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Week 1 Flashcards

1
Q

MELD score components and what its used for

A

Bili, INR, Cr, Na

Gives 90 day mortality risk liver disease

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2
Q

Treatment principle of acute hep B

A

Outpatient followup with serial labs…most cases spontaneously resolve

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3
Q

Rates of hep B progressing to chronic hepatitis (Adult, child, perinatal)

A

Adult <5%
Child 20-50%
Perinatal 90%

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4
Q

Best therapy for negative symptoms of schizophrenia

A

Social skills training

2nd generation antipsychotics are no longer recommended for negative symptoms

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5
Q

How do anginal symptoms differ in elderly (>80yo)?

A

Often present with SOB rather than chest pain

“SOB with exercise that resolves with rest” as opposed to CP with exercise that resolves with rest

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6
Q

Most important risk factor in AAA expansion/rupture

A

Smoking

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7
Q

Treatment of choice for localized dystonic reactions (blepharospasm)

A

botox

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8
Q

Chest pain in a SLE patient. Think…

A

CAD/MI

SLE leads to accelerated atherosclerosis, thus making it a HUGE risk factor for MI at early ages. (also think of pericarditis too)

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9
Q

3 benign calcification patterns in lung nodules

A

Popcorn
Concentric
Central

(all these things are mostly symmetric, which is good)

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10
Q

2 requirements for hospice care

A

Prognosis <6mo

Decided to forgoe all life prolonging tx

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11
Q

2 complications of scaphoid fractures if not adequately treated

A

Non union

Necrosis

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12
Q

At what gestational age should external cephalic version be offered?

A

> 37 weeks because most will spontaneously correct before then

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13
Q

3 main contraindications to ECV

A

Placental pathology
Multigestation
IUGR
(active herpes)

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14
Q

3 EGD findings associated with pernicious anemia

A

Atrophic rugae in FUNDUS
Glandular atrophy
Intestinal metaplasia

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15
Q

Triad of TTP

A

Hemolytic anemia (jaundice)
AMS
Petechial rash

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16
Q

Asthma patient develops recurrent episodes of cough, brown/bloody sputum…think:

A

Allergic Bronchopulmonary Aspergillosis

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17
Q

Treatment for ABPA

A

STEROIDS FIRST!!!

Then itraconoazole/Voricon (ampho if systemic)

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18
Q

PFTs for obstructive lung disease

A

FEV1 reduced

FEV1/FVC reduced

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19
Q

PFTs for restrictive lung disease

A

FEV1 decreased
FVC decreaed
FEV1/FVC normal or increaed

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20
Q

First step in managing shoulder dystocia

A

Mcroberts –> Hyperflexion of moms hips

Then add suprapubic pressure

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21
Q

How many kcal/kg/day is recommended for average adult getting NG feeds?

A

30kcal/kg/day

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22
Q

What infectious disase is lichun planus associated with?

A

Hepatitis C

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23
Q

Osmotic stool gap calculation

A

290 - 2x(StoolNa + StoolK)

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24
Q

Stool osmolar gap interpretation

A

Low <50, secretory diarrhea

High >125 osmotic diarrhea (lactose, celiac)

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25
Q

3 MCC of AOM

A

Strep pneumo > non typeable H flu&raquo_space; moraxella

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26
Q

Diaphragmatic paralysis presents with:

A

Orthopnea

FVC is worse when laying down than it is while standing…basically, it presents with heart failure without the edema

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27
Q

2 ways to confirm h pylori erradicaition

A

Stool antigen test or urea breath 4wks after treatment

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28
Q

What medication must you discontinue before any procedure with large amounts of IV contrast? i.e. cardiac cath

A

Metformin –> risk of lactic acidosis increases dramatically with all the contrast

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29
Q

2 EKG findings consistent with prior MI

A

T wave inversion

Q waves

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30
Q

What meds do every post-MI patient get?

A

BB
ACE/Aspirin
Statin

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31
Q

CREST syndrome

A 
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangectasias
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32
Q

What must all scleroderma patients be worked up for?

A

ILD and Pulm HTN

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33
Q

Schizoid

A

Social withdrawl..weird person. DOESNT really want friendships (vs avoidant)

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34
Q

Schizotypal

A

Eccentric, Magical thinking, weird

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35
Q

Antisocial

A

Violent, breaks rules, exploits others, fails to take responsibility

“Narcissistic + Agressive”

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36
Q

Borderline personality

A

Self harm, impuslive, LOTS OF BAD RELATIONSHIPS

Fear of abandonment

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37
Q

Histrionic

A

Excessive emotions, attention seeking, Sexual

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38
Q

Avoidant personality disorder

A

Feeling of rejection, low self esteem, loner, WANTS to have relationships (vs schizoid)

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39
Q

Malingering vs Factitious

A

Malingering - Secondary gain “work note”

Factitious - Primary gain “sick role”

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40
Q

4 different Diagnostic criteria for DM

A

A1c > 6.5
Fasting glucose >126
Random Glucose >200 w/ symptoms
GTT >200

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41
Q

How to differentiate neurosyphillis as being secondary or tertiary stage

A

Early neurosyphillis is secondary - Meningitis and ocular symptoms

Late neurosyphillis is tertiary - dementia, tabes dorsalis

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42
Q

What does a high C peptide mean in someone who is hypoglycemic?

A

They have high insulin levels that is being ENDOGNOUSLY made (not exogenous insulin injectinos)

I.e. - Insulin stimulating medications (sulfonylurea) or insulinoma

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43
Q

2 lab values to indicate severity of pancreatitis

A

BUN

Hematocrit

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44
Q

Endocrine side effect of SGLT2 inhibitors

A

Euglycemic DKA –> they have an AG acidosis, glucosiura, ketonuria, but a normal glucose level…wtf?

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45
Q

Preeclampsia definition

A

New onset HTN <140/90 with protinuria or other end organ damage (pulm edema, neuro defecits)

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46
Q

When to get a RAIU

A

Any case of primary hyperthyroidism (Low TSH, High T4)

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47
Q

High vs Low RAIU uptake

A 
High = Graves
Low = Thyroiditis, Stroma Ovarii
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48
Q

Ultrasound clue that mother has placental insufficency

A

Reversal of blood flow or increased vascular resistance in the umbilical arteries

(baby will also be IUGR, +/- oligohydramnios)

INDUCE DELIVERY

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49
Q

Etiology of symmetric vs asymmetric IUGR

A

Symmetric = chromosome problems, infection

Asymmetric “head sparing”= placental insuff

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50
Q

Which 3 groups of people need are at high risk for bacterial endocarditis?

A

Artificial valve
Congenital heart disease
Prior IE

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51
Q

3 surgical situations that a high risk cardiac patient would require abx ppx

A

Dental work
Respiratory tract procedures
Surgery in setting of active infection

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52
Q

Electrolyte triad in adrenal insufficiency

A

HyperK
HypoNa
Metabolic Acidosis

53
Q

Someone was exposed to HIV, but test directly after exposure was negative. What do you do and why?

A

Repeat testing in a month, because of the WINDOW period…antibody titers will be too low within the first month you can get a false negative

54
Q

Before starting HAART, what must you screen the patient for?

A

Hepatitis B –> some HAART meds treat both HIV and HepB, so they can be used if they are also hep b pos

55
Q

Interpreting Cobb Angle

A

<10, normal. Observe
10-40- back brase
>40- surgery

56
Q

Most important prognositc indicator in primary CNS lymphoma in HIV patients. why?

A

Start HAART –> improvement in CD4 count

Because the CNS lymphoma itself is secondary to severe immunosuppression

57
Q

How does a hematoma in <2yo raise suspicion for TBI?

A

any non-frontal hematoma is suggestive of underlying TBI

58
Q

Teen pregnancy is associated with what 3 complications?

A

Preterm delivery (preterm preg)
Low birth weight (teens are light)
Gastrochesis/Omphalocele

59
Q

What is the most effective birth control method

A

Progestin subdermal implant…even better than an IUD!

60
Q

Side effects of progestin implants

A

Breakthrough bleeding

Weight gain

61
Q

Vaccines and patients recently recieving IVIG…what do you do?

A

Delay any live vaccines for 1 year after IVIG is given

62
Q

2 main DDx for marfanoid habitus

A

marfan syndrome

homocystinuria

63
Q

lens dislocation in marfan vs homocystinuria

A 
marfan = up
homocystinuria = down (cis configuration is down pointing)
64
Q

management of lithium induced hypothyroid

A

Continue lithium, start Synthroid

UNLESS they haven’t tried any other mood stabilizers, and lithum hasn’t been working that well, then switch them

65
Q

5 features of melanoma

A 
Appearance
Borders (irregular)
Color (dark, different)
Diameter >6mm
Evolution
66
Q

4 situations when pregnancy exercise is contraindicated

A

Risk of Preterm delivery (cervical isuff, pPROM)

Risk for antepartum bleed (previa, persistent 2nd/3rd trmester bleeding)

67
Q

First step in workup of a woman >45 with AUB

A

Endometrial biopsy –> even though it is likely just menopause, you must rule out hyperplasia/cancer

68
Q

Differentiate hand foot mouth from herpangina

A

HFMD- Lesions on tongue, buccal mucosa

herpangina- posterior oropharynx

69
Q

HFMD vs HSV infection

A

HFMD lesions on bilateral hands, lips usually spared

HSV usally affects one hand, has lip/perioral involvement

70
Q

What does the antibody screen tell you in a pregnant woman?

A

it tells you whether alloimmunization has occured…i.e. does she have Rh+ antigen exposure?

GIVE RHOGAM FOR NEGATIVE AB SCREEN

71
Q

Timing for giving rhogam

A

28-32weeks

<72h post delivery

72
Q

First line treatment for Urticaria

A

H1 blocker

73
Q

Incidental adrenal mass- what do you do?

A

even if asymptomatic, must screen for hyperfunction and malignancy

ALL the tests - Electrolytes, Dex suppression test, Urine catecholamines, 17keto steroid levels

74
Q

When do adrenal masses need to be removed?

A

1- hyperfunctioning

2- >4cm or other features of malignancy on imaging

75
Q

How to interpret jones criteria

A

2 major criteria = Positive RF

Joint issue
Cardiac issue
Nodules
Erythmea nodosum
Sydenham chorea
76
Q

2 factors in family history that increase an individuals risk for colon cancer

A

Any relative with Colon CA <60yo

> 2 first degree relatives with Colon CA at any age

77
Q

MEN1

A

Pituitary
Parathyroid
Pancreatic

78
Q

MEN2A

A

Parathyroid
Pheochromocytoma
Medullary Thyroid

79
Q

MEN2B

A

Pheochromocytoma
Marfanoid
Medullary Thyroid

80
Q

Kid with SSD comes in with acute pain crisis then develops chest pain. What do you do?

A

START CTX/AZITHRO…he has acute chest

81
Q

How long do antidepressants take to have initial efect?

A

6 week

82
Q

Cryoglobulinemia triad

A

Palpable Purpura
Renal Disease
Arthralgias

IN A PATIENT WITH HEP C

83
Q

How to decrease CO2 on vent

A

Increase RR

Decrease TV

84
Q

How to affect O2 on a vetn

A

PEEP > FiO2

85
Q

Lights Criteria for transudate

A

LDH (fluid) <2/3 serum
LDHf/LDHserum <0.6
Proteinf/Protein(serum) <0.5

All 3 must be true to be a transudate

86
Q

Definition of subclinical hypothyroid

A

Elevated TSH (on 2 measurements)
Norrmal T4
Mild or absent symptoms

87
Q

MCC of restless leg syndrome

A

Iron deficency

88
Q

First 2 meds every heart failure patient needs to be on

A

ACEi (AT MAXIMUM DOSE)

Beta Blocker

89
Q

When is the only time you give tetanus immunoglobulin?

A

Dirty wound + unimmunized/unsure/<3 Td shots

90
Q

How do you workup subclinical hypothyroid?

A

Based on TSH

If TSH >10, start levothyroixine

If TSH<10, get anti TPO ab –> if pos, start levothyroixine

91
Q

Nelson Syndrome

A

Pituitary enlargement after removal of adrenals for adrenal cushings

Low cortisol = High ACTH = Pituitary growth

92
Q

Threshold for bhcg in ectopic pregnancy

A

1500

If less than 1500, repeat in 48hrs

93
Q

What is CURB65 and when to use it

A

To stratify bacterial PNA severity

Confusion
Uremia
Respiratory rate elevated
Blood pressure low

age>65

94
Q

Based on CURB65 score, when should patient be admitted vs outpatient treatment

A

Anything 1 or greater needs admission

Greater than 3 needs ICU

95
Q

Prognosis for sarcoidosis (uncomplicated)

A

1 year of steroids, then the majority of cases resolve and do not recur

96
Q

What is CHADSVASc and when do you use it?

A

Determining thromboemoblism risk in Afib

CHF
HTN
Age >75 (2 pts)
DM
Stroke/TIA (2)
Vascular disaese
Age 65-74 (1 pt)
97
Q

interpreting CHADSVASc

A 
0 = no anticoag
1 = oral anticoag
2= Warfarin or rivoraxaban
98
Q

Best med for long term treatment of varices

A

Beta blockers

99
Q

Differentiateing acute stress disorder from PTSD

A

ASD is 3d-1mo

PTSD is sx >1mo

100
Q

How long do you continue IV insulin in DKA?

A

Until BGL is <200 and the acidosis has resolved

101
Q

What do you do in DKA if the BGL normalizes, but patients till has acidosis

A

They still need to be on IV insluin b/c of the acidosis…So you half the infusion rate and add dextrose to the fluids. Continue until acidosis resolves then stop IV and start long acting insulin

102
Q

Roseaca treatemnt

A

Topical metronidazole

103
Q

Treatment of Cdiff

A

Oral Vanc or Oral Fixaxomicin

NO LONGER USING METRONIDAZOLE

104
Q

Management of thyroglossal duct cyst

A

Surgical removal (cysts have high risk of becoming infected)

105
Q

Diet recommendations for gastroenteritis

A

Regular diet with limited sugars (sugar is osmotically active)

NO LONGER THE BRAT DIET

106
Q

Ginkgo bill a major side effect

A

Bleeding

107
Q

Single greatest risk factor for osteoporosis

A

Age

108
Q

Sjogrens Antibodies

A

Anti SSA/SSB, Ro/La

109
Q

MCC of cancer in Sjogren

A

B cell non Hodgkin lymphoma

110
Q

Highly suspicous of a SAH, but CT is normal. Why? and what do you do?

A

CT is only good within the first few hours…patients that try to “wait out the pain” may actually have normal CT.

Get an LP to look for xanthochromia

111
Q

How to differentiate 21 hydroxylase from 17 or 11 hydroxylase deficiency

A

21OH def has HYPOtension and hyperkalemia

The rest have HYPERtension and hypokalemia

112
Q

Why doesn’t 11hydroylase deficency cause hypokalemia?

A

Because you still have weak mineralocorticoid activity (11deoxycortisone), which will prevent salt wasting

113
Q

Patient has dermatomyositis, what should you be worried about in the big pictur?

A

Underlying malignancy

Dermatomyositis is heavily associated with malignancy

114
Q

3 things Angiodysplasia is most commonly associated with

A

Aortic Stenosis
ESRD
VWD

All these things make you more likely to have bleding diathesis

115
Q

Tx for first vs multiple recurrence of C.diff

A

Vanc again for longer period, or do fidaxomicin

Multiple- Vanc + Fidaxomicin +/- fecal transpalnt

116
Q

When do you use flagyl for c.diff?

A

Fulminant cdiff (megacolon, hypotension, sepsis)

117
Q

When is CCK stim test used?

A

Classic signs/symptoms of biliary colic, but no stones on ultrasound

118
Q

Treatment for catatonia

A

Benzos

119
Q

Treatment for akathesia

A

Propanolol

120
Q

Treatment for tardive dyskinesia

A

Tetrabenazine

121
Q

Workup for nipple discharge (3 steps)

A

Unilateral? NEEDS WORKUP

If <30, get ultrasound
If >30, get ultrasound + mammogram

122
Q

Patient with URI symptoms, sore throat, gets amoxicillin an develops rash…think

A

MONO (classic rash after amoxicillin)

123
Q

4 things that suggest scoliosis is pathologic

A

Back Pain (particularly waking up at night)
Progression (worsening cobb angle)
Neurologic Symptoms
Vertebral anomalies

124
Q

MCC of death in Tuberus Sclerosis

A

Neurologic impairment (either tumor burden itself, or uncontrollable seizures from the tumors)

125
Q

Treatment rule for cleft palate

A

Rule of 10s

10lbs, 10wks, 10g hemoglobin

126
Q

Onset of multiple skin tags is associated with

A

Insullin resistence

127
Q

Treatmnt for mom with HIV during pregnancy (known prior to deliver vs known at time of delivery)

A

Known prior - HAART for entire preg

Known at delivery- Zidovudine for mom

128
Q

What role does zidovudine have in HIV pregnancy

A

Baby alwas gets it, mom gets it if she was HIV unknown prior to delivery

129
Q

Vaginal or Csection delivery for HIV mom?

A

Viral load < 1000 can be viral

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