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MS3 > Step studying 7 > Flashcards

Step studying 7 Flashcards

1
Q

Diagnose and treat: vesicular lesions on the uvula and soft palate of a child

A

Herpangina caused by Coxsackie (hand foot and mouth

Tx = reassurance

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2
Q

Tx of Kawasaki

A
  • Aspirin - to prevent thrombosis of coronary arteries

- IVIG

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3
Q

What part of vision is first affected in macular degeneration

A

Central vision

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4
Q

What are the options for tocolytics

A

Indomethacin, Nifedipine (CCB), Beta agonists (Terbutaline), Magnesium sulfate

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5
Q

At what age do you give the following in preterm labor

  • Betamethasone
  • Penicillin
  • Tocolytics
  • Magnesium
A
  • Betamethasone = <37 weeks
  • Penicillin = always if GBS+ or unknown
  • Tocolytics = <34 weeks
  • Magnesium = <32 weeks
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6
Q

Tx of Mallory Weiss tear

A

♣ Superficial tear
♣ Tear of the gastroesophageal junction caused by excessive/forceful vomiting
♣ Self-limiting

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7
Q

Tx of Boerhaave syndrome

A

♣ Transmural (esophagus ruptured into the chest), usually distal esophageal rupture
♣ Due to violent retching (alcohol or bulimia)
♣ CXR may show air in the mediastinum
♣ Surgical emergency

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8
Q

Pentad of sx suggestive of ascending cholangitis

A
  • RUQ pain
  • Jaundice
  • Fever
  • AMS
  • Hypotension
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9
Q

Tx of ascending cholangitis

A
  • Emergent ERCP to remove the stone so bile can flow and clear the infection
  • IVF, IV abx, NPO
  • Urgent cholecystectomy
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10
Q

Tx of choledocholithiasis

A

o NPO, IVF, IV abx
o Urgent ERCP
o Elective cholecystectomy

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11
Q

What disease is associated with migratory thrombophlebitis

A

Pancreatic adenocarcinoma (Troussea’s syndrome)

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12
Q

Erythromycin eye drops in newborns is used for prophylaxis of what bug

A

Gonococcal conjunctivitis (does not work against Chlamydia)

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13
Q

What is the difference between S3 and S4 heart sound

A

S3 = volume overload (rapid flow of blood from atria to ventricles)

S4 = atria contracting against stiffened ventricles

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14
Q

MEN1

A

♣ Pituitary tumors (prolactin or GH)
♣ Pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas)
♣ Parathyroid adenomas

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15
Q

MEN2A

A

♣ Medullary thyroid carcinoma (neoplasm of parafollicular C cells which secrete calcitonin)
♣ Pheochromocytoma
♣ Parathyroid hyperplasia

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16
Q

MEN2B

A

♣ Medullary thyroid carcinoma
♣ Pheochromocytoma
♣ Mucosal neuromas (oral/intestinal ganglioneuromatosis) / Marfanoid habitus

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17
Q

Tx if someone presents with acute chest pain

A 
MONA BASH 
M = morphine
O = O2
N = nitro
A = ASA
B = BB
A = ACEi
S = Statin
H = Heparin
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18
Q

Medical tx of hypertrophic cardiomyopathy

A

Want increased blood in the heart to stretch the ventricle and prevent obstruction

  • avoid dehydration
  • Beta blockers or CCBs to prolong diastole/filling
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19
Q

Is constrictive pericarditis a problem of systole or diastole

A

• Constrictive pericarditis is a problem of diastole – ventricle cannot expand against rigid pericardium

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20
Q

Medical tx of fast and wide arrythmia

A

E.g. V-tach

Amiodorone

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21
Q

Medical tx of fast and narrow arrythmia

A

E.g. SVT

Adenosine

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22
Q

Medical tx of slow rhythm

A

Atropine

23
Q

Why might you see bleeding/coagulopathy in renal failure

A
  • Uremic toxins are implicated in platelet dysfunction

- There will be normal platelet count but defect involving platelet-vessel wall and platelet-platelet interaction

24
Q

How does hypothyroidism cause amenorrhea

A

• Low T3/T4 increases TRH (produced by hypothalamus) = increased TRH stimulates the anterior pituitary to produce prolactin = high prolactin inhibits GnRH = low GnRH causes low FSH and LH

25
Q

What maneuver is for MCL vs LCL

A 
Valgus = MCL
Varus = LCL

REMEMBER: G comes before R in the alphabet and M comes before L

26
Q

What will you see on pulmonary artery catheter readings in cardiac tamponade

A

Equalization of intracardiac diastolic pressures (RA = RV = PCWP)

27
Q

Does factor VIII deficiency affect PT or PTT

A

PTT

28
Q

Which are the vitamin K dependent clotting factors

A

II, VII, IX, X, C, and S

THINK: diSCo started in 1972

29
Q

Does vitamin K deficiency affect PT or PTT

A

Both

- But mild disease will affect PT more (recall that PT measure extrinsic pathway - VII, X, and V)

30
Q

How does von Willbrand disease affect BT, PT, and PTT

A
  • Prolonged BT
  • Normal PT
  • May have prolonged PTT due to vWF stabilization of Factor VIII
31
Q

What clotting factors are involved in intrinsic vs extrinsic pathway

A

Intrinsic = XII, XI, IX, X, VIII

Extrinsic = VII, X

Both = X, V, II, I

32
Q

What form of anticoagulation is preferred in CKD

A

Warfarin

33
Q

What part of the brain is affected in Huntingtons

A

Caudate nucleus

Remember disease of C's:
•	Cognitive decline
•	Caudate atrophy
•	Chorea
•	CAG repeat
•	Chromosome cuatro (4)
•	Cuarents (40 y/o)
•	Decreased AcetylCholine
34
Q

Who should get low dose CT scan to screen for lung cancer

A
  • Age 55-80
  • 30 pack year smoking hx
  • Quit smoking <15 years ago
35
Q

Order of tx for COPD

A

In order – continue to add the next step until you gain control
• Short acting beta agonist (SABA)
• Long acting muscarinic antagonist (Tiotropium)
• Long acting beta agonist (LABA)
• Inhaled corticosteroids
• Phosphodiesterase 4 inhibitors
• Oral steroids

36
Q

What are the 2 things that improve mortality in COPD

A

O2 and smoking cessation

37
Q

Describe the following associated with Asbestosis

  • Exposure
  • Imaging findings
  • Histology
A
  • Exposure to shipbuilding, roofing, plumbing
  • Imaging shows pleural plaques
  • Can cause lung cancer and mesothelioma (cancer of lung pleura)
  • Histology shows fusiform rods (dumbbells)
38
Q

What should you look for in the eyes in PCP intoxication

A

Nystagmus (vertical or horizontal)

39
Q

What gene is affected in Fragile X

A

FMR1 (THINK: Fragile Mental Retardation)

40
Q

What mutation is associated with Prader Willi vs Angelman syndrome (associated with maternal vs paternal loss of gene)

A

Prader Willi due to 15q 11-13 deletion or mutation on paternal allele (so both genes are from mom)

Angelman due to maternal allele (so both genes are from dad)

41
Q

What hormone is most responsible for sx of acromegaly

A

Insulin-like growth factor
♣ GH increases hepatic production of insulin-like growth factor-I (IGF-I), which causes excessive growth of bone and soft tissues

42
Q

Describe work up for suspected acromegaly

A

Elevated IGF-1 levels –> inadequate GH suppression in oral glucose suppression test –> MRI of brain to determine if tumor is pituitary or extrapituitary

43
Q

Medical tx of cancer-related anorexia syndrome (CACS)

A

Progesterone analogue (e.g. megestrol acetate)

44
Q

Management following a recent cat bite that does not appear infected

A

Antibiotic prophylaxis for pasteurella (Amox-Clav)

45
Q

What is a lacunar stroke

A

Small penetrating artery occlusion due to hypertensive arteriolar sclerosis

Affected areas usually include basal ganglia, subcortical white matter, pons

46
Q

Presentation of lacunar stroke

A 
♣	Absence of cortical signs (e.g. aphasia, agnosia, neglect, apraxia, hemianopia), seizure, or mental status change
♣	Common syndromes:
•	Pure motor hemiparesis
•	Pure sensory stroke
•	Ataxic hemiparesis
•	Dysarthria-clumsy hand
47
Q

Most important risk factor for lacunar stroke

A

HTN - leads to arteriolar sclerosis and vessel occlusion (hypertensive vasculopathy)

48
Q

Diagnosis of GERD

A

PPI + lifestyle modification x6 weeks with resolution/improvement of symptoms

49
Q

Diagnosis and tx of eosinophilic esophagitis

A

♣ >15 eosinophiles per high powered field

♣ Trial PPI to r/u GERD (because GERD often causes eosinophilia)

50
Q

Tx of Barrett’s esophagus

A

High dose PPIs + surveillance EGDs

51
Q

Tx of H Pylori

A

• Triple therapy = PPI + clarithromycin (or metronidazole) + amoxicillin

52
Q

Describe GI effect of diabetes

A

Gastroparesis (subtype of peripheral neuropathy)

53
Q

How do you diagnose gastroparesis

A

Gastric emptying studying (radioactive eggs); positive if . . .
o >60% gastric contents remaining after 2 hours
o >10% gastric contents remaining after 4 hours
o Pt must be off opiate and anticholinergics with good blood glucose control in order for test to be reliable

54
Q

Tx of gastroparesis

A 
Prokinetic agents
o	Metaclopramide (PO) in stable disease
o	Erythromycin (IV) in acute flare
  • Avoid opiates
  • Blood glucose control
  • Low fiber, small volume meals

MS3 (88 decks)

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