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STEP 2 > UW10 > Flashcards

UW10 Flashcards

1
Q

Define pulmonary HTN?

A

Mean pulmonary artery pressure > 25 at rest or >30 with exercise

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2
Q

What is the best confirmatory test for AVN femoral head? i.e. if you suspect it but plain films negative

A

MRI

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2
Q

How do you tx lumbosacral strain after mechanical injury?

A

NSAIDs and early mobilization

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3
Q

What is the first line tx for central diabetes insipidus?

A

Intranasal DDAVP

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3
Q

What is door to balloon time for STEMI? Door to needle time (fibrinolytics)? What is often given in NSTEMI?

A

90 min; 30 min; heparin

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3
Q

What stain do G6PD cells take up?

A

Crystal violet

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3
Q

What is the empiric tx for a pt from a developing country returning to US with sx of malabsorption?

A

Metronidazole for Giardiasis; also keep tropical sprue in the differential

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3
Q

If a pt has had a mole for his whole life but it starts to change what do you do?

A

Excisional bx for possible melanoma

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3
Q

What dietary changes can help with Meniere’s dz?

A

Low salt diet

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3
Q

How do you tx MALT lymphoma of the gut? What if this therapy fails?

A

Triple therapy for H. pylori (amoxicillin, clarithromycin, and omeprazole) if that fails then CHOP + Bleomycin

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4
Q

What is the main risk a pt is at when she has had a hysterectomy and is receiving tamoxifen for breast CA?

A

VTE; obviously not at risk for endometrial CA because had hysterectomy

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5
Q

What is the cause of senile purpura?

A

Perivascular connective tissue atrophy and there are no dangers and requires no further workup, Coags are normal

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5
Q

What disorder involves inability to fall alseep at normal bedtimes?

A

Delayed sleep phase disorder; i.e. their sleep is normal if you let them sleep in

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6
Q

What is the best initial step in asymptomatic hyponatremia? Symptomatic?

A

Fluid restriction; 3% saline (demeclocycline is rarely necessary)

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7
Q

When is pain with ankylosing spondylitis worse?

A

At night, this is classic for chronic inflammatory diseases

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8
Q

How may theophylline toxicity present? Dx?

A

CNS excitation such as HA, insomnia, and seizures with tachyarrhythmias; Check theophylline levels

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10
Q

What is the best tx for uncomplicated cystitis? Complicated?

A

Things like TMP-SMX, nitrofurantoin, fosfomycin; Quinolones like cipro

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11
Q

What is the cryoglobulin in mixed cryoglobulinemia?

A

IgM against the anti-HCV IgG! Will be assoc with hypocomplimentemia due to immune complex formation

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13
Q

What is “Lone Atrial Fibrillation”

A

Paroxysmal, persistent, or permanent AF in pts without evidence of cardiopulmonary or structural heart disease

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13
Q

What will damage to the lateral spinothalamic tracts present like?

A

CONTRALATERAL pain and sensory loss TWO LEVELS down from the lesion

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14
Q

What should be done in pts on Warfarin who are dizzy and have back pain?

A

CT scan of spine to look for retroperitoneal hematoma which can occur even without supratherapeutic INR

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14
Q

What is the best way to treat a microcytic anemia in RA?

A

Assuming it is anemia of chronic disease, i.e. not Fe def, then you should aim tx at RA so MTX, etc.

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16
Q

How does a dipyridamol stress test work?

A

Basically causes coronary steal to identify stenosed vessels

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17
Q

Where do the eyes deviate in a thalamic hemorrhage?

A

Toward the side of the lesion

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18
Q

What vitamin deficiency can be seen after a partial gastrectomy?

A

B12

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20
Q

What is tachycardia-mediated cardiomyopathy

A

Can develop in persistent or recurrent tachyarrhythmia and prolonged periods of ventricular rate; control of the rate can improve the EF

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21
Q

What is the most likely cause of an elevated ALP in an elderly pt on statins?

A

Paget’s disease; Statins increase aminotransferases not ALP

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22
Q

How do you manage toxic megacolon?

A

Prompt IV steroids, NGT decompression, antibiotics and fluids

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23
Q

What is the best way to diagnose Parkinson’s disease?

A

A really solid H and P

25
Q

What if a pt says something is in their eye and you do a pen light exam and see nothing?

A

Flourscein exam? You should be overly suspicious for foreign body in eye!

25
Q

How do you tx echinococcal cysts?

A

First albendazole then surgery; DO NOT aspirate as this will cause anaphylaxis

27
Q

What is seen in ACA strokes?

A

Affects the lower body more than upper and will have urinary incontinence

28
Q

What should you suspect in a pt with endocarditis and focal neurologic deficit?

A

Septic Cerebral Embolus; Tx is IV abx and if the pt is already on abx then that would be an indication for valve replacement since embolizing after starting abx is an indication

28
Q

What can you give to a pt with C. diff refractory to metronidazole (i.e. tried it twice) who cannot tolerate vanc?

A

Fidaxomicin

29
Q

What is the most appropriate empiric abx for infective endocarditis?

A

Vancomycin

31
Q

How do you tx Guillian Barre?

A

Plasmapheresis and IVIG

32
Q

What screening tests should a pt with newly diagnosed cirrhosis get?

A

Screening endoscopy for varices and then screening US for HCC; US q6 months

33
Q

What should you think if you have increased creatinine and hyperkalemia in a pt on TMP-SMX?

A

Worry about the K if significant because it can compete with K for excretion? The creatinine is no big deal, it selectively inhibits creatinine without affecting GFR so there is usually no actual AKI

34
Q

What is the best tx for post-nasal drip?

A

PO antihistamine

36
Q

How do you treat asymptomatic PVC’s? Symptomatic? What is a run of 3 or more PVC’s called?

A

No tx; BB; Ventricular tachycardia

37
Q

What antibiotic may decrease the excretion rate of theophylline?

A

Ciprofloxacin

38
Q

What is a good DM II drug to add to metformin if there is suboptimal glycemic control?

A

GLP-1 agonists such as liraglutide and exanetide

39
Q

Who should be screened for C. trachomatis?

A

All sexually active femals under 24

41
Q

What is Type I HIT?

A

A nonimmune response that occurs in the first 48 hours of heparin and is a transient effect in which the platelet count does not drop below 100,000

42
Q

What is Type II HIT?

A

An immune-mediated response due to PF-4 abs that typically occurs 5-10 days after starting heparin and leads to drops > 50% in platelet count with venous and arterial thromboses

43
Q

What is the best way to initially tx metabolic alkalosis?

A

IV NS but note that there are saline-responsive alkaloses and saline-unresponsive alkaloses; unresponsive ones have high urinary Cl

45
Q

What is the most SENSITIVE test for nephropathy in DM

A

Random urine for albumin:creatinine ratio (done 1x per year along with ophtho exam and neuropathy screen)

46
Q

What is the best tx for fibromuscular dysplasia

A

Stent placement via angiography in the renal; note renal artery stenosis due to atherosclerosis does not respond as well to stenting

47
Q

What is the regimen for Hodgkin Lymphoma?

A

ABVD = Doxorubicin, Bleomycin, Vincristine, and Dacarbazine? If lymphocyte predominant then add rituximab, for other 3 just ABVD

48
Q

A pinkish red hue to the skin is common in pts with what toxicity

A

Carbone monoxide (100% O2 via nonrebreather and check carboxyhemoglobin if greater than 20 then do HBO)

49
Q

In whom is HIV screening recommended?

A

Pts 15-65 regardless of risk factors; p24 antigen and antibody testing (ELISA)

50
Q

When should women be screened for osteoporosis?

A

When at age 65 or up or if have suggestive hx

51
Q

What is porphyria cutanea tarda assoc with? What is deficient? How do you tx?

A

HCV; Uroporphyrinogen decarboxylase; Plasma exchange, hydroxychloroquine or IFN alpha

52
Q

What ppx abx should a post transplant pt be on?

A

TMP-SMX

53
Q

What is a concern when someone has been seizing greater than 5 min?

A

There is an increased risk of cortical necrosis due to excitotoxicity; MRI can confirm dx

54
Q

What is the way to titrate chronic pain mgmt i.e. in CA pts? (General principle)

A

Start with short-acting pain medications and titrate them up to an effective dose, then transition that dose over to a long acting and give short acting for breakthrough pain

56
Q

Why do ppl with CHF exacerbations have tachypnea?

A

LV dysfunction causes pulmonary edema which widens the A-a gradient leading to hypoxemia with increased central respiratory drive (resp. alkalosis)

57
Q

What is a scleroderma renal crisis?

A

Acute renal failure with malignant HTN and shistocytes (MAHA) with thrombocytopenia as well.

58
Q

How does pneumoccocal vaccination work in adults over 65?

A

PCV13 first then followed by the 23 valent one 6-12 months later

59
Q

Which type of contrast agents have lower incidence of nephropathy?

A

Non-ionic contrast agents (Adequate IV hydration with NS or isotonic bicarb or acetylcysteine also good)

60
Q

When should HPV vaccines be given in women and men?

A

9-26 and 9-21, respectively

61
Q

What is the size limit for a pituitary microadenoma?

A

10 mm; if less than this you tx the biochemical sx i.e. cabergoline for prolactinoma; if larger you c/s neurosurgery

62
Q

How do you manage a pt with PE and renal insufficiency?

A

Start with UFH because renal insufficiency will increase anti-xa levels so don?t want to use LMWH; then do a V/Q scan rather than contrast CT (i.e. this is in GFR

63
Q

Why is there a metabolic alkalosis in Conn’s?

A

Aldosterone causes H secretion in DCT

64
Q

What should you suspect in a pt in the ICU who was just resuscitated from PEA, now in sinus rhythm with duskiness and coolness of the fingers and toes?

A

Distal ischemia from pressors; suspect in ICU pt who codes or in trauma pt who needs pressors

66
Q

How do you dx CMV colitis? What is the usual CD4 count?

A

Colonscopy with Bx showing cytomegalic cells with inclusion bodies; under 50

67
Q

What can you say about the prognostic utility of hyponatremia in the setting of CHF?

A

It parallels the severity of the heart failure and is an independent risk factor of clinical outcomes (due to increased ADH)

68
Q

What is “Upper Respiratory Cough Syndrome”?

A

Post nasal drip best initial tx is antihistamine

69
Q

What is the best way to dx CLL

A

Flow cytometry to show clonality

70
Q

Why would a pt with an acute GI bleed have increased BUN:Creatinine?

A

Reabsorption of blood in the GI tract can cause increased nitrogenous load

71
Q

What do you do if a pt is stable in a blunt abdominal trauma setting and FAST is inconclusive?

A

DPL

STEP 2 (13 decks)

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