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Miscellaneous 2 Flashcards

1
Q

Management of tamponade in the setting of aortic dissection

A
  • OR for surgery, NOT pericardiocentesis
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2
Q

second line treatment of ankylosing spondylitis

A
  • add TNF inhibitor (adalimumab)
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3
Q

Management of patient with endocarditis presenting with dyspnea

A
  • TEE to rule out valvular insufficiency
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4
Q

DAPT duration of therapy after coronary stenting

A
  • DAPT for minimum of 6-12 months

- aspirin indefinitely

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5
Q

Conjunctivitis differential, unique features of bacterial conjunctivitis

A
  • bacterial has thick, purulent discharge + reappears after wiping
  • “eye stuck shut” is nonspecific
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6
Q

other features of plaque psoriasis

A
  • can be on scalp, knees, elbows, back, gluteal cleft

- mild itching

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7
Q

what is a normal hematocrit?

A

41% to 50%. Normal level for women is 36% to 48%.

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8
Q

other potential presenting features of RCC

A
  • unexplained fever

- dull ache in abdomen

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9
Q

GPA diagnosis

A
  • p-ANCA can be negative

- tissue biopsy at site of active disease (skin, kidney, lung)

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10
Q

Treatment of neurosyphilis in a patient with a history of penicillin allergy

A
  • penicillin desensitization
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11
Q

neurosyphilis lab features

A
  • lymphocytic pleocytosis (high lymphocyte count) + elevated protein
  • VDRL may be negative in up to 70% of patients
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12
Q

Other features of tuberous sclerosis

A
  • cutaneous angiomas
  • dental pitting
  • cystic lung disease
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13
Q

Staphylococcal toxic shock syndrome triggers

A

*tampons, nasal packing, surgical or postpartum wound infections

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14
Q

Staphylococcal toxic shock syndrome treatment

A

Vanc + clinda (antistaphylococcal)

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15
Q

Staphylococcal toxic shock syndrome clinical features

A

triggers + hypotension, rash, *desquamating rash

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16
Q

Treatment of stomatitis from methotrexate

A

folic acid supplementation

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17
Q

Clinical features of stomatitis from methotrexate toxicity

A
  • decreased appetite + sore throat + oral ulcers
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18
Q

Management of ED in ESRD patients

A

Phosphodiesterase inhibitors (sildenafil)

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19
Q

Management of complete occlusion of the carotid artery

A

If asymptomatic – medical management alone (adequate collateral blood flow)

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20
Q

Management of severe hypercalcemia

A
  • Saline hydration
  • calcitonin (decrease bone resorption)
  • bisphosphonates
  • No lasix unless volume overload
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21
Q

Management of intrahepatic cholestasis of pregnancy

A
  • urosdeoxycholic acid

- delivery at 37 weeks

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22
Q

intrahepatic cholestasis of pregnancy clinical and lab featuresl

A
  • pruritus

* elevated liver enzymes + hyperbilirubinemia

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23
Q

Type 1 VWD physiology in general + epidemiology

A

quantitative disorder of VWF

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24
Q

Perioperative management of patients with type 1 VWD

A

IF severe bleeding or invasive surgeries (neurosurgeries) – VWF concentrates
IF mild bleeding – desmopression
- accounts for 75% of cases

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25
Q

Management of thyroid adenoma or multinodular goiter

A

RAI ablation or surgical thyroidectomy

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26
Q

Clinical features of erythromelalgia

A
  • episodic warmth, redness, burning in extremities symmetrically
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27
Q

Treatment of erythromelalgia

A

Aspirin

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28
Q

How to differentiate between hyperthyroidism and euthyroid sick syndrome in hospitalized patients

A

T3

critical illness suppression conversion of T4 to T3 and T3 is typically elevated in other causes of hyperthyroidism

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29
Q

Linezolid toxicity

A
  • optic neuropathy
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30
Q

Workup of suspected radiation proctitis

A

SIgmoidoscopy

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31
Q

Clinical course of acute radiation proctitis

A
  • typically resolves once RT completes but may continue for up to 1 year after treatment discontinuation
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32
Q

Pathophysiology + timing of chronic radiation proctitis

A
  • 9-12 months after RT

- fibrosis leading to stricture formation and bleeding

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33
Q

Management of panic disorder

A

SSRIs or SNRIs and CBT for long term control, benzos for immediate symptom relief

34
Q

Initial management of central hypothyroidism

A

1) MRI
2) Test for concurrent adrenal insufficiency (Often coexists with other disorders of the pituitary. Even if cortisol low normal, which can be seen with AI) before treating (this can induce adrenal crisis)

35
Q

Overflow incontinence cause

A
  • underactive detrusor function (due to DM2. patient has decreased bladder contractility) or outflow obstruction (organ prolase)
36
Q

Treatment of overflow incontinence

A
  • cholinergic agonists

- intermittent self catheterization

37
Q

Presentation of overflow incontinence

A
  • poor stream, dribbling, sensation of incomplete emptying, nocturia (this is due to urinary retention caused by outflow obstruction)
38
Q

Differentiating stress from overflow incontinence

A
  • stress = no elevated PVR
39
Q

Meds for malaria ppx

A
  • atovaquone-progunail
  • doxycycline
  • mefloquine
40
Q

Urine anion gap calculation

A

(Na + K) - urinary chloride

*positive and negatively charged anions

41
Q

Inflammatory diarrhea presentation

A
  • frequent small-volume diarrhea

- *sometimes don’t have blood in stool

42
Q

Inflammatory diarrhea pathogens

A
  • campylobacter, shigella, salmonella
43
Q

Non-inflammatory diarrhea presentation

A
  • large-volume watery diarrhea (small bowel involvement)
44
Q

Non-inflammatory diarrhea pathogens

A
  • C perfringens

- E coli

45
Q

Other features of GBS

A
  • bulbar symptoms (dysphagia, dysarthria) following development of ascending paralysis
  • back pain can be a presenting feature
  • sluggish pupils
46
Q

argyll-robertson pupil

A

accomodate but don’t react (like a prostitute)

47
Q

Presentation of eustachian tube dysfunction

A
  • typically following URI

- ear fullness, popping, decreased hearing

48
Q

Treatment of eustachian tube dysfunction

A
  • oral decongestants
49
Q

How long patients need to be on antidepressants for if recurrent episodes

A

IF recurrent – 1-3 years

IF 3 or more – indefinitely

50
Q

Antidepressant duration for single major depressive episode

A

IF single episode – continue for 6 months following a response

51
Q

Acute GVHD vs. chronic GVHD in terms of timing

A

Acute GVHD = within 100 days of HSCT

Chronic = can occur at any time

52
Q

Acute GVHD presentation + lab features

A
  • abdominal pain, diarrhea, maculopapular rash

- elevated liver enzymes (bilirubin, alkaline phosphatase)

53
Q

Why rash in GVHD is an emergency

A
  • can progress to TEN
54
Q

Pathogen associated with hot tubs and aerosolized municipal water + clinical features

A

MAC (NTMB)

- causes hypersensitivity pneumonitis (“hot tub lung”) with bilateral infiltrates

55
Q

Presentation of pseudomonal infections associated with hot tub use

A
  • folliculitis
56
Q

Additional feature of hypocalcemia after total thyroidectomy

A

Late complication, can cause laryngospasm leading to respiratory distress and inspiratory stridor

57
Q

Management of sexual dysfunction with SSRI’s

A
  • augment with a PDE-5 inhibitor (sildenafil) or bupropion)

* shouldn’t stop SSRI

58
Q

Initial management of suspected vitiligo

A
  • TSH (frequently associated with thyroid disorders and DM1)

* diagnosis is clinical

59
Q

Treatment of vitiligo

A

topical steroids, UV light, topical calcineurin inhibitors

60
Q

Management of asymptomatic patient with a tick bite from endemic area

A

IF asymptomatic – no testing required (antibodies take weeks to appear thus there may be false negatives)
IF attached for 36 hours or more – prophylaxis (no testing) (infection isn’t transmitted within first 2-3 days)
IF erythema migrans – no testing

61
Q

lithium toxicity presentation

A
  • confusion, agitation, ataxia, neuromuscular excitability (myoclonic jerks)
62
Q

contraindications to aldosterone antagonists

A

CrCl less than 30 (severe)

K greater than 5

63
Q

indication for pacer in CHF patients

A

EF less than or equal to 35% + LBBB with QRS duration greater than 150 + persistent symptoms despite optimal medical therapy

64
Q

Management of exercise-induced bronchoconstriction in asthmatics

A
  • SABA 5-15 minutes before exercise

IF symptoms persist – leukotriene receptor antagonists (montelukast) or inhaled steroids

65
Q

when to never use LABAs for asthmatics?

A

without ICS, never used as monotherapy

66
Q

Management of nocturnal cardiac arrhythmias

A
  • workup for OSA – full-night polysomnography with ECG monitoring
67
Q

High risk conditions that require bridging

A
  • mechanical *mitral valve
  • VTE within 3 months
  • severe thrombophilia (protein C deficiency)
  • AF with TIA or stroke within 3 months
    NOT mechanical AV valve
68
Q

CVA and TIA management in patients with symptomatic high-grade carotid stenosis

A
  • early carotid revascularization (within 1-2 weeks0
69
Q

Other clinical features of SLE

A
  • oral ulcers

- alopecia

70
Q

ruptured ectopic pregnancy presentation

A
  • bleeding + lower abdominal pain + *complex adnexal mass
71
Q

incomplete abortion presentation

A
  • heavy vaginal bleeding + dilated cervix
72
Q

abruptio placentae clinical features

A

vaginal bleeding + pain + *third trimester

73
Q

hydatidiform mole clinical features

A

bleeding + enlarged uterus + *very high beta hcg + intrauterine heterogenous mass with cystic areas (snowstorm appearance)

74
Q

ectopic pregnancy management

A

IF hemodynamically unstable – surgery (bleeding into peritoneal cavity)
IF hemodynamically stable – methotexate

75
Q

What is the physiologic reason why patients with cardiogenic pulmonary edema benefit from BiPaP?

A
  • decreased dead space ventilation
  • increased tidal volume
  • increased alveolar to minute ventilation
  • decreases preload (reduced cardiac output increases LV filling pressures and LA pressure (which is preload) – elevated presssure is transmitted to pulmonary capillaries, leading to fluid transudation
  • decreases afterload
76
Q

Next step after patient diagnosed with primary hyperparathyroidism and no surgical indication

A

24-hour urine calcium (need to rule out familial hypocalciuric hypercalcemia and very high calcium excretion is an indication for surgery)

77
Q

Indications for parathyroidectomy in primary hyperparathyroidism

A
  • age under 50
  • symptomatic
  • complications (stones, SCKD, osteoporosis)
  • calcium 1 mg or higher above normal
  • high urinary calcium excretion
78
Q

anal fissure management

A
  • topical nitroglycerin (improves blood flow to the anal area, which improves wound healing)
  • sitz bathes
    IF refractory – botox injection
79
Q

Varenicline in patients with cardiovascular disease

A
  • adverse CV events are possible, but benefits of stopping smoking outweigh risks
80
Q

only time to avoid varenicline

A
  • currently unstable psych status or recent SI
81
Q

tamoxifen and raloxifene SE’s

A

(estrogen antagonists)

  • hot flashes
  • VTE
  • endometrial hyperplasia and carcinoma (tamoxifen only)
  • uterine sarcoma (tamoxifen only)

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