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Self Made Shizz > Step2 Algorithm Questions > Flashcards

Step2 Algorithm Questions Flashcards

1
Q

What PaO2/SaO2 does PCP pneumonia go from Mild to Moderate and what must be added

A

Moderate when PaO2 <70/SaO2 <92%, add prednisone to TMP/SMX

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2
Q

Painless palpable gallbladder

A

Courvoisier sign - indicates pancreatic cancer

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3
Q

History of aortic graft; Small GI bleed involving duodenum quickly progressing to fatal hemorrhage.

A

Aortoenteric Fistula

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4
Q

Classifying GI bleed as upper vs lower

A

Relative to Ligament of Treitz

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5
Q

What lead level do you chelate?

A

45-69 (succimer), >70 (dimercaprol british + EDTA)

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6
Q

Kidney stone treatment by size (<5mm, 5-20, >20mm)

A

<5mm NSAID/passage; 5-20mm lithotripsy; >20mm surgical nephrolithotomy

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7
Q

Bladder Cancer Tx

A

No muscle invasion: transurethral resection of bladder tumor (TURBT) + intravesical chemotherapy or immunotherapy (BCG); Muscle invasion: Cystectomy + chemo/radiation therapy

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8
Q

HRT with intact uterus

A

Estrogen and Progestin

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9
Q

HRT with non-intact uterus

A

Estrogen only

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10
Q

Hemorrhoid management

A

Initial: increase fluid/fibre; refractory: rubber band ligation, sclerotherapy, IR coag; Last resort: hemorrhoidectomy

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11
Q

What is considered “recurrent” UTI

A

2 or more infections in 6 months OR 3 or more in 1 year

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12
Q

Prosthetic Joint Infection causes (early onset, delayed, late)

A

Early (<3 months): S Aureus
Delayed (3-12 months): S Epidermidis
Late (>12 months): S Aureus

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13
Q

Screening of breast mass in women <30 vs >30

A

<30: Start with ultrasound
>30: Start with mammogram

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14
Q

Treatment for acute ischemic stroke in sickle cell patients <18 vs >18

A

<18: Exchange transfusion therapy
>18: IV thrombolytic therapy within 3hours

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15
Q

Amylase-rich exudative pleural effusion ddx for pH >7 vs pH <6

A

pH >7: Pancreaticopleural fistula
pH <6: Esophageal rupture

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16
Q

What must be done before checking gastrin levels in suspected gastrinoma (ZE)?

A

PPI cessation for 1 week. Gastrin >1000pg/mL is diagnostic

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17
Q

What are high risk features of pancreatic cysts? (4) ; Treatment?

A

-Large size (>-3cm)
-Solid components or calcifications
-Main pancreatic duct involvement (ductal dilation)
-Thickened or irregular cyst wall

Endoscopic ultrasound guided FNA

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18
Q

Scoliosis Cobb angle 10-30 degree Tx

A

Clinical monitoring every 6 months

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19
Q

Scoliosis Cobb angle >30 degree Tx

A

Thoracolumbarsacral spinal brace

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20
Q

Scoliosis Cobb angle >40-50 degree Tx

A

Surgical fixation

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21
Q

Test of choice for Choledocholithiasis

A

Endoscopic Retrograde Cholangiopancreatography (ERCP)

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22
Q

Test of choice for Cholecystitis

A

HIDA scan (hepatobiliary iminodiacetic acid)

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23
Q

Test to diagnose Chronic Mesenteric Ischemia

A

Mesenteric Angiography

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24
Q

Uses of MRCP (Magnetic Resonance Cholangiopancreatography)

A

Visualize biliary and pancreatic ducts, suspected cholangiocarcinoma

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25
Q

Diagnostic testing for Gastroparesis (2)

A

-Gastric Emptying Study (Scintigraphy)
-Esophagogastroduodenoscopy (EGD)

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26
Q

Treatment in nonbleeding vs bleeding esophageal varices

A

Nonbleeding: Nonselective beta blockers
Bleeding: Ocreotide

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27
Q

Next step in patient with diverticulitis complicated by an abscess (<3cm vs >3cm)

A

<3 cm: IV antibiotics and observation
>3 cm: CT guided percutaneous drainage

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28
Q

Treatment for SIADH

A

Fluid restriction (<800mL/day) +/- salt tablets

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29
Q

Treatment/s for outpatient community acquired pneumonia (CAP) in person <65yrs, healthy, no recent antibiotic use

A

-Amoxicillin plus macrolide (Azithromycin) OR Doxycycline

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30
Q

Treatment/s for outpatient community acquired pneumonia (CAP) in person >65yrs with comorbidities and recent antibiotic use

A

-Amoxicillin/Clavulanate plus macrolide (Azithromycin) OR Doxycycline OR respiratory fluoroquinolone (Levofloxacin)

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31
Q

Treatment/s for inpatient community acquired pneumonia (CAP)

A

Beta lactam (Ceftriaxone) plus a Macrolide (Azithromycin) OR respiratory fluoroquinolone (Levofloxacin)

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32
Q

Treatment/s for ICU community acquired pneumonia (CAP)

A

Same as inpatient PLUS Vancomycin OR Linezolid to cover MRSA

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33
Q

Obtaining urine culture in uncomplicated vs complicated UTI

A

-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

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34
Q

Treatment for Influenza

A

Symptomatic treatment; Patients with risk factors (>65, medical problems, pregnancy) should be given Oseltamivir

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35
Q

Pancreatitis with ALT >150 suggests what?

A

Gallstone pancreatitis

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36
Q

Indications for platelet transfusion

A

<50,000 with active bleeding OR <10,000 with no bleeding

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37
Q

DKA guideline for fluids, insulin, potassium, bicarbonate, and phosphate

A

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

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38
Q

Why can’t you give sulfa drugs to newborns under 1 month?

A

Displaces bilirubin from hemoglobin causing kernicterus

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39
Q

Most severe adverse outcome of mastectomy

A

Lymphedema leading to lymphangiosarcoma

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40
Q

Which test is used for diagnosis of CLL

A

Peripheral smear Flow cytometry (B-cell proliferation)

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41
Q

Treatment of Ulcerative Colitis (mild, moderate/severe, refractory)

A

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

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42
Q

How can you differentiate Achalasia from Pseudo-Achalasia?

A

Endoscopy; Will be unable to push endoscope through LES if there’s malignancy (pseudo)

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43
Q

Amylase/Lipase levels in Chronic Pancreatitis

A

Normal

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44
Q

Imaging modality in Mallory-Weiss vs Boerhaave

A

Mallory-Weiss: EGD
Boerhaave: CT

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45
Q

Treatment of spontaneous pneumothorax (small (<2cm) vs large/stable)

A

Small (<2cm): Observation + Oxygen
Large & Stable: Needle decompression or chest tube

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46
Q

Evaluation of minimal bright red blood per rectum, by age.

A

<40 w/o red flags: Anoscopy
40-49 w/o red flags: Sigmoidoscopy/colonoscopy
50 or red flags: Colonoscopy

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47
Q

Primary long-term intervention for persistent asthma vs persistent COPD

A

Persistent asthma: inhaled corticosteroids
Persistent COPD: long acting anticholinergic

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48
Q

Treatment for SBP prophylaxis

A

Fluoroquinolone (norfloxacin)

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49
Q

DMARDs (4) for RA (4) -> resistant treatment Tx

A

DMARDs: Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide

Resistant: TNFa inhibitors (I.e, adalimumab)

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50
Q

DOC for hypertension in Gout

A

Losartan (ARB)

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51
Q

Best initial test for antiphospholipid syndrome and result

A

Mixing study, aPTT will not correct

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52
Q

Next step in pituitary incidentaloma <1cm vs >1cm

A

<1cm: Prolactin level, MRI yearly

> 1cm: Prolactin level, MRI yearly, 24-hour urine cortisol, TSH, T4, LH, FSH, IGF, visual field testing

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53
Q

Treatment for exercise-induced bronchoconstriction in person who exercises daily vs few times a week

A

Daily exercise: inhaled corticosteroids or anti-leukotriene 10-20 minutes before exercise

Few times a week: SABA 10-20 minutes before exercise

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54
Q

Differentiating between Obstructive Sleep Apnea (OSA) and Obesity Hypoventilation Syndrome (Pickwickian)

A

OSA: Normal daytime CO2

Obesity hypoventilation: Elevated daytime CO2

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55
Q

Primary use for Ventilation-perfusion lung scan

A

Pulmonary embolism detection in those who can’t tolerate CTAP

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56
Q

How to differentiate surreptitious vomiting vs other causes of hypokalemic, alkalosis with normotension

A

Surreptitious vomiting will how LOW urine chloride

Diuretic, barter, gitelmans will have HIGH urinary chloride

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57
Q

Saline-responsive vs Saline-resistant metabolic alkalosis

A

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)

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58
Q

Treatment of choice in mild hypovolemic hypernatremia vs severe hypovolemic hypernatremia

A

Mild: 5% dextrose in 0.45% saline

Severe: 0.9% saline

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59
Q

Disorders in MEN 1, 2A, and 2B

A

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

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60
Q

Acute & Prophylactic treatment of headaches (Migraine, Tension, Cluster)

A

Migraine: Acute - Triptans, Preventative- bblocker, topiramate

Tension: Acute - NSAIDs, Chronic - Amitriptyline

Cluster: Acute - 100% O2, Triptans, Chronic - Verapamil

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61
Q

What deems cystitis to be “complicated”?

A

Diabetes, pregnancy, renal failure, hospital-acquired, indwelling catheter, recent procedure, immunosuppression, urinary tract obstruction

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62
Q

Timeline for PCI

A

-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

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63
Q

Indication for ICD in heart failure patient

A

-Symptomatic with EF <35% or asymptomatic <30%
-40 days post-MI and 3 months post-revascularization

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64
Q

Criteria for typical vs atypical chest pain

A

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

65
Q

Ventilation extubation criteria

A

-pH >7.25
-PaO2 >60mmHg, FiO2 <40%, PEEP <5
-Sufficient mental status to protect airway

*Prior to extubation, perform spontaneous breathing trial (SBT)

66
Q

Opioids that are recommended (4) and avoided (4) with impaired kidney function

A

Recommended: Fentanyl, Hydromorphone, Methadone, Buprenorphine

Avoided: Morphine, Meperidine, Codeine, Tramadol

67
Q

Low vs Intermediate vs High risk variables in solitary pulmonary nodule

A

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

68
Q

Difference between vestibular neuritis and labrynthitis

A

Vestibular Neurinitis : usually after viral illness, constant episode of vertigo +- tinnitus ( without hearing loss )

Labyrinthis : like latter but WITH Hearing loss

69
Q

Drug of choice s/p subarachnoid hemorrhage

A

Nimodipine

70
Q

How to differentiate pleural friction rub and pericardial friction rub

A

A pericardial friction rub can be heard even when the patient is holding breath

71
Q

When is intervention of pseudocyst required?

A

Larger than 5cm or symptomatic

72
Q

Method of diagnosis in Cauda Equina Syndrome? What symptoms would be seen?

A

-Lumbosacral spine MRI

-B/l lower extremity weakness, loss of DTRs, bowel/bladder dysfunction, saddle anesthesia

73
Q

What size thyroid nodule would you do FNA?

A

> 1cm

74
Q

Acute hemolytic transfusion reaction vs Delayed hemolytic transfusion reaction

A

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.

75
Q

Guideline for antibiotic prophylaxis in IE (5)

A

-Oral Amoxicillin 1 hour before procedure

-Prosthetic cardiac valves, prosthetic implanted material, previous infective endocarditis, unrepaired cyanotic congenital heart defects, transplanted heart

76
Q

Tropical sprue treatment

A

Tetracycline

77
Q

Next step in Ogilvie if NGT/electrolyte/bowel rest don’t fix issue?

A

Neostigmine +/- Atropine* (if bradycardia)

78
Q
  1. Myocarditis vs Myocardial infarction
  2. Myocarditis vs Pericarditis
A
  1. Myocarditis will show a FEVER
  2. Myocarditis will have decreased EF
79
Q

Sound associated with Constrictive Pericarditis

A

Coarse, sandpaper diastolic friction rub

80
Q

What is Kussmaul’s sign?

Where is it seen? (5)

A

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

81
Q

Next step in diagnosing thyroid nodule AFTER getting TSH, low vs normal/high TSH

A

Low TSH: Radioactive iodine uptake (RAIU)

Normal/high TSH: FNA

82
Q

Heparin-induced thrombocytopenia (HIT) treatment in patient with ESRD vs Liver disease

A

Stop all heparin products

ESRD: Argatroban (thrombin inhibitor)
Liver dx: Bivalirudin

83
Q

Tx of pneumocystis + when to add steroids

A

3 weeks bactrim, pentamidine, or primaquine/clindamycin

*Add steroids if PO2 <70 or A-a >35

84
Q

Primary treatment in acromegaly vs prolactinoma

A

Acromegaly: Start with transsphenoidal surgery; 2nd line Ocreotide, dopamine agonist, pegvisomant

Prolactinoma: Start with dopamine agonist; 2nd line transsphenoidal surgery

85
Q

Antibiotic regimen in infective endocarditis with native valve vs prosthetic valve

A

Native valve: Vancomycin plus beta-lactam (e.g. ceftriaxone, cefepime)

Prosthetic valve: ADD gentamicin and rifampin

86
Q

Diuretic regimen for ascites

A

Spironolactone and Furosemide

87
Q

Meniere’s triad? What can be used for treatment?

A

-Vertigo, tinnitus, hearing loss

Tx: Meclizine/Diazepam for vertigo, promethazine for nausea, salt restricted diet for long term prevention

88
Q

Medications the may worsen myasthenia

A

Aminoglycosides, Fluoroquinolones, Magnesium sulfate, and others

89
Q

Which drug/s can be given in Parkinson’s to increase bioavailability of levodopa? MOA?

A

COMT inhibitors; Entacapone, Tolcapone

90
Q

Wet vs Dry Macular Degeneration; Treatments?

A

Wet: Rapid, severe vision damage. Tx VEGF inhibitors

Dry: Gradual vision loss. No current treatment (slow progression with Vit C/E, zinc)

91
Q

Treatment of acute cholecystitis (stable vs unstable)

A

Stable: Cholecystectomy
Unstable: Percutaneous cholecystostomy)

92
Q

Chemoprophylaxis for areas with high rates of chloroquine-resistant malaria

A

Atovaqone-proguanil, doxycycline, mefloquine

93
Q

Two causes of SBO (prior surgery vs w/o prior surgery)

A

Prior surgery: Adhesions

W/o prior surgery: Hernia

94
Q

When to check G6PD levels after acute episode

A

Wait 3 months after episode

95
Q

Which stones can be treated with urine alkalinization vs acidification

A

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.

96
Q

First line FDA approved weight loss drug

A

Phentermine. Anorectic drug causing appetite suppression

97
Q

Exceptions to minors having no decision-making capacity (4)

A

Contraception, prenatal care, substance use treatment, STDs

98
Q

What can be administered to children with measles to reduce mortality

A

Vitamin A

99
Q

Treatment of Acute bacterial rhinosinusitis

A

Amoxicillin-Clavulanate

100
Q

Test to dx gestational diabetes

A

Oral glucose tolerance test

101
Q

Molluscum tx in children vs adults

A

Children: Reassurance
Adults: Cryotherapy, curettage, topical (cantharidin, podophyllotoxin)

102
Q

Indication for carotid revascularization

A

Asymptomatic with narrowing of 80-99% OR symptomatic with narrowing of 70-99%

103
Q

Tx of De Quervain tendinopathy

A

NSAIDs and thumb spica splint

104
Q

Acute lumbosacral radiculopathy management

A

Activity modification
First 1-2 weeks: NSAIDs
After 2 weeks: PT, oral steroids
After 4-6 weeks: Obtain MRI to assess for surgery

105
Q

Treatment in milk/soy protein-induced colitis

A

Elimination of milk and soy from maternal diet of breastfed infants.

Initiation of hydrolysed formula in formula-fed infants

106
Q

First step in suspected precocious puberty

A

Determine bone age (wrist/hand xray)

107
Q

Treatment of disfiguring strawberry hemangioma

A

B blocker like propranolol

108
Q

Vaccine schedule for HepB

A

Birth, 2 months, 6 months

109
Q

Vaccine schedule for DTap

A

2 months, 4 months, 6 months, 15-18 months, 4-6 years

110
Q

Vaccine schedule for Rotavirus

A

2 months, 4 months, 6 months

111
Q

Vaccine schedule for Haemophilus influenzae

A

2 months, 4 months, 6 months, 12-15 months

112
Q

Vaccine schedule for pneumococcal (PCV15, PCV20)

A

2 months, 4 months, 6 months, 12-15 months

113
Q

Vaccine schedule for inactivated polio

A

2 months, 4 months, 6 months

114
Q

Vaccine schedule for influenza

A

Annually STARTING at 6 months

115
Q

Vaccine schedule for Varicella

A

12-15, 4-6 years

116
Q

Vaccine schedule for MMR

A

1-1.5 years, 4-6 years

117
Q

Vaccine schedule for HPV

A

11-12 years (can start at 9)

118
Q

Vaccine schedule for Meningicoccal

A

11-12 years, booster at 16 years

119
Q

Vaccine schedule for TdaP

A

11-12 years

120
Q

Immunizations during pregnancy

A

Tdap, preferably at 27-36 weeks gestation
RSV between 32-36 weeks gestation
Inactive influenza during flu season
Covid

121
Q

Drug of choice in HepB; Drug contraindicated in autoimmune comorbidity

A

Drug of choice: Tenofovir, Entecavir

Pegylated interferon alpha c/I in patient with autoimmune disease like SLE

122
Q

Dx in neonate from birth to 3 days with pustules on erythematous base on trunk and proximal extremities; management?

A

Erythema toxicum neonatorum; Observation, resolves within a week

123
Q

Dx in neonate with erythematous, papular rash on occluded/intertriginous areas that wasn’t present at birth; management?

A

Miliaria rubra; Avoid overheating, topical corticosteroid is severe

124
Q

Dx in 3-week neonate with erythematous papules and pustules on face and scalp only; management?

A

Neonatal cephalic pustulosis; Observation, resolves in weeks to months. If severe, topical steroids or ketoconazole

125
Q

When should pregnant women undergo gestational diabetes screening?

A

24-28 weeks with an oral glucose challenge test

126
Q

What amniotic fluid index indicates polyhydramnios?

A

> 25cm

127
Q

Mild vs moderate/severe croup sx? Treatment?

A

Mild: Stridor resolving with rest, no subcostal retraction. Moderate/severe: Stridor at rest, retractions

Tx: Mild - oral dexamethasone; Moderate/severe - inhaled racemic epinephrine

128
Q

Contraindications to NPPV (noninvasive positive-pressure ventilation)

A

-Respiratory arrest
-Severe acidosis (<7.10)
-ARDS
-Inability to protect airway
-Unstable arrhythmia
-GI bleed

129
Q

Exudative vs Transudative pleural effusion by pH

A

Normal pleural pH 7.60
Exudative 7.30-7.45
Transudative 7.40-7.55

130
Q

What is availability bias? Visceral bias? Confirmation bias? Commission bias?

A

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

131
Q

Absolute contraindications for organ donation (4)

A

Incurable or metastatic malignancy, sepsis, spongiform encephalopathy, and cardiac arrest that occurred before brain death

132
Q

Treatment of nephrogenic DI vs lithium-induced nephrogenic DI

A

Nephrogenic DI: Thiazides
Lithium-induced DI: Amiloride

133
Q

PCOS treatment

A

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

134
Q

Ottawa Ankle Rule indications

A

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

135
Q

What PAC/PRA ratio is indicative of Primary Hyperaldosteronism ; Next steps?

A

PAC/PRA >20

Confirm with saline infusion test->If confirmed with PAC >10, check for malignancy to consider surgery

136
Q

Treatment options of Primary Hyperaldosteronism

A

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

137
Q

Simple vs Complex Febrile Seizures (5)

A

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

138
Q

Recurrence prevention and maintenance therapy for Meniere disease

A

Begin with lifestyle modification (stress reduction, low sodium, avoid caffeine/alcohol/smoking

Maintenance therapy with diuretics

139
Q

What is the entrainment test

A

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

140
Q

Which malignancy are GLP1 inhibitors contraindicated with?

A

Medullary thyroid carcinoma

141
Q

Antiphospholipid syndrome prophylaxis in non-pregnant and pregnant patient

A

Non-pregnant: low-dose aspirin

Pregnant: low-dose aspirin PLUS heparin/LMWH

142
Q

Areas requiring yellow fever vaccination

A

Tropical Africa (e.g. Guinea, Ghana), and parts of central and South America (e.g Brazil, Ecuador)

143
Q

Dx criteria of oligoarticular juvenile idiopathic arthritis

A

Arthritis involving 4 or less joints within 6 months of disease onset. Associated with positive ANA and iridocyclitis

144
Q

Which SSRI is avoided post-MI

A

Citalopram; Potential for dose-dependent QT prolongation

145
Q

Indications for parathyroidectomy

A

Age <50, symptomatic hypercalcemia, osteoporosis/nephrolithiasis/CKD

146
Q

HepA prophylaxis in younger vs older patients

A

Younger (<40): Hepatitis A vaccine

Older (>40): Hepatitis A immune globulin

147
Q

What is the Thompson test?

A

Test to diagnose Achilles rupture. Pt in prone, squeeze calves and look for plantar flexion, no plantarflexion = Achilles rupture

148
Q

Preseptal vs orbital cellulitis features + treatment

A

Features: Eyelid erythema/swelling and chemosis. Orbital cellulitis includes pain with EOM

Treatment: Oral Abx for preseptal. IV Abx +- surgery for orbital

149
Q

Worst complication of chronic pancreatitis

A

Splenic vein thrombosis leading to gastric varices

150
Q

Vaccines during pregnancy: recommended (3), high risk (6), contraindicated (4)

A

Recommended: Tdap, inactivated influenza, Rho(D) Ig

High-risk patients: HepA, HepB, pneumococcal, Haemophilus, meningococcus, varicella

Contraindicated: HPV, MMR, Live influenza, Varicella

151
Q

What gestational age do you administer Tdap

A

27-36 weeks gestation

152
Q

Drug of choice for hirsutism

A

Spironolactone (androgen receptor antagonist)

153
Q

COPD GOLD staging w/ risk assessment

A

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

154
Q

When would you switch from LABA/LAMA to LABA/ICS in COPD?

A

Blood eosinophils count >300

155
Q

How to differentiate between median nerve compression at wrist vs forearm

A

Thenar eminence sensation preserved with compression at the wrist as palmar cutaneous branch is spared

156
Q

Criteria for gastric bypass surgery approval

A

BMI >40, BMI >35 with at least one obesity-related complication, or BMI >30 with uncontrolled diabetes or metabolic syndrome

157
Q

Where do you see a high riding patella and inability to maintain extended knee

A

Patellar tendon rupture

158
Q

What is rhinitis medicamentosa? Clinical finding? Treatment?

A

Nasal congestion after prolonged use of nasal decongestant spray (I.e., oxymetazoline). Beefy-red nasal mucosa. Nasal glucocorticoids during cessation of decongestant

159
Q

Next best step in ITP for child vs adult

A

Child: Observation regardless of platelet count; Corticosteroids only with severe bleeding

Adult: Corticosteroids + platelets if <30,000

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