Random Qs Flashcards
aprepitant and olanzapine
For patients receiving high-emetic-risk chemotherapy, standard antiemetic treatments include a four-drug combination of an NK1 receptor antagonist, a 5-hydroxytryptamine-3 receptor antagonist (zofran), dexamethasone, and olanzapine.
levothyroxine treatment of med-high risk thyroid cancer
Treatment of intermediate- to high-risk differentiated thyroid cancer includes thyroid-stimulating hormone (TSH) suppression with daily levothyroxine
aspirin in a GI bleed
aspirin for secondary prevention should not be held unless life-threatening bleed - risk of stroke or MI within 7-10 days of holding - and should be restarted as soon as hemostasis is achieved
treatment of functional dyspepsia
TCAs (amitriptyline, nortriptyline)
Follow-up of indeterminate pulmonary nodule
Repeat CT 6mos, if it persists but is unchanged in size, CT should be repeated at 2-year intervals for 5 years
Vaccines in well-controlled HIV
Live vaccines, including varicella, measles-mumps-rubella, and influenza are not recommended for patients who are severely immunocompromised, but well-controlled HIV can get everything except live flu vaccine
exemestane
an option for chemoprevention of breast cancer in postmenopausal women with a previous history of VTE. Exemestane is not associated with an increased risk of VTE
Fundic Gland Polyp treatment
fundic gland polyps are the most common benign epithelial gastric polyp and require no endoscopic follow-up.
aristolochic acid nephropathy
chinese herbal medications –> chronic tubulointerstial nephritis and is associated with urothelial cancer.
Adjuvant Chemo Management for early breast CA
Increasingly, the use of adjuvant chemotherapy for early breast cancer is based more on tumor biology rather than on stage. For hormone receptor–positive, HER2-negative breast cancers with zero to three positive axillary nodes, the use of multigene assays (e.g., the 21-gene recurrence score assay) will help guide management.
Management of cancer survivors who received chest irradiation between age 10-30
For women survivors of Hodgkin lymphoma who received chest irradiation, annual breast cancer screening with mammography and breast MRI is recommended to begin 8 to 10 years posttherapy or at age 40 years, whichever comes first.
malignant hyperthermia
Malignant hyperthermia is an autosomal dominant condition resulting from deranged intracellular calcium metabolism in response to inhaled anesthetic agents and succinylcholine. Treat with dantrolene
Recurrent UTIs in a man
chronic bacterial prostatitis even without other findings - treat with abx x6 weeks, only need massage if no organism identified
Management of a high-risk gastric ulcer
high-dose IV proton pump inhibitor (PPI) therapy for 72 hours while hospitalized, followed by an oral PPI twice daily for a total of 2 weeks following the therapeutic endoscopy.
Textured breast implant -> pain/swelling
Anaplastic T-cell lymphoma. Although uncommon, there are increasing reports of non-Hodgkin lymphoma, typically anaplastic T-cell lymphoma, arising around breast implants.
treatment for SLE with nephritis
prednisone + HCQ + MMF
alectinib
chemo for lung cancer with ROS1 or ALK driver mutations
HER2 positive breast cancer
Be aggressive! At risk for local recurrence -> endocrine therapy, radiation, chemo (paclitaxel), and trastuzumab (ab against HER2)
osteomalacia
prolonged and severe vitamin D deficiency; diffuse bone pain, pathologic fractures, rise in alk phos, widespread uptake on whole-body bone scan
apple-green birefringence and congo red stain under polarized light
amyloidosis
Goal BP in pregnancy
<160/110
at what point do you treat a PDA
When there is L sided cardiac chamber enlargement as long as there is no severe pulmonary hypertension
leflunomide in pregnancy
absolutely contraindicated (demonstration of undetectable blood levels needed prior to conception)
when is a tuberculin skin test positive?
HIV, immunosuppression, known contact: 5mm
immigrants, IVDU, health care workers: 10mm
no risk factors: 15mm
calcium phosphate arthritis in the shoulder
can cause progressive destruction of the glenohumeral joint and rotator cuff
prevention of cardiovascular disease in pts with PAD
aspirin and very low-dose rivaroxaban (2.5mg BID) lowers risk by 2%, only use if no risk of bleeding
first step to work-up female infertility
midluteal phase serum progresterone level (tests ovulatory function), if normal would evaluate tubal patency and uterine abnormalities
treatment of exercise induced asthma
budesonide-formoterol (LABA/ICS) prior to exercise
Statin in CKD
atorvastatin is preferred because rosuvastatin is renally excreted
When to screen for AAA
one time for men 65-75 who have smoked five packs of cigarettes in their lifetime
acute reaction to zoledronic acid
low-grade fever, myalgias, headaches in the first 1-3 days in 30% patients; usually improves with subsequent infusions
contraindication to flecanide?
absolutely contraindicated in patients with ischemic heart disease due to risk for ventricular arrhythmias
treatment of CMV
oral valganciclovir or IV ganciclovir
when do you need angiography in PAD
Only for surgical planning for symptomatic disease, no need if asymptomatic
treatment of nonmetastatic castrate-resistant prostate cancer
apalutamide (androgen receptor blocker)
stress testing in patients with LBBB
vasodilator single-photon emission CT (others may be complicated in interpretation due to LBBB)
PMR puts you at risk for ….
giant cell arteritis (headache, jaw claudication, vision changes)
Acute painful knee in someone with psoriatic arthritis
Likely gout! PsA flares are usually less painful and slower
treatment of gonorrhea alone
ceftriaxone (add doxycycline if chlamydia has not been ruled out)
w/u of marked elevation in DHEAS
abdominal CT to locate likely adrenal tumor
when should a HF patient get a CRT-D?
New York Heart Association functional class II to IV symptoms despite guideline-directed medical therapy who have an ejection fraction of 35% or less, sinus rhythm, and left bundle branch block with a QRS duration of 120 ms or longer.
viral meningitis in the winter
most likely HSV-2
treatment of Behcet’s syndrome
prednisone, colchicine, and alpremilast (PDE-4 inhibitor)
when to treat renovascular hypertension
short duration of hypertension; refractory to medical therapy; recurrent flash pulmonary edema; progressive impaired kidney function; or unilateral stenosis affecting a solitary functioning kidney
treatment of limited-stage small cell lung cancer includes:
chemo, radiation of the tumor, and prophylactic brain radiation
at what size gallbladder polyp should you treat?
>1cm = cholecystectomy <1cm = 6 or 12 month US monitoring
treatment of ANCA vasculitis
high-dose steroids and rituximab
treatment of salicylate toxicity
Intravenous sodium bicarbonate administration is used to treat patients with salicylate toxicity, as it increases urinary elimination of salicylate (goal urinary pH >7.5), would only do HD if this is failing
how do you diagnose GPA
kidney biopsy
treatment of edema related to nephrotic syndrome
loop diuretics, and add thiazides or potassium-sparing diuretics if not effective; treatment of the underlying etiology with steroids can take 12-16 weeks
how to evaluate for mitral regurg if echo seems insufficient?
cardiac MRI
indications for parathyroidectomy in primary hyper-PTH
fragility fractures, vertebral fractures, and a dual-energy x-ray absorptiometry T-score of less than -2.5 or less at lumbar spine, total hip, femoral neck, or distal one-third radius.
winter’s formula
predicted pCO2 = 1.5 x [HCO3-] + 8
treatment of interstitial lung disease in systemic sclerosis
MMF
increased activation of vitamin D (with hyperCa)
think fungal infections, tuberculosis, sarcoidosis, and lymphoma
treatment for dermatitis herpetaformis
dapsone (test for G6PD before using)
treatment of brain abscess
aspiration first, then CTX/metronidazole +/- Vanc if risk factors
How long to wait for elective surgery after CVA
At least 6mos, but ideally 9
