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
Human infection associated with contact of tissue rich in erythritol and fluids from goats and sheep
Brucella melitensis
Gram negative coccobacilli
24 AA M cough x weeks, b/l facial n. palsy. NL CBC and UA. CXR w/ b/l LN enlargement. Dx?
Sarcoidosis
b/l FN palsy in <5% of cases
Can have hemoptysis d/t aspergillus infection/cavitation
Rare renal involvement
Take what OTC supplement is associated with serious intracerebral bleeding if take with AC
Ginko biloba
Which NSAID is safest to use in pt w/ h/o MI?
Naproxen
Where is a tracheostomy inserted?
Cricothyroid membrane
Directly ABOVE the cricoid cartilage
lies below the larynx
problem with having a RBB + L anterior hemiblock on EKG?
Trifascicular block puts pt at risk of tachyarrhythmias and bradyarrhythmias
if symptomatic, Needs cardiac monitoring to decide if pacemaker is needed
Why do we do a 2 step PPD?
If second step is positive demonstrates that pt has long standing latent TB
shoulder exam: forward flex am to 90 with elbow bent at 90. Internally rotate shoulder. Test name?
Hawkins’ impingement
suggest subacromial impingement
4 w/o with cough, poor feeding, conjunctivitis, CXR with interstitial infiltrates. WBC with eosinophilia. Dx?
Chlamydia trachomatis
presents at 3-16 wk of age and can be sick for weeks.
when and how to treat triglycerides
If >1000 would start fenofibrate in addition to lifestyle modification to lessen the risk of significant pancreatitis
can also start statin but statin won’t lower TG
Omega 3 can also lower TG and LDL but does not decrease mortality or CV events so not recommended
Niacin does increase HDL and LDL but studies have not demonstrated that CV outcomes are affected
what medication can cause hyperthyroidism?
amiodarone
made up of 37% iodine
Pt wants advice about DHEA?
It does not enhance performance or muscle strength
Precursor to testosterone and estrogen
infection of the lateral nail fold
paronychia
Tx top abx +/- TOP steroid, po ab, warm compress. I&D if not responsive
when leg is extended, patella deviates laterally. Dx?
patellofemoral syndrome
cyp450 inducer
phenytoin
preferred initial test in post menopausal VB?
TVUS
less invasive than EMB and if endometrial stripe <3-4 mm then carcinoma is r/o
Pulmonary embolism is associated with which type of effusion?
exudative
unvax preggo in 1st trimester found out hubs has acute hep b. what to do?
Give HBIG and Hep B vax now
which vaccine preventable illness has had an increase in number of deaths in recent years?
Pertussis
adults lose immunity. Should get booster once between 19 and 65
proximal muscle weakness with elevated CK
drug induced myopathy (usually d/t statin)
proximal muscle weakness with elevated ESR
polymyalgia rheumatica
best evidence to prevent fractures in postmenopausal women with osteoporosis?
Bisphosphonates
pt has pelvic pain but during and exam you have her raise both legs off table which intensifies her pain. Dx?
Suggests MSK etiology
If pain was improved would call this Carnett’s sign which would decrease abdominal pain as the and muscles tighten because the taut muscle protects the viscera during the exam
Pt admitted for CHF x2 weeks develops copious semi formed stool. Dx?
C diff
Long hospitalization even without abx use is a risk factor for c diff. Exposure to toxin
pt has annular rash on dorsal of hands. Bx reveals granuloma annular. Now what
No tx. Self limited.
when to screen for gDM?
24-28 wk
Boxer fx of 5th metacarpal has < 40degree of angulation. Tx?
Ulnar gutter splint
>40 needs surgery
Best US measurement to estimate gestational age
Crown rump length @ 10wks pregnancy
Tx for HIV + with latent TB?
Isoniazid x 9 months
Rifampin is not recommended in HIV d/t resistance and drug interactions with HART therapy
Pt has a cold sore and that 2 days later develops maculopapular rash in multiple areas that look like target lesions. Dx?
HSV
Rash = erythema multiforme and HSV is the most common etiologic agent
What imaging study should you get for pts with hematuria?
CT urography (not RBUS)
what can help reduce leg pain in PAD?
Statin
Tx for neurogenic bladder (retention)
scheduled urination +/- Crede’s maneuver
+/- bethanechol
self-cath
Tx for cocaine induced chest pain?
IV Ativan
niacin can have side effect on which organ?
Liver
Hepatotoxitiy in elderly
Well controlled t2dm on insulin is now having hypoglycemia despite no change in diet or insulin. Why?
Kidney disease
2 y/o M isn’t walking, if c/f Duchenne MD what lab test would be helpful?
CK
Most common cause of 24-48h food poisoning?
Staph
How to confirm dx of Parkinson’s dz?
positive response to levodopa
when does mid shaft clavicle fx need surgery?
Older female (ie >50) Comminution or displaced fx clavicle shortening
Tx for postpartum urinary retention
Foley or intermittent Cath
common cause of wheeze in infants?
GERD
Dosing of amoxicillin for AOM?
80-90mg/kg/day
Surgeries with the highest risk of preoperative MI?
Aortic and peripheral vascular surgery
Emergent operations
Tx for inpatient cellulitis w/o abscess
CTX, PCN, Cefazolin, clinda mono therapy
If purulent drainage or IVDU or MRSA + –> vanc
Good exercises for low back/pelvic pain in 3rd trimester?
Core stability exercise (pilates, back extension, abd crunches)
Presence of skin tags means a patient is at an increased risk of?
T2DM
pt with polyuria, euvolemic on exam, 24h urine puts out >5L with low urine osmolality. Pt has a deficiency of?
arginine vasopressin
Dx DI
problem with Sudafed in elderly?
Worsens urinary retention
Pt with adrenal insufficiency on 5mg pred and 0.1mg fludrocortison has cellulitis. How do you manager her steroids?
Increase red to 15mg and keep fludrocortisone at current dose
Only increase fludrocortisone to stress dosing for surgery or major infection
which elderly ppl have highest risk of dying in a heat wave
Home bound
bed bound
unable to do ADLs
4 w/o m prominence on L scrotom
Oblong, nontender, non reducible, light transmitting mass closely adhered to testes. Dx and tx?
Hydrocele
Observe - resolves in week to months
Pt wants to take a herbal supplement for anxiety. Rec?
Kava
works in short term (up to 6 months)
avoid hepatotoxins
pain/tingling in medial aspect of ankle and plantar surface. worse with activity. Reflex hammer inferior to the medial malleolus causes parathesia. Dx?
Tarsal tunnel syndrome
tx for tooth abscess
clinda
pt w/ anosmia but no congestion. now what?
MRI brain - rare brain tumors can do this
asyx pt has Tbili 1.8, indirect bili 1.3. all other labs nl. dx?
Gilbert syndrome
AD, elevated indirect hyperbole d/t impaired glucuronyl transferase activity
which anemias have a normal rdw?
beta thalassemia
rdw measures variability
tx for TMJ
Can do dental splints, but the majority of cases are self limiting
What causes most cases of acute interstitial nephritis?
drug induced
usually 2 weeks after starting medication
associated with NSAIDs, abx (cephalosporins, PCN, sulfonamies, ahminoglycosides, rifampin), diuretics, allopurinol
Tx for orthostatic hypotension
Fludrocortisone
Midodrine
Physostigmine
What decreases mortality in CHF?
ACEI
B block
NOT CCB - decrease cardiac contractility and cause peripheral vasodilation
pt with hypercalcemia has a normal PTH hormone level. How do you interpret?
Dx hyperPTH
IF parathyroid function was appropriate PTH would be low
RFs for latent TB to progress to active TB?
Lung CA T2DM alcoholism contact w/ active TB person pt on immunosuppressant parenchyma lung dz (COPD, silicosis)
goal Hgb range for pts with CKD?
10-12
characteristic lab findings in intrahepatic cholestasis of pregnancy?
elevated total bile acids
NL GGT
NL coags
which intervention for CTS has the best evidence to delay need for surgery
Steroid injection
Although this isn’t first line
work up for microhematuria (3-5 cells) in a male
RVUS
Cytology
Cystoscopy
Valvular abnormality in Marfans
Mitral valve prolapse
This can cause aortic insufficiency
Can lead to aortic root dilation
toddler refuses to eat meals, only cookies. What do. you do?
Provide healthy snacks for all meals and end the meal if kiddo won’t eat
Do not offer food as a reward
pt has mitosis, unilateral pupil mitosis, decreased sweating. Next?
CXR
C/f Horner’s syndrome
Looking for pan coast superior sulcus tumors of the lung
most likely cause of hearing loss in newborns?
genetic dz
What helps iron absorption?
Acidic environments (ie take with OJ)
most tines improves with TOP therapy, except?
tines capitis
Tx for antiphospholipid syndrom in a gravid pt?
ASA and heparin
when is dizziness concerning
when it is associated with other neurologic syx (diplopia, difficulty with speech, weakness, etc)
Ocular misalignment on cover/uncover test when the corneal light reflex is deviated from normal position to slightly nasal to mid pupil. Misaligned eye then moves to fixate on a held object when the opposite eye is covered, but back to normal when other eye is uncovered
Strabismus
slutty dude with chlamydia won’t tell you name of partners. how do you expedite tx of partners?
Make Rx for patient + Rxs for expedited partner therapy (written to EPT)
best pre-treatment to prevent contrast induced nephropathy when undergoing cardiac cath?
hydration with sodium bicarb fluids
After AOM in a toddler parent noes changes in hearing. Exam TM is retracted and tympanogram shows a flat tracing. Next?
Unilateral serous otitis is unlikely to cause delayed language
Observe (no antihistamines or steroids)
if hearing loss >3 months –> tympanovstomy tubes
most effective at helping with nipple pain in Breast feeding?
Education on positioning
preferred ankle support in a pt with a sprain
Simi rigid stirrup brace (air cast)
OR lace up support
Tx for meth user that wants sobriety?
CBT
No FDA approved meds
Peds nurse has fever, faint maculopapular irregular reticulate exanthema over thighs and upper arms. Symmetric synovitis in several DIP, PIP, MCP joints, wrist and elbow. Dx?
Parvo B19
Erythema inectiosum
common in younger women
Do you have to stop statin in cirrhosis pts?
No, the CV benefit outweighs risk
Pt is now asplenic. Which tax does he need?
Pneumococcal
Meningococcal
Hib
Ab specific to RA?
anti CCP Ab
Young pt has OAB/Urge incontinence. Best 1st line tx?
Pelvic floor exercises
can be more effective than medications
What tx can make grave’s ophthalmopathy worse?
Radioactive iodine
hyperthyroid syx
22 y/o FOOSH and has torn RTC tendon on MRI. Next?
Surgery
Acute tears need to be repaired within 6 weeks
Pap: NILM, HPV +, non typable. Next?
Pap in 1 year
IF she were HPV 16 or 18 + –> colposcopy
Imiquimod (Aldara) is FDA approved treatment for?
External anogenital warts
septic pt blood cx + for strep Boris. Now what?
Needs c-scope to r/o CRC
ECHO to r/o endocarditis
Interventions for hyperK rapidly
Sodium bicarb
insulin + glucose
Albuterol
- lokelma works but isn’t rapid
how do you counsel about nicotine replacement therapy?
NRT usually doubles the smokers chances of quitting
when can kids drink cows milk?
1 y/o +
not enough vitamin E, iron, essential fatty acids and overburdens them with too much protein, Na, K
Leading cause of death in first 30 days s/p bariatric surgery
PE
What age is a H&H indicated at a WCC?
12 months
What is important to be aware of as far as pharmacokinetics in geriatric patients?
Increased % of body fat
Decrease in lean body mass
Causes an increased distribution of fat soluble drugs such as diazepam
Increases half life of fat soluble drugs
Medication that improves claudication in PAD patient
Cilostazol (Pletal)
Antiplatelet therapy reduces risk of MI but doesn’t affect claudication
what is diagnostic of SBP in a febrile cirrhotic?
paracentesis fluid with PMNs >250
young adult recently on camping trip returns with fever, myalgias, and pink blanching rash that includes palms/soles. dx tx?
Ricketsial dz- likely rosy mountain spotted fever
Tx doxy 100 BID
pt climbing mountain gets HA nausea and progresses to ataxia and confusion. Next?
give oxygen and immediate descent
dx - high altitude cerebral edema
thromboses hemorrhoid, next step for relief
excision
steroids help but not enough apparently
RFs for Macular degeneration
smoking
HTN
which pap cytology finding has the highest risk of developing CA?
Atypical glandular cells not otherwise specific (AGC-HOS) - CA rate of 17%
HSIL - 3% CA rate
What does a p value of <0.05 mean?
There is a 5% likelihood that the results occurred by chance alone
6 y/ohas fever, joint pain, colicky belly pain after a viral URI. Has a palpable dark purple rash. Dx
Henoch-schonlein purpura
Tx that help prevent postherpetic neuralgia
antiviral (acyclovir, famiciclovir)
low dose TCA may also help (amitriptyline)
what other lab tests help confirm vit b12 deficiency
elevated methylmalonic acid and homocysteine
precursors that require b12 for metabolism
65 y/o
weakness, fatigue, weight loss, recurrent infections, bleeding
Hepatosplenomagaly, LN
Anemia, monoclonal IgM peaks, Bence-Jones protein
Xray w/o lytic lesions
Bone Marrow bx –> lymphocytes
Dx?
Waldenstrom’s macroblobulinemia
Non Hodgkins lymphoma has similar presentation, but no monoclonal gammopathy or Bence-Jones protein. Bx would have had distinctive malignant lymphocytes
19 y/o F runner w/ constant groin pain. Limited hip ROM on flexion and internal rotation of hip. Xray NL. Dx?
Stress fx of R femoral neck
Tx for labial adhesion 4 y/o that has frequent UTIs
TOP estrogen cream
Makes them prone to UTIs
BMI for anorexia?
17 and under
Alzheimer’s pt on cholinesterase inhibitor is wandering and pacing and family is asking for more medications
No additional treatments
not much will help the wandering
Alternative therapy for pt that can’t tolerate bisphosphonate that would be the most effective
Zoledronic acid (Recast)
F patient tested positive for chlamydia. What do you counsel
Need to treat her and every partner she has had in the past 60 days
Needs to use barrier method for 7 days after treatment
Failure to treat her would increase her risk of infertility later
when is morning sickness considered abnormal?
After 9 weeks of gestation
Most likely to cause seizure in elderly pt?
CVA, especially hemorrhagic cva
surgical therapy for unilateral tremor and dyskinesia in Parkinsons
Thalamotomy and pallidotomy
characteristic lab finding in pyloric stenosis
hypochloremic alkalosis
The accuracy of a Mini mental exam is affected by?
Education level of the pt
what antibiotics can increase the risk of statin toxicity?
Erythromycin or clarithromycin
what causes rhinitis medicaments?
IN decongestants (ie phenylephrine) causes rebound congestion
Elderly woman has nighttime incontinence, wakens from sleep with intense desire to void but doesn’t make it to bathroom, dx and mech?
Urge incontinence
caused by detrusor instability
what measures the severity of DKA
pH
Bicarb
AG
Mental status
pt has a lesion suspicious for melanoma. Which bx technique would you do?
elliptical excision
Only get a punch bx if the size of the lesion is too big for excision because there is a risk of missing the malignant cells
Pt at term is admitted for HTN and proteinuria. Next day she has a drop in PLT and LFTs double. Now what?
Induce labor if cervix favorable
c-section if not
HELLP syndrome
Toddler bangs his head when he is frustrated. Has some swelling on exam. What do you tell parent?
They typically outgrow this by age 3
28 wk preggo is in a MVA and on a backboard in c-collar. Until her spine is cleared, how do you position her?
supine w/ uterus manually deflected laterally
try to prevent uterus from compressing great vessels
Start bisphosphonate based on which FRAX score?
10 year risk of major fracture is 20%+
OR 10 year probability of hip fx is 3%+
T score -2.0 is osteopenia
which fluoroquinolone should not be used for UTI?
Moxifloxacin
Poor urinary concentration
Most common type of adverse event in a hospitalized pt > 65
Drug related events
NOT wounds or falls
what is considered an adequate trial of an antidepressant?
4-6 weeks
Compared to po opioids, epidurals in labor increase rate of?
prolonged second stage of labor
increased rate of instrument assisted vaginal deliveries
increased likelihood of maternal fever
NOT c-section
What does a USPTF D recommendation mean?
Moderate or high certainty that the service offers no benefit or that the harm outweighs benefit
Which type of mood stabilizers can induce w/d is stopped abruptly
Venlafaxine (Effexor)
Much more severe than with SSRIs
syx - agitation, anorexia, confusion, impaired coordination, seizures, sweating, tremor, vomiting
Make dose changes gradually
Pt has RA syx but ANA and rF negative, elevated esr. Now what?
Still has RA
Clinical diagnosis counts
ANA + in 35% of RA pts
What medications can help prevent contrast induced renal failure
N-acetylcysteine
Sodium bicarb
Most common cause of proteinuria in children?
Orthostatic proteinuria
60% of asymptomatic proteinuria in kiddos
What helps to relieve pain in a osteoporotic fx?
SQ or IN calcitonin
80 y/o M with heel pain that gets worse as day progresses. Xray normal. Dx?
Fat pad atrophy
what imaging should you get to confirm if T2DM has osteomyelitis?
MRI
NOT CT or tagged WBC study
When do you give tpn?
when patient has poorly functioning GI who cannot tolerate enteral feeding
Most effective Rx for head lice?
Malathion (Ovide)
Less toxic than lindane. More effective than permethrin
Most common stress fx in kiddos?
Tibia
Actually most common stress fx in kids and adults (about 50%)
Pt has osteoporotic vertebral compression fx. On oxycontin and NSAIDs, what else is helpful in pain control?
Calcitonin either IN or SQ
pain relief within a few days
2 y/o is flat footed with weight bearing but with toe standing and sitting the arch appears. Now what?
Reassure the parents
Only pathologic if it is painful
Usually spontaneously resolve after 1 year of walking
Tx for overt hyperthyroidism in 1st trimester
Propyltiouracil
Cannot use methimazole in 1st trimester. Cannot observe d/t hyperthyroid having Ads on mother and fetus.
Formula for NNT
1/ARR
Syx of Mag toxicity
respiratory depression
Reason to check reflexes
