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Step 3 one Flashcards

1
Q

Tx cluster HA

A

Verapamil

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2
Q

Tx trigeminal neuralgia

A

Carbamazepine

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3
Q

Tx bacterial vaginosis (gardnerella, mycoplasma),think clue cells on wet mount, amine odor, pH>4.5. Thin, white

A

Metronidazole or Clindamycin

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4
Q

Tx Chlamydia

A

Azithromycin

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5
Q

Tx Gonorrhea

A

Ctx and azithro/doxy

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6
Q

Tx vag candida (thick, white, clumps)

A

Fluconazole

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7
Q

Beta thalassemia electrophoresis

A

Inc hgb A2

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8
Q

Alpha thalassema electrophoresis

A

Nomal (has norm RDW)

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9
Q

What age to repair congenital indirect hernia

A

ASAP

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10
Q

C. Diff Tx

A

Metro, if WBC >15,000 or cr high then oral Vanc

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11
Q

Tx intertrigo

A

topical miconazole, nystatin, terbinafine

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12
Q

Tx seborrheic dermatitis

A

Selenium sulfide or topical ketoconazole, may need tx q1-2 wks

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13
Q

Tx Tinea Capitis

A

Griseofulvin

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14
Q

Tx normal scabies/Crusted scabies

A

Oral ivermectin, or topical permetrin sacabies.

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15
Q

Dx pernicious anemia (low B12)

A

Test anti IF (intrinsic factor). Also has absent rugae in fundus.

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16
Q

what does saw palmeto tx and SE

A

BPH (poorly), SE bleeding

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17
Q

What does Kava Kava Tx

A

Anxiey and insomnia (poorly), SE liver tox

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18
Q

What do glucosamine and chondroitin Tx

A

(poorly) osteoarthritis

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19
Q

Post infarct pericarditis tx

A

High dose aspirin

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20
Q

Viral pericarditis tx

A

NSAIDs +/- colchicine

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21
Q

Anti-TPO antibodies high

A

Hashimoto’s thyroiditis

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22
Q

Time to test for HIV post-exposure

A

4 weeks

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23
Q

Post exposure ppx for HIV time

A

<72 hrs

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24
Q

C. diff 2nd time Tx

A

Metro, (vanc if severe or 3rd time)

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25
Q

When start statin for DM

A

age 40-75 T1 or T2 with LDL >70

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26
Q

When start DM eye exam for retinopathy

A

3-5 yrs after dx for T1 and immediately for T2

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27
Q

When start DM nephropathy (microalbuminemia)

A

5 yrs after dx for T1 and immediately for T1, and Tx w/ ACEi

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28
Q

Age to start ADHD tx

A

6 yo or more (do behavior if younger)

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29
Q

How to switch ADHD meds

A

immediate switch (no wash out or taper needed)

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30
Q

Normal LV EF in MR

A

60% (most people >50% is normal)

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31
Q

Timing for fibrinolytic therapy

A

3-4.5 hours

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32
Q

Fibrnolytic exclusion for BP

A

185/110

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33
Q

Fibrnolytic exclusion Platelets and glucose

A

<100,000, <50

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34
Q

2 days after stroke

A

start sub q low dose heparin to prevent DVT

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35
Q

BP level limit post stroke

A

220/120, <185/105 if received fibrinolytics

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36
Q

Renal stone management

A

<10mm give alpha blocker, >10 mm urology consult and surgery

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37
Q

Hyperthyroid with afib first tx

A

Beta Blocker

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38
Q

Choking <1yo

A

5 back blows (if unconscious do CPR)

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39
Q

Choking >1 yo

A

abdominal thrust (if unconscious do CPR)

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40
Q

Infant with vertical Hep B infection serology

A

HBeAg positive (chronic), get Hep B vax and Ig age 0, then just vax 2, 6 months. Serology @ 9 mo.

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41
Q

Hepatic adenoma

A

Due to OCPs, stop OCPs for Tx

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42
Q

Which liver cyst caused by parasite

A

Echinococcus

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43
Q

menegitis with AIDS, and Tx

A

Cryptococcus (can have skin lesions) Tx. amphotericin and flucytosine. (Also CMV w/ AIDS)

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44
Q

Dx Cerebral Palsy

A

increased tone and reflexes (spastic most common). Brain MRI

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45
Q

DIPs, nail pitting, spondylarthritides +/- skin lesion. Dx and Tx

A

Psoriatic arthritis, Tx methotrexate

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46
Q

MCP and PIP involvement.

A

Rheumatoid arthritis (anti-citrullinated peptide antibodies may be +)

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47
Q

Loss pupillary reaction, vertical gaze paralysis, ataxia, headache.

A

Pineal tumor (parinaud’s syndrome)

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48
Q

Cosyntropin level

A

Test for addison’s dx (adrenal failutre)

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49
Q

High iron levels and elevated glucose

A

Hemochromatosis (bronze diabetes)

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50
Q

Murmur in HOCM (cards)

A

midsystolic that decreases with standing (lower afterload), increase with valsalva

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51
Q

Tx HOCM

A

Beta blocker, implant defibrilator if relative with SCD or if syncope

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52
Q

Tx SVT

A

vagal or IV adenosine. Cardioversion if bad sx

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53
Q

Mexican or South/central American Immigrant with ventricular apical aneurysm

A

Chagas (Trypanasoma Cruzi), can cause heart fibrosis, esophageal and colonic dilation.

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54
Q

Borrelia burgdorferi

A

Lyme or borrelis disease

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55
Q

Post surgery decreased urine w/o rebound/gaurding

A

Urinary retention

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56
Q

SBO timing after surgery

A

2-3 days after

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57
Q

Rapid warfarin reversal (intracranial bleed)

A

Prothrombin complex concentrate

FFP takes longer (2 L)

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58
Q

Tx minor vWF disease

A

Desmopressin (increased factor VIII and vWF)

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59
Q

Function and reversal of dabigatran

A

Dierect thrombin inhibitor, reverse w/ idarcizumab

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60
Q

Biggest complication w/ IVC placement

A

Recurrent DVTs

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61
Q

Tx otitis externa

A

Antibiotic ear drops (polymyxin/neomycin)

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62
Q

Anemia, high Ca++, high Cr, bone pain DX

A

Multiple myeloma, serum urine protein electophoresis and bone biopsy

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63
Q

High parathyroid related peptide

A

Squamous cell carcinoma (lung)

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64
Q

cough and high ACE levels

A

sacrcoidosis

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65
Q

After Dx multiple myeloma, next step

A

skeletal survey Xray

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66
Q

Elevated IgM

A

Waldenstroms macroglobinemia

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67
Q

Multiple myeloma w/ headache, dizziness, vertigo, nystagmus, hearing loss, and visual impairment.

A

Hyperviscosity syndrome, tx is plasmapherisis

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68
Q

Strep pyogenese (Group A) pharyngitis length of Tx

A

10 days w/ penicillin oral or 1 dose IM pcn, or 5 day azithromycin if allergic

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69
Q

Young patient, new onset afib, apical diastolic murmur, arterial embolism

A

Atrial myxoma

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70
Q

Vesicle posterior mouth dx and tx

A

herpangina (coxsachi A) tx supportive

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71
Q

Vesicles in anteror mouth and around mouth dx and tx

A

gingivastomatitis (HSV-1) tx acyclovir

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72
Q

WBC for joint aspirate to be inflammatory

A

> 2000 WBC (>100,000 in infectious)

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73
Q

EKG finding for ACS

A

new LBBB, or ST elevation

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74
Q

Time to do PCI in MI

A

Less than 90 minutes, fibrinolytics w/in 120 min

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75
Q

when does troponin first become positive

A

4-8 hrs

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76
Q

Tx pericarditis

A

Colchicine and NSAIDs

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77
Q

Solmonella enteritidis tx

A

supportive

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78
Q

Liver dx with +ANA and anti smooth muscle

A

Autoimmune hepatitis

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79
Q

Liver dx with antimitocondrial antibodies

A

PBC (primary biliary cirrhosis)

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80
Q

Positive stress test tx

A

Aspirin, atovastatin or rosuvastatin, beta blocker, +/- PCI

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81
Q

Tx giardia

A

metronidazole if sx and avoid public water

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82
Q

Vaginal bleeding tx

A

stable tx is OCPs, unstable is IV estrogen

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83
Q

Pt w/ HIV, fat accumulation on neck, loss fat on arms, face ,legs, abdomen, and insulin resistance

A

HIV lipdystrophy d/t NRTI

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84
Q

proximal muscle weakness and straie dx

A

Cushing syndrome (adrenal hyperplasia, increased cortisol)

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85
Q

tx for elevated triglycerides

A

gemfibrozil (doesn’t help heart disease)

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86
Q

A1C for T2DM

A

> = 6.5

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87
Q

fasting glucose for T2DM

A

> =126

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88
Q

Random glucose w/ sx to Dx T2DM

A

> = 200

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89
Q

Oral gluc tolerance test for T2DM

A

> =200

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90
Q

Wallengerg syndrome sx

A

D/t PICA occlusion, face waek, decreased sensation, vertigo, nystagmus

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91
Q

STEMI Tx

A

Aspirin+clopidogrel, beta blocker, nitrates, heparin, PCI, statin

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92
Q

When to give rhogam

A

28 wks, postpartum, and bleeding

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93
Q

When to screen with Low dose CT

A

55-80 yo and smoke 30 yrs w/in 15 yrs

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94
Q

PIP and MCP swelling dx

A

Rhuematoid Arthritis, +CCP (citrulinated protein), + rheumatoid factor. Tx MTX

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95
Q

Screen test SLE

A

ANA

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96
Q

Confirm + ANA for SLE test

A

anti dsDNA

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97
Q

Dx Parkinson’s

A

Physical exam. MRI to rule out other causes

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98
Q

First drug Tx of Parkinson’s

A

Pramipexole (save levadopa for later)

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99
Q

Tx essential tremor (worsen with action)

A

Propranolol or primidone

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100
Q

Tx Tinea versicolor (Malassezia furfur)

A

Topical ketoconazole

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101
Q

Tx HELLP syndrome

A

Mag Sulfate, and delivery

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102
Q

Dx cushing’s disease

A

Low dose dexamethasone test

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103
Q

Dx renal artery stenosis

A

MR angio of renal arteries

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104
Q

Contraindications to living kidney donation

A

<18 yo, Diabetes, cancer, BMI >35, untreated psych disorder

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105
Q

Organism related to guillane barre

A

Camphylobacter jejuni (also has bloddy stools and psuedoappendicitis)

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106
Q

bulbar symptoms (weakness, eye issues) without sensory issues Dx and Tx

A

Botulism, descending limb weakness. Tx equine antitoxin

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107
Q

eryethema, constricted pupil, eye pain, blurred vison

A

anterior uvitis (related to sacroidosis, which also has erythema nodosum)

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108
Q

weight loss, large foul stools how to dx

A

Fat malabsorption (chronic pancreatitis) dx w/ MRCP or abd CT

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109
Q

Tx w/ bisphosphonate base on T score and/or FRAX %

A

T score 20% with osteopenia (T -1 to -2.5); or hx of a fragility fracture

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110
Q

Tx cat scratch disease (bartonella henselae)

A

azithromycin

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111
Q

Tx most animal bites

A

amoxicillin-clavulanic acid

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112
Q

Number of neutrophils in ascites to dx SBP

A

> 250 neutrophils or SAAG >1.1

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113
Q

Abx for SBP

A

third gen cephalosporin, also give IV albumin

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114
Q

Colonoscopy screening

A

50 q10 yrs unless 1st degree relative colon cancer (or adenomatous polyp) <60; start 40 yo q5 yrs

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115
Q

1st step for gastroparesis dx

A

EGD then scintigraphic gastric emptying test

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116
Q

Tx gastroparesis

A

small frequent meals (then metoclopramide if needed)

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117
Q

Tx pediatric epistaxis

A
  1. Pressure 2. Topical vasoconstrictor 3. Cautery
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118
Q

Benign features of pulmonary nodule

A

popcorn, concentric or laminated, central, and diffuse homogeneous calcifications

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119
Q

Diarrhea, high blood sugar, skin rash

A

Glucagonoma

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120
Q

dementia, diarrhea, dermatitis, stomatitis and cheilosis

A

Niacin deficiency (pellegra)

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121
Q

Glucose level for hypoglycemia

A

<60

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122
Q

HIV in pregnancy antepartum guidelines

A
  • HIV RNA viral load at initial visit, every 2-4 weeks after initiation or change of therapy, monthly until undetectable, then every 3 months
  • CD4 cell count every 3-6 months
  • Resistance testing if not previously performed
  • ART initiation as early as possible
  • Avoid amniocentesis unless viral load ≤1,000 copies/mL
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123
Q

HIV in pregnancy peripartum guidelines

A

Viral load ≤1,000 copies/mL: ART + vaginal delivery

Viral load >1,000 copies/mL: ART + zidovudine + cesarean delivery

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124
Q

HIV postpartum and infant

A
  • Mother: Continue ART
  • Infant (maternal viral load ≤1,000 copies/mL): Zidovudine
  • Infant (maternal viral load >1,000 copies/mL): Multi-drug ART
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125
Q

Next step if dx with Hep C

A

Vaccination for Hep A and Hep B (unless already immune)

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126
Q

Repeat troponin timing for observation

A

3, 6 hours apart

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127
Q

When to stress test

A

Unstable angina with ACS ruled out

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128
Q

First step dx achalasia

A

Barium swallow?

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129
Q

When to Tx subclinical hypothyroid

A
  • antithyroid antibodies
  • abnormal lipid profile
  • symptoms of hypothyroidism
  • ovulatory and menstrual dysfunction
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130
Q

High TSH, normal T4 (subclinical hypothyroid), next step?

A

Check anti-TPO antibodies

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131
Q

Thiazide diuretics and calcium

A

Increase serum Ca++ and decreases urine Ca++

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132
Q

Emergent Tx ITP with plts <30,000

A

IVIG

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133
Q

Stool study with increased osmotic gap, low stool pH

A

Lactose intolerance

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134
Q

Stool study with increased osmotic gap and villous atrophy

A

Celiac disease

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135
Q

Positive lactulose breath test, macrocytic anemia and B12 deficiency

A

Small intestinal bacterial overgrowth

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136
Q

Tx dermatitis herpetiformis

A

Dapsone + gluten free medication

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137
Q

Screening after dx celiac

A

DXA scan for bone loss and pnuemococcal vaccination

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138
Q

Nonejection click followed by systolic murmur (holosystolic)

A

Mitral valve prolapse

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139
Q

Increased venous return decreases these two murmurs

A

HCM (also decreases with increased afterload) and MVP

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140
Q

Harsh holosystolic murmur with palpaple thrill over left 3-4th intercostal

A

VSD

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141
Q

Ejection click followed by crescendo/decrescendo systolic

A

Aortic or pulmonic stenosis

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142
Q

Holosystolic murmur at lower sternal border

A

tricuspid regurgitation

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143
Q

Accentuated S1 with an opening snap heard after S2, and a low-pitched mid-diastolic murmur

A

Mitral stenosis

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144
Q

decreased sensation over the anterolateral thigh without any muscle weakness or deep tendon reflex abnormalities.

A

Lateral femoral cutaneous nerve entrapment

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145
Q

sensory loss over the medial thigh and weakness in leg adduction

A

Obturator nerve entrapment

146
Q

Meralgia paresthetica (nerve pain like lat fem cutaneous entrapment) Tx

A

Weight loss, avoid tight clothing

147
Q

Recurrent infections and daily cough with mucopurulent sputum production

A

Bronchiectasis

148
Q

First step variceal bleeding awaiting EGD

A

Octreotide

149
Q

Prevent variceal bleeding

A

Nonselective beta blockers (propranolo or nadalol) + endoscopic band ligation

150
Q

major depressive episodes (requiring a duration >2 weeks) and hypomanic episodes (requiring a duration >4 days)

A

Bipolar II

151
Q

Best Tx for borderline personality

A

Psychotherapy (Dialectical behavior therapy)

152
Q

Therapy for depression

A

Interpersonal psychotherapy

153
Q

Tx Varicella zoster

A

Oral valycyclovir if <72hrs (if >72 hrs then pain control)

154
Q

Post exposure prophylaxis to VZV (if not immune)

A

VZV vaccination w/in 5 days (varicella-zoster immune globulin if immnocompromised)

155
Q

Post-herpetic neuralgia tx (>4 months post infection)

A

tricyclic antidepressants, gabapentin, or pregabalin

156
Q

First-line therapy for bacterial conjunctivitis

A

erythromycin ointment or polymyxin-trimethoprim drops (fluoroquinolones if contact wearing d/t psuedomonas)

157
Q

Complication of bacterial conjunctivitis

A

Keratitis, or inflammation of the cornea

158
Q

Dx acute calculous cholecystitis

A
  1. RUQ US 2. HIDA scan

Tx emergent lap chole (w/in 72 hrs of sx)

159
Q

Low risk patient post MI, when have sex again?

160
Q

Intermediate patient post MI, when have sex

A

stress testing first

161
Q

Phosphate levels in refeeding syndrome

162
Q

What is Dx: dysuria, postvoid dribbling, dyspareunia, and an anterior vaginal mass

A

Urethral diverticululm

163
Q

How to Dx Urethral diverticulum

A

Pelvic MRI or transvaginal ultrasound

164
Q

What id Dx: immobile uterus, tender adnexal mass, and nodularity along the posterior cul-de-sac (also dysmenorrhea, dyschezia and dyspareunia)

A

Endometriosis

165
Q

What is Dx: fever, dyspareunia, abdominopelvic pain, mucopurulent cervical discharge, and cervical motion tenderness

A

PID (pelvic inflammatory disorder)

166
Q

How to dx Urethral hypermobility (stress urinary incontinence)

A

Q-tip test

167
Q

How to dx vesicovaginal fistula

A

Methylene blue

168
Q

What med to switch to if ACE-> angioedema

A

ARB (losartan) [don’t affect kinin system]

169
Q

Which pneumonia vaccine for children <2yo

A

13-valent pneumococcal conjugate vaccine

170
Q

When to place tympanostomy tubes

A

> 3 episodes in 6 months or >4 episodes in 12 months, high risk for speech and hearing impairment such as children with craniofacial abnormalities or neurodevelopmental disorders

171
Q

Tx menopausal symptoms (hot flashes) if have thrombosis

A

SSRI or SNRI

172
Q

Raloxifene

A

estrogenic effects on bones and anti-estrogenic effects on the breasts and uterus

173
Q

Heparin induced thrombocytopenia dx timing

A

> 50% drop in the platelet count from baseline 5–10 days after the initiation of treatment.

174
Q

Tx HIT (heparin)

A

Stop heparin, warfarin. Begin direct thrombin inhibitor

175
Q

Confirm HIT (heparin) dx

A

Serotonin release assay, heparin induced platelet aggregation assay, or heparin-PF4 antibody ELISA

176
Q

Can you use LMWH after HIT

A

No, avoid unfractionated heparin and LMWH for life

177
Q

Tx alopecia areata

A

Intralesional corticosteroids (high relapse rate)

178
Q

low serum testosterone level. His gonadotropin levels are low

A

Secondary hypogonadism (or pituitary problem)

179
Q

elevated hepatic transaminases with hepatomegaly, hyperpigmentation, elevated glucose

A

hereditary hemochromatosis (HH), an autosomal recessive disorder

180
Q

Test to confirm hereditary hemochromatosis, and then Tx

A

confirmed with genetic testing for HFE mutations. Tx is therapeutic phlebotomy.

181
Q

What is Dx and Tx of: proximal muscle weakness, fatigue, elevated CK

A

Polymyositis. Tx glucocorticoids with steroid sparing agent.

182
Q

Dx Dematomyositis

A

Serology (anti-RNP, Anti-Jo) (then muscle biopsy if necessary)

183
Q

What do people with Dermatomyositis have increased risk of

A

Malignancy (Most common cancers include adenocarcinoma of the cervix, ovaries, lung, pancreas, bladder, and stomach)

184
Q

Management of seizure >5min or status epilepticus (>30 min)

A

ABC, 1. IV lorazepam, midazolam, or diazepam

  1. IV fosphenytoin phenytoin or Valproic acid
  2. EEG and continuous IV propfol, midazolam, or barbituate
185
Q

Tx rectocele or cystocele

A

Pessary, exercises, or surgery

186
Q

How to Dx Graves

A

Thyrotropin receptor antibodies (TSI)

Also radioiodine uptake (increased diffusely)

187
Q

Best Tx for graves

A

Radioactive iodine ablation for adults

Young adults tx medications

188
Q

Kava Kava SE

A

liver toxicity

189
Q

Thiazide SE

A

High uric acid (and calcium?) and low K and Na

190
Q

Tx bone metastasis pain

191
Q

Limited internal hip rotation, young male, posterior head of humerus displacement

A

slipped capital femoral epiphysis

192
Q

slipped capital femoral epiphysis Tx

A

Surgical pinning immediate (or get avascular necrosis)

193
Q

Abscence seizure (3 Hz spike and wave), usually remits by puberty w/o problems. Tx

A

Ethosuximide

194
Q

1st step if bleeding in rectum if pt is stable

A

Colonoscopy

195
Q

Allergen most associated with asthma?

A

Dust mites

196
Q

Tx asymptomatic or cystitis in pregnant women

A

Cephalexin, nitrofurantoin, augmentin-clavulanate fosphomycin

197
Q

Vasoocclusive pain syndrome (dactylitis/swelling of hands) in Sickle cell Tx and pain control for infants

A

Oxycodone (after acetaminophen)

Other Tx is heat and hydration

198
Q

Medication to prevent sickle cell vasoocclusive episodes

A

Hydroxyzurea (not good in the acute setting)

199
Q

How to dx allergic bronchopulmonary aspergillosis (ABPA)

A

elevated Aspergillus-specific IgE with an elevated total IgE, positive Aspergillus-specific IgG, eosinophilia, and positive skin test reactivity for Aspergillus

200
Q

Treatment for allergic bronchopulmonary aspergillosis (ABPA)

A

acutely stopping the underlying inflammation and decreasing fungal burden to reduce the risk of recurrence. Systemic glucocorticoids and itroconazole

201
Q

What is dx, peripheral nerve paralysis, erythema nodosum, liver issues

A

Sacroidosis

202
Q

Confirm Dx of sarcoidosis

A

Lung biopsy (or bx of any other accessible node)

203
Q

Nontreponemal test for syphillus

A

RPR and VDRL

204
Q

Treponemal test for syphillus

205
Q

What heart vessel supplies the left lateral wall

A

Left circumflex

206
Q

What heart vessel supplies the interventricular septum and LV anterior wall

207
Q

What heart vessel supplies the Inferiorposerior LV and right ventricular wall

A

Right coronary artery

208
Q

How to dx malaria

A

Peripheral blood smear

209
Q

Malaria prophylaxis

A 
Usually mefloquin (SE neuropysch, good pregnancy) or atovaquone/progaunil (SE GI), 
Chloroquine (usually resistant) SE is skin issues
210
Q

Renal disease related to Chronic Hep C

A

Mixed Cryoglobulinema

211
Q

Dx? cough, sinusitis, palpable purpura, renal insuficiency with normal complement levels

A

Granulomatosis with Polyangitis (c-ANCA)

212
Q

Anti-GBM antibodies

A

Goodpasture disease

213
Q

What heart rhythm can provoke torsades de pointes

A

[long QT w/] sinus bradycardia, or AV block

214
Q

Tx Torsades de Pointes

A

Magnesium sulfate

215
Q

Ca++ and Phos in hyperparathyroid

A

High Ca++, low Phos

216
Q

failure of lactation after bleeding from pregnancy

A

Pituitary necrosis

217
Q

Dx? Hyperthyroid (high T4, low TSH) after pregnancy and tender goiter w/ thyroid peroxidase antibodies

A

Postpartum thyroiditis

218
Q

Dx? papule on vagina that turn white with asetic acid

A

HPV condyloma accuminata

219
Q

Tx condyloma accuminata

A

Trichrlorocetic acid (podophylin if wart on external skin)

220
Q

Stage III or IV ulcers need debridement

A

Don’t give antibiotics for non-infected ulcers

221
Q

Screening for breast cancer

A

start age 40-50 q 2yrs mammogram until 75

222
Q

When genetic test for breast cancer

A

2 first degree relatives, or 3 first or second degree relatives w/ breast cancer

223
Q

Suspect Scaphoid fracture management

A

Xray 1-2 wks, or MRI/CT now

Nondisplaced short thumb spica, displaced refer to ortho

224
Q

Tx Bell’s palsy

A

Prednisone (if bilateral or in lyme area do ELIZA)

225
Q

How to dx abusive head trauma

A

CT scan of head

226
Q

Good screening question for alcoholism

A

How many times in last week have you had 5 or more drinks in one setting

227
Q

Infant with constipation, hypotonia (descending paralysis), lives on farm

A

Botulism (inhibit presynaptic release of ACh)

228
Q

Demylenation of periferal nerve fibers

A

Guilliane Barre Syndrome

229
Q

Tx myesthenia gravis

A

Pyridostigmine (anti-ACh esterase)

230
Q

Dx and Tx intussecption

A

Air contrast enema

231
Q

Infant with hyperkalemic metabolic acidosis

A

CAH (congenital adrenal hyperplasia) dx w/ 21 alpha hydroxylase

232
Q

Medication that increases risk for pyloric stenosis

A

Erythromycin or azithromycin

233
Q

Tx rectal prolapse

A

Surgical consultation if full thickness

Medical management if partial thickness

234
Q

High INR Tx per ranges of INR

A

<9 hold warfarin for 1-2 days (give oral vit K if bleedng risk)
>9 give oral vitamin K
If serious bleeding give FFP

235
Q

Steps to do root cause analysis

A
  1. Gather data
  2. create flow chart
  3. generate recommendations and implement changes
  4. measure success of changes
236
Q

How to prevent UTI in children

A

Decrease constipation

237
Q

Dx? Infant with purpuric lesions, cataracts, PDA, hearing loss

A

Congenital rubella, tx supportive

238
Q

Infant symmetrically small, is it infection or drugs?

239
Q

Next step HSIL on Pap

A

Colposcopy or LEEP (if no CIN 1 or 2 repeat colposcopy in 6 months)

240
Q

Dx and next step? Young person with isolated proteinuria

A

Orthostatic proteinuria. Dx with split 24 hr urine collection
Tx none

241
Q

Tx cocaine intoxication

A

Benzodiazepine first then phentolamine (alpha blocker) if still high BP, nitro (may need PCI if have MI)

242
Q

Dx? breast without hair or menstration

A

Androgen insensitivity syndrome. XY

243
Q

1st step in pediatric amenorhea

A

Pregnancy test then Pelvic ultrasound

244
Q

Uterus absent with Karyotype XX and normal female testosterone levels

A

Mullerian agenesis

245
Q

Dx and Tx corkscrew on esophagram

A

Diffuse esophageal spasm, Tx Ca++ blocker diltiazem, or nitrates

246
Q

Dx & Tx? Iron dificiency anemia, esophageal webs, dysphagia

A

Plummer Vinson syndrome, Tx iron supplementation

247
Q

Untreated Celiac can lead to what?

A

T cell lymphoma in jejunum

248
Q

Dx? HIV and bloody diarrhea

A

CMV enterocolitis

249
Q

Dx? Transmural inflammation of GI tract

250
Q

Tx hyperthyroid in pregnancy and its SE?

A

Propothyouracil (liver failure) 1st trimester then switch to methimazole

251
Q

Pt on lithium w/ new fatigue

A

Lithium induced hypothyroid (tx w/ levothyroxine)

252
Q

Dx STEMI via EKG?

A

2 contiguous leads STEMI (except V2-V3) or new LBBB, example: I and aVL

253
Q

Hyponatremia, serum osm <275, urine osm >100, urine sodium >40

A

SIADH (spilling out sodium but still retaining water), Tx fluid restriction

254
Q

Hyponatremia w/ Low urine sodium <40

A

Hypovolemic hyponatremia (low Na intake)

255
Q

Hyponatremia, serum osm <275, urine osm <100

A

Psychogenic polydipsia

256
Q

Tx acute Hep B infection

A

Supportive outpatient (do not need vaccination), repeat labs in 3 months,

257
Q

Oligoclonal IgG on CSF, T2 periventricular white matter lesions

A

MS (dx w/ MRI, Tx acute w/ IV steroids, chronic w/ Beta interferon or glateramer)

258
Q

Dx? prox muscle weakness, elevated CK, Anti Jo

A

Polymyositis (dx w/ muscle bx- endomysial infiltrate) heliotrope rash and gotten’s papules

259
Q

Dx? age >50, stiffness and pain (not as weak), elevated ESR/CRP

A

Polymyalgia rheumatica (assn w/ giant cell temporal arteritis) Tx steroids

260
Q

Tx pancreatic psuedocyst

A

Mild-supportive, severe-drainage

261
Q

Chlamydia untreated (azithro) during pregnancy increases risk of what?

A

PPROM, neonate pna, neonate conjunctivitis

262
Q

Exercise contraindicated in pregnancy w/ these conditions?

A

Cerclage, placenta previa, persistent bleeding, PPROM

263
Q

Pregnancy thyroid levels and tx hypothyroid

A

Total T3 and T4 high, free T4 unreliably low, TSH normal/low. Increase Levo dose

264
Q

Hypopigmented spots, FmHx of bilateral hearing loss

A

NF-2 (NF-1 has hyperpigmented spots, cutaneous neurofibromas, and axillary freckling)

265
Q

Port wine stain on face

A

Sturge Weber

266
Q

True or false, antipsychotics increase risk of death in dementia patients

267
Q

Which has less hypoglycemia NPH or glargine

268
Q

Thyroid nodule-> TSH & US-> no cancer risk-> ?

A
  • Norm/high TSH-> FNA

- Low TSH-> Iodine uptake scan-> (if cold FNA, if hot pre-treat w/ methimazole then surg or ablation)

269
Q

Antiretroviral tx will decrease HIV viral load to what in 6 months

270
Q

Duodenal atresia (double bubble) is assn w/ what genetic disorder

A

Trisomy 21

271
Q

White lacey appearance in mouth with papules on skin

A

(Wickham staie in mouth) Lichen Planus, LP is also associated w/ Hep C

272
Q

Thyroid cancer with elevated calcitonin levels

A

Meddulary thyroid cancer (CT if suspect malignancy b/c they don’t uptake iodine)

273
Q

Dx and Tx? Elevated alk phos w/ normal Ca++ and LFTs

A

Padget’s disease, tx bisphophonates +/- calcitonin (slow but don’t reverse hearing loss)

274
Q

What size (or growth) AAA should you have for elective repair?

A

> 5.5 cm or growing >0.5 cm in 6 months

med size 4-5.4 cm US q6 months

275
Q

Biggest AAA risk factor

276
Q

When to use thrombolytics in PE

A

SBP <90 and low bleeding risk (do embolectomy if this fails and may die)

277
Q

Tx osteonecrosis of femoral head

A

Total hip replacement

278
Q

Low phosphate in alcoholic pt can cause what?

A

rhabdomyolysis

279
Q

Tx restless leg syndrome

A

1st check ferrittin, then premipexole (dopamine agonist)

280
Q

Light criteria for exudate (PE, malig, post CABG, pancreatitis, infection) on pleural fluid [transudate d/t CHF, nephrotic, cirrhosis]

A

Pleural prot/serum prot >.5
LDH >.6
Pleural LDH > 2/3 upper limit of normal

281
Q

SAAG

A

Serum albumin-ascietes albumin=
>1.1 cirrhosis, alcoholic hepatitis, CHF, massive hepatic metastasis
<1.1 Nephrotic, peritoneal carcinoma, pancreatitis, TB,

282
Q

Tx sulfonyurea poisoning

A

D5W first, then octreotide

283
Q

Predictors of poor pancreatitis outcomes

A

high Hct, BUN, age, CRP, obesity

284
Q

When does gilbert disease present and what kind of bilirubin?

A

Adolescence and unconjugated

285
Q

Tx alzheimer’s dementia

A

Chollinesterase inhibitor (donepezil, rivastigmine)
Vitamin E
+/- antipsychotic (onlanzapine)

286
Q

MEN 2 syndrome

A

Medullary thyroid carcinoma (check calcitonin),, pheochromocytoma, parathyroid hyperplasia

287
Q

MEN 3 Syndrome

A

Medullary thyroid carcinoma (check calcitonin),, pheochromocytoma, mucosal tumors/marfans syndrome

288
Q

Tx cryptocordism (undescended teste)

A

Orchiopexy by 6 months

289
Q

Better schizophrenia outcomes

A

Older age, acute onset, psychotic symptoms

290
Q

Dx and Tx? newborn hydrocephalus, intracranial calcifications, hepatomegally

A

Toxoplasmosis tx permethamine, sulfadiazine

291
Q

When CABG vs PCI in angina

A

PCI in 1-2 vessel not LAD.

CAGB if DM with multi vessel disease

292
Q

Tx H. Pylori w/ and w/o pcn allergy

A

PPI+ clarithromycin + amoxicillin (or metronidazole)

293
Q

Tx TCA overdose and MOA

A

Sodium bicarbonate, to prevent arrythmia (also alkalinize urine to help salycilate toxicity)

294
Q

Sudden onset holosystolic murmur, pulm edema,

A

Acute severe mitral regur (likely ruptured chordae tend)

295
Q

Stretchy skin, scoliosis, mitral valve prolapse

A

Erhlers Danos (marfan doesn’t have stretchy skin)

296
Q

Tx CHF medications

A

ACE/ARB, B-blocker, spirinolactone, lasix,

Isosorbide dinitrate/hydralazine if black

297
Q

ASCVD risk level to start a statin

298
Q

LDL level to start statin w/o anything else

299
Q

Neonatal hypertrophic cardimyopathy cause and Tx?

A

Uncontrolled diabetes, tx conservative tx

300
Q

RBBB with ST elevation in V1-3

A

Brugada syndrome

301
Q

Tx aortic dissection (medication first)

A

IV B-blocker esmolol

302
Q

Step aproach to tx PAD

A
  1. Statin, aspirin lifestyle 1B. Supervised exercise 2. Cilostizol 3. Revascularization
    Do these steps even if 90% occluded (only revasc 1st if emergency)
303
Q

Anti topo I (anti Scl-70), anti centromere antibody. Raynauds, loss of skin folds of fingers, interstitial lung dx, dysphagia,

A

Scleroderma (get PFTs)

304
Q

Dx? diarrhea, misosis, bradycardia, lacrimation, emesis, after a drug exposure

A

Organophosphate poisoning, tx atropine and (pyridostigmine?)

305
Q

Lead toxicity tx based on level (house built before 1978)?

A

fist get veinous sample, <45 nothing, >45 chelation

306
Q

Neiserria menengitidis prophylaxis

A

Ciprofloxacin or ceftriaxone one dose, or rifampin bid for 2 days

307
Q

Tx latent TB

A

9 months isoniazid (after tx if develop sx need CXR to evaluate)

308
Q

Tx nitroprusside toxicity (cyanide)

A

sodium thiosulfate

309
Q

Tx alzheimer’s dementia

A

Chollinesterase inhibitor (donepezil, rivastigmine)

310
Q

Tx renal cancer that extends beyond capsule

A

Radical nephrectomy (partial if not extending)

311
Q

Ca++ and phosphate, and VIt D levels in Renal failure

A

Decreased Vit D, phosphate retention, decreased Ca++ reapsorption (decreased Ca++), increased secondary PTH

312
Q

Tx Lithium toxicity (NSAIDs, ACEi, Thiazides increase concentration)

A

Hemodialysis

313
Q

Young female,, what is she at risk for for donating a kidney

A

Gestational issues/loss

314
Q

Type 1 vs Type 2 CRPS and Tx?

A

Type 1 has no know nerve lesion, type 2 does. Tx sympathetic nerve block or regional anesthesia

315
Q

SE of isoniazid (besides neuropathy from low B6 pyridoxine)

A

Hepatotoxicity

316
Q

Tx Hepatorenal syndrome

A

First albumin (to see if not hepatorenal, just low volume), if it fails then octreotide and midodrine. Or NE alone

317
Q

OB, high AFP at risk for what?, low AFP at risk for what?

A

Low AFP risk trisomies. High AFP, NTD, gastrochesis, multiple gestation. Next step OB US.

318
Q

Tx Rosacea (rosacea can lead to occular issues)

A

Topical metronidazole

319
Q

Yellow sulfur granules on face

A

Actinomyces

320
Q

Varenicline SE

A

Psychiatric issues (don’t give if unstable psych or suicidal)

321
Q

Hypocretin-1 deficiency in CSF, dx and Tx?

A

Narcolepsy, dx with sleep study, tx: modafinil, then for cataplexy tx is SNRI, SSRI or TCA if severe.

322
Q

What electrolyte causes hyperreflexia

A

Hypocalcemia

323
Q

Down syndrome has increased risk of what cancer

A

Leukemia (also alzheimers)

324
Q

Tx peds viral gastroenteritis

A

Normal diet with low sugar

325
Q

Trastuzumab (anti-Her2) SE

A

Cardiotoxic, but resolves with time

326
Q

Most common cause of nephrotic syndrome in adults

327
Q

Tx acute chest syndrome in sickle cell?

A

Ctx and azithro, + blood transfusion if O2 sat <92%

328
Q

Next step breast mass >30, <30 yo

A

> 30 mamogram (then US or core bx), <30 US then core biopsy (unless simple cyst then FNA)

329
Q

First step with Guillane Barre

A

Measure Vital capacity

330
Q

Tx Guillane Barre (symmetric ascending weakness)

A

IVIG or plasma exchage

331
Q

Tx Transverse myelitis (has sensory involvement which botulism does not, except blindness) Increased risk of MS

A

IV corticosteroids

332
Q

Tx ALS (asymetric weakness ex. foot drop)

333
Q

2-3 medications for preterm delivery <34 wks

A

Corticosteroids, mag sulfate (neuro-protect) and maybe tocolytic

334
Q

Neonate gonococcal conjunctivitis tx

A

IM 3rd gen cephlosporin (prevention w/ topical erythromycin)

335
Q

Croup (laryngotracheitis) barking cough and stridor, steeple on XR

A

Tx humidified ari +/- IM dexamthesone

336
Q

Tx Epiglotitis

A

Intubation

337
Q

Tx tinea onchomycosis

A

Oral terbinafine, 2nd line is griseofulvin

338
Q

PFTs in Asthma

A

Decreased FEV1 and FEV1/FVC ratio (normal TLC and DLCO), increased FEV1 by >15% post Beta agonist

339
Q

PFTs in Restrictive Lung

A

Decreased TLC, FEV1, Increased FEV1/FVC ration

340
Q

PFTs in COPD

A

Same as asthma but decreased DLCO

341
Q

When and what do you use to prevent RSV?

A

Palivizumab for pre-term infants <29 wks
Chronic lung of prematurity
Congenital Heart causing issues

342
Q

Sitagliptin (DPPV4 inhibitor) SE

A

Pancreatitis

343
Q

Tx idiopathic pulmonary HTN

A

Bosetan (endothelial antagonist) then sildenafil (PDE-5 inhibitor)

344
Q

No OCPs with smoking after this age

A

35 years old

345
Q

Tx gonoccocal infection

A

Ceftriaxone w/ azithromycin (even if negative Chlamydia via PCR)

346
Q

Tx Bartonella henseia (cat scratch)

A

Azithromycin (Augmentin ppx for cat bite)

347
Q

Is ACTH high or low in primary adrenal insuficiency (Addison’s, test ACTH and morning cortisol)

A

High (low in secondary and no hyperpigmentation)

348
Q

Gene bad in Marfan’s

349
Q

What happens to thyroid tests in acute illness

A

Low T3, norm TSH and T4. Elevated reverse T3 (euthyroid sick syndrome)

350
Q

Colles fracture?

A

Distal radius, outstreatched hand fall, risk for acute carpal tunnel, and ulnar styloid fracture.

351
Q

Horseshoe kidney, coarctation of aorta, bicuspid aorta, webbed neck dx?

A

Turner’s syndrome, d/t nondisjuction (normal births after for mother)

352
Q

Mutations in what oncogene cause MEN 2a and 2b

A

RET proto-oncogene

353
Q

Most common complication of TURP (prostate)

A

Retrograde ejaculation

354
Q

Most common infection from human bite, and Tx

A

Eikinella, strep viridans, staph A. Tx amox/clavulanate

355
Q

SE thiazolidinedione (Pioglitazone)

A

Fluid retention (worsen CHF)

356
Q

Dyspepsia next steps?

A

> 60 EGD, <60 H. Pylori, if neg, then PPI,

357
Q

Signs of cardiac tamponade?

A

R atrial/vent collapse. Drop in SBP by >10 w/ inspiration. EKG electrical alternans

358
Q

Positive high risk stress test next step?

A

Angiogram, possibly revascularization

359
Q

First Tx HCM (hypertrophic heart)

A

Beta blocker (metoprolol) or verapamil

360
Q

Young person jerks of arms when waking, can -> tonic clonic Dx, tx?

A

Juvinile myocloninc epilepsy. Valproic acid (SE thrombocytopenia)

361
Q

Gleason score for prostate low risk

A

<= 6 and PSA <10

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