Week 2 Flashcards
1
Q
Who gets a statin?
A
1- anyone with vascular disease
2-LDL >190
3- Age >40 with DM
3- LDL >70 with lots of risk factors (smoke, DM, obesity, HTN)4
2
Q
What gets checked at 1st prenatal visit
A
Infection
Immunity (titers, RH status)
Anemia
3
Q
Timing for amniocentesis vs chorionic villous sampling
A
Amnio >15weeks
CVS 10-13 weeks
4
Q
Quad screen results for trisomy 21
A
Hcg - up
AFP- down
Estrol- down
Inhibin- up
“HAEI” “Down is Up”
5
Q
Quad screen for trisomy 18
A
ALL DOWN
6
Q
Cutoff for 1hr GTT in pregnancy
A
> 140, then you need 3hr GTT
7
Q
3hr GTT results
A
fasting >90
3hr >140
8
Q
How to manage baby at high risk for getting congenital HepB
A
Csection
IVIG and Hep b vaccine at birth
9
Q
How to interpret biophysical profile >8
A
Reassuranc
10
Q
How to interpret BPP 4-6
A
Based on age…
If <36 weeks, need Contraction stress test. If that’s bad looking, deliver baby
If >36weeks, just deliver them
11
Q
Preterm Labor or pPROM management based on age
A
If >34 weeks: Treat GBS, Steroids if <36, then deliver
<34 weeks: Steroids, Abx, Mg if <32 weeks
12
Q
Tx for uterine atony
A
Metylergovine (cause HTN)
Carboprost (worsns asthma)
Oxytoscin
13
Q
Delayed post partum hemorroage, about 1hr after delivery
A
Retained products
Do ultrasound then D/C to remove
14
Q
Size criteria for Renal stone management
A
<5mm pass spontaneously
5-10 get medical mgmt (tamsulosin)
>10mm need surgery
15
Q
Anti centromere ab
A
CREST
16
Q
anti mitochondrial ab
A
Primary Biliary Cirrhosis
17
Q
anti smith ab
A
highly SPECIFIC for lupus….screen with dsDNA, confirm with Anti Smith
18
Q
Which titer is used to follow disease progression in Lupus
A
Anti dsDNA ab levels
19
Q
Classic presentation of carotid artery dissection
A
Unilateral headache
Horner syndrome
20
Q
HbBarts is associated with
A
Alpha thal
21
Q
Sickle Cell Trait hb electrophersis findings
A
40%HbS
60%HbA
22
Q
Treatment principle for RV MI
A
MAINTAIN PRELOAD…more preload means you keep RV open. If you reduce preload, or increae afterload, you won’t be able to get blood out of R heart
23
Q
First line treatment hot thyroid nodule
A
Methimizole…this is just a bridge to definitive therapy with ablation/surgery
24
Q
First line treatment for non-perforated toxic megacolon
A
Steroids (reduce colitis)
Abx if infection suspected
25
What is the best test to measure efficacy of anti-thyroid drugs on a patient's repeat visit?
T3 and T4...NOT TSH
26
How to diagnose narcolepsy
```
Sleep study (reduced REM latency)
LP (low hypocretin)
```
27
In evaluating brain death, what do you do if neuro exam shows no reflexes?
Go straight to apnea testing (assuming they're temp, BP, electrolytes are nml of course)
28
In evaluating brain death, what do you do if neuro exam is inconclusive or they're paralyzed?
EEG or Brain imaging
29
Definition of recurrent UTI
>2 in 6 mo
| >3 in a year
30
First line treatment for recurrent UTI
Prophylactic antibiotics
31
Pleural effusion findings in TB
Elevated Adenosine Deaminase lvls
32
First 2 treatments for PCOS
WEIGHT LOSS >>> OCPs
33
How to help PCOS woman get pregnant
Letrozole (induces ovulation)
34
GDM in the 2nd/3rd trimester is associated with what cardiac anomoly?
Congenital hypertrophic IV septum...it will resolve on its own
35
Differentiating between mycobacterium marinium and vibrio vulnificus
```
Marinium = red, ulcerated lesions
Vulnificus= rapidly progressive hemorrhagic bullae
```
36
Management of Barrets based on biopsy (dysplasia level)
No dysplaisa - PPI, repeat endo in 3yrs
Mild dysplasia- PPI, endo in 6-12 mo
High dysplasia- Ablation
37
Classic CSF finding for fungal meningitis
Low Cell count w/lymphocytic predominance
Viral and bacteial have huge cell counts
38
Chronic unilateral Middle ear effusion that persists despite antibiotics. Think:
Nasopharyngeal cancer
If bilateral, usually non cancerous (obstructive, allergies, smoke exposure etc)
39
CSF findings for fungal vs TB meningitis
Both have lymphocytic predominance, but TB has pleocytosis whereas fungal has pretty low cell count
40
Multi-nutrient deficiency in a young-ish person: first thought should be
Celiac disease (even in the absence of diarrhea)
41
Breast lump <30, first step in management
Ultrasound...no longer just observe them without imaging
42
Chronic unilateral middle ear effusion that is resistant to antibiotics....think:
Nasopharyngeal cancer
If it's bilateral, its probably due to obstruction from infection, allergies, environmental irritants etc...
43
Main contraindication to placing copper IUD for emergency contraception
Evidence of active pelvic infection....otherwise, it is the best option
44
4 Sexual assault victim post exposure PPX
CTX/Azithro (for GC/Chlam)
Flagyl (trichomonas)
HIV ppx (tenofovir-emtricetabine, raltegrovir)
Hep B vaccine if not immunized, and Hep B Ig if rapist is Hep B pos
45
Rhogam timing and dosing (relative)
At 28 weeks for all comers
Post partum (same dose as at 28wks if delivery uncomplicated, but must INCREASE DOSE IF DELIVERY ASSOCIATED WITH HEMORRHAGE)
46
Mom gets Rhogam during preg 1 at 28 weeks, has postpartum hemorrhage and gets it again. Next pregnancy, she has positive antibodies. What happened?
Inadequate dose of Rhogam post partum, because of the hemorrhage (need to increase dose)
47
Patient has lupus nephritis. First step in management
Renal biopsy --> must classify what kind of lupus nephritis they have, because it determines treatment
48
Mammogram recommendations for general population
q2years between 50-75yo
49
Who gets mammogram before 50?
- 2 first degree relatives with BC, one being <50 at age of diagnosis
- Relatives with both breast/ovarian CA
50
CSF bacterial meningitis
VERY High cell count
High Protein
Low Glucose
51
CSF viral meningitis
Mildly elevated cell count (lymphocyte)
Mildly elevated protein
Normal glucose
52
Unique imaging and PE findings for TB meningitis
Basilar Meningeal enhancement on CT
Yellow/White "tubercles" seen on fundoscopic exam
53
Treatment of TB meningitis
GLUCOCORTICOIDS
| 4x therapy, followed by dual therapy for 1 year
54
What screens are done at 1st trimester visit?
Infection
Immunity
Anemia
55
What screens are done at 2nd trimester visit?
Anemia
| Glucose Tolerance
56
Thrombocytopnia during pregnancy. No history of bleeding or affects on baby. Diagnosis and prognosis
Gestational thrombocytopenia (due to dilution)...will resolve after delivery
57
Treatment algorithm for carpal tunnel
Splinting --> steroid injection --> surgery
58
First step in working up nocturnal enuresis (after lifestyle modifications failed)
Urinalysis to screen for glucosuria, DI, or occult infection
59
Treatment of drug induced lupus
Symptomatic tx, and removal of offending agnt
60
Guidance for returning to sports after concussion
Rest for 24hrs, then graudually return to sports over the course of a week
61
3 Most common complication of bicuspid aortic valve
Thoracic aortic aneurysm
Aortic dissection
Aortic root dilation
62
when to use qtip test
Assess stress incontinence
63
Diagnostic test for uretheral diverticulum
MRI pelvis
64
Raloxifine mechanism
Pro estrogen effect on bone
| Anti estrogen effect in breast, endometrium
65
Treatment for primary ovarian insufficiency
Combination estrogen and progesterone
66
2 Most common paraneoplastic syndrome with RCC
Hypercalcemia (PTHrP)
| Erythrocytosis (elevated EPO production)
67
Smoker with hematuria and erythrocytosis...think:
RCC
68
Definition of subclinical hyperthyroid
Low TSH, normal T3/T4
69
2 Indications to treat subclinical hyperthyroid
TSH persistently <0.1 or patient has other risk factors (age, tyroid nodule)
70
Patient has Cdiff and is treated with vanc. Then develops an episode of diarrhea a week later, Cdiff PCR is positive. What do you do?
Observe. Cdiff PCR can be positive for weeks....in order to reconsider treatement, patient must have PERSISTENT diarrhea with LEUKOCYTOSIS/FEVER. A single episode isn't a concern
71
Target Fasting, 1hr, and 2hr BGL in GDM
Fasting <95
1hr <140
2hr<120
72
Diagnosis of thyroid cancer is made. next step?
Staging, like every cancer. best way to do this is Neck Ulrasound to look at nodes
73
Classic triad of constitutional delay
Delayed bone age
Short stature
Normal growth velocity
74
2 cases to repeat colonoscopy in 3 years
High grade dysplasia
| >3 polyps
75
2 cases to repeat colonoscopy in a few months
Very large polyp (>2cm)
| Carcinoma incitu
76
Who gets annual colonoscopy
Familial Adeomatous Polyposis
77
Cscope shows small tubular adenomas. When do you repeat?
5 years (3yrs if villous or high grade)
78
Treatment for lithium tox (all comers). What do you do for very high levels?
IV Hydration
| Hemodyalsis if levels >4
79
Best way to prevent exercise induced hypoglycemia in diabetics
Reduce mealtime insulin prior to working out
80
3 absolute contraindications to estrogen containing contraception (besides vascular diseas)
Heavy smoking with age >35
Migraines
Hypertension >160
81
MCC of urinary retention in old people
UTI...get urinalysis
82
Differentiating between oropharyngeal and esophageal dysmotility
Oropharyngeal- coughing, aspiration
Esophageal- chest pain, food gets "stuck"
83
4 med classes that increase lithium levels
ACEi/ARBs
Thiazides
NSIADs
84
Age cutoff for pap vs pap + HPV
30
Under 30, just do cytology q3 years
30-65 can do cytology q3y or Cytology + HPV q5y
85
Psoriatic vs RF joint involvement
Psoriatic- DIPs + axial bones (spine)
| RF- PIPs, MCPs, large joints
86
WBC/RBC ratio. When its used and how to interpret it
Used in LP to determine if a RBCs in a tap is due to meningitis or SAH/Bloody tap
If WBC/RBC ratio <0.01, it is NOT meningitis
87
3 DDx for elevated AFP
Multi Gestation
Abdominal wall defect
Neural Tube Defect
88
Best single item screening question for alcohol abuse
"how many times in the last year have you had more than 5 drinks per day"
89
Best treatment for MAT
Fix the underlying respiratory issue...don't give antiarrhythmics
90
Role of LP vs VP shunt in NPH
LP to diagnose (if sx improve after, its NPH)
VP shunt is definitive therapy
91
What lab value differentiates hypoPTH from pseudohypoPTH
PTH levels
```
HypoPTH = low PTH
PseudohypoPTH= High PTH
```
Both have high phos and low Ca
92
How does EPO differentiat between polycythemia vera and RCC
Low EPO = Polycythmia vera
High EPO = RCC
93
Xanthalasma + Elevated LFTs. Think:
Primary Biliary Cirrhosis
94
PBC antibody screen
Antimitochondrial Ab
95
Anti Smooth Muscle Ab
Autoimmune Hepatitis
96
Exception to the Cobb rule 10-40 needs bracing
If they completed puberty, bracing wont do anything...so if Cobb <40 in someone who is done with puberty, nothing needs to be done
97
What does late life depression increase your risk for developing? (onset >65yo)
Alzheimers
98
Besides fluroide and sugary drinks, what icnreases childrens risk for cavities?
Night time feedings
99
Pt with concussion is working on gradually returning to play, then develops Nausea/Vomiting. Next steps?
Rest for 24 hours, then restart the gradual return to play
100
After treatment for thyroid cancer, what do you do to prevent recurrence?
Give enough levothyroxine to keep TSH suppressed....more severe the cancer, the lower you need TSH to be becuse you don't want overstimulation of a thyroid that just had cancer in it
101
Patient comes in with MI and acute heart failure, what med is contraindiated?
Beta blockers
102
4 classes of HF treatment
All comers- BB/ACEi
SOB w/exercise, but not ADL- add Loop Durietc
SOB with ADLs- Add isosorbide/nirate/hydralazine or spironolacone
SOB at rest- Start Inotropes
103
2 criteria for biventricular pacemaker for HF
EF <35
| Presence of LBBB
104
Urinalysis with blood but no RBCs
Rhabdo
105
First step in managing dyspepsia
Depens on Age!
>60y needs an EGD
<60y without alarm sx get H.pylori testing
106
5 red flags for back pain
```
Constitutional Symptoms (i.e. cancer)
Night time pain
Neuro symptoms
Age >50
IVDU, recent bacterial infection
```
107
General treatment principals for acne (4 steps)
```
Topical retinoids/Benzoyl Peroxide (comedone)
Topical Antibiotics (inflammatory)
Oral Antibiotics (inflammaory/nodcularcystic)
Oral Retinoids (nodularcystic only)
```
108
2 meds to give for opioid withdrawl
Methadone
| Clonidine
109
Prognosis for febrile seizure
Increased risk of having another febrile seizure
Mild increase risk of epiliepsy
110
2 DDx for acute severe anemia in Sickle Cell
Aplastic Crisis
| Splenic Sequestration
111
Which lab tells the difference between Aplastic crisis and Splenic Sequestration
Retics
Low in Aplastic Crisis
Elevated in Sequestration
112
T score interpretation
-2.5 is osteoporosis
Anything in between is osteopenia
113
First step in someone with osteopenia vs osteoporosis
Osteopenia- cacluate Fracture risk
Osteoporosis- Start bisphosphonate
114
Pt on warfarin, best plan for anticoagulation in pregnancy (based on trimester)
LMWH thoughout pregnancy
| Unfractionated heparin at delivery becaue you can easily reverse it then switch back to warfarin
115
Interpreting VQ scan results (genral rule)
If there is a very high suspicion for PE before getting the scan, and the scan says no PE...that doesn't necessarily rule out a PE. You should get more imaging
116
Patient has history of substance ABUSE (more than use). What is best ADHD choice?
Non-amphetamines.
Amphetamines for all other patients, even with some recreational drug use
117
Patient with ACS symptoms has normal EKG and Trops. Next step?
Repeat EKG and Trops
Initial tests can be negative for up to 6 hours
118
2 Tx for Akathesia
Beta Blocker
| Benzos
119
2 Acute dystonia treatments
Diphenhydramine or Benztropine
120
Treatment and prognosis for pregnancy induced gallstones (without colic)
Nothing. They will resolve spontaneously after delivery.
121
If a pregnant patient needs a cholecystectomy, when should it be done?
2nd trimester
122
Suspicious for pagets disase, imaging and treatment?
Radionucleeotide scan - look for other involved areas
Tx- bisphosphonates
123
Common complication of Pagets disase of bone
Hearing loss
124
3 treatments for ITP
Steroids --> IVIG --> Splenectomy
125
Timing for Tdap and Flu vaccines or pregnant women
Flu as soon as it becomes available, can be given at any time
Tdap in 3rd trimester
126
Main contraindication to varenacline
Psychiatric history
127
When do you need to do serologic testing for Lyme disease vs. diagnosing clinically?
Diagnose clincially if in early stages (Erythema migrans, viral sx)
If disseminated, you need to do ELISA, then Western Blot
128
Classic EEG finding for Juvenille Myoclonic Epilepsy
Bilateral polyspike and slow wave discharge
129
Tx for Juvenille myoclonic Epilepsy
Valproic Acid
130
Hypsarrhythmia on EEG .Think:
Infantile Spasms
131
Tx for infantile spasms
ACTh (corticotropin)
132
Classic story for Juvenille Myoclonic Epilepsy
Upper extremity myoclonus in the MORNINGS
133
Indication for hypertonic saline in Hyponatremia
Profound hypoNa <120
| Coma, Seizure
134
Tx for moderte/asymptomatic SIADH
Water restriction +/1 salt tabs
135
Whn do you use isotonic fluids for SIADH
NEVER. it actually worsens the hyponatremia
136
3 indications to treat asymptomatic bacturia
Pregnancy
Undergoing urologic procedure
recent transplant patient
137
Non dominant parietal stroke causes:
apraxia (difficulty following instruction to complete a motor skill....ie. can't copy a picture)
138
Age in neonatal sepsis where CTX can start being used
28 days
139
How do you dtermine if patient with gallstone pancratitis should have cholecystectomy this hospitlaization or in a few months
If stable - this hospitalization
If evidence of persistant organ damage, hypotension etc...then wait 2 months for everything to calm down
140
Treatment principle for congential hypothyroid
Start levothryoxine ASAP to prevent neurodevelopmental delays...
even if asymptomatic. start. Don't need to repeat lab values
141
Differentiating hyperalo from renovascular htn based on labs
Plasma aldosterone/renin ratio (high in hyper aldo)
Also, would have hypokalemia in hyperaldo
142
Indication for needle decompression vs chest tube in pneumothorax
Only do a needle if they have tension physiology (RV failure, hypotension, tracheal deviation)
Otherwise, do a chest tube
143
Dupytren contracture associated with
Diabetes...both start with D
144
What is the major physiologic reason behind hypoxemia in COPD
VQ mismatch... low perfusion due to hypoxic vasoconstriction
145
How does O2 help (physiologically) in COPD exaerbation
The areas with low VQ ratios are all vasoconstricted (so blood goes to other areas of lung)...by giving O2, it vasodilates the vasculature thereby increasing perfusion and oxygenation
146
Xray findings in TTN
Flattened diaphragms (hyperinflation)
Prominent lobar fissures (fluid in the fissure)
147
Definition of proracted active labor
```
<1cm/2hr of cervical dilation
Inadequate contractions (should be q3min)
```
148
2 tx for protracted active labor
Oxytocin
| AROM
149
Features of Scomboid poisoning
Eats seafood develop facial flushing, sweating, chest pain
because when fish is old, it generates a lot of serotonin
150
Patient most likely has ruptured ectopic. When do you do surgery vs TVUS?
If hemodynamically unstable --> Surgery
151
4 effects of amiodarone on thyroid
Decrased T4-->T3 conversion (TSH nml)
Hypothyroid (High TSH, low T4)
Primary Hyperthyroid (low TSH, high T4)
Destructive thyroiditis
152
Tx for amiodarone induced T3-T4 conversion
Nothing...the TSH is normal and they aren't symptomatic
153
First line empiric antibiotic for septic joint
Vanc
CTX doesn't cover staph!
154
3 Contraindications to pregnancy (i.e. terminate pregnancy if they're pregnant)
1- HF with EF <40
2- Prior peripartum cardiomyopathy
3- Severe pulm HTN
