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UWORLD Review > Review Set 1 > Flashcards

Review Set 1 Flashcards

1
Q

A pt presenting with fatigue, low fever, bilateral ankle arthritis, headaches, and cervical lymphadenopathy with non-caseating granulomas is most likely to also have what additional finding?

A

Bilateral Hilar Adenopathy (Associated with Sarcoidosis)

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2
Q

When should post-exposure prophylaxis against HIV be given to a health care worker who has an occupational exposure to urine from an HIV + patient?

A

Iff the urine contained visible blood. (if no blood, just cleanse the area well with soap and water)

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3
Q

What are the first line agents for acute gout?

A

NSAIDs

Colchicine

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4
Q

What antihypertensive medication/class can be helpful in decreasing uric acid levels (modesty)?

A

Angiotensin Receptor Blockers (ARBs)

-Losartan

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5
Q

Which hypertensive/ cardiac medications can worsen hyperuricemia in patients with gout?

A 
Thiazide Diuretics (can increase serum uric acid level)
Loop Diuretics (can raise blood urc
Aspirin (decreases renal urate excretion)
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6
Q 
What type of heart murmur is associated with 
   Loud first heart sound and     
   Low-pitched diastolic 
    rumble  (heard best at apex) 
    EKG showing broad, notched P-waves
A

Mitral Stenosis

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7
Q

What are the signs and symptoms associated with Methylphenidate toxicity?

A 
Anorexia
Weight Loss
Nausea/Vomiting
Insomnia
Palpitations/Tachycardia
Elevated BP
Dilated Pupils (Mydriasis)
Dry Mouth
Nervousness
Tics
Agitation/Irritability/Aggression
Growth Retardation (later)
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8
Q

What are the paraneoplastic syndromes associated with Small Cell Carcinoma of the Lung?

A

SIADH
Lambert-Eaton Myesthenia Syndrome
Ectopic ACTH production

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9
Q

What paraneoplastic syndrome is associated with Squamous Cell Lung Cancer?

A

Hypercalcemia d/t Parathyroid hormone-like Protein (PTHP) production

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10
Q

Which antidiabetic medication class is associated with Lactic Acidosis?

A

Metformin (Biguanides)

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11
Q

Which antidiabetic medication class is associated with Weight Gain and Hypoglycemia?

A

Insulin Secretagogues:
Sulfonylureas
Meglitinides

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12
Q

Which antidiabetic medication class is associated with Pancreatitis?

A

GLP-1 Agonists (Exenatide)

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13
Q

Which antidiabetic medication class is associated with Fluid retention, heart failure, and weight gain?

A

Thiazolidinediones

-glitazones

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14
Q

Which antidiabetic medication class is associated with UTI and Hypotension?

A 
SGLT2 Inhibitors (act at the kidneys):
  -gliflozins
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15
Q

Which antidiabetic medications class is associated with diarrhea and flatulence?

A

Alpha-glucosidase Inhibitors:
Acarbose
Miglitol

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16
Q

Which antidiabetic class of medication is associated with Nasopharyngitis?

A

DPP4- inhibitors:

-gliptins

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17
Q

What are three physical exam findings that can confirm a diagnosis of Carpel Tunnel Syndrome?

A

1) Wrist Hyperflexion –>Sx
2) Tapping on Median Nerve at Carpel tunel–>Sx
3) Raised hand overhead–>Sx

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18
Q

How is disease progression in Ankylosing Spondylitis monitored?

A 
Serial Radiographs of Spine:
  -AP and Lateral Lumbar 
  -Lateral Cervical
  -Sacroiliac joints and Hip
Measure ESR (or other acute phase reactants)
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19
Q

What are the common extraarticular manifestations of Ankylosing Spondylitis?(6)

A

Restrictive Lung Disease
Apical Pulmonary Fibrosis
Anterior Uveitis (can be initial presentation)
Aortic Regurgitation
IgA Nephropathy
Secondary Amyloidosis (Nephrotic Syndrome)

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20
Q

What is the empiric treatment for a hospitalized patient with Community Acquired Pneumonia?

A

IV Ceftriaxone + Azithromycin (or Clarithromycin)

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21
Q

When should Aminoglycosides be used to in the treatment of Community Acquired Pneumonia?

A

Suspicion of Pseudomonas involvement

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22
Q

What is the formula for NNT

A

If an intervention shows a benefit for the specified outcome, then calculate NNT:
NNT= 1/ARR
ARR= incidence rate (unexposed) - incidence rate (exposed)

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23
Q

What is the formula for NNH

A

If the intervention does not show any benefit for the specified outcome, then calculate NNH:

NNH= 1/ARI
ARI= incidence rate(exposed) - incidence rate (unexposed)
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24
Q

What is the formula for calculating the Odds Ratio?

A

Odds Ratio (OR)= ad/bc

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25
Q

What is the management for a pt presenting with substernal chest pain relieved with nitrates, mild SOB, a h/o HTN and active smoking, with an EKG showing sinus tachycardia and ST-depression in several leads?

A 
Acute Coronary Syndrome:
*Aspirin (Immediately)
*Antiplatelet (ADP Rec Blocker)
*Anticoagulation
B-Blocker
Statin (before discharge)

*These have been shown to decrease risk of nonfatal MI and CV-related death in pts with ACS

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26
Q

What is the first step in management for a pt who presents with acute ischemic stroke?

A

CT w/o contrast to R/O hemorrhage (to inform TPA use)
If no bleed: review any contraindications to TPA
If no contraindications: Administer TPA w/in 4.5 hrs of symptom onset

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27
Q

What is the ideal range for BP management following TPA?

A

Greater than 140/90mmHg

Less than 185/105

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28
Q

What is the max allowed BP for pts with ischemic stroke who did NOT receive TPA?

A

up to 220/120mmHg

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29
Q

What are the contraindications to MMR vaccine?

A

1)Anaphylaxis to: Neomycin, gelatin

2) Pregnancy
3) Immunecompromised state (including tumors)

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30
Q

What is the most likely dx in a child with Sickle Cell disease who presents with pain in hands and feet?

A

Dactylitis

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31
Q

What medication should be used to manage a pt with chest pain following cocaine use?

A

Benxodiazepines

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32
Q

What medicationis used to control BP in pt with cocaine use who has received benzos?

A

Alpha-Antagonists : Phentolamine

Can also use:
Nitrate: Nitroglycerine or Nitroprusside

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33
Q

Why should b-blockers be avoided in cocaine -related hypertensive patients?

A

To prevent coronary vasospasm (secondary to unopposed alpha stimulation)

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34
Q

What pesentation is most likely associated with a mechanical obstruction of the oropharyngeal/upper esophageal area.

A

Dysphagia of solids first, then liquids

Associated aspiration, coughing, drooling, or difficulty initiating swallowing

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35
Q

When an upper esophageal/oropharyngeal obstruction is suspected, what imaging modality is preferred?

A

Nasopharyngeal Laryngoscopy or Barium Swallow (esophagram)

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36
Q

What presentation is associated with neuromuscular swallowing disorder?

A

Difficulty swallowing solids and liquids simultaneously

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37
Q

When there is suspicion of a lower esophageal pathology, what initial test(s) is/are indicated?

A

Barium Swallow followed by Esophagogastroduodenoscopy (EGD)

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38
Q

What is the treatment for mild Otitis Externa (Swimmer’s Ear)

A

Clean ear canal

Apply Topical Acidifiers (Acetic Acid)

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39
Q

What is the treatment for Mild/Severe Otitis Externa?

A

Clean canal
Apply topical Antibiotics 7-10 days:
-Polymixin B/Neomycin
-Ciprofloxacin

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40
Q

What should be added to the treatment regimen for patients with mild-severe Otitis Externa who have associated pruritis and severe pain?

A

Topical corticosteroids (Hydrocortisone)

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41
Q

What evaluation should take place in elderly patients with cataracts before cataract surgery becomes the definitive treatment plan?

A

Eye exam to r/o Macular Degeneration

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42
Q

What is the most likely dx for a patient presenting with hypopigmented cafe-au-lait spots and fhx of bilateral deafness (acoutsic neuromas)?

.

A

Neurofibromatosis 2

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43
Q

What symptoms are typically associated with NF-1?

A

Axillary Freckles

Hyperpigmented cafe-au-lait spots Unilateral Acousitc Neuroma

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44
Q

What is the most important side effect of Nitroprusside thereapy and its treatment?

A

Cyanide Toxicity

Tx: Stop the drug and give Sodium Thiosulfate

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45
Q

What are the signs/symptoms of cyanide toxicity?

A 
Flushing (early)
Cyanosis (late)
Altered Metal Status
N/V
Arrhythmias
Tachypnea then respiratory depression
Pulmonary Edema
Metabolic Acidosis (Lactic Acisosis)
Renal Failure
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46
Q

Which medications/drugs decrease free T4 and increase TBG?

A

Estrogen
Tamoxien
Raloxifene
Methadone, heroin

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47
Q

When should GBS screening take place in pregnancy?

A

Between 35-37 weeks: vaginorectal swab

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48
Q

When should GBS prophylaxis be given to a pregnant pt. withunknown GBS status?

A

Iff they also have:

  • h/o infant with early GBS infection
  • h/o GBS+ bacturia in current pregnancy
  • preterm labor before 37 weeks GA
  • membranes ruptured >/= 18 hrs
  • has intrapartum fever >/=100.4
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49
Q

When should antibiotics be included with incision and drainage for the treatmetn of skin abscess?

A 
Add Antibiotics if :
Multiple abscesses
Diameter >5cm
Extensive surrounding Cellulitis
Systemic Signs
Immunecompromised State
Age less than 6 months
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50
Q

What thyroid patholigies are associated with decreased RAIU?

A
  • Subacute Thyroiditis (Dequervaine’s)
  • Painless Thyroiditis
  • Iatrogenic/Factitious Thyroiditis
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51
Q

What is the treatment for Painless Thyroiditis?

A

B-Blockers (hor hyperthroid phase symtpoms)

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52
Q

What is the most likely diagnosis in a pt with a h/o schizophrenia or any psychotic disorder who is on medication but comes to the office and on physical exam exhibits abnormal limb/muscle activity (catalepsy), extreme fatigue/stupor, mutism, negativism, posturing, echolalia, echopraxia, or waxy flexibility (resistance to positioning)?

A

Catatonia

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53
Q

What is the preferred treatment for catatonia?

A

Benzodiazepines or ECT

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54
Q

What is the preferred treatment for singular, non-metastatic, early stage glottic tumors without Lymph node involvement?

A

Radiation

May also consider Laser Excision

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55
Q

What is the initial management for a pt with symptoms suggesting Sicca (Sjogren’s) Syndrome?

A

Schirmer Test (secretory deficiency)

and AutoAntibody screen (Anti-Ro,La, ANA, RF)

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56
Q

What is the most likely dx ina pt with a h/o benzodiazeepine use that was recently stopped, autonomic instability, tremors, and restlessness/agitation?

A

Benzodiazepine withdrawal

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57
Q

What is the treatment of choice for benzodiezepine withdrawal?

A

Benzodiazepines (IV) and slowly taper once sx’s resolve.

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58
Q

What diagnosis should be considered in a pt with symptoms of Sjogren’s syndrome who also presents with submandibular mass?

A

B-cell non-Hodgkin’s Lymphoma (d/t ncreases B-cell activation and infiltration of salivary glans asociated with Sjogen’s Syndrome)

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59
Q

How are Central Retinal Artery Occlusion and Central Retinal Vein Occlusion differentiated?

A

Central Retinal Artery Occlusion is associated with Cherry Red Spot on fundus and w/w/o h/o Amaurosis Fugax

Central Retinal Vein Occlusion is associated with more gradual onset, retinal hemorrhages and optic disc edema (BLOOD and THUNDER)

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60
Q

What is the etiology of Progressive multifocal Leukoenceohalopathy (PML)?

A

JC Virus (polyomavirus)

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61
Q

What is the most likely dx in an immune compromised pt who presents with hemiparesis, speech, vision, and gait disturbances found to have multiple demyelinating, non-caseating lesions w/NO mass effect?

A

Progressive Multifocal Leukoencephalopathy (PML)

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62
Q

How are PML and HIV Encephalopathy distinguished?

A

PML: focal neuro deficits, asymmetric demyelinating lesions.

HIV Encephalopathy: Dementia prominent symptom, No focal deficits (or very few), Symmetric demyelinating lesions

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63
Q

What is the most likely dx in a pt. presenting with flushing, miosis, wheezing, bradycardia, altered mental status or sensorium, and garlic odor on clothes?

A

Organoposphate Toxicity

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64
Q

When a pt is suspected of having organophosphate toxicity, what test can confirm the diagnosis?

A

RBC Acetylcholinesterase Activity

RBC Cholinesterase

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65
Q

What is the preferred first line treatment for Primary Dysmenorrhea?

A

NSAIDs for 2-4 months, started 2-3 days before menses onset.

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66
Q

What is the pathophysiological cause of Primary dysmenorrhea?

A

Excessive prostaglandin (F2) release

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67
Q

For what Glascow Coma Scale (GCS) score is intubation recommended?

A

8 or less

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68
Q

What test is the recommended initial test to detect pernicious Anemia?

A

Serum anti-Intrinsic Factor Autoantibodies

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69
Q

What are the three main histological components of Pernicious Anemia?

A

Glandular Atrophy ( Body and Fundus)
Intestinal Metaplasia
Inflammation

This type of gatritis is called Autoimmune Metaplastic Atrophic Gastritis (AMAG)

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70
Q

What is the treatment for Photoaging?

A

Tretinoin (all-trans-retinoic acid)

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71
Q

What antibiotic is used to treat rosacea?

A

Metronidazole

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72
Q

What finding is associated with a worse prognosis in a pt with acute PE?

A

Elevated Cardiac Troponin

associated with higher risk of death

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73
Q

What skin condition is associated with HepC virus?

A

Lichen Planus

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74
Q

What is the most likely dx for a pt who presents with mental status changes, autonomic dysfunction (htn, tachycardia, diaphoresis, hyperthermia, mydriasis, diarrhea), and neuromuscular hyperactivity (myoclonus/ocular clonus, rigidity, hyperreflexia, tremor)
and a h/o of medication treated depression?

A

Serotonin Syndrome

(diaphoreses, tachycardia, mydriasis, hyperthermia/fever, tremor, agitation, rigidity, clonus, diarrhea)

Clinical Dx

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75
Q

What is the treatment for Serotnin Syndrome?

A

Stop serotonergic medications
Benzos for sedation
Supportive Care

Severe Cases:
Serotonin antagonist: Cyproheptadine

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76
Q

How are Serotonin Syndrome and NMS distinguished?

A

Serotonin Syndrome: Hyperreflexia, hyperkinesia/Clonus

NMS: Lead Pipe rigidity ( far more apparent than Serotonin syndrome), bradykinesia,

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77
Q

What are the 3 D’s associated with urethral diverticulum?

A

Dribbling
Dysuria
Dyspareunia

78
Q

What is the imaging modality of choice in evaluating a pt for urethral diverticulum?

A

Transvaginal Ultrasound or

MRI

79
Q

What is the mot likely dx for an adolescent pt who presents with a inter-ictal EEG that shows bilateral polyspike and slow discharge pattern?

A

Juvenille Myoclonic Epilepsy

80
Q

What is the treatment of choice for Juvenille Myoclonic Epilepsy?

A

Valproic Acid

81
Q

What is the gold standard for diagnosing active Tb?

A 
Sputum culture (microscopy)
Should perform simultaneously with sputum microscopy
82
Q

What is the criteria for determining a pt with active Tb non-infectious?

A

3 negative sputum smears

(Note, they can be noninfectious but still have active disease that needs t

83
Q

What factor(s ) about CVS increase risk of transverse limb reduction anomaly?

A

Age of gestation

84
Q

What should be used to treat acute gout in a pt with renal failure or those who have recently undergone renal transplant?

A

Intraarticular or Systemic Gucocorticoids.

85
Q

What is the prophylaxis of choice for a human bite?

A

Amoxicillin-Clavulanate or (Ampicilin/sulbactam)

86
Q

What is the most likely dx in a pt presenting with shiny, pruritic, polygonal-shaped violaceous plaques and papules on the flexural surfaces of skin, nails, mucours membranes of mouth (white streaks), or genetalia and lesions can appear with whitish, lacy pattern (Wickham striae)?

A

Lichen Planus

87
Q

What is the treatment for Seborrheic Dermatitis?

A

Antifungal Shampoo
-Ketokonazole-daily

              OR

Antiproliferative (medicated) Sahmpoo
-Selenium, Tar, orZinc-based

88
Q

What is the normal Reticulocyte Count Range?

A

0.5% - 1.5% of the RBCs

89
Q

What are two typical features of a Posterior Communicating Artery Stroke?

A

Cranial Nerve III Palsy: ptosis and anisocoria

90
Q

What are the treatments for severe GBS?

A

Plasmapharesis and IVIG

91
Q

What two initial medications should be given to patients with Acute Decompensated Heart failure with pulmonary edema and persistent HTN?

A

IV Diuretics (furosemide)

IV Vasodilators (Nitrates): decrease preload and afterload

92
Q

What are the typical findings on an ECG Tracing associated with Wolf-Parkinson-White (WPW) Syndrome?

A

Short PR Interval ( less than 120msec)
Delta wave
Wide(ning) QRS

93
Q

What cardiac conditions are pts with bicuspid aortic valves at risk of developing?

A

Aortic Dilation
Aortic Aneurysm
Aortic Dissection

94
Q

What is the best modality to eveluate a pancreatic cyst?

A

Endoscopic Ultrasound with Aspiration

95
Q

Which anatomic region of cells becomes responsive during acute Otitis Media and can result in persistent symptoms?

A

Mastoid Air cells

96
Q

What is the involuntary normal response to Caloric Stimulation in the oculovestibular test?

A

Transient, conjugate, slow deviation of gaze to the side of stimulation (brainstem) followed by saccadic correction to the midline (cortical correction)

97
Q

Which antidiabic medication is associated with inducing fluid retention and how?

A

Thiazolidinedione (PPAR-y agonist)

[These receptors are also in collecting ducts and activation increases Na reabsorption]

98
Q

What are the ECG findings typically associated with Paroxysmal Supraventricular Tachycardias?

A

Narrow, Regular QRS
Unidentifiable P-waves
Sudden Onset

99
Q

What is the modality of choice to confirm a dx of Spinal Stenosis?

A

MRI of spine

100
Q

Which patients presenting with anginal-chest pain should be sent for coronary angiography without Stress Test first?

A

Those with High Pretest probability:
-typical angina with CAD risk factors
(HTN, DM, FHx)

OR

Those with chronic uncontrolled angina despite optimal therapy

101
Q

What is the most likely dx in a pregnant pt who presents with pruritis, papules, vesicles around the umbilicus?

A

Herpes Gestationis (Pemphigoid Gestationis)

102
Q

What is the main difference between Herpes Gestationis and Papular Urticarial Papules and Plaques of pregnancy (PUPPP)?

A

HG: periumbilicar area is involved but abdominal striae are NOT involved.

PUPPP: striae are involved but periumbilical area is spared.

103
Q

What is the treatment for HG?

A

Topical Trimacinoline

Note: Herpes Gestationis is an autoimmune condition)

104
Q

What are the contraindications to using Ulipristal for emergency conrtaception?

A

Renal/liver disease

Uncontrolled Asthma

105
Q

What is the treatment of choice for severe PID?

A

IV ceftriaxone and IV Doxycycline

or

IV cefoxitin and IV doxycycline

Need all drugs IV for severe PID

106
Q

What is the hallmark EKG finding of Multifocal Atrial Tachycardia (MAT)?

A

3 or more distict P wave shapes
Narrow QRS
PR, RR segment variability
HR up to 200 bpm

107
Q

What are the main causes of Multifocal Atrial Tachycardia?

A

Hypoxia (always r/o fisrt with trial of O2 supp)
COPD
Hypokalemia
Hypomagnesemia
Coronary/Hypertensive/valvular disease
Meds (Theo/amino-phylline, Isopreterenol)

108
Q

How Is Multifocal Atrial Tachycardia managed?

A

R/o underlying causes first with hypoxia, hypokalemia and hypomagnesemia being investigated first.
If O2 supp fails and labs do not show electrolyte problem, can treat with medication:
-B-blockers (if no contraindications like
COPD, asthma)
-Verapamil (in those with COPD or
asthma)

109
Q

What is the empiric treatment of choice for Cat SCRATCH Disease?

A

Observation for Immune competent and localized cases

Azithromycin for disseminated or immunocompromised cases

110
Q

What is the empiric treatmetn of choice for a mammalian bite?

A

Amoxicilin-Clavulanate (does not cover bartonella henselae

111
Q

When should oral vancomycin be the first line treatment for C. difficile colitis?

A 
In severer cases:
Serum WBC >15000/mm3
Fever (>38 or 100.9)
Creatinine >1.5 x baseline
Serum Albumin
112
Q

What is the most likely complication associated with Bacterial Conjunctivitis?

A

Keratitis (inflammation of the Cornea)

113
Q

What is the treatment of choice for Bacterial Conjunctivitis?

A

Erythromicin Ointment

NOTE: can also use sulfa drops or polymixin/TMP drops

114
Q

What are the most common organisms associated with bacterial conjunctivitis?

A

S.aureas
Strep pneumo
Moraxella catarrhalis
Haemophilus influenzae

115
Q

What is the treatment for latent Tb?

A

Isoniazid (INH) for 9 mos

116
Q

If a pt has a colonoscopy which shows 2 non-villous adenomas each

A

In 5 years

117
Q

If a pt has a colonoscopy which shows hyperplastic polyps,

A

10 years

118
Q

If a pt has a colonoscopy which shows > 2 tubular or vilious adenomas, or adenomas that are > 1cm, when should the next colonoscopy be done?

A

In 3 years

119
Q

What is the most likely diagnosis in a pt who presents with sudden onset SOB, dry cough, high fever, tachycardia, a CXR showing multiple round pulmonary lesions bilaterally, and is an IV drug user? What condition is this dx often associated with?

A

Septic Pulmonary Embolism (common in IV drug users)

Tend to arise from septic thrombophlebitis (presents as painful subcutaneous mass)

120
Q

What is the main risk associated with long term PPI use and how so?

A

Osteoporosis –> Increased Hip Fracture Risk

PPIs: inhibit osteoclast activity, decrease Ca absorption, eventually decreased bone mineral density

121
Q

What are less common risk factors associated with long-term PPI use?

A 
GI infections
HypoMg
Interstitial Nephritis
Decreased Vit B12 absorption
Decreased Iron Absorption
122
Q

What is the most likely structure injured in a pt who presents with anterior knee pain and swelling associated with normal passive knee extension and flexion but cannot maintain extension of knee against gravity and cannot perform active knee extension.

A

Patellar Tendon Rupture (complete or incomplete)

123
Q

At what age should adults receive the VZV vaccine to immunize against Herpes Zoster?

A

60 and over (immunecompetent)

124
Q

Which drugs/drug classes tend to interfere with Lithium Levels?

A

ACEi/ARBs
Diuretics
NSAIDs
SSRI’s
Antiepiletics carbamazepine and phenytoin)
Any medication that can slow GFR or alter K+ and Na+ levels

125
Q

Which medications are preferred to control BP in pts taking lithium?

A

Dihydropyridine Ca-channel Blockers (Amlodipine)

Beta-blockers (second line)

126
Q

What is the treatment of choice for premenstrual syndrome/premenstrual dysphoric disorder?

A

SSRI’s

127
Q

What should be done next for a pt who has not had any relief using initial SSRI monotherapy to treat PMS/PMDD?

A

Try another SSRI

NOTE: If pt not interested in child bearing at the time, and SSRI’s didtn work, can se combination OCPs.

128
Q

Which anticonvulsant/psychotropic medication carries the greatest risk of severe congenital anomalies if taken during pregnancy?

A

Valproate

129
Q

What is the preferred empiric treatment for neonatal sepsis?

A

Ampicillin + Cefotaxime or Gentamicin (=28 days )
NOTE: Cefotaxime preferred when meningitis suspected

Ceftriaxone or Cefotaxime +/- Vancomcin (if suspect meningitis) (>28 days)

130
Q

Why should ceftriaxone be avoided in neonates?

A

Displaces Bilirubin form Albumin–> Hyperbilirubinemia –> Kernicterus

131
Q

What is the initial step in management for a pt who presents with a h/o asthma that has sudden onset of recurrent fever, malaise cough with brownish mucoid sputum, and wheezing?

A

Skin prick test for mold Ag (aspergillus)

132
Q

What is the treatment for Acute Bronchopulmonary Aspergillosis?

A

Prednisone

133
Q

How is treatment tracked in ABPA?

A

Check Serum IgE levels
Clinical resolution
Xray resolution

134
Q

What are the adverse effects of Ginko biloba?

A

Bleeding and Platelet Dysfunction

135
Q

What are the antibiotic options for meningococcal prophylaxis?

A

Rifampin (2 doses for 2 days, PO)
Ciprofloxacin (1 dose, PO)
Ceftriaxone (1 dose)

136
Q

What is the preferred prophylaxis option for meningitis in a female taking OCPs and why?

A

Ciprofloxacin (1 dose PO)

No medication interaction as seen with rifampin (increases hepatic metabolism of OCPs)

137
Q

What are the indications for surgery in a pt with Primary Hyperparathyroid?

A

Symptomatic Hypercalcemia
Asymtomatic and one or more of:

Calcium 1 or more above upper limit of normal
Age

138
Q

Why should SERMs like Reloxifene be avoided before surgery?

A

SERMs increase risk of thromboembolic event. Stop use 4weeks before surgery

139
Q

What is a characteristic finding in pts with PCP intoxication?

A

Nystagmus (esp with agitation)

140
Q

What is the treatment for Comedonal Acne?

A

Topical Retinoids
Salicylic Acid
Azelaic Acid
Glycolic Acid

141
Q

What should be done before prescribing medication for acne in females?

A

Discuss plans for pregnancy

142
Q

Which acne medications are considered safe during pregnancy?

A

Topical Erythromycin,
Topical Clindamycin
Azelaic Acid

143
Q

What is the treatment for Mild Inflammatory Acne?

A

Topical Retinoids + Benzoyl Peroxide

144
Q

What is the treatment for Moderate Inflammatory Acne?

A

Topical Retinoinds +Bezoyl Peroxide+ Topical Antibiotics

145
Q

What is the treatment for Severe Inflammatory Acne?

A

Topical Retinoids, benzoyld peroxide, topical Antibiotics+Oral antibiotics

146
Q

What is the treatment for Nodular Cystic Acne that is unresponsive to treatment?

A

Oral Isotrtinoin

147
Q

What is the initial step in evaluating a patient for Duchenne Muscular dystrophy?

A

Measure serum CPK

148
Q

What test is used to confirm the dx of Duchenne Muscular Dystrophy?

A

Genetic Testing (deletion of dystrophin gene on X-chromosome at p21)

149
Q

What diagnosis should be considered in a patient whose physical exam demonstrates pupillary response with accommodation but NOT to direct light ?

A

Neurosyphilis (Argyll Robertson Pupils)

150
Q

What is the most common indication for hopitaliazation in a pt with Sickle Cell Disease?

A

Vaso-occlusive Crisis

151
Q

Which anatomic locations tend to be affected by Vaso-occlusive Cirses?

A

Back, Chest, Abdomen, Extremeties

152
Q

What is the management for a pt with Vaso-occulsive Crisis?

A

1) Pain Medics (IV or PO Opiates)
2) Gentle rehydration

Note: Outpatient therapy is NSAIDS and Tylenol

153
Q

What type of fluids should be used to rehydrate a pt in the ED for vaso-occlusive crisis?

A

I/2 or I/4 normal saline if BP and volume status are normal

Normal Saline (1 bolus) if hypotensive or hypovolemic

154
Q

What is the most common cause of death in a pt with sickle cell disease?

A

Acute Chest Syndrome

155
Q

How is Acute Chest Syndrome diagnosed in a pt with Sickle cell disease?

A

New Lung Infiltrates (CXR) + one of the following:

     -wheezing, cough, difficuty breathing  
      tachypnea
     -Temp > 101.3 (38.5)
     -Chest Pain
     -Hypoxemia (O2sat)
156
Q

What tests shold be done in a new dx of Medullary Thyroid cancer?

A 
Urine Metanephrines/catecholamines
Calcitonin
CEA (carcinoembryonic antigen)
Neck U/S (ck for mets)
Genetic testing for RET mutation
157
Q

Should a pt with hypothyroidism be started on levothroxine prior to cardiac surgery and why/why not?

A

NO
Levothyroxine can increase myocardial Oxygen demand and this can precipitate an MI, angina, or dysrrhythmia in a pt with compromised coronary perfusion.

Do surgery first then treat hypothyroidism after (as long as no signs of myxedema coma)

158
Q

What treatment combination should be included in Arican-American pts who are dx’d with NYHeart Associateion Class III or IV symptoms associated with LVsystolic dysfunction?

A

Hydralazine with Nitrates

159
Q

what is the strongest known risk factor for male breast cancer?

A

Kleinfelter’s Syndrome (47, XXY)

160
Q

What electrolyte abnormality can serve as an independent predictor of adverse clinical outcomes in pts with CHF?

A

Hyponatremia

161
Q

Which antibiotics are treatment options for uncomplicated UTI in pregnancy?

A

Nitrofurantoin
Amoxicillin
Amoxicillin-clavulanate
Cephalexin

162
Q

Which antibiotics are options for treatment of Pyelonephritis in pregnant patients?

A

Ceftriaxona (or other 3rd Gen Cephalosporin)
Aztreonam
Ampicillin + Gentamicin

163
Q

What is the most common long term complication of Transurethral Resection Procedure (TURP)?

A

Retrograde ejaculation –> Dry ejaculate

164
Q

what is the most common shoirt-term complication of TURP?

A

Hyponatremia (possibly d/t absorption of fluid during procedure form copious irrigation)

165
Q

Why should anesthetics like lidocaine not be used in pt. with local skin infections?

A

They will not work d/t the localized acidic environment created secondary to infection. Anesthetics like lidocaine are basic substances and will be neutralized in acid.

166
Q

Describe category A drug risk according to FDA?

A

Human and animal studies show no fetal risk.

167
Q

Describe category B drug risk according to FDA?

A

Animal studies show no risk, no human studies done

OR

Fetal risk in animals but no human risk shown

168
Q

Describe category C drug risk according to FDA?

A

Animal studies show fetal risk, no adequate human studies done

or

No adequate data on animal or human

169
Q

Describe category D drug risk according to FDA?

A

Fetal risk in human studies or post market surveillance

170
Q

Describe category X drug risk according to FDA?

A

fetal risk in animals, or human or post market surveillance

171
Q

what is the treatment for mild-moderate plaque psoriasis?

A

Topical high potency steroids or Vit D derivatives

172
Q

what is the treatment for severe plaque psoriasis or psoriatic arthritis ?

A 
phototherapy
systemic therapy (Methotrexate)
173
Q

When should propranolol be used in patients with Strawberry (infantile) hemangioma?

A

If disfiguring or located in area that might interfere with function (eyelid, airway)

174
Q

What is the most likely dx in a pt who presents with lethargy, constipation, weight loss, nausea and vomiting, low-normal TSH and low Free T4?

A

Central Hypothyroidism

175
Q

What is the next step in management for a pt whose symptoms and thyroid labs suggest central hypothyroidism?

A 
Urine cortisol (results show low normal)
Then serum ACTH and ACTH stimulation test
176
Q

At what point after birth does physiological jaundice usually appear?

A

24 hours after birth

177
Q

Whaen does pathologic jaundice usually appear?

A

Within the first 24 hours of birth (immune or non-immune heloysys

178
Q

What nonpharmacologic intervention has thegreatest reduction capacity on BP?

A

Weight Loss (at least 10%)

179
Q

What are the 6 P’s of Acute Limb Ischemia?

A 
Pain
Pallor
Paresthesia
Pulselessness
Pikoilothermia
Paralysis
180
Q

What is the immediate step in intervention for a pt with signs of severe acute limb ischemia?

A

IV Heparin and surgical revascularization

181
Q

What is a major contraindication for Bupropion use?

A

Seizure disorder

182
Q

What is tone of the best prognostic indicators for acute hepatitis B infection?

A

Prothrombin time (extrinsic factors)

183
Q

What is the next step in management for a pt whose initial screening test shows +anti-HBc (total core antibody) only?

A

Check Serum IgM antiHbc (if positive = window period of acute infection)

184
Q

What is the immediate treatment of choice for a pt dx with toxic megacolon?

A

Steroids if pt has Inflammatory Bowel Dx

Antibiotics if Infectious Bowel process

185
Q

What is the most likely dx in a pt who presents with pesistent urinary symptoms, anemia, hematuris on dipstick (microhematuria), anemia (microcytic), and recent emigration from another country (in Africa, South America, Asia)?

A

Shistosomiasis

186
Q

What is the next step in managemnet for a pt suspected of having schistosomiasis whose urinalysis shows microhematuria?

A

Urine microscopy (see eggs in urine)

Can also do stool microscopy and visualize ova in stool

187
Q

What treatment should be added to dextrose fluids for a pt with a h/o diabetes who is taking sulfonylurea medications and presents with intractible hypoglycemia?

A

Octreatide (she likely took excessive dose of sulfonylurea and has over production of insulin)

188
Q

What is the next step in management for a pt who has a copper IUD and whose recent PAP demonstrates Actinomyces but no other findings and pt is asymptomatic?

A

Follow-up with physician if symptoms occur

Note: actinomyces is normal flora but can be a complication of IUD, it is rare. Remove IUD if symptomatic

189
Q

what is the preferred imaging modality for a young non-obese boy who presents with hip pain , especially during internal rotation, and swollen, erythematous, warm , tender joint?

A

Ultrasound (widened Joint space)

Dx Transient sinovitis (boys 3-10 yrs old, can have hip, knee, or thigh pain)

190
Q

What lab test should be performed initially in the work up of a patient with chronic diarrhea?

A

Stool Microscopy (check for ova, parasites, blood, WBCs)

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