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Step 2 DIT > Treatments 4 > Flashcards

Treatments 4 Flashcards

1
Q

Celiac sprue

A

Remove gluten from diet (wheat, barley, rye; can still eat corn, rice)
Corticosteroids for refractory disease

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2
Q

Tropical sprue

A

Folic acid replacement
Tetracycline or sulfa drugs 3-6 months
Gluten removal from diet has no effect

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3
Q

Lactose intolerance

A

Remove lactose from diet
Adequate diet Ca, protein, fat, vitamins
May use lactase replacement

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4
Q

Whipple disease

A

TMP-SMX or ceftriaxone for 12 months

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5
Q

Crohn’s

A

Azathioprine or Mercaptopurine
Anti-TNFa (infliximab, adalimumab)
Steroids and abx for acute exacerbation
Try to avoid surgical resection

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6
Q

UC

A

Total colectomy is curative
Sulfasalazine (large bowel), 5-ASA/mesalamine (SB)
Supplemental iron
Steroids (acute exacerbations)

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7
Q

IBS

A

Diarrhea predominant - TCAs/SSRIs, Lotronex (woman), Loperamide PRN
Constipation pred - Fiber building agents, hydration
Reassurance, possible psychosocial therapy

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8
Q

SBO

A

NPO, hydration
NG decompression
Surgery if refractory, complete obstruction, strangulation

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9
Q

Large bowel obstruction

A

NPO, hydration
Colonoscopy
Surgery if refractory

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10
Q

Ischemic colitis

A

IVF, bowel rest
Antibiotics for GI bacteria
Surgical resection of necrotic bowel

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11
Q

Appendicitis

A

Appendectomy if symptom onset w/i 24-72 hrs

If >5 days: Abx, IVF, bowel rest + interval appendectomy 8 weeks later

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12
Q

Abscess formation w/ appendicitis

A

Percutaneous drainage

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13
Q

Ileus

A

Treat underlying cause
NPO
Colonoscopic decompression if no resolution

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14
Q

Volvulus

A

Self-limited sometimes
Colonoscopic decompression of sigmoid
Surgical repair or resection if cecal volvulus, failed colonoscopic decompression

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15
Q

Diverticulosis

A

High-fiber diet

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16
Q

Diverticulitis, mild/early

A 
Bowel rest (liquids only) x 3 days
Abx (gram neg + anaerobics): fluoro (cipro) + metronidazole OR TMP-SMX + metro OR amoxicillin-clavulanate
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17
Q

Diverticulitis, surgical indications

A

Any sign of perforation
(including free air under diaphragm on x-ray)
Severe cases
Peritonitis

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18
Q

Hemorrhoids

A

Warm (sitz) baths
Increase fiber, avoid prolonged straining
Sclerotherapy, ligation, excision if worsening

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19
Q

Anal fissures

A 
Stool softeners + hydration (first line)
Topical nitroglycerine (first line)
Topical diltiazem, nifedipine, bethanechol (2nd line)
Botox injection (2nd/3rd line)
Partial sphincterotomy (recurrent)
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20
Q

Anorectal abscesses

A

Antibiotics

Surgical I&D

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21
Q

Rectal fistula (fistula in ano)

A

Fistulotomy

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22
Q

Pilonidal disease

A

Surgical I&D w/ packing

Surgical closure of sinus tracts may prevent recurrence

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23
Q

Carcinoid tumor

A

Octreotide, IFN-alpha (if refractory) for symptoms
Cyproheptadine, codine, cholestyramine (diarrhea)
Albuterol, theophylline (bronchospasm)
Surgical resection
Vavulvar surgery if needed

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24
Q

Upper GI bleed, stable

A 
PPI IV (in case PUD)
Octreotide/somatostatin (splanchnic VC)
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25
Q

FAP

A

Prophylactic subtotal colectomy <25 yo

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26
Q

Pancreatic pseudocyst

A

Possibly self-resolving

Treat (drain) if lasting >6 wks, painful, rapidly growing

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27
Q

Exocrine pancreatic cancer

A

Whipple procedure for non-metastatic cancer limited to head of pancreas
Lesions in body or tail rarely resectable if found early
Adjuvent chemo for resectable cancer
Enzyme replacement therapy
Stenting of ducts, duodenum = palliative

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28
Q

Insulinoma

A

Octreotide or diazoxide

Surgical resection if you can

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29
Q

Glucagonoma

A

Octreotide, IFN-a, chemo
Surgical resection if you can
Embolization in metastatic

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30
Q

VIPoma

A

IVF + electrolyte replacement
Octreotide, corticosteroids, chemo
Surgical resection if you can
Embolization in metastatic

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31
Q

Cholelithiasis

A

Cholecystectomy for symptomatic patients

Dietary modification, bile salts, shock wave lithotripsy

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32
Q

Cholecystitis

A

Cholecystectomy (frequently delayed 24-48 hrs for hydration, abx)

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33
Q

Cholangitis

A

Hydration, IV abx
ERCP/stent to drain bile ducts
Cholecystectomy (delayed)

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34
Q

Gallbladder cancer

A

Cholecystectomy + LN dissection + partial removal of adjacent hepatic tissue
Adjuvant radiation and chemo

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35
Q

PBC

A

Ursodeoxycholic acid slows damage, increases survival
Liver transplant may be needed
Treat symptoms as needed

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36
Q

PSC

A

Ursodeoxycholic acid, MTX, stseroids
Endoscopic stenting, surgical resection
Liver transplant

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37
Q

Gilbert disease

A

None

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38
Q

Crigler-Najjar syndrome Type I

A

Phototherapy, plasmapheresis

Liver transplantation

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39
Q

Crigler-Najjar syndrome Type II

A

Phenobarbital (induces hepatic synthesis of UDP-GT)

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40
Q

Liver transplant alcohol requirement

A

None for at least 6 months

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41
Q

Varices (hepatic failure)

A

Prevent w/ BB (propranolol, nadolol)

Rx w/ vasopressin or sclerotherapy

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42
Q

Hepatic encephalopathy

A

Lactulose

Maybe rifaximin

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43
Q

Budd-Chiari syndrome

A 
Thrombolytics
Diuretics
AC
Angioplasty
Shunting
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44
Q

Cirrhosis

A

Stop alcohol, hepatotoxins
Treat symptoms
Liver transplant if progressive

45
Q

Ascites

A

Salt restriction

Diuretics (furosemide + spironolactone together)

46
Q

Spontaneous bacterial peritonitis

A

Cefotaxime (or ceftriaxone or other 3rd gen ceph) x 5 d

Albumin (maintains plasma volume, renal fxn)

47
Q

Portal HTN

A

Treat symptoms inc dialysis for renal failure
Hepatic shunting (laparotomy/TIPS) (short-term)
Liver transplant usu required in progressive

48
Q

Wilson disease

A 
Trientine or penicillamine (chelation)
Lifelong zinc (maintenance)
Restrict dietary copper
Supplementary vitamin B6
May need liver transplant
49
Q

alpha-1-antitrypsin

A

May need liver or lung transplant

50
Q

HCC

A

Surgical resection of small tumors + chemo
Transplant for limited disease
Radiofrequency ablation and chemoembolization if unresectable

51
Q

Benign liver neoplasms (eg adenoma)

A

D/C OCP
Serial imaging and aFP (10% malignant transformation)
Resection if >5 cm, growing, etc.

52
Q

TEF

A

Surgical repair

53
Q

Pyloric stenosis

A

Pyloromyotomy

54
Q

Necrotizing enterocolitis

A

TPN
IV broad-spectrum antibiotics
NG decompression
Surgical resection of affected bowel if necrosis

55
Q

Hirschsprung disease

A

Colostomy and resection of affected area

56
Q

Intussusception

A

Barium enema may reduce defect

Surgery if refractory

57
Q

Meckel diverticulum

A

Surgical resection if symptomatic

58
Q

Glaucoma

A

Acetazolamide

Mannitol (acute)

59
Q

Altitude sickness

A

Acetazolamide

60
Q

Metabolic alkalosis

A

Acetazolamide

61
Q

CHF, diuretics

A

Loop diuretic + aldosterone antagonist

Thiazide if mild/early

62
Q

Increased ICP, diuretic

A

Mannitol

63
Q

Acute renal failure, diuretic

A

Mannitol

64
Q

HTN, diuretic

A

Thiazide (first line)

Other K sparing (to replace K)

65
Q

Pulmonary edema, diuretic

A

Loop

66
Q

Hypercalcemia, diuretic

A

Loop

67
Q

Hypercalciuria, diuretic

A

Thiazide

68
Q

Nephrogenic DI

A

Thiazide

69
Q

Acne, PCOS; diuretic

A

Spironolactone

70
Q

Uric acid kidney stones

A

Alkalinize urine (K citrate / bicarb)

71
Q

Dietary treatment kidney stones

A

Hydration
Normal dietary Ca
Reduce dietary Na, protein, oxalate

72
Q

Kidney stones that pass (size)

A

< 4 cm all (8-12 days)
5-7 mm (60%)
8-9 mm (50%)
>10 mm (<25%)

73
Q

Expectant management kidney stones

A

Strain urine, 3L fluid daily
Tamsulosin facilitates passage
Pain meds (NSAIDs, Vicodin)
CT repeat in 4 weeks

74
Q

Hospitalization required for kidney stones

A 
No PO intake b/c nausea
Intractable pain
Acutely elevated BUN, creatitine
Anuria
Fever, pyelonephritis, urosepsis
75
Q

Surgical treatment for kidney stones

A

If unable to pass stone after 4-6 wks, obstruction, impairment of renal fxn, persistent infection
ESWL if stone in renal pelvis or upper ureter
Ureterorenoscopy w/ possible lithotripsy/stent for ureter stones
Percutaneous nephrostolithotomy for staghorn / >3 cm

76
Q

Hydronephrosis

A

Drainage via nephrostomy tube

Treat underlying obstruction (maybe balloon dilation or stent)

77
Q

ADPKD

A

Vasopressin antagonists + amiloride (prevent fluid collection in cysts)
Treat UTI and HTN
Drain large cysts for pain control
May need dialysis or transplant

78
Q

Interstitial nephropathy (AIN)

A

Stop offending agent
Supportive care until renal recovery
Steroids may help in refractory cases

79
Q

ARF

A 
Prevent fluid overload
Stop drugs causing ATN
Dietary protein restriction
Steroids
Dialysis
80
Q

CKD

A 
Stop smoking
Aggressive BP control (ACE/ARB, BB, loop diuretic, DHP CCP, clonidine, minoxidil)
Aggressive DM control (<70 is better)
Iron/Epo (Anemia Hgb goal 11-12)
Vitamin D
Phophate binders
ASA 81 daily
81
Q

RTA Type I

A

Oral HCO3, K

Diuretics

82
Q

RTA Type II

A

Oral HCO3, K

Diuretics

83
Q

RTA Type IV

A

Fludrocortisone

K restriction

84
Q

SIADH

A

Fluid restriction
Loop diuretics or hypertonic saline if severe (correct Na slowly)
Demeclocycline (last resort)

85
Q

Hypernatremia

A

Gradual hydration w/ normal saline (<12 meq/24 hrs)

Too fast = cerebral edema

86
Q

Hyperkalemia

A

Calcium gluconate/Cl (treats cardiotoxicity)
NaHCO3 or insulin+glucose or albuterol (shift K)
Sodium polystyrene sulfonate (kayexalate) binds K and removes through GI tract
Furosemide/loop diuretic
Dialysis in severe cases

87
Q

Hypokalemia

A 
Replace K (oral or IV)
(Too fast = arrhythmias)
88
Q

Hypercalcemia

A 
Hydration
Treat underlying disorder
Calcitonin and bisphosphonates
Steroids decrease intestinal absorption
Surgery for hyperPTH or neoplasm
89
Q

Hypocalcemia

A

Replace Ca (oral or IV) if needed
Treat underlying disorder
Vitamin D supplementation if needed

90
Q

UTI

A

Amoxicillin, TMP-SMX, fluoroquinolones x3-5 days

91
Q

UTI, pregnant

A

Amoxicillin, Ampicillin, Cephalosporin

Nitrofurantoin x 7d

92
Q

Urge incontinence

A

Anticholinergics (oxybutynin, tolterodine, solifenacin)
Imipramine
Bladder training

93
Q

Stress incontinence

A 
Conservative therapy (weight loss, Kegel exercises)
Surgery (midurethral sling, etc)
94
Q

Overflow incontinence

A

Decompress bladder w/ Foley initially
Treat underlying obstruction (surgery), detrusor underactivity (sacral nerve stimulation) as needed
May need intermittent self-catheterization

95
Q

Bladder cancer

A

Transurethral cystoscopic resection (superficial)
Partial or total cystectomy (invasive)
Adjuvant intravesical chemo and radiation (try to prevent recurrence), regional radiation and systemic chemo for large/metastatic

96
Q

Urethritis

A

One dose IM ceftriaxone +
Doxycycline or Azithromycin x 10 days
Treat sexual partners

97
Q

Prostatitis

A

TMP-SMX or fluoro x 4-6 weeks

Treat STD if needed

98
Q

BPH

A

Saw palmetto (alternative)
alpha-1-receptor blockers (tamsulosin, selective; terazosin, non-selective, less frequent)
5-alpha-reductase inhibitors (finasteride)
TURP, needle ablation for refractory

99
Q

Prostate cancer

A

Radical prostatectomy
Radiation (external beam/brachytherapy)
F/U w/ PSA posttreatment
Antiandrogen esp high-grade/metastatic (luprolide / flutamide)
Older / low life expectancy may not be treated (or active surveillance if caught early)

100
Q

Epididymitis

A

< 35: Ceftriaxone + Doxycycline/Azithromycin

> 35 or anal sex: Fluoro or TMP-SMX

101
Q

Testicular torsion

A

Manual detorsion

Surgical detorsion + bilateral orchiopexy w/i 6 hrs

102
Q

Testicular cancer

A

Eradicate Ball Cancer (etoposide, bleomycin, cisplatin)
Radical orchiectomy
+/- chemo and radiation (seminomas)
+/- retroperitoneal LN dissection, chemo (nonseminomas)

103
Q

Impotence

A

Phosphodiesterase-5 inhibitors

Androgen replacement if hypogonadal

104
Q

Wilm’s tumor

A

Surgical resection or nephrectomy + chemo

Possible radiation

105
Q

Urethral displacement (epispadias/hypospadias)

A

Surgical correction (don’t circumcise before surgery)

106
Q

Enuresis

A

Enuresis alarm (most effective long-term)
Behavioral/motivational therapy
Restrict fluids, nighttime chaperone/wakening
Imipramine (up to 6 weeks)
Desmopressin, indomethacin (short term)

107
Q

Cryptorchidism (undescended testes)

A 
Exogenous hCG (encourage spontaneous descent)
Orchiopexy before age 5 (should be brought into scrotum by 6-12 months for +function)
108
Q

Posterior urethral valves

A

Cystoscopic transurethral ablation of abnormal tissue

If sick, temporary Foley or urinary diversion (vesicostomy)

Step 2 DIT (23 decks)

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