VENI VIDI VICI 3 Flashcards
1
Q
SE of lithium
A
hypothyroidism
nephrogenic DI
Toxicity: N/V, ataxia, slurred speech, hyperreflexia, seizures
2
Q
Management of lithium toxicity
A
stop lithium, hydrate aggressively with isotonic NaCL and consider hemodyalisis
3
Q
SE of second generation antipsychotics ( Olanzapine, Clozapine)
A
Weight gain
Dyslipidemia
HYPERGLYCEMIA- Can cause new onset DM
4
Q
SE SSRIs
A
ED Insomnia Jitteriness GI ss weight gain
5
Q
SE TCAs
A
Dry mouth
Blurry vision
urinary retention/constipation
confusion
toxicity ; 3 Cs: Coma, Convulsions, Cardiotoxicity ( long QT, arrhythmia due to na channel inhibition)
6
Q
TTo of TCA toxicity
A
monitor ECG, sodium bicarbonate
7
Q
SE valoproate
A
weight gain hepatotoxicity thrombocytopenia GI distress pancreatitis
8
Q
PDA dependent congenital heart disease
A
CHDTT
Coarctation of aorta hypoplastic left heart syndrome D-transposition TAPVR Tricuspid atresia
9
Q
Neonate who develops severe cyanosis and respiratory distress at day 1. At birth had mild cyanosis. no murmurs, cardiogenic shock. Dx?
A
left hypoplastic heart syndrome
10
Q
Glucosuria in healthy kid, next step?
A
assess for DM
11
Q
S. aureus can cause necrotizing pneumonia- which would present with rapid decompensation of respiratory symptoms and chest X ray with infiltrate and cavitation
A
true
12
Q
Before starting TNF inhibitors ( i.e etanercept) always do…
A
Tb screen
Give pneumococcal and varicella vaccine
13
Q
Riskd of TNF inhibitors
A
injection site reaction serious infection neutropenia malignancy HF demyelinating disease
14
Q
Rh- pregnant mom with anti RhD titer rising trough pregnancy, next step?
A
means she is already alloimmunized ( probably for. prior prengnacy ) and there is no benefit in giving RhoGam. Baby should be studied immediately for hemolytic disease for anemia and hydrops
15
Q
When do you give RhoGam
A
28 weeks and < 72 from delivery.
16
Q
< 60 years, progressive dyspnea on exertion, fatigue, clear sounds, but signs of right heart failure
A
pulmonary HTN- do an echo
dx confirmation: right heart cath
they can have ENLARGED HILA - ENLARGED
17
Q
Trichomonas vaginalis test is indicated in the first prenatal visit if HIV positive
A
true
18
Q
In men neck circumference ( > 43.2 cm/17 in) correlates better with OSA
In women is obesity that correlates better with OSA
A
TRUE
19
Q
STOP Bang survey for OSA
A
Snoring Tiredness during the day Observed choking or apnea episodes P- High blood pressure BMI> 35 Age > 50 Neck circumference M> 17, F> 16 Gender male
20
Q
Management of umbilical hernia
A
it tends to close spontaenouly in the first years of life, but can take longer if > 1. 5cm or if African American
If reducible, asymptomatic and size stable surgery can be deferred until 5 years old.
21
Q
Syndromes associated with umbilical hernia
A
hypothyroidism ( lethargy, poor feeding, FTT) Beckman Wideman ( hypoglycemia, macrosomia, macroglossia, hemihyperplasia)
22
Q
GLYCOGEN STORAGES AND LYSOSOMAL STORAGES
A
Say it
23
Q
obese with heavy bleedings, exam is normal. next step
A
pelvic US
Labs would show high testosterone, high estrogen, LH/FSH imbalance
24
Q
FSH and LH in PCOS
A
NORMAL!Although there is a LH/FSH imbalance
25
In patients with PCOS additional tests
test for metabolic syndrome ( DM, Hypertension)
OSA
Non alcoholic hepatitis
Endometrial hyperplasia, endometrial cancer
26
surgical indications of severe chronic mitral regurgitation
primary MR ( ie. structural defect, MVP)
- Asymptomatic with LEFV 30-60%
- Symptomatic if LEVF< 30
Asymptomatic and LEVF > 60%
seconday MR ( MIR, dilated cardiomyopathy) - medical management
27
treatmento for SICCA
methylcellulose eye drops
if resistent to that: topical cyclosporin or corticosteroids
28
Joint aspiration findings
leukocyte< 2,000 - non inflammatory- osteoarthritis
luekocyste 2,000-75,000- RA or gout
leukos > 100,000- infectious
29
why early treatment of varicella zoster is important?
within 72 hours: To prevent risk of complications: post herpetic neuralgia and more rapid healing of vesicular lesions
30
anatomy of femoral hernia
pass below the inguinal ligament and medial to the femoral vein, nerve, and artery.
Femoral hernias are at higher risk for incarceration and strangulation than the inguinal hernias
31
female < 35 years that has been trying to be pregnant for 6 months and cant. next step?
nothing! still not called infertility ( 12 months in < 35, and 6 months in >=35).
32
hemorrhagic pustule, teosynovitis, polyarthritis asymmetric
disseminated gonoccocal infection
33
RF disseminated gonoccocal infection
Recent menses, pregnancy or postpartum
SLE
complement deficiency
34
Percutaenous endoscopic gastrostomy does not improe survival in dementia patients, and it does not prevent aspiration pneumonia it still can happen.
true
35
presentation of guillain barre
immune-mediated demyelination
-paresthesias
-neuropathic pain
-symmetric, ascending paresthesias
hypo-arreflexia
respiratory compromise
high protein, normal leukos
36
tto guillain barre
IVIG , plasmapheresis
37
sick sinus syndrome presentation
alternating tachycardia and bradycardia
tachycardia can be afib and bradycardia can be sinus brady, arrest.
when symptomatic often have dizziness, pre syncope, angina.
often in elderly, multiple comorbidities
chronic sinus node dysfunction
38
Patient who underwent catheterization, and on third day has worsening of renal function and a blue toe
has atheroembolism from catheterization - has elevated urine and serum eosinophils.
renal failure can be from atheroembolism or contrast induced
39
hyponatremia algorithm
say it
40
flank mass that moves with respiration, is not tender
| associated with anemia, hematuria and flank pain
renal cell carcinoma
41
Overall survival of renal cell carcinoma at 5 years
> 70%
42
Dx of renal cell carcinoma
CT
43
When can patients with pancreatitis initiate oral feedings?
as soon as they have appetite
in those with severe- parenteral or NG tube should be started ithin 72 hours of hospitalization
low fat, soft, low resideu diet
44
Why is it important that patients with pancreatitis initiate oral feedings?
reduces mortality, organ failure, need for surgery, infection rate
45
chronic management of gout
urate lowering drugs + low dose colchicine
urate lowering drugs: allopurinol, febuxstat
are recommended when:
1. multiple episodes, chronic gouty arthropathy, renal failure, tophi, recurrent kidney stones.
When initiating therapy there is risk of flare, so give colchicine. if CI, can give NSAIDs
46
the most significant factor of developing stroke is
a prior stroke
47
Human bites antibiotic
amoxi clavulanate
48
Patient with swelling of arm, and tortous engorged veins , splenomegaly+ high hemoglobin , high platelets, high leukos, Dx, next step
Polycythemia vera
49
presentation of polycythemia vera
- increased blood viscosity:
- HTN
- Erythromelalgia ( burning cyanosis)
- visual disturbances
- thrombosis
- increased RBC turnover- gouty arthritis
- aquagenic pruritus
- bleeding/thrombosis
- facial plethora
- splenomegaly
- increased in all three lines, rbc, thrombocytosis and leukocytosis
- epo is low
50
complications of polycythemia vera
thrombosis
| myelofibrosis and acute leukemia
51
Dx and tto of polycythemia vera
Genetic analysis- JAK 2 Mutation
| tto: phlebotomy, and hydroxyurea if high risk of thrombosis
52
long term prognosis of postpartum thyroiditis
there is an increased risk of persistent goiter and chronic thyroid dysfunction
53
complications subclinical hypothyroidism
```
recurrent miscarriages
severe pre-eclampsia
-preterm birth
- low birth weight
-placental abruption
```
54
Indications for Implantable cardioverter defibrillator in HF
- Prior MI and LVEF =< 30%
- NYHA II or III and LVEF =< 35%
- Prior VF or unstable VT without reversible cause
- Prior sustained VT with underlying cardiomyopathy
DIFFERENT FROM BIVENTRICULAR PACEMAKER FOR CARDIAC RESYNCHRONIZATION : LVEF =< 35 PLUS sinus rhythm and PROLONGED QRS
55
hyperprolactinemia-- decreases testosterone-- decreased libido, muscle mass, body hair and testicular size.
Who meets criteria for tto, and prognosis?
Criteria for tto:
- neuro ss secondary to mass
- hypogonadism secondary to hyperprolactinoma
TTO: Bromocriptine or cabergoline. REGARDLESS OF THE PRL LEVEL OR TUMOR SIZE In 90% of the cases medical therapy alone is helpful and shrinks the tumor.
surgery is left for refractory cases.
56
Prognosis of prolactinoma
Bromocriptine or cabergoline. REGARDLESS OF THE PRL LEVEL OR TUMOR SIZE
In 90% of the cases medical therapy alone is helpful and shrinks the tumor.
surgery is left for refractory cases.
57
Iniital labs for obesity
Glucose
TSH
Lipids
Hepatic enzymes
58
When do you consider drugs vs bariatric surgery in obesity
Drugs ( phenteramine/topiramate, Orlistat, bupropion, naltrexone, liraglutide): Failure to lose weight plus BMI>=30 ( OR BMI 27-29 with comorbidity)
Bariatric surgery : failure to lose weight and BMO>=40
Or BMI>=35 plus comorbidity
59
patient who believes he has parasites, has been to doctors and nothing has been shown, he is anxious and affect is flat. dx?
delusional disorder
60
5 yo with bloody stools. How to differentiate if is EHEC or Shigella?
EHEC: bloody stools, abdominal pain NO FEVER
Exposure to farms, petting zoos, undercooked meat
Dx: sorbitol McConkey agar and production of shiga toxin
tto: supportive, no antibiotics risk of HUS
Shigella: bloody stools, abdominal cramps FEVER.
61
Dx of thalassemias
electrophoresis and target cells on smear
| b thalasemia increased HbA.
62
RF for neural tube defects
prior pregnancy with enural tube defect
low folic acid intake
methrotexate, antiepileptics
Diabetes mellitus
63
Pregnant patient with high AFP, next step
US to visualize fetal vertebral or intracranial structures.
| If it fails can go with amniocentesis
64
When do you do cell free fetal DNA?
for chromosomal abnormalities
65
Medicaid and Medicare
Medicaid :Disabled, limited income /resources. 50% are children and only 15% have expenditure because they are healthy.
Medicare: elderly >=65, those with < 65 with certain disabilitites, and those with EDRD
66
Fetal macrosomia >=4.5 kg is an indication for cesarea
true
67
patients with hypothyroidism can have carpal tunnel syndrome ( sensation of pins and needles at night), hyperlipidemia, anemia, mild hyponatremia.
true
68
5 types of myopathy and which of those have elevated CK
1. Glucocorticoid induced myopathy: proximal m. weakness and atrophy. NO PAIN, lower extremities more involved.
2. Polymyalgia rheumatica: pain and stiffness of proximal shoulders , pelvic girdle. tendrness with decreased range of motion
3. Inflammatory myopathies: tenderness and weakness of proximal muscles. skin and rash. HIGH CK
4. Statin induced myopathy: prominent muscle pain/tenderness with or without weakness. HIGH CK
5, Hpothyroid myopathy. Muscle pain and cramps, wealness involving proximal . delayed tendon reflexes, features of hypothyroidism. HIGH CK.
69
CK in lambert eaton and myasthenia gravis
normal
70
When do you recommend migraine prophylaxis
> 2 migraine headaches in a month
Meds: b blockers. ( propanolol), TCA ( Amytriptiline), Valproate, topiramate
71
Patient who was admitted by pancreatitis and at the third day has hypoxemia, respiratory distress and bilateral infiltrates on Xray
ARDS
72
What is the ventilator setting that is associated with improved mortality in ARDS
Low tidal volume- to avoid alveoli overdistension and barotrauma
73
strongest risk factor for abdominal aortic aneurysm
smoking
74
strongest risk factors for expansion of abdominal aortic aneurism
large size
rapid rate
smoking
75
tto of abdominal aortic aneurism
```
stop smoking
aspirin and statin
indications for surgery:
- >=5.5
-rate of 0.5 cm in 6 months, or 1 cm in 12 months
- ss regardless of the size
```
76
how can posititve pressure ventilation cause hypotension
increases intrathoracic pressure,
give bolus of saline and if possible decrease ppv
77
THERE IS NOT ENOUGH EVIDENCE TO GIVE ANTICOAGULANTS TO NEPHROTIC SYNDROME!
TRUE
most common places are renal vein and lower extremities
78
Which patients with nephrotic syndrome are at higher risk for thrombotic events
albumin < 2, membranous nephropathy, and massive proteinuria
79
pregnant woman who has active parvovirus infection, next step
baby has to be monitored with serial US.
risk of fetal anemia, hydrops fetalis and fetal demise
- test mom IgM
- test baby PCR ANALYSIS IN amniotic fluid
anemia is diagnosed with middle cerebral artery doppler
hydrops: with accumulation of fluid in 2 body compartments.
anemia is often transit , but in severe cases may need inutero transfusions.
80
patient with fatigue, decreased sexual drive, elevated ferritin, transferrin, and mildly elevated transaminases. Dx?
Hemochromatosis - Do genetic studies. It is AR.
81
Which medications can cause esophagitis, and how to treat them
tetracyclines, NSAIDs, Potassium chloride, Biphosphonates
TTO: discontinue offending agent. Often resolves in a week. If persistent may pursue upper endoscopy
82
COPD who is in respiratory failure, next step
trial NIPPV- reduces mortality, decreased intubation rate, and reduces hospital lenght.
83
Steroids can induce mood symptoms, anxiety and psychosis
true - so if a patient is started on steroids and then comes with symptoms think of medication induced depressive disorder.
84
tto of eating disorders
cognitive behavior therapy and then workin on food.
| SSRIs are also part of the tto
85
treatment of vaginal candidiasis in pregnant
TOPICAL Clotrimazole, miconazole, nystatin
NOt oral fluconazole ( which is the 1st line in non-pregnant) as it can cause spontanous abortion and congenitla defects ( cleft palate, femur bowing, congenital heart disease)
86
Depression in patients with stroke can manifest as restlessness, anxiety, behavioral agitation. tto?
SSRIs
87
patient with catheter that is febrile, and has back pain. Spine imaging shows vertebral bony destruction with space disc narrowing. Blood cultures positive for S.aureus . Dx? Next step?
Vertebral osteomyelitis
- in these cases there is risk for infective endocarditis with a TTE, and particularly in those who have a history of valve dysfunction
- then just pursue antibiotic treatment
88
What is the most common life threatening condition of granulomatosis with polyangitis
diffuse alveolar hemorrhage
89
patient with hx of ulcerative colitis, high bilirubin, high ALP, mildly elevated transaminases. Dx?
Primary sclerosing cholangitis -- endoscopic cholangiography
multifocal areas of stricture and dilation intra and extrahepatic
90
fetal demise, next step?
offer parents to hold baby, that contact decreases risk of depression, PTSD, and anxiety
91
anti smith antibodies are associated with..
SLE
92
antimitochondrial antibodies are associated with
primary biliary cirrhosis
93
tto of inflammatory breast cancer
chemo, mastectomy and radiation
conservative therapy is not an option.
94
Patient with nodulocystic acne tto?
oral tetracycline, doxycycline, minocycline, ,
erythromycin
TMP/SMX
- Last resource is isotretinoin
95
Uterine fibroids can be treated with medication ( OCPs) or surgery
true
96
unstable patient in who you suspect retroperitoneal hemorrhage, next step
CT abdomen despite them being unstable as it is more sensitive and is able to localize the hemorrhage.
97
management of hypercalcemia causing confusion due to malignancy
agressive hydration
98
Gold standard for treatment and diagnosis of intussusseption
air or saline contrast enema
99
Patients with intussusspetion
stabilize them first, before doing the enema
100
The diagnostic test for C. difficile
PCR to asses for bacteerial toxin A and B ,very rapid PCR within an hour
101
White coat hypertension, next step
24 hour BP monitoring
it is not always totally benign as it can have cardiovascular risk
102
electrical alternans is associated with
cardiac tamponade
103
tto of bph
alpha 1 adrenergic antagonists ( tamsulosin)
| 5 alpha reductase inhibitors ( Finasteride)
104
tto of polymyalgia rheumatica
is low dose glucocorticoids- almost 100% respond well to this.
- mortality of patients with PMR is same as general populatio
105
patients with history of otitis media are at higher risk of ?
recurrence! particularly if previous episodes, attend to daycare and are exposed to second hand smoking
If recurrence occurs within 2 weeks its likely that it is caused by the same organism. If after 2 weeks, different organism
Mastoiditis is very rare!
106
testicular mass that appears with valsalva and standing up, disappears when supine
Varicocele
107
US findings in varicocele
retrograde blood flow
tortuous anechoic tubules adjacent to testis
dilation of pampiniform plexus
108
tto of varicocele
asymptomatic patients do not need treatment
| if ss ligation of gonadal vein
109
complications of varicocele
at risk of testicular atrophy and infertility
110
elderely who was started on levofloxacin and had a syncopal event
consider ventricular arrhythmia- long QT syndrome
hypomagnesemia, hypokalemia, lefloxocain antipsychotics.
111
how to monitor prostate cancer after surgical resection
serail PSA measurements
iF IT GOES UP then additional imaging can be done such as US
112
Dx of PCP ( fungus)
sputum production with hypertonic saline
113
Patients in the ICU who have Foley Cath can have Candiduria, unless they are symptomatic there is no treatment, and Foley should be removed.
true
114
MC causes of Small bowel obstruction
pop adhesions, hernias( incarcerations) , tumor
115
Indications of parathyroidectomy
```
age < 50
symptomatic hypercalcemia
complications:
- osteoporisis
- nephrolithiasis/calcinosis
-CKD ( GFR< 60)
```
at risk of complications
- calcium > 1 above normal
- urinary ca excretion > 400
Those who do not meet criteria for surgery then follow up serum Ca, creatinine and dexa
116
Causes of erythema multiforme
HSV Mycoplasma pneumoniae, hepatitis C virus, Coxsackie virus, and Epstein Barr virus
allopurinol, phenobarbital, phenytoin, valproic acid, antibacterial sulfonamides, penicillins, erythromycin, nitrofurantoin, tetracyclines, chlormezanone, acetylsalicylic acid, statins, as well as different TNF-α inhibitors such as adalimumab, infliximab, and etanercept were reported as possible implicated drugs. Recently, cases of erythema multiforme associated with vaccination, immunotherapy for melanoma, and even with topical drugs like imiquimod have been described.
117
Patient with back pain and X ray consistent with degenerative disease- has decreased ankle reflexes but nothing else on exam. Next step
NSAIDs and follow-up in 4-12 weeks
Indications for MRI: Progressive neuro ss, suspicion of infection/tumor, no improvement of pain despite NSAIDs after 12 weeks.
118
first line treatment of bordetella pertussi
Azithromyicin
- give also to close contacts
- contacts that are not immunized should also receie vaccine
119
treatment of inguinal hernias
elective surgery in 1-2 weeks
120
hydrocele typically resolve by age 1 year
true
121
Oral advanced directive is only acceptable if it was given in the presence of 2 witnesses and if the patient is diagnosed with a irreversible or a terminal condition
true
