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Treatments And Tests Flashcards

0
Q

What is the treatment for nonexertional heat stroke?

A

Evaporative cooling

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1
Q

What is the treatment of exertional heat stroke?

A

Rapid cooling with ice water immersion
Fluid resuscitation
Electrolyte correction

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2
Q

What is the treatment for cocaine abuse resulting in chest pain?

A

IV BZDs + oxygen
Aspirin ( to retard thrombus formation because cocaine promotes platelet aggregation and activation)
Nitroglycerin & CCBs for pain
May do cardiac cath if have ST elevation with maximal medical therapy

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3
Q

What is the tx for SVC syndrome?

A

Radiation therapy

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4
Q

What is the tx for poly arteritis nodosa?

A

Corticosteroids

Cyclophosphamide

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5
Q

What is the tx for Kawasaki disease?

A

IVIG and ASA

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6
Q

What is the tx for urge incontinence?

A

Frequent voluntary voiding

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7
Q

How do you diagnose HSP?

A

Skin biopsy

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8
Q

What is the best next step when you suspect an aortic rupture in stable patient ?

A

TEE or CT chest

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9
Q

How do you diagnose cataracts?

A

Ophthalmic exam

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10
Q

How do you diagnose duodenal hematoma?

A

Ab CT with oral contrast

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11
Q

How do you treat a duodenal hematoma?

A

NG tube decompression

Parenteral nutrition

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12
Q

How do you diagnose pelvic fracture?

A

Pelvic XR

Pelvic CT

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13
Q

What is the tx of a pelvic fracture?

A

External binder and surgical eval
Emergent external fixation.
Angiography with embolization of bleeding vessels
Retrograde urethrogram

Internal fixation for stable patients

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14
Q

What is the tx for warm autoimmune hemolytic anemia?

A

Prednisone

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15
Q

What is the tx for autoimmune hemolytic anemia that is not responsive to prednisone?

A

Splenectomy

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16
Q

What is the diagnostic test for retained products of conception?

A

Pelvic US: shows increased vascularity, increased echogenicity, thick endometrial stripe

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17
Q

What is the tx for retained products of conception/septic abortion?

A

Blood and endometrial cultures
IV antibiotics
Surgical evacuation of the uterus (suction curettage)
Close obs

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18
Q

What is the management for caustic ingestion?

A
  1. ABC
  2. Decontamination: remove clothing, irrigate exposed skin
  3. CXR for respiratory sx
  4. Endoscopy within 24 hours
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19
Q

What should you do if there are esophageal burns on endoscopy?

A

Order barium swallow 2-3 weeks after to look for strictures

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20
Q

What is the tx for septic arthritis with greater than 100K WBC, >90% neutrophils and purulent drainage?

A

Emergent surgical drainage to prevent joint destruction. And lifelong consequences

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21
Q

What is the best next step for someone with predominantly elevated alk phos and slightly elevated LFTs?

A

Ab US or CT

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22
Q

What is the first step in the evaluation of primary amenorrhea?

A

Pelvic exam and US

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23
Q

What is the best next step after a pelvic US reveals an absent uterus in the eval or primary amenorrhea?

A

Karytotyping and serum testosterone

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24
What is the best next step after pelvic US revealing the presence of a uterus in the eval of primary amenorrhea?
Serum FSH
25
If serum FSH is decreased, what is the next step?
Cranial MRI
26
If serum FSH is increased, what do you do next?
Karytotyping
27
What should be done before starting Clozapine?
A CBC
28
What is the tx of akithisia?
Bb
29
What is the tx of drug induced Parkinsonism?
Benztropine (anticholinergic)
30
What should you supplement with chronic hemolysis
Folate
31
What is the tx for theophylline toxicity?
Charcoal
32
What is the tx for postnasal drip?
Antihistamine Nasal steroid Or nasal antihistamine
33
What is the tx for exercise induced asthma?
Beta adrenergic agonist before exercise?
34
What is the tx for neuroleptic malignant syndrome?
Dantrolene then bromocriptine and amantadine
35
What is the tx for GBS prophylaxis?
Penicillin or ampicillin
36
What antibiotic is given for GBS prophylaxis if the patient is allergic to penicillin?
Cefazolin
37
When is GBS prophylaxis given?
When patient has baby with GBS infection | Patient had GBS bacteriuria
38
What is a more appropriate tx for depression in a patient with a shorter life expectancy?
Stimulants like modafinil or methylphenidate
39
What is the most appropriate initial test in a non-African American patient with a possible family hx of thalassemias?
A CBC
40
What is the tx for esodeviation (strabismus)?
Covering the normal eye | Contact lenses
41
What can riluzole do?
Prolong survival and time to tracheostomy in ALS
42
What does a pleural ph of less than 7.2 mean?
Empyema --> chest tube!
43
What are the two criteria for chest tube placement for pleural fluid ?
Ph less than 7.2 | Glucose less than 60
44
What is the tx for os good schlatter?
Rest NSAIDs Stretching
45
How do you diagnose Bruton's agammaglobulinemia?
Quantitative immunoglobulin levels
46
What is the tx of Bruton's?
Prophylactic antibiotics | IVIG
47
How do you diagnose CVID?
Quantitative immunoglobulin levels
48
How do you confirm CVID?
Confirm with B and T cell subsets
49
What is the tx of CVID?
IVIG
50
What is the tx for IgA deficiency?
Treat infections | Do NOT give IVIG
51
How do you diagnose digeorge syndrome?
Absolute lymphocyte count Mitogen stimulatin response Delayed hypersensitivity skin testing
52
What is the tx for DiGeorge?
Bone marrow transplant Thymus transplant IVIG PCP prophylaxis
53
How do you treat SCID?
Bone marrow transplant IVIG PCP prophylaxis
54
How do you treat Wiskott Aldrich?
IVIG and antibiotics
55
What is the treatment for CGD?
Daily TMP-SMX IFN-gamma BM transplant
56
What is the diagnostic test for CGD?
Nitroblue tetrazolium test
57
What is curative for leukocyte adhesion deficiency?
Bone marrow transplant
58
What is the tx of choice in Chediak Higashi?
Bone marrow transplant
59
What is the tx if choice for Lyme disease in a 7 year old?
Oral amoxicillin or cefuroxime
60
What is the INR range goal for patients with prosthetic heart valves?
2.5-3.5
61
What is the best way to prevent contrast induced nephropathy?
IV hydration
62
What is the tx of congenital hypothyroidism?
10 mcg of levothyroxine and then titrated from there
63
What is the tx for crystal induced nephropathy from acyclovir?
Discontinue the drug | IVF
64
What is the tx for a threatened abortion?
Reassurance and follow up US in one week
65
What is first line nonpharmcologic tx for social anxiety disorder?
Cognitive behavior therapy
66
What is first line nonpharmalogical tx of Tourette's?
Habit reversal training
67
What is the tx for anemia of chronic disease due to CKD?
IV iron dextran and EPO
68
What is the tx of metabolic alkalosis?
NS and potassium to increase renal perfusion stopping the secretion of H and K to retain water
69
What is the first step in the work up of delirium?
UA and serum electrolytes, CBC, review med list, H&P
70
What are the indications for a cystoscopy?
``` Gross hematuria with no evidence of glomerular disease Microscopic hematuria Recurrent UTIs Obstructive sx Abnormal bladder imaging Abnormal urine cytology ```
71
What is the treatment for cachexia/anorexia?
Progesterone analogs - megestrol acetate or medroxyprogesterone Steroids and mirtazapine have been used too
72
What is the tx for chediak higashi?
Daily vit C and TMP-SMX
73
What is the dihydrorhodamine test for?
CGD | It is more sensitive and can quantify the severity of disease
74
What is the gold standard for diagnosis of partial adrenal deficiency?
Cosyntropin stimulation
75
What would acclimation of 17-hydroxy pregnenolone signify?
3-beta hydroxy steroid dehydrogenase deficiency causing deficiency in all steroid hormones
76
What would the accumulation of corticosterone mean?
Deficiency of 17-alpha hydroxylase - no androgen or cortisol synthesis, overproduction of mineralocorticoid Hypokalemia, hypogonadism, HTN
77
What are the steps in eval of a kidney stone?
CT without contrast 2. Pain control (NSAIDs if normal renal function) 3. If stone is small enough to pass (less than 5 mm) --> increase fluid intake to greater than 2 L per day
78
How do you treat infertility in premature ovarian failure?
IVF with donor oocyte
79
What is the tx for flail chest?
Oxygen Pain control Surgery
80
What are the immunosuppressive agents used in the tx of myasthenia gravis?
Prednisone, azathioprine, cyclosporine
81
What is the tx for body dysmorphic disorder?
Establish rapport with patient, regular visits to discuss their concerns SSRI Referral to psych
82
What drug do you start when a child with CF comes in with the flu?
Vanc for s.aureus
83
What is the drug of choice for outpatient tx of S. pneumo?
High dose amoxicillin
84
What is the most appropriate first step in treating DKA?
1. NS and regular insulin 2. Potassium replacement 3. Antibiotics
85
What is the fluid infusion in DKA once the blood glucose reaches 200-250?
D5W with half NS + K
86
When is sodium bicarbonate given in DKA?
Ph less than 7.1 Bicarb less than 5 Severe hyperkalemia
87
How do you tx INR over 5 with no bleeding?
Skip next warfarin dose
88
How do you tx INR 5-9 with no bleeding?
Stop warfarin temporarily
89
How do you tx an INR greater than 9?
Stop warfarin and start oral vit K
90
What is the tx of choice for acute cystitis and pyelo in no pregnant women?
Nitrofurantoin for 5 days (only if GFR over 60 and no pyelo) TMP-SMX for 3 days Fosfomycin in a single dose
91
What is the tx of choice for complicated cystitis?
Fluoroquinolones for 5-14 days | Urine culture
92
What is the tx for outpatient pyelonephritis?
Fluoroquinolones
93
What is the tx for inpatient pyelo?
Urine culture | IV fluoroquinolones, ceftriaxone
94
What is the first thing that should be done to evaluate a blunt abdominal trauma?
FAST or DPL to assess for intra peritoneal fluid
95
What should be done if a FAST is positive?
Exploratory laparotomy
96
What should be done if patient is stable and FAST is negative?
CT
97
What is the tx for endometritis?
IV clindamycin and gentamicin
98
What is cordocentesis or percutaneous umbilical cord sampling used for?
Rapid karytotyping Detection of fetal anemia or Rhesus isoimmunization Or to detect mosaicism after CVS or amino suggestive of such
99
What is the tx for homocysturia?
Vit B6 Restrict methionine Supplement cysteine
100
How do you diagnose homocystinuria?
Increased homocysteine and methionine
101
How do you diagnose appendicitis?
Clinically
102
What are the imaging tests used for acute appendicitis?
CT with PO and IV contrast | US
103
What is the tx for appendicitis?
NPO IVF antibiotics for gram negs and anaerobic bac
104
What is the tx for perforation of the appendix?
Antibiotics until patient is afebrile and normal WBC | Close by delayed primary closure
105
What is the tx for appendiceal abscess?
Antibiotics Percutaneous drainage Elective appendectomy 6-8 weeks later
106
What is the tx for cervical adenitis
Clindamycin
107
How do you confirm diagnosis of esophageal perforation?
Contrast esophagogram
108
What is the tx for bacterial rhinosinusitis?
Augmentin
109
How do you diagnose a bladder injury?
Retrograde cystogram with postvoid films
110
How do you diagnose choanal atresia?
CT with intranasal IV contrast
111
How do you diagnose a retro pharyngeal abscess?
CT with contrast
112
What is the dx test for primary ciliary dyskinesia?
Exhaled nitric oxide
113
What is another name for the dx test for CF?
Pilocarpine iontophoresis
114
What is the immediate tx for hypercalcemia over 14?
Normal saline hydration plus calcitonin | Avoid loops
115
What is the long term tx for hypercalcemia?
Bisphosphonates (zoledronic acid)
116
What is considered severe hypercalcemia?
Over 14
117
How do you diagnose atlantoaxial subluxation?
Lateral XR of c-spine in flexion
118
What is the tx of atlantoaxial subluxation?
Surgical fusion of C1-C2
119
How do you treat Ricketts?
Vit D 1000-2000 IU daily
120
How do you tx diabetic retinopathy?
Argon laser photo coagulation
121
What is the first step in the management of gastroschisis?
Sterile wrap the bowel
122
What are the steps in management of gastroschisis and omphalocele?
``` NG tube to decompress IV access Broad spectrum antibiotics Wrap bowel Maintain neonate in thermoneutra environment ```
123
What is the tx for suspected variceal hemorrhage?
IVF IV octreotide Antibiotics
124
What is the tx for recurrent variceal bleeding after endoscopic therapy?
TIPS or shunt surgery
125
What screening do you do for Beckwith- Weidemann syndrome?
Ab US q 3 months from until 8 AFP - Every 3 months until 4 years old Renal US from 8 to adolescence
126
What is the tx for mild SIADH (forgetfulness, ataxia)?
Fluid restriction Oral salt tablets Loop diuretic is urine osmolality is 2 X the serum osmolality
127
What is the tx for moderate SIADH (confusion, lethargy?
Hypertonic saline for 3-4 hours then fluid restriction
128
What is the tx for severe SIADH?
``` Bolus of hypertonic saline Vasopressin antagonist (conivaptan) ```
129
What is the first step in evaluating post op oliguria?
Bladder scan
130
What is the tx for bleeding in liver failure?
FFP
131
How do you diagnose Patellofemoral syndrome?
Extension of the knee while compressing the patella
132
What is the antibiotic of choice for treating a human bite?
Amoxicillin-clavulanate
133
How do you treat acetaminophen toxicity?
Charcoal if ingested within the last 4 hours Obtain acetaminophen level at 4 hours Give N-acetylcysteine within 8 hours depending on results of acetaminophen level
134
What is the tx for asx bacteriuria of pregnancy?
Nitrofurantoin Amoxicillin Or cefazolin/cephalexin for 7 days
135
What is the preferred tx for Paget's disease?
Bisphosphonates
136
What is the tx for anorexia?
CBT Nutritional rehab Olanzapine (if no response)
137
What is the tx for bulimia?
CBT Nutritional rehab SSRI
138
What are the indications for hospitalization of a bulimic or anorexic patient?
Electrolyte imbalance Dehydration Bradycardia Severe weight loss
139
What is first line tx for acute mania?
Antipsychotics and mood stabilizers
140
What are the indications for GBS prophylaxis when GBS status is unknown?
Less than 37 weeks gestation GBS cultured from urine at any time during the pregnancy ROM more than 18 hours Prior hx of delivery to a infant with GBS sepsis
141
What test can be used to confirm a ruptured fetal umbilical vessel?
The Apt test
142
What is the tx of choice for foreign body ingestion?
Flexible endoscopy
143
What is the tx of choice for foreign body aspiration?
Rigid bronchoscope
144
What is the tx for anemia of chronic disease?
Treat the underlying disease
145
What is the tx for anemia of prematurity?
Iron supplements and serial Hb checks | Possible transfusion
146
What is the tx for diamond Blackman anemia?
Corticosteroids
147
What is the tx for carotid stenosis of less than 50% and sx?
Statins and aspirin
148
What are the recommended meds for prophylaxis of cluster headaches?
Verapamil Lithium Ergotamine
149
What is the tx for autoimmune hemolytic anemia?
Prednisone | Splenectomy
150
What is the management of a UTI in a child less than 24 months?
Treat with antibiotics for 7-14 days with follow up | Renal US and bladder US
151
Who should get a renal and bladder US ?
Children under 24 months with first febrile UTI Children with recurrent febrile UTIs UTI in a child if any age with a family hx of renal or urological disease, HTN, or poor growth If don't respond to tx
152
What is the prevention med for bronciolitis in infants with bronchopulmonary dysplasia, severe congenital heart defects and prematurity?
Palivizumab = monoclonal antibody against RSV
153
What is the tx for bronchiolitis?
Contact isolation Hydration Oxygen
154
What is the tx for diagnosing diaphragmatic rupture?
Ct scan
155
How do you diagnose urethral hypermobility?
Stick a cotton swab in the urethra and demonstrate an angle greater than 30 degrees upon valsalva (increase in abdominal pressure)
156
What is the tx for meconium aspiration?
Suction nose and upper airway Oxygen Empiric antibiotics for pneumonia Intubation
157
What is the tx for neonatal RDS?
CPAP Or intubation/mechanical ventilation Surfactant
158
What should be done in the case of tendinopathy caused by fluoroquinolones?
Stop the quinolone | Do not exercise or use the affected area
159
What should all transplant patients receive prophylaxis for?
Opportunistic infections like PCP | Use TMP-SMX
160
What is the tx for narcolepsy?
Modafinil Maintain proper sleep habits Minimize alcohol Avoid meds that make you sleepy
161
What medicine treats cataplexy in narcolepsy?
Sodium oxybate
162
What is used to tx restless leg syndrome?
Pramipexole
163
How do you diagnose a psoas abscess?
CT scan of abdomen
164
What is the tx for adjustment disorder?
Psychodynamic psychotherapy
165
What is the tx for endometrial hyperplasia without atypia?
Progestin therapy | Repeat endometrial bx at 3 months
166
What is the tx for endometrial hyperplasia with atypia if the patient still desires children?
Progestin therapy
167
What is the tx for endometrial hyperplasia with atypia?
Hysterectomy
168
How do you evaluate for a spinal abscess?
MRI with gad or CT with contrast ESR/CRP CBC Blood cultures
169
What is the tx for an epidural abscess?
CT guided aspiration and culture | Immediate surgical decompression
170
What is the tx for mild bipolar disorder?
Monotherapy with an atypical antipsychotic or lithium/valproate
171
What is the tx for severe bipolar?
Lithium/valproate + atypical antipsychotic
172
What is empiric tx for intoxication/psychotic/withdrawal sx?
Glucose, thiamine, oxygen, naloxone
173
What is the tx for peripheral neuropathy related to INH?
100mg/day of pyridoxine
174
What is the best next step in evaluating for a primary cancer after finding brain mets?
chest CT
175
What is the gold standard for diagnosing myocarditis?
Endomyocardial bx
176
What is the tx for myocarditis?
Diuretics and inotropic
177
What is the tx for kleptomania?
CBT
178
What is the immediate tx for panic attack?
Lorazepam
179
What is the tx for rhabdo from NMS?
Alkalinization of the urine | IVF
180
What is the first line tx for specific phobia?
CBT
181
How can tracheobronchial rupture be confirmed?
CT Bronchoscope Surgical exploration
182
What is the diagnostic test for myocardial rupture
US
183
How do you diagnose a splenic rupture?
CT with contrast

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