QBank Review Flashcards
What is a MUGA scan used for?
asessing EF in CHF
How do you dx Churg-Strauss syndrome?
p-ANCA is present
pthology of affected tissue
How do you treat a diabetic pt with microalbumuria?
ACE inhibitor
What side effects are associated with 5-flucytosine?
bone marrow suppression
What are the indications for hyperbaric oxygen therapy in carbon monoxide poisoning?
loss of consciousness
age >50
metabolic acidosis
carboxyhemoglobin >25%
cerebellar findings on neuro exam
What conditions make exercise stress tests useless bc the EKG is unreadable?
LBBB
digoxin effect
LVH
Pacemaker
any major baseline abnormality of the ST segment
*do a nuclear/checmical stress test instead
What is a great antifungal medicine class for candida, but does not cover cryptococcus?
Echinocandins (caspofungin, micafungin, and anidulafungin)
How do you dx Sjogren’s syndrome?
salivary gland biopsy - gold standard
most people ANA positive (95%)
some people will have anti-Roa nd -La present (50-65%)
How to anticoagulate after non-hemorrhagic stroke?
aspirin, clopidogrel, or aspirin + dipyridamole
How do you manage temporal (giant cell) arteritis?
Immediate IV steroids and admission! so that doesn’t progress to blindness or stroke
What neuro findings if present when Wernicke’s area is affected?
word salad - fluent speech but meaningless
What type of hepatitis is most likely transmitted through a blood transfusion?
Hep C, takes 5-10 wks to incubate
What is the follow up management after MI?
- B-blockers, aspirin, ACE inhibitors, statins
- stop smoking
- exercise
- moderate alcohol comsumption
- low-fat, vegetarian, and mediterranean diets
- sex can be resumed after 1-2 weeks or after 6 wks in pts with residual symptoms
What is a side effect of ticlopidine (anti-platelet)?
neutropenia
*switch to clopidogrel
What fungus grows septated hyphae?
aspergillus - tx with voriconazole
What are good topical antibiotics for otitis externa?
polymyxin, neomycin, ciprofloxacin, ofloxacin, gentamicin, tobramycin
What physical exam findings are seen with anabolic steroid usage?
Testicular atrophy
gynecomastia
htn
tachycardia
What bacteria causes pneumonia and is lancet-shaped, gram positive diplococci?
strep pneumo
What neuro findings if present when Broca’s area is affected?
expressive aphasia
How to w/u urethritis in men?
gram-stain for gonorrhea
How do you manage an acute COPD exacerbation?
oxygen, albuterol, budesonide, ipratropium, steroids, and ABX (azithromycin)
How do you dx hepatopulmonary syndrome?
liver disease
increased A-a gradient
evidence of intrapulmonary vascular abnormalities on conrast-enhanced ECHO, pulm arteriography, or Tech-99 labeled albumin scanning
What is the best initial therapy for cryptococcus?
amphotericin and flucytosine
Can GERD be caused by H pylori?
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
When should you start inhaled steroids when a pt is hospitalized for acute asthma exacerbation?
right away - takes 5-10 days to see an effect, so when you start tapering oral/IV steroids, they will be ready to go
Where does breast cancer metastasize to?
bone
What lifestyle modification will ahve teh greatest immediate impact on coronary artery disease?
smoking cessation
What is the most effective tx for aspergillus?
voriconazole
How do you assess the severity of DKA?
bicarb (low)
pH (low - acidosis!)
increased anion gap
What are teh 5 A’s of smoking cessation?
Ask, advise, assess, assist, arrange (f/u)
What is the next step in management of Parksinon’s disease if levodopa/carbidopa is not controlling symptoms?
Add a COMT inhibitor - tolcapone or entacapone
How do you test for legionella?
urine
What are the options for empiric tx of neutropenia and fever?
- carbapenems (imipenem, meropenem, doripenem)
- cefepime
- pip/tazo
What parameters must be kept in mind when ventilating a pt with ARDS?
“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”
What settings do you use to ventilate pts with asthma?
low ventilatory rate (allow time for expiration), small tidal volume (prevent damage - air trapping), high flow
How do you initially manage DKA?
IV Bolus NS and IV Insulin
What is the most common type of fistula formed as a complication from diverticulitis?
colovesical (colon to bladder)
if pneumaturia present - needs surgery right away!
How to tx impetigo?
mupirocin and retapamulin
What is acute rheumatic fever?
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
How do you treat acute prostatitis?
10-14 days ciprofloxacin or TMP-SMZ
How do you tx a mallet finger (avulsion of distal phalanx)?
extension splinting for 4-5 weeks
How do you dx Wegner granulomatosis?
presence of c-ANCA
like churg-strauss w/o asthma or eosinophilia
presents with sinus problems or nasal septal perforation
What is a simple vs complicated UTI and how do you tx each?
simple - bactiuria (bladder infection)
complicated - UTI in male, diabetic, HIV +, or pregnant
tx:
simple 3 days abx (TMP-SMZ)
complicated 10-14 days abx
What is a side effect of hydroxychloroquine?
ocular or retinal toxicity
*can be reversed if caught early and you stop the drug
What are symptoms of legionella?
viral prodrome, initial dry cough, confusion, diarrhea, hyponatremia, leukocytosis
How do you treat acute rheumatic fever?
penicillin V now
aspirin if fever or arthritis
prophylaxis with pencillin G for…
- 10 yrs or until age 21 (whichever is longer) if you have carditis
- 5 years or until age 21 (whichever is longer) if no carditis
- forever if carditis with residual effects on ECHO
How do you treat herpes simplex encephalitis?
IV acyclovir
What is the MOST controllable risk factor for stroke?
hypertension
What is Churg-Stauss syndrome?
vasculitis associated with nephritic syndrome, eosinophilia, and asthma
After a pt is treated for diverticulitis, when should confirmatory imaging be done?
do a barium enema in 2-3 weeks (in acute period the risk for perforation is too high)
Shock States
How do you decide to anticoagulate a pt with a fib to prevent stroke?
CHAD 0-1 : aspirin
CHAD 2+ : warfarin or dabigatran
What do you check yealy at a diabetic pt’s check up?
urine microalbumin
foot exam
LDL level
dilated eye exam
How do you treat esophageal spasm?
CCB like diltiazem
What side effects are associated with amphotericin?
renal toxicity (distal RTA and hypokalemia)
What EKG findings are associated with Brugada syndrome?
RRRB and ST segment elevation in V1-V3
What is a prolonged QT for men and women?
men >450
women >470
How to manage NSTEMI?
Dual antiplatelet therapy
Nitrates
beta blockers
statins
anticoagulant therapy
What is a common complication to look out for with bicuspid aortic valve?
aortic dilation (can lead to aortic aneurysm)
How do you treat symptomatic HOCM?
Beta-blocker
What are the features of CREST Sydnrome?
calcinosis cutis
Raynaud phenomenon
esophageal dysmotility
sclerodactyly (fatty puffy fingers)
telangiectasias
*when there is lung involvement - it is usually pulmonary HTN
What are the features of systemic scleroderma?
skin, lung (interstitial lung dz), kidney, and IG involvement
What sreening tests should be done at time of dx for scleroderma?
PFTs to get baseline lung fx
What are the clinical manifestations of celiac disease?
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
What is diverticular bleeding?
arterial erosion due to colonic mucosal outcropping
*can cause painless hematochezia
What causes the mitral chordae tendineae to rupture vs a papillary muscle to rupture?
chordae - mitral valve prolapse, infective endocarditis, rheumatic heart dz, trauma
muscle - MI or trauma
What are clinical features of Ehlers-Danlos?
skin - velvety w/ atrophy and scarring, poor healing, hyperextensible
MSK - joint hypermobile, pectus, scoliosis
cardiac - MV prolapse
Other - abdominal/inguinal hernias, uterine prolapse
What are clinical features of Marfan?
MSK - joint hypermobile, pectus, scoliosis, tall w/ long extremities
Heart - progressive aortic root dilation, MV prolapse
other - lens and retinal detachment, spon. pneumothorax
How do you dx and manage gastroparesis?
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
What conditions are pts with Down syndrome more likely to develop later in life?
acute leukemia, dementia, autism, ADHD, depression, seizures
How to tx acute decompensated heart failure?
IV furosemide (decr preload and get fluid off lungs)
IV nitroglycerin (decr preload)
EHO to figure otu cause
What heart findings are associated with ASD (in adulthood)?
wide and fixed splitting of S2, right atrial or ventricular dilation
First line tx for DVT?
factor Xa inhibitor - rivaroxaban for >/= 3 months *if pt doesn’t have cancer
*if has cancer - LMWH
What is an alternative non-hormonal treatment for hot flashes?
SSRIs (escitalopram) or SNRIs (venlafaxine)
What is the genetic mutation in marfan?
defect to fibrillin-1 (glycoprotein)
What is a common presentation of GERD?
chronic cough due to irritation of cough receptors in the Respiratory tract
What medications cause digoxin toxicity?
verapamil, quinidine, amiodarone, spironolactone
How do you manage peri-infarction pericarditis?
high dose aspirin
How do you determine the cause (or narrow the ddx) of ascites?
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)
how do you tx idopathic pulmonary arterial HTN?
endothelin receptor antagonists
How to dx STEMI?
>1mm ST elevation in >/= 2 contiguous leads except V2 and V3, which need >2mm
or new LBBB
When can radiation proctitis occur?
anytime after radation tx (acute - years)
causes diarrhea, muscus discharge, feeling need to defecate and not being able to pass much
How to eval and treat blood in the stool?
If suggestive of upper bleeding - EGD, if don’t find it - colonoscopy
How to treat type 2 heart block?
pacemaker
What can chronic gerd lead to that causes obstructive dysphagia?
esophageal stricture
What are the most significant risk factors for coronary heart disease?
noncoronary atherosclerotic dz (AAA, peripheral artery, carotid dz)
DM
chronic kidney dz
How do you manage a stable aortic aneursym?
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
What is the most important risk factor to stop for AAA?
smoking
How do you tx cocaine tintoxication wtih chest pain?
benzos and nitroglycerin
CCBs for perisistent chest pain
phentolamine for perisistent HTN
PCI for MI
What are the most common causes of acute pancreatitis in adults?
alcohol and gallstones (65% of time)
metabolic - hyperCa and hypertriglyceridemia
What is the standard reccommendation for enteral feeding formulas for adults?
30 kcal/day and 1 g/kg/day of protein
What are the best non=pharm managment strategies for decreasing BP?
weight loss to BMI <25 *best!
DASH diet (8-14 mm Hg decr)
exercise (4-9 decr)
decr Na in deit (2-8 decr)
What does afib look like on EKG and how to tx?
narrow QRS
no p waves
irregularly irregular rhythm
tx: beta blockers or CCB (unless hypotensive or in Heart failure)
What drug must you decrease warfarin dose to compensate for when starting?
amiodarone
How to decide if you can clear a patient with a CAD hx for surgery?
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
Does antibodiy testing confirm active hep C dz?
no! could mean active, past infection, or false pos
need HCV RNA testing
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?
yes - recheck CK and if normalized, can try again
What are complications of diptheria?
pharyngitis (pseudomembrane)
toxin-mediated myocarditis
How to tx diptheria?
erythromycin or penicillin G
diptheria antitoxin (if severe)
What are symptoms of congenital rubella?
hearing loss, cataracts, PDA
“blueberry muffin rash)
How to think about heart meds and continuing/discontinuing before surgery…
Way to think about how to step up therapy with heart failure meds,,,
What is the classic KUB finding for sigmoid volvulus?
A distended colonic loop in the RUQ and the tip ointing toward the left lower quadrant
How to manage a sigmoid volvulus?
if febrile and peritoneal signs - surgical detorsion
if stable without fever or peritoneal signs - flex sigmoidoscopy or colonoscopy for dx and tx
How to manage drug induced parkinson dz (tardive dyskinesia and other extrapyramidal symptoms)?
switch to clozapine or quetiapine
*if s/sx continue, try an anti-cholinergic med like benztropine
What is the standard of care for dx chlamydial and gonorrheal infections?
NAAT on urine in man or self-urethral swab on woman
What childhood viral illness causes high fevers and then ?rose-pink” maculopapular rash afterwards?
Roseola infantum (HHV-6)
What childhood viral illness causes slapped cheek rash and mottled looking skin?
erythema infectiosum (Parvovirus B-19)
What childhood viral illness causes rash and fever with cough and Koplik spots?
Rubeola (measles virus)
What childhood viral illness causes pharyngitis, rash, and strawberry tongue?
scarlet fever (strep infection)
What preventative counseling/advice is most likely to prevent disability w/in 5-10 yrs in an adolescent?
don’t drink and drive
MVA’s one of highest causes of mortality in adolescent age group (10-24)
What are the most important risk factors for men and women in regards to osteoporosis?
women - being a woman!
men - caucasian
What criteria must be met to dx brain death?
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
how to w/u abnormal PAP with ASCUS
How to deliver ventilator breaths to COPD pts?
slow breaths (8-12 bpm) with 6-10 cc/kg tidal volumes to prevent baro-trauma to blebs or bulla
How to dx Wernicke’s encephalopathy?
clinical! (eye, confusion, and gait abnormalities in malnourished alcoholic)
no lab testing needed - just start tx with IV thiamine
How can you differentiate between spontanrous SLE and drug-induced SLE?
drug induced does NOT have renal or CNS involvement
*otherwise identical
What is the medical w/u for panic attacks?
Thyroid function tests
CBC, CMP, fasting glucose, LFTs, urea, Cr, Ca, UA, Urine drug screen, EKG
What condition presents with painless juandice and elevation of conjugated bilirubin and alk phos and how do you image?
pancreatic adenocarcinoma - get an abd CT
What is the next step in T2DM management when metformin is not controlling blood glucose levels?
add an incretin (sitagliptin) or a sulfonylurea (glimepiride, glyburide, or glipizide)
don’t go to insulin until fails 2-3 oral meds
What is the most common complication of placental abruption?
disseminated intravascular coagulopathy (DIC)
What antibodies are found in transfusion-assocaited acute lung injury (TRALI)?
antigranulocyte antibodies in the blood donor
What is a contraindiaction for a TIPS procedure?
hx of hepatic encephalopathy
(makes it worse, bc not all blood is being filtered through liver)
What is Legg-Calve-Perthes disease?
avascular necrosis of the femoral head in 4-8 yo
How do you tx vibrio septicemia (caused by ocean exposure to cut and making black bullous lesions over skin)?
cefotaxime and minocycline
What is the best treatment for hepatopulmonary syndrome?
liver transplant
What is the right to left shunt refering to that is seen in pulmonary syndrome?
arteriovenous shunting - blood moving fast pass the lung tissue and there is no time for oxygen exchange
How to calculate the Aa Gradient?
A-a Gradient = 150 - (1.2 * PaCO2) - PaO2.
What are findings of adernal crisis and how do you manage it?
hypokalemia, hyoptension (dehydration), circulatory failure
tx: saline, steroids, Abx (if infection precipitated it)
What should be screened for in all pts with HTN?
diabetes!
HgA1c >6.5%
or fasting glucoses x2 >125 mg/dl
or serum glucose >200 mg/dl w/ symptoms
What should you suspect in an newborn who hasn’t urinated, has a hx of oligohydraminios, and has acute renal failure?
how to dx?
posterior urethral valves
voiding cystourethrogram
How to treat exacerbation of mild asthma in ED?
3 doses of albuterol in 1 hour
(add steroids if pt was on them recently)
What are indications for hemodialysis in lithium toxicity?
serum level >4
signs of lithium toxicity (seizures, mental status changes)
What is paget disease and what are complications that it can cause?
osteitis deformans - increased bone turnover
complications: fractures, tumors, high-output heart failure (bc incr blood flow through bone), arthritis
How to classify types of asthma?
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
What are the side effects of metformin?
lactic acidosis, contraindicated in renal insufficiency
What antibodies should be screened for in pregnant pts with lupus?
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
How to manage Barrett esophagus?
PPI and endoscopy q3 years
How to tx allergic contact dermiatitis?
stop agent and apply topical steroids
What is the best test for seeing if a pt had a new MI within days of a previous one?
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)
What is the best early screening test for hemochromatosis?
transferrin saturation (fe/TIBC)
What are normal opening pressures on LP in an adult?
100-200 mm Hg
What electrolyte derrangement to consider in a DKA pt with new weakness, muscle apain, and SOB?
hypophosphatemia
