Step 3 10/12 Flashcards
(214 cards)
1
Q
4 yo w sickle cell disease bumps knee and develops infection…what abx?
A
Ceftriaxone and clindamycin for staph aureus as well as salmonella(asplenia) osteomyleitis
2
Q
Patient with sjogren’s syndrome and focal submandibular mass?
A
C/f b-cell non-Hodgkin’s lymphona.(polyclonal B cell activation and infiltration of the salivary glands)
3
Q
45 yo woman BMI 38 and DM with rash on breast?
A
Intertrigo, likely due to candida.
4
Q
When do you need to do a glucocoritcoid taper?
A
If greater than 3 weeks
5
Q
Acute stress disorder vs PTSD?
A
Acute stress id order lasts >3 days but <1 month.
6
Q
POtential problem in case-control studies?
A
REcall bias
7
Q
Patient with cough, pleuritic chest pain, and hemoptysis after bone marrow transplant? X-ray with nodules with surrdouning ground-glass opacities?
A
Aspergillosis. Do BAL and tx with vori
8
Q
Patient with low-ptiched, rumbling diastolic murmur preceded by an opening snap?
A
Mitral stenosis, heard beath between the fifth and sixth ribs at the left mid-clavicular line
9
Q
Treatment of gout in ESRD/post-transplant patients?
A
Intrarticulr glucocoritcoids
10
Q
Patient with meningitis sx, no mass on CT, CSF pressure of >250, low leukocyte count with lymphocitic predomoninance, elevated protein and low glucose?
A
Suspicious for cryptococcus in Hiv patients. May have papulas lesions with central umbilication and are positive for india ink preparation.May need to do serial LPs to reduce elevated pressure.
11
Q
General treatment for cryptococcal meningitits?
A
Induction: ampho and fluctyosine for >2 weeks, consolidaiton: hihg dose oral fluconazole for 8 weeks 3. Maintenance: lower dose fluconazole for >1 year to prevent recurrent
12
Q
Most important factor for appropriate transplant?
A
HLA and ABO compatibility, living donors.
13
Q
Turner syndrome heritability?
A
Random error in cell division, loss of an x chromosome
14
Q
Man with progressive weakness accompanied by both upper and lower motorn neuron deficits?
A
Suspect ALS(ocular motilityu, sensory, bowel, bladder, and cognitive functions are preserved)Tx with riluzole: Glutamate inhibitor.
15
Q
Mom with greenish vaginal discharge 3 months afte rhaving baby? ph.4.5, motiel flagellated organisms.
A
Single dose oral-metronidazole for trichomoniasis, express and iscard breast milke for 24 hours
16
Q
persistent,spontaenous,Unilateral nipple discharge?
A
Do mammography plus ultrasound, likely papillary tumor but could be intraductal carcinoma..
17
Q
First lab value changes first after treating iron deficiency anemia?
A
Reticulocyte count
18
Q
Hypopigmented spots with history of bilateral deafness?
A
NF-2, autosomal dominat
19
Q
Newborn with fever and positive leuk esterase, poor appetite, lassitude?
A
Treat for E.coli UTI and also listeria (ampicillin plus gentamicin/cefotaxime) No cetriaxone or sulfonamide due to risk of hyperbilirubinemia.
20
Q
Patient with palpable purpura after an URI? Positive stool-guiac?
A
HSP: IgA deposition, pediatric vasculitis, small bowel intussusception.
21
Q
Patient with uncontrolled HTN with low renin and low
A
Licorice inhibits 11-beta-hydroxysteroid dhydrgenase, preventing local conversion of cortisol to cortisone. Excess cortisol binds mineralcorticoid receptors and causes hypertension, hypokalemia, and metabolic alkalosis.
22
Q
38 yo woman with asthma exacerbation found to have bilateral upper lobe opacities, atelectasis, bronchiectasis?
A
Do Skin test and blood test for allergic broncoopulmonary aspergillosis. Treat with systemic glucocorticoids wit antifungal (decrease fungal burden and antigenic stimulus.)
23
Q
Pain control for DM neuropathy besides gabapentin?
A
TCADS ie duloxetine
24
Q
Patient with scar tissues after ear piercing that is growin?
A
tx with intralesional glucocorticoids, may need surgical excision if it reccurs.
25
When to anticoagulate patient with A fib?
ChADSVASC SCore >2
26
Woman with >3 UTI in 1 year?
recurrent UTI, use postcoital antibiotic prophylaxis.
27
Patient with ACS?
Dual antiplatelet therapy (ASA and clopidegrol), nitrates, beta blockers, statins, anticoagulant therapy (heparin)
28
Woman <30 with mobile breast mass..next step?
Ultrasound. LIkely fibrocystic change, but must rule out malignancy.
29
38 yo woman with dysuria, dyspareunia, anterior vaginal mass?
Urethral diverticulum, dx with MRI of the pelvis or Pelvic US.
30
Significant of Kappa statistic?
inter-relater reliability
31
74 yo M with pain in left hip joint with thickening of his left proximal femur.
Likely Paget's, treat with bisphosphoate
32
If patient with SVT, you give adenosine, and they actually have WPW?
Can provoke A fib with RVR and can degenerate into V fib.
33
82 yo woman with shingles?
Treat with oral valacyclovir if less than 72 hours.
34
81 yo woman with shingles in the hospital, how to prevent spread?
If desseminated disease, place on contact and airborne precatutions. If localized disease, standard precautions.
35
Newly pregnant woman with hypothyroidism?
Increase once pregnancy is detected 30% (increased metabolix demands, B-hcg binds TSH receptors and stimulates T3 T4 proudciton and suppress TSH secretion.
36
CT scan for lung cancer is smoker recommendation?
Patients age 55-80 who have >30 pack-year smoking history and are current smokers or quit within the last 15 years.
37
2 yo boy abdominal pain and lethargy, nonbilious emeses and drawying up of legs to the abdomen?
Intussusception(RF are recent viral illness pathologic lead point ie HSP, meckels etc): Also, suasage-shpaed mass and "currant jelly" stools. Do radiographs to r/o intestinal perforaiton, do air or water-soluble enema.
38
Cardiac exercise stress testing?
Prongnostic info: if negative <1 % risk of cardiovascular events within the next year.
39
When to supplement with iron in a anemic ESRD patient?
transferrin saturation<30, ferritin <500
40
Child with sickle cell disease with new pulmonary infiltrate on chest x-ray plus hypoxemia?
Acute chest syndrome, treat with ceftriaxone plus aizthromycin
41
inflammatory acne?
Topical abx ie erythromycin, clindamycin
42
35 yo woman with hypertension, hyperglycemia, osteoporosis, mood swings, hypokalemia, and metabolic alkalosis?
Do dexamethesone suppression test for cushing's disease.
43
27 to with cocaine related chest pain?
GIve lorazepam to reduce symmpathetic outflow and psychomotor agitation. Use phentalomanine if benzo and nitro does not work.
44
Pain with chest pain and neuro sx after cocaine use?
Suspect dissection of ascending aorta, do CT angiography of the chest.
45
56 yo man with fatigue, night sweates, arthralgias, one sided pleural effusion wit CAD on hydralazine??
Drug-induced lupus: do ANA,
46
Stain for patient with diabetes?
Recommended if LDLD >70.
47
31 yo pregnant women with elevated AFP?
do anatomic ultrasound. Could be due to NTDs, VEntral wall defects, multiple gestation. (Decreased MSAFP due to trisomy 18, 21)
48
untreated hiv with widespread skin papules with umbilication? also central hemorrhage
cutaneous cryptococcus (kaposi would be red or purple with no necrosis) Dx with skin biopsy (PAS staining)
49
Hepatitis B vaccination?
0, 2, and 6 months.
50
CLose contacts of meningitis? (?8 hours of exposure in close proximity, diret exposure to respiratory secretions within 7 days of onset of paient's symptoms)
give rifampin, cipro of ceftriaxone.
51
When to begin bone density screening in women?
ag 65. Otherwise encourage calcium 1200 mg and vitamin D 600-800 IU
52
MCC heart defect down's syndrome?
Endocardial cushion defect.
53
Disease in later Down syndrome?
Alzheimers, acute leukemia, ADHD, seizure
54
When to considere exchange transfusion in hyperbilirubinemia?
>20 mg/dl
55
Suspect fibromyalgia?
Do TSH to rule it out.
56
When to give tetanus vaccine? Immune globulin?
Tetanus with severe/dirty wounds, most recent vaccin >5 years ago and to those with minor, clean wounds who received a booster >10 years ago. IG to those with dirty wounds or with unclear history of tetnanus vacciantion.
57
MM concern for fx?
to X-ray skeletal survery, other modalities reserved for patients with bone pain and negative x-rays
58
Adolescent pregnancy?
Risk for preterm birth, low birth wegith, and perinatal mortality, gastrocisis, omphalocele.
59
When to DC estrogen receptor modulators like raloxifene before surgery?
DC 4 weeks prior to surgery for high rates of VTE
60
Patient with Hydrophobia?
Think rabies, water triggers pharyngeal spasms that cause patient to be frightened of frinking. Human Rabies is almost always fatal once patient is symptomatic.
61
Patient with acute MR, pulmonary effusions?
POssible chordae tendinae rupture.
62
Patient with chordae tendinae rupture and thoracolumbar scoliosis?
Ehlerds danos: joint hypermobility, recurrent junt dislocations, hyperexntesibility skin, delayed healing with atrophic scars (Marfan syndrome will not have skin findings like velvety skin with atrophic scarring)
63
When is vaginal delivery safe with patients with HIv?
If <1000 copies/ml. Continue triple therapy during pregnancy. NO breastfeeding in resource rich countries.
64
Most common side effect of isoniazid?
hepatotoxicity. DC if >5 times the ULN. or if with sx and 3 x upper limit of normal. Ocular toxicity with ethmabutol.
65
When to screen for breast cancer?
age 50, every 2 years. 40 if risk factors.
66
Plan to give TNF-a, what should you check?
IFN-gamma release for latent tb.
67
Untreated celiac disease risk>
Enteropathy-associated T-cell lymphoma in proximal jejunum.
68
4 yo with plt <100,000 and sudden onset of bleedin?
COnsider ITP and give IVIG
69
Patient with variceal bleed?
Ensure to treat with cipro for 7-10 days to prevent SBP.
70
Patient in acute decompensated HF non-responsive to diuretic therapy?
Nitroglycerin: decresae in cardiac preload with reduced intracardiac filling presures and improvement in pulmonary edema. Also recommended for flash pulmonary edema
71
Acute rhinosinisusits but sx persist >10 days?
Acute bacterial rhinosinusisits, treat with amox-clav./
72
retroorbital pain, hemorrhagic signs, fever after travel?
thinkg Dengue fever and watch out for dengue hemorhagiv fever and cirulatory collapse.
73
When is delyaed puberty?
Lack of testicular enlargement by age 14. Check LH, FSH, and testosterone.
74
acute hypoxemi respiratory failure within 6 hours of blood product ?
TRALI...can lead to neurocogititnve defevets for greater than a year after
75
Patient with multiple transfusions cant find appropriate blood, why?
alloantibodies
76
GTT during pregnancy?
If >140, 3 hr GTT. load iwth
77
Pregnancy glucose targets?
fasting <95, 1-hour postprandial <140 2 hour <120
78
osteoporosis?
T score >-2.5. Tx with biphosphonoates if with fragility fracacutres.
79
Low Tsh, low t4?
do ACTH sitim test, dont treat with levo in case of adrenal crisis in patients with uncorrected adrenal insufficiency.
80
Onychomycosis of toes?
KOH preparation or PAS of nail scrapings, treat with terbinafine.
81
Bad pancreatitis?
Measure BUN, hematocrit. Bad if BUN >20 and if elevated hct >44 (hemoconctration from thrid space losses)
82
LIkelihood ratio?
sensitivity/(1-specificity)
83
palpable purpura, elevated rheumatoid factor, hypocomplementemia, kindey failure, weakness?Hep C?
Mixed cryoglobulinemia(vasculitis due to immune compleces within the wall of small and medium-size vessels. Come with chronic hepatitis C. Tx hep c with antiviral and immunosuppressive therapy for cryoglobulinemia.
84
Renal failure bleeding?
Desmopressin to help with platelet dysfunction.
85
TSH and OCPs?
INcrease Levo dose due to increase in thyrid-binding globulin from estrogen-containing oral contraceptives.
86
hypoglycemia with high proinsulin levels?
Endogenous insulin production.
87
Extra benefit of metformin and pioglitazone?
Decreases triglycerides, increases HDL and improves NASH.
88
Tx of metoclopramide-induced acute dystonia?
diphenhydramine
89
Undescended testes age of concern?
>6 months
90
PE vs Cardiogenic shock?
PE has elevated R atrail, r ventricular, and pulmonary artery pressures, but more likely hyperdynamic LV function with increased CI. PCWP and SVR are generally not affected, cardiongenic schock they will both increase (volume overload and compensation)
91
PTH and calcium?
Increases absorption from kidneys. (also low PTH means ineffective conversion of ctiamin D in the kidneys to the active 1,25-hydroxyvtimianin K.
92
Patient with dumping syndrome after gastrectomy?
High protein, low carb diet. Smaler and more frequent meals throughout the day.
93
WHen to give steroids for PCP PNA?
If A-A gradient is > 35 or arterial oxygen tension <70 mm on room air.
94
WHen does protracted labor occur?
at >6cm when the rate of cerical change is slower than 1 cm/2 hour. MCC is contraction inadequacy, give oxytocin and amniotomy.
95
Rotator cuff tendonitis PE?
Lateral shoulder pain aggravated by abduction and external rotation of the shoulder.
96
WHen to follow sigmoidoscopy with colonoscopy?
Large >1.o cm adenomatous polyps. Multiple adenomatous polyps, polyps with villouw or tubulovillous morphology.
97
Diptheria sx?
REspiratory, sore throate, pharyngitis with grey exudates, myocarditis, nervous system and kidney problme.s
98
Patient with non-supressable high-dose dexamethasone suppression test and low plasma ACTH levels?
Likely cushings syndrome with adrenal etiology, do CT scan of the adrenal glands(no MRI, not central)
99
Warfarin in pregnancy?
1st trimester, use LMWH(does not cross placenta) instead. Can use in 2nd and 3rd if really high risk. UFH in the last few weeks because it is readily reversed with protamined.
100
Perinaud syndrome?
loss of pupillary reaction, vertical gaze paralysis, loss of optokinetic nystagmus, and ataxia.
101
Craniopharyngioma assocttion?
DI and anterior pituitary hormone (LH, FSH, TSH, GNRH, ACTH)
102
Tx for infantile spasms?
ACTH and vigabatrin.
103
Side effect of valproic acid?
thrombocytopenia, hepatotoxicity. pregnancy issues
104
Ischemic stroke BP goals?
2220/120, 185/105 if patient has not received thrombolysis
105
Hemorhaggic stroke bp goals?
<140
106
12 yo with tall stature, myopia, and increased arm span to height ratio?
Suspect marfans and do an ECHO to eval for aortic root disease, as this is a risk for sudden cardiac death.
107
Giardia tx?
Metronidazole
108
Meta-analysis of large sample size?
Consider clinical significant.(meta combines the results of several studies to increase statistical power through an increased sample size.
109
Left sided pleural effusion after CABG?
Reassure. Occur in 60 percent of patients due to postsurigcal pericardial inflammation(usually small and left -sided) Worry if >24% of hemithroax or sx effusion, late-onset effusion greater than 30 days, or predominantly right-sided effusino in the absence of heart failuyre.
110
Subperiosteal bleed that does not cross suture lines?
Cephalohematoma. If crosses suture line: caput succedaeum. Rapid swelling after vaccum assited delivery is soncern for subgaleal hemorrhage.
111
Girl who starts fire in school?
Conduct disorder if less than 18, anti-social personality disorder after.
112
Hip dysplasis in children?
COnsul ortho for pavlik harness. US if <4 months, x-ray if greater than 4 months
113
Major depression with psychotic features who refused to eat and drink along with severe depression, psychotic, suicidal?
COnsider ECT as combo of antidepressant plus anti-psychotic.
114
Side effect of glucocorticoid spray for allergies?
Epistaxis.
115
15-month old boy with fever, harsh cough, stridor, narrowing of subglottic space?
Parainfluenza(croup) (no cough with H influenzA)
116
ecological studies?
Measure populations, do not translate into the individual level.
117
Bladder pain for >6 weeks?
Consider interstitial cystitis. Pain is worse when the bladder is full and relieved during urination.
118
32 yo woman with decompensated heart failure in pregnancy?
Tx with loop diuretics, hydralazine (direct arterial dilatorthat reduces afterload) and isosorbide mononitrate(venous dilator that reduces preload). ACE-I associated with fetal renal toxicity, persistent patent ductus, neonatal death, and are contraindicated.
119
Conjunctivitis in kid?
Think measles or kawasakis. (Erythema infectiosum=fifths=parvovirus b15 is well-appearing without conjuncivitis along with rash on face and abdomen after nonspecific prodrome)
120
Patient delirious(disorientation and lethargy) in shizophrenic patient?
Consider psychogenic polydipsia. (clue is doing MOCA exam on patient)
121
Sexually active primary dysmenorrhea?
OCPs, also nSAIDs first line if no sexually active.
122
utliity of control group in
study of group of individuals who are not exposed to the treatment or intervention being studied. establishes internal validity. External valididty is dependent on the adequacy and size of the sample.
123
Lupus in pregnancy?
Neonatal lupus can develop from transplacental passage of maternal anti-SSA (ro) and anti-SBB la antibodies and is associtated with a risk of complete heart block. Women with lupus should avoid pregnancy unil their disease is quiscent for 6 months and those taking hydroxycloroquine should continue the medication.
124
Spontaneous pneumomediastinum?
Resolves spontaneously and give analagesic and oxygen as needed. Chest tube if pneumothroax.
125
What is greatest risk after starting stimulant?
Blood pressure and heart rate.
126
Woman with stress urinary incontinence?
Initial management is lifestyle modifications ie weight less, smoking cessation, decrased intake of caffeine and alcohol, pelvi floor exercises, pessary.
127
RF for rapidly progressive kidney disease?
HTN, proteinuria, and hyperflycemia.
128
ACE inhibitor with aki?
Normal within first several weeks of treatment due to decreased glomerular filtration rate.
129
Patient with sanblasting history, foundry work, with small, round opacities in the upper lobes?
Conisder silicosis. Respiratory protection is best prevention.
130
Patient with recurrent nephrolithiasis and non-angion gap metabolic acidosis on lab eval?
Distal(type 1 ) Rental tubular acidosis. When kdineys are unable to excrete hydrogen ions into te collecting tubules, resulting in elevated urine ph (greater than 5.5) and decreased bicarb, hyperchloremia, hypokalemis. Give bicard to corrected metabolic acdisosis.
131
Painful ulcer on penis?
Chancroid (lumphogranuloma venerum is painless like syphilis and has lymphadenitis during its second stage.
132
36 yo man itchy rash on buttocks and thighs, raised, erythematous, linear rash from dominican republic?Tropical region with
Strongyloidiasis.
133
Case control ?
Assess retrosecptively for exposure to >1 risk factor.
134
Pragmatic trial?
effectiveness trial. (alternative is explanatory trials)
135
Fluoxetine for eating disorders?
bulimia nervosa (anorexia is better with CBT)
136
tx for menopasual hot flashes?
estrogen based hormone replacement...SSRI if patient with contranindication. (breast cancer, VTE, CAD, endometrial cancer)
137
WBC casts after infection?
Consider AIN (antibiotics) also post-infectious IgA nephropathy(within 3 days) or post-strep (weeks after0
138
Most common cause of skin abscesses ?
Staph aureus (cellulitis: Strep pyogenes is more common)
139
tx for transient synovititis?
NSAID. vs septic arthritis: aspiration (ill appearing, inability to bear weight, high CRP etc.
140
UNtreated kawasaki disease?
Aneurysms with calcifications
141
Patient with hepatic encephalopathy ?
Consider reversible causes ie temazepam and sedative use, hypovolemia, hypokalemia, hyponatremia, infection GI bleeding as precipitating events.
142
Abrutpyl stopping shorter half-life depressant?
Antidepressant discontinuation syndrome...similar to depression.
143
PCP vs cocaine?
PCP with nystagmus and atazia, along with violent behaviour and dissociation.
144
Pleural fluid serum glucose ratio?
if
145
Obstructive airway pattern?
FEV1/FVC ratio
146
Patient with visible swelling of elbow on x-ray?
COnsider olecranon bursitis, do aspiration of bursa fluid to differentiat from septic vs inflammatory sterile
147
What medications can raise bP?
NSAIDS, decongestatnts, antidepressants, OCPS, glucocorticoids, stimulants.
148
Herpes in pregnancy?
Tx with acyclovir from 36 weeks gestations to delivery with Cesarean delivery if there are symtpoms at term.
149
Hypospadias in infant w/o crypoorchidism (undescdended testicles)?
Do surgery at 6 months, if cryporchidism, do ultrasound to identify uterus or karyotye. Renal US if UPPer urinary tract abnormalities if other organi system are present with.
150
ITP?
Viral illness that generates autoantibodies against platelet antigens, normal platelets, normal leukocytes, erythrocytes , and coagulation studies. Tx with steroids if <30,000, IVIG and platelety transfuion if hemorrhage. vs (TTP which is microangiopathy that cuases severe thrombocytoenia, hemolytic anemia, organi damage....tx with plasma exchange)
151
Diarrhea in kid?
Rotavirus
152
Failure to thrive?
<5th percentile or decrease in weight that crosses 2 major percentiles.
153
Loss of peripheral vision and enlargement of the optic cup (cupping)?
open-angle glaucoma(atrophy of the optic nerve head(commonly in older, african americans)Elevated IOP due to increased outflow of auqeous humor. (macular dengeration would have loss of central vision rather than peripheral vision with drusen present.
154
Ovarian cancer?
Surgical exploration for dx, staging, and cytoreduction. No biopsy because possible to spread cancer to abdmoinal cavity.
155
Women with +IgG and -IGM antibodies ?
Immune, not at risk fro acute infection. Do ultrasound if patient is not immune.
156
Patient with calcium stones, how to prevent?
increase fluids and decrease oxalate, animal protein, and sodium intake.
157
Patient with syncope without prodrome and left fascicular block?
THink cardiogenic due to SA or AV conduction abnormlaitiy.
158
3 yo with stroke like symptoms?
Do transcranio dopper ultrasound for eval to screen for elevated arterial velocieies, which indicate an increased risk of stroke in patients with vaso-occlusion from sickle cell-anemia (most common cause of stroke in children)
159
Monochorionic diamniotic twin gestations?
INcreased risk for twin-twin transfuion syndrome.
160
HIT type 1 ?
<2 days after hep administration and mild platelet reduction that resovles without changes. Hit 2 is platelet decline in 30-50 percent <1 day after hap administration. Requires dc hep, HIT antibody testing, and argatroban
161
3 yo boy with left sided abdominal pain, palpable splenomaegaly, and severe anemia in the setting of sickle cell disease?
Splenic sequestration, and casocllusion.....give crystalloid fluids for hypotensive schok, then blood transufion
162
Patient sick in the ICU that develops fever, leukocytosis, and jaundice? CT or ultrasound shouds gallbladder wall thickening without choleliths?
Likely acalculous cholecystisits. Treat with percuatenous cholecystosomy.
163
Opioid induced constipation?
Senna and docusate.
164
Patient with hypotension, postpartum hemorrhage, and smooth, round, vaginal mass?
Uterine inversion. Uterine fundus collpaes into the endometrial cavity and prolapses through the vagina(from excessive umbilical cord traction)Tx with manual uterine replacement, DC uterotonics ie oxytocin. (if actual hemorrahge uterotonics--> uterine blaoon tamponade--> uterine artery embolization if stable.
165
Baby with hematocrit >65 and hg > 22?
Neonatal polycythemia. Monitor blood glucose and bilirubin. (fyi initiate phototherapy if bili is >5.
166
Sickle cell trait and exercise?
At risk for explosive rhabdo
167
Protective factors ovarian cancer?
OCPs, muliparity, breastfeeding, salpingo-oophorectomy
168
IUFD, risk of waiting for term?
Increases risk of coagulopathy.
169
Otitis externa?
Pseudomonas
170
Options of bipolar depression?
Lamotrigine, quietapine, and lurasidone.
171
35 yo woman with firm mass on l breast, best next step?
Mammogram. If <30 do US
172
MI due to cocaine?
IV benzos, nitroglycerin...persistent ST elevations should undergo cardiac revascularization without delay.
173
Normal T3 and T4 in pregnancy?
1.5 x nonpregnant reference range, adjust dose to mainatain a mild hyperthryoid state.
174
Polyhydramnios cutoff?
>24 cm amniotic fluid index
175
Metformin contraindications?
renal insufficiency, hepatic dysfunction, alcohol abuse, sepsis, or congestive heart failure (creatinin >1.). Increase risk of lactic acidosis when combined with large-dose IV iodine contrasts
176
When to get endoscopy for dyspepsia?
>55 yo, or alarm symptoms (dysphagia, weight loss, vomiting, iron deficiency anemia)
177
Previously vaccinated for rabies, with repeat exposure?
Booster with rabies vaccine. (unvaccinated patients receive rabies vaccine and rabies immunoglobulin)
178
Patient with delusions or hallucinations >2 weeks?
Shizoaffective disorder(major depressive with psychotic happens with mood episodes, shizophrenia is more brief symptoms.) >2 weeks in shizoaffective
179
76 yo man in moderate distress with bluish discoloration, concentric rings, and friability on anus?
Rectal collapse, consult surgery for
180
HOw to test for EBV?
heterophile anitbodies...associated with B cell lymphoma, T cell lymphoma, hodgkin lymphoma, and nasopharyngeal carcinoma.
181
Ampicllin in HIV with EBV?
Morbilliform rash.
182
Patient with pituitary adenoma, when to give cabergoline?
any degress of hypogonadism.(high doses associtaed with valvular heart disease)
183
How long for depression?
>2 weeks of sig e caps
184
Adjustment disorder with depressed mood?
Within 3 months of stressor, appropriate response.
185
Patient with anti-smooth muscle antibodies and LFTs?
consider type 1 autoimmune hepatitis, tx with ursodeoxycholic acid, may need liver tx.
186
Complication of PBC?
osteoporosis (normal vitamin D)
187
GBS prophylaxis?
ampicillin, pencilline, cefazolin >4 hours before delivery. If GBS positive, observe for 48 hours for sx of infections. (dont get blood cx iunless pre-term infant and PROM)
188
Patient with stroke that received TPA?
BP goal <185, if no TPA 220/120
189
Malignant otitis externa?
pseudomonas, tx with cipro
190
Good prognostic factors for Shizophrenia?
later age of onset, acute onset. POsitive sx respon well to antipsychoitic meds.
191
ferritin level for iron deficiency anemia?
<15
192
starting amio and warfarin at same time?
decrease warfarin dose by 25 %
193
Lumbar spinal stenosis dx?
MRI
194
New dx HIV?
Get CD4 count, viral load, HIV genotpying and hep B(some drugs are affective aginst hep B and HIV
195
Lichen planus association?
Dx with skin biospy, associated with hepatitis C and liver antibodies.
196
Dark rash in pregnancy?
Melasma, irregularly shaped, hyperpigmented macules on the face. Avoid sun(due to estrogen, progesterone, and MSH
197
Subacute thyroiditis vs Graves?
Low radioodine uptake (graves will have increased)
198
WHen to use ANOVA?
where means of a continous variables in several groups (categorical variable) CHi square is for association between categorical variables. Paired T-test tests difference between 2 paried means.
199
Patient with widespread redness and blistering across neck and trunk withs evere itching and vesicles and tense bullae?
DO skin biopsy to differntiate bullous pemphigoid from pemphigus bulgaris, demratitis heptifromeis, linear IG bullous dermatosis.....May need to use high-potency glucocritcoids.
200
Patient with positive stress test?
Coronary aniography to eval for revascularization
201
Tinea capitus?
DO KOH of shair shaft oral griseofulvin or oral terbinafine. Can use ketoconazole shampoot, but insufficienct as monotherapy.
202
How to monitor heart for patient on doxorubicin?
Daionuclid ventriculography has high accuracy and reproducibility for measuring ejection fractions.
203
Patient with right sided, scrotal serythema, swelling, and tenderness with cremasteric reflex intact?
UA and cx , tx with ceftiaxone/doxy.
204
UNhealthy alcohol use?
>3 drinks a day,
205
when to treat sublinical hypothyroidism?
if antithryoid antibodies, abnormal lipid profile, symptoms, ovulatory and menstrual dysfunction.
206
Best treatment for pancreatogenic DM?
insulin
207
Opioid withdrawal ?
clonicidine and methadone
208
Pelivs mass during pregnancy?
Remove during 2nd trimester if >10 cm, has complex features, and is persistent.
209
Patinet with RUQ pain, fever, nausea, vomiting, and leukocytosis but no gallbladder thickening of Murphy sign on ultrasound?
Do HIDA scan to confirm diagnosis. (if acute cholecysitis, need lap chole within 72 ours) biliary colic have transient <6 hours RUQ pain, nausea and comiting, without abdominal pain, fever, and leukocytosis.
210
Tests for vaginal candida?
make sure to do wet mount and vaginal ph
211
FNA is bloody?
Send for cytology, if solid and malignant: excise. If solid and benign, mammogram if >35 , repeat in 6 months if negative
212
Hypertensive emergency drug of choice?
Nitroprusside
213
Increased PTT, lower factor VIII?
Hemophilia A (order XI, IX just in case)
214
MCC of non-gonococcal septic arthritis in adults?
Staph aureus
