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Nuggets Flashcards

1
Q

first line treatment of onychomycosis

A

terbinafine or itraconazole

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2
Q

types of esophageal CA

A

adenocarcinoma - distal to mid *GERD

SCC - upper *alcohol, tobacco

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3
Q

patients with late life depression are at greater risk for: ?

A

alzheimer disease and vascular dementia

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4
Q

what medications are used acutely and for prevention for patients with cirrhosis and variceal hemorrhage?

A

acute - IV octreotide
chronic - BB
Both decrease elevated portal venous P

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5
Q

treatment of ureterolithiasis associated with infection, AKI, or severe pain and has failed initial measures?

A

decompression with percutaneous nephrostomy or ureteral stent placement

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6
Q

tick paralysis etiology

A

neurotoxins in the tick saliva are transmitted to host over 4-7 days of tick attachment
tx = tick removal

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7
Q

iritis = ?

A

anterior uveitis

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8
Q

modifiable risk factors for c diff (2)

A

recent abx

gastric acid suppression

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9
Q

UTI abx contraindicated in pregnancy (3)

A

tetracyclines
fluoroquinolones
TMP-Sulfa

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10
Q

meds that should be started at time of dx of peripheral artery disease (2)

A

ASA

statin

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11
Q

chronic pancreatitis

A 
sxs = abdominal pain (relieved by sitting up) + fat malabsorption 
dx = MRCP or abd CT showing pancreatic calcifications
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12
Q

cluster HA

A
  • men
  • episodic HA 1-8x/day over period of weeks
  • orbital, supraorbital, or temporal pain that is UNILATERAL
  • autonomic sxs and restless agitation
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13
Q

high potency steroids

A

flucinonide

betamethasone

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14
Q

management of ADPKD

A

control of risk factors for CV and CKD - statins
ACE inhibitors
dialysis, kidney transplant

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15
Q

screening for ADPKD

A

renal US for >18yo with family history

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16
Q

MELD score

A

used to determine 90day mortality risk in advanced liver disease
uses: serum bili, INR, serum Cr, serum Na

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17
Q

MVP physical exam findings

A

non ejection click with systolic murmur (from mitral regurg)

increases with standing/dec venous return

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18
Q

Mentzer index

A

MCV/RBC
>13 - Fe deficiency likely
<13 - thalassemias

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19
Q

complications of bicuspid aortic valve (4)

A 
infective endocarditis
aortic regurg or stenosis
aortic root or ascending aortic dilation
dissection 
**screening for dilation
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20
Q

Sjogren syndrome - increased risk for what type of CA?

A

B cell lymphoma

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21
Q

diagnosis of dermatomyositis

A

ANA screening
specific Ab (anti-Ro, Anti-La, anti-Sm, anti-RNP)
muscle or skin biopsy if Ab are negative/unclear dx

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22
Q

when to use steroids in PCP

A

used in those with A-a gradient >35 mmHg or PaO2 <70

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23
Q

dx of PCP

A

sputum testing

if sputum is negative -> BAL (more sensitive)

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24
Q

lichen planus

A

discrete, itchy, polygonal violaceous papule or plaques on flexural surfaces, buccal mucosa, ext genitalia (sometimes lacy like pattern)
dx confirmed with biopsy

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25
Q

electrolyte risk of repeated RBC transfusion

A

symptomatic hypocalcemia
more common with massive transfusion or liver/renal failure, hypothermia, shock
serum Ca often normal, need ionized Ca level

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26
Q

prenatal screening at 24-28 wks

A

Hb/Hct
Ab screen if Rh(D) negative
50 g 1 hr GCT

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27
Q

treatment/workup for medullary thyroid CA

A

*MEN 2A syndrome
- serum calcitonin and carcinoembryonic Ag, neck U/S, genetic testing for germline RET mutation, eval for coexisting tumors (hyperparathyroidism, pheochromocytoma)
Pheo eval important before surgery

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28
Q

initial manifestation of hypoCa

A

hyperactive DTR

HypoCa can occur during/immediately after major surgery or transfusions

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29
Q

glucagonoma

A

pancreatic tumor associated with mold diabetes and skin rash (necrolytic migratory erythema - scaling/crusting, central clearing)

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30
Q

sensitivity analysis

A

repeating primary analysis calculations by modifying certain criteria or variable ranges

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31
Q

treatment for ADHD in ages 3-5

A

1st line = behavior therapy

meds if needed

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32
Q

rotator cuff tendonitis

A

lateral shoulder pain aggravated by abduction and ext rotation of shoulder

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33
Q

ETEC

A

most common cause of travelers diarrhea - contaminated water and food
manifests 1-3 days after exposure
watery diarrhea

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34
Q

treatment of hidradenitis suppurativa (acne inversa)

A

mild - topical abx
moderate (sinus tracts, scar formation) - oral abx
severe - TNF alpha inhibitors, wide surgical excision

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35
Q

treatment of lithium toxicity

A

Li level q2-4hr
IVF
bowel irrigation for asym acute overdose
hemodialysis for >4 or >2.5 + symptoms or increasing level despite IVF

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36
Q

Sydenham chorea

A

major manifestation of ARF

emotional lability + jerking movements

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37
Q

treatment of bacterial vaginosis

A

metronidozole

clindamycin

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38
Q

first line treatment of chronic bacterial prostatitis

A

6 weeks of fluoroquinolone or TMP-sulfa

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39
Q

pagets disease - sxs, labs, dx, tx

A

SXS- most pts are asym
skull deformity with enlargement, hearing loss, dizziness
bone pain, spinal stenosis, nerve compression
long bone bowing with fracture risk
bone tumors
LABS- elev AlkPhos, normal Ca and Phos, radiograph show lytic or mixed lesion
DX - bone scan/Xray & elev AlkPhos
TX- bisphosphonates

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40
Q

conditions that alter TBG [ ]

A

inc TBG - estrogens, acute hepatitis

dec TBG - androgen hormones, high dose steroids, hypo protein, chronic liver disease

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41
Q

vaccines after IVIG

A

IVIG alters normal response to vaccine, so live vaccines should not be administered for 11 months after IVIG treatment

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42
Q

physical exam of scaphoid fracture

A

dec grip strength
dec ROM wrist
tenderness to palpation of anatomic snuffbox

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43
Q

actinic keratosis tx

A

excision or destruction of lesion - cryotherapy, topical 5FU cream

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44
Q

raloxifene

A

selective estrogen receptor modulators

*D/C 4 wks prior to surgery with risk of VTE

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45
Q

side effect of Na-glucose cotransporter inhibitors used for DM

A

vulvovaginal candidiasis, UTI, polyuria

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46
Q

initial imaging for palpable breast mass

A

<30yo - US

>30 - mammography

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47
Q

vit B12 deficiency in older populations

A

dementia + subacute combined degeneration (dorsal spinal column dysfunction, lateral spino tract abnorm)ineffective erythropoiesis -> anemia, intramedullary hemolysis

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48
Q

multifocal atrial tachycardia etiologies

A

COPD or pulm dz exacerbation
electrolyte disturbance *hypoK, hypoMg
catecholamine surge (sepsis)

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49
Q

Nelsons syndrome

A

pituitary enlargement and hyperpigmentation following bilateral adrenalectomy for bushings disease (older treatment option)
treated with surgery and/or radiation

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50
Q

phentolamine

A

used for HTN emergency during surgery of pheochromocytoma

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51
Q

urgency incontinence

A

sudden urges
caused by detrusor muscle overactivity
tx = bladder training, weight loss, smoking cessation, avoid caffeine and alcohol, antimuscarinic meds (tolterodine, solifenacin, oxybutynin)

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52
Q

trastuzumab side effect

A

reversible cardio toxicity (dec in LVEF), not dose related

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53
Q

saw palmetto

A

used by some to treat BPH though studies haven’t shown usefulness
risk is bleeding, stomach discomfort

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54
Q

mycotic aneurysms

A

occur in cerebral or systemic circulation due to septic emboli and local vessel wall destruction
complication of infective endocarditis
intracerebral mycotic aneurysms can present its focal near findings or with rupture and subarachnoid hemorrhage

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55
Q

treatment of gout in renal failure/ post transplant

A

intraarticular steroids or increasing dose of systemic steroids

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56
Q

microbiology of human bite

A

eikenella corrodens (gram neg anaerobe)
strep viridans
anaerobes

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57
Q

routine lab testing in initial workup or suspected cognitive impairment

A

CBC
B12
TSH
CMP

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58
Q

most common causes of death in tuberous sclerosis

A

neurological impairment/epilepsy

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59
Q

which lung CA typically causes SIADH?

A

small cell

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60
Q

signs of acute salicylate toxicity

A

N/V *stimulates chemoreceptor trigger zone
tachypnea w. resp alka *stimulates medullary resp center
tinnitus
AMS
hyperthermia
lactic acidosis

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61
Q

treatment of acute salicylate toxicity

A

NaBicarb to alkalinizine urine and plasma
glucose
+/- activated charcoal if presentation within 2 hrs
+/- dialysis

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62
Q

causes of acquired long QT syndrome

A 
meds
metabolic disorders
bradyarrhythmias
hypothermia
MI
intracranial disease
HIV
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63
Q

major drug interactions of levothyroxine

A

dec absorption: bile acid binding agents, Fe, Ca, alum hydroxide, PPI, sucralfate
inc TBG [ ]: estrogen, heroin, methadone
dec TBG [ ]: androgens, steroids,
inc thyroid hormone meta: rifampin, phenytoin, carbamezepine

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64
Q

interferon gamma release assay and benefits

A

TB test
no false + after BCG vaccine
doesn’t require return visit
no 2 step confirmation test needed

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65
Q

porcelain bladder management

A

prophylactic cholecystectomy

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66
Q

how long are kids with viral conjunctivitis infectious?

A

until eye discharge resolves

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67
Q

TTP (thrombotic thrombocytopenia purpura)

A

etiology - dec ADAMTS13 activity -> microvascular thrombosis *can be precipitated by pregame’s
SXS- petechial rash, neuro abnormalities, thrombocytopenia, MAHA/hemolytic anemia abdominal pain/N, fever, renal failure
TX - plasma exchange

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68
Q

complications for infants of diabetic mother

A

1st trimester: CHD, neural tube defect, small left colon, abortion
2nd/3rd trimester: fetal hyperglycemia and hyperinsulism -> polycythemia and viscosity , organomegaly,. neonatal hypoglycemia, macrosomia, shoulder dystocia, hypertrophic cardiomyopathy (glycogen disposition)

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69
Q

how many weeks = adequate trial of SSRI?

A

6 weeks

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70
Q

dementia with lewy bodies treatment

A

cholinesterase inhibitors for cognitive impairment
carbidopa-levadopa for Parkinsonism
melatonin for REM sleep d/o
+/- antipsychotics for visual hallucinations **2nd gen, low potency. Stronger antipsychotics can exacerbate confusion, Parkinsonism, and autonomic dysfunction

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71
Q

pelvis surgery during pregnancy - when and for what

A

for what: pelvic mass that is complex, persistent, and/or >10cm
best time is early 2nd trimester

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72
Q

pregnancy induced pruiritis - sxs and tx

A

benign
presents with localized, focal pruiritis over abdomen without rash, +/- mild transaminitis
tx = oatmeal bath, UW lights, antihistamines

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73
Q

pemphigoid gestationis - etiology, sxs, dx, tx

A 
etiology - autoimmune to BM
sxs - prodromal pruritus, periumbilical papules and plaques, bullae, spares mucous membranes, occurs during 2nd or 3rd trimester 
dx - clinical, biopsy
tx - topical steroids, antihistamines
resolves after delivery
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74
Q

candida endophthalmitis

A

at risk populations, neutropenia, TPN via central venous cath
sxs - fever, dec vision acuity, eye pain, white mound like lesion on retina into vitreous
tx - systemic and intravitreql anti fungal vitrectomy

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75
Q

treatment of endometriosis

A

NSAIDs and OCPs
medroxyprogesteron, leuprolide, danazol
surgery

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76
Q

chronic prostatitis/chronic pelvic pain syndrome vs chronic bacterial prostatitis

A

chronic prostatitis/chronic pelvic pain syndrome - leukocytes in UA but sterile culture
chronic bacterial prostatitis - leukocytes in UA + culture growth

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77
Q

seizure meds in pregnancy

A

AED inc risk of congenital anomalies
should switch to lowest possible dose of a single medication before conception to limit tetarogenicity
if conception has already occurred, no changes are made due to risk for seizure. Just add folic acid and screen for anomalies with alpha fetoprotein.
Valproate is worst teratogen

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78
Q

major cause of adverse drug reactions in elderly?

A

poly pharmacy

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79
Q

net clinical benefit of a medication = ?

A

measure of its possible benefit minus its possible harm

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80
Q

desmoid tumor

A

slow growing and locally aggressive benign neoplasm with high rate of local recurrence
deeply seated painless or painful masses

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81
Q

tuberculous meningitis - sxs, labs, imaging, tx

A

prodrome then signs of meningeal irritation, nerve palsies, coma, death can occur
choroidal tubercles (yellow white nodules near optic disk) can occur
CSF analysis: elevated protein, low glucose, lymphocytic pleocytosis, elevated adenosine deaminase
imaging: basilar meingeal enhancement
tx = 4 drug for 2 months then 2 drug for 9-12 months, steroids

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82
Q

threshold for transfusion in most stable patients?

A

Hb <7

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83
Q

abx therapy for postpartum endometritis

A

clindamycin + gentamicin

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84
Q

most important predictors of survival in COPD?

A

**FEV1

age

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85
Q

management of opioid withdrawal

A 
opioid agonis (methadone or buprenorphine - need supervised setting)
clonidine, antiemetics, antidiarrheals, Benzos
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86
Q

HTN drug of choice with lithium

A

CCB

drugs that affect renal function or Na/K levels increase lithium levels

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87
Q

colonic diverticulosis

A

painless hematochezia from arterial erosion
dx = colonoscopy or tased RBC scan
tx = usually self limited, IVF, transfusion if necessary, +/- endoscopic theory or embolization

88
Q

treatment for stress incontinence

A

lifestyle modification
pelvic floor exercises
pessary
urethral sling surgery

89
Q

initial treatment of parkinson disease

A 
levodopa
dopamine agonists (pramipexole) *preferred in younger patients
90
Q

entacapone

A

COMT inhibitor, helps prolong effect of levadopa

has no effect on PD by itself

91
Q

Wallenberg syndrome = lateral medullary infarct

A

PICA or vertebral artery
loss of pain and T over ipsi face and contra body
ipsi bulbar weakness
vestibulocerebellar impairment
horners syndrome
motor function of face and body preserved

92
Q

delayed puberty in boys

A

lack of testicular enlargement by age 14 and delayed growth spurt
initial workup = FSH, LH, T, TSH, prolactin, bone age

93
Q

prostate CA screening

A

PSA screening considered for ages 55-59, but absolute benefit is small
most men with prostate CA die from other causes
No screening recommended for <55 or >70 or life expectancy <10 yrs

94
Q

treatment for bacterial conjunctivitis

A

erythromycin ointment or polymyxin-trimethoprim drops

topical fluoroquinolone for contact wearers (for anti-pseudomonas activity)

95
Q

otitis-conjunctivitis syndrome pathogen

A

nontypeable H flu

96
Q

treatment of AOM

A

first line = amox

2nd line = amox-clav (repeat infection within 1 month)

97
Q

cardiac findings of massive PE

A

pulm HTN -> acute RV dysfunction, tricuspid annulus dilation and regurgitation

98
Q

allergic bronchopulmonary aspergillosis - sxs, labs, imaging, tx

A

preexisting asthma or CF pt with recurrent episodes of fever, malaise, cough with brownish/blood tinged sputum, wheezing
dx = eosinophilia, positive skin test for aspergillum, positive aspergillus IgG, elevated aspergillum specific and total IgE
imaging = typical upper lobe opacities, atelectasis, bronchiectasis
tx= steroids, itraconazole, voriconazole

99
Q

complication of cryptococcal meningoencephalitis

A

increased ICP

requires serial LPs

100
Q

most common cause of secondary dilated cardiomyopathy

A

CAD
*all patient presenting with unexplained heart failure due to LV sys dysfunction should be evaluated with stress testing or coronary angiography

101
Q

most important modifiable risk factors of AAA formation, expansion, and rupture?

A

cigarette smoking

102
Q

treatment of graves disease

A

BB for acute symptoms antithyroid drugs: mild hyperthyroidism, old age, prep for RAI or surgery, pregnancy (PTU in first trimester)
radioactive iodine: moder to sever hyperthyroidism, patient preference
surgery: CA, large goiter, severe ophthalmopathy, pregnancy that can’t tolerate meds

103
Q

best labs to assess response to antithyroid drugs (for graves)?

A

total T3 and free T4

TSH may remain suppressed for several months after therapy is initiated

104
Q

empiric treatment for osteomyelitis

A

coverage against staph *clinda or vanc if high likelihood of MRSA
*Add ceftriaxone for SCD its to cover salmonella

105
Q

constitutional delay of growth and puberty

A

delayed puberty + short stature
normal growth velocity
delayed bone age
+/- family history of late bloomers

106
Q

parvovirus B19

A

young children: flu like symptoms followed by slapped cheek rash (rarely arthralgias)
adolescents/adults: flue like sxs followed by acute onset symmetric joint pain, swelling, and stiffness *small joints (rarely faint reticular rash)

107
Q

laryngeal edema

A

typically presents with post extubation stridor
consider early reintubation
IV steroids prior to extubation reduce risk

108
Q

conduct disorder

A

repetitive and persistent pattern of behavior violating rights of others and major societal norms
cruelty towards people and animals
<18yo version of antisocial PD

109
Q

oppositional defiant disorder

A

pattern of angry/irritable moof and argumentative behavior towards authority figures, stealing, destruction of property likes CD does
doesn’t involved cruelty toward people or animal

110
Q

when are abx indicated for acute rhino sinusitis?

A

if infection doesn’t improve in 7-10 days or worsens after initial improvement

111
Q

Hb and BP goal for elderly

A

HbA1c 7-8% because high risk of hypoglycemia

BP <150/90

112
Q

int vs ext validity

A

int validity = describes causality (inc as study is more tightly controlled)
ext validity = generalizability to real world

113
Q

maternal and fetal risk for mother with SLE

A
  • greater with active disease
  • requires close monitoring
    fetal: fetal demise, congenital complete heart block, anti-SAA and SSB Ab cross placenta, hepatic, term, hematologic, neonatal lupus
    maternal: thrombosis with antiphospholipid syndrome, preeclampsia *ASA starting at 12wks
114
Q

central hypothyroidism management

A

levothyroxine, monitor T4 not TSH

ACTH stim test before treatment to r/o adrenal insufficiency

115
Q

major risk factors for rapid progression of CKD? (3)

A

HTN
proteinuria
hyperglycemia

116
Q

strongyloides - sxs, dx, tx

A

sxs - linear itchy rash, GI and pulm issues *often mild and recurrent
dx = serology, eosinophilia
tx = ivermectin or albendazole, recheck titers at 3-6 months

117
Q

types of clinical trials

A 
explanatory = test efficacy under optimal and controlled situations
pragmatic = test effectiveness in real life conditions
118
Q

first line treatment for menopausal hot flashes

A

mild - behavioral modifications

mod to severe - estrogen (+P if intact uterus) OR SSRI if contraindication to estrogen (thromboembolism, breast CA)

119
Q

causes of AIN

A

drugs : abx, NSAIDs, PPI, diuretics

infections: legionella, strep
autoimmune: lupus, sarcoidosis, Sjogren syndrome

120
Q

lung CA and AAA screening

A

AAA screening for any smoking history men age 65-75 *U/S, one time
lung CA screening for ages 55-80 with >30pack year smoking historians currently smoke or quit in last 15 years *CT, annual

121
Q

treatment of Hirschsprung disease

A

surgical resection of ganglionic bowel

122
Q

transient synovitis

A

hip pain + limp in otherwise well appearing child *able to bear weight, afebrile, labs normal/mild elev
often preceding viral illness
tx = NSAIDs

123
Q

physiologic leukorrhea

A

increase in amount of normal vaginal discharge due to increased E levels
presents without other associated symptoms

124
Q

tx for hyperCa 2* to malignancy

A

Ca >14 or severe sxs
short term: IVF and calcitonin
long term: bisphosphonates (e.g. zoledronic acid)

125
Q

common meds that can raise BP (6)

A 
NSAIDs
decongestant
antidepressants
OCPs
steroids 
stimulants
126
Q

HSV in pregnancy

A

antiviral therapy started at 36 wks for suppression

C/S if active lesion at time of delivery

127
Q

immune thrombocytopenic purpura (ITP) - cause, sxs, labs, tx

A

cause = acquired Ab to platelet Ag
often preceding viral illness or medical problem
sxs = mucous bleeding,(menorrhagia, epistaxis), petechia
labs = thrombocytopenia with normal platelet morphology (may have anemia due to bleeding), other labs normal
tx = observation, steroids if plt <30,000, IVIG and transfusion if hemorrhage

128
Q

military TB - epi, sxs, dx, tx

A

epi: inc risk with immunosuppression, hematogenous dissemination from lungs
sxs: subacute/chronic fever, night sweats, weight loss, malaise, pulm, liver, CNS, adrenal sxs
dx = cytopenias, diffuse nodular pulm infiltrate, biopsy and culture
tx = 4 drug tx (same as for pulm tb)

129
Q

tx of PTSD

A

trauma focused CBT

SSRI/SNRI

130
Q

initial management of postmenopausal bleeding

A

transvaginal US or endometrial biopsy

131
Q

screening test for risk fo stroke in SCD pts

A

Transcranial doppler US for ages 2-16

132
Q

common CV complications of OSA (4)

A

resistent HTN
CAD
arrhythmias
heart failure

133
Q

thyroid function in elderly

A

TSH levels rise with age, TSH<7 in elderly doesn’t need treatment if T4 is normal

134
Q

HIT 1 vs 2 (heparin induced thrombocytopenia)

A

HIT 1- mild, non immune mediated, <2days after heparin initiation, lowest plt 100,000 typically , no treatment needed
HIT 2 - plts decline >30-50%, 5-10 days after heparin initiation (<1 day if prior exposure), thrombosis, tx = stop heparin, switch to other anticoagulant, plt factor 4 Ab testing

135
Q

mucormycosis

A

invasive fungal infection in immunocompromised patient (DM, malignancy)
fever + nasal congestion + purulent nasal discharge + HA + sinus pain + necrotic invasion of plate, orbit, brain
dx/tx = sinus endoscopy with debridement, amp B

136
Q

tx for splenic sequestration

A

IVF
pRBC
+/- splenectomy

137
Q

when is imaging required in c diff?

A 
evidence of sever or fulminenat disease
WBC>15
Cr >1.5
septic shock
apparent ileum 
severe abdominal pain
138
Q

treatment of acalculous cholecystitis

A

percutaneous cholecystomy and drainage + IV abs

cholecystectomy for perf or necrosis

139
Q

what is anti CCP specific for?

A

RA

140
Q

treatment of uterine inversion

A

d/c uterotonics + manual uterine replacement

*sometimes uterine relaxants are needed for replacement

141
Q

management of neonatal polycythemia

A

monitor glucose and bili

IVF if symptomatic (resp distress, tachy, apnea, lethargic)

142
Q

complications of sickle cell trait

A 
hematuria/papillary necrosis, hyposthenuria
splenic infarction (*high altitudes), venous thromboembolism, priapism
external rhabdomyolysis
143
Q

Frailty

A

characteristics - fatigue, weakness, impaired ambulation, weight loss
labs - check TSH, CBC, Vit D, B12, metabolic panel
tx = structured exercise program, d/c necessary meds, nutrition and Vitamins D

144
Q

chronic alcohol use then IVF with dextrose –> risk of ?

A

hypophosphatemia 12-36 hr later (because depleted intracellular P stores and then insulin drive P into cells)

145
Q

what is the risk of waiting for spontaneous labor for intrauterine demise?

A

increase risk of DIC

*still an option for patients however

146
Q

EKG findings of LVH

A

high voltage QRD + inverted T waves

*should get echo if sxs to determine cause - e.g. athletes heart or hypertrophic cardiomyopathy

147
Q

workup of lower urinary tract symptoms in male?

A 
*urinary frequency, nocturne, hesitancy
UA
PSA
\+/- Cr
neuro and digital rectal exam
148
Q

synovial fluid analysis in reactive arthritis

A

high WBC but culture negative

149
Q

IgA nephropathy

A

gross hematuria following acute URI, no definitive tx

*can be distinguished from post strep GN b/c in PSGN there is a gap of 10+ days between throat infection and onset

150
Q

relationship between specificity and PPV

A

as specificity increases, PPV increases

151
Q

symptoms of ACL injury

A

popping then hemarthrosis/effusion

joint instability

152
Q

chronic mesenteric ischemia

A

crampy epigastric pain that worsens after meal and workup otherwise negative
look for CAD risk factors
dx with angiography

153
Q

recommendation re: future heparin use for patients with HIT?

A

avoid all forms of heparin for life

“heparin allergy”

154
Q

3 clinical criteria for dx of ankylosing spondylitits

A
  1. low back pain/stiffness for 3+ month, improves with exercise/activity
  2. lumbar spine ROM limited
  3. chest expansion limited
    * *Eval with Xray initially
155
Q

px for ankylosing spondyilitis

A

no functional or employment disabilities, no increased mortality

156
Q

preeclampsia: define, sxs, tx

A

new onset HTN >140/90 at >20wks + proteinuria or end organ damage
severe features: >160/110, thromobcytopenia, inc Cr, inc LFTs, pulm edeam, visual or cerebral sxs
tx = Mag, BP control, +/-delivery (>34 wks for sever features, >37 without sever features)

157
Q

hyperthyroidism in pregnancy

A

treat with PTU in first trimester and methimazol din 2nd and 3rd trimester
treatment should be titrated to mild hyperthyroid state (similar to physiologic changes in pregnancy)

158
Q

treatment of prolactinoma

A

dopamine receptor agonist (bromocriptine, cabergoline)

159
Q

microbiology of nec fasc

A

GAS most common
clostridium *crepitus
staph
polymicrobial in those with underlying DM or PVD

160
Q

cutaneous cryptococcosis

A

widespread skin papule with umbiliication *head and neck most common, small area of central hemorrhage or necrosis
in severe immunocompromise
usually a sign of disseminated cryptococcus

161
Q

pan coast tumor presentation

A

shoulder pain
Horner syndrome
C8-T2 involvement - weakness of hand muscles, pain/parasthesias of 4tha nd 5th digits, medial arm, and forearm
tumor can spread to spinal cord causing asym LE DTR *needs immediate tx

162
Q

NNT

A

1/ARR

ARR = R1-R2

163
Q

disseminated gonoccal infection

A

arthritis +/- dermatitis (pustules) + tenosynovitis

dx = NAAT of urogenital sample

164
Q

treatment for uncomplicated urogenital gonorrhea urogenital infection

A

1 IM ceftriaxone + 1 PO azithro

165
Q

how to adjust warfarin when starting amiodarone?

A

decrease warfarin by 25-50% (amiodarone is CYP inhibitor)

166
Q

most common complication of compartment syndrome?

A

rhabdo and AKT/renal failure

167
Q

primary biliary cholangitis - patho, sxs, labs, tx

A

autoimmune disease
causes fibrosis and obliteration of intrahepatic bile duct
sxs = fatigue, pruritus most common +/- hyperpigmentation, inflam arthritis, RUQ discomfort, xanthelasmata and xanthomata
increased risk for osteopenia/porosis
labs = sig elev alk phos, +AMA
tx = ursodeox acid

168
Q

when is exchange transfusion indicated for hyperbili?

A

> 20-25, worsening hyperbili on phototherapy, or signs of near dysfunction

169
Q

what does tight glycemic control in DM decrease risk of?

A

microvascular complications (retinopathy, nephropathy)

170
Q

pituitary adenoma

A

increased serum alpha unit, low FSH, LH
sxs related to mass effect
tx = transsphenoidal surgery

171
Q

adrenal mass workup

A 
lytes &amp; hormone workup:
dexameth suppression testing
24hr urine catecholamine
metanephrine
vanillylmandelic acid
17-ketosteroid
172
Q

treatment of cocaine intoxication

A

Benzos + nitro +/- CCB, phentolamine for persistant HTN
NO BB!!
+percutaneous coronary intervention with persistent ST elevation after medical therapy

173
Q

reversal of warfarin

A

prothrombin complex [ ] (FFP if not available)

Vit K

174
Q

endometriosis physical exam and complications

A

exam: nodularity, ovarian mass (endometrioma), immobile uterus, cervical motion tenderness
complications: infertility, chronic pain

175
Q

prognosis in febrile seizure

A

30% risk fo recurrence
inc risk of epilepsy (<5%)
normal development

176
Q

rabies ppx guidelines

A

pre exposure: 3 series vaccine
post exposure, unvaccinated: 4 series vaccine + Ig
post exposure, previous vaccination: 2 series vaccine

177
Q

pt with syphilis + neuro sx workup?

A

LP to eval for neurosyphilis

  • even if just HA, blurry vision
  • greater risk in HIV
178
Q

treatment of syphilis by stage

A

1, 2, early latent (<12 mths): 1 IM penicillin
late latent, unknown duration, gumma/CV syph: 3 wks IM weekly penicillin
neuro: IV penicillin for 10-14 days
congenital: IV penicillin 10 days
** treatment can cause Jarisch Herxheimer reaction - febrile syndrome within 24hrs after initial treatment, self limited

179
Q

clinical manifestations of hereditary hemochromatosis

A

hyperpigmentation *bronze diabetes
arthropathy & chondrocalcinosis
elev LFTs
DM, secondary hypogonadism and hypothyroidism
restrictive or dilated cardiomyopathy, conduction abnormalities
inc susceptibility of Listeria, vibrio, yersinia

180
Q

population attributable risk percent

A

proportion of disease in the population that is attributed to exposure
= (risk in total population - risk in unexposed) / risk in total population
= (prevalence x (RR-1)) / [(Prevalence x (RR-1) + 1 ]

181
Q

pseudohypoparathyroidism

A 
end organ resistance to PTH
chronic hypoCa
hyperPh
elevated PTH
sxs are related to low Ca - seizures, cramping, hyperreflexia, basal ganglia calcifications, cataracts
182
Q

colles’ fracture

A

distal radius fracture (+/- concurrent ulnar styloid fracture, scaphoid fracture, actor carpel tunnel syndrome)
FOOSH injury

183
Q

contact precautions for localized shingles - outpatient treatment

A

cover the area until lesion are completely crusted

184
Q

alopecia areata

A

smooth and discrete areas of complete hair loss w/o scaling, scarring, inflammation.
tx = topical or intralesional steroids
Recurring but hair regrows

185
Q

IVF and insulin for DKA

A

start with NS IVF and IV insulin infusion
Add dextrose to fluids when glucose <200
Switch from IV to subQ insulin when glucose <200, AG <12, bicarb>15 *must be able to eat
*continue IV insulin for 1-2 hours after 1st subQ is given

186
Q

imaging for possible bony metastasis

A

osteolytic (multiple myeloma): plain x ray and PET scan
osteblastic (prostate): bone scan
mixed (breast): bone scan, PET

187
Q

what Ab can be used to follow disease severity in SLE?

A

anti-dsDNA

-also associated with development of lupus nephritis

188
Q

pulmonary contusion

A

from blunt chest trauma, presentation can be delayed 24 hrs after injury
chest pain + resp distress/hypoxemia
CXR shows irregular localized lung opacification

189
Q

complication of subclinical hypothyroidism?

A

increased risk for pregnancy complications, including recurrent miscarriage

190
Q

indications for ppx antiD Ig for Rh(D) negative patients

A 
**not indicated if father is Rh(d) negative too
28-32 wks gestation
<72 hrs after delivery of RhD+ infant 
<72 hrs after spontaneous abortion
ectopic or threatened pregnancy
hydatidiform mole
chorionic villus smapling, amniocentesis
abdominal trauma
2nd and 3rd trimester bleeding
external cephalic version
191
Q

treatment of large pneumothorax

A

needle decompression in tension pneumo, unstable

chest if tension pneumo hasn’t developed yet and patient is stable

192
Q

what do you monitor resp status with in Guillain barre syndrome?

A

tidal volume and negative inspiratory force

193
Q

Guillain barre syndrome treatment

A

plasma exchange or IVIG if:
-nonambulatory
-within4 wks of sxs onset
speeds recovery and decreases need for mechanical ventilation

194
Q

when should carotid endarterectomy be done?

A

high grade stenosis (70-99%) and symptomatic and life expectancy 5+ years

195
Q

types of transfusion reactions

A

anaphylaxis: immediate, think IgA deficiency, prevent with washed RBC
acute hemolytic rxn: w/in 1 hr, fever, chills, flank pain, hemoglobinuria, can progress to DIC and renal failure, positive direct Coombs, prevent with cross matching
febrile nonhemolytic: 1-6hrs, fever, chills, malaise from leukocyte debris released cytokines, prevent with leukoreduction
TRALI: 1-6hr
delayed hemolytic: 2-10days

196
Q

thyroid and sodium connection?

A

moderate to severe hypothyroidism can be associated with mild euvolemic hyponatremia
Levothyroxine corrects the sodium

197
Q

iodine induced hyoperthyroidism

A

risk factors: nodular thyroid disease, chronic iodine deficiency
sxs - hyperthyroid sx onset following iodine exposure, temporary
labs = suppressed TSH, negative thyrotropin receptor Ab
tx - BB for sxs, antithyroid meds if needed

198
Q

seborrheic dermatitis tx

A

topical antifungals
topical steroids
topical calcineurin inhibitor
Weekly retreatment may be necessary

199
Q

lung CA screening effectiveness

A

25% will have nodule identified, 95% of which are false +

200
Q

orthostatic proteinuria

A

most common cause of proteinuria in adolescents
mild proteinuria, but otherwise normal and asymptomatic
dx = split day and night 24hr urine collection or UPC when standing and supine
*elevated protein during day/standing, but not at night/supine
resolves spontaneously

201
Q

target glucose levels in pregnancy

A

fasting <95
1hr postprandial <140
2hr postprandial <120

202
Q

SGLT2 inhibitors (-flozins) side effects

A 
euglycemic ketoacidosis
hyperK
hyperlipidemia
fluid loss (hypoBP, AKI)
vulvovaginal candiasis
UTI
low trauma fracture, amputation
203
Q

medical contraindications to pregnancy

A 
LVEF <40%
class III-IV HF
prior peripartum cardiomyopathy
severe obstructive cardiac lesions
severe pHTN
unstable aortic dilation 
> 40mm
204
Q

imaging that should be performed after diagnosis of multiple myeloma?

A

skeletal survey

205
Q

hyper viscosity syndrome sxs

A 
nasal or oral bleeding
blurry visions
neuro ses - confusion ,HA
heart failure 
*complication of Waldenstrom macroglobulenemia or MM
tx = plasmapharesis
206
Q

verification bias

A

occurs when a study uses a gold standard test selectively in order to confirm a positive or negative result of preliminary testing

207
Q

workup of dyspepsia

A

> 60 upper endoscopy

<60 H pylori testing (upper endoscopy if alarm sxs/high risk)

208
Q

treatment of infant botulism

A

IV botulism Ig

209
Q

anomalous aortic origin of coronary artery

A

common cause of sudden cardiac death in young athlete
patients usually have premonitory sxs of exertion angina, lightheadedness, or syncope
dx = coronary angiography, ECG and echo can be normal

210
Q

treatment of expanding neck hematoma

A

secure airway immediately due to risk of upper airway obstruction

211
Q

carpal tunnel dx

A

nerve conduction studies to confirm dx or assess severity

only used for those with chronic or refractory sxs

212
Q

primary ovarian insufficiency sxs and tx

A

sxs: amenorrhea at <40, hypoE sxs (hot flashes), inc FHS, dec E
tx: estrogen therapy (with P if intact uterus)

213
Q

treatment of malignant otitis externa

A

IV anti-pseudomonas abx, switch to PO when ESR/CRP normalize

total therapy 6-8wks

214
Q

hepatic encephalopathy

A

precipitating factors: drugs, hypoV, electrolyte changes, inc N load (diarrhea), infection, TIPS
tx = current underlying factor, dec blood ammonia (lactulose, rifaximin)

215
Q

papillary renal necrosis

A

chronic nephropathy
can present acutely as hematuria, pyuria, proteinuria, and renal colic
occurs with heavy long term use of analgesics

216
Q

CKD and its affect on P, Ca, PTH

A

CKD -> P retention, dec Ca, dec Vit D -> inc PTH (2* hyperparathryoidism) -> autonomous PTH secretion (3* hyperparathyroidism)
tx = parathyroidectomy in cases of persistent HyperCa or hyperPh, very high PTH, soft tissue calcification, or intractable bone pain

217
Q

BP control after ischemic stroke

A

<185/105 >140/90

*if no thrombolytic therapy received, <220/120

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