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treatments Flashcards

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1
Q

trx for Tourettes

A
  • habit reversal
  • training anti-D2 = tetrabenazine (VMAT-2 inhibitor depletes),
  • second gen antipsychotics= risperidone, aripriprazole (block)

second line- guanfacine, clonidine

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2
Q

empiric treatment for UTI in v small kids

trx pyelonephritis

A

tmp-smx or nitrofurantoin

IV ceftriaxone 14 days OR amp+gent

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3
Q

chlamydia (URI, STD, acute cervicitis)

A

doxycycline

azithromycin in preg

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4
Q

UTI secondary to indwelling catheter (+ the MC bug)

A

ciprofloxacin for Pseudomonas coverage

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5
Q

staph aureus including MRSA

A

clindamycin

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6
Q

acute bacterial rhinosinusitis

A

amoxicillin + clavulanate

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7
Q

medical trx for crohn

A

medical management

  • TNF alpha inhibitors (infliximab)
  • immunomodulators (azothioprine, 6-mercaptopurine

severe= surgery = partial bowel resection

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8
Q

c. diff treatment what abx can be given to prevent c.diff from happening

A

trx : ORAL vancomycin (iv will bypass colon, pointless) if severe, fulminate - oral vanco + IV metronidazole trx w piperacillin + tazobactam prevents C diff from colonizing

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9
Q

nocturnal enuresis

A

desmopressin

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10
Q

empiric trx for aspiration pneumonia/ lung abscess

A

STRONG Anaerobic coverage

  • -amoxicillin-clavulanate
  • -ampicillin-sulbactam,
  • -clindamycin + azithromycin
  • -imipenem (carbapenems have strong anaerobic activity)
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11
Q

path that clindamycin is used for

A

staph (including MRSA) strep bacteroides fusobacterium

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12
Q

ascites

A

furosemide + spironolactone (K sparing)

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13
Q

first line alternative to stimulants for ADHD

A

strattera = atomexatine

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14
Q

premature ejaculation

A

SSRIs, topical lidocaine, psychotherapy / couple’s therapy

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15
Q

chronic cough following a URI

A

upper respiratory cough syndrome (i.e. post nasal drip) antihistamines= chlorpheniramine, pseudoephedrine

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16
Q

chronic rhinitis

A

intranasal glucocorticoids

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17
Q

best agents for treating psychotic sx in Parkinsons

A

antipsychotics w low D antagonism =quetiapine, clozapine, pimavanserin

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18
Q

meds to add to carbidopa/levidopa w worsening PD sx

A

pramiprexole, ropinorole

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19
Q

acute gout flare-ups

A

first line = naproxen + indomethacin

IF PT IS ON ANTICOAG (ASA, clopidogrel, apixaban) = colchicine

  • inhibitor of microtubule formation (from beta tubulin)
  • AE= nausea, abd pain, diarrhea
  • CONTRA in the elderly and those w severe renal dysfunction
    • would consider glucocorticoids, as long as no complicated DM
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20
Q

first line and alt trx for chronic stable angina how does each med help angina? acute angina daily meds to prevent attacks

A

ACUTE:

  • 1st= nitrates ( dec preload, vasodilate)

DAILY: -

  • 1st= beta blocker = dec contractility + HR -2nd=
  • 2nd= ND CCBs = verapamil, diltiazem (dec contract +HR)
  • 3rd= DP CCBs= nifedipine, etc = dec afterload, systemic vasodilation
  • anti-angina=ranolazine (dec Ca influx into myocardium)
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21
Q

babesiosis

A

azithromycin + atovaquone

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22
Q

treatments for mania which drug is best for acute psychotic episode

A

mania

  • -antipsychotics: clozapine (require CBCs), olanzapine, mirtazapine,
  • -adjunctive benzo if needed ACUTE PSYCHOTIC EPISODE
    • = olanzapine -quick onset, can be given IM
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23
Q

trx for suspected snake bites

A

only given to people w severe sx (neuro, skin, CV) that is progressing (continued oozing) i.e hypotension

  • antivenom = crotalidae polyvalant immune Fab and (for rattlesnake spec)= crotalidae immune F(ab’)
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24
Q

primary biliary cholangitis

A

ursodeoxycholic acid

  • replaced hydrophobic bile salts with hydrophilic bile salts
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25
Q

acute cellular rejection of transplant organ

A

high dose corticosteroids (occurs w/in 3 months)

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26
Q

first line treatment for panic attacks (panic disorder)

A

long term

  • SSRIs/SNRIs + CBT
  • snri= duloxetine, venlafaxine

acute panic attack (i.e. in ED)/ waiting for SSRI to kick in=

  • benzos (lorazepam)
  • (NOT beta blockers like propranolol - sometimes used for performance anxiety but not even really)
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27
Q

what kind of anxiety is buspirone used for

A

generalized anxiety disorder (not for panic attacks/ panic disorder)

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28
Q

enteromibus vermicularis = pinworm (2 possible drugs)

A

( + scotch tape test ) -albendazole OR pyrantel pamoate -treat all household contacts bc v contagious

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29
Q

trx of QRS duration > 100 msec -to avoid what complications

A

IV sodium bicarbonate to dec risk of ventricular arrhythmia (PVCs)

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30
Q

myasthenia gravis

A

pyridostigmine + immunotherapy (steroids, azathioprine) -thymectomy

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31
Q

first line trx for ADHD clinical presentation -6+ -4-5 yo (preschool)

A

-6+ = methylphenidate -<6= behavioral therapy, i.e.parent-child (effective behavior strategies and how to stay calm)

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32
Q

cyanide poisoning

A

sodium thiosulfate hydroxocobalamin

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33
Q

medical trx for mild-mod heavy menstrual bleeding possible AE?

A

intranasal desmopressin (inc release of vWF) -associated with SIADH (is an ADH analog) so watch out for hypotonic hyponatremia (acute N, fatigue)

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34
Q

ankylosing spondylitis first line and refractory

A

1st= NSAIDs (ibuprofen, naproxen) or COX-2 inhibitors (celecoxib) 2nd= TNFa-I (infliximab, etanercept) or anti-IL17 Ab (secukinumab)

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35
Q

impetigo trx *possible complication?*

A

local = topical mupirocin

extensive = oral cephalexin *complications = post-strep glomerulonephritis

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36
Q

disease modifying agents for MS acute MS exacerbation

A
  • interferon-beta and glatiramer -glucocorticoids for acute
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37
Q

meconium aspiration syndrome/ neonatal pneumonia

A

nitric oxide (pulmonary vasodilator)

ampicillin + gentamicin

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38
Q

idiopathic pulmonary fibrosis

A

antifibrotic therapy = perfenidone, nintedanib smoking cessation, possible lung transplant, O2 and pulmonary rehab avg survival = 2-3 years

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39
Q

ALS

A

riluzole (inc survival) can add edaravone (slow progress) +support + palliative

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40
Q

the cognitive impairment associated with Parkinson Ds vs treatment of Parkinson Disease Dementia (PDD)

A

anticholinesterase = donepezil

  • dec PD agents
  • OR add low potency anti-psychotic (pimavanserin, quetiapine)
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41
Q

neuroleptic malignant syndrome

A

-stop antipyschotic // restart dopamine agent + support -refractory = dantrolene or bromocriptine

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42
Q

epidural hematoma

A

(lens shaped “biconvex” bleed) -symptomatic= emergent neurosurg for surgical evac

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43
Q

elevated intracranial pressure

A

IV mannitol

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44
Q

wernicke encephalopathy

A

IV Vit B1 (thiamine) + IV glucose

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45
Q

acute infective endocarditis

A

empiric IV vancomycin

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46
Q

mucormycosis

A

surgical debridement + amphotericin B (HALL: palatal/orbit necrosis)

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47
Q

small intestine bacterial overload

A

rifamixin (abx for traveler’s diarrhea or hapetic encephalopathy)

2nd line= amoxicillin/clavulanate

+metoclopramide to inc motility

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48
Q

alcohol use disorder

A

naltrexone acamprosate (a glutamate modulator) –> these will decrease the cravings in someone who wants to quit but hasn’t

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49
Q

secratory diarrhea

A

(watery diarrhea even after periods of fasting aka nocturnal) =loperamide = diphenoxylate-atropine

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50
Q

Guillan-Barre

A

–MONITOR autonomics and respiration (with spirometry) to see if need prophylactic intubation bc GB can cause respiratory failure –IV Ig or plasmapharesis

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51
Q

treatment resistant schizophrenia

schizophrenia associated w suicidality

A

clozapine

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52
Q

treatment resistant depression

A

phenelzine (MOA-I)

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53
Q

organophosphate poisoning

A

atropine then pralidoxime organophosphate = pro-cholinergic sx want to treat w anticholinergics

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54
Q

atropine toxicity

A

physostigmine = Ach-E inhibitor (pro-cholinergic) (can also use with any other anticholinergic toxicity)

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55
Q

high altitude sickness AMS vs cerebral edema

A

AMS : O2 + acetazolamide

cerebral edema (N/V/ drowsy) = O2 + dexamethasone

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56
Q

DVT anticoagulation in a patient with ESRD

A

unfractioned heparin, then warfarin

GFR < 30 CANNOT USE: Xa inhib (fondaparineux or rivaroxaban), LMWH (enoxaparin), or

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57
Q

smoking cessation

A

-verenicline (contra in pts w CV ds or risk) -bupropion (contra in active or hx bulimia) -nicotine patch/gum/lozenge : for those who can’t take ^^, works for long term and short term cravings

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58
Q

acute + subacute shingles

postherpetic neuralgia

A
  • -acute/subacute shingles = NSAIDs and analegesics
  • -postherpetic neuralgia = gabapentin, TCAs, pregabalin
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59
Q

giardia

A

metronidazole, tinidazole

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60
Q

proctalgia frugax

A

(recurrent episodes <30 min of rectal pain unrelated to defecation) -reassurance -nitroglycerin cream +/- biofeedback therapy for refractory sx

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61
Q

molluscum contagiousum

A

reassurance (clinical dx)= common, benign sx of poxvirus self resolve in 6-12 mo

-in adults w genital lesions, can do topical cantharidin, podophyllotoxin)

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62
Q

prostatis

A

acute bacterial prostatis (MC) =lovafloxacin or TMP-SMX for ~6 weeks to ensure eradication

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63
Q

delusional disorder

A

antipsychotics (even though the dx requires no hallucinations/delusions) +CBT

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64
Q

seborrheic dermatitis

A

anti-fungal = ketoconazole, selenium sulfide -SD associated w Malassezia species

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65
Q

post-organ transplant, to protect from opportunistic infections due to immunosuppression

A
  • biggest infections= pneumocystis pneumonia + CMV pneumonia (both have diffuse interstitial infiltrates but CMV is acute onset over days, pneumocystis is indolent

PCP prophylaxis = TMP-SMX (also protects against listeria, toxo, most URI pathogens) CMV prophylaxis = gancyclovir

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66
Q

sickle cell priaprism

A

aspirate the blood from corpus cavernosum intracavernous injection of phenylephrine (to contract vessels to push venous blood out)

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67
Q

depression characterized by insomnia and poor appetite

A

mirtazapine (associated w somnolence, inc appetite, weight gain) =SNRI = first line along w ssri, but better for sleep and inc appetite

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68
Q

antithrombotic prophylaxis in nonvalvular a fib

which patients need it

A

NON VitK antagonists: dabigatran, apixaban (-axabans)

  • equally or higher reduction of embolization risk as warfarin but without bleeding risk NOT nearly as effective to use anti-plts (ASA, clopidogrel)

or warfarin

CHA2DS2VASc score

  • 1 = intermediate score so give oral anticoag or ASA
  • 2+ = give oral anticoag
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69
Q

akathisia

A

is DOSE DEPENDENT 1. decrease the dose of the current antipsychotic 2. add on either a beta blocker (PROPRANOLOL) or an antichol (BENZTROPINE) -consider changing to an antipyschotic w less EPS sx aka second gen

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70
Q

anal fissures

A

topical nifedipine (reduce anal sphincter pressure)

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71
Q

first line anti-hypertensives

A

lisinopril losartan amlodipine chlorthalidone (thiazide diuretic)

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72
Q

hepatic encephalopathy

A

*presents w* = asterixis (flapping tremor of outstretched hands), confusion and somnolence progressive over hours to days

  • correct underlying cause = fluids, abx
  • dec blood ammonia = IV lactulose, rifaximin
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73
Q

trx for plantar fasciitis

A

heal inserts for shoes / orthotics activity modification stretching exercises (fasciotomy only for severe, refractory cases)

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74
Q

hepatitis C

A

ledipasvir-sofosbuvir (HCV dx requires +virus Ab AND +Ag)

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75
Q

triglycerides

A

<500 = lifestyle modification (inc exercise, reduce alc, weight loss) add statin for known CV risk >1000 = gemfibrozil (fibrates), fish oil, alc ABSTINENCE

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76
Q

impetigo local vs systemic

A

local = topical mupirocin (abx) systemic = oral cephalexin

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77
Q

atopic dermatiits

A

(eczema) always= topical emollients acute attack 1st line = topical steroids 2nd line= topical pimecrolimus (calcineurin inhib)

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78
Q

trigeminal neuralgia

A

carbamezapine or oxcarbezapine

TN=compression of CNV, with episodic facial pain triggered by innocuous stimuli

  • oxcarbezapine+carbamezapine = antiepileptic drugs that will inhibit action potentials via the Na channels
  • ox is better tolerated: associated w inc risk of hypoNa bc inc ADH sensitivity
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79
Q

inc uric acid (chronic gout, tumor lysis syndrome)

A

allopurinol rasburicase febuxostat

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80
Q

allergic rhinitis

A

intranasal steroid + avoid trigger (nasal drip –> cough, eye itching, “allergic salute” on nose)

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81
Q

alzheimers dementia

A

mild to moderate = cholinesterase inhibitors =rivastigmine , donepezil, galantamine mod-severe =NMDA antagonist =memantine

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82
Q

MDD with psychotic features i.e. depression and thinking their body is decaying from the inside

A

=SSRI + antipyschotic i.e. =sertraline + risperidone

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83
Q

bile acid diarrhea

A

~post-cholecystectomy, crohn’s, abd radiation =cholestyramine, colestipol (bile acid binding resins)

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84
Q

bloody diarrhea from E Coli O157:H7, Shigella, Campylobacter, or Salmonella

A

supportive care only only give abx if the pt is ill appearing / severe sick

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85
Q

chronic myeloid leukemia

vs

chornic lymphocytic leukemia

A

CML=

  • imatinib = works against BCR-ABL tyrosine kinase
  • 9-22 BCR-ABL fusion–> constitutive activation of tyrosine kinase –> CA

CLL

  • rituximab (+/- fludarabine)
  • = anti CD20 mAB, expressed on B cells
  • **pts on trx for CLL are at inc risk of infection = one of the leading causes of morbidity and mortality**
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86
Q

acute promyelocytic leukemia

A

(a subtype of AML) all-trans retinoic acid

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87
Q

warfarin induced intracerebral hemorrhage

A

(supra-therapeutic INR) warfarin refersal = -Vit K infusion (takes 12-24 hours to work) + prothrombin complex concentrate (short acting but also quick onset)

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88
Q

torsades des pointes

A

hemodynamically unstable = immediate defibrillation stable and conscious= IV magnesium sulfate (if w n mg levels)

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89
Q

paroxysmal SVT

A

acute= adenosine

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90
Q

atrial or ventricular tachycardia

A

amiodarone

may be used in polymorphic OR monomorphic vtach

vs SVT = verapamil / metoprolol

91
Q

symptomatic sinus bradycardia

A

atropine

92
Q

symptomatic AV node block

A

(mobitz II or type 3) atropine

93
Q

cardiotoxicity secondary to hyperkalemia

vs

chronic, asx hyperkalemia

A

calcium gluconate + (IV insulin + glucose)

  • EKG changes dec w severity : tall T waves –>low/absent P waves and high degree AV block –> QRS wide –> sine pattern

vs

low-K diet (<40-70 mEq/day), + oral cation exchangers (patiromer, zirconium cyclosilicate) to inc K excretion, avoid meds that inc K levels = NSAIDs, antiinflammatory

  • ACE-Is inc K levels but their net effect is more beneficial so you keep it
  • CKD pts w hypervolemia –> furosemide/ hydrochlorthiazide
94
Q

persistent raynaud’s (more than a few episodes)

A

amlodipine, nifedipine (D-CCB)

95
Q

syphillis

  1. primary
  2. secondary
  3. tertiary

first line and the alternative if first line is CONTRA

A
96
Q

myasthenia crisis

A

intubate + plasma exchange/ IVIG

97
Q

hypertrophic cardiomyopathy

A
  • metoprolol / atenolol >> verapamil
  • dec LVOT obstruction + dec angina sx
  • avoid volume depletion
  • surgery if sx persist
98
Q

osteoarthritis w sx

A

topical/oral NSAIDS = diclofenac

consider: dulextine, tramadol, topical capsaicin

99
Q

preop trx of pheochromocytoma

A

alpha blockers

=phenoxybenzamine, prazosin, doxazosin, terazosin, phentolamine

100
Q

antidepressants that can simultaneously treat neuropathic pain / chronic pain conditions

A

SNRIs = duloxetine

TCAs = amytriptiline

101
Q

inc fecal calprotectin is associated with what

A

inc fecal calprotectin and leukocytes is associated w IBD (crohn or UC)

waterry diarrhea

102
Q

painful rash on UE+LE

trx?

A

erythema multiforme = erythematous papules that develop into target lesions with dusky central area (inflammatory zone) surrounded by a pale area, and then another erythematous halo at the periphery

  • vs lyme with central clearing

=painful: episodes of rash that comes and goes

  • associated with
    • HSV (may have recurrent painful genital vesicles/ulcers) or mycoplasma
    • sulfanomides
    • malignancies
    • collagen vascular ds

trx = EM is self limited, can give antihistamines or steroids

103
Q

acute stress disorder

A
  • brief, trauma-focused CBT
  • consider meds for anxiety, insomnia
  • monitor for PTSD (> 1 month)
104
Q

trx of brown spider bite

was burning pain, then became blister, now is a black eschat with surrounding erythema that has spread out

A

brown recluse spider bite

none- supportive wound care only + ice (cold dec venom activity)

  • no surgical debridement until the lesion has stopped growing
  • supportive therapy for systemic sx
  • update tetanus
105
Q

empirical treatment for bacterial meningitis in the following groups

  • 2-50 yo
  • >50 yo
  • immunocompromised
  • skull trauma (penetrating/neurosurgery)
A

cefepime= 4th gen = heavy duty for immuncomp and trauma

old people and immunocomp need penicillin

everyone gets vancomycin

106
Q

pertussis

A

= whooping cough

macrolides = azithryomycin

(crows on the windowsill)

107
Q

abx prophylaxis for rheumatic fever

A

pts who have hx of rheuamtic fever (arthralgias after a febrile illness) may have rheumatic heart ds = chronic complication, which has inc risk of recurrance

most pts need prophylaxis to prevent recurrance

108
Q

pt w bipolar presents to the hospital in the midst of a depressive/suicidal episode

immediate trx?

A

acute bipolar depression = second gen antipsychotics quetiapine / lurasidone

=antipsychotics, even tho depressed bc ssri will trigger manic

109
Q

PUD from h. pylori

A

PPI + abx

amoxicillin + clarithromycin

110
Q

cataracts

A

(opacification of lens, pts see glare and halos around bright lights)

trx- surgical replacement of the lens, done once cataracts start to impair ADLs

111
Q

temporal lobe seizuresate associated w what

MC cause of focal epilepsy?

A
  • olfactory hallucinations, epigastric uneasiness
  • mesial temporal (hippocampal) lobe sclerosis
112
Q

condyloma acuminata

A

(HPV warts)

=thrichloroacetic acid

(soft, verrocous growth in inguinal area)

113
Q

hydradenitis suppurativa

A

doxycycline

=tender inflammatory nodules, often in intertriginous areas , associated with sinus tract formation and multiple open comedones

-associated w genetic predisposition, inc androgens, follicular hyperkeratosis, or colonization by c. acnes as well as climate, food, drugs (steroids, progestin only OCP)

114
Q

what is the next best step in the management of vascular damage in an extremity due to trauma (MVC, GSW, etc)

A

signs of digital ischemia= absent pulses, cool extremity

115
Q

bipolar maintenence therapy in pregnancy / trying-to-become-pregnant people

A

mood stabilizer: lamotrigine

  • the safest mood stabilizer for pregnancy
  • _valproate + carbamezapin_e = teratogen = most harmful in first trimester = nueral tube defects
  • lithium: relatively low risk teratogen : if stable on lithium before pregnany, may continue, but switching to lithium is inappropriate

delay pregnancy for 3-6 months after switching meds to assess the efficacy of the new med

antipsychotics =

-use second generation =quetiapine, risperidone

116
Q

bacterial conjunctivitis

viral conjunctivitis

allergic conjunctivitis

A

bacterial

  • erythromycin ointment
  • polymixin-trimethoprim / azithromycin drops
  • (lenses) = flouroquinolone drops

viral

  • warm/cold compress
  • +/- antihistamine drops = olopatadine or azelastine

allergic

  • olopatadine or azelastine = OTC antihistamines/ mast cell stabilizers
117
Q

horse farmer in TX presents for 4 days of HA, myalgias, and fever+chills. PE= petechial rash over UE+LEs.

hx= MI and TIA :: labs= plts 40,000, Na=129, rest wnl

dx? management?

A

rocky mountain spotted fever

  • throughout US, associated w summer in grassy/wooded areas
  • petechial rash spreads from extremities to trunk
  • trx= doxycycline
    • the confusion and lethargy is NOT associated w low Na: symptomatic hyponatremic usually presents <125
118
Q

acute cystitis in nonpregnany Fs

  • uncomplicated
  • complicated

asx bateriuria

A

uncomplicated acute cystitis

  • oral nitrofurantoin 5 days (unless Cr<60)
  • OR oral TMP-SMX 3 days
  • OR one dose fosfomycin

complicated acute cystitis

  • fluoroquinolones for 5-14 days
  • severe= broad spectrum abx= ampicillin/gentamicin

asx bacteriura

  • nitrofurantoin and repeat urine to test for cured
  • (dx= 100+ colonies e. coli on routine first prenatal visit urine test)
119
Q

acute pyelonephritis in F: nonpregnant vs pregnant

A

nonpregnant = floroquinolones

  • inpatient = IV floroquinolones +/- ampicillin / aminoglycoside

pregnant= cephalosporine, or amoxicillin-clavulanate, or fosfomycin

120
Q

sudden onset severe CP, diffuse

A

initial therapy = IV beta blockers

  • labetalol, esmolol, propranolol
  • = dec HR, SBP, LV contractility –> dec rate of inc in aortic wall stress

+ pain control

  • nitroprusside is a second line only if SBP remains >120
    • hydralazine = associated w inc risk of reflex sympa activation –> usually used in HTN emergency
121
Q

narcolepsy

A

modafinil = nonamphetamine trx to promote daytime wakefulness

sign cataplexy (M wknss triggered by emotions)–> antidepressants/ sodium oxybate (REM sleep suppressors)

122
Q

trx of a clavicular frx

A

NO reduction:

  • uncomplicated (no arterial damage) –> non-operative healing w rest, ice, and figure 8 bandage / sling
  • possible arterial damage
    • soft signs –> get CT angiography to see if there is damage
    • hard signs –> immediate surgical intervention (can nick brachial plexus, subclavian A and V)
123
Q

migrain prophylactic therapies (4)

A
124
Q

vasovagal syncope

A

=reflex syncope

recurrent= counterpressure techniques

  • inc venous return and cardiac output and somtimes abort the syncopal episode
  • i.e.when feel prodrome –> synope w legs about head, legs crossed w tensing of muscles, hand grip and tense UE w clenched fists
125
Q

topical and systemic trx

A
126
Q

restless leg syndrome

A

pramipexole, gabapentin

associtaed w abn iron / DA in CNS

127
Q

what are the following antifungals used for

  • griseofulvin
  • sulfadiazine - pyrimethamine
  • amphotericin B + flucytosine
  • flucanazole
A

griseofulvin = dermatophytes and onychomycosis

sulfadiazene-pyrumethamine = cerebral toxo

  • multiple, ring enhancing lesions

Amph B+flucytosine IV 2 weeks –> fucanazole 8 weeks = cryptococcal meningitis

  • CSF india ink stain = transparent capsule : fungal stain = encapsulated yeast + sabourad agar
  • subacute; acute + v severe w HIV

fluconazole >> itraconazole (less reliable, more AE)

-in pts w HIV and opp infections: antiretrovirals should NOT be started until 2+ weeks after antifungals are started or can worsen the infection

128
Q

adult w lead (Pb) poisening

A

chelation w calcium disodium (EDTA)

129
Q

ALS patient w orthopnea

A

=oft the first sign of respiratory insufficiency in ALS

noninvasive positive pressure ventilation

=improve survival by improving respiratory function

130
Q

primary adrenal insufficiency treated w hydrocortisone but still have hypoNa, hyperK, and orthostatic hypotension

A

hydrocortisone (or can use prednisone) is a glucocorticoid w mild mineralcorticoid action

  • (vs dexamethasone= only glucocorticoid action (only cortisol)

add low dose fludrocortisone = mineralcorticoid to help w the dec ALD in addition to the hydrocortisone which covers the cortisol

(vs adrenal insuff from hypothalamus/pituitary failure : n ALD, only need hydrocortisone)

131
Q

hypercalcemia

symptomatic vs asymptomatic

A

symptomatic

  • immediate= IV saline (restrore intravasc volume and promote Ca excretion) and calcitonin (inhibit osteoclast, rapid dec in Ca)
  • long term= bisphophonates (takes 2-4 days to kick in= zoledronic acid, pamidronate)

asx= no initial trx, avoid things that make it worse

132
Q

achilles tendinopathy

A

in athletes/ sudden inc activity = 2-6 cm proximal to insertion where BF is lowest

primary = activity modification, NSAIDS, ice+ cold compression

chronic = eccentric resistance (calf-strengthening) excercise= lengthening the m under load

133
Q

diabetic gastroparesis

A

metoclopramide = prokinetic and antiemetic

  • small inc risk of EPS sx

alt= erythromycin

  • mild prokinetic effect but usually wears off, mostly used in short term settings = <4 wks
134
Q

scabies

A

topical permethrin

= v pruritic, small papules btwn fingers and toes , axillae, and along waistline

135
Q

overflow incontinence

urge incontinence

stress incontinence

A

first line for all=bladder training

overflow =neurogenic bladder, i.e. periph neuropathy

  • presistant dribbling, inc residual V = neurogenic bladder, i.e. periph neuropathy
    • INC RESIDUAL V
  • cholinergic agonist = bethanechol: to inc detrusor contraction and urethral relaxation –> v severe= self-cath

urge incontinence

  • sudden, ovewhelming urge may not be able to make it to bathroom, wake up at night to pee =detrusor overactivity
    • n residual volume, may be unable to void w when bear down
  • mAcR ANTagonists (oxybutynin, tolterodine) and beta agnoists (mirabegron)

stress incontinence

  • leak w inc intrathoracic P bc dec urethral sphincter tone / urethral hypoermobility
  • trx= Kegel (pelvic floor) excercises, continence pessary, best long term= midurethral sling procedure
  • **continence pessary also used for pelvic organ prolapse**
136
Q

benign paroxysmal positional vertigo

A

vertigo = spinning sensation

paroxysmal = intermittant, short episodes (30-60 sec) of vertigo (most associated w peripheral path)

positional = associated w rolling over in bed, standing up too quickly

  • et= displacement of otoliths
  • dx= dix hallpick maneuver (place in multiple positions to look for nystagmus)
  • trx= head maneuvers to reposition displaced otoliths i.e. epley maneuver
137
Q

intrahepatic cholestasis

extrahepatic cholestasis

A

extrahepatic i.e. pancreatic CA = jaundice and pruritis

  • endoscopic stent placement to relieve the common bile duct obstruction
  • second line = bypass surgery by making an anastamosis

intrahepatic i.e. PBC

  • ursodeoxycholic acid
138
Q

acute agitation in the hospital

  • haloperidol vs lorazepam
A

underlying cause = delirium

  • haloperidol

acute psychotic agitation

  • either antipsychotic or benzo (or a combo)
  • some antipsychotics can cause inc Qtc interval : in pts w qtc interval greater than 500 –> use lorazepam ; haloperidol (or ziprasidone)may inc risk of torsades

due to alc withdrawal

  • lorazepam
139
Q

acute COPD exacerbation

A

O2

inhaled bronchodilators (i.e. albuterol, inhaled inpratropium if they take those)

systemic glucocorticoids associated w dec hospitalization length and improved pumonary function

140
Q

erythematotelangiectasia rosacea

papulopustular rosacea

phymatous rosacea

ocular rosacea

A

chronic “rash” that waxes and wanes but is always there, may tingle before beaking out again

associated w UV lights, microbac, spicy foods..

erythematotelangiectasia = topic brimonidine + photoherapy

papulopustular = topical metrinidazole or ivermectin

phymatous= oral isoretinoin

ocular= lid scrubs and lubricants

141
Q

pt, hx of MI, presents for sudden onset palpitations and diaphoresis and dizzy.

ecg = regular, wide qrs. PE= irregular , high amplitude jugular venous pulsations

dx?

A

some kind of AV dissociation post ischemic infarct

=v tach, or PVCs, or AV block

= ventricles contracting withou atria, so see high JV pulsations bc blood pushing against a closed tricuspid

  • vs tricuspid regurge= prominent V wave and absent x descent (not “high amplitude”) : RA don’t fill as much so you get lower amplitude and a softer diastole
142
Q

spinal epidural abscess

A

Broad spectrum abx= vancomycin + ceftriaxone

(Subacute LBP and hx of recent illness/IVDA–> acute fever, localized back pain, neuro sx)

143
Q

Empiric abx for community acquired bacterial meningitis in immunocompromised pts or pts 50+ yo

A

For most common causes = strep pneumo, neisseria, and hib = ceftriaxone + vancomycin

in immunocomp or 50+ have to also cover listeria = add ampicillin

144
Q

alopecia areata

A

= painless patches of hair loss, + hair pull test, w thinning at the base(explanation point hairs), may itch.tingle before falling out

=genetic predisposition, autoimmune, can present in teens

  • local area = intralesional/topical steroid = triamcinolone
  • areata totali = immunotherapy (diphenylcyclopropenone) or oral steroids
145
Q

neonatal sepsis = <28 days

vs >1 mo w sepsis

A

neonatal sepsis = ampicillin + gentamicin

  • amp = GBS and listeria
  • gentamicin = E. Coli
  • given empirically: often presents w poor feeding and irritability, may have n T/hypo/hyperthermia, abn leukocytes= <4500 or >11k, need to have high index of suspicion
    • may or may not have jaundice, respiratory distress, CNS sx : give abx while waiting on cultures

infant sepsis = > 1 mo

  • vancomycin + ceftriaxone
    • these can cause hyperbili in neonate so don’t use before 1 mo
146
Q

acute pericarditis

A

whether viral and idiopathic

= (ibuprofen/indomethacin) + colchicine

(only use prednisone if contra or refractory to NSAIDs)

147
Q

when is diclofenac used

A

= an NSAID

MC NSAID used in the trx of arthritic pain

diclofenac+triptan can trx Acute migraine

148
Q

when are ergotamines used

what medication are they known to have a bad reaction with

A

i.e dihydroergotamine

can be an acute trx of migraines

bad reaction with triptans

  • when a triptan or an ergotamine is used for an acute migraine, cannot give another triptan for the next 24 hours
  • both triptans and ergotamine work on the 5HT receptors and cause vasoconstriction and dec cerebral inflammation BUT double dose would case too much vasoconstriction that can cause inc BP, MI, or stroke
149
Q

acute vs chronic trx of migraines

A

acute migraine

  • triptans
  • ergotamines
  • NSAIDs (naproxen)
  • acetominophen
  • metoclopramide / perchlorperazine for antiemetic

chronic migraine

  • topiramate
  • TCAs (amytriptyline)
  • propanolol
  • divalproex sodium
150
Q

improve survivability in LV systolic dysfunction

A

i.e = displaced maximal point of impulse, previous ischemia and now HF…

  • ACE-I / ARB,
  • ALD antagonists = spironolactone/eplerenone
  • beta blockers = metoprolol succinate, carvedilol, bisoprolol
151
Q

labor protraction vs labor arrest

A
152
Q

hypertriglyceridemia

A

fenofibrates

153
Q

Raynaud’s phenomenon

A

Whether idiopathic, or secondary to scleroderma/ SLE

first line = avoid the cold

nifedipine = peripheral vasodilation

154
Q

Torsades does pointes

A

Magenesium sulfate = first line, whether or not there is hypokalemis

second line = temp pacemaker or IV protenerol

155
Q

asymptomatic bacteriuria in pregnant patients

A

all pts are screen in the initial prenatal visit, and trx if + urine culture

MC pathogen = E. Coli

  • amoxicillin - clavulanate
  • cephalexin
  • nitrofurantoin
  • fosfomycin
156
Q

top three anxiety

  1. paxil - most anxiolytic, most sedating
  2. prozac
  3. zoloft

what meds are these? what is a common side effect seen with all of them that dictates how to dose?

A

all SSRIs!

  1. paxil = paroxetine
  2. prozac = fluoxetine
  3. zoloft = sertraline hydrochloride

SSRIs tend to cause a dec serotonin before they cause inc serotonin –> can cause initial inc anxiety, restless, sleep problems

  • especially in anxiety pts
  • start the dose low and build tolerance to avoid those AEs

buspirone : less side effects but less effective at dec anxiety

157
Q

external hemorroids

A

uncomplicated = conservative management

“thrombosed” = acute onset of severe pain –> hemorrhoidectomy

158
Q

anorexia nervosa

bulimia nervosa

binge eating disorder

A

first line for ALL is CBT and behavioral therapy

+

AN= olanzapine (zyprexa)

BN= fluoxetine (prozac)

BED = SSRI/lisdexemfetamine (vyvanse)

159
Q

sunburn

A

mild = cool compress, lotion, aloe vera, oral NSAIDS

severe= IV fluids + wound care hospitalization

+ blisters= bacterial prophylaxis = silver sulfadiazine + topical mupirocin ointment

160
Q

threatened abortion

A

=vaginal bleeding w closed cervix and n FHT

  • = expectant management : most will continue to have n pregnancy
  • provide reassurace, do follow up US regularly to observe
    • US may show subchorionic hematoma = blood between placenta and uterus
    • risk for spontaenous abortion inc w inc maternal age/previous spont ab

no give R-immunoglobulin

  • that is for cases of fetal-maternal hemorrhage
  • =delivery, spontaneous abortion, abruptio placentae
161
Q

acute a fib in WPW

vs isolated a fib w RVR

A

w WPW

  • can be life threatining and lead to v fib
  • unstable –> electrical cardioversion
  • stable –> procainamide

a fb w RVR (= most common a tachy)

  • unstable –> cardioversion,
  • stable –>
    • onset >48 hours= rate control w esmolol/propranolol/metopralol + verapamil/diltiazem (ND CCB-CONTRA in decompensated HF)
    • onset < 48 hours = rate contol (^^)
      • failure to get rate control –> rhythm control (flecainide, propafinone, dofetilide) = CONTRA in chronic a fib/a tachy, digoxin toxicity, or high risk for thromobo-embolic :
162
Q

CA related cachexia/anorexia

HIV related cachexia/anorexia

A
  • CA related
    • progesterone analogues = megestrol acetate, medroxyprogesterone acetate
    • corticosteroids
  • HIV related
    • synthetic cannabinoids = dronabinol
163
Q

acute pancreatits

A

IV crystalloids (fluids) = just like sepsis

  • the luekocytosis and fever are from systemic infl caused by release of pancreatic enzymes, not an infection
  • sepsis= release of too many cytokines, rather than an/the actual infection

give abx if there is a evidence of pancreatic necrosis (on CT) or extrapancreatic infection (i.e. pneumonia)

  • pancreatitis non-infection is still associated w L pleural effusion

trx w IV fluid in first 48 hours = major dec in mortality and morbidity

164
Q

acute colonic pseudobstruction

A

NPO, decompression (NG or rectal)

if persist >48 hours after initial trx –> neostigmine

165
Q

malaria acquired in Africa

malaria acquired outside of Africa

A

P falcifarum is MC in African countries

  • chloroquine

P vivax is MC outside of Africa

  • need chloroquine and primiquine
    • for dormant hepatic phase
166
Q

what (3) vaccines are recommended in preg

what (4) are contraindicated in preg

A

“high risk* = immunocomp, chronic heart/lung/liver ds

3 rec= tdap, flu, RhD

4 contra= HPV, MMR, live flu, varicella

167
Q

hyponatremia due to high osmolality?

how does that happen?? when would this happen?

A

hyperglycemia –> inc osmolality >295 –> kidneys respond by pumping out Na (+water) –> worsened high osmolality but now hyponatremia too

  • missed doses of DM medications / inadequate dose
168
Q

legionella pnuemonia

A

(recent travel, now have GI + pulm + fever)

levofloxacin or azithromycin/clarithromycin

169
Q

pt presents, on amlodipine and carbamezapine, for recent onset fatigue, nausea, and forgetfulness. labs= hyponatremia

most likely dx?

A

SIADH

associated w SSRIs, carbamezapine,NSAIDS

170
Q

condyloma acuminata

A

nonpregnant = vaccine

pregnant = topical trichloroacetic acid

171
Q

AEs of the following RA Ds-Modifying Agents:

  • methotrexate (3)
  • leflunomide (2)
  • hydroxychloroquine (1)
  • sulfasalazine (3)
  • TNF inhibitors (4)
A

big AEs associated w multiple DMD = hepatotoxicity, stomatitis, cytopenias

methotrexate induced lung injury

  • NOT dose dependent = hypersensitivity pneumonitis
  • risk inc w RA, parenchymal lung ds
  • clin= exertional dyspnea, hypoxemia, pulm infiltrates w reticular thickening (fibrosis) w negative microbio
    • onset 1-12 months after start w pneumoitis –> fibrosis = restrictive lung ds
    • CT scan =inflammation w ground glass opacities or consolidations and.or fibrosis = reticulation
    • bronchoalveolar lavage = lymphocytosis, peripheral blood= eosinophilia
  • dx= trial of stopping MTX to see if sx improve
172
Q

scleroderma renal crisis

A

ACE-I (to inhibit the RAAS)

  • Cr will inc a little bit when you start the ACE-I, but that’s okay
  • steroids would make it worse by salt/water retention
173
Q

acute psychosis (nonviolent)

A

aka acute schizophrenia

first line 2nd gen

risperidone : aripriprazole : olanzapine : quetiapine : ziprasidone

174
Q

acute limb ischemia in the setting of PAD

A

IV heparin

thrombolysis

thrombectomy

175
Q

pt came in after bee sting w anaphylactic shock. given IM Epi, resolved sx.

now, an hour later, worse hives, mild wheezing, and an episode of emesis.

next step trx?

A

another dose of IM Epi –> can be given 3 times!

  • = biphasic anaphylaxis

if after 3 doses IM Epi no respond / recurr … give IV Epi

  • if also have bronchoconstrictions –> add albuterol
  • if also have hypotension : add IV fluids and trendelenburg
176
Q

photokeratitis

A

pain relief and lubrication

topical abx= erythromycin

eye protecting gear in future(goggles, sunglasses)

~usually resolves within 1-3 days~

177
Q

list (4) drugs/groups of drugs that are associated with ototoxicity as a known AE

A
  • aminoglycoside abx = gentamicin, tobramycin, streptomycin,
  • furosemide (loop diuretic)
  • cisplatin (platinum chemo)
  • high dose salicylates (ASA)
178
Q

apnea of prematurity

A

=intermittant episodes (seconds) of no breathing in babies a few days old, MC associated w prematurity

  • if no hypoxia = no need to treat
  • recurrent episodes assoiciated dec O2 sat/BP –> trx w caffeine, noninvasive ventilation
  • resolves w time
179
Q

name 5 meds to absolutely avoid in G6PD deficiency pts

A
180
Q

pt w splenectomy/asplenia develops a fever

A

can lead to fulminant bacterial infection v quickly

IMMEDIATELY prescribe amoxicillin-clavulunate bc asplenia = inc risk of encapsulated bac= strep, h flu, neisseria

181
Q

35 yo presents w a breast mass noticed a week. ago.

mammography= 3x3 cm spiculated mass w coarse calcificaitons in upper outer quadrant

US= hyperechoic

FNB= foamy Mø

A
  • fat necrosis
  • FNB= foaomy histiocytes w fat globules
  • excise mass and then reassure w routine follow uo
  • =benign mass
182
Q

describe the flow volume loop

  • normal
  • asthma
  • laryngeal edema
  • pnuemothorax
  • pulmonary edema
A
183
Q

13 yo presents w two months of inc fatigue throughout the day.

labs= hgb 8.4, MCV 70

PE= a few brown macules on lips and buccal mucosa

most likely dx? cause of anemia?

next best step in management?

A

peutz jeger

  • colonic hamartoma that is bleeding or occult malignancy or intestinal obstruction causing iron deificeny anemia
  • get an upper endoscopy to assess for occult bleed or malignancy
184
Q

cervical radiculopathy

A

trx=

  • NSAIDS and avoid provacative activities
  • maintain mod activity (no bedrest)
  • if v severe pain= oral steroids

MOST WILL GRADUALLY RESOLVE ON OWN

=acute from disk herniation (weight lifting) or progressive w spinal spondylosis

= no imaging needed w classic clinical suspicion and low risk pts

  • MRI spine if: severe, progressive, or bilat neuro pain
185
Q

pt hx of enuresis and liquid stool incontinence

A

constipation can cause detrusor muscle instability = enuresis

  • liquid stools = around chronic constipation
  • trx w laxatives can resolve both enuresis and stool incontinence
186
Q

tricyclic OD

A
  1. O2, intubation if needed
  2. IV fluids
  3. activated charcoal if present within 2 hours of ingestin
  4. sodium bicarb if have inc QRS interval or ventricular arrhythmia
187
Q

when to give the meningoccoccal booster vaccine (3)

A
  • @ 16 yo
  • before travel to endemic regions= sub-saharan (including central0 Africa and Hajj
  • +/- military recruits, 1st year college
188
Q

tetanus prophylaxis: what do you give for:

  • known 3+ toxoid doses of vaccine for a clean, simple wound
  • known 3+ toxoid dose for deep, dirty wound
  • unknown/ < 3 for clean, simple wound
  • uknown/ < 3 for deep, dirty wound
A

tetanus immune globulin is ONLY FOR unknown/not full immunized AND deep dirty wound

  • = booster + IG

if fully vaccinated: only give booster if last vacc was

  • 10 years+ in simple clean wound
  • 5 years+ in a deep dirty wound
189
Q

beta blocker toxicity

A

glucagon

190
Q

campylobacter GI

A

is self-limited = supportive care only

mucusy diarrhea +/- blood

191
Q

venous air embolism

A

left lateral decubitus positioning

high flow or hyperbaric O2

192
Q

prolactinoma

A

=galactorrhea/amenorrhea +/- HA, visual changes

asx + < 10 mm = no trx, just follow

sx/ >10 mm –>

  • < 3 cm = D-agonist = bromocriptine/ cabergoline
  • >3 cm OR worse w ^ meds = resection
193
Q

one day old bb born to mom w uncontrolled GDM. presents w systolic ejection murmur and thickened IV septum on sonograph

A

= hyptertrophic cardiomyopathy

  • infants from GDM have transieny HOCM that can cause HF

trx= IV fluids and beta blockers (propranolol) to inc LV volume and overcome obstruction

  • will self-resolve in a few months
194
Q

lyme prophylaxis

-what 5 criterion must be met for qualification for prophylaxis

A

=single dose of doxycycline

-erythema around attached tick= no means bit, just local irritation

195
Q

nephrotic syndrome is associated with what CV complications

A

dec osmotic pressure bc dec protein

  • = in lipid synthesis = inc LDL and TGs –> accelerated atherosclerotic ds
  • = hypercoaguability, affects veins more than As
  • inc risk renal V thrombosis, stroke, MI
196
Q

2 years of hand pain + stiffness, work when working w hand tools. PE= mild, hard, periarticular enlargements at multiples PIPs and DIPs

trx?

A
  • stretching and strengthening
  • oral OR TOPICAL NSAIDs = i.e. topical diclofenac
197
Q

pts receiving high dose bisphosphanates need to have what medical work checked out/ done before hand

A

dental procedures –> inc risk of osteonecrosis of the jaw

198
Q

community acquired pneumonia

A

curb-65 score <2 = outpatient amoxicillin+ sulbactam

curb-65 2+ (aka need hospital stay) = bata-lactam / flouroquinoloe + macrolide

  • ceftriaxone + azithromycin
  • levofloxacin + azithromycin : avoid in elderly due to inc risk of c. diff
199
Q

chronic pancreatitis

A
  1. pancreatic enzyme (lipase, amylase, protease) supplementation
    1. even if serum levels are n
    2. will provide the (-)feedback to CCK and break the cycle of hyperstimulation
  2. change diet = small, frequent meals
  3. cessation of tobacco+alc, fix DM
  4. SECONDARY
    1. pregabalin, amytriptyline
200
Q

epiglottitis

A

Hib = v low bc vaccinated. but can still be caused by strep, staph, and other variants of hib

= ceftriaxone + vancomycin

201
Q

opioid withdrawal (2 options)

A

methadone or buprenorphine

202
Q

burn wound infection

A

i. e. loss of viable graft, erythema
systemic: pseudomonas/ s. aureas

  • pepiracillin-tazobactam OR meropenem
  • and vancomycin

local, nonsystemic

  • cefezine, clindaymycin
203
Q
  1. good G- coverage : i.e. what bugs
  2. anaerobic : what situations?
  3. MRSA
  4. when to use: amoxicillin-clavulunate or ampicillin-sulbactam (5 classes, total 9)
  5. meningitis
  6. severe, life threatening infections including nosocomial
A
  1. G- = pseudomonas, E. coli, klebsiella
  • piperacillin-tazobactam / ampicillin/sulbactam
  • OR carbapenem / meropenem
  • IV aztreonam is G- only = alternate for penicillin allergy
  • pseudomonos: only cephalosporin that is effective = cefipime, ceftazidime
  1. anaerobic : clostridium, actinomyces, fusobacterium bacteroidies
  • = colonic infections, dental abscess, gut flora, FOUL SMELLING
  • penicillins, carbapenems, any gen cephalosporin
  1. S. aureus
  • vancomycin, nafcillin/oxacillin (penicillinase resistant)
  • 5th gen ceph = ceftaroline
  1. amoxicillin-clavulunate or ampicillin-sulbactam
  • H. pylori,
  • H. influ
  • e. coli, listeria, salmonella, shigella, enteroccoci
  • proteus,
  • spirochetes
  1. cross CNS BBB
    * 3rd gen cephs : cefixime, ceftriaxone, ceftazidime, cefotaxime
  2. 4th gen ceph =IV cefepime
204
Q

initial COPD dx management

-what are parameters by which you base your trx?

A

severity and hospital/ outpt exacerbation

everyone gets a LAMA (tiotropium) UNLESS they have had no hospital / <2 oupt exac AND its not severe = SAMA = inhaled tiotropium

205
Q

chronic inflammatory demyelinating polyneuropathy

A

IV IG, glucocorticoids, plasmapharesis

206
Q

reverse warfarin anticoag

reverse heparin anticoag

A

warfarin –> vit K

heparin –> protamine sulfate

207
Q

head ct reveals hemorrhagic stroke

next best step

A

IV nicardipine / labetolol to control BP

reverse any anticoag

elevate head, sedation, mannitol = regulate ICP

208
Q

diabetic drugs

  • post prandial effects
  • associated w weight loss
  • associated w weight gain
  • no risk of hypoglycemia
  • dec cardiovascular mortality
  • improve dyslipidemia
  • improve BP
  • contraindicated with malabsortption
  • contraindicated w renal failure
  • contra in heart failure
  • disulfuram like reaction
A
  • post-prandial
    • insulin glusin, aspart, lispro
    • amylin
    • acarbose, miglitol
  • associated w weight loss
    • SGLT2-I (-glifazolin)
    • GLP-1 agonists (-tide)
    • biguanide (metformin)
  • weight gain
    • sulfonylureas
    • thiazolidediones (glitazone)
  • no risk of hypoglycemia
    • biguanide (metformin)
    • thiazolidinediones (-glitazone)
    • GLP-1 agonists (-tide)
    • DPP-4 inhibitors (gliptin)
    • alpa-glucosidase inhib (miglitol, acarbose)
  • dec cardiovascular mortality
    • SGLT-2 inhibs (glifozolin)
      • (use in DM+CV comorbidities)
  • improve dyslipidemia
    • biguanides (metformin)
    • thiazolidediones (glitazone)
  • improve BP
    • SGLT-2 inhibs (-glifozolin)
  • contraindicated with malabsortption
    • alpha glucosidase inhibs (acarbose, miglitol)
  • contraindicated w renal failure
    • alpha glucosidase (acarbose, miglitol)
    • DPP-4 inhibs (gliptins)
    • SGLT2 inhibitors (flozin)
    • metformin (–> lactic acidosis)
  • contraindicated in heart failure
    • thiazolidediones (glitazone)
    • metformin
  • disulfuram like rxn
    • sulfonylureas (don’t drink pond water)
209
Q

acute management of DKA (5 aspects)

what labs is best to monitor pt response to trx

A

dx= hyperglycemia + HAGMA

  • best monitor of response = resolving anion gap (lytes and venous pH)

acute management

  1. fluids
    1. 0.9% saline rapid infusion
    2. when glucose <200 , add dextrose 5%
  2. insulin
    1. IV insulin only if K is 3.3+
    2. switch to SQ insulin once: gluose <200, anion gap < 12, bicarb 15+
      1. overlap IV and SQ 1-2 hours
  3. K
    1. add IV K if <5.3 , hold if 5.3+
  4. bicarb
    1. consider if pH<6.9
  5. phosphate
    1. conside if ph<1 OR cardiac dysfunction OR respiratory dysfunction
    2. monior Ca frequently
210
Q

drugs that cause hyperkalemia

5 drugs

4 classes

A

drugs:

  • cyclosporine (used to prevent transplant rejection)
  • heparin
  • trimethoprim (TMP)
  • digoxin
  • succinylcholine

classes

  • ACE-I/ ARBs
  • NSAIDs
  • K sparing diuretics (spironolactone, amiloride, triamterene)
  • beta agonist BLOCKERS
211
Q

acute management of unstable angina / NSTEMI

(6)

A

t wave inversion V1-V4 = NSTEMI

  • nitrates
    • (CAUTION W HYPOTENSION)
  • beta blocker = metoprolol, atenolol
    • CONTRA in HF and pulse<60
  • antiplt
    • ASA + clopidogrelP2Y12-blocker
  • anticoag
    • unfrx haprin, enoxaprin, fondaparineux, or bivalirudin
  • statin = high intenstity = atorvastatin, rosuvastatin
  • cath reperfusion w/in 12 hours
212
Q

bisphosphonates are contra indicated in what pts?

  • second line Oporosis
    • denosumab requires monitoring of what
    • anabolic agents require monitoring of what
    • AE of SSRIs
    • use of nasal calcitonin
A

denosumab

  • monitor Ca

anabolic agents = teriparatide

  • monitor Ca, uric acid, renal function

SSRI = inc risk of DVT

nasal calcitonin = dec pain of frx, modest reduction of frx risk

213
Q

first line maintenence therapy of severe bipolar

A

nonsevere= maintain on lithium/valporate/quetiapine/lamotrigine

severe

(valproate or lithium) + queitiapine

  • no diff between lithium or valproate
214
Q

name 4 AEs of statins

A

myalgias

fatigue

hepatic dysfunction

new onset DM

215
Q

insulin

  • short acting
  • intermediate acting
  • long acting

w DKA?

A

short acting (w meals)

  • insulin glusine, aspart, lispro

intermediate

  • regular insulin
  • NPH

long acting (bolus)

  • detemir, glargine

w DKA = regular insulin bc only one that can be given IV

216
Q

uterine atony

1st, 2nd, and 3rd line

A

MC cause of postpartum hemorrhage
risk = macrosomia, operative vaginal delivery —> continuous bleeding

  • first line= bimanual uterine massage, high dose of oxytocin
    • (+correction of bladder distention, misoprostol)
  • second line; tranexamic acid = antifibrinolytic to reduce maternal mortality from hemorrhage
  • third one = carboprost, methylgonovin
217
Q

eclampsia and pre-eclampsia

A

lower P acutely to decrease stroke risk =

  • first line = IV labetalol = fast acting BUT can cause dizzy in bradycardia <60 bpm
  • IV hydralazine = can cause tachy
  • oral nifedipine , may not be able to swallow if N/V

prevent seizures = IV/IM magnesium sulfate

ECLAMPSIA = head CT shows white matter edema

218
Q

preterm labor (4)

prophylaxis?

A

preterm labor = < 32weeks

  • (tocolysis); < 32 weeks = indomethacin

32-34 weeks = nifedipine

* causes dec prostaglandins —\> fetal vasoconstriction —\> can cause dec renal perfusion and oligohydramnios * **betamethasone** to promote fetal lung maturity * **magnesium sulfate** to decreased risk of cerebral palsy (fetal neuroprotection) * **penicillin** to decrease risk of neonatal GBS infection

biggest risks = hx preterm labor, short cervix, prior cold knife conization

  • screen for short cervix (if no hx) @ 16-24 weeks
  • if <2.5 cm on US, give vaginal progesterone to prevent contractions and preterm labor
219
Q

preterm and prelabor rupture of membranes

  • <34 weeks
  • 34-37 weeks
A

<34 weeks =

  • uncomplicated
    • ampicillin + azithromycin
    • expectant + monitor fetus
  • infection, fetal or maternal compromise
    • ampicillin + gentamicin
    • delivery
220
Q

birth control in a pt w migraine w aura

contra-indications to IUD placement

A

migraines = NO estrogen containing contraception

CAN HAVE progestin release subnormal implant

  • long actin (up to 3 years),
  • reversible,
  • reduce menstrual bleeding of 50%
  • cause amenorrhea in 20%
  • also good for patients who have difficulty w pelvic exams

IUD placement

  • general contra = ds of uterus/cervix
    • pregnancy,
    • endometrial/cervical CA,
    • unexplained vaginal bleeding,
    • gestational trophoblastic disease,
    • distorted endometrial cavity,
    • acute pelvic infection (PID, cervicitis)
  • progestin IUD
    • acute liver ds
    • acute breast CA
  • copper IUD
    • anemia
    • heavy menstrual bleeding
    • wilson ds
221
Q

lieomyomata uteri

A

fibroids

c<em>ommon cause of heavy menstrual bleeding = proliferation of sm M within myometrium can cause profuse menses and irregular uterine enlargement</em>

  • oral contraceptives can dec bleeding duration and volume but won’t resolve
  • sx anemia –> transfusion + more invasive fibroid trx (myomectomy, uterine artery embolization, hysterectomy)
222
Q

most effective emergency contraception

A

copper IUD

ulipristal

up to 99% efficacy; work up to 5 days later

223
Q

vaginitis

  • thin off white dc w fishy smell
  • yellow-green malodorous dc
  • thick white dc
A

gardnerlla= metronidazole or clindamyin

trichomonas= metronidazole + trx partner

candida = fluconazole

224
Q
A

steeple sign = croup

MC= parainfluenza virus

racemic epinephrine

level 2 (4 decks)

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