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OBGYN > step 2 first aid > Flashcards

step 2 first aid Flashcards

1
Q

causes of atypical pneumonia

A

mycoplasma, legionella, chlamydia pneumo

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2
Q

common causes of pneumonia in pts with COPD

A

H influenzas, moraxella, s pneumo

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3
Q

how can you diagnose pneumonia

A

2 or more symptoms of acute respiratory infection plus a new infiltrate on Xray or CT

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4
Q

complications of pneumonia

A

pleural effusion, empyema, lung abscess, necrotizing pneumonia,

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5
Q

how do you treat empyema

A

surgical drainage and chest tube placement.

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6
Q

treatment of outpatient CAP under 65

A

macrolide or doxy

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7
Q

treatment of CAP in older than 65 or a comorbidity (COPD, heart failure, renal failure, diabetes)

A

fluoroquinolone or beta lactam + macrolide

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8
Q

treatment of CAP in hospitalized patients

A

fluoroquinolone or antipneumococcal beta lactam + macrolide

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9
Q

what is the best INITIAL test for tb?

A

sputum acid fast stain

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10
Q

what is the most common finding of TB on CXR

A

cavitary lesion in upper lobe

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11
Q

treatment of active TB

A

INH, pyrazinamide, rifampin, ethambutol for 2 months followed by INH and rifampin for 4 months

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12
Q

Treatment of latent TB

A

INH for 9 months

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13
Q

side effect of TB RICE treatment

A

R: turns body fluid orange
I: peripheral neuropathy and hepatitis
E: optic neuritis

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14
Q

treatment of allergic bronchopulmonary aspergillosis

A

oral corticosteroids, add itraconazole for recurrent or chronic cases

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15
Q

what does aspergilloma look like on CT or CXR

A

solid mass within a preexisting lung cavity

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16
Q

treatment of aspergilloma

A

if symptomatic: itraconazole or surgical resection

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17
Q

common bacterial causes of pharyngitis

A

group A strep, neisseria gonorrhoeae, C diphtheria, M pneumonia

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18
Q

common causes of viral pharyngitis

A

rhinovirus, coronavirus, adenovirus, HSV, EBV, CMV, flu, coxsackievirus, HIV

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19
Q

symptoms of strep pharyngitis

A

fever, sore throat, pharyngeal erythema, tonsillar exudate, cervical lymph, soft palate petechiae, headache, vomiting, scarlatiniform rash

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20
Q

atypical presentation of strep throat

A

coryza, hoarseness, rhinorrhea, cough, conjunctivitis, anterior stomatitis, ulcerative lesions, GI symptoms.

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21
Q

treatment of group a strep throat

A

PCN for 10 days

alternative: cephalosporins, amoxicillin, azithromycin.

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22
Q

what is CENTOR criteria

A 
\+ 1 fever
\+1 tonsillar exidate
\+1 tender LAD
\+1 if NO cough
\+1 if 0-14, -1 if >45
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23
Q

how do you use centor criteria to treat

A

score 4-5 give antibiotics
score 2-3 do rapid strep, if negative then culture.
0-1 symptomatic treatment only

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24
Q

symptoms of ludwig angina

A

rapidly progressive cellulitis of submandibular space- fever, airway compromise

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25
Q

treatment of ludwig angina

A

IV broad spectrum antibiotics and surgical drainage of abscess

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26
Q

how can you prevent parotitis

A

adequate fluid intake and good oral hygiene

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27
Q

how do you treat parotitis

A

IV antibiotics

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28
Q

treatment of acute bacterial sinusitis

A

amoxicillin-clavulanate for 10 days

alternates: clarithromycin, azithromycin, bactrim, or fluoroquinolone

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29
Q

treatment of chronic sinusitis

A

3-6 weeks of antibiotics used for acute, adjuvant therapy with intranasal corticosteroids

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30
Q

presentation of orbital cellulitis

A

fever, proptosis, decreased extraocular movements, ocular pain, decreased visual acuity.

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31
Q

treatment of N gonorrhoae conjunctivitis

A

IM or IV ceftriaxone

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32
Q

diagnosis of orbital cellulitis

A

blood and tissue culture

CT to rule out abscess and intracranial involvement

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33
Q

treatment of orbital cellulitis

A

admit to hospital for IV antibiotics

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34
Q

how does herpes simplex keratitis present

A

pain, blurred vision, tearing, redness

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35
Q

common cause of contact lens keratitis

A

pseudomonas

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36
Q

treatment of otitis externa

A

ofloxacin or ciprofloxacin and steroid eardrops

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37
Q

what symptoms make you order a CT before LP

A

altered mental status, papilledema, focal neurologic deficits

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38
Q

what do you give to close contacts of pts with meningococcal meningitis

A

rifampin or cipro, and meningococcal vaccine

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39
Q

treatment of bacterial meningitis in pts <1 month

A

ampicillin + cefotaxime or gentamicin

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40
Q

treatment of bacterial meningitis in pts 1-3 month

A

IV Vanco + ceftriaxone or cefotaxime

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41
Q

treatment of bacterial meningitis in 3 month-adult

A

IV van + ceftriaxone

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42
Q

treatment of bacterial meningitis in >60 yo

A

ampicillin + Vanco + ceftriaxone

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43
Q

how does HSV encephalitis look on CT

A

temporal lobe signal abnormalities

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44
Q

CSF findings for HSV encephalitis

A

RBCs without history of trauma

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45
Q

treatment of HSV encephalitis

A

IV acyclovir. Foscarnet if resistant

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46
Q

treatment of CMV encephalitis

A

IV ganciclovir +- foscarnet

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47
Q

treatment of brain abscesses <2 cm

A

metronidazole + 3rd gen cephalosporin +- vanco for 6-8 weeks.
Serial CT/MRI
dexamethasone w/ taper in severe cases to decrease cerebral edema, IV mannitol.
Prophylactic anticonvulsants.

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48
Q

treatment of infants of HIV mothers

A

ZDV therapy for 6 weeks

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49
Q

prophylaxis for MAC in HIV pts

A

when CD4 <50

Weekly Azithromycin

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50
Q

prophylaxis for toxoplasmosis in HIV

A

when Cd4 <100

TMP-SMX

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51
Q

pneumonia vaccine schedule in pts with HIV

A

PCV13 followed by PSV23 in 2 months.

Give every 5 years as long as CD4 > 200

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52
Q

treatment of canida esophagitis

A

PO azole

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53
Q

treatment of oral thrush

A

nystatin suspension, clotrimazole tablet, PO azole

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54
Q

How does cryptococcal meningitis presentq

A

headache, fever, impaired mental status, increased ICP, absent meningeal signs

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55
Q

treatment of cryptococcal meningitis

A

IV amphotericin B + flucytosine for 2 weeks, then fluconazole for 8 weeks.

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56
Q

Symptoms of disseminated histoplasmosis

A

fever, weight loss, hepatosplenomegally, LAD, nonproductive cough, palatal ulcers, pancytopenia

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57
Q

what test is most sensitive for diagnosis of disseminated histo

A

urine and serum polysaccharide antigen test

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58
Q

Treatment of mild histo

A

supportive or itraconazole

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59
Q

treatment of chronic histo with cavitary lesions

A

itraconazole for 1 year

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60
Q

treatment of disseminated histo

A

amphotericin B for 14 days followed by itraconazole for 1 year

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61
Q

how can coccidiomycosis present

A

fever, anorexia, headache, chest pain, cough, dyspnea, arthralgia, night sweats. Disseminated: meningitis, bone lesions, soft tissue abscess.

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62
Q

how will an anterior shoulder dislocation present

A

pt hold arm in aBduction and external rotation

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63
Q

rotator cuff tear will present with pain during which movements

A

abduction or external rotation

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64
Q

symptoms of humerus fracture

A

wrist drop and loss of thumb extension

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65
Q

how will a hip fracture present

A

shortened and externally rotated leg

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66
Q

what’s the diagnosis:

hypernatremia, urine osmolality <300, rise in urine osmolality with desmopressin following water restriction

A

central DI

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67
Q

how do you treat a pt with hypernatremia who is hypovolemic and unstable

A

isotonic .9 NaCl–> until pt is euvolemic

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68
Q

how much does sodium decrease for every 100 mg/dL increase in glucose

A

1.6

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69
Q

causes of hypovolemic hypotonic hyponatremia with FENa<1 %

A 
GI losses (diarrhea, vomiting, NG suction)
skin losses (burns)
third spacing
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70
Q

causes of hypovolemic hypotonic hyponatremia with FENa>2 %

A

Diuretics
Urinary obstruction
Adrenal Insufficiency
Bicarbonaturia (RTA, metabolic alkalosis)

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71
Q

Causes of isovolemic hypotonic hyptonatremia w/ urine osmolality >100

A

SIADH
Hypothyroid
Gluccocordicoid deficiency

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72
Q

causes of isovolemic hypotonic hyponatremia w/ urine osmolality <100

A

Primary polydipsia

Beer drinkers

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73
Q

causes of hypervolemic hypotonic hyponatremia with FENa<1%

A

Cirrhosis
CHF
nephrotic syndrome

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74
Q

causes of hypervolemic hypotonic hyponatremia with FENa>2%

A

AKI

Chronic renal failure

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75
Q

when do you use hypertonic saline in a pt with hyponatremia

A

only if they have seizures from hyponatremia or serum Na is <120

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76
Q

EKG findings of hyperkalemia

A

peaked t waves, wide QRS, PR prolongation, loss of P waves

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77
Q

best initial treatment of hyperkalemia

A

calcium glutinate if K>6.5 or EKG changes

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78
Q

treatment of serum calcium >14

A

isotonic IV fluids (+- furosemide) and calcitonin

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79
Q

Causes of HAGMA

A 
Methanol
Uremia
DKA
Propylene glycol
Iron tables or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates
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80
Q

Type 1 RTA

A

defect in H+ secretion
hypokalemia
urinary pH> 5.5

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81
Q

complications of type 1 RTA

A

kidney stones

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82
Q

causes of RTA type 1

A

autoimmune disorders, hypercalciuria, amphotericin B, ifosfamide, genetic disorder

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83
Q

RTA type 2

A

defect in bicarb reabsorption

Hypokalemia

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84
Q

causes of RTA type 2

A

multiple myeloma, amyloidosis, dancing, ahminoglycosides, cisplatin, acetazolamide

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85
Q

RTA type 4

A

aldosterone deficiency or resistance

kyperkalemia

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86
Q

causes of RTA type 4

A

hypoaldosteronism, ACE/ARBs, urinary tract obstruction, heparin

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87
Q

How does tissue factor work

A

triggers coagulation cascade via extrinsic pathway and factor 7

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88
Q

how does vWF work

A

facilitates attachment and aggregation of platelets, forms platelet plug

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89
Q

MOA of unfractinated heparin

A

activates antithrombin –> inactivates factor Xa, thrombin, and other proteases

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90
Q

what lab value changes will you see with unfractionated heparin

A

increased PTT

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91
Q

how does warfarin affect lab values

A

increases PT

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92
Q

how do you rapidly reverse warfarin

A

FFP

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93
Q

what lab values change with tPAs

A

increased PT and PTT

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94
Q

what is the reversal for factor Xa inhibitors

A

andexant alfa

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95
Q

Which has a longer half life: LMWH or unfractionated heparin

A

LMWH

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96
Q

what is the reversal to dabigatran

A

idarucizumab

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97
Q

Labs for hemophillia

A

PTT pronged

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98
Q

how can you diagnose hemophillia

A

mixing test: mix hemophillia blood with normal blood and PTT will correct

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99
Q

treatment of severe hemophillia

A

transfuse missing factor or give cryoprecipitate

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100
Q

treatment of moderate hemophilia

A

desmopressin

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101
Q

what medication makes vWD worse

A

aspirin

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102
Q

Labs for vWD

A

increased bleeding time, may have increased PTT

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103
Q

how do you diagnose vWD

A

ristocetin cofactor assay

104
Q

labs for antiphospholipid antibody syndrome

A

paradoxically elevated PTT

105
Q

labs in DIC

A

increased PT, PTT, decreased platelets and fibrinogen, increased D dimer

106
Q

treatment of DIC

A

reverse cause

transfuse RBC, platelets, RRP

107
Q

what conditions is TTP associated with

A

SLE, malignancy, pregnancy, cyclosporine, quinidine, clopidogrel, ticlopidine, AIDS

108
Q

what will you see on blood smear in TTP and HUS

A

shistocytes

109
Q

what conditions are associated with ITP

A

lymphoma, leukemia, SLE, HIV, hep C

110
Q

what additional tests should you do for all patients with ITP

A

H pylori testing, hep C testing, direct antiglobulin testing, blood type

111
Q

how do you treat ITP

A

if platelet count <30,000 or clinically significant bleeding–> steroids or IVIG

112
Q

what drug class may interfere with iron absorption

A

antacids

113
Q

Causes of sideroblastic anemia

A 
alcoholism 
lead poisoning
chloramphenicol
isoniazid
Vit B6 def
malignancy
114
Q

MOA of paroxysmal nocturnal hemoglobinuria

A

deficiency in glycosylphosphatidylinositol anchor molecules that inhibit CD55/CD59–> results in complement mediated hemolysis and thrombosis

115
Q

how can paroxysmal nocturnal hemoglobinuria present

A

can manifest as iron deficiency anemia, episodic dark urine, venous thrombosis, pancytopenia, abdominal pain

116
Q

treatment of paroxysmal nocturnal hemoglobinuria

A

prednisone
allogenic bone marrow transplant is curative
eculizimab

117
Q

MOA of hereditary spherocytosis

A

defect in spectrum or ankyrin –> loss of RBC membrane surface area–> spheres that are trapped and destroyed by spleen

118
Q

Presentation of hereditary spherocytosis

A

jaundice and splenomegaly

acute cholecystitis from pigmented gallstones

119
Q

lab tests for hereditary spherocytosis

A

decreased MCV, increased MCHC, negative coombs.

120
Q

most accurate test to diagnosis hereditary spherocytosis

A

Eosin-5 maleimide flow cytometry and acidified glycerol lysis test

121
Q

what level of hcg do you need to see gestational sac

A

1000-1500

122
Q

what happens to GFR during pregnancy

A

increases

123
Q

what happens to BP in pregnancy

A

decreases

124
Q

what happens to cardiac output during pregnancy

A

increases

125
Q

when do you screen for gestational diabetes

A

24-28 wks

126
Q

quad screen results for trisomy 18

A

decreased alpha fetoprotein
decreased estriol
decreased inhibit A
decreased hCG

127
Q

quad screen results for down syndrome

A

decreased alpha fetoprotein
decreased estriol
increased inhibit A
increased hCG

128
Q

what weeks do you do amniocentesis

A

15-20

129
Q

indications for amniocentesis

A

women >35
abnormal nuchal translucency, abnormal quad screen, abnormal invasive prenatal testing.
Rh sensitized pregnancy
evaluation for lung prematurity

130
Q

what ratio indicates fetal lung maturity

A

L to S ratio > 2.5

131
Q

symptoms of congenital toxo

A

hydrocephalus
intracranial calcifications
chorioretinitis
ring enhancing lesions on MRI

132
Q

symptoms of congenital rubella

A 
blueberry muffin rash
cataracts
mental retardation
hearing loss
PDA
133
Q

symptoms of congenital CMV

A

petechial rash

periventricular calcifications

134
Q

symptoms of congenital HSV

A

skin, eye, mouth infections

CNS infection

135
Q

symptoms of congenital HIV

A

often asymptomatic
failure to thrive
increased infections

136
Q

symptoms of congenital syphilis

A 
maculopapular rash
LAD
hepatomegaly
snuffles
saber shings
saddle nose
CNS involvement
137
Q

management of intrauterine fetal demise if <24 wks

A

D&E

138
Q

management of intrauterine fetal demise if >24 wks

A

induce labor within 1-2 weeks

*DONT do C section even if baby is breech.

139
Q

side effects of oxytocin

A

hyponatremia
tachysystole
hypotension

140
Q

normal active stage of labor timing

A

nulliparious: 4-6 hours (1.2 cm/hr)
multiparous: 2-3 hours (1.5 cm/hr)

141
Q

what does absent variability mean

A

fetal acidemia

142
Q

what does minimal variability mean

A

fetal hypoxia or due to opioids, magnesium, or sleep cycle.

143
Q

what do early decelerations indicate

A

head compression (normal)

144
Q

what do late decelerations indicate

A

uteroplacental insufficiency and fetal hypoxemia

145
Q

what do variable decelerations indicate

A

umbilical cord compression

146
Q

what is a reactive stress test

A

2 accelerations lasting at least 15 seconds in 20 min.

if >32 wks then >15 bpm
if <32 wks then >10 bpm

147
Q

abnormal result of 1 hour glucose tolerance test

A

glucose >140

148
Q

what should you do after delivery for a mom who had gestational diabetes

A

at 6-12 wks out screen for diabetes

149
Q

what is ideal delivery date for pts with preeclampsia

A

by 37 weeks

150
Q

signs of magnesium sulfate toxicity

A

loss of DTR, respiratory paralysis, coma

151
Q

how do you treat magnesium toxicity

A

calcium gluconate

152
Q

management of severe preeclampsia

A

control BP with labetalol or hydralazine (want diastolic between 90-100)
continuous magnesium drip
deliver baby once mom is stable

153
Q

treatment of asymptomatic bacteriuria and UTI in pregnancy

A

3-7 days nitrofurantoin (avoid in first trimester), cephalexin, or amox-clauv

154
Q

treatment of pyelonephritis in pregnancy

A

IV fluids, IV 3rd gen cephalosporin. antibiotics for remainder of pregnancy

155
Q

risks for placental abruption

A

HTN
trauma
tobacco or cocaine use
previous abruption

156
Q

risks for placenta previa

A

prior c section
advanced maternal age
multiparty

157
Q

risks for vasa previa

A 
multiple gestations
IVF
single umbilical artery 
placenta previa
low lying placenta
158
Q

management of vasa previa

A

if diagnosed before bleeding:

  • steroids at 28-32 wks
  • hospitalization at 30-32 wks
  • c section at 35 wks
159
Q

complications of oligiohydraminos

A

MSK abnormalities
pulmonary hypoplasia
umbilical cord compression
IUGR

160
Q

what is the karyotype of a complete molar pregnancy

A

46 XX

does not contain fetal tissue

161
Q

treatment of hydatiform mole

A

D&C
follow weekly with hug
treat malignant disease with chemo (methotrexate or dactinomycin)

162
Q

treatment of tourettes

A

therapy

drugs: 2nd get antipsychotics (risperidone, aripiprazole), alpha 2 agonists

163
Q

cause of asymmetric IUGR

A

maternal HTN or maternal chronic disease

164
Q

management of molar pregnancy

A

D&C
follow with weekly b-hCG
treat malignancy with chemo

165
Q

management of shoulder dystocia

A

McRoberts maneuver: flex hip, apply suprapubic pressure

166
Q

what age do you give magnesium in preterm labor

A

if under 32 wks

167
Q

what antibiotics for GBS prophylaxis

A

PCN and ampicillin

168
Q

symptoms of postpartum endometritis

A

fever >38 within 36 hours
uterine tenderness
malodorous lochi

169
Q

septic pelvic thrombophlebitis

A

abdominal pain and back pain, swinging fevers (high and low), unresponsive to antibiotics

DX: blood cultures and CT
tx: broad spectrum antibiotics and heparin

170
Q

symptoms of sheehan

A

no lactation, weakness, lethargy, cold intolerance, genital atrophy, menstrual disorders

171
Q

most common cause of mastitis in breast feeding

A

staph a

172
Q

treatment of mastitis

A 
continue breast feeding 
PO antibiotics (dicloxacillin, cephalexin, amor-clav, azithro)
173
Q

MOA of metformin

A

inhibits hepatic gluconeogenesis and increased peripheral sensitivity to insulin

174
Q

MOA of sulfonylureas (glipizide, glyburide, glimepiride)

A

increase endogenous insulin

175
Q

MOA of thiazolidinediones (rosiglitazone, pioglitazone)

A

increase insulin sensitivity

176
Q

MOA of DDP4 inhibitors (sitagliptin, linagliptan)

A

inhibit degradation of GLP1, increase insulin secretion and decrease glucagon secretion

177
Q

MOA of incretins (eventide, liraglutide)

A

GLP1 agonists, delay absorption of food, increase insulin secretion, decrease glucagon secretion

178
Q

MOA of SGLT2 inhibitors (dapagliflozin)

A

inhibit SLGT2 in proximal tubule to decrease glucose reabsorption

179
Q

MOA of alpha-glucosidase inhibitors (acarbose, miglitiol)

A

increase intestinal absorption of carbs

180
Q

what should all diabetes over 40 be on?

A

statin

181
Q

what is first line BP drug for diabetic patients

A

ACE/ARB

182
Q

Tight glucose control reduces what complications of diabetes

A

nephropathy and retinopathy

183
Q

how does peripheral neuropathy of diabetes present

A

symmetrical sensorimotor polyneuropathy–> burning foot pain, foot trauma, infections, ulcers

184
Q

treatment fo diabetic gastroparesis

A

metoclopramide or erythromycin

185
Q

screening for DMT2 in pts without risk factors

A

test HbA1c at 45 years, then every 3 years

186
Q

diagnostic criteria for metabolic syndrome

A 
abdominal obesity 
triglycerides >150
HDL <40 in men or 50 in women
BP >130/85
fasting glucose >100
187
Q

treatment of graves exopthalmoplegia

A

steroids

188
Q

what is a complication of untreated hyperthyroidism

A

bone loss

189
Q

presentation of cause of congenital hypothyroidism

A

failure to thrive, hypotonia, umbilical hernia, prolonged jaundice
due to thyroid dysgenesis

190
Q

symptoms of myxedema coma

A

severe hypothyroidism, decreased mental status, hypothermia, hypotension, bradycardia, hypoglycemia, hypoventilation

191
Q

treatment of myxedema coma

A

admit to ICU. IV levothyroxine and IV hydrocortisone

192
Q

management of thyroid nodule with high TSH

A

FNA or US guided biopsy

193
Q

management of thyroid nodule with low TSH

A

TC99 scan or RIU, if cold nodule go to FNA

194
Q

what should you check if you suspect medullary thyroid cancer

A

calcitonin levels

195
Q

best initial test for pagets disease of bone

A

plain film xray

196
Q

Lab values for pagets disease of bone

A

increased serum alk phos

normal calcium and phosphate

197
Q

First line treatment of pagets disease of bone

A

bisphosphonates

198
Q

complications of pagets

A

osteoarthritis, fractures, high output heart failure, osteosarcoma

199
Q

labs in pseudohypoparathyroidism

A

increased PTH
hypocalcemia
hyperphosphatemia

200
Q

labs in primary hyperparathyroidism

A

increased PTH
hypercalcemia
hypophosphatemia

201
Q

treatment of acute hypercalcemia

A

IV fluids and calcitonin

202
Q

diagnosis of cushing syndrome

A
  1. 24 hour urinary free cortisol or overnight dexamethasone suppression test
  2. If no suppression–> confirm with elevated urinary free cortisol
  3. Measure plasma ACTH
  4. If ACTH low–> adrenal tumor –> CT
    If ACTH high–> MRI pituitary
203
Q

how can you differentiate cushing disease from ectopic ACTH

A

cushing disease–> suppressed cortisol on high dose test

204
Q

lab tests for DI

A

serum osmolality > urine osmolality
decreased urinary sodium
possible hypernatremia

205
Q

lab findings in primary adrenal insufficiency

A 
decreased cortisol
decreased aldosterone
increased ACTH
decreased sodium
increased potassium
206
Q

Lab findings in secondary adrenal insufficiency

A

decreased cortisol
normal aldosterone
decreased ACTH
normal sodium and potassium

207
Q

how does hyepraldosteronism present

A

HTN, headache, polyuria, muscle weakness (hypokalemia)

208
Q

Lab findings in hyperaldosteronism

A

hypokalemia, metabolic alkalosis, hypomagnesemia, hyperaldosterone, increased aldosterone to plasma renin ratio (>30)

209
Q

treatment of bilateral adrenal hyperplasia

A

aldosterone receptor antagonist

210
Q

increase in what is diagnostic for 21-hydroxylase deficiency

A

elevated 17 hydroxyprogesterone

211
Q

MEN1 tumors

A

pancreatic, pituitary adenomas, parathyroid hyperplasia

also: zollinger ellison, insulinomas, VIPomas, glucagonoma

212
Q

how does VIPoma present

A

watery diarrhea, hypokalemia, hypochlorhydria

213
Q

MEN2 tumors

A

medullary thyroid, pheochromocytoma, parathyroid gland hyperplasia

214
Q

MEN3 tumors

A

medullary thyroid, pheochromocytoma, oral and intestinal ganglioneuromatosis, marfinoid

215
Q

best initial test for esophageal dysphagia

A

EGD

*consider pre-EGD barium swallow in pts with history of esophageal radiation or strictures due to increased risk of perforation

216
Q

how does CMV esophagitis present and what is treatment

A

large, linear, superficial ulcerations with intranuclear and intracytoplasmic inclusions on biopsy.

IV ganciclovir

217
Q

diagnosis of esophageal spasm

A 
barium swallow: corkscrew esophagus 
esophageal manometry (most accurate)
218
Q

treatment of esophageal spasm

A

symptomatic relief: CCB, TCAs, nitrates

Severe symptoms: surgery

219
Q

treatment of achalasia

A

short term: CCB, nitrates, botulism

long term: pneumatic balloon dilation or surgical myotomy.

220
Q

diagnosis of zenker diverticulum

A

barium swallow

221
Q

risk factors for SCC of esophagus

A

alcohol, tobacco, nitrosamines

222
Q

risk factors for adenocarcinoma of the esophagus

A

barretts

223
Q

diagnosis of esophageal cancer

A

best initial test: barium study
Most accurate test: EGD with biopsy.
CT and endoscopic US for tumor staging.

224
Q

most accurate test for GERD

A

24 hour pH monitoring

225
Q

when do you need to do an EGD with biopsy for GERD

A

if refractory to treatment
if longstanding –> rule out barretts
if alarm symptoms –> GI bleed, weight loss

226
Q

what foods should you advice pts with GERD to avoid

A

chocolate, alcohol, coffee

227
Q

treatment of sliding hiatus hernia

A

medical therapy and lifestyle modifications to decrease GERD symptoms

228
Q

treatment of paraesophageal hernia

A

surgical gastropexy to prevent gastric volvulus

229
Q

extrapyramidal side effects: treatment of acute dystonia

A

benztropine

diphenhydramine

230
Q

extrapyramidal side effects: treatment of akathisia

A

beta blocker
benztropine
benzo

231
Q

extrapyramidal side effects: treatment of parkinsonism

A

benztropine

amantadine

232
Q

extrapyramidal side effects: tar dive dyskinesia

A

valbenazine

debtetrabenzine

233
Q

how do you diagnose botulism

A

repetitive nerve conduction study

234
Q

side effects of clozapine

A

agranulocytosis, seizures, myocarditis

235
Q

treatment of emphysematous cholecystitis

A

emergency cholesecectomy

broad IV antibiotics (tip tazo)

236
Q

what’s a common GI complication of henoch-schloein purpura

A

intussusception

237
Q

what vitamins are vegans at risk for deficiency of?

A

vit b12, calcium, vit D

possible iron and zinc

238
Q

what’s the difference between athletes heart and HCM

A

HCM- left atrium is enlarged, LV decreased, focal septal hypertrophy, LV diastolic function is impaired.

239
Q

how do pineal gland tumors present

A

decreased upward gaze
upper eyelid retraction
pupillary abnormalities

240
Q

initial evaluation of primary adrenal insufficiency

A

8 am cortisol test and ACTH stimulation test

241
Q

order of normal female developement

A

thelarche –> pubarche –> growth acceleration –> menarche

242
Q

best initial treatment of menopause

A

hormone replacement therapy

243
Q

what non-hormone replacement therapy can you use to decrease hot flashes

A

SSRI/SNRI, clonidine, gabapentin

244
Q

how does complete androgen insensitivity present

A

will have breast development but are amenorrhea and lack pubic hair

245
Q

in workup for amenorrhea, do US and no uterus, what is next step

A

karyotype and serum testosterone

246
Q

PCWP is the same as

A

left sided preload

247
Q

CVP is the same as

A

right sided preload

248
Q

what are some contraindications to using NSAIDs in gout treatment

A

heart failure, pts on anticoagulants

249
Q

who should not use colchicine for gout treatment

A

elderly and those with severe renal impairment

250
Q

what is the triad of diagnostic requirements for acute liver failure

A

elevated liver enzymes, hepatic encephalopathy, increased pT

251
Q

what is a complication of basal ganglia hemorrhage

A

uncal herniation

252
Q

symptoms of uncal herniation

A

dilated, nonreactive ipsilateral pupil, contralateral extensor posturing

253
Q

what are 2 days to decrease incidence of post op pneumonia

A

start physical therapy before surgery and smoking cessation >8 weeks before

254
Q

diagnostic criteria for narcolepsy

A

At least 1 or more of the following:
cataplexy (brief loss of muscle tone with strong emotion)
low CSF levels of hypocretin 1
decreased REM latency

255
Q

what are the predominate types of hemoglobin in beta thalassemia major

A

HbA2 and HgF

256
Q

treatment of beta-thalassemia and sickle cell

A

transfusions and chelation treatment

OBGYN (5 decks)

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