Week 2 Flashcards
Who gets a statin?
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
What gets checked at 1st prenatal visit
Infection
Immunity (titers, RH status)
Anemia
Timing for amniocentesis vs chorionic villous sampling
Amnio >15weeks
CVS 10-13 weeks
Quad screen results for trisomy 21
Hcg - up
AFP- down
Estrol- down
Inhibin- up
“HAEI” “Down is Up”
Quad screen for trisomy 18
ALL DOWN
Cutoff for 1hr GTT in pregnancy
> 140, then you need 3hr GTT
3hr GTT results
fasting >90
3hr >140
How to manage baby at high risk for getting congenital HepB
Csection
IVIG and Hep b vaccine at birth
How to interpret biophysical profile >8
Reassuranc
How to interpret BPP 4-6
Based on age…
If <36 weeks, need Contraction stress test. If that’s bad looking, deliver baby
If >36weeks, just deliver them
Preterm Labor or pPROM management based on age
If >34 weeks: Treat GBS, Steroids if <36, then deliver
<34 weeks: Steroids, Abx, Mg if <32 weeks
Tx for uterine atony
Metylergovine (cause HTN)
Carboprost (worsns asthma)
Oxytoscin
Delayed post partum hemorroage, about 1hr after delivery
Retained products
Do ultrasound then D/C to remove
Size criteria for Renal stone management
<5mm pass spontaneously
5-10 get medical mgmt (tamsulosin)
>10mm need surgery
Anti centromere ab
CREST
anti mitochondrial ab
Primary Biliary Cirrhosis
anti smith ab
highly SPECIFIC for lupus….screen with dsDNA, confirm with Anti Smith
Which titer is used to follow disease progression in Lupus
Anti dsDNA ab levels
Classic presentation of carotid artery dissection
Unilateral headache
Horner syndrome
HbBarts is associated with
Alpha thal
Sickle Cell Trait hb electrophersis findings
40%HbS
60%HbA
Treatment principle for RV MI
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
First line treatment hot thyroid nodule
Methimizole…this is just a bridge to definitive therapy with ablation/surgery
First line treatment for non-perforated toxic megacolon
Steroids (reduce colitis)
Abx if infection suspected
What is the best test to measure efficacy of anti-thyroid drugs on a patient’s repeat visit?
T3 and T4…NOT TSH
How to diagnose narcolepsy
Sleep study (reduced REM latency) LP (low hypocretin)
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)
In evaluating brain death, what do you do if neuro exam is inconclusive or they’re paralyzed?
EEG or Brain imaging
Definition of recurrent UTI
> 2 in 6 mo
>3 in a year
First line treatment for recurrent UTI
Prophylactic antibiotics
Pleural effusion findings in TB
Elevated Adenosine Deaminase lvls
First 2 treatments for PCOS
WEIGHT LOSS»_space;> OCPs
How to help PCOS woman get pregnant
Letrozole (induces ovulation)
GDM in the 2nd/3rd trimester is associated with what cardiac anomoly?
Congenital hypertrophic IV septum…it will resolve on its own
Differentiating between mycobacterium marinium and vibrio vulnificus
Marinium = red, ulcerated lesions Vulnificus= rapidly progressive hemorrhagic bullae
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
Classic CSF finding for fungal meningitis
Low Cell count w/lymphocytic predominance
Viral and bacteial have huge cell counts
Chronic unilateral Middle ear effusion that persists despite antibiotics. Think:
Nasopharyngeal cancer
If bilateral, usually non cancerous (obstructive, allergies, smoke exposure etc)
CSF findings for fungal vs TB meningitis
Both have lymphocytic predominance, but TB has pleocytosis whereas fungal has pretty low cell count
Multi-nutrient deficiency in a young-ish person: first thought should be
Celiac disease (even in the absence of diarrhea)
Breast lump <30, first step in management
Ultrasound…no longer just observe them without imaging
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…
Main contraindication to placing copper IUD for emergency contraception
Evidence of active pelvic infection….otherwise, it is the best option
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
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)
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)
Patient has lupus nephritis. First step in management
Renal biopsy –> must classify what kind of lupus nephritis they have, because it determines treatment
Mammogram recommendations for general population
q2years between 50-75yo
Who gets mammogram before 50?
- 2 first degree relatives with BC, one being <50 at age of diagnosis
- Relatives with both breast/ovarian CA
CSF bacterial meningitis
VERY High cell count
High Protein
Low Glucose
CSF viral meningitis
Mildly elevated cell count (lymphocyte)
Mildly elevated protein
Normal glucose
Unique imaging and PE findings for TB meningitis
Basilar Meningeal enhancement on CT
Yellow/White “tubercles” seen on fundoscopic exam
Treatment of TB meningitis
GLUCOCORTICOIDS
4x therapy, followed by dual therapy for 1 year
What screens are done at 1st trimester visit?
Infection
Immunity
Anemia
What screens are done at 2nd trimester visit?
Anemia
Glucose Tolerance
Thrombocytopnia during pregnancy. No history of bleeding or affects on baby. Diagnosis and prognosis
Gestational thrombocytopenia (due to dilution)…will resolve after delivery
Treatment algorithm for carpal tunnel
Splinting –> steroid injection –> surgery
First step in working up nocturnal enuresis (after lifestyle modifications failed)
Urinalysis to screen for glucosuria, DI, or occult infection
Treatment of drug induced lupus
Symptomatic tx, and removal of offending agnt
Guidance for returning to sports after concussion
Rest for 24hrs, then graudually return to sports over the course of a week
3 Most common complication of bicuspid aortic valve
Thoracic aortic aneurysm
Aortic dissection
Aortic root dilation
when to use qtip test
Assess stress incontinence
Diagnostic test for uretheral diverticulum
MRI pelvis
Raloxifine mechanism
Pro estrogen effect on bone
Anti estrogen effect in breast, endometrium
Treatment for primary ovarian insufficiency
Combination estrogen and progesterone
2 Most common paraneoplastic syndrome with RCC
Hypercalcemia (PTHrP)
Erythrocytosis (elevated EPO production)
Smoker with hematuria and erythrocytosis…think:
RCC
Definition of subclinical hyperthyroid
Low TSH, normal T3/T4
2 Indications to treat subclinical hyperthyroid
TSH persistently <0.1 or patient has other risk factors (age, tyroid nodule)
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
Target Fasting, 1hr, and 2hr BGL in GDM
Fasting <95
1hr <140
2hr<120
Diagnosis of thyroid cancer is made. next step?
Staging, like every cancer. best way to do this is Neck Ulrasound to look at nodes
Classic triad of constitutional delay
Delayed bone age
Short stature
Normal growth velocity
2 cases to repeat colonoscopy in 3 years
High grade dysplasia
>3 polyps
2 cases to repeat colonoscopy in a few months
Very large polyp (>2cm)
Carcinoma incitu
Who gets annual colonoscopy
Familial Adeomatous Polyposis
Cscope shows small tubular adenomas. When do you repeat?
5 years (3yrs if villous or high grade)
Treatment for lithium tox (all comers). What do you do for very high levels?
IV Hydration
Hemodyalsis if levels >4
Best way to prevent exercise induced hypoglycemia in diabetics
Reduce mealtime insulin prior to working out
3 absolute contraindications to estrogen containing contraception (besides vascular diseas)
Heavy smoking with age >35
Migraines
Hypertension >160
MCC of urinary retention in old people
UTI…get urinalysis
Differentiating between oropharyngeal and esophageal dysmotility
Oropharyngeal- coughing, aspiration
Esophageal- chest pain, food gets “stuck”
4 med classes that increase lithium levels
ACEi/ARBs
Thiazides
NSIADs
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
Psoriatic vs RF joint involvement
Psoriatic- DIPs + axial bones (spine)
RF- PIPs, MCPs, large joints
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
3 DDx for elevated AFP
Multi Gestation
Abdominal wall defect
Neural Tube Defect
Best single item screening question for alcohol abuse
“how many times in the last year have you had more than 5 drinks per day”
Best treatment for MAT
Fix the underlying respiratory issue…don’t give antiarrhythmics
Role of LP vs VP shunt in NPH
LP to diagnose (if sx improve after, its NPH)
VP shunt is definitive therapy
What lab value differentiates hypoPTH from pseudohypoPTH
PTH levels
HypoPTH = low PTH PseudohypoPTH= High PTH
Both have high phos and low Ca
How does EPO differentiat between polycythemia vera and RCC
Low EPO = Polycythmia vera
High EPO = RCC
Xanthalasma + Elevated LFTs. Think:
Primary Biliary Cirrhosis
PBC antibody screen
Antimitochondrial Ab
Anti Smooth Muscle Ab
Autoimmune Hepatitis
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
What does late life depression increase your risk for developing? (onset >65yo)
Alzheimers
Besides fluroide and sugary drinks, what icnreases childrens risk for cavities?
Night time feedings
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
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
Patient comes in with MI and acute heart failure, what med is contraindiated?
Beta blockers
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
2 criteria for biventricular pacemaker for HF
EF <35
Presence of LBBB
Urinalysis with blood but no RBCs
Rhabdo
First step in managing dyspepsia
Depens on Age!
> 60y needs an EGD
<60y without alarm sx get H.pylori testing
5 red flags for back pain
Constitutional Symptoms (i.e. cancer) Night time pain Neuro symptoms Age >50 IVDU, recent bacterial infection
General treatment principals for acne (4 steps)
Topical retinoids/Benzoyl Peroxide (comedone) Topical Antibiotics (inflammatory) Oral Antibiotics (inflammaory/nodcularcystic) Oral Retinoids (nodularcystic only)
2 meds to give for opioid withdrawl
Methadone
Clonidine
Prognosis for febrile seizure
Increased risk of having another febrile seizure
Mild increase risk of epiliepsy
2 DDx for acute severe anemia in Sickle Cell
Aplastic Crisis
Splenic Sequestration
Which lab tells the difference between Aplastic crisis and Splenic Sequestration
Retics
Low in Aplastic Crisis
Elevated in Sequestration
T score interpretation
-2.5 is osteoporosis
Anything in between is osteopenia
First step in someone with osteopenia vs osteoporosis
Osteopenia- cacluate Fracture risk
Osteoporosis- Start bisphosphonate
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
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
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
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
2 Tx for Akathesia
Beta Blocker
Benzos
2 Acute dystonia treatments
Diphenhydramine or Benztropine
Treatment and prognosis for pregnancy induced gallstones (without colic)
Nothing. They will resolve spontaneously after delivery.
If a pregnant patient needs a cholecystectomy, when should it be done?
2nd trimester
Suspicious for pagets disase, imaging and treatment?
Radionucleeotide scan - look for other involved areas
Tx- bisphosphonates
Common complication of Pagets disase of bone
Hearing loss
3 treatments for ITP
Steroids –> IVIG –> Splenectomy
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
Main contraindication to varenacline
Psychiatric history
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
Classic EEG finding for Juvenille Myoclonic Epilepsy
Bilateral polyspike and slow wave discharge
Tx for Juvenille myoclonic Epilepsy
Valproic Acid
Hypsarrhythmia on EEG .Think:
Infantile Spasms
Tx for infantile spasms
ACTh (corticotropin)
Classic story for Juvenille Myoclonic Epilepsy
Upper extremity myoclonus in the MORNINGS
Indication for hypertonic saline in Hyponatremia
Profound hypoNa <120
Coma, Seizure
Tx for moderte/asymptomatic SIADH
Water restriction +/1 salt tabs
Whn do you use isotonic fluids for SIADH
NEVER. it actually worsens the hyponatremia
3 indications to treat asymptomatic bacturia
Pregnancy
Undergoing urologic procedure
recent transplant patient
Non dominant parietal stroke causes:
apraxia (difficulty following instruction to complete a motor skill….ie. can’t copy a picture)
Age in neonatal sepsis where CTX can start being used
28 days
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
Treatment principle for congential hypothyroid
Start levothryoxine ASAP to prevent neurodevelopmental delays…
even if asymptomatic. start. Don’t need to repeat lab values
Differentiating hyperalo from renovascular htn based on labs
Plasma aldosterone/renin ratio (high in hyper aldo)
Also, would have hypokalemia in hyperaldo
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
Dupytren contracture associated with
Diabetes…both start with D
What is the major physiologic reason behind hypoxemia in COPD
VQ mismatch… low perfusion due to hypoxic vasoconstriction
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
Xray findings in TTN
Flattened diaphragms (hyperinflation)
Prominent lobar fissures (fluid in the fissure)
Definition of proracted active labor
<1cm/2hr of cervical dilation Inadequate contractions (should be q3min)
2 tx for protracted active labor
Oxytocin
AROM
Features of Scomboid poisoning
Eats seafood develop facial flushing, sweating, chest pain
because when fish is old, it generates a lot of serotonin
Patient most likely has ruptured ectopic. When do you do surgery vs TVUS?
If hemodynamically unstable –> Surgery
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
Tx for amiodarone induced T3-T4 conversion
Nothing…the TSH is normal and they aren’t symptomatic
First line empiric antibiotic for septic joint
Vanc
CTX doesn’t cover staph!
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
