Practice question notes Flashcards
Last-ditch treatment for left BBB
Cardioversion if have maxed out medical therapy
Treatment of AAA
IV labetalol to get systemic BP <100-120
SVT treatment
IV adenosine
DOC HTN in AAs
CCB or diuretics over ACEi
What is Still’s murmur?
Benign childhood systolic murmur best heart at lower precordium; low, short tone
How is Lovenox eliminated?
Renal, do renal dosing
When do you give thrombolytics for heart attacks?
If LBBB - bc occluded LAD
Give for STEMI but not ST depression
What is ABI and what is a normal number
Systolic ankle/sys arm; 0.9-1.2
After 1st DVT?
Warfarin 3 months + LMWH
What is SMA syndrome?
- Vomiting, 2. Cardiac problems, 3. Leukocytosis
DOC a fib
BB for rhythm and rate
What do fibrates do
Lower TGs, inc. HDL
Niacin is contraindicated in __
diabetics
Treatment of WPW with SVT
Radiofrequency ablation, not digoxin
DOC for acute delirium/AMS
Haldol q 30 and more doses q necessary
High LDL found. Need to screen for:
Hypothyroid, DM, liver dz, CRF, meds
Treating arrythmias 2/2 cocaine, do NOT:
Don’t use BBs–>vasospasm
DOC intermittent claudication?
Cilostazol, a PDE5 inhibitor, C/I CHF
Subclinical hypothyroidism lab pattern TSH Te
TSH>10, normal T3. Assoc w high LDL
Lithium AEs
hypterthyroidism, renal impairment, congenital heart
Byetta/exenatide MOA
Increases gastric emptying time and C/I gastroparesis
DDx hot nodules thyroid
Grave’s, multinodular goiter, solitary hot nodule, TSH adenoma, molar pregnancy/choriocarcinoma
DDx cold nodules thyroid
Subacute thyroiditis, PP lymphocytic thyroiditis, radiation-induced, struma ovarii, follicular cancer
UC or Crohn’s which has an increased risk of colon cancer?
UC
Characteristics of Crohn’s (vs. UC)
No rectal involvement, transmural, segmental, fistulas
S/S radiation proctitis
Pain with defecation, diarrhea, rectal bleeding
Tx of traveler’s diarrhea
Cipro 3 days
MSM need this preventative service
HepA vaccine
Best test for hemochromatosis
Serum transferrin saturation (not Bx!)
Bilirubin over __ is always pathologic in neonates
17
Finding on peritoneocentesis dx of acute bacterial peritonitis
PMN>300/mL
Gilbert’s increased direct or indirect bili?
Indirect
IBS symptoms worsen:
At night
DOC torsades
Magnesium
Erythema toxicum neonatorum rash appearance
Flea bitten
DOC preventing spread of pertussis
Azithromycin
Tarsal coalition?
Bone fusion in adolescents. Often bilateral, ankle pain with dec ROM and pain with inversion
Os trigonum?
Non-ossification of cartilage; unilateral and palpable with heel tenderness
Sever’s apophysitis?
Heel pain from calcaneal inflammation
Navicular fractures
Tender over dorsomedial navicular
Bupropion weight gain?
NO
Delayed bone age as well as growth velocity suggest:
GH deficiency
What is xerosis?
Pathologic dryness, usually in the elderly, worst in winter
Test of choice hypogonadism in men
Total T
Treatment of hypercalcemia of pregnancy?
pamidronate
Valsalva maneuver and murmurs mechanism
Decreases venous return and CO
SCFE presentation
Overweight boys with limited internal rotation
Pts with immediate family member with colon cancer screening recommendations
Start at 40, q 5 years
These drugs act at the AV node and may worsen WPW by causing v fib
Adenosine, digoxin, and CCBs
DOC WPW
procainamide or amiodarone
SSRI DOC pregnancy
Prozac (fluoxetine)
Tx of severe BPP resistant osteoporosis?
Teriparatide (Teri is so strong) for up to 2 years
ASA recommendations
Men 45-79 to reduce MI risk
Women 55-79 to reduce stroke risk
Erythema multiforme is the rash of:
HSV
ASCUS–>
3 options: 1) repeat at 6 and 12 mo 2) test for HPV 3) colposcopy
Omeprazole decreases __ absorption
B12
Treatment of atrial flutter with acute HF
Cardioversion
Treatment of atrial flutter if pt is stable
Digoxin or verapamil
Patellofemoral pain syndrome
Active teenagers with anterior knee pain that worsens with running -> get PT
TZDs mechanism
Act on PPARg to increase insulin sensitivity
Vacuum or forceps?
Vacuum worse bc more dystocia, cephalohematoma, retinal hemorrhage
Trazodone side effects
Sedation, orthostatic hypotension
This antidepressant can worsen insomnia
bupropion
Mirtazepine is great for:
appetite stimulation and weight gain
ACD iron study pattern
Low TIBC, low serum iron, high ferritin
Preventing recurrent calcium stones
Low sodium diet, increase fluids, take K citrate at mealtime to increase urinary pH, also HCTZ!
Metabolic acidosis plus acute renal failure suggests:
Methanol poisoning; check gap, look for hypocalcemia, check for fluorescent pee
Treatment of methanol poisoning
fomepizole
Is glipizide safe for CKD?
Yes
Therapies for essential tremor
Propanolol, primodone
Who should be screened for diabetes?
BMI>25, Inactive, HTN, HDL250, A1C>5.7, Hx of GDM or PCOS
Spinal stenosis pain is relived by:
Sitting
Herniated disc pain is made worse by:
Sitting
Pseudogout joint findings
Short, blunt, rhomboid and cuboid crystals with lots of PMNs
Cat bite what do you do?
Prophylax for pasturella
Methadone worrisome cardiac effect
torsades
A fib low risk DOC anticoag
ASA 325
A fib high risk DOC anticoag
Warfarin
Cat scratch DOC
Azithromycin
Nortryptilline and duloxetine AEs
Worsen arrhythmias, worsen urinary retention
Celexocib AE
reflux
Which NSAID is on Beers list?
Indomethacin
Pain after cholecystectomy plus jaundice?
Retained common duct stone
Recommendations for gastric bypass
BMI>40 or 35-40 with comorbidity with dietician and mental health eval first
First test in patients with abnormal renal function plus hypertension
Duplex Doppler USG
Who should be screened for osteoporosis
Women over 65, men over 70, men and women 50-69 with risk factors
DOC ascites?
Spironolactone over loops
V tach acute treatment
amiodarone
Bronchiolitis in ED best drug first?
Albuterol
Contraindications to zolendronate
Hypocalcemia, creatinine less than 35
ESRD associated with hypo or hyper pth?
hypoparathyroid
Common EKG finding in anorexia nervosa?
Sinus bradycardia
GC treatment?
Ceftriaxone 250 IM
Chlamydia tx?
Azithromycin
Zostavax is contraindicated in:
immunocompromised
Sevelamer MOA
Blocks intestinal absorption of phosphate, lowering PTH
Tx of acute otitis externa?
Cipro + dex
Which type of renal stone needs acidification of the urine?
CA phosphate
Calcaneal aphophysitis presents?
Heel pain in kids with tight Achilles, pain with dorsiflexion and activity
Tx of SCFE?
Surgery; more common in blacks that are fat
Length of thromboprhophylaxis for THA?
35 days
Phenytoin long-term side effect?
osteoporosis, by increasing hepatic metabolism of vitamin D
When to begin breastmilk supplementation and with what?
Vitamin D at 2 months
Does polymyalgia rheumatica have increased CPK?
Nope
In those on long-term prednisone, they also need to take:
BPP and vit D
What are some drug options for incomplete response to an antidepressant?
T3, lithium, or atypical antipsychotic
Pertussis phases
Prodrome 1-2 weeks similar to URI, then paroxysmal coughing fits
Baby has rash on perineum that’s not diaper? What is the organism
GAS
What is an appropriate monotherapy for exercise induced asthma?
Pre-activity beta agonist
Posterior tibial tendonopathy presentation
women over 40 with no trauma, but pain with plantarflexion an worse with foot inversion
How are sulfonamides teratogenic?
Kernicterus in 3rd trimester
Rare side effect of dextromethorphan?
Serotonin syndrome
How do you interpret an AM cortisol test? High low etc
> 13 excludes adrenal insufficiency; if <13, need to do ACTH stimulation test
All patients with HHT (OWR) need to be screened for:
Pulmonary venous malformations by contrast echo
Best way to image septic arthritis of hip?
USG
Treatment of Paget’s bone?
BPP
Presentation of acute closed glaucoma
Severe pain, blurry vision, halos, increased extra-ocular pressure, red conjnctiva, dilated pupils, hazy cornea
What is Gottron’s papules?
Flat violaceous papules on knuckles nearly pathognomonic for dermatomyositis
Which arrhythmia is adenosine used for?
SVT
How to check vit D levels?
25-OH, not D3
What is rifamixin used for?
Unabsorbed antibx that reduces ris kof traveler’s diarrhea
Who should avoid zanamavir?
COPD
Clonidine is C/I in:
Depression
Working up an incidental adrenal mass (not imaging)
O/N dex test; if cortisol >5, indicates adrenal hyperfunctioning
Glucose goal for gDM
Fasting 95 or less
Do not use ziprasidone in combination with these drugs
Clarithromycin, TCAs, or antiarrhythmics bc of qt prolongation
Sjogren’s antibodies to check
anti SSA and SSB
What is empiric therapy for suspected bacterial endocarditis?
Vanc + gent
Aricept increases risk for:
Cataracts
You find large parotid glands in someone. You should check to see if they have :
Diabetes
Drugs to reverse acute dystonia?
Diphenhydramine or benztropine
What is linagliptin?
DPP4 inhibitor
What is exenatide?
GLP analog
What is saxagliptin?
DPP4 inhibitor
What is sitagliptin?
DPP4 inhibitor
What is liraglutide?
GLP analog
What is glyburide?
Sulfonylurea
What is glimepizide?
Sulfonylurea
What is glipizide?
Sulfonylurea
What is pioglitazone
TZD
ST elevation in leads V1-V6, which artery is clogged?
LAD
ST elevation in leads II, III, aVF, which artery is clogged?
RAD
ST elevation in leads I, aVF, which artery?
Circumflex
Treatment for bullous impetigo?
Bactrim
Telogen effluxivum timeline
Hair loss 3 months after a stressful event that lasts 6 months after removal of the stressor
Iron anemia lab pattern TIBC ferritin reitulocytes
high TIBC, low ferritin, reticulocytosis 1 week after supp
ALT >3x UNL is specific for
gallstone pancreatitis
What is Behcet’s disease?
Asians with eye problems, cutaneous sensitivity, esp needle pricks
Most sensitive 1st trimester option to screen for Down’s?
Chorionic villus sampling
How do you monitor Lovenox?
Anti-Xa levels
How do you monitor LMWH?
PTT
Long-term use of H2 blockers or PPIs decreases __ absorption
Ca carb, so use Ca citrate
Where are the common fibromyalgia spots?
Medial scapula, back of neck, medial knee
Best SSRI for adolescents?
Fluoxetine
Tx of fungal toenail infection
Oral terbinafine 12 weeks
If PSA is >40, then:
Start 5 alpha reductase inhibitors
Otosclerosis presentation
Women in 20s-40s with progressive conductive hearling loss
Ottawa rules for X-raying ankles
Image if unable to take 4 steps, local navicular tenderness, local 5th MT tenderness, posterior or tip of malleolus is tender (Malleolus, Navicular, 4 steps, 5th metatarsal)
What is trifascicular block?
RBB + L anterior hemiblock inc risk of arrhythmia and bradycardia, so do heart monitoring
A 2nd PPD is + after a - one a few days before, what does that mean?
Long-standing latent infection
What is Hawkin’s impingement test?
Pain w int rot while 90 flex and 90 elbow - indicates rotator cuff
What is granuloma annulare?
Self-limited , not congaeious, treat with steroids. Red bumps on skin arranged in rings, usually on hands or feet
DI urine findings
Uosm < 300
Pressors used for septic shock
NE and DA
Tx of orthostatic HTN
Fludrocortisone, midodrine, physostigmine
What is a J sign?
Patella moves medial to lateral when extended
BZDs for alcohol withdrawal?
Long-acting like chlordiazepoxide
SIADH UA
FeNa>1, Uosm high
Differences between Waldenstrom’s, MM, and MGUS?
Waldenstrom’s has kappa Igm with lymphocytes, MM has plasma cells instead, MGUS has no BJ proteins like the others
Varicocle - which side is worrisome
R. Usually they are on L and unilateral. On R should be susp for abdominal or intraperitoneal mass
Which SSRIs have the highest withdrawal symptoms?
Venlafaxine (Effexor)
Preventing contrast nephropathy before CT
Give N-acetylcysteine
Tx of SIADH in a stable patient
Water restriction
Marfan’s suspected, need to do:
Echo
What is DRESS syndrome?
Drug reaction with eosinophilia and systemic symptoms; erythroderma plus fever, LAD, LFTs
Gonococcal conjunctivitis pres and tx
2-5 days life, tx ceftriaxone IM
Tx of dog and cat bites
5-7 days augmentin
Bacteria commonly associated with closed fist injuries?
Eikenella
What is amaurosis fugax?
Blockage of opthalmic artery leading to transient eye problems, assoc w strokes
What is the ABCD scoring system for people who have a TIA?
Age, BP, Clinical features, Duration/diabetes - identifies those at high risk of stroke within 7 days of TIA: BP >140/>90 1, Clinical 1, duration > 60 min 2 pt, less than 1 hr 1 point, diabetes 1 point
Aphasia during stroke indicates this artery is occluded or bleeding
MCA
Stroke work-up, acute
Head CT w/o contrast EKG MRI if symptoms have already resolved, w/in 24h Non-hemorrhagic: ASA w/in 48h tPA if w/in 3 hours Watch for post-stroke brain edema
How long should PEP be given for HIV
4 weeks, with TMP-SMX, ideally within 2 hours
What are the stages of AIDS?
1 CD4 >500, 2 CD4 200-499, 3 (AIDS) CD4<200 plus AIDS-defining condition, 4 Unknown labs with AIDS-defining
Clinic follow-up for someone with AIDS
Measure CD4 count q 3-6 mo, with CBC, CMP, UA at baseline and periodically to monitor for complications of HIV and its drugs; serology for toxo and CMV, screen for other STDs, do PPD too; women need regular Pap smears with HPV dna
When do you begin PCP pneumonia prophylaxis in AIDS?
CD4<200 with TMP-SMX
When do you begin MAC prophylaxis?
CD4<50 with azithromycin or clarithromycin
What are some risk factors for hepatitis A?
International travel, contaminated foods (raw oysters esp)
Which form of bilirubin is excreted in the urine?
Conjugated, while unconjugated is albumin-bound
Mild unconjugated hyperbili off and on throughout a patient’s life w/o symptoms…
Gilbert’s
How is hep A transmitted?
Fecal-oral
What is the average incubation for hep A
25-50 days
How long does the hep A icteric phase usually last?
6-8 weeks
Who should get the hepatitis A vaccine? Besides just MSM
Children age 1, children 2-18 in high risk counties, traveler’s to endemic areas, persons with chronic liver disease or clotting disorders, IV drug users, HIV+, high risk exposure workers, and anyone who desires immunity
What is the incubation time for hep B?
6 weeks to 6 mo., but only 50% are ever symptomatic
Risk of developing chronic hepatitis from the B virus is related to:
Age at infection; 90% of infants, but 5% of adults
This is responsible for 80% of HCC worldwide
hepatitis B
A patient is found to be anti-HBcAg IgM positive, with all other antibodies negative. What does that mean?
Window period
What percentage of those infected with hep C will develop chronic infection?
60-80%
What is the leading cause for liver transplant in the US?
Hep C
LFTs…viral hepatitis usually causes this one to be very high
ALT
What is the preferred non-invasive office test for H pylori now?
Stool antigen because of superior PPV, but must be off PPIs for at least 2 weeks
Drawback of H pylori serology
Cannot distinguish active vs treated infection
Roseola course
High fever and mild URI for up to 5 days, then exanthem of maculopapular eruption on face for 1-2 days
A new breast mass in women over 35 should undergo:
Triple assessment, with clinical exam, mammography, and either core biopsy or surgical excision
For women under 35, suspected lesions of fibroadenoma or fibrocystic change may be assed with:
USG, or rarely mammogram w/ FNA
DOC for breast pain
Danazol
Drugs that cause galactorrhea
SSRIs, TCAs, atenolol, verpamil, antipsychotics, H2 blockers, opiates, estrogens
What are Bouchard’s and Heberden’s nodes?
Bouchard: DIP
Heberden: PIP
Subluxed OA
Pseudogout
Pseudogout most often affects the elderly, and usually affects the knee, wrist, and ankle. Joint contains rhomboid-shaped, weakly POSITIVE birefringent calcium pyrophosphate
What are you worried about with premature closure of the fontanelles?
Craniosynostosis, if suspected get skull radiograph initially and if seen do CT
Tramadol should be used with caution in those with:
seizures esp older ppl
What are the approved treatments for men with osteoporosis?
Alendronate and PTH hormone
What is the treatment to reverse nerve gas (sarin)?
Atropine (anti-cholinergic)
What is the most effective drug for alcohol abuse?
Naltrexone
A post-traumatic air-fluid level in the sphenoid sinus is associated with:
A basal skull fracture
To test for median nerve inact after cut to hand ask them to:
Oppose thumb to pinky
What is autonomic hyperreflexia?
Sudden-onset sympathetic symptoms in those with spinal lesions above T6; fairly common; main concern is hypertension
This pain medication should be avoided in the elderly because of seizure risk
Meperidine (metabolite causes seizures sometimes)