Step 3 one Flashcards
1
Q
Tx cluster HA
A
Verapamil
2
Q
Tx trigeminal neuralgia
A
Carbamazepine
3
Q
Tx bacterial vaginosis (gardnerella, mycoplasma),think clue cells on wet mount, amine odor, pH>4.5. Thin, white
A
Metronidazole or Clindamycin
4
Q
Tx Chlamydia
A
Azithromycin
5
Q
Tx Gonorrhea
A
Ctx and azithro/doxy
6
Q
Tx vag candida (thick, white, clumps)
A
Fluconazole
7
Q
Beta thalassemia electrophoresis
A
Inc hgb A2
8
Q
Alpha thalassema electrophoresis
A
Nomal (has norm RDW)
9
Q
What age to repair congenital indirect hernia
A
ASAP
10
Q
C. Diff Tx
A
Metro, if WBC >15,000 or cr high then oral Vanc
11
Q
Tx intertrigo
A
topical miconazole, nystatin, terbinafine
12
Q
Tx seborrheic dermatitis
A
Selenium sulfide or topical ketoconazole, may need tx q1-2 wks
13
Q
Tx Tinea Capitis
A
Griseofulvin
14
Q
Tx normal scabies/Crusted scabies
A
Oral ivermectin, or topical permetrin sacabies.
15
Q
Dx pernicious anemia (low B12)
A
Test anti IF (intrinsic factor). Also has absent rugae in fundus.
16
Q
what does saw palmeto tx and SE
A
BPH (poorly), SE bleeding
17
Q
What does Kava Kava Tx
A
Anxiey and insomnia (poorly), SE liver tox
18
Q
What do glucosamine and chondroitin Tx
A
(poorly) osteoarthritis
19
Q
Post infarct pericarditis tx
A
High dose aspirin
20
Q
Viral pericarditis tx
A
NSAIDs +/- colchicine
21
Q
Anti-TPO antibodies high
A
Hashimoto’s thyroiditis
22
Q
Time to test for HIV post-exposure
A
4 weeks
23
Q
Post exposure ppx for HIV time
A
<72 hrs
24
Q
C. diff 2nd time Tx
A
Metro, (vanc if severe or 3rd time)
25
When start statin for DM
age 40-75 T1 or T2 with LDL >70
26
When start DM eye exam for retinopathy
3-5 yrs after dx for T1 and immediately for T2
27
When start DM nephropathy (microalbuminemia)
5 yrs after dx for T1 and immediately for T1, and Tx w/ ACEi
28
Age to start ADHD tx
6 yo or more (do behavior if younger)
29
How to switch ADHD meds
immediate switch (no wash out or taper needed)
30
Normal LV EF in MR
60% (most people >50% is normal)
31
Timing for fibrinolytic therapy
3-4.5 hours
32
Fibrnolytic exclusion for BP
185/110
33
Fibrnolytic exclusion Platelets and glucose
<100,000, <50
34
2 days after stroke
start sub q low dose heparin to prevent DVT
35
BP level limit post stroke
220/120, <185/105 if received fibrinolytics
36
Renal stone management
<10mm give alpha blocker, >10 mm urology consult and surgery
37
Hyperthyroid with afib first tx
Beta Blocker
38
Choking <1yo
5 back blows (if unconscious do CPR)
39
Choking >1 yo
abdominal thrust (if unconscious do CPR)
40
Infant with vertical Hep B infection serology
HBeAg positive (chronic), get Hep B vax and Ig age 0, then just vax 2, 6 months. Serology @ 9 mo.
41
Hepatic adenoma
Due to OCPs, stop OCPs for Tx
42
Which liver cyst caused by parasite
Echinococcus
43
menegitis with AIDS, and Tx
Cryptococcus (can have skin lesions) Tx. amphotericin and flucytosine. (Also CMV w/ AIDS)
44
Dx Cerebral Palsy
increased tone and reflexes (spastic most common). Brain MRI
45
DIPs, nail pitting, spondylarthritides +/- skin lesion. Dx and Tx
Psoriatic arthritis, Tx methotrexate
46
MCP and PIP involvement.
Rheumatoid arthritis (anti-citrullinated peptide antibodies may be +)
47
Loss pupillary reaction, vertical gaze paralysis, ataxia, headache.
Pineal tumor (parinaud's syndrome)
48
Cosyntropin level
Test for addison's dx (adrenal failutre)
49
High iron levels and elevated glucose
Hemochromatosis (bronze diabetes)
50
Murmur in HOCM (cards)
midsystolic that decreases with standing (lower afterload), increase with valsalva
51
Tx HOCM
Beta blocker, implant defibrilator if relative with SCD or if syncope
52
Tx SVT
vagal or IV adenosine. Cardioversion if bad sx
53
Mexican or South/central American Immigrant with ventricular apical aneurysm
Chagas (Trypanasoma Cruzi), can cause heart fibrosis, esophageal and colonic dilation.
54
Borrelia burgdorferi
Lyme or borrelis disease
55
Post surgery decreased urine w/o rebound/gaurding
Urinary retention
56
SBO timing after surgery
2-3 days after
57
Rapid warfarin reversal (intracranial bleed)
Prothrombin complex concentrate
| FFP takes longer (2 L)
58
Tx minor vWF disease
Desmopressin (increased factor VIII and vWF)
59
Function and reversal of dabigatran
Dierect thrombin inhibitor, reverse w/ idarcizumab
60
Biggest complication w/ IVC placement
Recurrent DVTs
61
Tx otitis externa
Antibiotic ear drops (polymyxin/neomycin)
62
Anemia, high Ca++, high Cr, bone pain DX
Multiple myeloma, serum urine protein electophoresis and bone biopsy
63
High parathyroid related peptide
Squamous cell carcinoma (lung)
64
cough and high ACE levels
sacrcoidosis
65
After Dx multiple myeloma, next step
skeletal survey Xray
66
Elevated IgM
Waldenstroms macroglobinemia
67
Multiple myeloma w/ headache, dizziness, vertigo, nystagmus, hearing loss, and visual impairment.
Hyperviscosity syndrome, tx is plasmapherisis
68
Strep pyogenese (Group A) pharyngitis length of Tx
10 days w/ penicillin oral or 1 dose IM pcn, or 5 day azithromycin if allergic
69
Young patient, new onset afib, apical diastolic murmur, arterial embolism
Atrial myxoma
70
Vesicle posterior mouth dx and tx
herpangina (coxsachi A) tx supportive
71
Vesicles in anteror mouth and around mouth dx and tx
gingivastomatitis (HSV-1) tx acyclovir
72
WBC for joint aspirate to be inflammatory
>2000 WBC (>100,000 in infectious)
73
EKG finding for ACS
new LBBB, or ST elevation
74
Time to do PCI in MI
Less than 90 minutes, fibrinolytics w/in 120 min
75
when does troponin first become positive
4-8 hrs
76
Tx pericarditis
Colchicine and NSAIDs
77
Solmonella enteritidis tx
supportive
78
Liver dx with +ANA and anti smooth muscle
Autoimmune hepatitis
79
Liver dx with antimitocondrial antibodies
PBC (primary biliary cirrhosis)
80
Positive stress test tx
Aspirin, atovastatin or rosuvastatin, beta blocker, +/- PCI
81
Tx giardia
metronidazole if sx and avoid public water
82
Vaginal bleeding tx
stable tx is OCPs, unstable is IV estrogen
83
Pt w/ HIV, fat accumulation on neck, loss fat on arms, face ,legs, abdomen, and insulin resistance
HIV lipdystrophy d/t NRTI
84
proximal muscle weakness and straie dx
Cushing syndrome (adrenal hyperplasia, increased cortisol)
85
tx for elevated triglycerides
gemfibrozil (doesn't help heart disease)
86
A1C for T2DM
>= 6.5
87
fasting glucose for T2DM
>=126
88
Random glucose w/ sx to Dx T2DM
>= 200
89
Oral gluc tolerance test for T2DM
>=200
90
Wallengerg syndrome sx
D/t PICA occlusion, face waek, decreased sensation, vertigo, nystagmus
91
STEMI Tx
Aspirin+clopidogrel, beta blocker, nitrates, heparin, PCI, statin
92
When to give rhogam
28 wks, postpartum, and bleeding
93
When to screen with Low dose CT
55-80 yo and smoke 30 yrs w/in 15 yrs
94
PIP and MCP swelling dx
Rhuematoid Arthritis, +CCP (citrulinated protein), + rheumatoid factor. Tx MTX
95
Screen test SLE
ANA
96
Confirm + ANA for SLE test
anti dsDNA
97
Dx Parkinson's
Physical exam. MRI to rule out other causes
98
First drug Tx of Parkinson's
Pramipexole (save levadopa for later)
99
Tx essential tremor (worsen with action)
Propranolol or primidone
100
Tx Tinea versicolor (Malassezia furfur)
Topical ketoconazole
101
Tx HELLP syndrome
Mag Sulfate, and delivery
102
Dx cushing's disease
Low dose dexamethasone test
103
Dx renal artery stenosis
MR angio of renal arteries
104
Contraindications to living kidney donation
<18 yo, Diabetes, cancer, BMI >35, untreated psych disorder
105
Organism related to guillane barre
Camphylobacter jejuni (also has bloddy stools and psuedoappendicitis)
106
bulbar symptoms (weakness, eye issues) without sensory issues Dx and Tx
Botulism, descending limb weakness. Tx equine antitoxin
107
eryethema, constricted pupil, eye pain, blurred vison
anterior uvitis (related to sacroidosis, which also has erythema nodosum)
108
weight loss, large foul stools how to dx
Fat malabsorption (chronic pancreatitis) dx w/ MRCP or abd CT
109
Tx w/ bisphosphonate base on T score and/or FRAX %
T score 20% with osteopenia (T -1 to -2.5); or hx of a fragility fracture
110
Tx cat scratch disease (bartonella henselae)
azithromycin
111
Tx most animal bites
amoxicillin-clavulanic acid
112
Number of neutrophils in ascites to dx SBP
>250 neutrophils or SAAG >1.1
113
Abx for SBP
third gen cephalosporin, also give IV albumin
114
Colonoscopy screening
50 q10 yrs unless 1st degree relative colon cancer (or adenomatous polyp) <60; start 40 yo q5 yrs
115
1st step for gastroparesis dx
EGD then scintigraphic gastric emptying test
116
Tx gastroparesis
small frequent meals (then metoclopramide if needed)
117
Tx pediatric epistaxis
1. Pressure 2. Topical vasoconstrictor 3. Cautery
118
Benign features of pulmonary nodule
popcorn, concentric or laminated, central, and diffuse homogeneous calcifications
119
Diarrhea, high blood sugar, skin rash
Glucagonoma
120
dementia, diarrhea, dermatitis, stomatitis and cheilosis
Niacin deficiency (pellegra)
121
Glucose level for hypoglycemia
<60
122
HIV in pregnancy antepartum guidelines
- 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
123
HIV in pregnancy peripartum guidelines
Viral load ≤1,000 copies/mL: ART + vaginal delivery
| Viral load >1,000 copies/mL: ART + zidovudine + cesarean delivery
124
HIV postpartum and infant
- Mother: Continue ART
- Infant (maternal viral load ≤1,000 copies/mL): Zidovudine
- Infant (maternal viral load >1,000 copies/mL): Multi-drug ART
125
Next step if dx with Hep C
Vaccination for Hep A and Hep B (unless already immune)
126
Repeat troponin timing for observation
3, 6 hours apart
127
When to stress test
Unstable angina with ACS ruled out
128
First step dx achalasia
Barium swallow?
129
When to Tx subclinical hypothyroid
- antithyroid antibodies
- abnormal lipid profile
- symptoms of hypothyroidism
- ovulatory and menstrual dysfunction
130
High TSH, normal T4 (subclinical hypothyroid), next step?
Check anti-TPO antibodies
131
Thiazide diuretics and calcium
Increase serum Ca++ and decreases urine Ca++
132
Emergent Tx ITP with plts <30,000
IVIG
133
Stool study with increased osmotic gap, low stool pH
Lactose intolerance
134
Stool study with increased osmotic gap and villous atrophy
Celiac disease
135
Positive lactulose breath test, macrocytic anemia and B12 deficiency
Small intestinal bacterial overgrowth
136
Tx dermatitis herpetiformis
Dapsone + gluten free medication
137
Screening after dx celiac
DXA scan for bone loss and pnuemococcal vaccination
138
Nonejection click followed by systolic murmur (holosystolic)
Mitral valve prolapse
139
Increased venous return decreases these two murmurs
HCM (also decreases with increased afterload) and MVP
140
Harsh holosystolic murmur with palpaple thrill over left 3-4th intercostal
VSD
141
Ejection click followed by crescendo/decrescendo systolic
Aortic or pulmonic stenosis
142
Holosystolic murmur at lower sternal border
tricuspid regurgitation
143
Accentuated S1 with an opening snap heard after S2, and a low-pitched mid-diastolic murmur
Mitral stenosis
144
decreased sensation over the anterolateral thigh without any muscle weakness or deep tendon reflex abnormalities.
Lateral femoral cutaneous nerve entrapment
145
sensory loss over the medial thigh and weakness in leg adduction
Obturator nerve entrapment
146
Meralgia paresthetica (nerve pain like lat fem cutaneous entrapment) Tx
Weight loss, avoid tight clothing
147
Recurrent infections and daily cough with mucopurulent sputum production
Bronchiectasis
148
First step variceal bleeding awaiting EGD
Octreotide
149
Prevent variceal bleeding
Nonselective beta blockers (propranolo or nadalol) + endoscopic band ligation
150
major depressive episodes (requiring a duration >2 weeks) and hypomanic episodes (requiring a duration >4 days)
Bipolar II
151
Best Tx for borderline personality
Psychotherapy (Dialectical behavior therapy)
152
Therapy for depression
Interpersonal psychotherapy
153
Tx Varicella zoster
Oral valycyclovir if <72hrs (if >72 hrs then pain control)
154
Post exposure prophylaxis to VZV (if not immune)
VZV vaccination w/in 5 days (varicella-zoster immune globulin if immnocompromised)
155
Post-herpetic neuralgia tx (>4 months post infection)
tricyclic antidepressants, gabapentin, or pregabalin
156
First-line therapy for bacterial conjunctivitis
erythromycin ointment or polymyxin-trimethoprim drops (fluoroquinolones if contact wearing d/t psuedomonas)
157
Complication of bacterial conjunctivitis
Keratitis, or inflammation of the cornea
158
Dx acute calculous cholecystitis
1. RUQ US 2. HIDA scan
| Tx emergent lap chole (w/in 72 hrs of sx)
159
Low risk patient post MI, when have sex again?
3-4 wks
160
Intermediate patient post MI, when have sex
stress testing first
161
Phosphate levels in refeeding syndrome
Decrease
162
What is Dx: dysuria, postvoid dribbling, dyspareunia, and an anterior vaginal mass
Urethral diverticululm
163
How to Dx Urethral diverticulum
Pelvic MRI or transvaginal ultrasound
164
What id Dx: immobile uterus, tender adnexal mass, and nodularity along the posterior cul-de-sac (also dysmenorrhea, dyschezia and dyspareunia)
Endometriosis
165
What is Dx: fever, dyspareunia, abdominopelvic pain, mucopurulent cervical discharge, and cervical motion tenderness
PID (pelvic inflammatory disorder)
166
How to dx Urethral hypermobility (stress urinary incontinence)
Q-tip test
167
How to dx vesicovaginal fistula
Methylene blue
168
What med to switch to if ACE-> angioedema
ARB (losartan) [don't affect kinin system]
169
Which pneumonia vaccine for children <2yo
13-valent pneumococcal conjugate vaccine
170
When to place tympanostomy tubes
>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
Tx menopausal symptoms (hot flashes) if have thrombosis
SSRI or SNRI
172
Raloxifene
estrogenic effects on bones and anti-estrogenic effects on the breasts and uterus
173
Heparin induced thrombocytopenia dx timing
>50% drop in the platelet count from baseline 5–10 days after the initiation of treatment.
174
Tx HIT (heparin)
Stop heparin, warfarin. Begin direct thrombin inhibitor
175
Confirm HIT (heparin) dx
Serotonin release assay, heparin induced platelet aggregation assay, or heparin-PF4 antibody ELISA
176
Can you use LMWH after HIT
No, avoid unfractionated heparin and LMWH for life
177
Tx alopecia areata
Intralesional corticosteroids (high relapse rate)
178
low serum testosterone level. His gonadotropin levels are low
Secondary hypogonadism (or pituitary problem)
179
elevated hepatic transaminases with hepatomegaly, hyperpigmentation, elevated glucose
hereditary hemochromatosis (HH), an autosomal recessive disorder
180
Test to confirm hereditary hemochromatosis, and then Tx
confirmed with genetic testing for HFE mutations. Tx is therapeutic phlebotomy.
181
What is Dx and Tx of: proximal muscle weakness, fatigue, elevated CK
Polymyositis. Tx glucocorticoids with steroid sparing agent.
182
Dx Dematomyositis
Serology (anti-RNP, Anti-Jo) (then muscle biopsy if necessary)
183
What do people with Dermatomyositis have increased risk of
Malignancy (Most common cancers include adenocarcinoma of the cervix, ovaries, lung, pancreas, bladder, and stomach)
184
Management of seizure >5min or status epilepticus (>30 min)
ABC, 1. IV lorazepam, midazolam, or diazepam
2. IV fosphenytoin phenytoin or Valproic acid
3. EEG and continuous IV propfol, midazolam, or barbituate
185
Tx rectocele or cystocele
Pessary, exercises, or surgery
186
How to Dx Graves
Thyrotropin receptor antibodies (TSI)
| Also radioiodine uptake (increased diffusely)
187
Best Tx for graves
Radioactive iodine ablation for adults
| Young adults tx medications
188
Kava Kava SE
liver toxicity
189
Thiazide SE
High uric acid (and calcium?) and low K and Na
190
Tx bone metastasis pain
Radiation
191
Limited internal hip rotation, young male, posterior head of humerus displacement
slipped capital femoral epiphysis
192
slipped capital femoral epiphysis Tx
Surgical pinning immediate (or get avascular necrosis)
193
Abscence seizure (3 Hz spike and wave), usually remits by puberty w/o problems. Tx
Ethosuximide
194
1st step if bleeding in rectum if pt is stable
Colonoscopy
195
Allergen most associated with asthma?
Dust mites
196
Tx asymptomatic or cystitis in pregnant women
Cephalexin, nitrofurantoin, augmentin-clavulanate fosphomycin
197
Vasoocclusive pain syndrome (dactylitis/swelling of hands) in Sickle cell Tx and pain control for infants
Oxycodone (after acetaminophen)
| Other Tx is heat and hydration
198
Medication to prevent sickle cell vasoocclusive episodes
Hydroxyzurea (not good in the acute setting)
199
How to dx allergic bronchopulmonary aspergillosis (ABPA)
elevated Aspergillus-specific IgE with an elevated total IgE, positive Aspergillus-specific IgG, eosinophilia, and positive skin test reactivity for Aspergillus
200
Treatment for allergic bronchopulmonary aspergillosis (ABPA)
acutely stopping the underlying inflammation and decreasing fungal burden to reduce the risk of recurrence. Systemic glucocorticoids and itroconazole
201
What is dx, peripheral nerve paralysis, erythema nodosum, liver issues
Sacroidosis
202
Confirm Dx of sarcoidosis
Lung biopsy (or bx of any other accessible node)
203
Nontreponemal test for syphillus
RPR and VDRL
204
Treponemal test for syphillus
FTA-ABS
205
What heart vessel supplies the left lateral wall
Left circumflex
206
What heart vessel supplies the interventricular septum and LV anterior wall
LAD
207
What heart vessel supplies the Inferiorposerior LV and right ventricular wall
Right coronary artery
208
How to dx malaria
Peripheral blood smear
209
Malaria prophylaxis
```
Usually mefloquin (SE neuropysch, good pregnancy) or atovaquone/progaunil (SE GI),
Chloroquine (usually resistant) SE is skin issues
```
210
Renal disease related to Chronic Hep C
Mixed Cryoglobulinema
211
Dx? cough, sinusitis, palpable purpura, renal insuficiency with normal complement levels
Granulomatosis with Polyangitis (c-ANCA)
212
Anti-GBM antibodies
Goodpasture disease
213
What heart rhythm can provoke torsades de pointes
[long QT w/] sinus bradycardia, or AV block
214
Tx Torsades de Pointes
Magnesium sulfate
215
Ca++ and Phos in hyperparathyroid
High Ca++, low Phos
216
failure of lactation after bleeding from pregnancy
Pituitary necrosis
217
Dx? Hyperthyroid (high T4, low TSH) after pregnancy and tender goiter w/ thyroid peroxidase antibodies
Postpartum thyroiditis
218
Dx? papule on vagina that turn white with asetic acid
HPV condyloma accuminata
219
Tx condyloma accuminata
Trichrlorocetic acid (podophylin if wart on external skin)
220
Stage III or IV ulcers need debridement
Don't give antibiotics for non-infected ulcers
221
Screening for breast cancer
start age 40-50 q 2yrs mammogram until 75
222
When genetic test for breast cancer
2 first degree relatives, or 3 first or second degree relatives w/ breast cancer
223
Suspect Scaphoid fracture management
Xray 1-2 wks, or MRI/CT now
| Nondisplaced short thumb spica, displaced refer to ortho
224
Tx Bell's palsy
Prednisone (if bilateral or in lyme area do ELIZA)
225
How to dx abusive head trauma
CT scan of head
226
Good screening question for alcoholism
How many times in last week have you had 5 or more drinks in one setting
227
Infant with constipation, hypotonia (descending paralysis), lives on farm
Botulism (inhibit presynaptic release of ACh)
228
Demylenation of periferal nerve fibers
Guilliane Barre Syndrome
229
Tx myesthenia gravis
Pyridostigmine (anti-ACh esterase)
230
Dx and Tx intussecption
Air contrast enema
231
Infant with hyperkalemic metabolic acidosis
CAH (congenital adrenal hyperplasia) dx w/ 21 alpha hydroxylase
232
Medication that increases risk for pyloric stenosis
Erythromycin or azithromycin
233
Tx rectal prolapse
Surgical consultation if full thickness
| Medical management if partial thickness
234
High INR Tx per ranges of INR
<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
Steps to do root cause analysis
1. Gather data
2. create flow chart
3. generate recommendations and implement changes
4. measure success of changes
236
How to prevent UTI in children
Decrease constipation
237
Dx? Infant with purpuric lesions, cataracts, PDA, hearing loss
Congenital rubella, tx supportive
238
Infant symmetrically small, is it infection or drugs?
Infection
239
Next step HSIL on Pap
Colposcopy or LEEP (if no CIN 1 or 2 repeat colposcopy in 6 months)
240
Dx and next step? Young person with isolated proteinuria
Orthostatic proteinuria. Dx with split 24 hr urine collection
Tx none
241
Tx cocaine intoxication
Benzodiazepine first then phentolamine (alpha blocker) if still high BP, nitro (may need PCI if have MI)
242
Dx? breast without hair or menstration
Androgen insensitivity syndrome. XY
243
1st step in pediatric amenorhea
Pregnancy test then Pelvic ultrasound
244
Uterus absent with Karyotype XX and normal female testosterone levels
Mullerian agenesis
245
Dx and Tx corkscrew on esophagram
Diffuse esophageal spasm, Tx Ca++ blocker diltiazem, or nitrates
246
Dx & Tx? Iron dificiency anemia, esophageal webs, dysphagia
Plummer Vinson syndrome, Tx iron supplementation
247
Untreated Celiac can lead to what?
T cell lymphoma in jejunum
248
Dx? HIV and bloody diarrhea
CMV enterocolitis
249
Dx? Transmural inflammation of GI tract
Chron's
250
Tx hyperthyroid in pregnancy and its SE?
Propothyouracil (liver failure) 1st trimester then switch to methimazole
251
Pt on lithium w/ new fatigue
Lithium induced hypothyroid (tx w/ levothyroxine)
252
Dx STEMI via EKG?
2 contiguous leads STEMI (except V2-V3) or new LBBB, example: I and aVL
253
Hyponatremia, serum osm <275, urine osm >100, urine sodium >40
SIADH (spilling out sodium but still retaining water), Tx fluid restriction
254
Hyponatremia w/ Low urine sodium <40
Hypovolemic hyponatremia (low Na intake)
255
Hyponatremia, serum osm <275, urine osm <100
Psychogenic polydipsia
256
Tx acute Hep B infection
Supportive outpatient (do not need vaccination), repeat labs in 3 months,
257
Oligoclonal IgG on CSF, T2 periventricular white matter lesions
MS (dx w/ MRI, Tx acute w/ IV steroids, chronic w/ Beta interferon or glateramer)
258
Dx? prox muscle weakness, elevated CK, Anti Jo
Polymyositis (dx w/ muscle bx- endomysial infiltrate) heliotrope rash and gotten's papules
259
Dx? age >50, stiffness and pain (not as weak), elevated ESR/CRP
Polymyalgia rheumatica (assn w/ giant cell temporal arteritis) Tx steroids
260
Tx pancreatic psuedocyst
Mild-supportive, severe-drainage
261
Chlamydia untreated (azithro) during pregnancy increases risk of what?
PPROM, neonate pna, neonate conjunctivitis
262
Exercise contraindicated in pregnancy w/ these conditions?
Cerclage, placenta previa, persistent bleeding, PPROM
263
Pregnancy thyroid levels and tx hypothyroid
Total T3 and T4 high, free T4 unreliably low, TSH normal/low. Increase Levo dose
264
Hypopigmented spots, FmHx of bilateral hearing loss
NF-2 (NF-1 has hyperpigmented spots, cutaneous neurofibromas, and axillary freckling)
265
Port wine stain on face
Sturge Weber
266
True or false, antipsychotics increase risk of death in dementia patients
True
267
Which has less hypoglycemia NPH or glargine
Glargine
268
Thyroid nodule-> TSH & US-> no cancer risk-> ?
- Norm/high TSH-> FNA
| - Low TSH-> Iodine uptake scan-> (if cold FNA, if hot pre-treat w/ methimazole then surg or ablation)
269
Antiretroviral tx will decrease HIV viral load to what in 6 months
<50
270
Duodenal atresia (double bubble) is assn w/ what genetic disorder
Trisomy 21
271
White lacey appearance in mouth with papules on skin
(Wickham staie in mouth) Lichen Planus, LP is also associated w/ Hep C
272
Thyroid cancer with elevated calcitonin levels
Meddulary thyroid cancer (CT if suspect malignancy b/c they don't uptake iodine)
273
Dx and Tx? Elevated alk phos w/ normal Ca++ and LFTs
Padget's disease, tx bisphophonates +/- calcitonin (slow but don't reverse hearing loss)
274
What size (or growth) AAA should you have for elective repair?
>5.5 cm or growing >0.5 cm in 6 months
| med size 4-5.4 cm US q6 months
275
Biggest AAA risk factor
Smoking
276
When to use thrombolytics in PE
SBP <90 and low bleeding risk (do embolectomy if this fails and may die)
277
Tx osteonecrosis of femoral head
Total hip replacement
278
Low phosphate in alcoholic pt can cause what?
rhabdomyolysis
279
Tx restless leg syndrome
1st check ferrittin, then premipexole (dopamine agonist)
280
Light criteria for exudate (PE, malig, post CABG, pancreatitis, infection) on pleural fluid [transudate d/t CHF, nephrotic, cirrhosis]
Pleural prot/serum prot >.5
LDH >.6
Pleural LDH > 2/3 upper limit of normal
281
SAAG
Serum albumin-ascietes albumin=
>1.1 cirrhosis, alcoholic hepatitis, CHF, massive hepatic metastasis
<1.1 Nephrotic, peritoneal carcinoma, pancreatitis, TB,
282
Tx sulfonyurea poisoning
D5W first, then octreotide
283
Predictors of poor pancreatitis outcomes
high Hct*, BUN*, age, CRP, obesity
284
When does gilbert disease present and what kind of bilirubin?
Adolescence and unconjugated
285
Tx alzheimer's dementia
Chollinesterase inhibitor (donepezil, rivastigmine)
Vitamin E
+/- antipsychotic (onlanzapine)
286
MEN 2 syndrome
Medullary thyroid carcinoma (check calcitonin),, pheochromocytoma, parathyroid hyperplasia
287
MEN 3 Syndrome
Medullary thyroid carcinoma (check calcitonin),, pheochromocytoma, mucosal tumors/marfans syndrome
288
Tx cryptocordism (undescended teste)
Orchiopexy by 6 months
289
Better schizophrenia outcomes
Older age, acute onset, psychotic symptoms
290
Dx and Tx? newborn hydrocephalus, intracranial calcifications, hepatomegally
Toxoplasmosis tx permethamine, sulfadiazine
291
When CABG vs PCI in angina
PCI in 1-2 vessel not LAD.
| CAGB if DM with multi vessel disease
292
Tx H. Pylori w/ and w/o pcn allergy
PPI+ clarithromycin + amoxicillin (or metronidazole)
293
Tx TCA overdose and MOA
Sodium bicarbonate, to prevent arrythmia (also alkalinize urine to help salycilate toxicity)
294
Sudden onset holosystolic murmur, pulm edema,
Acute severe mitral regur (likely ruptured chordae tend)
295
Stretchy skin, scoliosis, mitral valve prolapse
Erhlers Danos (marfan doesn't have stretchy skin)
296
Tx CHF medications
ACE/ARB, B-blocker, spirinolactone, lasix,
| Isosorbide dinitrate/hydralazine if black
297
ASCVD risk level to start a statin
7.5%
298
LDL level to start statin w/o anything else
190
299
Neonatal hypertrophic cardimyopathy cause and Tx?
Uncontrolled diabetes, tx conservative tx
300
RBBB with ST elevation in V1-3
Brugada syndrome
301
Tx aortic dissection (medication first)
IV B-blocker esmolol
302
Step aproach to tx PAD
1. Statin, aspirin lifestyle 1B. Supervised exercise 2. Cilostizol 3. Revascularization
Do these steps even if 90% occluded (only revasc 1st if emergency)
303
Anti topo I (anti Scl-70), anti centromere antibody. Raynauds, loss of skin folds of fingers, interstitial lung dx, dysphagia,
Scleroderma (get PFTs)
304
Dx? diarrhea, misosis, bradycardia, lacrimation, emesis, after a drug exposure
Organophosphate poisoning, tx atropine and (pyridostigmine?)
305
Lead toxicity tx based on level (house built before 1978)?
fist get veinous sample, <45 nothing, >45 chelation
306
Neiserria menengitidis prophylaxis
Ciprofloxacin or ceftriaxone one dose, or rifampin bid for 2 days
307
Tx latent TB
9 months isoniazid (after tx if develop sx need CXR to evaluate)
308
Tx nitroprusside toxicity (cyanide)
sodium thiosulfate
309
Tx alzheimer's dementia
Chollinesterase inhibitor (donepezil, rivastigmine)
310
Tx renal cancer that extends beyond capsule
Radical nephrectomy (partial if not extending)
311
Ca++ and phosphate, and VIt D levels in Renal failure
Decreased Vit D, phosphate retention, decreased Ca++ reapsorption (decreased Ca++), increased secondary PTH
312
Tx Lithium toxicity (NSAIDs, ACEi, Thiazides increase concentration)
Hemodialysis
313
Young female,, what is she at risk for for donating a kidney
Gestational issues/loss
314
Type 1 vs Type 2 CRPS and Tx?
Type 1 has no know nerve lesion, type 2 does. Tx sympathetic nerve block or regional anesthesia
315
SE of isoniazid (besides neuropathy from low B6 pyridoxine)
Hepatotoxicity
316
Tx Hepatorenal syndrome
First albumin (to see if not hepatorenal, just low volume), if it fails then octreotide and midodrine. Or NE alone
317
OB, high AFP at risk for what?, low AFP at risk for what?
Low AFP risk trisomies. High AFP, NTD, gastrochesis, multiple gestation. Next step OB US.
318
Tx Rosacea (rosacea can lead to occular issues)
Topical metronidazole
319
Yellow sulfur granules on face
Actinomyces
320
Varenicline SE
Psychiatric issues (don't give if unstable psych or suicidal)
321
Hypocretin-1 deficiency in CSF, dx and Tx?
Narcolepsy, dx with sleep study, tx: modafinil, then for cataplexy tx is SNRI, SSRI or TCA if severe.
322
What electrolyte causes hyperreflexia
Hypocalcemia
323
Down syndrome has increased risk of what cancer
Leukemia (also alzheimers)
324
Tx peds viral gastroenteritis
Normal diet with low sugar
325
Trastuzumab (anti-Her2) SE
Cardiotoxic, but resolves with time
326
Most common cause of nephrotic syndrome in adults
FSGS
327
Tx acute chest syndrome in sickle cell?
Ctx and azithro, + blood transfusion if O2 sat <92%
328
Next step breast mass >30, <30 yo
>30 mamogram (then US or core bx), <30 US then core biopsy (unless simple cyst then FNA)
329
First step with Guillane Barre
Measure Vital capacity
330
Tx Guillane Barre (symmetric ascending weakness)
IVIG or plasma exchage
331
Tx Transverse myelitis (has sensory involvement which botulism does not, except blindness) Increased risk of MS
IV corticosteroids
332
Tx ALS (asymetric weakness ex. foot drop)
Rilouzole
333
2-3 medications for preterm delivery <34 wks
Corticosteroids, mag sulfate (neuro-protect) and maybe tocolytic
334
Neonate gonococcal conjunctivitis tx
IM 3rd gen cephlosporin (prevention w/ topical erythromycin)
335
Croup (laryngotracheitis) barking cough and stridor, steeple on XR
Tx humidified ari +/- IM dexamthesone
336
Tx Epiglotitis
Intubation
337
Tx tinea onchomycosis
Oral terbinafine, 2nd line is griseofulvin
338
PFTs in Asthma
Decreased FEV1 and FEV1/FVC ratio (normal TLC and DLCO), increased FEV1 by >15% post Beta agonist
339
PFTs in Restrictive Lung
Decreased TLC, FEV1, Increased FEV1/FVC ration
340
PFTs in COPD
Same as asthma but decreased DLCO
341
When and what do you use to prevent RSV?
Palivizumab for pre-term infants <29 wks
Chronic lung of prematurity
Congenital Heart causing issues
342
Sitagliptin (DPPV4 inhibitor) SE
Pancreatitis
343
Tx idiopathic pulmonary HTN
Bosetan (endothelial antagonist) then sildenafil (PDE-5 inhibitor)
344
No OCPs with smoking after this age
35 years old
345
Tx gonoccocal infection
Ceftriaxone w/ azithromycin (even if negative Chlamydia via PCR)
346
Tx Bartonella henseia (cat scratch)
Azithromycin (Augmentin ppx for cat bite)
347
Is ACTH high or low in primary adrenal insuficiency (Addison's, test ACTH and morning cortisol)
High (low in secondary and no hyperpigmentation)
348
Gene bad in Marfan's
Fibrillin
349
What happens to thyroid tests in acute illness
Low T3, norm TSH and T4. Elevated reverse T3 (euthyroid sick syndrome)
350
Colles fracture?
Distal radius, outstreatched hand fall, risk for acute carpal tunnel, and ulnar styloid fracture.
351
Horseshoe kidney, coarctation of aorta, bicuspid aorta, webbed neck dx?
Turner's syndrome, d/t nondisjuction (normal births after for mother)
352
Mutations in what oncogene cause MEN 2a and 2b
RET proto-oncogene
353
Most common complication of TURP (prostate)
Retrograde ejaculation
354
Most common infection from human bite, and Tx
Eikinella, strep viridans, staph A. Tx amox/clavulanate
355
SE thiazolidinedione (Pioglitazone)
Fluid retention (worsen CHF)
356
Dyspepsia next steps?
>60 EGD, <60 H. Pylori, if neg, then PPI,
357
Signs of cardiac tamponade?
R atrial/vent collapse. Drop in SBP by >10 w/ inspiration. EKG electrical alternans
358
Positive high risk stress test next step?
Angiogram, possibly revascularization
359
First Tx HCM (hypertrophic heart)
Beta blocker (metoprolol) or verapamil
360
Young person jerks of arms when waking, can -> tonic clonic Dx, tx?
Juvinile myocloninc epilepsy. Valproic acid (SE thrombocytopenia)
361
Gleason score for prostate low risk
<= 6 and PSA <10
