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Questions Flashcards

1
Q

Pt with episode of chronic, inflamed knee joint and crystals

What is seen on xray?

A

Acute calcium pyrophosphate crystal arthritis

Radiopaque lines on chondral surfaces of long bones called “chondrocalcinosis”

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2
Q

Ranolazine

A

Inhibits the Na+ current leading to decrease myocardial wall tension, O2 consumption

=>Decreased angina and increased exercise tolerance

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3
Q

What medications cannot be used w/ ranolazine?

A

Ketoconazole, azithromycin, ritonavir (strong CYP inhibitors)

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4
Q

Initial studies for FUO

A

CMP, CBC, Blood cx, UA, ESR, PPD, CXR, CT Abd

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5
Q

Orthopnea corresponds to what CWP

A

20mmHg

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6
Q

Patient w/ urticarial wheals that are lasting for >24hrs, are painful, and leave bruises

A

Urticarial vasulitis

-Is associated w/ other AI disease

Dx: Skin biopsy

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7
Q

Pt w/ stroke of undetermined origin and inpatient workup is all negative

A

Will require 30 days of cardiac rhythm monitoring

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8
Q

Post-Lyme Disease Syndrome

A

Disordered immunologic response to Lyme characterized by myalgia, arthralgia, fever,and fatigue up to 6 months after acute disease and may wax/wane

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9
Q

Difference b/w scleritis and episcleritis

A

Scleritis has PAIN

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10
Q

Causes of tricuspid regurgitation

A 
Rheumatic disease 
Radiation
Endocarditis
Myxomatous degeneration
Ebstein anomaly
Carcinoid syndrome 
Trauma
PACEMAKER/ICD PLACEMENT
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11
Q

ASD that is associated w/ mitral regurgitation

A

Ostium primum defect

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12
Q

Uncommon side effect of heparin

A

Hypoaldosteronism =» Hyperkalemia

-Especially common w/ CKD or DM

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13
Q

MCCo primary adrenal insufficiency

A

AI adrenalitis

  • Test=21-hydroxylase antibodies
  • Glands will appear atrophic on CT
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14
Q

Increase RF for having sclerodermic crisis

A

Presence of anti-RNA Polymerase III abs

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15
Q

Paroxysmal Nocturnal Hemoglobinurea

A

Intravascular hemolysis, pancytopenia, fatigue, abd pain
-Increased risk of malignancy, clots in unusual locations

*Test=Flow cytometry (lack of CD 55 and 59)

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16
Q

Lab to check prior to statin initiation

A

Hepatic profile

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17
Q

Hemoglobin BS

A

Pts have lifelong mild hemolytic anemia and microcytosis and detectable HgbA

-Amount of HgbA is inversely proportional to symptom severity

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18
Q

Amount of HgbS in Sickle Cell Disease

A

90% approx

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19
Q

First step to take in Parkinson’s patient w/ hallucinations

A

D/c any dopamine agonisist BUT don’t stop L-dopa

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20
Q

Pimavanserin

A

Non-dopaminergic atypical antipsychotic that is the ONLY FDA approved medicine for Parkinson’s psychosis

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21
Q

Alport syndrome diagnosis

A

Genetic analysis

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22
Q

Patient who has persistent supraclavicular lymphadenopathy

A

Excisional biopsy required

R-side=Thoracic malginancy; L side=abdominal malignancy or lymphoma

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23
Q

Tumor marker for gastroesophageal adenocarcinoma

A

HER-2

-Can treat w/ Herceptin if positive

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24
Q

Cabergoline monitoring for hyperprolactinemia tx

A

1 month; then 3-4; then maybe stop at 6

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25
Q

1st line tx of comedonal acne

A

Topical retinoid

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26
Q

3 drugs approved for fibromyalgia

A
  1. Duloxetine
  2. Pregabalin
  3. Milnacipran
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27
Q

Pregabalin MoA

A

Inhibits glutamate release in the DRG =» decreased perception of pain

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28
Q

Recovery from Guillan-Barre

A

Typically, the disease reaches a peak in <4 weeks and then will slowly improve w/ most pts becoming ambulatory within 6 months

-Therefore, once a pt starts to improve, they no longer need inpatient monitoring

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29
Q

Management of acute hemolytic crisis splenomegaly

A

Observation; only perform splenectomy if CHRONIC

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30
Q

Tx of severe allergic contact dermatitis

A

2-3 weeks of systemic glucocorticoids

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31
Q

D-lactic acidosis

A

Form of LA presenting in patients specifically w/ short-bowel syndrome

  • Think of this w/ history of small bowel resection or jejunal bypass
  • Typically occurs after pt consumes large carbohydrate load
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32
Q

Acute management of severe head injury

A 
Maintain pO2 > 60mmHg 
SBP >90mmHg 
Treat fever (common complication)
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33
Q

Follow up after acute diverticulitis

A

Colonoscopy within 4-8 weeks

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34
Q

Young women needing chemo needs what before starting treatment

A

Fertility doctor consult

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35
Q

Pts who receive radiation therapy during childhood have an increased risk of developing what type of cancer

A

Papillary Thyroid Cancer

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36
Q

Fingolimod

A

Sequesters lymphs in LNs =» decreased MS relapse rate by 50% over 2 yrs and also decreases disease progression

*0.5% risk/year of macular edema =» Needs annual ophthalmology f/up

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37
Q

Drug that reactivates JC virus

A

Natilizumab (Tysabri)

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38
Q

First test to look at with metabolic alkalosis

A

Urine Cl

If <15 =» Saline RESPONSIVE

If >15 =» Suspect mineralcorticoid excess

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39
Q

Subacute cutaneous lupus erythematosis

A

Photodistributed, burning rash w/ light pink tone

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40
Q

Causes of subacute cutaneous lupus erythematosis

A

TNF-a inhibitors (adalimumab), HCTZ, ACEIs, NSAIDs, PPIs, Terbinafine

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41
Q

Treatment of refractory MS-fatigue after trying lifestyle management

A

Modafanil, amantadine, methylphenidate

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42
Q

Screening needed 2 weeks prior to cardiothoracic or orthopedic surgery

A

MRSA surveillance

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43
Q

3-2-1-1-0 Rule

A

3 family members affected
2 successive generations affected
1 family member is a first-degree relative of the other 2
1 cancer diagnosed at age <50
O chance of FAP; tumor histological diagnosis

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44
Q

Gene deletions associated w/ Lynch Syndrome

A

MLH1, MSH2, MSH6, PMS2

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45
Q

Screening for Lynch Syndrome

A

Age 20 or 2 years prior to earliest affected family member

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46
Q

Tx of Lynch Syndrome if cancer found

A

Colectomy + annual surveillance of remaining rectum

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47
Q

MCCo muscle disease in elderly

A

Inclusion Body Myositis

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48
Q

Infertility eval in 35 year old

A

Starts at 6 months of no conception

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49
Q

Initial eval for ICU-acquired weakness

A

Medical Research Council (MRC) muscle scale

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50
Q

Lupus pernio

A

Variant of sarcoidosis involving non-caseating, granulomatous inflammation of the skin around the nares producing plaques and nodules on the central face and nose
Has chronic, refractory course

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51
Q

Tx of alcoholic ketoacidosis

A

D5W + NS’

-Need D5W to induce insulin secretion

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52
Q

Restrictive Lung Disease findings

A

Decreased TLC (should be normal in obstructive)

If RV and FRC are preserved, suspect neuromuscular weakness

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53
Q

Test to perform prior to aortic valve replacement

A

Cardiac catheterization

-Must make sure symptoms aren’t due to CAD

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54
Q

Pts w/ Inflammatory Bowel Disease have an increased risk of what while hospitalized?

A

DVT; Only avoid anticoagulation w/ hemodynamic instability

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55
Q

Olaparib

A

Oral poly-adenosine diphosphate-ribose polymerase inhibitor (PARP)

FDA approved as monotherapy for pts w/ germline BRCA (+) advanced ovarian cancer after 3 or more lines of chemotherapy have failed

PARP inhibition =» double-stranded DNA breaks in BRCA tumors that they are unable to repair

One study showed response rate of 31% in ovarian, prostate, breast, and pancreatic cancers

ADR: N/V, anemia

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56
Q

PMNs in Folate Deficiency

A

Also hypersegmented

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57
Q

Victoza (and questions to ask before starting it)

A

Liraglutide (GLP-1 agonist): patients must be asked about history of pancreatitis and FH of medullary thyroid cancer

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58
Q

Recommended length of VTE therapy for prophylaxis following major orthopedic surgery

A

35 days of LMWH

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59
Q

Emergently placed central lines pose a risk for what

A

Sepsis

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60
Q

Tx for small cell carcinoma

A

Chemo + Rads

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61
Q

Tx for EHEC

A

Supportive

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62
Q

Tx for UC

A

Mesalamine; preferable oral AND enema

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63
Q

Palpable purpura + Abd pain + Arthralgia =?

A

IgA vasculitis (Henoch-Schonlein)

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64
Q

Diabetic mononeuropathy

A

Acute or subacute pain and paresthesia in a dermatomal distribution pattern in the thoracic or abdominal region in pts w/ poorly controlled DM and no evidence of active Zoster infxn

Can be unilateral or cross the midline

Can be associated w/ superficial abdominal swelling in the affected area

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65
Q

Abs in primary membranous glomerulopathy

A

Anti-phospholipase A2 receptor (PLA2R)

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66
Q

Primary Restrictive Cardiomyopathy

A

A lot of the same findings as constrictive pericarditis BUT has…

  1. Elevated BNP
  2. Concordant rise and fall of L/R systolic pressures w/ respiration (should be vice versa in constrictive pericarditis)
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67
Q

When to stop NOACs prior to surgery

A

2-3 days

If renal fnxn exists, check anti-Xa level 72 hours before surgery

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68
Q

Myelodysplastic syndrome findings on peripheral smear

A

Dysplastic PMNs w/ hypogranulation, hypersegmentation and NRBCs

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69
Q

Tx of necrotizing fascitis 2/2 Aeromonas Hydrophilia infxn

A

Doxy + Rocephin/Cipro

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70
Q

Patient who presents w/ viral meningitis in the winter time

A

More likely to be HSV-2; enteroviruses are May-November

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71
Q

Focal Segmental Glomerulosclerosis

A

Seen in African Americans, people who were preemies, obese pts, or people w/ only one kidney

Path: Hyperfiltration injury in setting of relative reduction of renal mass =» adaptive podocyte injury and segmental sclerosis

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72
Q

Gastral antral vascular ectasia (GAVE)

A

Pts w/ AI disease or cirrhosis who have “watermelon stripes” on upper endoscopy; tx is argon plasma or laser photocoagulation

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73
Q

Cameron Lesions

A

Erosions of the crest of the gastric folds within a large hiatal hernia thought to be caused by mechanical trauma of the esophagus sliding up and down

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74
Q

Dieulafoy lesions

A

Submucosal gastric vessels that occasionally protrude through the gastric mucosa and can cause hemorrhage

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75
Q

Tx for acute Bell’s Palsy

A

Prednisone w/in 72hrs

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76
Q

Meds to give prior to intubation

A

Midzolam 1-2mg IV q 5mins

Fentanyl 20-50mg IV

Etomidate .3mg/kg

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77
Q

Patient w/ SEVERE leukocytosis and elevated K+

A

Recheck Plasma K+

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78
Q

RAVE Trial (Rituximab vs Cyclophosphamide for ANCA-assoc. vasculitis)

A

Rituximab > Cyclophosphomide for tx of RELAPSE at 6 months pts had 67% improvement vs 42%

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79
Q

Rapid improvement in blood glucose in DM should concern you for what

A

Increased risk of development of diabetic retinopathy

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80
Q

DM patient who is pregnant

A

NEEDS EYE EXAM

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81
Q

Preferred tx of cancer related pain w/ CKD

A

Dilaudid

Can also consider fentanyl patch in non-opioid naive pts

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82
Q

Recommended duration of therapy for VAP

A

7 days

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83
Q

Cisplatin-Induced AKI

A

Characterized by polyuria, tubular injury (due to oxidative stress, mitochondrial injury, and activation of apoptosis pathways), proximal RTA, hypomagnesemia

Occurs 7-10 days after initiation of therapy

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84
Q

Neoadjuvant chemotherapy

A

Given prior to planned curative-intent surgery to patients with fully resectable disease

*Goal is to eradicate micrometastatic disease

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85
Q

Subsolid nodules on CT Chest and monitoring

A

“Ground glass” = No solid component

6-8mm = @6-12 months; then q2yrs for 5yrs

-Average doubling time for these nodules = 3-5yrs

86
Q

Rhythmic life threatening complication of MI

A

Mobitz Type II

87
Q

Pts to treat prophylactically for traveler’s diarrhea

A

IBD and IC pts

Tx w/ Cipro for 2-3 weeks max

88
Q

Common ADR of ticagrelor

A

Dyspnea; occurs in 15-20% of pts; is self-limiting

89
Q

Methylnaltrexone

A

Peripherally acting opioid antagonist given for tx of opioid induced constipation

90
Q

Primary Progressive Aphasia

A

“Language variant FTD”

  • Prominent early changes in language
  • Typically, see asymptomatic degeneration of the LEFT frontotemporal regions
91
Q

Relapsing Polychondritis

A

AI condition characterized by inflammation and damage of cartilaginous tissues
MC=External/Middle ear, nose, tracheobronchial tree, joints

  • Pts need CT chest to address for airway damage
  • Labwork is nonspecific; clinical diagnosis
92
Q

Cogan Syndrome

A

Interstitial keratitis + cochlear/vestibular dysfunction

93
Q

Pt w/ stable CAD and new onset of afib; CHADS-VASC >2

A

Tx ONLY W AC

  • Adding antiplatelet therapy only increases bleeding risk w/ no improvement in mortality
  • Only DAPT if w/ MI or stent in last 12 months
94
Q

Work up for myeloproliferative neoplasm

A

JAK2 V617F testing

Performed in setting of abnormal thromboses, splenomegaly, and portal HTN

DONE EVEN W/O ERYTHROCYTOSIS

95
Q

Tx of carbapenem-resistant infection

A

Ceftolozane-Tazobactam

-New, antipseudomonal B-lactam and B lactamase inhibitor

96
Q

Tx of cyclospora diarrhea

A

Dbl-strength bactrim for 7-10 days

97
Q

Tx for PAH w/ response to NO

98
Q

Treatment of actinic keratosis

A
  1. Cryotherapy
  2. 5-FU, imiquimod
  3. Biopsy to r/out cancer (NOT AN EXCISIONAL BIOPSY)
99
Q

Caprini Score

A

A score used to assess pts risk for development of pos-surgical thrombosis

> 5 = HIGH RISK; requires BOTH ICD and medicinal prophylaxis

100
Q

Pt w/ history of gout who has cellulitis that has not responded to antibiotics

A

This is gouty cellulitis; just treat it like gout

101
Q

Mycobacterium fortuitum

A

Chronic, rapidly growing mycobacterium that grows in small breaks in the skin (or ulcers) and do not respond to antibiotic therapy

-May have history of hot tub exposure

102
Q

Pt w/ chronic silicosis and develops red-flag symptoms w/ increasing pulmonary illness

A

May need to consider TB

-Pts w/ silicosis already have DECREASED macrophage function increasing their risk for mycobacterium infxn

103
Q

Diagnosis of hepatopulmonary syndrome

A

Diagnose O2 tension of <80mmHg or an A-a gradient of >15 along w/ evidence of intrapulmonary shunting on echocardiography w/ agitated saline or macroaggregated albumin study

Symptoms include platypnea and orthodoexia

104
Q

Tx of bladder cancer that has not invaded muscular wall

A

Intravesicular bacillus-CG injection and cystoscopy at 3 and 6 months

105
Q

POEMS syndrome

A 
Peripheral neuropathy, Papilledema 
Organomegaly
Edema
Monoclonal plasma cell dyscrasia 
Skin changes

Also has Castleman disease (angiofollicular lymph node hyperplasia)

106
Q

Colon cancer screening that does not require bowel prep or dietary changes

A

FIT testing

107
Q

Sumatriptan in migraine

A

Targets trigeminovascular activation assoc. w/ migraine headache by activating 5-HT1B and reversing vasodilation

**Pts must use this at first sign of headache

108
Q

Tx of refractory ACUTE gout

A

Anakinra: IL-1 inhibitor; it is expensive tho

109
Q

Meds to d/c prior to screening for pheochromocytoma

A 
SNRIs 
TCAs
OTC decongestants 
L-dopa
Buspirone 
Prochlorperazine 
Amphetamines
110
Q

Prochlorperazine

A

Antipsychotic that blocks D1 and D2 receptors in mesolimbic system =>anti-a1, anti-a2, and anticholinergic effects => decreased RAS stimulation

Uses: N/V

ADRs: Anticholinergic, CNS depression, aspiration, EPS, hyperprolactinemia, hypothyroidism

111
Q

New pt w/ onset of dyspepsia and is <60 yrs old

A

Stool H Pylori testing needed

112
Q

Pt w/ brisk bleed and hypotension that briefly stops but then has a repeat GI Bleed

A

HERALD BLEED

***Worrisome for AORTOENTERIC FISTULA

***Consider in ANY pt w/ history of aortic graft and GI bleed

-Possibly assoc. w/ an inciting infxn; needs CT w/ CONTRAST

113
Q

Metabolic surgery in diabetic consideration

A

W/ BMI >35 and if they are unable to meet their A1c goals

*Assoc. w/ decreased CV events and deaths

114
Q

IgG4-disease

A

Characterized by IgG4-producing plasma cell infiltration and tumefication of affected tissues => painless organ enlargement, fibrosis, and dysfnxn

***Commonly see retroperitoneal fibrosis + inflammatory aortitis

115
Q

Management of acute hemodynamic compromise in HOCM

A

Theory: Increase pt volume status and decreased LVOT obstruction

  1. Elevate legs and give IVF (increase preload)
    a. Also correct anemia
  2. IV BB
  3. Phenylephrine (has NO B-adrenergic activity)
  4. Consult cards for possible myomectomy

***Avoid inotropes

116
Q

Stone w/ increased urine pH

A

Calcium phosphate

*Common w/ distal RTA, hyperparathyroidism, CA inhibitors (increase proximal tube reabsoprtion of Na, HCO3, and Cl)

117
Q

Main difference b/w labyrinthitis and vestibular neuritis

A

Auditory symptoms present in labyrinthitis

Otherwise, similar disease processes

118
Q

Antiepileptic drugs which do NOT cause bone loss

A

Lamotrigine, Levitracetem

119
Q

Pt w/ chronic joint pain presenting w/ pulm effusion but find SEVERELY LOW GLUCOSE <10 in exudate

A

Likely rheumatoid pleuritis; MC pulmonary manifestation of RA

120
Q

Unique finding in TB pulm effusion

A

Elevated adenosine deaminase

-Normal level essentially excludes TB

121
Q

ICD placement in HOCM indications

A
  1. Massive myocardial hypertrophy (wall thickness >30mm)
  2. Previous cardiac arrest due to ventricular arrythmia
  3. Blunted BP response or hypotension during exercise
  4. Unexplained syncope
  5. Non-sustained V-tach on ambulatory EKG
  6. FH of sudden cardiac death 2/2 HOCM
122
Q

Pts on prolonged abx therapy and suddenly develop bleed

A

Suspect Vitamin K deficiency; check INR

*Most vitamin K is derived from saprophytic bacteria of the gut

123
Q

EKG findings consistent w/ PE

A

S1Q3T3
Inverted T-waves
RBBB
RAD

124
Q

Goal of urate lowering therapy for tophaceous gout

125
Q

Med to worry about when using allopurinol

A

Diuretics

Otherwise, max dose = 800mg/day

126
Q

Main therapy for HFpEF

A

DIURETICS (including lasix)

BBs, ACEIs, ARBs not giving mortality benefit; some question w/ aldosterone tho

127
Q

Red Flags of new headache

A 
Age >50 
Use of anticoagulant 
Progression
Abnormal physical exam
"Thunderclap" 
Episode of neurologic sx lasting >1hr w/ headache 
AMS 
Onset after exertion/sex/valsalva
128
Q

1st line treatment for tics

129
Q

Tx of iron overload in pts w/ ongoing anemia requiring chronic transfusions

A

Deferoxamine or Deferasirox (oral version)

-Require close monitoring due to kidney/eye/brain toxicity

130
Q

Indications for cardiac transplantation in CHF

A

Age <65
No end organ complications from disease
Good social support
Good adherence to therapy previously

131
Q

Pt w/ MGUS and develops renal failure

A

GET BIOPSY

-Diagnose Monoclonal gammopathy or renal significance

132
Q

Tx of acute epididymitis in pts >65 who do insertive anal intercourse

A

Rocephin + FQN

*Needs pseudomonas coverage

133
Q

Amyopathic dermatomyositis

A

Characteristic features of dermatomyositis w/ muscular manifestations

*Still at increased risk for malignancies and pulmonary fibrosis

134
Q

Tx of hepatorenal syndrome

A

Octreotide + milrinone

135
Q

Management of HTN w/ CKD

A

Needs diuretic; w/ low GFR, thiazides will be ineffective tho

136
Q

Tx of early-stage laryngeal cancer

A

Radiation ALONE

137
Q

Pts w/ genetically confirmed HOCM need what offered?

A

Genetic counseling to offspring

138
Q

Polymorphous light eruption

A

Light-induced, pruritic eruption of pink/red papules or vesicles

Appear within hrs of exposure and persist for weaks

Dx of exclusion

139
Q

Tx of Q Fever

140
Q

Linaclotide

A

Peripherally acting guanylate-cyclase C receptor antagonist used for tx of chronic idiopathic constipation that has NOT responded to 1st line therapy

MoA: Increased c-GMP => Increased Cl and HCO3 secretion into the intestinal lumen => increased intestinal fluid content

*Take on an empty stomach 30mins before meals to avoid diarrhea

141
Q

Managment for well-differentiated, low-grade metastatic GI neuroendocrine tumors

A

JUST MONITORING; usually indolent

142
Q

Populations at increased risk of Giardia

A

Campers
Child-care workers
Fucking kids

143
Q

Flow-volume loop of variable intrathoracic upper airway obstruction

A

Plateau during expiration due to increase in pleural pressure; this pressure during inspiration relieves the obstruction

144
Q

Tool to use for STEMIs

A

TIMI calculator

145
Q

Prevention of repeat secondary spontaneous pneuomothorax or 2nd occurrence of primary pneumonthorax

A

Pleurodesis

Performed w/ blood patch, tetracycline, or talc powder thru thoracostomy tube OR VATS

146
Q

Prevention of breast cancer recurrence w/ high risk, early stage tumors

A

Leuprolide

147
Q

Tx of epidermal inclusion cyst

148
Q

Management of non-small cell lung cancer for maintenance chemo following adequate response

A

Pemetrexed

or

Erlotonib (if EGFR positive)

149
Q

Unexplained chronic cough management

A

Multimodality speech pathology therapy; can also try gabapentin to decrease neurologic sensation

150
Q

MVR murmur

A

ALWAYS NEEDS A TTE at least

151
Q

Pt w/ asthma-COPD overlap and eosinophilia need what

A

LABA AND GLUCOCORTICOID

152
Q

Left posterior fascicular block on EKG

A

Small QRS in I, aVL, tall positive R wave in II, aVF

*Also needs positive QRS in I and negative in aVF

153
Q

Fracture Intervention Trial in Long-Term Extension (FLEX)

A

Continuing alendronate for 10yrs vs stopping after 5yrs was associated w/ more vertebral fractures

*Predictive factors for repeat fracture: Age >76, Femoral neck T-score

154
Q

Pitted Keratolysis

A

Waxy, scaly plaques of the plantar skin w/ small punctate erosions; also very smelly

RFs; Hyperhidrosis

Tx: Topical abx; antiperspirant

155
Q

Pseudoachalasia

A

Caused by tumor at GEJ infiltrating the myenteric plexus and causing esophageal motor dysfunction

-Similar signs/symptoms and studies as achalasia

Management: Upper EGD

156
Q

Sweet Syndrome

A

Acute Febrile Neutrophilic Dermatosis

Causes: Idiopathic, post-infectious, medications, hematologic malignancy (MC AML)

Sx: Abrupt onset of fever, arthalgia, myalgia, cutaneous tender and bright-pink papules/plaques

157
Q

Diagnosing overflow incontinence

A

Check Urinary Bladder scan

158
Q

Mirabegron

A

B-agonist medication by enhancing the inhibitory signals to the detrusor muscle

Good medication for BPH induced incontinence

159
Q

Pt with a massive increase in DLCO in PFTs likely has what?

A

Pulmonary hemorrhage

160
Q

Patients w/ Parkinson’s who need their sinemet but experience dyskinesia and hypotension

A

May be candidates for DBS

161
Q

Dyshydriotic eczema

A

Characterised by multiple small vesicles on the palmar or plantar skin, especially along the lateral aspects of fingers/toes

Pts have history of recurrent episodes of intense pruritis with the lesions

Vesicles desquamate leaving erosions and fissures

162
Q

Goal calcium in hypoparathyroid patients

A

Low-normal WO EVIDENCE OF CALCIURIA

-Especially important w/ history of thyroidectomy or parathyroidectomy

If urine Ca is greater than 300, calcium and vit d should be decreased

Consider thiazides for patients w hypercalciuria

163
Q

Management of Acidosis in CKD

A

Initiating daily bicarbonate therapy once the serum bicarbonate is chronically less than 22

164
Q

Textbook answer for treatment of gallstone pancreatitis

A

Same-admission cholecystectomy following stabilisation

165
Q

Additional therapy for MM patients who receive chemo

A

IV bisphosphonates

IV zoledronic acid has been shown to improve survival and prevent skeletal-related events

166
Q

Management of hypertensive emergency

A

Lower SBP by 25% in first hour followed by lowering to <160 within the next 2-6 if stable

Then return to normal over 48hrs

167
Q

Helpful DM med for weight loss

A

Liraglutide

Increases satiety and helps weight loss over one year

168
Q

Code check list

A

1 Summary
-What’s been given, how long, what’s on the monitor, what they’re here for, prior events, PMH, meds

2 Use your cards, it’s ok

3 Contact ICU

4 Intubate
-3 Mac for regular/4mac if obese
-Neck towels and move quickly; don’t rush
-Check cuff, lubricate tube, check blade
-21cm F/ 23 Cm M
-Check tub, listen to epigastrium and chest
5 contact primary attending and specialist if indicated
6 Get sheet; write note

169
Q

Induction agents for intubating

A

Midazolam 1-2mg q5mins

Fentanyl 25-50mcg

Propofol 40mg to start

Etomidate .3mg/kg

170
Q

Hs and Ts

A 
Hypovolemja 
Hypoxia
Hydrogen
Hypo/hyperkalemia
Hypothermia
Tension pneumo
Tamponade
Toxins
Thrombosis, Pulm
Thrombosis, cars
171
Q

Patient with diffuse dilation of the main pancreatic duct without evidence of obstruction and mucin exuding from ampulla on endoscopy

A

Main duct intraductal papillary mucinous neoplasms

172
Q

Pt who has scabies and was treated with topical permethrin, however, still has itching but no new lesions

A

Post scabetic pruritis

Tx with antihistamine; maybe glucocorticoid

173
Q

Pts getting parathyroidectomy need what checked prior to surgery?

A

Vitamin D level

Need to avoid postoperative hypocalcemia

174
Q

Transient acantholytic dermatosis

A

Benign eruption in elderly men with scaly, papules on the trunk that are itchy

Triggered by excessive sweating

Treat with cortisone ya dingus

175
Q

Treatment of acute mountain sickness

A

High dose dexamethasone + supplemental O2

176
Q

Which women with epithelial ovarian cancer should get BRCA testing?

177
Q

Treatment for BRCA-mutated ovarian cancer treated w/ 3+ lines of chemo

A

Olaparib

Oral PARP-inhibitor that induces breaks in dsDNA that BRCA cells cannot repair; response rate of 31% for 7 months

Also approved for maintenance therapy in patient’s who have successfully completed 1st line platinum based therapy

178
Q

Sickle Cell Management in pregnant ladies

A

Monitor; exchange transfusion not prophylactically helpful and hydrea is teratogenic

179
Q

Evaluation of smoldering MM

A

Needs whole body MRI

180
Q

Chemo drug you can’t use w/ renal dysfunction

181
Q

Tx of chronic noncancer pain after exhausting typical modalities

182
Q

Indication for thoracic artery aneurysm repair

A

> 4.5cm or concurrent CAD w/ CABG

183
Q

Definitive diagnosis of late, disseminated Lyme

A

B. Burgdorferi enzyme immunoassay

If positive => IgG Western Blot

184
Q

Iron goals for CKD patients

A

Transferrin saturation >30%

Ferritin >500

185
Q

Mepolizumab

A

Antibody to IL-5, pro-eosinophilic cytokine

***Used in patients w/ mod-severe uncontrolled asthma w/ concurrent eosinophilia

186
Q

Erythrasma

A

Scaly, reddish-brown rash w/ thin-wrinkled appearance that occurs in inguinal or axillary areas and is caused by Corynebacterium minutissimum

*Will fluoresce coral red under UV light from Wood’s lamp

187
Q

W/up or erythema nodosum

A

NEEDS CXR; Also ANA, med review, possibly IBD w/up if clinically indicated

188
Q

Type I Amiodarone Thyrotoxicosis

A

Occurs in pts w/ underlying multinodular goiter or latent Grave’s; assoc. w/ increased vascularity of thyroid on Dopper

Tx: Methimazole

189
Q

Type II Amiodarone Thyrotoxicosis

A

Affects pts w/o preexisting thyroid disease; pts DO NOT have anti-thyroid abs and no structural disease on doppler

Tx: High-dose prednisone

190
Q

MS medication to avoid w/ hepatic dysfunction

A

Fingolimad

Natalizumab

191
Q

Gallbladder polp management

A

Cholecystectomy

192
Q

Moh’s Surgery indications

A

Tumors w/ aggressive subtypes
High cosmetic risk w/ surgery

*Otherwise, can do electrocurettage D&C

193
Q

Test to check for Cushing’s patient w/ estrogen use OR abnormal sleep patterns

A

24 hour urine cortisol test

194
Q

Generalized pustular psoriasis

A

Occurs following withdrawal of steroids in psoriasis patients

195
Q

Ivabradine indications for CHF

A
  1. LVEF <35%
  2. NYHA II-IV
  3. HR >70
  4. BB at max dose

If all present, start med

196
Q

Eval for unexplained erythrocytosis and increased EPO

A

CT abdomen; needs RCC eval

197
Q

“Sausage-shaped” pancreas

A

AUTOIMMUNE PANCREATITIS

-CHECK IG-G4 antibodies

198
Q

DAPT duration for stent placement in STABLE ANGINA

199
Q

Pts who have increased risk of neutropenia following chemo

A

Give G-CSF on Day 2 of cycle

200
Q

Tx of glucocorticoid refractory transverse myelitis

A

Plasma-exchange therapy

201
Q

Outpatient monitoring for pt w/ SYMPTOMATIC palpitations

A

External event recorder

*Only need the 24 hour holter if ASYMPTOMATIC

202
Q

Contraindication to IO line

A

Osteoporosis

203
Q

Pt who is muscular and you want to check kidney fnxn

A

Check Cystatin C

204
Q

When is a patient in ACCELERATED idioventricular rhythm

A

HR 50-120

> 120=V tach

205
Q

When to use hyperbaric O2 in CO poisoning

A

Carboxyhemoglobin level >25%

206
Q

Cyanide poisoning in fire

A

Path: Disruptive oxidative phosphorylation => anaerobic metabolism => MODS

Dx: Lactic acidosis + Increased venous O2 sat

207
Q

Do I have to give steroids for a brain tumor if there is no vasogenic edema?

208
Q

Finerenone

A

Finerenone is recommended for patients with type 2 diabetes mellitus and chronic kidney disease (CKD) who have persistent albuminuria despite maximal renin-angiotensin system (RAS) inhibition, normal serum potassium levels (<4.8 mEq/L [4.8 mmol/L]), and an estimated glomerular filtration rate ≥25 mL/min/1.73 m2 to slow the progression of kidney disease.

In the pooled analysis of the FIGARO and FIDELIO-CKD trials, finerenone showed significant cardiorenal benefits in more than 13,000 individuals with diabetic kidney disease (DKD). Although robust data are lacking for the combined effects of a non-steroidal MRA with sodium-glucose cotransporter 2 (SGLT2) inhibitors, the American Diabetes Association and Kidney Disease: Improving Global Outcomes recommend the addition of finerenone for high-risk patients with DKD (i.e., those with persistent albuminuria) in combination with a maximal renin-angiotensin-aldosterone system inhibitor and SGLT2 inhibitor treatment.

209
Q

Screening interval for esophageal varices in patients with compensated cirrhosis

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