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QBank Review Flashcards

1
Q

What is a MUGA scan used for?

A

asessing EF in CHF

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2
Q

How do you dx Churg-Strauss syndrome?

A

p-ANCA is present

pthology of affected tissue

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3
Q

How do you treat a diabetic pt with microalbumuria?

A

ACE inhibitor

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4
Q

What side effects are associated with 5-flucytosine?

A

bone marrow suppression

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5
Q

What are the indications for hyperbaric oxygen therapy in carbon monoxide poisoning?

A

loss of consciousness

age >50

metabolic acidosis

carboxyhemoglobin >25%

cerebellar findings on neuro exam

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6
Q

What conditions make exercise stress tests useless bc the EKG is unreadable?

A

LBBB
digoxin effect
LVH
Pacemaker
any major baseline abnormality of the ST segment
*do a nuclear/checmical stress test instead

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7
Q

What is a great antifungal medicine class for candida, but does not cover cryptococcus?

A

Echinocandins (caspofungin, micafungin, and anidulafungin)

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8
Q

How do you dx Sjogren’s syndrome?

A

salivary gland biopsy - gold standard

most people ANA positive (95%)

some people will have anti-Roa nd -La present (50-65%)

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9
Q

How to anticoagulate after non-hemorrhagic stroke?

A

aspirin, clopidogrel, or aspirin + dipyridamole

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10
Q

How do you manage temporal (giant cell) arteritis?

A

Immediate IV steroids and admission! so that doesn’t progress to blindness or stroke

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11
Q

What neuro findings if present when Wernicke’s area is affected?

A

word salad - fluent speech but meaningless

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12
Q

What type of hepatitis is most likely transmitted through a blood transfusion?

A

Hep C, takes 5-10 wks to incubate

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13
Q

What is the follow up management after MI?

A
  1. B-blockers, aspirin, ACE inhibitors, statins
  2. stop smoking
  3. exercise
  4. moderate alcohol comsumption
  5. low-fat, vegetarian, and mediterranean diets
  6. sex can be resumed after 1-2 weeks or after 6 wks in pts with residual symptoms
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14
Q

What is a side effect of ticlopidine (anti-platelet)?

A

neutropenia
*switch to clopidogrel

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15
Q

What fungus grows septated hyphae?

A

aspergillus - tx with voriconazole

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16
Q

What are good topical antibiotics for otitis externa?

A

polymyxin, neomycin, ciprofloxacin, ofloxacin, gentamicin, tobramycin

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17
Q

What physical exam findings are seen with anabolic steroid usage?

A

Testicular atrophy

gynecomastia

htn

tachycardia

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18
Q

What bacteria causes pneumonia and is lancet-shaped, gram positive diplococci?

A

strep pneumo

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19
Q

What neuro findings if present when Broca’s area is affected?

A

expressive aphasia

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20
Q

How to w/u urethritis in men?

A

gram-stain for gonorrhea

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21
Q

How do you manage an acute COPD exacerbation?

A

oxygen, albuterol, budesonide, ipratropium, steroids, and ABX (azithromycin)

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22
Q

How do you dx hepatopulmonary syndrome?

A

liver disease

increased A-a gradient

evidence of intrapulmonary vascular abnormalities on conrast-enhanced ECHO, pulm arteriography, or Tech-99 labeled albumin scanning

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23
Q

What is the best initial therapy for cryptococcus?

A

amphotericin and flucytosine

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24
Q

Can GERD be caused by H pylori?

A

NO. if pt with GERD is foudn to have H pylori it is incidental unless they also have ulcer dz, gastritis, or mucosal associated lymphoid tissue

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25
Q

When should you start inhaled steroids when a pt is hospitalized for acute asthma exacerbation?

A

right away - takes 5-10 days to see an effect, so when you start tapering oral/IV steroids, they will be ready to go

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26
Q

Where does breast cancer metastasize to?

A

bone

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27
Q

What lifestyle modification will ahve teh greatest immediate impact on coronary artery disease?

A

smoking cessation

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28
Q

What is the most effective tx for aspergillus?

A

voriconazole

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29
Q

How do you assess the severity of DKA?

A

bicarb (low)

pH (low - acidosis!)

increased anion gap

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30
Q

What are teh 5 A’s of smoking cessation?

A

Ask, advise, assess, assist, arrange (f/u)

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31
Q

What is the next step in management of Parksinon’s disease if levodopa/carbidopa is not controlling symptoms?

A

Add a COMT inhibitor - tolcapone or entacapone

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32
Q

How do you test for legionella?

A

urine

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33
Q

What are the options for empiric tx of neutropenia and fever?

A
  1. carbapenems (imipenem, meropenem, doripenem)
  2. cefepime
  3. pip/tazo
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34
Q

What parameters must be kept in mind when ventilating a pt with ARDS?

A

“lung tissue very non-compliant and prone to rupture *limit tidal volume to 6 cc/kg or less * limit PIP to 35 or less so you don’t over extend the lung *make sure PEEP is atleast 10 cm H2O to prevent full collapse of the lung”

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35
Q

What settings do you use to ventilate pts with asthma?

A

low ventilatory rate (allow time for expiration), small tidal volume (prevent damage - air trapping), high flow

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36
Q

How do you initially manage DKA?

A

IV Bolus NS and IV Insulin

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37
Q

What is the most common type of fistula formed as a complication from diverticulitis?

A

colovesical (colon to bladder)

if pneumaturia present - needs surgery right away!

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38
Q

How to tx impetigo?

A

mupirocin and retapamulin

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39
Q

What is acute rheumatic fever?

A

post-streptococcal disease complication that is diagnosed with the JONES criteria.

Migratory Arthritis, Carditis, Sydenham chorea, erythema marginatum, or subcutanous nodules

+

(2 of) arthralgia, fever, elevated ESR/CRP, prolonged PR interval, and positive ASO titers

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40
Q

How do you treat acute prostatitis?

A

10-14 days ciprofloxacin or TMP-SMZ

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41
Q

How do you tx a mallet finger (avulsion of distal phalanx)?

A

extension splinting for 4-5 weeks

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42
Q

How do you dx Wegner granulomatosis?

A

presence of c-ANCA

like churg-strauss w/o asthma or eosinophilia

presents with sinus problems or nasal septal perforation

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43
Q

What is a simple vs complicated UTI and how do you tx each?

A

simple - bactiuria (bladder infection)

complicated - UTI in male, diabetic, HIV +, or pregnant

tx:

simple 3 days abx (TMP-SMZ)

complicated 10-14 days abx

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44
Q

What is a side effect of hydroxychloroquine?

A

ocular or retinal toxicity

*can be reversed if caught early and you stop the drug

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45
Q

What are symptoms of legionella?

A

viral prodrome, initial dry cough, confusion, diarrhea, hyponatremia, leukocytosis

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46
Q

How do you treat acute rheumatic fever?

A

penicillin V now

aspirin if fever or arthritis

prophylaxis with pencillin G for…

  1. 10 yrs or until age 21 (whichever is longer) if you have carditis
  2. 5 years or until age 21 (whichever is longer) if no carditis
  3. forever if carditis with residual effects on ECHO
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47
Q

How do you treat herpes simplex encephalitis?

A

IV acyclovir

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48
Q

What is the MOST controllable risk factor for stroke?

A

hypertension

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49
Q

What is Churg-Stauss syndrome?

A

vasculitis associated with nephritic syndrome, eosinophilia, and asthma

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50
Q

After a pt is treated for diverticulitis, when should confirmatory imaging be done?

A

do a barium enema in 2-3 weeks (in acute period the risk for perforation is too high)

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51
Q

Shock States

A
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52
Q

How do you decide to anticoagulate a pt with a fib to prevent stroke?

A

CHAD 0-1 : aspirin
CHAD 2+ : warfarin or dabigatran

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53
Q

What do you check yealy at a diabetic pt’s check up?

A

urine microalbumin

foot exam

LDL level

dilated eye exam

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54
Q

How do you treat esophageal spasm?

A

CCB like diltiazem

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55
Q

What side effects are associated with amphotericin?

A

renal toxicity (distal RTA and hypokalemia)

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56
Q

What EKG findings are associated with Brugada syndrome?

A

RRRB and ST segment elevation in V1-V3

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57
Q

What is a prolonged QT for men and women?

A

men >450

women >470

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58
Q

How to manage NSTEMI?

A

Dual antiplatelet therapy

Nitrates

beta blockers

statins

anticoagulant therapy

59
Q

What is a common complication to look out for with bicuspid aortic valve?

A

aortic dilation (can lead to aortic aneurysm)

60
Q

How do you treat symptomatic HOCM?

A

Beta-blocker

61
Q

What are the features of CREST Sydnrome?

A

calcinosis cutis

Raynaud phenomenon

esophageal dysmotility

sclerodactyly (fatty puffy fingers)

telangiectasias

*when there is lung involvement - it is usually pulmonary HTN

62
Q

What are the features of systemic scleroderma?

A

skin, lung (interstitial lung dz), kidney, and IG involvement

63
Q

What sreening tests should be done at time of dx for scleroderma?

A

PFTs to get baseline lung fx

64
Q

What are the clinical manifestations of celiac disease?

A

GI - diarrhea, abd pain, bloating

Mucocutaneous - dermatitis herpetiformis, atrophic glossitis

Endocrine - Vit D deficiency and secondary hyperparathyroidism

Bone - rickets, osteomalacia/porosis

Heme - iron deficiency anemia

Neuro - depression/anxiety, peripheral neuropathy

65
Q

What is diverticular bleeding?

A

arterial erosion due to colonic mucosal outcropping

*can cause painless hematochezia

66
Q

What causes the mitral chordae tendineae to rupture vs a papillary muscle to rupture?

A

chordae - mitral valve prolapse, infective endocarditis, rheumatic heart dz, trauma

muscle - MI or trauma

67
Q

What are clinical features of Ehlers-Danlos?

A

skin - velvety w/ atrophy and scarring, poor healing, hyperextensible

MSK - joint hypermobile, pectus, scoliosis

cardiac - MV prolapse

Other - abdominal/inguinal hernias, uterine prolapse

68
Q

What are clinical features of Marfan?

A

MSK - joint hypermobile, pectus, scoliosis, tall w/ long extremities

Heart - progressive aortic root dilation, MV prolapse

other - lens and retinal detachment, spon. pneumothorax

69
Q

How do you dx and manage gastroparesis?

A

dx - nuclear gastric emptying study

dietary modification - frequent small meals w/ decr fat and fiber intake

*can use erythromycin or metoclopramide for motility if needed

70
Q

What conditions are pts with Down syndrome more likely to develop later in life?

A

acute leukemia, dementia, autism, ADHD, depression, seizures

71
Q

How to tx acute decompensated heart failure?

A

IV furosemide (decr preload and get fluid off lungs)

IV nitroglycerin (decr preload)

EHO to figure otu cause

72
Q

What heart findings are associated with ASD (in adulthood)?

A

wide and fixed splitting of S2, right atrial or ventricular dilation

73
Q

First line tx for DVT?

A

factor Xa inhibitor - rivaroxaban for >/= 3 months *if pt doesn’t have cancer

*if has cancer - LMWH

74
Q

What is an alternative non-hormonal treatment for hot flashes?

A

SSRIs (escitalopram) or SNRIs (venlafaxine)

75
Q

What is the genetic mutation in marfan?

A

defect to fibrillin-1 (glycoprotein)

76
Q

What is a common presentation of GERD?

A

chronic cough due to irritation of cough receptors in the Respiratory tract

77
Q

What medications cause digoxin toxicity?

A

verapamil, quinidine, amiodarone, spironolactone

78
Q

How do you manage peri-infarction pericarditis?

A

high dose aspirin

79
Q

How do you determine the cause (or narrow the ddx) of ascites?

A

SAAG value = serum albumin - ascitis albumin

IF >/= 1.1 - means portal htn (CHF, cirrhosis, alcoholic hepatitis)

IF <1.1 - means not portal HTN (TB, nephrotic syndreom, pancreatitis, serositis, carcinomatosis)

80
Q

how do you tx idopathic pulmonary arterial HTN?

A

endothelin receptor antagonists

81
Q

How to dx STEMI?

A

>1mm ST elevation in >/= 2 contiguous leads except V2 and V3, which need >2mm

or new LBBB

82
Q

When can radiation proctitis occur?

A

anytime after radation tx (acute - years)

causes diarrhea, muscus discharge, feeling need to defecate and not being able to pass much

83
Q

How to eval and treat blood in the stool?

A

If suggestive of upper bleeding - EGD, if don’t find it - colonoscopy

84
Q

How to treat type 2 heart block?

A

pacemaker

85
Q

What can chronic gerd lead to that causes obstructive dysphagia?

A

esophageal stricture

86
Q

What are the most significant risk factors for coronary heart disease?

A

noncoronary atherosclerotic dz (AAA, peripheral artery, carotid dz)

DM

chronic kidney dz

87
Q

How do you manage a stable aortic aneursym?

A

smoking cessation

aspirin and statin therapy

elective repair is >5.5cm, rapidly enlarging >0.5 cm in 6 months or assoc with peripheral artery dz/aneurysm

88
Q

What is the most important risk factor to stop for AAA?

A

smoking

89
Q

How do you tx cocaine tintoxication wtih chest pain?

A

benzos and nitroglycerin

CCBs for perisistent chest pain

phentolamine for perisistent HTN

PCI for MI

90
Q

What are the most common causes of acute pancreatitis in adults?

A

alcohol and gallstones (65% of time)

metabolic - hyperCa and hypertriglyceridemia

91
Q

What is the standard reccommendation for enteral feeding formulas for adults?

A

30 kcal/day and 1 g/kg/day of protein

92
Q

What are the best non=pharm managment strategies for decreasing BP?

A

weight loss to BMI <25 *best!

DASH diet (8-14 mm Hg decr)

exercise (4-9 decr)

decr Na in deit (2-8 decr)

93
Q

What does afib look like on EKG and how to tx?

A

narrow QRS

no p waves

irregularly irregular rhythm

tx: beta blockers or CCB (unless hypotensive or in Heart failure)

94
Q

What drug must you decrease warfarin dose to compensate for when starting?

A

amiodarone

95
Q

How to decide if you can clear a patient with a CAD hx for surgery?

A

If minor surgery (eye, breast, amubulatory, endoscopy) - ok unless acutely active dz

If any bigger surgery - if they can do a full exercise stress test or equivalent by hx (walking up 2 flights of stairs, briskly walk)- good, if they can’t, they need further w/u

96
Q

Does antibodiy testing confirm active hep C dz?

A

no! could mean active, past infection, or false pos

need HCV RNA testing

97
Q

Can you re-try a statin drug if a pt had myositis from exercise provoked by the statin but was previously asymptomatic on the statin?

A

yes - recheck CK and if normalized, can try again

98
Q

What are complications of diptheria?

A

pharyngitis (pseudomembrane)

toxin-mediated myocarditis

99
Q

How to tx diptheria?

A

erythromycin or penicillin G

diptheria antitoxin (if severe)

100
Q

What are symptoms of congenital rubella?

A

hearing loss, cataracts, PDA

“blueberry muffin rash)

101
Q

How to think about heart meds and continuing/discontinuing before surgery…

A
102
Q

Way to think about how to step up therapy with heart failure meds,,,

A
103
Q

What is the classic KUB finding for sigmoid volvulus?

A

A distended colonic loop in the RUQ and the tip ointing toward the left lower quadrant

104
Q

How to manage a sigmoid volvulus?

A

if febrile and peritoneal signs - surgical detorsion

if stable without fever or peritoneal signs - flex sigmoidoscopy or colonoscopy for dx and tx

105
Q

How to manage drug induced parkinson dz (tardive dyskinesia and other extrapyramidal symptoms)?

A

switch to clozapine or quetiapine

*if s/sx continue, try an anti-cholinergic med like benztropine

106
Q

What is the standard of care for dx chlamydial and gonorrheal infections?

A

NAAT on urine in man or self-urethral swab on woman

107
Q

What childhood viral illness causes high fevers and then ?rose-pink” maculopapular rash afterwards?

A

Roseola infantum (HHV-6)

108
Q

What childhood viral illness causes slapped cheek rash and mottled looking skin?

A

erythema infectiosum (Parvovirus B-19)

109
Q

What childhood viral illness causes rash and fever with cough and Koplik spots?

A

Rubeola (measles virus)

110
Q

What childhood viral illness causes pharyngitis, rash, and strawberry tongue?

A

scarlet fever (strep infection)

111
Q

What preventative counseling/advice is most likely to prevent disability w/in 5-10 yrs in an adolescent?

A

don’t drink and drive

MVA’s one of highest causes of mortality in adolescent age group (10-24)

112
Q

What are the most important risk factors for men and women in regards to osteoporosis?

A

women - being a woman!

men - caucasian

113
Q

What criteria must be met to dx brain death?

A

no spontaneous movement

no response to painful stimuli

no seizure or decerebrate, decorticate, or dyskinetic movements

no cranial nerve reflexes

no central respiratory drive with apnea test

114
Q

how to w/u abnormal PAP with ASCUS

A
115
Q

How to deliver ventilator breaths to COPD pts?

A

slow breaths (8-12 bpm) with 6-10 cc/kg tidal volumes to prevent baro-trauma to blebs or bulla

116
Q

How to dx Wernicke’s encephalopathy?

A

clinical! (eye, confusion, and gait abnormalities in malnourished alcoholic)

no lab testing needed - just start tx with IV thiamine

117
Q

How can you differentiate between spontanrous SLE and drug-induced SLE?

A

drug induced does NOT have renal or CNS involvement

*otherwise identical

118
Q

What is the medical w/u for panic attacks?

A

Thyroid function tests

CBC, CMP, fasting glucose, LFTs, urea, Cr, Ca, UA, Urine drug screen, EKG

119
Q

What condition presents with painless juandice and elevation of conjugated bilirubin and alk phos and how do you image?

A

pancreatic adenocarcinoma - get an abd CT

120
Q

What is the next step in T2DM management when metformin is not controlling blood glucose levels?

A

add an incretin (sitagliptin) or a sulfonylurea (glimepiride, glyburide, or glipizide)

don’t go to insulin until fails 2-3 oral meds

121
Q

What is the most common complication of placental abruption?

A

disseminated intravascular coagulopathy (DIC)

122
Q

What antibodies are found in transfusion-assocaited acute lung injury (TRALI)?

A

antigranulocyte antibodies in the blood donor

123
Q

What is a contraindiaction for a TIPS procedure?

A

hx of hepatic encephalopathy

(makes it worse, bc not all blood is being filtered through liver)

124
Q

What is Legg-Calve-Perthes disease?

A

avascular necrosis of the femoral head in 4-8 yo

125
Q

How do you tx vibrio septicemia (caused by ocean exposure to cut and making black bullous lesions over skin)?

A

cefotaxime and minocycline

126
Q

What is the best treatment for hepatopulmonary syndrome?

A

liver transplant

127
Q

What is the right to left shunt refering to that is seen in pulmonary syndrome?

A

arteriovenous shunting - blood moving fast pass the lung tissue and there is no time for oxygen exchange

128
Q

How to calculate the Aa Gradient?

A

A-a Gradient = 150 - (1.2 * PaCO2) - PaO2.

129
Q

What are findings of adernal crisis and how do you manage it?

A

hypokalemia, hyoptension (dehydration), circulatory failure

tx: saline, steroids, Abx (if infection precipitated it)

130
Q

What should be screened for in all pts with HTN?

A

diabetes!

HgA1c >6.5%

or fasting glucoses x2 >125 mg/dl

or serum glucose >200 mg/dl w/ symptoms

131
Q

What should you suspect in an newborn who hasn’t urinated, has a hx of oligohydraminios, and has acute renal failure?

how to dx?

A

posterior urethral valves

voiding cystourethrogram

132
Q

How to treat exacerbation of mild asthma in ED?

A

3 doses of albuterol in 1 hour

(add steroids if pt was on them recently)

133
Q

What are indications for hemodialysis in lithium toxicity?

A

serum level >4

signs of lithium toxicity (seizures, mental status changes)

134
Q

What is paget disease and what are complications that it can cause?

A

osteitis deformans - increased bone turnover

complications: fractures, tumors, high-output heart failure (bc incr blood flow through bone), arthritis

135
Q

How to classify types of asthma?

A

intermittent - less than 2 days per week

mild - symptoms 2+ days, but NOT daily

moderate - daily symptoms, limits activity

severe - daily and nightly, limits activity

136
Q

What are the side effects of metformin?

A

lactic acidosis, contraindicated in renal insufficiency

137
Q

What antibodies should be screened for in pregnant pts with lupus?

A

anti-phospholipid and anti-ro antibodies

*put on LMWH and aspirin in pregnancy d/t risk for placental infarction)

*anti-ro can indicate neonatal lupus and risk congenital heart block

138
Q

How to manage Barrett esophagus?

A

PPI and endoscopy q3 years

139
Q

How to tx allergic contact dermiatitis?

A

stop agent and apply topical steroids

140
Q

What is the best test for seeing if a pt had a new MI within days of a previous one?

A

CK-MB bc it only stays around for 1-2 days, so if elevated, it will be a new rise.

(troponin sticks around a lot longer 1-2 wks)

141
Q

What is the best early screening test for hemochromatosis?

A

transferrin saturation (fe/TIBC)

142
Q

What are normal opening pressures on LP in an adult?

A

100-200 mm Hg

143
Q

What electrolyte derrangement to consider in a DKA pt with new weakness, muscle apain, and SOB?

A

hypophosphatemia

144
Q
A

Step 3 (15 decks)

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