Mix5 Flashcards
Why are beta-blockers considered a first line therapy for A-fib?
Beta blockers are recommended as a first line therapy for HR and hyperadrenergic Sx and helps decrease conversion of T4 to T3 in peripheral tissue.
- Thyroid hormones cause an increase in beta adrenergic R expression»_space; increased sympathetic response.
What’s the treatment of choice for bacterial meningitis prophylaxis in immunocompromised patients?
Treatment of choice is cefepime or ceftazidime + vanco + ampicillin.
- Cefepime = 4th gen cephalosporin, covers most bugs responsible for bacterial meningitis (S pneumo, N meningitidis, GBS, haemophilus, Pseudomonas)
Vanco covers cephalosporin resistant pneumococci
Ampicillin covers Listeria.
Pt should also receive empiric dexamethasone to help prevent neurologic complications (deafness, focal deficit) of S pneumo meningitis but should be discontinued as soon as pneumococcal meningitis is ruled out.
Why do you often have dysphagia and heartburn with systemic sclerosis?
In SSc you can have SM atrophy and fibrosis of distal 1/3 of esophagus. Common sx = dysphagia, choking, heartburn.
Confirm with esophageal manometry which demonstrates hypomotility and incompetence of LES.
- Treat with PPI and H2 blocker. Strictures need surgery. Promotility for GI Sx.
What clinical findings would help you differentiate between reactive arthritis vs gonococcal septic arthritis?
Both can present with asymmetric arthropathy. Pt with reactive arthritis will be afebrile, and have mouth ulcers, enthesitis (inflammation around ligamentous insertion), and lower back pain that will be absent in septic arthritis.
What is the first line treatment for a patient with fibromyalgia?
TCA - amitryptiline
** SSRI, NE reuptake inhibitors (duloxetine, milnaciprin), and pregabalin are alternative therapies if Pt doesn’t respond to TCA. Note that conservative measures like aerobic exercise and good sleep hygiene should be attempted before TCA.
Aside from crystal structure, how does calcium pyrophosphate crystal (pseudogout) arthritis differ from gout attack?
Pseudogout = typically monoarticular arthritis (knees and ankles) but can also affect multiple joints at the same time. Pseudogout has CHONDROCALCINOSIS (calcification of articular cartilage). Typically occurs in cases of overuse/trauma
The presence of nephrotic syndrome with palpable kidneys, hepatomegaly, and ventricular hypertrophy (evidenced by 4th heart sound) in the setting of a chronic inflammatory Dz w/recurrent pulmonary infection is characteristic of this underlying disorder:
Secondary Amyloidosis (AA).
Rx is directed at correcting the underlying inflammatory condition.
Why are calcium oxalate stones more likely to be seen in cases of small bowel disease?
Small bowel disease, fat malabsorption, surgical bowel resection, and chronic diarrhea can»_space; malabsorption of FA and bile salts»_space; formation of calcium oxalate stones because increased absorption of oxalic acid (unabsorbed FA chelate calcium»_space; ^ free oxalic acid absorption).
Ipratropium and tiotropium may be used as maintenance therapy in patients with COPD. What is their MOA?
These achieve bronchodilation via anti-muscarinic activity.
What is Beck’s triad and what condition is it used for diagnosis?
Beck’s triad = hypotension, JVD, and diminished heart sounds
Used in defining cardiac tamponade. * May also see pulsus paradoxus with this.
Urgent echocardiography is used to confirm a Dx of suspected cardiac tamponade. What would you likely see on echo?
Possibly see moderate to large pericardial effusion, RA diastolic collapse, RV diastolic collapse (highly specific for cardiac tamponade) and bowing of the IV septum into the LV during inspiration.
** Cardiac tamponade occurs when you have rapid accumulation of blood into the pericardial sac»_space; Increased diastolic pressure in all chambers of the heart + severely impaired venous return.
What is the best next step in treating cardiac tamponade after confirming Dx?
You need to do immediate percutaneous or surgical (pericardial window) drainage of pericardial fluid in order to relieve the elevated intrapericardial pressures to allow for symptomatic relief and return of hemostasis.
If a young IV drug user presents with worsening lower back pain for the past several weeks unrelieved with rest and tender to light palpation along spinous processes then what should be high on the differential?
Vertebral Osteomyelitis. Tenderness to gentle palpation is the most reliable finding. Pain unrelieved with rest. Fever and leukocytosis are unreliable. ESR grossly elevated. MRI is best diagnostic study.
What is the next appropriate step for Dx if you suspect kidney stone?
Abdominal U/S or nonspiral CT of abdomen and pelvis.
If you suspect multiple myeloma in a patient, then what screening tests would you order to confirm/refute the Dx?
Patients with suspected multiple myeloma should have serum/urine protein electrophoresis (M spike), a peripheral blood smear (rouleaux formation), and serum free light chains. If screening tests support tx then confirm Dx with biopsy.
** Pt with MM typically have Bence Jones proteinuria or waxy laminated casts»_space; renal damage.
