Q Bank 2 Flashcards
Tx for upper airway cough syndrome
Decongestant
po or IN antihistamine
IN corticosteroid
Saline rinses
PE fingins - swollen turbinates and posterior pharyngeal cobblestoneing
Refer to allergy if no improvement after 2 months
If you suspect a bicep tendon tear what do you do next?
Get an MRI
PT isn’t going to be helpful
At what HA1C level do you need to add a second agent?
> 9%
Time to peak effect of po opioids?
1 hour
IV reaches peak in 10 minutes
What is the only tx that reduces mortality in pHTN related to COPD?
Supplemental O2
What anti HTN meds lessen severity of OSA?
Diuretics, especially spironolactone d/t aldosterone effect
What test is most specific for fibromuscular dysplasia?
MRA of the renal arteries
OR CT Angio
Greatest risk factor for developing OA?
Obesity
Tx for exercise induces asthma?
SABA 15 min before their run
Pt has pain anterior to L ear extending to mandible. VSS. L parotid is diffusely enlarged, tender and purulent material is coming from the L parotid duct orifice. tx?
Augmentin
Dx - acute parotitis
caused by dehydration
can also try lemon drops and parotid gland massage
What is an absolute contraindication for testosterone therapy
PolycytemaHCT > 54% Breast cancer prostate cancer PSA > 4 ABN rectal exam w/ nodule
Most effective medication to help maintain alcohol abstinence?
Acamprosate
Common cardiac anomaly in Marfan’s?
Aortic insufficiency
40 + Pt with 30 pyr smoking history has “quarter size” hemoptysis. Now what?
CT chest
Football player has pain limiting practice at proximal 5th metatarsal, Xray negative. Now what?
Order MRI of foot
If + get a hard shoe x 3 weeks with progressive activity and NSAIDs as tolerated
If you want to start an atypical antipsychotic on a dementia pt, what do you tell family regarding side effects?
Risk of mortality is increased
Which type of T2DM meds are likely to cause weight gain?
Sulfonylures (glimepiride)
Teen M Tanner 3 has a lump on L chest under areola. No nipple discharge or adenopathy. Next?
Follow up in 6-12 months Adolescent physiologic gynecomastia Normal in up to half of M teens Resolves in 6-24 months Be concerns if: present >2 years, hard/immobile/nontender, >5cm, nipple discharge, testicular mass, weight loss
Man has itchy rash around nasolabials and mustache. Tx and Dx?
Seborrheic dermatitis
Erythematous patches with white/yellow greasy scales
Tx - TOP anti fungal
Next step for peripartum depression?
Refer for therapy
Peripartum blues lasts <10 days
1st line Tx for RA?
Methotrexate
You want to start a statin on a pt planning to undergo planned TKR in 6 months. How do you counsel?
Start now to decrease risk of CV did and preoperative mortality
Male, just quit smoking has microscopic hematuria on UA>. What does he need next?
Cystoscopy
Indicated if pt > 35
1st line Tx for T2DM?
Metformin
Pt has allergies 5-7 days/wk x 6 months despite Allegra. Next tx?
IN budesonide (Rhinocort) Pt has persistent allergic rhinitis (syx >4 days x > 4weeks)
Tx for a venous stasis ulcer?
Compression Therapy
Cut off GFR for Gadolinium in MRI?
<30
Most important factors to prevent Post party hemorrhage?
Active management of 3rd stage of labor
Giving oxytocin after delivery of anterior shoulder
During a code you see Vtach. What do you do?
Defibrillation
If unsuccessful give episodes and def again
In pts with COPD which INH have been shown to reduce exacerbation and exacerbation related hospitalizations?
Tiotropium (Spiriva)
Beter than LABA (Salmetrerol)
Otherwise healthy patient has mildly elevated LFTS with negative viral hep panel. LFTs elevated on 2 occasions. Next?
US and ferritin
r/o hemochromatosis before working up FLD
Best way to determine if a pt is safe to take metformin?
eGFR
Initial Tx for Sarcoid
Prednisone
Pt has depression syx present x several years but is worse around menses, but present all throughout the month. Dx?
Dysthymia
In premenstrual dysmorphic disorder syx would only be present around menses
M pt has rash on neck where beard is x 1 year. Exam - curly facial hair, slightly tender, red hyperpigmented papules. Dx and Tx
pseudofolliculitis barbae - more common in folks with curly hair. Hairs are cute an an angle and curl in on themselves creating a foreign body rxn
Tx - electric clippers or to stop shaving
Teenager with athletes triad (BMI 16) and amenorrhea, what studies do you need?
BhCG
FSH/LH
TSH
DEXA
DVT Tx in pregnancy?
SQ Lovenox
Warfarin and DOACs have not been studied in pregnancy
PCOS patient has hyperpigmented patches along mandible. Dx and what med is causing it?
Melasma
Associated with pregnancy, OCPs, anticonvulsants
Medications that improve mortality in HFrEF
ACEI
Bblck
ARBs
Aldosterone antagonists (Spironolactone)
Pt with active cancer has a new PE. What are they d/c’d on?
Lovenox
DOACs haven’t been studied in malignancy
Pt on Warfarin for afib is planning to undergo surgery. How do you manage warfarin?
Stop 5 days prior to surgery and restart 12-24h post operatively unless there is a complication
Pt has dysphagia to solids but not liquids. Next?
EGD
C/f structural lesion
Pt with CAP was d/c’d on supplemental O2. Home health aid trialed pt off O2 x 1 hour and Sat >90%. What do you do?
d/c supplemental O2
No real benefit once they are over 88%
keeping pt on O2 too long increases risk of falls, fires, mucosal irritation
PCOS treatment associated with great live birth and ovulation rates
Letrozole (Femara)
Beter than clomiphene
Pt has sudden onset of multiple well circumscribed brown, oval, rough papule with “stuck on appearance” weight loss, pallor. What is on ddx and what to do next?
Sudden appearance of multiple seborrheic keratoses concerning for underlying malignancy - most common is adenocarcinoma of the stomach
Needs EGD and c-scope
NOT skin bx
Tx for Rocky Mountain spotted fever
Doxycycline
Start ASAP to decrease mortality
What T2DM medications are you hesitant with in a pt with hx of pancreatitis?
DPP-4 Inhibitor (Sitagliptin (Januvia))
GLP-1 agonist (Liraglutide (Victoza))
What co-morbidity can falsely lower the HA1C in a T2DM pt
Hemolytic anemia
Not Asplenia, IDA, CKD, Bit B12 deficiency - increases HA1C d/t increased longevity of RBC
Syx of Lithium toxicity
Often triggered by an inciting event (volume depletion, change in renal fxn)
Syx - GI upset, arrhythmia, CNS changes (tremor, confusion, agitation)
Usually a chronic toxicity seen in elderly patients d/t low muscle mass and decreased GFR. Usually follows an illness
How many days of abx should a routine CAP receive?
5 days. No benefit of longer courses
Asthmatic poorly controlled on Albuterol. Next step?
Fluticasone/salmeterol (Advair)
ICS/LABA
2 most common etiologies of neonatal sepsis?
1st - Group B Strep
2nd - E coli
Listeria is pretty uncommon now. Staph aureus and Group A strep are possible, but less likely. Strep pneumonia does not cause neonatal sepsis
Pt is bothered b tinnitus. What else should you check for?
Sensorineural hearing loss
Most tinnitus is idiopathic, but it is also associated with hearing loss
Penile lesions x 6 months, reddish-blue papule on the scrotom with a few similar lesions on the shaft. Dx?
Angiokeratomas
No tx needed unless bleeding
If present on shaft, suprapubic region or sacrum could be associated w/ Fabry dz and should be referred
Penile lesion - small skin colored dome shaped populates in circular pattern around coronal sulcus
Pearly penile papules
Benigns
Penile lesion - discrete pinhead-sized hypopigmented papule, asymptomatic. Can be scattered over penis and abdomen/legs
Lichen nitidus
Benign
Penile lesion - hypopigmented lesion with the texture of cellophane, usually on glans or prepuce. Atrophy, erosions, bull are common.
Lichen sclerosus - can be associated with SCC
Uncircumscrised M over 60 y/o - penile lesion beefy red, raised, irregular plaques on the glans, meatus, frenulum, coronal sulcus, prepuce. Can be ulcerated or crusted. Pain, itch common
squamous cell Carcinoma in situ (need Bx)
Pt hs 10 yr hx of HA QD. b/l with pressure/tightening quality w/o phono or photophobia. tend to worsen as day progresses. dx and tx?
chronic tension type HA
Amitriptyline can reduce HA duration and severity
1st line tx of diabetic neuropathy
Pregabalin (Lyrica) or gabapentin
F pt with hair loss, has a smooth circular area of complete hair loss on scalp w/o skin changes. Tx?
Intralesional corticosteroids
Dx - alopecia areata - chronic relapsing immune mediated inflammatory disorder affecting hair follicles causing patchy hair loss
IF over 50% of scalp is involved can use TOP immunotherapy
TOP steroid is only used in kids or adults that can’t handle the injection
What’s the formula for fluids in sepsis?
30mL/kg in first 3 hours in 500mL boluses
Lactate >3.6 suggests severe dz even if BP is ok
When do women need breast MRIs
Women at very high risk of breast cancer
ie - known genetic mutations, history of breast irradiation, high risk FHx, chest radiation (ie for Hodgkin’s dz)
Bball player has pain and flexion deformity in DIP joint. What wouldn’t make you want more of a work up before splinting?
Pt is unable to passively fully extend the joint
Hallmark of mallet finger is that pt can’t actively extending DIP joint.
However, inability to passively extend the DIP joint suggests trapped soft tissue or bone that may require surgery
IF > 30% avulsion needs ortho referral
Tx - splint with strict avoidance of keeping DIP joint in flexion even if delayed presentation. Can do activities even with splint in place
Pt under 65 needing both PCV 13 and PPSV23?
Chronic renal failure
Pt Under 65 needing just PPSV23
Chronic lung dz T2DM heart disease smoking EtOH abuse
Sudden facial droop, unable to furrow brow on that side. Tx?
Valacyclovir and tapering dose of steroid
Dx - Bell’s palsy
Antiviral + steroid more effective than steroid alone and if started within 72h of onset
Test to dx Cushing syndrome
24h urinary cortisol
NOT dexamethasone depression
Obese smoker with NL FEV/FVC ratio but Bicarb is 35. Dx?
Obesity-hypoventilation syndrome
Restrictive on spirometry
What is a complication of having an over treated hypothyroid with TSH <0.1
Increased risk of hip and vertebral fx
young pt with weight loss, oral thrush, lymphadenopathy, ulcerative esophagitis, c/f?
HIV
Dx and tx of honey crusted lesions on a kiddo?
Impetigo
TOP mupirocin
31 wk GA preggo is given tocolytics and betamethasone and d/c’d 2 days later with stable cervical exam. Returns 2 weeks later with contractions and unchanged exam. Now what?
Expectant management. Goal of tocolytics prior to 34 weeks is to allow betamethasone time to work
No benefit in tocolytic for one more week
Trigger points in fibromyalgia?
Medial scapula borders, posterior neck, upper outer quadrants of the gluteal muscles, medial fat pads of knees
1st line CAP tx for output of young adult
Azithromycin
RF for intermittent claudication
T2DM
Smoking
HTN
dyslipidemia
A singer has had hoarseness x 10 days, she wants to sing again as soon as possible
No talking whispering, throat clearing for 48 hours
when would you get labs on a kiddo with acne
acne in mid childhood (>1 yr to 8 y/o)
Start ASA at what ACSVD cut off
10%
Hallmarks of baby friendly hospital
Counsel on breast feeding, esp w/in 1 hour of birth No other fluids or foods Roomin in BF on demand No pacifiers
Tx for pituitary adenoma
<10 mm –> bromocriptine
> 10 mm –> surgery
Tx for acute bronchitis
Sudafed, honey, guaifenesin
which patients need abx before dental procedures?
prosthetic heart valves
Previous dx of endocarditis
unprepared cyanotic congenital heart disease (or repaired with residual shunt), heart transplant w/ regurgitation
Tx - Amoxicillin 2g once
type of therapy that works for OCD
CBT
At what age do you consider life expectancy when referring for screening c-scope
75
18 m/o WCC not meeting gross motor milestones. What would suggest MD?
Head lag when sitting up
Think syx d/t muscle weakness. Anything that suggests increased tone or hyperrreflexia is more c/w CP
Oligohydramnios is associated with what fetal anomalies?
Oliguria or anuria (renal genesis, obstruction from posterior urethral valves)
What abx combo would cover strep pyogenes and MRSA in a cellulitis?
Bactrim (MRSA) + keflex (Strep)
OR Clinda
At what age does a lazy eye become abnormal?
6 m/o - refer to ophtho
prior to 6 m it can be d/t imperfect coordination
most successful way to prevent travelers diarrhea?
Washing hands frequently or hand sanitizer
Avoiding street meat, tap water, ice, raw foods has not been shown to reduce risk
30 y/o G2P2 with amenorrhea, hot flashes, vaginal dryness x 1 year. Preg neg, NL TSH, prolactin. Elevated LH/FSH. Dx?
Primary Ovarian Insufficiency
Definition - menopause before age 40 d/t ovarian follicular depletion. Low estradiol, high FSH/LH
Most common cause of hypercalcemia?
hyperParathyroid
When do you think about doing NG feeds in a bronchiolitis?
RR >60, too hard to tolerate feeds
All pt handouts should be writing to what level?
5th grade
Pt is on chronic oxygen for knee OA. Refuses NSAID and PT. What do you do?
Taper oxycodone by 5-10% every 1-4 weeks
Teen football player has R shoulder pain d/t lots of throwing practice. Pain when raising hand above shoulder, +TTP proximal and lateral humerus. Dx and work up?
Little league shoulder (disruption at the growth plate of the humerus)
Get XRAY - look for widening, demineralization, or sclerosis at the growth plate.
If Nl Xray but suspicion still high get bone scan or MRI
sudden onset of pain and redness in eye, sluggish pupil reaction, decreased visual acuity
emergent referal to ophthalmology
c/f acute angle closure glaucoma
3 y/o turns toes in when he walks and has a clumsy gait. On exam feet point inward but patellae face forward. Dx and management?
Internal tibial torsion
No intervention, resolves spontaneously by age 5
May consider surgery if present at age 8 if symptomatic
no splints or shoe changes
62 y/o healthy female in rural NM has intractable n/v, hypotension after cleaning out a chicken coop and being exposed to rodents. blood Cx grow GNRs. Most likely pathogen?
Yersinia pestis
Kinda a dumb answer..
Human infection associated with contact of infected sheep, cattle, goats, dogs, cats
Coxiella burnetii
Gram neg
Q fevere