Q Bank 3 Flashcards
viral uri syx with abrupt onset?
influenza like illness
Nonthrobocytopenic palpable purpura
colicky abdominal pain
Arthritis
dx?
Henoch-Schonlein purpura
At what heights should you think about Marfan’s?
70 - female
72 - male
+ 2 other common findings (ie myopia, long arms)
Strongly consider ECHO for MVP
which bed wetting treatment has highest cure rate and lowest relapse rate?
Bed alarms
When can you get a false positive on UDS?
Eating poppy seed muffins
It only takes one
Ottawa ankle rules
Can’t take 4 weight bearing steps
Get Xray if pain: over malleolar zone, TTP over posterior edge of malleolus or midpoint or base of 5th metatarsal/navicular
Parasitic disease that if untreated leads to cardiomyopathy, heart failure, fatal arrhythmia
American trypanosomiasis (Chagas disease)
common to Central America
vector - kissing bug
Long term outcomes of trichomonas
infertility, poor birth outcomes
Long term outcome of cysticercosis?
epilepsy
Head/neck LN most likely to be cancerous?
Supraclavicular
Dosing of RhoGAM
If < 12 wks –> 50ug
If >12 weeks –> 300 ug
Give to all Rh - pregnancies with bleeding
most common nutritional deficiency?
Iron
28 wk gravid
O-, Ab+
What does this mean?
Fetus is at risk of hemolytic dz but only if father is Rh+
Most common complication after Roux-en Y bypass
Iron and B12 definciency
NOT dumping syndromes (rare apparently)
1 y/o has microcytic anemia, next?
tx w/ po iron
NOT additional bloodwork
If failure to respond then you do a work up
most sensitive method for identifying risk for postoperative bleeding?
Bleeding history
NOT coats
Scabies are primarily transmitted through?
direct contact
electrosurgical destruction in contraindicated for which type of skin lesion?
Melanoma
(also use of pacemaker)
Basal cell can be treated with electrosurgery
How to drain a felon?
High lateral incision OR volar longitudinal incision OR high lateral incision
young adult w/ fever, fatigue, weight loss, diarrhea x 2 months with palpable mass in RLQ. most likely dx?
Crohn’s
this pattern of syx is characteristic when Crohn’s affects the distal small intestine (regional enteritis)
pt has erythroderma and fever, leukocytosis with 20% EOS, elevated LFTs. Dx?
Drug run with eosinophilia and systemic symptoms (DRESS syndrome)
stop offending meds - anti seizure meds, allopurinol
Start steroids
Characteristic findings in secondary hyperaldosteronism
Sodium retention (decreased Ur sodium) Increased potassium secretion
preferred imaging for dx of appendicitis?
spiral CT (sensitive 97%, specificity 98%) NOT US - kid was 15
What happens if you start ACEI in a pt with renovascular HTN?
Increased Cr, HyperK+
Fancy name for target rash
erythema migrans
Scattered individual purple macules on ankles and wrists. Dx?
Rocky Mountain spotted fever
dry scaling dark red rash in groin with an active border and centra clearing. Dx?
Tinea cruris
migratory pruritic erythematous population eruption. dx?
uticaria
Pt wants to stop Pradaxa and switch to warfarin. How?
Start warfarin now and stop dabigatran in 3 days
Dabigatran does raise INR, won’t see the real INR until it has been stopped for 2 days
Mech of action of metformin
Inhibit glucose production by liver
Tx for air hunger in hospice pt
Morphine
Use haloperidol for n/v and delirium
Use scopolamine for secretions
hypothyroid pt gets preggo. How do you manage?
Will need more thyroid hormone
Increase to 9 doses/weekly (take extra dose on 2 days/wk)
Frequent TSH/T4 to guide dosage
Pt with FOOSH, + fx of radius has hyperCa and found to have hyperPTH. Now what?
Refer to surgery for parathyroidectomy
Indicated in PTH + fragility fx
Factor V leiden is associated with?
DVTs
Infant has conjunctivitis and gram Stan is gram neg diplococci. next?
IM CTX
NOT topicals - ppx only
helpful treatment in the common cold?
Ipratropium nasal spray (Atrovent)
The only recommended tx to help with colds. Helps with cough and rhinorrhea
when should a preggo get live virus vaccine?
immediate post partum
what labs should be checked before starting reclast (bisphosphonate) for osteoporosis?
GFR
Ca2+ (hypocalcemia is contraindication to bisphosphonate
pathognomonic exam finding for SCFE?
Limited internal rotation of the flexed hip
Osmotic demyelination (central pontine myelinolysis) occurs from too rapid correction of?
Hyponatremia
what can help prevent melanoma?
Avoiding hormones
High potency broad spectrum sunscreen
pt presents with episodes of hypoxia, no finding on CXR. He is doing basement projects. Dx?
Hypersensitivity pneumonitis
Relapsing/remitting episodes that occur after exposure to fungus
tx - avoidance
What other metabolic abnormality if seen in CKD 4
HyperPTH
Resevoir for hantavirus?
Deer mice
How to calculate negative predictive value
True negative/(all those that tested negative)
PCOS increases risk for which carcinoma?
Endometrial
cardiac rhythm in anorexia?
Brady
Tx for gonorrhea
250mg IM CTX
how do you counsel laboring pt interested in regional analgesia.
Increases the risk of instrument assisted van delivery
Toddler w/ behavioral probs, on exam long wide protruding ears, elongated face, frontal bossing, macrocephaly. Dx?
Fragile X syndrome
At puberty get prominent jaw and macro-orchidist
microbrachycephaly, maxillary hyperplasia, large mouth, prognathism
Angelman syndrome
Narrow distance between temples, almond shaped eyes, thin upper lip. Dx?
Trader-Wili syndrome
Mechanism of action of sevelamer in CKD pts
Blocks intestinal absorption of phosphate which lowers PTH hormone secretion. End goal is to prevent hypercalcemia from secondary hyperPTH
Tx for otitis externa
TOP cipro/dexamethasone
this is safe to use even if you are not sure if TM is intact
Tx for childhood OSA
Adenotonsillectomy
poor cpap compliance in kids
acidification of the urine is helpful with which type of renal stone?
calcium phosphate (struvite stone)
for all others acidic urine promotes formation
cranberry juice or betaine lower urine pH
10 y/o has heel pain during first few minutes of playing sport. Never at walk. No TTP over achilles. + b/l heel pain with passive dorsiflex of ankles. Dx?
Calcaneal apophysisitis (Sever disease)
Usually kids 5-11
Tight chilles is pulling on the posterior calcaneus with running/jumping causing micro trauma
NL Xray
Tx avoid painful activity, NSAIDs, ice, stretch
1st line study to dx endometriosis?
TVUS
Tx for non inflammatory acne
topical retinoids
Tx for mild to moderate inflammatory or mixed acne
TOP abx
13 y/o with limp
R hip: decreased internal rotation. Hip externally rotates involuntarily with passive flexion. Dx?
SCFE
Needs surgery - no weight bearing
pretibial myxedema is a cutaneous manifestation of?
Graves dz (can present in hypo or hyper thyroid phase) Increased deposition of mucin
healthy pt, 3 mo h/o hoarseness w/o syx. Next?
Laryngoscopy
NOT PPI trial
Who needs US for AAA screening?
Men 65-75 who have ever smoked
PNA + AMS + hyponatremia. Etiology?
Legionella
Pt after stenting for ACS is on statin, ASA, AACEI, HCTZ. What is missing?
beta block
FEV1/FVC 60%, on CT bronchial wall thickening and luminal dilation. Dx?
Bronchiectasis
Length of DVT ppx after hip replacement
35 days
Tx for mag toxicity
Calcium gluconate
Can use calcium chloride if central line is available
why do we prefer methimazole over propylthiouracil for hyperthyroid?
propylthiouracil is associated with severe hepatotoxicity
best strategy to get long term pain relief from lateral epicondylitis?
Modify work/activity
GBS ppx intrapartum for pt with PCN allergy (rash, itch)
Cefazolin
IF there is a risk of anaphylaxis may consider vanc vs. Glinda
CENTOR criteria
Fever
Exudate
anterior cervical N
Absence of cough
What pain med is contraindicated in compensated cirrhosis?
Naproxen
NOT Tylenol
NSAIDs should be avoided in cirrhosis d/t risk of precipitating hepatorenal syndrom
Tyl can be taking in cirrhosis in 2-3g/day doses
Tx for corynebacterium minutissimum
Erythromycin
AKA erythrasma
Pt has trauma syx after an accident two weeks ago. Dx?
Acute stress disorder
PTSD when syx present > 1 month
pt with exertion claudication, ABI is 1.45. Next?
Get MR or CT angio of lower extremities
Can have PAD with ABI > 1.4, this suggests the vessels are so calcified that they cannot be compressed
Need imaging to confirm if PAD is present
Pt has chronic cough, worked in navy ship yard for 40 years. worry for?
asbestos
obese M pt is concerned about increased breast tissue, no glandular tissue appreciated on palpation. Dx?
pseudogynecomastia
Increase in subareolar fat 2/2 obesity
Most likely to cause hypoglycemia in elderly?
Glyburide (sulfonylurea)
More likely to cause hypoglycemia than Glipizide
What is Ramsay Hunt
Shingles of the facial n.
Can present with palsy
Painful vesicles in side of palate and ipsilateral ear
Can also have vomiting, vertigo
- Tx acyclovir, pred
- HSV wouldn’t typically spread to oral cavity and ear
Extracorporeal shock wave therapy to the shoulder is helpful with?
Calcific tendinitis
NOT frozen shoulder
Risk factors for still birth
AMA
smoking > 0.5ppd
congenital anomalies
BMI >30
Tx for borderline personality disorder
No pharmacotherapy currently available
Dialectic behavioral therapy (DBT) is the most promising
1st line for HTN in pregnancy
labetalol
nifed (but not IR d/t hypotension)
Most common cause of infectious endocarditis?
Staph aureus
2nd - Strep viridian’s
Kiddo has fever and knee pain with fairly normal exam. Next?
CBC, CRP, ESR
Tx for low libido in otherwise healthy female?
TOP testosterone
Dx if 1) have absence of sexual desire, 2) pt is bothered by it
Tx for Jarisch-Herxheimer rxn?
Reassurance and antipyretics
When should aysx patient with no risk factors be screened for T2DM?
45 y/o
risk of long term tamoxifen?
Endometrial CA
pts on letrozole are more likely to have which syx compared to pts on tamoxifen?
Myalgias and non inflammatory arthralgia
Macrocytic anemia
thrombocytopenia
Neutropenia
Dx?
Myelodysplastic syndrome
Blood malignancy with predisposition for leukemic transformation
asthma less than once or twice weekly, <2 nighttime awakenings a month
Intermittent
asthma syx > 2days/week but not daily, nighttime awakening 3-4x/month, SABA >2days/week but not daily. Minor limitation in daily acitivity
Mild persistent
asthma syx daily, nighttime awakenings weekly but not nightly, daily SABA with some limitations in activity. FEV1 60-80%
Moderate persistent
asthma syx throughout day, nightly awakenings. SABA multiple times a day
Severe persistent
1st line tx for depression in pregnancy
SSRI
Fluoxetine, sertraline, citalopram
avoid paroxetine
What is the concept behind accountable care organizations?
Deliver more efficient, high quality services by encouraging cooperation between health care providers
Does identifying a mallory weiss tear on EGD in pt with VSS and no active bleeding change management?
No can still d/c on PPI
what are the timing rules for rotavirus vx
Do not start after 15 wks of age
do not doses after 8 months of age
when occiput is posterior, pt is less likely to?
have a SVD
high risk for c-section of VBAC
Tx for mallet fx (unable to extend finger on exam)
Splint in full extension x 8 weeks
apparently this is a way you can treat depression in a patient with only 2-3 weeks to live
Methylphenidate (Ritalin)
SSRIs will take at least 4 weeks where are Ritalin could help within days
Tx for bell’s palsy
steroids
Antivirals have little benefit
Pt given course of azithromycin for CAP. After completing abx CXR shows he still has a single thin-walled cavity in LLL. Tx?
Clindamycin
Likely PNA was caused by anaerobes that weren’t covered by azithro
Flagyl isn’t as good as covering pulmonary anaerobes
who is legally responsible for notifying a pt about a mammogram result?
The facility performing the test
Difference between heat exhaustion and heat stroke?
Heat stroke is more severe and has some element of CNS dysfunction
When does NSGY deceit a intracerebral hemorrhage?
When it is a cerebellar hemorrhage
Lower SBP if >180
Reverse INR if > 1.5
PNA pt rapidly deteriorates and is intubated. BNP normal. Dx?
ARDS
Tx for endometrial hyperplasia w/o atypia
Progestational drugs
Convert proliferative endometrium to a secretory one causing a withdrawal bleed
Most common is cyclical proverb 14 days/mo. IUDs also work
IF medical management fails then you can explore endometrial ablation or hysterectomy
Varicella non immune mom had varicella at 38 week gestation. has healthy infant at 40 weeks. Now what?
observe
NO IVIG or vax
Tx for travelers diarrhea
Azithromycin
Ciprofloxacin
Tx for delirium in hospice pt
Haldol
Why can’t we use ACEI and ARB together?
Increases risk of HD
most effective drug tor tx and prevention of allergic rhinitis?
Flonase
NOT Ipratroprium nasal spray or Zyrtec
Most common cause of refractory HTN in middle aged adults
Primary hyperaldosteronism
Get a plasma aldo/renin ratio
supported if pt has hypokalemia
Most common cause of refractory HTN in elderly adults?
Renal artery stenosis
Dx with renal MRA
Psych medication associated w/ angranulocytosis
Carbamazepine (tegratol)
Get BL CBC, CMP and monitor perodically
1st line tx for Alzheimers
Donepezil (Aricept)
anticholinesterase inhibitor
Memantine (Namenda) is used as an adjunct with donepezil in moderate to severe cases. Not effective as a monotheray
30s adult shoulder pain worse with laying on it. Pain on abduction but no weakness. ROM nl. Dx?
Subacromial bursitis
associated with calcific deposits on the supraspinatus tendon
What is the benefit of static stretching before a run?
None
Slows performance in sprinters
No benefit in muscle injury or soreness
Celiac dz increases a pts risk of?
Iron deficiency anemia
Osteoporosis (decreased Calcium and Vitamin D absorption)
NOT at increased risk of IBS, diverticulitis or CRC
how do you counsel pt about a low carb diet?
Better short term weight loss than low fat diet
similar to a reduced calorie diet with normal ratio of macros
low carb does seem to be effective in reducing insulin resistance
Pt on antiepileptic drugs wants a contraceptive. Offer?
IUD
Can’t do combo contraception d/t antieleptic drugs inducing hepatic metabolism of hormonal contraceptives
Pt on Dual anti platelet is undergoing CABG. What do you do with meds?
Stop placid 5 days before surgery
2 m/o has a misshaped head, NL at birth. What do you do?
Counsel parents about positioning (alternate L and R) and tummy time, follow up in 1-2 months
Pt has EF of 35% and pHTN. What is the best way to treat her pHTN?
maximize her CHF tx
NOT vasodilation or RHC
Vasodilators could actually be harmful in L HF
How much time for the get up and go test?
10s
Get up, walk 10 feet, turn around, walk back, sit
Tx for methanol poisoning?
Ethanol
Slows formation of formaldehyde so it can be secreted
6 mo WCC only has on testicle. Now what?
Urologic referral for surgical exploration
NOT US
Tx unilateral testes at 6-12 m/oage
Most effective method for natural family planning
Cervical mucos monitoring
Stillbirth at 33wk gestation in a white preggo - most likely cause?
Placental disease
Pt is septic with PNA on Xray and was exposed to flu 2 days ago. Rapid flu negative. Tx?
CTX/Azithro/Vanc
oseltavivir
High false negative rate on rapids
Apparently include vanc because septic shock puts him at high risk of MRSA confection
1st line HTN tx for pt with CAD
Bblocker
vertigo + tinnitus or unilateral hearing loss
Meniere’s dz
Pt with MDD + hypomania
Bipolar II
Tx - depakote or Lithium mono therapy
Pt with T2DM and multi vessel CAD should get a
CABG
2 y/o with belly pain and billious vomiting x hours. Get a ?
Upper GI series
C/f volvulus
Tx c. diff pt with po vanc, not getting better so can add what IV?
Flagyl
What vent setting is helpful in ARDS?
Lower Tidal Volume
1st line tx for diabetic peripheral neuropathy
TCAs (amitriptyline)
characteristic exam finding in pt with pericarditis
Pain improves when sitting up and leaning forward
Screen for T1DM in kiddos that have what other dx?
hypothyroid
Celiac dz
kiddo with fever and hip pain, NL Xray, FROM. elevated WBC, ESR. Next?
HIP US, c/f septic joint
IF negative, next step would be bone scan
Ppx LCC for asymptomatic gallstones is indicated in which pt population?
Sickle cell dz
d/t risk of developing pigmented stones
70% of SCD pts have gallstones
if pt develops biliary collic, it is difficult to determine if colic vs Sickling crisis and were high risk of open cases
if ppx removed - better odds they will get a LCC in a controlled way
Can be done at same time as splenectomy
NOT T2DM or Renal transplant
Tx for chronic fatigue syndrome
CBT
Dx if fatigue x 6 months, impaired memory, post exertion malaise, muscle pain, polyarthralgia, tender LN, sore throat, HA, unrefreshing sleep
CBT and graded exercises are helpful
NOT Ritalin
Which medication causes a syndrome similar to SLE (polyarthralgia, friction rub), ANA +?
hydralazine
procainamide
most pts improve within weeks with avoidance of drug
You extract a metal foreign body that has been present 2 days in the sclera. Rust ring present. Now?
See eye doc within 48h
Toxic to the cornea -
unvax kid is exposed to kiddo with Hep A. Next?
Give hep a Vax
preferred over iVIG because effect lasts longer
Only give family PPX if there is an outbreak and if kiddo is still in diapers
ppx abx for ortho procedures
Cefazolin
Thessaly test is positive in?
Medial meniscus tear
Pt stands on one leg and flex knee to 20degree theninteranlly and externally rotate over the knee
How long do you check BP when screening for orthostatic while standing?
for 3 minutes
erysipelas is caused by?
Group A Strep (strep progenies)
Tx PCN
Which basal cell carcinomas have the highest risk of recurrence
Those that are not treated with Mohs surgery
High risk locations - in the “mask” of the face(eyelids, nose, lips, chin, mandible, periauricular, temple, ear), genitalia, hands, feet
Elevated AST and GGT?
Alcoholic liver dz
Tx for tinea wapitis?
po griseofulvin
skin infection associated with intertrigo?
Candida
intertrigo = skin on skin friction –> inflammation
