Step 3 Flashcards
(125 cards)
1
Q
Severe Aortic Stenosis Criteria
A
- Aortic Jet Velocity >/= 4m/sec
- Mean transvalvular pressure gradient >/= 40 mmHg
- Valve Area usually =1cm
2
Q
Indications for valve replacement
A
- Severe AS and >/= 1 of the following:
- Onset of symptoms
- LVEF <50%
- Undergoing other cardiac surgery
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
4
Q
An elevation of what hormone confirms the diagnosis of 21-hydroxylase deficiency?
A
17-hydroxyprogesterone
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
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)
7
Q
How do you treat H Pylori?
A
PPI + Clarithromycin + Amoxicillin for 10-14 days
8
Q
How do you treat H Pylori with penicillin allergy?
A
PPI + Clarithromycin + flagyl for 10-14 days
9
Q
How do you treat H Pylori with treatment failure?
A
PPI + Bismuth + Flagyl + tetracycline for 10-14 days
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
11
Q
What is Penicillamine used for?
A
Increased excretion of copper in Wilson’s Disease
12
Q
What is the gold standard for treatment of infantile spasms?
A
Corticotropin (ACTH) and vigabatrin
13
Q
What is the treatment for typical absence seizures?
A
ethosuximide
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
15
Q
How do calcineurin inhibitors cause nephrotoxicity?
A
increasing vasoconstrictor endothelin, inhibiting nitric oxide activity and increasing sympathetic outflow
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
17
Q
What has St. John’s wort (hypericum perforatum) been proven to treat?
A
mild to moderate depression (equivalent to TCAs and SSRIs)
18
Q
What is the initial treatment for mixed cryoglobulinemia syndrome?
A
rituximab + prednisone
19
Q
What are the lab findings in post-strep GN?
A
low C3, normal C4 and positive streptozyme test
20
Q
What are the lab findings in mixed cryoglobulinemia syndrome?
A
elevated RF and hypocomplementemia (also HCV positive)
21
Q
How do you treat epididymitis?
A
CTX/Doxycycline if STI
Levofloxacin (if coliform bacteria–see more in BOO with age >35)
22
Q
When is iron supplementation recommended in patients with ESRD?
A
transferrin saturation <30% and ferritin <500 ng/mL
23
Q
When is EPO recommended in CKD?
A
Hemoglobin <10
24
Q
What are the lab findings in absolute iron deficiency?
A
Transferrin Saturation <20% or ferritin <100ng/mL
25
What are the contraindications to neuraxial analgesia?
severe thrombocytopenia (<70K) or rapidly dropping platelet count (often associated with preeclampsia with severe features)
26
What are the initial screening labs at the first prenatal visit?
- 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
27
When do you send 50-g 1-hour GCT?
24-28 weeks
28
When do you check for GBS?
35-37 weeks
29
What is the treatment for septic arthritis in kids?
vancomycin (plus cefotaxime if age <3 months as you have to cover GNRs)
30
What is the treatment for diptheria?
erythromycin or penicillin G
31
What are the complications of diptheria?
toxin-mediated myocarditis, neuritis, kidney disease
32
How do you manage infants born to mothers requiring GBS ppx?
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
33
Primary Prevention ICD indications
Prior MI and LVEF =30%
NYHA class II or III symptoms and LVEF = 35%
34
Secondary Prevention ICD inidcations
Prior VF or unstable VT without reversible cause
Prior sustained VT with underlying CM
35
What is a worrisome Hgb Level in pregnancy?
<11 g/dL in first trimester and third trimester and <10.5 g/dL in the third trimester
36
What is the agent of choice for prevention of episodic and chronic cluster HA?
Verapamil
37
What is STOP Bang Survey?
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
38
What test is used to evaluate for torn achilles tendon
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
39
Sensitivity
True Positives/ (true positives + false negatives)
40
Specificity
True Negatives/ (true negatives + false positives)
41
Positive Predictive Value
True Positives/ (true positives + false positives)
42
Negative Predictive Value
True Negatives/ (true negatives + false negatives)
43
Positive Likelihood Ratio
Sensitivity/(1-specificity)
44
Negative Likelihood Ratio
(1-Sensitivity)/Specificity
45
What is aristolochic acid used for and what is the major risk?
weight loss
| biggest risk is nephrotoxicity
46
What is ginkgo biloba used for and what is the major risk?
memory enhancement
| increased bleeding risk
47
What is ginseng used for and what is the major risk?
improved mental performance
| increased bleeding risk
48
What is saw palmetto used for and what is the major risk?
BPH
| mild stomach discomfort and increased bleeding risk
49
What is black cohosh used for and what is the major risk?
postmenopausal symptoms
| hepatic injury
50
What is St John's Wort used for and what is the major risk?
Depression/Insomnia
(drug interactions with antidepressants, OCPs, anticoagulants and digoxin) and HTN crisis
51
What is kava used for and what are the major adverse effects?
anxiety and insomnia
| sever liver damage
52
What is licorice used for and what are the major adverse effects?
stomach ulcers, bronchitis/viral infections
| hypertension and hypoK
53
What is echinacea used for and what are the major adverse effects?
Treatment and prevention of cold and flu
| anaphylaxis--usually in asthmatics
54
What are glucosamine and chrondroitin used to treat?
osteoarthritis (safe but not been shown to be effective)
55
What is the biggest risk factor for Kava Kava?
potential risk for severe liver toxicity
56
What is a Smith's fracture and how do you get it?
Ventrally displaced distal radius fracture due to hyperflexion with a fall
**Need to consult ortho
57
What is a Colles' fracture?
distal radius fracture with shortening and dorsal displacement
58
How do you treat a Colles' fracture?
sugar tong splinting (with or without closed reduction)
59
What happens with nursemaid elbow?
sudden pulling force causes the annular ligament to slide over the radial head and become entrapped in the radiohumeral joint (radial head subluxation)
60
What is the difference between breast milk jaundice and breastfeeding failure jaundice?
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
Methotrexate adverse effects.
Hepatotoxicicty
Stomatitis
Cytopenias
62
Leflunomide adverse effects
Hepatotoxicity
| Cytopenias
63
Hydroxychloroquine adverse effects
Retinopathy
64
Sulfasalazine adverse effects
Hepatotoxicity
Stomatitis
Hemolytic anemia
65
TNF Inhibitor (adalimumab, etanercept, infliximab) adverse effects
infection
demyelination
CHF
malignancy
66
Cause of atopic dermatitis.
Mutations of filaggrin and other epidermal barrier proteins
67
Treatment of comedonal acne
Topical retinoids, salicylic, azelaic acid or glycolic acid
68
Treatment of inflammatory acne
- Mild: topical retinoids + benzoyl peroxide
- Moderate: add topical abx (erythromycin and clindamycin)
- Severe: add oral abx
69
Treatment of nodular (cystic) acne
- Moderate: topical retinoid + benzoyl peroxide + topical abx
- Severe: add oral abx
- Unresponsive severe: oral isotretinoin
70
Definition of recurrent UTI
- >/= 2 infections in 6 months
| - >/= 3 infections in 1 year
71
What is acanthosis nigricans associated with?
insulin resistance and GI malignancy
72
What are multiple skin tags associated with?
insulin resistance and pregnancy and Crohn disease (perianal)
73
What are porphyria cutanea tarda and cutaneous leukocytoclastic vasculitis (secondary to cryoglobulinemia) associated with?
HCV
74
What is dermatitis herpetiformis associated with?
celiac disease
75
What skin conditions are associated with HIV?
severe SD, sudden onset severe psoriasis, recurrent herpes zoster, disseminated molluscum contagiosum
76
What is severe seborrheic dermatitis associated with?
HIV and Parkinson's Disease
77
What is pyoderma gangrenosum associated with?
IBD
78
How do you manage HSIL?
LEEP or Colposcopy
79
What is the management of CIN2 or 3 in patients 21-24?
if 21-24: repeat colposcopy and cytology and 6 months intervals for 2 years
80
What are the two auto-antibodies of pernicious anemia?
anti-parietal and anti-intrinsic factor antibodies
| start with Anti-IF testing
81
HIT chart.
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
Activity restrictions for mono
Avoid all sports for minimum 3 weeks and contact sports for minimum of 4 weeks
83
What antibiotic changes can be made to avoid c-diff?
restrict use of clinda, fluoroquinolones and cephalosporines
consider using aminoglycosides or Bactrim instead of fluoroquinolones
84
What are normal measurements in a RHC?
```
RA: 4mmHg
PCWP: 9mmHg
CI: 2.8-4.2
SVR: 1150 (afterload)
Mixed Venous oxygen saturation: 60-80%
```
85
What are the RHC measurements in hypovolemic shock?
low RA (preload), Low PCWP (preload), Low CI, High SVR, low mixed venous oxygen saturation
86
What are the RHC measurements in cardiogenic shock?
high RA, High PCWP, very low CI, high SVR, low mixed venous oxygen saturation
87
What are the RHC measurements in septic shock?
normal or decreased RA and PCWP, increased CI, decreased SVR, increased mixed venous oxygen
88
How would hepatic veno-occlusive disease present?
patients with bone marrow transplant and presents with tender hepatomegaly, jaundice and ascites
89
Becks triad for pericardial effusion
Hypotension
JVD
Decreased Heart Sounds
90
Antibiotic treatment for septic abortion.
gentamicin plus clindamycin
91
How do you treat dirty wounds (tetanus)?
If >/= 3 tetanus toxoid doses, give vaccine (only if last dose is >/= 5 years ago)
If unknown, give TIG and tetanus containing vaccine
92
How do you treat clean wounds (tetanus)?
If >/= 3 tetanus toxoid doses, give tetanus shot only if last dose >/= 10 years ago
If unknown, give tetanus vaccine only
93
Which people (other than hospitalized) should get Tamiflu regardless of symptom duration if they test positive?
- 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
What are contraindications to breastfeeding?
- active untreated Tb
- Maternal HIV
- Herpetic breast lesions
- Active varicella infection
- Chemo or radiation
- Active substance abuse
95
How do you manage infants born to mothers with HIV?
If maternal viral load <1000, treat with zidovudine
If maternal viral load >1000, treat with multi-drug ART
96
How do you treat women who are pregnant with HIV?
ART with vaginal delivery with viral load <1000
ART with zidovudine and C-section if viral load >1000
97
In what groups of children are tubes recommended for AOM recurrence?
- 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
CSF for bacterial meningitis
>1000 WBC
<40 glucose
>250 protein
99
CSF for Tb Meningitis
100-500 WBC
<45 glucose
100-500 protein
100
CSF for Viral Meningitis
10-500 Wbc
40-70 Glucose
<150 protein
101
CSF for GBS
0-5 WBC
40-70 glucose
45-1000 protein
102
What is required for a diagnosis of acute pancreatitis?
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
Hypercalcemia findings with elevated PTHrP (what types of cancer)?
low PTH, high PTHrP
Squamous cell carcinoma, Renal, Bladder, Breast, Ovarian
104
Hypercalcemia findings with bone mets (what types of cancer)?
Low PTH, Low PTHrP, low Vitamin D
Breast and MM
105
Hypercalcemia findings with high vitamin D (what types of cancer)?
low PTH, high Vit D
| Lymphoma
106
What abx have the highest c-diff risk?
```
Fluoroquinolones
Clinda
3rd and 4th generation cephalosporins
Carbapenems
Monobactams
```
107
What abx have the lowest c-diff risk?
Bactrim
Macrolides
Tetracyclines
Aminoglycosides
108
Meds that cause prolonged QT?
- diuretics
- Zofran
- Haldol, risperidol, quetiapine
- TCAs
- SSRIs
- Anti-arrhythmics
- Anti-anginals
- Macrolides, fluoroquinolones, antifungals
109
Management of pediatric sepsis (= 28 days)?
ampicillin with gent or cefotaxime
| covering for EColi and GBS
110
Management of pediatric sepsis (>28 days)?
CTX or cefotaxime +/- vancomycin (when meningeal involvement is suspected)
(covering for strep pneumo, Neisseria meningitidis)
111
How do you calculate q-SOFA?
1 point each (and if >/= 2 points, likely to be septic):
-RR >22
-AMS
SBP <100
112
Beast mass workup if <30.
Ultrasound +/-mammogram
113
Breast mass workup if >/= 30.
Mammogram +/- ultrasound
114
What happens if an ultrasound of a breast mass shows a simple cyst
needle aspiration (if patient desires)
115
What happens if an ultrasound of a breast mass shows a complex cys or a mass?
get an image-guided core biopsy
116
What happens if an ultrasound or mammogram of a breast mass shows findings suspicious for malignancy?
core biopsy
117
Formula for calculation of A-a gradient?
[FiO2 * (760-47) - (PaCO2/0.8)] - PaO2
Normal is <15 of patient age/4 +4
118
How good is the ABCDE criteria?
Any 1 of 5 positive is a 97% sensitivity for melanoma with 36% specificity (using all 5 is 100% specific and 43% sensitive)
119
Conjunctivitis findings in viral infection.
watery/mucoid discharge, 1-2 weeks duration, viral prodrome
120
Conjunctivitis findings in bacterial infections.
purulent discharge, 1-2 weeks, unremitting ocular discharge
121
Conjunctivitis findings in allergic infections.
always bilateral, <30 minutes or perennial, watery discharge and ocular pruritis
122
How do you treat organophosphate poisoing (brady, pupil constriction, tearing, vomiting, etc)?
atropine and pralidoxime
123
What is the most sensitive imaging finding for osteomyelitis?
MRI
124
What is the most specific diagnostic test for osteomyelitis?
probe to bone
125
How long are plain films negative in osteo?
> 2 weeks after infection onset
