Random Flashcards
Hallmark of re-feeding syndrome
Hypophophatemia
Most sensitive clinical test and initial test for ACL tear
Lachman test
anterior drawer test is next
Hoarseness of voice not resolved in 3 months. What to do?
Laryngoscopy
initial management of hypercalcemia of malignancy
fluid replacement with normal saline.
You need to correct the volume depletion that is present and to enhance renal calcium excretion BEFORE giving IV pamidronate (to help excrete the calcium).
brown to black leopard spotting of the colonic mucosa.
benign condition
results from abuse of anthraquinone laxatives.
Stop medication.
When should colon cancer screening start for those with affected relative that was diagnosed?
How often should they be rescreened if normal?
at age 40, or 10 years before the earliest age at which an affected relative was diagnosed (whichever comes first) and be rescreened every 5 years.
Several drugs are associated with drug-induced pleural disease or drug-induced lupus pleuritis. What are they?
lupus pleuritis- hydralazine, procainamide, and quinidine.
pleural disease - amiodarone, bleomycin, bromocriptine, cyclophosphamide, methotrexate, minoxidil, and mitomycin.
Drugs to avoid in Wolff-Parkinson-White syndrome.
What is the treatment of choice?
Adenosine, digoxin, and calcium channel antagonists
(blocks conduction through AV node, which may increase the ventricular rate paradoxically, initiating ventricular fibrillation.
Procainamide (class III antiarrhythmic medications will slow AP conduction, facilitating blockage of SVT)
Metformin (Glucophage) should be stopped prior to what test, and withheld until 48 hours after completion of the test?
CT angiography
Since even a temporary reduction in renal function, such as occurs after pyelography or angiography, can cause lactic acidosis in patients taking metformin, the drug should be discontinued 48 hours before such procedures and restarted 48 hours after the procedure if renal function is normal.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
Hospitalized versus those that do not need to be hospitalized.
Hospitalized patients
- its empiric coverage MRSA and Pseudomonas aeruginosa
- antipseudomonal cephalosporin (cefepime or ceftazidime), an antipseudomonal carbapenem such as imipenem or meropenem, or an extended-spectrum β-lactam/β-lactamase inhibitor such as piperacillin/tazobactam, PLUS an antipseudomonal fluoroquinolone such as levofloxacin or ciprofloxacin, or an aminoglycoside such as gentamicin, tobramycin, or amikacin, PLUS an anti-MRSA agent (vancomycin or linezolid).
Those that do not require hospitalization
-Ceftriaxone and azithromycin or levofloxacin alone
Treatment for severe osteoporosis in men, for patients with multiple osteoporosis risk factors, or for patients with failure of bisphosphonate therapy
Teriparatide
Pharmacological prevention of acute mountain sickness:
Acetazolamide (contraindicated in patients with a sulfa allergy)
Use Dexamethasone in those with a sulfa allergy
most common drug-related cause of acute interstitial nephritis.
Antibiotics, especially penicillins, cephalosporins, and sulfonamides.
Corticosteroids may be useful for treating this condition.
Contradictions:
Metformin
Pioglitazone
Metformin- CI in patients with renal insufficiency.
Pioglitazone can cause fluid retention and therefore would not be a good choice for a patient with cardiomyopathy.
HPV vaccine
not recommended for:
- those over 26.
- pregnant.
Tdap vaccine
administered to patients 65 years and older who have close contact with an infant less than 1 year.
Ehrlichiosis versus Malaria
Ehrlichiosis causes thrombocytopenia
Malaria causes hemolytic anemia.
Repaglinide and nateglinide Pioglitazone Acarbose Sitagliptin Exenatide
Repaglinide and nateglinide
- nonsulfonylureas
- that act on a portion of the sulfonylurea receptor to stimulate insulin secretion.
Pioglitazone
- thiazolidinedione, which reduces insulin resistance.
- activation of PPAR-Y, a receptor that affects several insulin-responsive genes.
Acarbose
- competitive inhibitor of α-glucosidases, enzymes that break down complex carbohydrates into monosaccharides.
- This delays the absorption of carbohydrates such as starch, sucrose, and maltose, but does not affect the absorption of glucose.
Sitagliptin
- DPP-IV inhibitor
- inhibits the enzyme responsible for the breakdown of the incretins GLP-1 and GIP.
- Exenatide
- incretin mimetic
- stimulates insulin secretion in a glucose-dependent fashion, slows gastric emptying, and may promote satiety.
best initial imaging study for acute pelvic pain in women is
transvaginal ultrasonography
Serum uric acid levels with Thiazides versus losartans.
hydrochlorothiazide-increase serum uric acid levels
Losartan has been shown to decrease uric acid
child’s hand is suddenly jerked up
Nursemaid’s elbow
forcing the elbow into extension and radial head slips out from the annular ligament.
Management of acute asthma exacerbations
In children already receiving standard treatment with albuterol and corticosteroids, the addition of intravenous magnesium sulfate has been shown to improve lung function and reduce the need for hospitalization.
Oral administration of corticosteroids is as effective as the intravenous route for reducing the need for hospital admission
50-year-old female who has passed six calcium oxalate stones over the past 4 years should do what?
Calcium oxalate stones are the most common of all renal calculi.
Potassium citrate should be taken at mealtime to increase urinary pH and urinary citrate.
- Calcium binds to citrate instead of to oxalate.
- calcium citrate tends to stay dissolved whereas calcium oxalate tends to precipitate out as mineral deposit.
- Potassium citrate also helps create alkaline urine (in which calcium oxalate stones have difficulty forming).
A low-sodium, restricted-protein diet with increased fluid intake reduces stone formation
Treatment of ethylene glycol poisoning
suspect in patients with metabolic acidosis of unknown cause and subsequent renal failure.
Fomepizole immediately.
If treated early, hemodialysis may be avoided, but once severe acidosis and renal failure have occurred hemodialysis is necessary.
metformin be avoided in patients with a creatinine level?
What should be used instead?
> 1.5 mg/dL for men or >1.4 mg/dL for women.
Glipizide (Sulfonylurea) does not have an active metabolite, and is safe in patients with chronic renal disease.
Treatment of essential tremor if they are intolerant to beta blockers.
Primidone
what is consistent with spinal stenosis but not with a herniated vertebral disk?
Pain from spinal stenosis is relieved by sitting and aggravated by standing, whereas the opposite is true for pain from a herniated disk.
Numbness and muscle weakness may be present in both.
cardiac toxicity of methadone is primarily related to
QT prolongation and torsades de pointes.
Atrial fibrillation: Diagnosis and treatment.
CHADS stands for: CHF, HTN, Age >75, DM, and Stroke (previous) or transient ischemic attack.
Each = 1 point except for stroke, which is worth 2 points.
> 4 is at high risk (warfarin)
2–3 is moderate risk. (warfarin)
≤1 is low risk (treated with aspirin)
most common cause of acute bronchitis and what is the treatment?
Respiratory viruses
Supportive care only
“sprained wrist” presenting with tenderness in the anatomic snuffbox.
Treatment
Fracture of the scaphoid should be suspected
treated with a thumb spica cast for 10–12 weeks.
Treatment of otitis media in children under 2 years of age
amoxicillin for 10 days
In breastfeeding women, bilateral nipple pain with and between feedings after initial soreness has resolved is usually due to
Candida.
antibiotics is most appropriate for treatment of Bartonella henselae infection
Azithromycin has been shown to reduce the duration of lymphadenopathy in cat-scratch disease.
Other antibiotics that have been used include rifampin, ciprofloxacin, trimethoprim/sulfamethoxazole, and gentamicin.
Treatment of allergic rhinitis.
Intranasal corticosteroids
Primary, Secondary, Tertiary Hyperparathyroidism.
Primary - due to gland itself.
Secondary - due to renal failure
Tertiary: persistent hyperparathyroidism after renal transplantation or new hypercalcemia in the setting of chronic secondary hyperparathyroidism.
23 month old who cough, wheezing, and mildly labored breathing. He has no prior history of similar episodes and there is no improvement with administration of an aerosolized bronchodilator.
What is the treatment?
bronchiolitis. Usually caused by RSV.
The initial infection usually occurs by the age of 2 years.
Bronchodilator treatment may be tried once and discontinued if there is no improvement.
Treatment usually consists of supportive care only, including oxygen and intravenous fluids if indicated
platelet transfusion guidelines
prophylactic platelet transfusion is 10,000
A count below 50,000/μL is an indication for platelet transfusion in patients undergoing an invasive procedure.
What the only drugs that have been confirmed in sufficiently powered studies to prevent hip fracture and is the osteoporosis drug of choice.
Which is the drug of choice for vertebral compression fractures?
zoledronic acid,
alendronate
risedronate,
Teraparatide
Raloxifene
Calcitonin*
First-line agents for ovulation induction and treatment of infertility in patients with polycystic ovary syndrome (PCOS)
metformin and clomiphene, alone or in combination, as well as rosiglitazone
recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine
All adults over the age of 65 receive a SINGLE dose of pneumococcal polysaccharide vaccine.
Immunization before age 65 -
chronic heart, lung, kidney, liver, disease, DM, anatomic asplenia, and health-care workers.
Those that It is recommended that those receiving the vaccine before the age of 65 receive an additional dose at age 65 or 5 years after the first dose, whichever is later.
Imaging to Reevaluation of the solitary pulmonary nodule
CT is the imaging modality of choice to reevaluate pulmonary nodules seen on a radiograph
radiologic evaluation of chronic neck pain
a complete cervical spine series
For patients with a PE, initial treatment with low molecular weight heparin (LMWH), unfractionated heparin, or fondaparinux must be for at least how many days and when can it be stopped?
for at least 5 days, and then can be stopped if the INR has been ≥2.0 for at least 24 hours.
*LMWH and warfarin must be given concomitantly for at least 5 days
Symptomatic treatment of recurrent migraine in children
Propranolol
Ibuprofen or acetaminophen could still be used as rescue medications, but a daily agent is indicated and propranolol is the best choice for this patient
Sumatriptan is not approved for children under the age of 12 years.
Guidelines for the Diagnosis and Management of Asthma
UNDER 12
NOT well-controlled if they have had symptoms or:
-used a β-agonist for symptom relief more than 2x per week,
-had 2 or more nocturnal awakenings due to asthma symptoms in the past month,
-2 or exacerbations requiring systemic corticosteroids in the past year.
OVER 12
there must be more than two nocturnal awakenings per month to classify their asthma as not well controlled.
*A β-agonist used as premedication before exercise is not a factor when assessing asthma control.
American Heart Association recommends a goal blood pressure of 130/80 mm Hg or less for the treatment of hypertension in patients with
Diabetes mellitus, chronic kidney disease, or coronary artery disease
First line therapy for aortic dissection
The use of a β-blocker such as propranolol or labetalol to get the heart rate below 60 beats/min
If the systolic blood pressure remains over 100 mm Hg, intravenous nitroprusside should be added. Without prior beta-blocade, vasodilation from the nitroprusside will induce reflex activation of the sympathetic nervous system, causing increased ventricular contraction and increased shear stress on the aorta.
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can usually be terminated by the administration of intravenous
verapamil or a β-blocker.
Order:
- Carotid massage
- Adenosine
- Verapamil or beta blocker
What is the best treatment for hypertension in African-Americans?
diuretics or calcium channel blockers rather than β-blockers or ACE inhibitors.
It has been suggested that hypertension in African-Americans is not as angiotensin II-dependent as it appears to be in Caucasians.
Best initial therapy for Hypertrophic Obstructive cardiomyopathy.
What is contraindicated?
beta blockers
diuretic.
Best initial Radiologic evaluation for suspected renovascular hypertension
Duplex Doppler ultrasonography is the preferred initial test for renovascular hypertension in patients with impaired renal function.
Tests involving intravenous radiographic contrast material may cause deterioration in renal function.
Clostridium difficile infection management
Can be treated with either metronidazole or vancomycin daily.
Mild recurrent disease - repeat the course of the original agent
Multiple recurrences or severe disease warrants the use of both agents.
Criteria that can be used to diagnose diabetes mellitus
hemoglobin A1c level ≥6.5% .
Fasting plasma glucose level ≥126 mg/dL,
Random glucose level ≥200 mg/dL in a patient with symptoms of diabetes,
2-hour oral glucose tolerance test value ≥200 mg/dL
When should you screen for osteoporosis.
All women ≥65 and all men ≥70
For men and women age 50–69, the presence of factors associated with low bone density would merit screening.
Management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis
grade 2 ascites (visible clinically by abdominal distention, not just with ultrasonography),
- diuretics with salt restriction.
- Aldosterone antagonists such as spironolactone are more effective than loop diuretics such as furosemide.
Grade 3 ascites (gross ascites with marked abdominal distention)
-Large-volume paracentesis followed by salt restriction and diuretics.
