Step2 Algorithm Questions Flashcards
What PaO2/SaO2 does PCP pneumonia go from Mild to Moderate and what must be added
Moderate when PaO2 <70/SaO2 <92%, add prednisone to TMP/SMX
Painless palpable gallbladder
Courvoisier sign - indicates pancreatic cancer
History of aortic graft; Small GI bleed involving duodenum quickly progressing to fatal hemorrhage.
Aortoenteric Fistula
Classifying GI bleed as upper vs lower
Relative to Ligament of Treitz
What lead level do you chelate?
45-69 (succimer), >70 (dimercaprol british + EDTA)
Kidney stone treatment by size (<5mm, 5-20, >20mm)
<5mm NSAID/passage; 5-20mm lithotripsy; >20mm surgical nephrolithotomy
In concomitant UTI, nephrostomy done until infection resolved to prevent sepsis
Bladder Cancer Tx
No muscle invasion: transurethral resection of bladder tumor (TURBT) + intravesical chemotherapy or immunotherapy (BCG); Muscle invasion: Cystectomy + chemo/radiation therapy
HRT with intact uterus
Estrogen and Progestin
HRT with non-intact uterus
Estrogen only
Hemorrhoid management
Initial: increase fluid/fibre; refractory: rubber band ligation, sclerotherapy, IR coag; Last resort: hemorrhoidectomy
What is considered “recurrent” UTI
2 or more infections in 6 months OR 3 or more in 1 year
Prosthetic Joint Infection causes (early onset, delayed, late)
Early (<3 months): S Aureus
Delayed (3-12 months): S Epidermidis
Late (>12 months): S Aureus
Screening of breast mass in women <30 vs >30
<30: Start with ultrasound
>30: Start with mammogram
Treatment for acute ischemic stroke in sickle cell patients <18 vs >18
<18: Exchange transfusion therapy
>18: IV thrombolytic therapy within 3hours
Amylase-rich exudative pleural effusion ddx for pH >7 vs pH <6
pH >7: Pancreaticopleural fistula
pH <6: Esophageal rupture
What must be done before checking gastrin levels in suspected gastrinoma (ZE)?
PPI cessation for 1 week. Gastrin >1000pg/mL is diagnostic
What are high risk features of pancreatic cysts? (4) ; Treatment?
-Large size (>-3cm)
-Solid components or calcifications
-Main pancreatic duct involvement (ductal dilation)
-Thickened or irregular cyst wall
Endoscopic ultrasound guided FNA
Scoliosis Cobb angle 10-30 degree Tx
Clinical monitoring every 6 months
Scoliosis Cobb angle >30 degree Tx
Thoracolumbarsacral spinal brace
Scoliosis Cobb angle >40-50 degree Tx
Surgical fixation
Test of choice for Choledocholithiasis
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Test of choice for Cholecystitis
HIDA scan (hepatobiliary iminodiacetic acid)
Test to diagnose Chronic Mesenteric Ischemia
Mesenteric Angiography
Uses of MRCP (Magnetic Resonance Cholangiopancreatography)
Visualize biliary and pancreatic ducts, suspected cholangiocarcinoma
Diagnostic testing for Gastroparesis (2)
-Gastric Emptying Study (Scintigraphy)
-Esophagogastroduodenoscopy (EGD)
Treatment in nonbleeding vs bleeding esophageal varices
Nonbleeding: Nonselective beta blockers
Bleeding: Ocreotide
Next step in patient with diverticulitis complicated by an abscess (<3cm vs >3cm)
<3 cm: IV antibiotics and observation
>3 cm: CT guided percutaneous drainage
Treatment for SIADH
Fluid restriction (<800mL/day) +/- salt tablets
Treatment/s for outpatient community acquired pneumonia (CAP) in person <65yrs, healthy, no recent antibiotic use
-Amoxicillin plus macrolide (Azithromycin) OR Doxycycline
Treatment/s for outpatient community acquired pneumonia (CAP) in person >65yrs with comorbidities and recent antibiotic use
-Amoxicillin/Clavulanate plus macrolide (Azithromycin) OR Doxycycline OR respiratory fluoroquinolone (Levofloxacin)
Treatment/s for inpatient community acquired pneumonia (CAP)
Beta lactam (Ceftriaxone) plus a Macrolide (Azithromycin) OR respiratory fluoroquinolone (Levofloxacin)
Treatment/s for ICU community acquired pneumonia (CAP)
Same as inpatient PLUS Vancomycin OR Linezolid to cover MRSA
Obtaining urine culture in uncomplicated vs complicated UTI
-Uncomplicated UTI can be diagnosed with urinalysis alone, urine culture obtained IF patient fails initial empiric antibiotic therapy.
-Urine cultures obtained BEFORE empiric therapy is started in complicated UTI
Treatment for Influenza
Symptomatic treatment; Patients with risk factors (>65, medical problems, pregnancy) should be given Oseltamivir
Pancreatitis with ALT >150 suggests what?
Gallstone pancreatitis
Indications for platelet transfusion
<50,000 with active bleeding OR <10,000 with no bleeding
DKA guideline for fluids, insulin, potassium, bicarbonate, and phosphate
Fluids: 0.9% NaCl, add D5W when glucose <200
Insulin: Hold insulin with potassium <3.3; switch to SQ insulin when glucose <200, anion gap <12, HCO3 >15, able to eat
Potassium: Add IV K if <5.2
Bicarbonate: Consider with ph <6.9
Phosphate: Consider with phosphate <1
Why can’t you give sulfa drugs to newborns under 1 month?
Displaces bilirubin from hemoglobin causing kernicterus
Most severe adverse outcome of mastectomy
Lymphedema leading to lymphangiosarcoma
Which test is used for diagnosis of CLL
Peripheral smear Flow cytometry (B-cell proliferation)
Treatment of Ulcerative Colitis (mild, moderate/severe, refractory)
Mild: induction/maintenance 5ASA agents (mesalamine, Sulfasalazine). Oral for extensive disease, mesalamine enema for rectosigmoid
Moderate/severe: Induction/maintenance TNFa inhibitors (I.e., infliximab, adalimumab)
Refractory: Proctocolectomy
How can you differentiate Achalasia from Pseudo-Achalasia?
Endoscopy; Will be unable to push endoscope through LES if there’s malignancy (pseudo)
Amylase/Lipase levels in Chronic Pancreatitis
Normal
Imaging modality in Mallory-Weiss vs Boerhaave
Mallory-Weiss: EGD
Boerhaave: CT
Treatment of spontaneous pneumothorax (small (<2cm) vs large/stable)
Small (<2cm): Observation + Oxygen
Large & Stable: Needle decompression or chest tube
Evaluation of minimal bright red blood per rectum, by age.
<40 w/o red flags: Anoscopy
40-49 w/o red flags: Sigmoidoscopy/colonoscopy
50 or red flags: Colonoscopy
Primary long-term intervention for persistent asthma vs persistent COPD
Persistent asthma: inhaled corticosteroids
Persistent COPD: long acting anticholinergic
Treatment for SBP prophylaxis
Fluoroquinolone (norfloxacin)
DMARDs (4) for RA (4) -> resistant treatment Tx
DMARDs: Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide
Resistant: TNFa inhibitors (I.e, adalimumab)
DOC for hypertension in Gout
Losartan (ARB)
Best initial test for antiphospholipid syndrome and result
Mixing study, aPTT will not correct
Next step in pituitary incidentaloma <1cm vs >1cm
<1cm: Prolactin level, MRI yearly
> 1cm: Prolactin level, MRI yearly, 24-hour urine cortisol, TSH, T4, LH, FSH, IGF, visual field testing
Treatment for exercise-induced bronchoconstriction in person who exercises daily vs few times a week
Daily exercise: inhaled corticosteroids or anti-leukotriene 10-20 minutes before exercise
Few times a week: SABA 10-20 minutes before exercise
Differentiating between Obstructive Sleep Apnea (OSA) and Obesity Hypoventilation Syndrome (Pickwickian)
OSA: Normal daytime CO2
Obesity hypoventilation: Elevated daytime CO2
Primary use for Ventilation-perfusion lung scan
Pulmonary embolism detection in those who can’t tolerate CTAP
How to differentiate surreptitious vomiting vs other causes of hypokalemic, alkalosis with normotension
Surreptitious vomiting will how LOW urine chloride
Diuretic, barter, gitelmans will have HIGH urinary chloride
Saline-responsive vs Saline-resistant metabolic alkalosis
Saline-responsive: associated with volume loss , urine chloride <20 mEq/L; Vomiting, gastric suctioning, diuretics, laxatives, decreased oral fluid intake
Saline-resistant: Urine chloride >20 mEq/L; Primary hyperaldosteronism, cushings, severe hypokalemia (<2)
Treatment of choice in mild hypovolemic hypernatremia vs severe hypovolemic hypernatremia
Mild: 5% dextrose in 0.45% saline
Severe: 0.9% saline
Disorders in MEN 1, 2A, and 2B
MEN 1: Pituitary adenoma, Parathyroid hyperplasia, Pancreatic tumour
MEN 2A: Parathyroid adenoma, Medullary thyroid carcinoma, Pheochromocytoma
MEN 2B: Mucosal neuromas, Marfanoid, Medullary thyroid carcinoma, Pheochromocytoma
Acute & Prophylactic treatment of headaches (Migraine, Tension, Cluster)
Migraine: Acute - Triptans, Preventative- bblocker, topiramate
Tension: Acute - NSAIDs, Chronic - Amitriptyline
Cluster: Acute - 100% O2, Triptans, Chronic - Verapamil
What deems cystitis to be “complicated”?
Diabetes, pregnancy, renal failure, hospital-acquired, indwelling catheter, recent procedure, immunosuppression, urinary tract obstruction
Timeline for PCI
-Within 12 hours of symptom onset
- Within 90 minutes from first contact at PCI-capable facility
-30 minutes more if needed to transfer centres
120 minutes total
Indication for ICD in heart failure patient
-Symptomatic with EF <35% or asymptomatic <30%
-40 days post-MI and 3 months post-revascularization
Criteria for typical vs atypical chest pain
Triad of substernal chest pain, exacerbated by exertion, relieved with rest or nitrates
Meeting all 3 is “typical” chest pain
Meeting 2/3 is “atypical” chest pain
Ventilation extubation criteria
-pH >7.25
-PaO2 >60mmHg, FiO2 <40%, PEEP <5
-Sufficient mental status to protect airway
*Prior to extubation, perform spontaneous breathing trial (SBT)
Opioids that are recommended (4) and avoided (4) with impaired kidney function
Recommended: Fentanyl, Hydromorphone, Methadone, Buprenorphine
Avoided: Morphine, Meperidine, Codeine, Tramadol
Low vs Intermediate vs High risk variables in solitary pulmonary nodule
Low risk: <0.8cm, age <40, never smoker or cessation >15yrs, smooth margins
Intermediate risk: 0.8-2.0cm, age 40-60, current smoker or cessation 5-15yrs, scalloped margins
High risk: >2.0cm, age >60, current smoker or cessation <5yrs, corona radiata or spiculated
Difference between vestibular neuritis and labrynthitis
Vestibular Neurinitis : usually after viral illness, constant episode of vertigo +- tinnitus ( without hearing loss )
Labyrinthis : like latter but WITH Hearing loss
Drug of choice s/p subarachnoid hemorrhage
Nimodipine
How to differentiate pleural friction rub and pericardial friction rub
A pericardial friction rub can be heard even when the patient is holding breath
When is intervention of pseudocyst required?
Larger than 5cm or symptomatic
Method of diagnosis in Cauda Equina Syndrome? What symptoms would be seen?
-Lumbosacral spine MRI
-B/l lower extremity weakness, loss of DTRs, bowel/bladder dysfunction, saddle anesthesia
What size thyroid nodule would you do FNA?
> 1cm
Acute hemolytic transfusion reaction vs Delayed hemolytic transfusion reaction
Clinical presentation of anaemia many days after transfusion suggests DHTR rather than Acute. Delayed haemolytic transfusion reaction results from presence of auto antibodies against minor antigens (e.g. Rh), opposed to acute haemolytic transfusion reaction, which is an ABO incompatibility and life-threatening.
Guideline for antibiotic prophylaxis in IE (5)
-Oral Amoxicillin 1 hour before procedure
-Prosthetic cardiac valves, prosthetic implanted material, previous infective endocarditis, unrepaired cyanotic congenital heart defects, transplanted heart
Tropical sprue treatment
Tetracycline
Next step in Ogilvie if NGT/electrolyte/bowel rest don’t fix issue?
Neostigmine +/- Atropine* (if bradycardia)
- Myocarditis vs Myocardial infarction
- Myocarditis vs Pericarditis
- Myocarditis will show a FEVER
- Myocarditis will have decreased EF
Sound associated with Constrictive Pericarditis
Coarse, sandpaper diastolic friction rub
What is Kussmaul’s sign?
Where is it seen? (5)
JVP increase instead of decrease during inspiration
-Constrictive pericarditis, restrictive cardiomyopathy, large PE, RV infarct, tricuspid stenosis
*if you get chronic constrictive pericarditis, tx with pericardiectomy
Next step in diagnosing thyroid nodule AFTER getting TSH, low vs normal/high TSH
Low TSH: Radioactive iodine uptake (RAIU)
Normal/high TSH: FNA
Heparin-induced thrombocytopenia (HIT) treatment in patient with ESRD vs Liver disease
Stop all heparin products
ESRD: Argatroban (thrombin inhibitor)
Liver dx: Bivalirudin
Tx of pneumocystis + when to add steroids
3 weeks bactrim, pentamidine, or primaquine/clindamycin
*Add steroids if PO2 <70 or A-a >35
Primary treatment in acromegaly vs prolactinoma
Acromegaly: Start with transsphenoidal surgery; 2nd line Ocreotide, dopamine agonist, pegvisomant
Prolactinoma: Start with dopamine agonist; 2nd line transsphenoidal surgery
Antibiotic regimen in infective endocarditis with native valve vs prosthetic valve
Native valve: Vancomycin plus beta-lactam (e.g. ceftriaxone, cefepime)
Prosthetic valve: ADD gentamicin and rifampin
Diuretic regimen for ascites
Spironolactone and Furosemide
Meniere’s triad? What can be used for treatment?
-Vertigo, tinnitus, hearing loss
Tx: Meclizine/Diazepam for vertigo, promethazine for nausea, salt restricted diet for long term prevention
Medications the may worsen myasthenia
Aminoglycosides, Fluoroquinolones, Magnesium sulfate, and others
Which drug/s can be given in Parkinson’s to increase bioavailability of levodopa? MOA?
COMT inhibitors; Entacapone, Tolcapone
Wet vs Dry Macular Degeneration; Treatments?
Wet: Rapid, severe vision damage. Tx VEGF inhibitors
Dry: Gradual vision loss. No current treatment (slow progression with Vit C/E, zinc)
Treatment of acute cholecystitis (stable vs unstable)
Stable: Cholecystectomy
Unstable: Percutaneous cholecystostomy)
Chemoprophylaxis for areas with high rates of chloroquine-resistant malaria
Atovaqone-proguanil, doxycycline, mefloquine
Two causes of SBO (prior surgery vs w/o prior surgery)
Prior surgery: Adhesions
W/o prior surgery: Hernia
When to check G6PD levels after acute episode
Wait 3 months after episode
Which stones can be treated with urine alkalinization vs acidification
Alkalinization: Ca Oxalate, Uric acid, Cystine
Acidification: Struvite, Ca Phosphate
*Urine alkalizers (e.g., potassium citrate) prevent stones that form in acidic urine. Urine acidifiers (e.g., cranberry juice, betaine) prevent stones that form in alkaline urine.
First line FDA approved weight loss drug
Phentermine. Anorectic drug causing appetite suppression
Exceptions to minors having no decision-making capacity (4)
Contraception, prenatal care, substance use treatment, STDs
What can be administered to children with measles to reduce mortality
Vitamin A
Treatment of Acute bacterial rhinosinusitis
Amoxicillin-Clavulanate
Test to dx gestational diabetes
Oral glucose tolerance test
Molluscum tx in children vs adults
Children: Reassurance
Adults: Cryotherapy, curettage, topical (cantharidin, podophyllotoxin)
Indication for carotid revascularization
Asymptomatic with narrowing of 80-99% OR symptomatic with narrowing of 70-99%
Tx of De Quervain tendinopathy
NSAIDs and thumb spica splint
Acute lumbosacral radiculopathy management
Activity modification
First 1-2 weeks: NSAIDs
After 2 weeks: PT, oral steroids
After 4-6 weeks: Obtain MRI to assess for surgery
Treatment in milk/soy protein-induced colitis
Elimination of milk and soy from maternal diet of breastfed infants.
Initiation of hydrolysed formula in formula-fed infants
First step in suspected precocious puberty
Determine bone age (wrist/hand xray)
Treatment of disfiguring strawberry hemangioma
B blocker like propranolol
Vaccine schedule for HepB
Birth, 2 months, 6 months
Vaccine schedule for DTap
2 months, 4 months, 6 months, 15-18 months, 4-6 years
Vaccine schedule for Rotavirus
2 months, 4 months, 6 months
Vaccine schedule for Haemophilus influenzae
2 months, 4 months, 6 months, 12-15 months
Vaccine schedule for pneumococcal (PCV15, PCV20)
2 months, 4 months, 6 months, 12-15 months
Vaccine schedule for inactivated polio
2 months, 4 months, 6 months
Vaccine schedule for influenza
Annually STARTING at 6 months
Vaccine schedule for Varicella
12-15, 4-6 years
Vaccine schedule for MMR
1-1.5 years, 4-6 years
Vaccine schedule for HPV
11-12 years (can start at 9)
Vaccine schedule for Meningicoccal
11-12 years, booster at 16 years
Vaccine schedule for TdaP
11-12 years
Immunizations during pregnancy
Tdap, preferably at 27-36 weeks gestation
RSV between 32-36 weeks gestation
Inactive influenza during flu season
Covid
Drug of choice in HepB; Drug contraindicated in autoimmune comorbidity
Drug of choice: Tenofovir, Entecavir
Pegylated interferon alpha c/I in patient with autoimmune disease like SLE
Dx in neonate from birth to 3 days with pustules on erythematous base on trunk and proximal extremities; management?
Erythema toxicum neonatorum; Observation, resolves within a week
Dx in neonate with erythematous, papular rash on occluded/intertriginous areas that wasn’t present at birth; management?
Miliaria rubra; Avoid overheating, topical corticosteroid is severe
Dx in 3-week neonate with erythematous papules and pustules on face and scalp only; management?
Neonatal cephalic pustulosis; Observation, resolves in weeks to months. If severe, topical steroids or ketoconazole
When should pregnant women undergo gestational diabetes screening?
24-28 weeks with an oral glucose challenge test
What amniotic fluid index indicates polyhydramnios?
> 25cm
Mild vs moderate/severe croup sx? Treatment?
Mild: Stridor resolving with rest, no subcostal retraction. Moderate/severe: Stridor at rest, retractions
Tx: Mild - oral dexamethasone; Moderate/severe - inhaled racemic epinephrine
Contraindications to NPPV (noninvasive positive-pressure ventilation)
-Respiratory arrest
-Severe acidosis (<7.10)
-ARDS
-Inability to protect airway
-Unstable arrhythmia
-GI bleed
Exudative vs Transudative pleural effusion by pH
Normal pleural pH 7.60
Exudative 7.30-7.45
Transudative 7.40-7.55
What is availability bias? Visceral bias? Confirmation bias? Commission bias?
Availability: Using recent events to help make a Dx (order d-dimer, recently seen PE)
Visceral: Decision making based on feelings about patient (doubting sx of drug addict)
Confirmation: Favoring evidence that supports perceived dx
Commission: Being in action when inaction will likely lead to same or better outcome
Absolute contraindications for organ donation (4)
Incurable or metastatic malignancy, sepsis, spongiform encephalopathy, and cardiac arrest that occurred before brain death
Treatment of nephrogenic DI vs lithium-induced nephrogenic DI
Nephrogenic DI: Thiazides
Lithium-induced DI: Amiloride
PCOS treatment
Lifestyle modifications to treat obesity if applicable (BMI < 25kg/m2).
Oral contraceptives to regulate menstrual periods in those who do not wish to conceive ; Aromatase inhibitors (Letrozole, exemestane) and clomiphene to induce ovulation in those wanting to conceive
Ottawa Ankle Rule indications
Malleolar: Tenderness at posterior edge or tip of lateral or medial malleolus; Patient unable to take four steps
*Yes to any = Ankle X-ray
Midfoot: Tenderness at base of 5th metatarsal, tenderness at navicular; Patient unable to take four steps
*Yes to any = Foot X-ray
What PAC/PRA ratio is indicative of Primary Hyperaldosteronism ; Next steps?
PAC/PRA >20
Confirm with saline infusion test->If confirmed with PAC >10, check for malignancy to consider surgery
Treatment options of Primary Hyperaldosteronism
If malignant: Surgery if a candidate, Aldosterone receptor antagonist if not candidate
If non-malignant: Surgery with unilateral hypersecretion, Aldosterone receptor antagonist with bilateral hypersecretion
Simple vs Complex Febrile Seizures (5)
Simple: Age 6mos-5yrs, single episode in 24hrs, generalized, lasting <15mins, post-ictal return to baseline
Complex: Any age, multiple episodes in 24hrs, focal or generalized, can be prolonged, may not return to baseline post-ictal
Recurrence prevention and maintenance therapy for Meniere disease
Begin with lifestyle modification (stress reduction, low sodium, avoid caffeine/alcohol/smoking
Maintenance therapy with diuretics
What is the entrainment test
Used to diagnose functional tremor which is psychological in nature; you ask patient to perform repetitive action with non-affected side and visualize cessation of tremor or alignment of tremor with unaffected side
Which malignancy are GLP1 inhibitors contraindicated with?
Medullary thyroid carcinoma
Antiphospholipid syndrome prophylaxis in non-pregnant and pregnant patient
Non-pregnant: low-dose aspirin
Pregnant: low-dose aspirin PLUS heparin/LMWH
Areas requiring yellow fever vaccination
Tropical Africa (e.g. Guinea, Ghana), and parts of central and South America (e.g Brazil, Ecuador)
Dx criteria of oligoarticular juvenile idiopathic arthritis
Arthritis involving 4 or less joints within 6 months of disease onset. Associated with positive ANA and iridocyclitis
Which SSRI is avoided post-MI
Citalopram; Potential for dose-dependent QT prolongation
Indications for parathyroidectomy
Age <50, symptomatic hypercalcemia, osteoporosis/nephrolithiasis/CKD
HepA prophylaxis in younger vs older patients
Younger (<40): Hepatitis A vaccine
Older (>40): Hepatitis A immune globulin
What is the Thompson test?
Test to diagnose Achilles rupture. Pt in prone, squeeze calves and look for plantar flexion, no plantarflexion = Achilles rupture
Preseptal vs orbital cellulitis features + treatment
Features: Eyelid erythema/swelling and chemosis. Orbital cellulitis includes pain with EOM
Treatment: Oral Abx for preseptal. IV Abx +- surgery for orbital
Worst complication of chronic pancreatitis
Splenic vein thrombosis leading to gastric varices
Vaccines during pregnancy: recommended (3), high risk (6), contraindicated (4)
Recommended: Tdap, inactivated influenza, Rho(D) Ig
High-risk patients: HepA, HepB, pneumococcal, Haemophilus, meningococcus, varicella
Contraindicated: HPV, MMR, Live influenza, Varicella
What gestational age do you administer Tdap
27-36 weeks gestation
Drug of choice for hirsutism
Spironolactone (androgen receptor antagonist)
COPD GOLD staging w/ risk assessment
GOLD 1: FEV1 >80%
GOLD 2: FEV1 50-79%
GOLD 3: FEV1 30-49%
GOLD 4: FEV1 <30%
Risk
A: 0 or 1 exacerbations (no hospital), CAT<10
B: 0 or 1 exacerbations (no hospital), CAT>10
C: 2 or more exacerbations (or 1 leading to hospital), CAT <10
D: 2 or more exacerbations (or 1 leading to hospital), CAT >10
When would you switch from LABA/LAMA to LABA/ICS in COPD?
Blood eosinophils count >300
How to differentiate between median nerve compression at wrist vs forearm
Thenar eminence sensation preserved with compression at the wrist as palmar cutaneous branch is spared
Criteria for gastric bypass surgery approval
BMI >40, BMI >35 with at least one obesity-related complication, or BMI >30 with uncontrolled diabetes or metabolic syndrome
Where do you see a high riding patella and inability to maintain extended knee
Patellar tendon rupture
What is rhinitis medicamentosa? Clinical finding? Treatment?
Nasal congestion after prolonged use of nasal decongestant spray (I.e., oxymetazoline). Beefy-red nasal mucosa. Nasal glucocorticoids during cessation of decongestant
Next best step in ITP for child vs adult
Child: Observation regardless of platelet count; Corticosteroids only with severe bleeding
Adult: Corticosteroids + platelets if <30,000
Post cholecystectomy syndrome treatment
ERCP w/ sphincterotomy
Management of cholecystitis is unstable patient
Begin broad-spectrum Abx (i.e., pip-tazo) and perform percutaneous cholecystostomy if too unstable for cholecystectomy
Next step in evaluation of blunt aortic injury in stable vs unstable pt
Stable: Contrast-enhanced CTA
Unstable: TEE
What constitutes surgical evaluation in subdural hematoma
-Evidence of neurological deterioration
-SDH >10mm
-Midline shift >5mm
Treatment of intermittent strabismus
Occlusion therapy
-Following cover test, patching of the healthy eye or blurring the healthy eye with cycloplegic eye drops such as cyclopentolate or atropine, forcing increased use of weak eye to build neural pathways
Treatment of second degree burns affecting periorbital area
Topical bacitracin ointment with nonadherent dressing
Peripheral facial nerve palsy s/p trauma cause? Treatment in acute symptoms vs delayed?
Caused by temporal bone fracture or trauma affecting the facial nerve. Acute symptoms indicate nerve transection requiring surgical nerve repair. Delayed symptoms from edema compression requiring corticosteroids
Next best step in confirming diagnosis of central retinal vein occlusion (CRVO)
Perform fluorescein angiography (FA) to determine need for laser coagulation for treatment
Treatment in susceptible prosthetic valve vs susceptible native valve vs resistant native valve infective endocarditis
Susceptible prosthetic: IV nafcillin/rifampin 6wks + gentamicin 2wks
Susceptible native: IV gentamicin + penicillin G 2wks
Resistant native: IV vancomycin 4wks
When is thoracotomy indicated in hemothorax treatment
Following chest tube placement, if output is >1500mL or 200mL/hour for 2-4 hours
Treatment of choice in symptomatic mitral stenosis
Percutaneous mitral balloon commissurotomy (PMBC)
Treatment of uncomplicated pseudoaneurysms
Ultrasound-guided thrombin injection
Diagnostic imaging modality in suspected appendicitis
Abdominopelvic CT; if pregnant/child, USG +/- MRI
Next step in diverticulitis abscess <4cm vs >4cm
<4cm: IV antibiotics alone
> 4cm: IV antibiotics + drainage
Ludwig angina tx
CT to rule out abscess. Remove inciting tooth + IV antibiotics (eg, ampicillin-sulbactam, clindamycin)
Indications for bariatric surgery
-BMI >35 kg/m
-BMI >30 kg/m w/ T2DM
-BMI >30 kg/m with unsuccessful attempts at weight loss
Surgical classification of axillary lymph nodes
Level 1: Lateral/inferior to pec minor
Level 2: Posterior to pec minor
Level 3: Medial/superior to pec minor
What is Nelson syndrome? Treatment?
Pituitary adenoma s/p bilateral adrenalectomy, presents with hyperpigmentation, headache, bitemporal hemianopsia, NV. Treat with radiotherapy of pituitary
Imaging modality in developmental dysplasia of the hip (DDH) ; Physical exam findings? Tx?
Ultrasound. PE look for uneven knee height on flexion, palpable clunk, uneven thigh/buttock creases. Tx pelvic harness
Lung cancer resections options based on pre operative pulmonary assessment
FEV1 <1.5L w DLCO <60%: Wedge resection
FEV1 1.5-2L w DLCO >60%: Lobectomy
FEV1 >2L: Pneumonectomy
Rule of 9s in burn patients
Head and neck (9%), each arm (9%), chest and abdomen (18%), back (18%), and each leg (18%) with the genital area accounting for just 1%.
Dx in pt with mastoid ecchymosis (battle sign), clear rhinorrhea, periorbital ecchymosis (raccoon eyes)? Area affected? Imaging?
Basilar skull fracture. Petrous portion of temporal bone. Cervical CT
Bilateral weakness (upper>lower extremities) in elderly following neck hyperextension? Imaging?
Central cord syndrome. MRI
Treatment of emphysematous pyelonephritis
Nephrectomy with antibiotic therapy
Imaging modality for suspected vertebral metastases
MRI
Breast cancer treatment during pregnancy?
Surgical resection and chemotherapy with low-risk drugs to the fetus (e.g., doxorubicin, cyclophosphamide, fluorouracil). Discontinue 3-4 weeks prior to delivery.
Management of suspected congenital cyanotic heart defect
IV prostaglandin to maintain PDA + echo to determine defect
Salter-Harris fractures w/ treatment
“SALTER”
T1 S- Straight across
T2 A- Above growth plate
T3 L- Lower to growth plate
T4 T- Through growth plate
T5 ER- Erasure of growth plate
I, II, III: Closed reduction
IV: Open reduction
V: Depends on severity
If cefazolin allergy in surgery, what can be given?
Clindamycin or Vancomycin
Treatment of symptomatic osler weber rendu
IR embolization
Treatment of triglyceride induced acute pancreatitis
Insulin + dextrose
Asymptomatic biliary cyst management
Cyst resection due to high risk of malignancy
When to perform CABG over PCI
Single LAD, two-vessel disease w diabetes, three-vessel disease
Next best step/s in suspected idiopathic intracranial hypertension (IIH)
CT to look for intracranial mass. If negative, lumbar puncture to look for increased opening pressure.
What HIV viral load is acceptable for delivery. Next steps?
<1000 copies; Zidovudine and C-Section if above
Management of preterm labour
<32wks: Betamethasone + tocolytics + mg
32-34wks: Betamethasone + tocolytics
34-37wks: Betamethasone
Tocolytics: Indomethacin, Nifedipine, Mg, Terbutaline “its not my time”
Types of abortions
Missed: Cervix closed, no fetal cardiac
Threatened: Closed os, no poc
Inevitable: Open os, no poc
Incomplete: Open os, poc
Complete: Closed os, poc have passed
starts with I, open os
What is arrest of active phase? (2)
- No cervical change over 4 hours with adequate contractions
- 6 hours without adequate contractions
Milia vs Milia Rubra in neonates
Milia: Present at birth, white firm papules on face, resolves in 1 month
Milia Rubra: NOT present at birth but can appear anytime after. Heat rash from blocked eccrine sweat glands. Prevent overheating, steroids if severe
Neonatal pustular melanosis vs neonatal cephalic pustulosis
Neonatal pustular melanosis: Present at birth. NONerythematous pustules evolving into hyperpigmented macule with scale. Observation, hyperpigmentation may take months to fade
Neonatal cephalic pustulosis: Onset around 3wks. Erythematous papules/pustules on face. Observation
Lipid lowering agent with greatest LDL decrease? (2) Greatest HDL increase? Greatest triglyceride decrease?
LDL decrease: Statins, PCSK9
HDL increase: Niacin
Triglyceride decrease: Fibrates
Treatment for apnea of prematurity (AOP)
Caffeine therapy
Diagnosis in pt with coarse facies, retained baby teeth, severe eczema
Job syndrome (HyperIgE)
Common cause of Bronchopulmonary dysplasia (BPD)
Prolonged ventilation in premature infants
What is a venous hum
Common benign murmur in children caused by turbulence in internal jugular vein. Continuous murmur heard on either side of neck (commonly right) that lessens or disappears with IJV compression, supine position, or flexion of head.
