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Step 3 Prep > Medicine 6 > Flashcards

Medicine 6 Flashcards

1
Q

Pt with clinically stable with unstable angina OR pt with non-ST elevated MI are low risk. After starting recommended therapies at hospital what is recommended for tx?
What if Intermediate or high risk?

A

Cardiac stress test

Early coronary angiography

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2
Q

MCC of sudden death in MVC when blunt trauma with steering wheel.

A

aortic rupture

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3
Q

Procedures that require antiBx PPx if patient has prosthetic valve

A

Dental surgery
GI or GU procedure in setting of active infection
Surgery on infected skin or muscle
Surgical replacement of prosthetic cardiac material

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4
Q

Superficial skin infection of the dermis; infected lymph nodes surrounding infection, very sharply demarcated borders, rapid onset and spread of infection
Pt has fevers and chills

A

Erysipelas

Most often Strep Pyogenes

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5
Q

Infection involved skin; deep dermis and subQ fat, ill defined and flat borders that develops over days

A

Cellulitis

S. pyogenes and MSSA

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6
Q

Infertility; or not being able to conceive >12 mo of appropriately time intercourse require which step in initial eval?

A

Semen analysis

IF hx of irregular menses; then confirm ovulation

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7
Q

Seen in pt with other autoimmune dx; can have loss of or changed sensation like numbness/tingling in the lower extremities; may have loss of reflexes.
Pt with macrocytic anemia on smear

A

pernicious anemia resulting in Vit B12 deficiency

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8
Q

Hx of two prior second trimester losses that were painless. Hx of cervical conization
What may prevent a subsequent loss

A

Cerclage placement for cervical insufficiency

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9
Q

Pt with scant hematemesis, EGD showing gastric varices, no esophageal. Hx of pancreatitis and EtOH abuse

A

Splenic vein thromobsis; leads to left sided portal HTN and congestive splenomegaly w/ congestive splenomegaly

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10
Q

Significant predictor of adverse cardiovascular outcomes especially women

A

Diabetes

Even more so than smoking

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11
Q

Treatment of choice for keloids

A

intralesional gulcocorticoids

can use slilcone gel sheeting to reduce symptoms

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12
Q

What eye drops should we prescribe for typical bacterial conjuctivitis?
What about contact wearers?

A

Erythromycin (macrolide) or Bactrim

If contact; rx fluoroquinolone drops or cipro/oxofloxacin (more common to have pseudomonal involvement)

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13
Q

Complication of bacterial conjuctivitis in contact lens wearers?

A

Keratitis from PSA; must urgently see optho; can lead to scrring and blindess; will likely do slit lamp with florosceie

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14
Q

Tx option for bone pain 2/2 to mets in pt with metastatic prostate cancer not responding to hormone therapy

A

radiation

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15
Q

PT with fever, jaundice and leukocytosis with biliary dilation on US

A

Criteria for acute cholangitis

Perform urgent ERCP to confirm and tx

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16
Q

Gout flare;

A

1st line is NSAIDS and colchicine (avoid if renal fail)
2nd line if monoarticular use systemic (better in pt w/ diabetes or hx of bleeds bc no systemic steroids)
3rd line is oral steroids if multiple joints

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17
Q

PT with dysphagia to solids and liquids; occational. Has chest pain when this happens. No wt loss or hx of smoking. Normal barium study, manometry shows premature and simultaneous contractions of the distal esophagus, lower esophagus is normal
Dx?
Tx?

A

Diffuse esophageal spasm; see corkscrew pattern on esophogram
Calcium channel blockers; may try nitrates or tricyclics

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18
Q

Immunocompromised pt, hemoptysis, peluritic chest pain and cough. They have been on steroids for past several months. CT shows nodular disease w/ ground glass opaciites and cavitation

A

Aspergillosis

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19
Q

Pt immunocompromosed, not on ppx meds. cough and fever, CT with diffuse interstitial pulmonary infiltrates and resp failure

A

Pneumocystisis

should be on Bactrim

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20
Q

Pt presents with cough, c/p and hemoptysis. Nodular or interstitial infiltrate on CXR. Has high fever, diarrhea/vomitting

A

Legionella, levofloxicin

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21
Q

Acute presynaptic neuromuscular jnx disorder; inhibits releasease of acetylcholine to cleft in autonomic and somatic NS.
What is this
How do patients present?

A

Botulism
Present acute bulbar and descending limb weakness; absent reflexes and autonimc dysnfx; preserved sensation.
Sluggish pupils

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22
Q

Autoimmune postsynaptic NMJ dxx; from antibodies in acetylcholine receptor; pt present with fatigue, fluctuating weakness (arms>legs) ptosis, dipolpia and dsyarthria as well as dysphagia

A

Myasthenia gravis

can have bulbar symptoms; ALWAYS spares pupils

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23
Q

Pt with illness then two weeks later has ascending muscle numbness/weakness–> later respiratory and bulbar involvement

A

Guillain barre

Acute autoimmune demyleniating polyradiculoneuropathy; often preseceded by respiratory or campylobacter illness

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24
Q

Newborn with macrocephaly, diffuse intracranial calcifications, juandice and hepatosplenomegaly
can have blueberry muffin rash and chorioretinitis with hearing impairement

A

Toxo

tx pyrimethamine, slfadiazine, folate

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25
Q

Congenital heart defect, cataracts and hearing impairement in newborn

A

congenital rubella

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26
Q

Consequences of untreated hyperthyroidism

A

arrythmia; a fib, dilated cardiomyopathy

Osteroporosis as TSH stims calcium and phosphate release from bone

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27
Q

Tx for Raynauds

A

Calcium channel blocker

Amplodipine, Nifedipine

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28
Q

Tx for patient with MDD, partial responder to the first line medication?

A

Add second agent; antidepressant w/ dif MOA, 2nd gen antipyschotic, lithium thyroid hormone

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29
Q

PT with PCOS have increased estrogen and testosterone levels, endometrial hyperplasia, androgen excess.
Best BC method for them?

A

Progestins for endometrial protection (thins and reverses hyperplasia), long acting IUD good option
weight loss and clomiphene citrate for ovulation induction if desire pregnancy

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30
Q

Pt with T2DM wiht BS >800s, hypoT, with afib and slightly elevated K, Na and AMS. ?How do we treat?
Do we rate/rhythm control?
Give insulin?

A

Fluid resuscitate
once partially resuscitated can start insulin
usually K depleted and if <5.3 start repleating
Can do RATE control over rhythm control

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31
Q

Pt with decreased ability of extension at the 3/4th digits, nodules along flexor tendons near distal palmar crease
Dx
Dx association
Tx

A

Dupuytren contracture; male, >50, tobacco/EtOH
associated with diabetes
Tx modification of hand tools, neele aponeurotomy, intralesional steroids or surgery if advanced

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32
Q 
Tx of asymptomatic lead poisoning
<5
5-14
15-44
45-69
>69
A

<5: No meds, anticipatory guidance, repeat 6mo-12mo
5-14: No meds, guidance, Ca/Ir supplementation; repeat 1-4 months
5-44: No meds, guidance, Ca/Fe supplementation; repeat 1-4 weeks
45-69: Chelation therapy; can use DMSA or succimer
>69: (or pt with symptoms) Dimercaprol PLUS calcium disodium edetate (EDTA)

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33
Q

Tx of pregnant women with syphillis

What about if PCN allergy?

A

Pen G

Penicillin desentiziation; dont’ do doxy; can mess up baby teeth and long bones

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34
Q

Rapid plt drop after patient has knee replacement. In hospital, on heparin for DVT ppx and ends up with PE. Tx option? Cause of issues?

A

type 2 heparin induced thrombocytopenia;
see drop of PLT >50% from initial, thrombosis, and anaphylactoid rx after heparing
confirm via serotonin release assay, STOP heparin
Start direct thrombin inhibitor; argatroban
–start Warfarin once PLT >150,000

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35
Q

CSF:
Elevated WBC >1,000
Glucose <40
Protein >250

A

bacterial meningitis

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36
Q

CSF analysis
WBC 0-5
Glucose 40-70
protein <40

A

NORMAL

37
Q

CSF
WBC 100-500
Glucose <45
Protein 100-500
pt with 2-3 weeks malaise, low grade fever, HA
Now with nuchal rigidity, vomitting, confusion
Can have CN nerve palsies, Sz and choroidal tubercles on fundoscopic exam (yellow/white nodules in optic disc) and basilar meningeal enhancement

A

TB meningitis

See CSF with acid-fast bacilli

38
Q

Pt with TB meningitis; what is treatment?

A

2 months of 4 month therapy; isoniazid, rifampin, pyrazinamide, fluoroquinolone
then by 9-12 months continuation with isoniazid + rifampin
**Give adjuvant steroids to reduce CNS inflammation and reduce morbidity and mortality

39
Q

Tox:
Pt with vomiting, diarrhea, miosis, lacrimation, salivation, paralysis, fasciulations and complicated by bradycardia, resp fail, seizure and coma.
Dx and tx

A

organophosphate poisoning
Tx; Atropine and pralidoxime
resuscitation

40
Q

____major cause of hypoxemia in pt with COPD and mismatch is worse during exacerbation. Supplemental O2 fixes this how?

A

V/Q mismatch in low V/Q regions of lung

O2 increases O2 exchange in these areas

41
Q

RF for preeclampsia

How to prevent Preeclampsia

A

RF: prior PreE, CKD chronic HTN, DM, mulitiple gestation, autoimmune dx
Tx to prevent: low dose ASA starting at 12 weeks

42
Q

When should you be able to visualize a pregnancy on US?

What does an ectopic pregnancy look like?

A

visualize on US when bHCG >1500
US will show empty uterus, complex adnexal mass and thickened endometrium
RF: prior ectopic, prior pelvic/tubal surgery or PID

43
Q

Tx for ectopic pregnancy?

A

MTX if HDS

otherwise surgical

44
Q

Autoimmune process that causes sudden non-scarring hair loss in round patches (non-inflammatory), nail pitting. Areas don’t itch

A

alopecia areata

seen with other autoimmune conditions

45
Q

Pt with sudden onsent unilateral pelvic pain, tender adnexal mass. Fever, cervix closed, no drainage, neg Upreg, not sexually active
Likely dx?
Imaging?

A

Ovarian torsion

Stat pelvic US with doppler; usually shows large, edematous ovary with decreased blood flow

46
Q

tight glycemic control of DM can reduce risk of _____ type of disease but has not been shown to have control in preventing this type of disease

A

reduce risk of MICROvasulcar disease (nephropathy so CKD or proteinuria) and retinopathy
Not associated with reduced risk of preventing MACROvascular disease (MI, PAD)

47
Q

What medications are typically started for atrial fibrillation?

A

Beta blocker: Atenolol or metoprolol for chronic management (IV esmolol, metoprolol, propranolol acute)
Ca Channel Blocker: Verapamil or diltiazam for acute (IV) and long term control

48
Q

Medication that can increase risk for Digoxin toxicity? What would this look like in patient?

A

Verapamil, amiodarone and quinidine increases risk

Dig toxicity: nausea, vomiting, confusion, fatigue, vision changes

49
Q

What are good prognostic signs for response to antipyschotics

A

Positive symptoms: delusions or hallucinations are better than negative ones (withdrawl or loss motivation) and for schizophrenia better if acute onset, occurs at later age

50
Q

Characterized by low T3 levels, normal TSH and normal T4 in pt with illness
Tx?

A

Euthyroid sick syndrome

Just recheck in a few weeks; tx if abnormal labs persist after return to health

51
Q

Presents with painful vaginal bleeding, fetal heart rate abnormalities like late decells and a tender, rigid uterus

A

placental abruption

52
Q

How does placental previa present

A

Presents with painless vaginal bleeding

53
Q

Pt delivered baby, has postpartum hemorrhage and cant remove the placenta

A

placenta accreta

from anterior placenta implanting over uterine scar

54
Q

Pt with long standing CKD can develop anemia and may need to be started on EPO, but what do we check first

A

Fe stores; these become rapidly depleted once therapy started

55
Q

First line treatment for patients with DVT/PE that do NOT have cancer

A

Oral factor Xa inhibitors (rivaroxaban)
Use LMWH if underlying malignancy
CANT use warfarin alone; get transient increase in hypercoaguable state and takes days to be fully effective

56
Q

Preferred first line tx for patients that are HDS with new onset a.fib

A

Beta blocker or Ca channel blockers

be careful if the patient has DECOMPENSATED HEART FAILURE, hypoT or bradyarrythmias

57
Q

Threshold for transfusion in stable patients with suspected upper GI bleed

A

HgB <7.0

If stable CV disease may benefit from goal HgB >8.0

58
Q

Pt with ESRD have goal of transferrin saturation ____ and ferritin of _____

A

transferrin saturation <30%
Ferritin <500
*have higher iron demand
*if on EPO even higher demand; monitor FE closely even if

59
Q

SGLT meds for DM work by inhibiting NA-Glucose cotransporters thus reducing glucose levels; get more glucose excreation in renal tubules… SE of this

A

incresaesd risk for vulvovaginal candidiasis

60
Q

DDP4 inhibitors for glycemic control have what neg SE

A

risk of pancreatitis; if hx dont use

61
Q

Patient’s with suspected ACS but unremarkable initial EKG and troponins should…

A

be observed with serial EKG and troponins to confirm or r/o diagnosis; done 3 times 6 hours apart

62
Q

What two markers are helpful in monitoring the progression of active renal involvement in patients with SLE nephritis?

A

Complement and Anti-dS DNA

63
Q

Pt with supsected HIV comes in with AMS, white plaques on tongue, outbreak looks like molluscum.
Hes gets a tap;
elevated OP, low glucose, elevated protein and cell count of 40 with lymphocytic predominance
Likely dx

A

Cytococcal meningitis; tx with amphotericin B and flucytosine
May need serial LPs bc of high fungal burdern

64
Q

Tx of cyrptococcal meningitis in HIV pt

A
  1. Induction: amphoB + flucytosine for >2 weeks til sx gone
  2. Consolidation: high dose oral fluconazole x 8 weeks
  3. Maint: lower dose of oral fluconazole >1 year
65
Q 
Pt comes in with suspected OD: 
mydriasis, tachycardia, resp despression, dry mouth and vision change, urinary retention, flushing. 
EKG with prolongued QRS or QT
OD?
Tx?
Why?
A

OD on TCA;s
Sodium bicarb to prevent arrhythmia
Supportive cares
can do charcoal if present w/i 2 hrs ingestion if awake

66
Q

First line tx for tinea capitus

A

on scalp; need oral griseofulvin or oral terbinafine

topicals don’t penetrate the hair follicles

67
Q

Pt with multivessel CAD and diabetes what is preferred treatment

A

CABG is superior to PCI

68
Q

First line tx in patients with toxic megacolon that have IBD

A

Glucocorticoids! Bowel rest

may need antiBx, do not give 5-ASA or opiods

69
Q

Three meds that increase dig toxicity (nausea, vision changes, vomiting, anorexia, confusion and EKG changes)

A

Verapamil, quinidine, amiodarone

70
Q

First line tx for MS attack

Tx for long term management and prevention of relapse

A 
IV steroids (or oral steriods)... plasmapheresis if not responding
Long term is beta interferon
71
Q

Pt with chronic abdominal pain, fat loose stools and EtOH hx raises concern for…
Dx?
Diagnostic approach

A

chronic pancreatitis

get MRCP; A/L may not be elevated 2/2 to chronic pancreatic fibrosis

72
Q

MCC of secondary polycythemia

A

Chronic hypoxemia

  • -will see elevated epo levels (this excludes polycythemia vera) adn you should get carboxyhemoglobin levels to assess for CO poisoning
  • test for sleep apnea
73
Q

Best initial diagnostic test in patient with iron deficiency anemia and FOBT + if >50

A

stable.. do colonoscopy. Likely colon cancer

74
Q

Started on antipyschotics.. develop gradual onset tremor and rigidity.
Cause?
Tx

A

Parkinsonism

Tx with benztropine or amantidine

75
Q

Started on antipyschotics.. subjective restlessness and inability to sit still
Cause?
Tx?

A

Akathisia

Tx: Beta blocker (propranolol), Benzos (lorazepam) or benztropine

76
Q

Started on antipyschotics.. gradually develop dyskinesia of mouth, face and trunk
Cause?
Tx

A

Tardive dyskinesia

Tx Valbenzine or Deutetrabenzine

77
Q

First line therapy for dementia related impairment

A

Acetycholinsterase inhibitors: donepezil, rivastigmine, galantamine
Can do Memantine: NMDA for moderate to severe

78
Q

Pt with new onset seizure, he’s 15. Had GTC that self aborted after 2 mins. Noticed he has been having weird AM arm jerking movements for past three months.
EEG with bilateral poylspike and slow wave activity

A

Juvenile myoclonic epilepsy

Tx: Valproic Acid

79
Q

Tx for patient with catatonia

A

Benzos!

Giving antipyschotics can worsen catotonia

80
Q

Recommended tx for cancers of head and neck that are locally advanced?

A

Radiation + chemo

most are non-operable but often see high survival rates

81
Q

Increased suspicion for this diagnosis in patients with recent joint injury with burning pain and swelling with sweating and edema in the area then worsening edema and swelling followed by limited ROM and bone deminerilzations

A

Complex regional pain syndrome

82
Q

Post cholecystectomy diarrhea; bile salt induced diarrhea seen in 10% pt after cholestectomy is treated with…

A

Cholestyramine

83
Q

First line treatment for bacterial conjunctivitis in patient?

A

Erythromycin (macrolide) or POlymyxin-trimethoprim

Contacts; then use fluoroquinolone for increased PSA risk and increased risk of keratitis

84
Q

Sjogrens is associated with which type of malignancy?

A

non-hodkins B cell lymphoma

85
Q

Pain, redness, variable visual loss and constricted irregular pupil. See leukocytes in anterior segment

A

Anterior uveitis or Iritis

86
Q

_____ antibody is seen in primary biliary cholangitis

Treatment is ____

A

antimitochondiral antibody

Ursodeoxycholic acid

87
Q

Pt with fatigue, elevated alk phos, slight elevation in other LFTS. Xanthelasmata and xanthomata with itching and arthritis. Associated with bone loss; osteopenia and osteoprorsis

A

Primary biliary cholangitis
+antimitochondrial antiB
tx ursodeoxycholic acid

88
Q

Delivery is indicated in mom with preeclampsia wihtout severe features when > ____GA
Delivery indicated for preeclampsia with severe features when >____GA

A

> 37 weeks

>34 weeks

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