
74
Good prognostic features of schizophrenia
acute onset (lack prodrome), older age at onset, positive pyschotic symptoms
75
Good drug for patients with obesity and diabetes; can decrease BS by 20% and help with weight loss and NASH and lowers TGs
Metformin
76
Good for patients with elevated BS and T2DM and NASH but bad bc can cause weight gain
Thiazolidinediones; pioglitazone
77
During pap you have pt with HSIL (high grade sq intraepitheralial lesion). next step management...
Colposcopy or diagnosic excisional procedure; high risk of premalignant/malignant cervical dx regardless of HPV results
78
Tx of febrile neonate <28 days (w/o concern HSV)
| Tx of febrile nenoate >28 days (w/ concerns SBI)
Amp and Gent OR Cefotax; e.coli, GBS
| Ceftraixone or Cefotax (consider vanc if c/f CSF); strep pneumo or neisseria men
79
monoclonal B cell leukemia causing: lymphadenopathy, organomegaly, lymphocytosis and anemia/thrombocytopenia
Median Survival:
Dx or confirmed by:
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
First line tx for uncomplicated acute cystitis in non-pregnant woman
Do we need to culture?
Do they need to be formally assesseed?
Often from E.Coli
| Tx Bactrim 3-5 days or Nitrofurantoin 5 days or Fosfmycin
81
Newborn with neonatal polycythemia or HCT >65% with symptoms should be treated with IV hydration; if not getting better next step?
Partial exchange transfusion
82
Tx for mild inflammatory acne
For moderate inflammatory acne
For severe
Mild: topical retinoids + benzoyl
Moderate: Add topical antiBx
Severe: Add oral antiB
83
Tx for Cystic acne
Moderate:
Severe:
Unresponsive:
Moderate: Topical retinoid + benzoyl + topical antiBx
Severe: Add oral antiBx
Unresponsive: oral isotretinoin
84
Jones criteria
Major
Minor
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
Preferred tx option for low and high risk invasive sq cell skin cancer (SCSC)
Surgery or MOHS
| Radiation, cyrotherapy and electrosurgery are options if inoperable, low risk or don't want surgery
86
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
Esophageal perf or Boerrhaave
Dx: Contrast esophagram with water soluble contrast
Tx emergent surgery; high mortality when associated w/ mediastinitis
87
Licorice supplement can have what neg side effects?
Hypertension
| Hypokalemia
88
Infection with TB is very likely if induraiton is >___mm at 48 hours.
If CXR is negative this is indicative of ____
Next steps?
>10 mm
Latent TB if normal CXR
Latent = noninfectious; go about daily activities. If work in healthcare, immunocompromized, prison, should be offered isoniazid
89
How do we confirm pt previously active TB is no longer infectious?
Once done w/ tx need 3 consecutive acid fast bacilli sputum cx that are negative
90
Pt with cocaine induced MI should be treated with standard MI therapy except_____
When do they get PCI or coronary angiography intervention?
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
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
Antifreeze or ethylene glycol.
| Tx with Fomepizole STAT
92
High suspicion for Subarachnoid hemmorage.
First step Dx?
What if its inconclusive?
CT non contrast
| Next step is LP
93
Bone pain that is at night, not better with NSAIDs. PE is normal; increases concern for
mets in setting of other primary cancer
| If PE normal or you are w/u other source of cancer get radionucleotide bone scan
94
chronic nonproductive cough, worse at night, triggered by exercise, forced expiration, allergen exposure; typically lack wheeze or SOB
cough variant asthma
95
Pt on steroids for prolonged duration should be on..
Ca and Vit D supplementation
| Also may need bone densitometry every year
96
```
Hyponatremia
Serum Osm <275 (hypotonic)
Urine Osm >100
Urine Na >40
Pt with PNA
```
SIADH
can also be from other lung dx like small cell
Meds: carbamazepine, SSRI or NSAID
CNS distrubance: stroke, trauma
97
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?
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
Pt presenting with hypertension and hypoKalemia; increased thrist/urination
Concerning for....
Screen with...
Primary hyperaldosteronims or Conns syndrome
| Screen with plasma aldosterone to plasma renin activity
99
Child with adominal mass, symptoms of weight loss and periodic flushing and sweating. Has HTN.
Neuroblasoma; can compress renal artery--> activate RAS = HTN and you see elevatd urine or serum catecholamines
N-mcy gene amplification
100
Painless hematochezia in pt with hx of diverticular disease
diverticular bleed; stems from vasa recta or exposed small artery of the colon
101
These drugs all cause a common side effect:
| trimethoprim, methotrexate and phenytoin
all interfere with folate metabolis; can get folic acid deficiency anemia which is macrocytic
102
Prevention or treatment of macrocytic anemia in patients taking methotrexate?
Leucovorin or folinic acid
103
inherited disorder with multiple bilateral renal cysts, usually asymptomatic and develop hypertension, hematuria, protenuria, renal insufficiency and flank pain.
Autosomal dominant polycystic kidney disease
Dx made with Ultrasound; if inconclusive may need CT or MRI
genetics not necessary unless inconclusive dx
104
Tx or management for autosomal dominant polycystic kidney disease
Associated risks
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
Preterm labor 34 to 36 6/7 weeks management
+/- Betamethasone and Penicillin if GBS + or unknown
106
Preterm labor 32 to 33 6/7 weeks management
Betamethasone, tocolytic, PCN if GBS +
107
<32 wks preterm labor managment
Betamethasone, tocolytics, Magnesium and PCN
108
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
Dx vibrio vulnificus
| Tx CTX plus Doxycycline
109
subacute or chronic infection from skin inoculation w/ contaminated organ material (soil/moss) and devo uclerative papule with legions along proximal lymph chain
Sporotrichosis
110
Most frequent complication of transurethral resection of the prostate
Retrograde ejaculation
111
First line tx for essential tremor of hands/forearms
| --worsens w/ activity
propranolol, primadone
112
Pt with cranial III palsy; ptosis and anisocoria; location of likely aneurysm
Posterior communicating artery anerusym
113
Best thing to prevent death in pt with HCM
cardioverter/defibrillator
114
Newborn with sensorineural hearing loss, blueberry rash, low birth weight with microcephaly, PDA and cataracts
Rubella
115
Newborn with later findings of hepatomegaly, jaundice, rhinitis
congenital syphillis
116
Newborn with hepatosplenomegaly, purpuric lesions, sensorineural hearing loss. Imaging showing periventricular calcifications
What about intracerebral calcifications
CMV
117
Tx for catatonia in pt with pyschosis or mood disorders
benzos for catatonia
118
Seond stage of labor arrest occurs when...
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
Pain in numbness in wrist and plamr surface of first three digits (thumb/pointer/middle) ...
carpal tunnel syndrome
| D/T pinched median nerve
120
PT with progressive eosphagus and colonic dilation. Also has ventricular apical aneurysm of heart with heart fail.
From Mexico
Chagas
Trypanosoma curzi; mexico or S/C america
see dilated CM as well as conduction anamolies
121
```
Pt with EtOH abuse...
Encephalopathy/confused
Oculomotor dysnfx; lateral rectal palsy
Gait ataxia
Dx and tx
```
Wernickes; thiamine deficiency
Tx with IV thiamine
Can devo over time to Korsocoff = chronic; mammilary body atrophy
122
Pt comes in with hand flapping, jaundice, hx of alcoholic cirrhosis and altered mentation
elevated bili, hypoK, coags elevated, elevated ammonia.. Dx and treatment
hepatic encephalopathy
Correct hypoK which can make hyperammonemia worse, tx hypovolemia; stop diuretics!
Give lactulose and if not responsive then give rifampin
123
Causes of hepatic encepholapthy
Drugs (sedatives, narcotis) hypovolemia (diarrhea), hypoK, GI bleeds, infection (UTI or SBP) and TIPS procedure can increase risk
124
Pt with incidental well demarcated lesion in lobe of liver, shows periopheral enhancement on CT, <5 cm
Pt on OCP
hepatic adenoma
<5cm and no symptoms can stop ocp; if symptoms resect
Complication: rupture with low chance of malignant transformation
125
Key for antibacterial coverage in CF pneumonia
Need Staph coverage
PLUS
2 anti-pseudomonal drgs
126
AntiBx that cover pseudomonas
```
Flouroquinolones: cipro or levofloxicin
Meropenum/impenem
Ceftaz, cefepime
Pip/tazo
Tobi, amikacin, colistin
```
127
Triad of dizziness, vertigo and hearing loss; not necessarily all at the same time
Menieres disease
Tx: diet modification; low salt/caffiene
may trial as needed vasodialator or diuretic
128
Who gets started on bisphophonate therapy?
Osteoporosis =
Osteopenia =
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
Low pitched diastolic rumble at the left lower mid clavicular region preceded by opening snap
mitral stenosi
| MCC rheumatic fever and occurs in 90% ppl with this dx
130
potent acetycholinesterase inhibitors; get excess buildup of acetylcholine in synapses--> cholinergic toxicity
Diarrhea, urination, miosis, bradycardia, emesis, tearing and salivation
Organophosphate poisoning
see on farms
Need atropine and pralidoxime to reverse
131
What type of enema do we use for intussusepction treatment?
```
AIR ENEMA
(don't use barium as much bc of risk for peritonitis)
```
