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Step 3 > Week 2 > Flashcards

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

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2
Q

What gets checked at 1st prenatal visit

A

Infection
Immunity (titers, RH status)
Anemia

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3
Q

Timing for amniocentesis vs chorionic villous sampling

A

Amnio >15weeks

CVS 10-13 weeks

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4
Q

Quad screen results for trisomy 21

A

Hcg - up
AFP- down
Estrol- down
Inhibin- up

“HAEI” “Down is Up”

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5
Q

Quad screen for trisomy 18

A

ALL DOWN

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6
Q

Cutoff for 1hr GTT in pregnancy

A

> 140, then you need 3hr GTT

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7
Q

3hr GTT results

A

fasting >90

3hr >140

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8
Q

How to manage baby at high risk for getting congenital HepB

A

Csection

IVIG and Hep b vaccine at birth

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9
Q

How to interpret biophysical profile >8

A

Reassuranc

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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

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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

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12
Q

Tx for uterine atony

A

Metylergovine (cause HTN)
Carboprost (worsns asthma)
Oxytoscin

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13
Q

Delayed post partum hemorroage, about 1hr after delivery

A

Retained products

Do ultrasound then D/C to remove

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14
Q

Size criteria for Renal stone management

A

<5mm pass spontaneously
5-10 get medical mgmt (tamsulosin)
>10mm need surgery

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15
Q

Anti centromere ab

A

CREST

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16
Q

anti mitochondrial ab

A

Primary Biliary Cirrhosis

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17
Q

anti smith ab

A

highly SPECIFIC for lupus….screen with dsDNA, confirm with Anti Smith

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18
Q

Which titer is used to follow disease progression in Lupus

A

Anti dsDNA ab levels

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19
Q

Classic presentation of carotid artery dissection

A

Unilateral headache

Horner syndrome

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20
Q

HbBarts is associated with

A

Alpha thal

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21
Q

Sickle Cell Trait hb electrophersis findings

A

40%HbS

60%HbA

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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

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23
Q

First line treatment hot thyroid nodule

A

Methimizole…this is just a bridge to definitive therapy with ablation/surgery

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24
Q

First line treatment for non-perforated toxic megacolon

A

Steroids (reduce colitis)

Abx if infection suspected

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25
Q

What is the best test to measure efficacy of anti-thyroid drugs on a patient’s repeat visit?

A

T3 and T4…NOT TSH

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26
Q

How to diagnose narcolepsy

A 
Sleep study (reduced REM latency)
LP (low hypocretin)
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27
Q

In evaluating brain death, what do you do if neuro exam shows no reflexes?

A

Go straight to apnea testing (assuming they’re temp, BP, electrolytes are nml of course)

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28
Q

In evaluating brain death, what do you do if neuro exam is inconclusive or they’re paralyzed?

A

EEG or Brain imaging

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29
Q

Definition of recurrent UTI

A

> 2 in 6 mo

>3 in a year

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30
Q

First line treatment for recurrent UTI

A

Prophylactic antibiotics

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31
Q

Pleural effusion findings in TB

A

Elevated Adenosine Deaminase lvls

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32
Q

First 2 treatments for PCOS

A

WEIGHT LOSS&raquo_space;> OCPs

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33
Q

How to help PCOS woman get pregnant

A

Letrozole (induces ovulation)

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34
Q

GDM in the 2nd/3rd trimester is associated with what cardiac anomoly?

A

Congenital hypertrophic IV septum…it will resolve on its own

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35
Q

Differentiating between mycobacterium marinium and vibrio vulnificus

A 
Marinium = red, ulcerated lesions
Vulnificus= rapidly progressive hemorrhagic bullae
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36
Q

Management of Barrets based on biopsy (dysplasia level)

A

No dysplaisa - PPI, repeat endo in 3yrs
Mild dysplasia- PPI, endo in 6-12 mo
High dysplasia- Ablation

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37
Q

Classic CSF finding for fungal meningitis

A

Low Cell count w/lymphocytic predominance

Viral and bacteial have huge cell counts

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38
Q

Chronic unilateral Middle ear effusion that persists despite antibiotics. Think:

A

Nasopharyngeal cancer

If bilateral, usually non cancerous (obstructive, allergies, smoke exposure etc)

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39
Q

CSF findings for fungal vs TB meningitis

A

Both have lymphocytic predominance, but TB has pleocytosis whereas fungal has pretty low cell count

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40
Q

Multi-nutrient deficiency in a young-ish person: first thought should be

A

Celiac disease (even in the absence of diarrhea)

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41
Q

Breast lump <30, first step in management

A

Ultrasound…no longer just observe them without imaging

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42
Q

Chronic unilateral middle ear effusion that is resistant to antibiotics….think:

A

Nasopharyngeal cancer

If it’s bilateral, its probably due to obstruction from infection, allergies, environmental irritants etc…

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43
Q

Main contraindication to placing copper IUD for emergency contraception

A

Evidence of active pelvic infection….otherwise, it is the best option

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44
Q

4 Sexual assault victim post exposure PPX

A

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

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45
Q

Rhogam timing and dosing (relative)

A

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)

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46
Q

Mom gets Rhogam during preg 1 at 28 weeks, has postpartum hemorrhage and gets it again. Next pregnancy, she has positive antibodies. What happened?

A

Inadequate dose of Rhogam post partum, because of the hemorrhage (need to increase dose)

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47
Q

Patient has lupus nephritis. First step in management

A

Renal biopsy –> must classify what kind of lupus nephritis they have, because it determines treatment

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48
Q

Mammogram recommendations for general population

A

q2years between 50-75yo

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49
Q

Who gets mammogram before 50?

A
  • 2 first degree relatives with BC, one being <50 at age of diagnosis
  • Relatives with both breast/ovarian CA
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50
Q

CSF bacterial meningitis

A

VERY High cell count
High Protein
Low Glucose

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51
Q

CSF viral meningitis

A

Mildly elevated cell count (lymphocyte)
Mildly elevated protein
Normal glucose

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52
Q

Unique imaging and PE findings for TB meningitis

A

Basilar Meningeal enhancement on CT

Yellow/White “tubercles” seen on fundoscopic exam

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53
Q

Treatment of TB meningitis

A

GLUCOCORTICOIDS

4x therapy, followed by dual therapy for 1 year

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54
Q

What screens are done at 1st trimester visit?

A

Infection
Immunity
Anemia

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55
Q

What screens are done at 2nd trimester visit?

A

Anemia

Glucose Tolerance

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56
Q

Thrombocytopnia during pregnancy. No history of bleeding or affects on baby. Diagnosis and prognosis

A

Gestational thrombocytopenia (due to dilution)…will resolve after delivery

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57
Q

Treatment algorithm for carpal tunnel

A

Splinting –> steroid injection –> surgery

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58
Q

First step in working up nocturnal enuresis (after lifestyle modifications failed)

A

Urinalysis to screen for glucosuria, DI, or occult infection

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59
Q

Treatment of drug induced lupus

A

Symptomatic tx, and removal of offending agnt

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60
Q

Guidance for returning to sports after concussion

A

Rest for 24hrs, then graudually return to sports over the course of a week

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61
Q

3 Most common complication of bicuspid aortic valve

A

Thoracic aortic aneurysm
Aortic dissection
Aortic root dilation

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62
Q

when to use qtip test

A

Assess stress incontinence

63
Q

Diagnostic test for uretheral diverticulum

A

MRI pelvis

64
Q

Raloxifine mechanism

A

Pro estrogen effect on bone

Anti estrogen effect in breast, endometrium

65
Q

Treatment for primary ovarian insufficiency

A

Combination estrogen and progesterone

66
Q

2 Most common paraneoplastic syndrome with RCC

A

Hypercalcemia (PTHrP)

Erythrocytosis (elevated EPO production)

67
Q

Smoker with hematuria and erythrocytosis…think:

A

RCC

68
Q

Definition of subclinical hyperthyroid

A

Low TSH, normal T3/T4

69
Q

2 Indications to treat subclinical hyperthyroid

A

TSH persistently <0.1 or patient has other risk factors (age, tyroid nodule)

70
Q

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?

A

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
Q

Target Fasting, 1hr, and 2hr BGL in GDM

A

Fasting <95
1hr <140
2hr<120

72
Q

Diagnosis of thyroid cancer is made. next step?

A

Staging, like every cancer. best way to do this is Neck Ulrasound to look at nodes

73
Q

Classic triad of constitutional delay

A

Delayed bone age
Short stature
Normal growth velocity

74
Q

2 cases to repeat colonoscopy in 3 years

A

High grade dysplasia

>3 polyps

75
Q

2 cases to repeat colonoscopy in a few months

A

Very large polyp (>2cm)

Carcinoma incitu

76
Q

Who gets annual colonoscopy

A

Familial Adeomatous Polyposis

77
Q

Cscope shows small tubular adenomas. When do you repeat?

A

5 years (3yrs if villous or high grade)

78
Q

Treatment for lithium tox (all comers). What do you do for very high levels?

A

IV Hydration

Hemodyalsis if levels >4

79
Q

Best way to prevent exercise induced hypoglycemia in diabetics

A

Reduce mealtime insulin prior to working out

80
Q

3 absolute contraindications to estrogen containing contraception (besides vascular diseas)

A

Heavy smoking with age >35
Migraines
Hypertension >160

81
Q

MCC of urinary retention in old people

A

UTI…get urinalysis

82
Q

Differentiating between oropharyngeal and esophageal dysmotility

A

Oropharyngeal- coughing, aspiration

Esophageal- chest pain, food gets “stuck”

83
Q

4 med classes that increase lithium levels

A

ACEi/ARBs
Thiazides
NSIADs

84
Q

Age cutoff for pap vs pap + HPV

A

30

Under 30, just do cytology q3 years
30-65 can do cytology q3y or Cytology + HPV q5y

85
Q

Psoriatic vs RF joint involvement

A

Psoriatic- DIPs + axial bones (spine)

RF- PIPs, MCPs, large joints

86
Q

WBC/RBC ratio. When its used and how to interpret it

A

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
Q

3 DDx for elevated AFP

A

Multi Gestation
Abdominal wall defect
Neural Tube Defect

88
Q

Best single item screening question for alcohol abuse

A

“how many times in the last year have you had more than 5 drinks per day”

89
Q

Best treatment for MAT

A

Fix the underlying respiratory issue…don’t give antiarrhythmics

90
Q

Role of LP vs VP shunt in NPH

A

LP to diagnose (if sx improve after, its NPH)

VP shunt is definitive therapy

91
Q

What lab value differentiates hypoPTH from pseudohypoPTH

A

PTH levels

HypoPTH = low PTH
PseudohypoPTH= High PTH

Both have high phos and low Ca

92
Q

How does EPO differentiat between polycythemia vera and RCC

A

Low EPO = Polycythmia vera

High EPO = RCC

93
Q

Xanthalasma + Elevated LFTs. Think:

A

Primary Biliary Cirrhosis

94
Q

PBC antibody screen

A

Antimitochondrial Ab

95
Q

Anti Smooth Muscle Ab

A

Autoimmune Hepatitis

96
Q

Exception to the Cobb rule 10-40 needs bracing

A

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
Q

What does late life depression increase your risk for developing? (onset >65yo)

A

Alzheimers

98
Q

Besides fluroide and sugary drinks, what icnreases childrens risk for cavities?

A

Night time feedings

99
Q

Pt with concussion is working on gradually returning to play, then develops Nausea/Vomiting. Next steps?

A

Rest for 24 hours, then restart the gradual return to play

100
Q

After treatment for thyroid cancer, what do you do to prevent recurrence?

A

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
Q

Patient comes in with MI and acute heart failure, what med is contraindiated?

A

Beta blockers

102
Q

4 classes of HF treatment

A

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
Q

2 criteria for biventricular pacemaker for HF

A

EF <35

Presence of LBBB

104
Q

Urinalysis with blood but no RBCs

A

Rhabdo

105
Q

First step in managing dyspepsia

A

Depens on Age!

> 60y needs an EGD
<60y without alarm sx get H.pylori testing

106
Q

5 red flags for back pain

A 
Constitutional Symptoms (i.e. cancer)
Night time pain
Neuro symptoms
Age >50
IVDU, recent bacterial infection
107
Q

General treatment principals for acne (4 steps)

A 
Topical retinoids/Benzoyl Peroxide (comedone)
Topical Antibiotics (inflammatory)
Oral Antibiotics (inflammaory/nodcularcystic)
Oral Retinoids (nodularcystic only)
108
Q

2 meds to give for opioid withdrawl

A

Methadone

Clonidine

109
Q

Prognosis for febrile seizure

A

Increased risk of having another febrile seizure

Mild increase risk of epiliepsy

110
Q

2 DDx for acute severe anemia in Sickle Cell

A

Aplastic Crisis

Splenic Sequestration

111
Q

Which lab tells the difference between Aplastic crisis and Splenic Sequestration

A

Retics

Low in Aplastic Crisis
Elevated in Sequestration

112
Q

T score interpretation

A

-2.5 is osteoporosis

Anything in between is osteopenia

113
Q

First step in someone with osteopenia vs osteoporosis

A

Osteopenia- cacluate Fracture risk

Osteoporosis- Start bisphosphonate

114
Q

Pt on warfarin, best plan for anticoagulation in pregnancy (based on trimester)

A

LMWH thoughout pregnancy

Unfractionated heparin at delivery becaue you can easily reverse it then switch back to warfarin

115
Q

Interpreting VQ scan results (genral rule)

A

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
Q

Patient has history of substance ABUSE (more than use). What is best ADHD choice?

A

Non-amphetamines.

Amphetamines for all other patients, even with some recreational drug use

117
Q

Patient with ACS symptoms has normal EKG and Trops. Next step?

A

Repeat EKG and Trops

Initial tests can be negative for up to 6 hours

118
Q

2 Tx for Akathesia

A

Beta Blocker

Benzos

119
Q

2 Acute dystonia treatments

A

Diphenhydramine or Benztropine

120
Q

Treatment and prognosis for pregnancy induced gallstones (without colic)

A

Nothing. They will resolve spontaneously after delivery.

121
Q

If a pregnant patient needs a cholecystectomy, when should it be done?

A

2nd trimester

122
Q

Suspicious for pagets disase, imaging and treatment?

A

Radionucleeotide scan - look for other involved areas

Tx- bisphosphonates

123
Q

Common complication of Pagets disase of bone

A

Hearing loss

124
Q

3 treatments for ITP

A

Steroids –> IVIG –> Splenectomy

125
Q

Timing for Tdap and Flu vaccines or pregnant women

A

Flu as soon as it becomes available, can be given at any time

Tdap in 3rd trimester

126
Q

Main contraindication to varenacline

A

Psychiatric history

127
Q

When do you need to do serologic testing for Lyme disease vs. diagnosing clinically?

A

Diagnose clincially if in early stages (Erythema migrans, viral sx)

If disseminated, you need to do ELISA, then Western Blot

128
Q

Classic EEG finding for Juvenille Myoclonic Epilepsy

A

Bilateral polyspike and slow wave discharge

129
Q

Tx for Juvenille myoclonic Epilepsy

A

Valproic Acid

130
Q

Hypsarrhythmia on EEG .Think:

A

Infantile Spasms

131
Q

Tx for infantile spasms

A

ACTh (corticotropin)

132
Q

Classic story for Juvenille Myoclonic Epilepsy

A

Upper extremity myoclonus in the MORNINGS

133
Q

Indication for hypertonic saline in Hyponatremia

A

Profound hypoNa <120

Coma, Seizure

134
Q

Tx for moderte/asymptomatic SIADH

A

Water restriction +/1 salt tabs

135
Q

Whn do you use isotonic fluids for SIADH

A

NEVER. it actually worsens the hyponatremia

136
Q

3 indications to treat asymptomatic bacturia

A

Pregnancy
Undergoing urologic procedure
recent transplant patient

137
Q

Non dominant parietal stroke causes:

A

apraxia (difficulty following instruction to complete a motor skill….ie. can’t copy a picture)

138
Q

Age in neonatal sepsis where CTX can start being used

A

28 days

139
Q

How do you dtermine if patient with gallstone pancratitis should have cholecystectomy this hospitlaization or in a few months

A

If stable - this hospitalization

If evidence of persistant organ damage, hypotension etc…then wait 2 months for everything to calm down

140
Q

Treatment principle for congential hypothyroid

A

Start levothryoxine ASAP to prevent neurodevelopmental delays…

even if asymptomatic. start. Don’t need to repeat lab values

141
Q

Differentiating hyperalo from renovascular htn based on labs

A

Plasma aldosterone/renin ratio (high in hyper aldo)

Also, would have hypokalemia in hyperaldo

142
Q

Indication for needle decompression vs chest tube in pneumothorax

A

Only do a needle if they have tension physiology (RV failure, hypotension, tracheal deviation)

Otherwise, do a chest tube

143
Q

Dupytren contracture associated with

A

Diabetes…both start with D

144
Q

What is the major physiologic reason behind hypoxemia in COPD

A

VQ mismatch… low perfusion due to hypoxic vasoconstriction

145
Q

How does O2 help (physiologically) in COPD exaerbation

A

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
Q

Xray findings in TTN

A

Flattened diaphragms (hyperinflation)

Prominent lobar fissures (fluid in the fissure)

147
Q

Definition of proracted active labor

A 
<1cm/2hr of cervical dilation
Inadequate contractions (should be q3min)
148
Q

2 tx for protracted active labor

A

Oxytocin

AROM

149
Q

Features of Scomboid poisoning

A

Eats seafood develop facial flushing, sweating, chest pain

because when fish is old, it generates a lot of serotonin

150
Q

Patient most likely has ruptured ectopic. When do you do surgery vs TVUS?

A

If hemodynamically unstable –> Surgery

151
Q

4 effects of amiodarone on thyroid

A

Decrased T4–>T3 conversion (TSH nml)
Hypothyroid (High TSH, low T4)
Primary Hyperthyroid (low TSH, high T4)
Destructive thyroiditis

152
Q

Tx for amiodarone induced T3-T4 conversion

A

Nothing…the TSH is normal and they aren’t symptomatic

153
Q

First line empiric antibiotic for septic joint

A

Vanc

CTX doesn’t cover staph!

154
Q

3 Contraindications to pregnancy (i.e. terminate pregnancy if they’re pregnant)

A

1- HF with EF <40
2- Prior peripartum cardiomyopathy
3- Severe pulm HTN

Step 3 (4 decks)

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