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1
Q

Severe Aortic Stenosis Criteria

A
  • Aortic Jet Velocity >/= 4m/sec
  • Mean transvalvular pressure gradient >/= 40 mmHg
  • Valve Area usually =1cm
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2
Q

Indications for valve replacement

A
  • Severe AS and >/= 1 of the following:
    • Onset of symptoms
    • LVEF <50%
    • Undergoing other cardiac surgery
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3
Q

What are the medical contraindications to pregnancy?

A
  • LVEF <40%
  • NYHA class III-IV heart failure
  • Prior peripartum cardiomyopathy
  • Severe obstructive cardiac lesions
  • Severe pulmonary HTN
  • Unstable aortic dilation >40mm
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4
Q

An elevation of what hormone confirms the diagnosis of 21-hydroxylase deficiency?

A

17-hydroxyprogesterone

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5
Q

How dto differentiate 21-hydroxylase and 11beta-hydroxylase deficiency?

A

hypotension (low sodium, high K) in 21-hydroxylase and hypertension in 11beta-hydroxylase (both have ambiguous genetalia

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6
Q

How to differentiate 11beta-hydroxylase from 17alpha-hydroxylase deficiency?

A

17-alpha hydroxylase deficiency will be phenotypically normal females and 11-beta hydroxylase will have ambiguous genitalia (both will have hypertension)

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7
Q

How do you treat H Pylori?

A

PPI + Clarithromycin + Amoxicillin for 10-14 days

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8
Q

How do you treat H Pylori with penicillin allergy?

A

PPI + Clarithromycin + flagyl for 10-14 days

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9
Q

How do you treat H Pylori with treatment failure?

A

PPI + Bismuth + Flagyl + tetracycline for 10-14 days

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10
Q

How does licorice cause hypertension?

A

Licorice contains glycyrrhetinic acid, which inhibits 11-beta-hydroxysteroid dehydrogenase, thereby preventing the local converstion of cortisol to cortisone. Excess cortisol binds to mineralocorticoid receptors and causes HTN

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11
Q

What is Penicillamine used for?

A

Increased excretion of copper in Wilson’s Disease

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12
Q

What is the gold standard for treatment of infantile spasms?

A

Corticotropin (ACTH) and vigabatrin

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13
Q

What is the treatment for typical absence seizures?

A

ethosuximide

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14
Q

What are the EEG findings for juvenile myoclonic epilepsy and how do you treat it?

A

bilateral polyspike slow wave activity and treat with Valproic acid

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15
Q

How do calcineurin inhibitors cause nephrotoxicity?

A

increasing vasoconstrictor endothelin, inhibiting nitric oxide activity and increasing sympathetic outflow

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16
Q

Which live vaccines are okay in HIV infected patients?

A

MMR vaccine, varicella and zoster virus vaccines

(must have CD4 >200 and no h/o AIDS defining illness

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17
Q

What has St. John’s wort (hypericum perforatum) been proven to treat?

A

mild to moderate depression (equivalent to TCAs and SSRIs)

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18
Q

What is the initial treatment for mixed cryoglobulinemia syndrome?

A

rituximab + prednisone

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19
Q

What are the lab findings in post-strep GN?

A

low C3, normal C4 and positive streptozyme test

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20
Q

What are the lab findings in mixed cryoglobulinemia syndrome?

A

elevated RF and hypocomplementemia (also HCV positive)

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21
Q

How do you treat epididymitis?

A

CTX/Doxycycline if STI

Levofloxacin (if coliform bacteria–see more in BOO with age >35)

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22
Q

When is iron supplementation recommended in patients with ESRD?

A

transferrin saturation <30% and ferritin <500 ng/mL

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23
Q

When is EPO recommended in CKD?

A

Hemoglobin <10

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24
Q

What are the lab findings in absolute iron deficiency?

A

Transferrin Saturation <20% or ferritin <100ng/mL

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25
Q

What are the contraindications to neuraxial analgesia?

A

severe thrombocytopenia (<70K) or rapidly dropping platelet count (often associated with preeclampsia with severe features)

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26
Q

What are the initial screening labs at the first prenatal visit?

A
  • Rh(D), antibody screen
  • Hgb/Hct, MCV
  • HIV, VDRL/PRP, HBsAg
  • Rubella and varicella immunity
  • Pap test (if screening indicated)
  • Chlamydia PCR
  • Urine culture
  • Dipstick for urine protein
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27
Q

When do you send 50-g 1-hour GCT?

A

24-28 weeks

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28
Q

When do you check for GBS?

A

35-37 weeks

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29
Q

What is the treatment for septic arthritis in kids?

A

vancomycin (plus cefotaxime if age <3 months as you have to cover GNRs)

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30
Q

What is the treatment for diptheria?

A

erythromycin or penicillin G

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31
Q

What are the complications of diptheria?

A

toxin-mediated myocarditis, neuritis, kidney disease

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32
Q

How do you manage infants born to mothers requiring GBS ppx?

A

If mother received ppx >/= 4h before delivery: observe for 48h

If >/= 37 weeks and membranes ruptured <18 hours: observe for 48h

If <37 weeks gestation and membranes ruptures >18 hours: CBC, blood culture and observe for 48h

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33
Q

Primary Prevention ICD indications

A

Prior MI and LVEF =30%

NYHA class II or III symptoms and LVEF = 35%

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34
Q

Secondary Prevention ICD inidcations

A

Prior VF or unstable VT without reversible cause

Prior sustained VT with underlying CM

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35
Q

What is a worrisome Hgb Level in pregnancy?

A

<11 g/dL in first trimester and third trimester and <10.5 g/dL in the third trimester

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36
Q

What is the agent of choice for prevention of episodic and chronic cluster HA?

A

Verapamil

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37
Q

What is STOP Bang Survey?

A

1 point each (>/=5 high and 3-4 points intermediate risk):

  • Snoring
  • Excessive day-time tiredness
  • Observed apneas or choking/gasping
  • HTN
  • BMI >35
  • Age >50
  • Neck size >17 men or >16 women
  • Male gender
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38
Q

What test is used to evaluate for torn achilles tendon

A

Thompson Test: squeeze the patient’s calf muscles and observe for presence of plantar flexion of the foot–if it is observed, test is negative and indicates normal function of the Achilles tendon

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39
Q

Sensitivity

A

True Positives/ (true positives + false negatives)

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40
Q

Specificity

A

True Negatives/ (true negatives + false positives)

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41
Q

Positive Predictive Value

A

True Positives/ (true positives + false positives)

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42
Q

Negative Predictive Value

A

True Negatives/ (true negatives + false negatives)

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43
Q

Positive Likelihood Ratio

A

Sensitivity/(1-specificity)

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44
Q

Negative Likelihood Ratio

A

(1-Sensitivity)/Specificity

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45
Q

What is aristolochic acid used for and what is the major risk?

A

weight loss

biggest risk is nephrotoxicity

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46
Q

What is ginkgo biloba used for and what is the major risk?

A

memory enhancement

increased bleeding risk

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47
Q

What is ginseng used for and what is the major risk?

A

improved mental performance

increased bleeding risk

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48
Q

What is saw palmetto used for and what is the major risk?

A

BPH

mild stomach discomfort and increased bleeding risk

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49
Q

What is black cohosh used for and what is the major risk?

A

postmenopausal symptoms

hepatic injury

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50
Q

What is St John’s Wort used for and what is the major risk?

A

Depression/Insomnia

(drug interactions with antidepressants, OCPs, anticoagulants and digoxin) and HTN crisis

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51
Q

What is kava used for and what are the major adverse effects?

A

anxiety and insomnia

sever liver damage

52
Q

What is licorice used for and what are the major adverse effects?

A

stomach ulcers, bronchitis/viral infections

hypertension and hypoK

53
Q

What is echinacea used for and what are the major adverse effects?

A

Treatment and prevention of cold and flu

anaphylaxis–usually in asthmatics

54
Q

What are glucosamine and chrondroitin used to treat?

A

osteoarthritis (safe but not been shown to be effective)

55
Q

What is the biggest risk factor for Kava Kava?

A

potential risk for severe liver toxicity

56
Q

What is a Smith’s fracture and how do you get it?

A

Ventrally displaced distal radius fracture due to hyperflexion with a fall

**Need to consult ortho

57
Q

What is a Colles’ fracture?

A

distal radius fracture with shortening and dorsal displacement

58
Q

How do you treat a Colles’ fracture?

A

sugar tong splinting (with or without closed reduction)

59
Q

What happens with nursemaid elbow?

A

sudden pulling force causes the annular ligament to slide over the radial head and become entrapped in the radiohumeral joint (radial head subluxation)

60
Q

What is the difference between breast milk jaundice and breastfeeding failure jaundice?

A

breastfeeding failure jaundice presents in the first week of life and breast milk jaundice starts at age 3-5 days and peaks at 2 weeks

61
Q

Methotrexate adverse effects.

A

Hepatotoxicicty
Stomatitis
Cytopenias

62
Q

Leflunomide adverse effects

A

Hepatotoxicity

Cytopenias

63
Q

Hydroxychloroquine adverse effects

A

Retinopathy

64
Q

Sulfasalazine adverse effects

A

Hepatotoxicity
Stomatitis
Hemolytic anemia

65
Q

TNF Inhibitor (adalimumab, etanercept, infliximab) adverse effects

A

infection
demyelination
CHF
malignancy

66
Q

Cause of atopic dermatitis.

A

Mutations of filaggrin and other epidermal barrier proteins

67
Q

Treatment of comedonal acne

A

Topical retinoids, salicylic, azelaic acid or glycolic acid

68
Q

Treatment of inflammatory acne

A
  • Mild: topical retinoids + benzoyl peroxide
  • Moderate: add topical abx (erythromycin and clindamycin)
  • Severe: add oral abx
69
Q

Treatment of nodular (cystic) acne

A
  • Moderate: topical retinoid + benzoyl peroxide + topical abx
  • Severe: add oral abx
  • Unresponsive severe: oral isotretinoin
70
Q

Definition of recurrent UTI

A
  • > /= 2 infections in 6 months

- >/= 3 infections in 1 year

71
Q

What is acanthosis nigricans associated with?

A

insulin resistance and GI malignancy

72
Q

What are multiple skin tags associated with?

A

insulin resistance and pregnancy and Crohn disease (perianal)

73
Q

What are porphyria cutanea tarda and cutaneous leukocytoclastic vasculitis (secondary to cryoglobulinemia) associated with?

A

HCV

74
Q

What is dermatitis herpetiformis associated with?

A

celiac disease

75
Q

What skin conditions are associated with HIV?

A

severe SD, sudden onset severe psoriasis, recurrent herpes zoster, disseminated molluscum contagiosum

76
Q

What is severe seborrheic dermatitis associated with?

A

HIV and Parkinson’s Disease

77
Q

What is pyoderma gangrenosum associated with?

A

IBD

78
Q

How do you manage HSIL?

A

LEEP or Colposcopy

79
Q

What is the management of CIN2 or 3 in patients 21-24?

A

if 21-24: repeat colposcopy and cytology and 6 months intervals for 2 years

80
Q

What are the two auto-antibodies of pernicious anemia?

A

anti-parietal and anti-intrinsic factor antibodies

start with Anti-IF testing

81
Q

HIT chart.

A

2 points for Platelet drop >50% and nadir >20K; onset 5-10 or <1 day if prior heparin exposure within 30 days, and thrombosis, skin necrosis or acute systemic reaction

1 point for platelet count drop 30-50% or nadir 10-19; consistent drop at 5-10 days, onset after 10 days, or <1 day with prior heparin exposure, progressive or recurrent thrombosis with non-necrotizing skin lesions

6-8 points = high prob
4-5 points = intermediate probability

82
Q

Activity restrictions for mono

A

Avoid all sports for minimum 3 weeks and contact sports for minimum of 4 weeks

83
Q

What antibiotic changes can be made to avoid c-diff?

A

restrict use of clinda, fluoroquinolones and cephalosporines

consider using aminoglycosides or Bactrim instead of fluoroquinolones

84
Q

What are normal measurements in a RHC?

A 
RA: 4mmHg
PCWP: 9mmHg
CI: 2.8-4.2
SVR: 1150 (afterload)
Mixed Venous oxygen saturation: 60-80%
85
Q

What are the RHC measurements in hypovolemic shock?

A

low RA (preload), Low PCWP (preload), Low CI, High SVR, low mixed venous oxygen saturation

86
Q

What are the RHC measurements in cardiogenic shock?

A

high RA, High PCWP, very low CI, high SVR, low mixed venous oxygen saturation

87
Q

What are the RHC measurements in septic shock?

A

normal or decreased RA and PCWP, increased CI, decreased SVR, increased mixed venous oxygen

88
Q

How would hepatic veno-occlusive disease present?

A

patients with bone marrow transplant and presents with tender hepatomegaly, jaundice and ascites

89
Q

Becks triad for pericardial effusion

A

Hypotension
JVD
Decreased Heart Sounds

90
Q

Antibiotic treatment for septic abortion.

A

gentamicin plus clindamycin

91
Q

How do you treat dirty wounds (tetanus)?

A

If >/= 3 tetanus toxoid doses, give vaccine (only if last dose is >/= 5 years ago)

If unknown, give TIG and tetanus containing vaccine

92
Q

How do you treat clean wounds (tetanus)?

A

If >/= 3 tetanus toxoid doses, give tetanus shot only if last dose >/= 10 years ago

If unknown, give tetanus vaccine only

93
Q

Which people (other than hospitalized) should get Tamiflu regardless of symptom duration if they test positive?

A
  • Age >65
  • Women who are pregnant and up to 2 weeks postpartum
  • Underlying chronic medical illness
  • Immunosuppression
  • Morbid obesity
  • Native americans
  • Nursing home or chronic care facility residents
94
Q

What are contraindications to breastfeeding?

A
  • active untreated Tb
  • Maternal HIV
  • Herpetic breast lesions
  • Active varicella infection
  • Chemo or radiation
  • Active substance abuse
95
Q

How do you manage infants born to mothers with HIV?

A

If maternal viral load <1000, treat with zidovudine

If maternal viral load >1000, treat with multi-drug ART

96
Q

How do you treat women who are pregnant with HIV?

A

ART with vaginal delivery with viral load <1000

ART with zidovudine and C-section if viral load >1000

97
Q

In what groups of children are tubes recommended for AOM recurrence?

A
  • at least 3 episodes in 6 months or at least 4 episodes in 12 months
  • high risk for speech impairment such as children with craniofacial abnormalities or neurodevelopmental disorders
98
Q

CSF for bacterial meningitis

A

> 1000 WBC
<40 glucose
250 protein

99
Q

CSF for Tb Meningitis

A

100-500 WBC
<45 glucose
100-500 protein

100
Q

CSF for Viral Meningitis

A

10-500 Wbc
40-70 Glucose
<150 protein

101
Q

CSF for GBS

A

0-5 WBC
40-70 glucose
45-1000 protein

102
Q

What is required for a diagnosis of acute pancreatitis?

A

2 of the following:

  • acute onset of persistent, severe epigastric pain
  • elevations in serum amylase/lipase >3 times the upper limit of normal
  • Findings of pancreatitis on abdominal imaging
103
Q

Hypercalcemia findings with elevated PTHrP (what types of cancer)?

A

low PTH, high PTHrP

Squamous cell carcinoma, Renal, Bladder, Breast, Ovarian

104
Q

Hypercalcemia findings with bone mets (what types of cancer)?

A

Low PTH, Low PTHrP, low Vitamin D

Breast and MM

105
Q

Hypercalcemia findings with high vitamin D (what types of cancer)?

A

low PTH, high Vit D

Lymphoma

106
Q

What abx have the highest c-diff risk?

A 
Fluoroquinolones
Clinda
3rd and 4th generation cephalosporins
Carbapenems
Monobactams
107
Q

What abx have the lowest c-diff risk?

A

Bactrim
Macrolides
Tetracyclines
Aminoglycosides

108
Q

Meds that cause prolonged QT?

A
  • diuretics
  • Zofran
  • Haldol, risperidol, quetiapine
  • TCAs
  • SSRIs
  • Anti-arrhythmics
  • Anti-anginals
  • Macrolides, fluoroquinolones, antifungals
109
Q

Management of pediatric sepsis (= 28 days)?

A

ampicillin with gent or cefotaxime

covering for EColi and GBS

110
Q

Management of pediatric sepsis (>28 days)?

A

CTX or cefotaxime +/- vancomycin (when meningeal involvement is suspected)

(covering for strep pneumo, Neisseria meningitidis)

111
Q

How do you calculate q-SOFA?

A

1 point each (and if >/= 2 points, likely to be septic):
-RR >22
-AMS
SBP <100

112
Q

Beast mass workup if <30.

A

Ultrasound +/-mammogram

113
Q

Breast mass workup if >/= 30.

A

Mammogram +/- ultrasound

114
Q

What happens if an ultrasound of a breast mass shows a simple cyst

A

needle aspiration (if patient desires)

115
Q

What happens if an ultrasound of a breast mass shows a complex cys or a mass?

A

get an image-guided core biopsy

116
Q

What happens if an ultrasound or mammogram of a breast mass shows findings suspicious for malignancy?

A

core biopsy

117
Q

Formula for calculation of A-a gradient?

A

[FiO2 * (760-47) - (PaCO2/0.8)] - PaO2

Normal is <15 of patient age/4 +4

118
Q

How good is the ABCDE criteria?

A

Any 1 of 5 positive is a 97% sensitivity for melanoma with 36% specificity (using all 5 is 100% specific and 43% sensitive)

119
Q

Conjunctivitis findings in viral infection.

A

watery/mucoid discharge, 1-2 weeks duration, viral prodrome

120
Q

Conjunctivitis findings in bacterial infections.

A

purulent discharge, 1-2 weeks, unremitting ocular discharge

121
Q

Conjunctivitis findings in allergic infections.

A

always bilateral, <30 minutes or perennial, watery discharge and ocular pruritis

122
Q

How do you treat organophosphate poisoing (brady, pupil constriction, tearing, vomiting, etc)?

A

atropine and pralidoxime

123
Q

What is the most sensitive imaging finding for osteomyelitis?

A

MRI

124
Q

What is the most specific diagnostic test for osteomyelitis?

A

probe to bone

125
Q

How long are plain films negative in osteo?

A

> 2 weeks after infection onset

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