- alleviate vasomotor instability - reduce risk of osteoporosis/fractures - reduce incidence of endometrial cancer

Random Ass Qs (IM) Flashcards by Stephanie Hawks

Initial evaluation of HTN

urinalysis (protein, blood, glucose)
EKG
fasting lipids
BUN/creatinine

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HRT effects

alleviate vasomotor instability
reduce risk of osteoporosis/fractures
reduce incidence of endometrial cancer

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Labs that diagnose diabetes

Fasting glucose >126
Nonfasting glucose >200 with symptoms
OGTT >200 after 2 hours
A1C > 6.5

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Cause of hip pain with long term glucocorticoid use?

Avascular necrosis of the femoral head

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Initial pharmacotherapy for C dif?

ORAL metronidazole

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First imaging in suspected gallstone pancreatitis?

Ultrasound

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Treatment for common bile duct stone causing biliary obstruction?

Sphincterotomy and endoscopic removal

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Depletion of what molecule leads to the hepatotoxicity of acetaminophen OD?

Glutathione

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Indicators of poor prognosis in acetaminophen OD?

serum lactate >3.5
pH <7.3
renal failure
coagulopathy

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Chronic diarrhea + pruritic vesiculopapular lesions on extensor surfaces……most likely dx?

Celiac sprue

***dermatitis herpetiformis

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Diagnostic confirmation of celiac sprue?

Small bowel biopsy

**villous atrophy and crypt hyperplasia

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Celiac sprue increases risk of what malignancies?

Adenocarcinoma and lymphoma of small bowel

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Primary sclerosing cholangitis increases risk of what malignancy?

Cholangiocarcinoma

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Diagnostic test for chronic pancreatitis?

**duct dilation, calcifications, pseudocysts

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What marker is frequently elevated in pancreatic cancer?

CA 19-9

**also seen in cholangiocarcinoma

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Initial treatment for reactive arthritis?

NSAIDs (ie Indomethacin)

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Patient does not respond to initial treatment for reactive arthritis, next step?

HIV test

***reactive arthritis may be first manifestation

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As gout progresses how do frequency and duration of attacks change if untreated?

More frequent and last longer

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What is initial long term therapy for gout with excessive urate excretion?

Allopurinol and colchicine

***allopurinol alone can precipitate attacks when first starting treatment

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What is the long term treatment of gout with normal/low excretion?

Probenecid

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What osteoporosis drug increases bone mass rather than just inhibiting reabsorption?

Teriparatide (recombinant PTH)

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What is the first test when you suspect pseudotumor cerebri? Second?

CT/MRI to rule out mass

- LP to check opening pressure

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What type of antidepressant can interact with the activity of warfarin?

SSRI

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What causes cloudy corneas in angle closure glaucoma?

Edema

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Does the presence of any epithelial cells in urinalysis make it invalid?

Nope

What type of medication is contraindicated in Alzheimer’s?

Anticholinergics or any drug with anticholinergic effect (ie TCAs)

What anxiolytic would you pick if nonsedation was important?

Buspirone

What are properties of anesthetics that have higher potency and longer duration of action?

- higher lipid solubility/higher partition coefficient - higher protein binding - pKa closer to pH = 7.4

What will hyperkalemia show on EKG?

Peaked T waves and widened QRS

What effect can Cisplatin have on electrolytes?

Renal potassium and magnesium loss

HTN, abd pain, red-blue rash on extremities, eosinophils in urine and recent hx of MI......dx?

Atheroembolic disease from dislodging plaque during cardiac catheterization

Why can’t you give NSAIDs with acute renal failure?

Potentially nephrotoxic and could prevent recovery of kidney function

What would you see in the urine of a patient with lupus nephritis flare?

RBC casts

What would be the mechanism of acute renal failure during chemotherapy?

Tumor lysis syndrome and renal tubular deposition of uric acid

What blood labs are seen in nephrotic syndrome?

- low calcium - low thyroxine - microcytic hypochromic anemia

What type of nephropathy is seen in HIV?

Collapsing glomerulopathy (variant of focal segmental)

What labs denote HBV “window period”?

Negative HBs antigen AND antibody

Tongue fasciculation, brain inflammation, elderly diabetic.......dx?

West Nile virus

What is first line medication for strep pharyngitis?

Penicillin *******erythromycin or 1st gen cephalosporin if allergic

Fever, chills, myalgias and headache 3 hours after receiving penicillin for primary syphilis......dx?

Jarisch Herxheimer reaction ********self limiting

You suspect a patient has histoplasmosis PNA, what test do you do?

ABG to determine hypoxia severity

Health care worker gets a needle stick injury. Assuming the patient is positive what is the risk of HBV? HCV? HIV?

HBV - 6-30% HCV - 1.8% HIV - 0.3%

What two drugs have the largest reduction in triglycerides?

Nicotinic acid and fibrates

What abx treatment is first line in V vulnificus sepsis?

Doxycycline + 3rd gen cephalosporin

What abx treatment is used for E faecalis sepsis?

Ampicillin + aminoglycoside

Patient on clozapine develops agranulocytosis.....tx?

Granulocyte colony stimulating factor *****decreasing/discontinuing drug does NOT always prevent progression

What labs are seen in primary hyperparathyroidism?

- increased serum calcium - decreased serum phosphate - increased urine calcium

Patient complains of “curtain coming down over visual field”.....dx?

Retinal detachment

Patient has symptoms of a “hot” thyroid nodule, what is the next diagnostic step?

Thyroid nuclear scan ****FNA not needed since hot nodules are rarely malignant

What treatment has the lowest recurrence rate for basal cell carcinoma?

Mohs micrographic surgery

What is the best oral agent for MRSA?

TMP-SMZ

What is the dilution strength of epinephrine used in an allergic reaction?

1:1000

How are most cancers staged?

0 - carcinoma insitu 1/2 - local (depends on depth) 3 - spread to nodes 4 - metastasized

What serum lab is suggestive of metastatic melanoma?

Elevated LDH

After surgery for colon cancer what’s the schedule for follow up colonoscopies?

1 year post op 3 years later Every 5 years after

What asthma medication is the best for prevention of symptoms?

Inhaled steroid

What type of antihypertensive is contraindicated with quinidine use and why?

Thiazide diuretics Quinidine SE is torsade de pointes; thiazides cause hypokalemia which increases the risk of torsade

Patient tells you the nitroglycerin he takes for angina makes his heart speed up. How should his treatment be modified?

Add propranolol to his nitroglycerin

How is polymyositis diagnosed?

Elevated muscle enzymes (CPK, aldolase)

Patient being monitored in ER for MI converts to ventricular tachycardia. What’s the next step?

Defibrillation

Patient being monitored in ER for MI converts to asystole. What’s the next step?

Check a second monitor lead to confirm asystole

What’s the most common cause of diastolic heart failure?

Hypertension

Patient with hx of HTN, CAD and smoking complains of pain/cramping in thighs/buttock for 2 months that worsens with ambulation and relieves when sitting down.......dx?

Peripheral arterial disease

What labs will be seen in tumor lysis syndrome?

- hyperuricemia - hyperkalemia - hyperphosphatemia - hypocalcemia - lactic acidosis

What imaging should be done in suspected lung cancer?

Spiral CT

Biopsy of a lung mass confirms small cell carcinoma, what’s the next step?

Staging including MRI of brain, CT abd/pelvis, bone scan and bone marrow aspirate/biopsy

Patient with pmh of urinary frequency and muscle weakness is being treated for acute pancreatitis. Labs at the time and follow up reveal hypercalcemia.......dx?

Hyperparathyroidism

What antibody can cross the placenta and cause neonatal lupus?

Sjögren syndrome antibodies (SSA/SSB)

Patient presents with joint pain, low positive ANA and elevated ALT/AST. What lab needs to be done?

Hep C antibody........rule out cryoglobulinemia

Patient presents with muscle weakness and elevated AST/ALT. What test needs to be run?

GGT, determines if liver or muscle origin

List cues that back pain may be due to cord injury

- worse with recumbency - worse with valsalva - electric sensation down back/extremities with extension or flexion of neck/spine

What is initial therapy for SVC syndrome due to lung tumor?

Elevate head and monitor for airway obstruction ****not emergency, don’t treat cancer before biopsy

What is the most appropriate treatment for micro-invasive cervical carcinoma (stage Ia)?

Simple hysterectomy

What virus can contribute to hepatocellular carcinoma?

Hep B & Hep C

How do you diagnose hereditary spherocytosis?

Osmotic fragility

High calcium is an indication of what type of thyroid cancer? What needs to be done before treatment?

- Medullary | - evaluate for pheochromocytoma (MEN)

Sickle cell patient presents in crisis with low reticulocyte count. What could be causing the crisis?

Parvovirus B19 (aplastic crisis)