Week 3 Flashcards
Management of SUPRAtherapuetic INR without active bleeding
If <5, hold warfarin
If >5 oral vitamin K
Patient develops hyperthyroid after CT angio. What happened?
Iodine induced thyrotoxicosis
Tx for iodine induced thyrotoxicosis
Self limiting once Iodine is discontinued
Methimazole for chronic/refractory cases
Sx of keratitis
Foreign body sensation, Light sensitivity
First line for ACUTE reversal of warfarin
Prothrombin complex (FFP is second line due to large volume needed)
First line tx for prolactinoma
Dopamine agonists (cabergoline, bromocriptine)
Even if they have huge prolacinomas with compressive symptoms, still do meds before surgery
At what gestational age are tocolytics contraindicated?
34 weeks…after this, there is increaed risk of morbidity
2 types of tocolytics and when to use each
Indomethacin <32 weeks
Nifedibpine 32-34 weeks
Triad of Korsakoff psychosis and prognosis
Retrograde/Anterograde amnesia
Confabulation
DOES NOT IMPROVE. unlike werneke encephaloathy
Classic CT finding in korsakoff syndrome
Disease in the mamillary bodies
Equalization of right heart pressures on cath: think
Cardiac Tamponade
What is the Kleihauer-Betke test and when do you use it
It measurs the amount of fetal RBCs in mothers blood. Used when you have an Rh negative mother who has evidence of a hemorrhage. Based on the results, you can calculate how much Rhogam she needs
Frequent, low amplitude contractions after abdominal trauma or in a cocaine user. Think:
Placental abruption (even without evidence of bleeding…it can be concealed)
Age at which you can observe vs need to intervene for undescended testicle
If <6mo, observe
after 6mo, need to do orchiopexy because spermatogonia start dying after 6 mo
First step in delayed puberty if bone age is premature and no evidence of constiutional delay
FSH/LH….need to determine if it is central or peripheral
definition of pubertal delay male
testes <4ml by 14yo
First line tx for cocaine inoxication with signifcant hypertension
Benzos first…phentolamine only if hypertension doesn’t resolve after benzo
Cocaine overdose develops sharp chest pain…think:
Aortic Dissection
When is an implantable defibrillator indicated in HOCM?
Syncope/Hypotension/Arrhythmia during exercise
FHx of Sudden Cardiac Death
basically, if the situation souds bad, they probably need an ICD
Tx for salicylate toxicity
Bicarb infusion…alkalinize the urine
Tumor marker for medullary thyroid cancer
Calcitonin
Pt has meduallry thyroid cancer removed. Calcitonin still elevated. Why?
They ahve metastatic disease…calcitonin is being produced from somewhere else
Time difference for post partum blues vs depression
2 weeks
Criteria for renal US in children with UTI
<2yo with Febrile UTI
Most common complication of TURP
Retrograde ejaculation
Time/Treatment/Route for gonococcal vs chlamydial conjunctivitis in newborn
gonorrhea- 2-5 days, topical erythro
Chlamydial- >1week, Oral macrolide
3 classic lab findings in RMSF
Thrombocytopnenia
Hyponatremia
Transaminitis
Patient found to have bicuspid aortic valve with no other complications. Next step?
Echo in first degree relatives, bcause they may have it too and it’s important to identify
Dx criteria for somatic symptom disorder
Excessive anxiety and preoccupation over more than 1 symptom
Illness anxiety disorder
Fear of serious illness despite being totally healthy
Conversion disorder
Neurologic symptoms that are incompatible with any known disease
What 4 screening tests do all Turner Syndrome patients need
Echo
Renal Ultrasound (horseshoe kidney)
TSH
Vision/Hearing
2 Tx for cholinergic toxicity
Atropine + Pralidoxime
First lab value to correct in Fe def anemia after giving iron supplement
Reticulocyte count (initially, your bone marrow is depleted of iron, so you give it iron and its going to start churning out RBCs)
Known exposure to active TB, but your PPD is negative. What do you do?
Repeat PPD in a couple months
If positive at that time, get CXR and sputum cx
4 protective factors for suicide
Close to family
Parenthood
Pregnancy
Religious affiliation
Who is at high risk for developing PreE?
Chronic HTN
CKD, DM, Autoimmune disease
Basically everyone who would be at risk for developing HTN in general
What must be done for patients at high risk for developing pre E
Low dose aspirin in 2nd trimester to prevent recurrence
prior PreE, CKD, DM, Autoimmune dz
Role of vaginal progesterone in pregnant women
Prevents preterm delivery if cervix is <2cm long (found incidentally)
Role of IM hydroxyprogesterone in pregnant women
women with history of pre-term delivery should get this to prevent recurrence
4 routine screening labs for all patients with dementia
CBC,CMP, TSH, B12
What are the 3 “selective” dementia screening labs, and who gets them
Folate - alcoholics
Syphillis- Known exposure
Vit D- Risk factors for deficiency
Best test to monitor for anthracycline induced cardiotoxicity
Radionucleotide ventriculography
Treatment of cherry hemangioma
Observation only
Breast lump over 35y. First test and what to do based on results
Mammogram
If malignant looking, do biopsy
If benign looking, do ultrasound
Antidote for ethylene glycol and methanol poisoning
Fomepizole alone, do NOT co-administer with ethanol
in patients with HIT, what is the role/duration of the direct thrombin inhibitors (dagabatron)
Use them as a bridge until your symptoms resolve and plt count normalizes…then switch to warfarin
2 tx for HPV (condolma accumulata)
Trichloroacetic acid - Internal or external warts
Podophyllin - external only
Tx for outpatient CAP
Doxy or macrolide
2 Tx for inpatient CAP
CTX and macrolide
Levoquin or moxifloxacin
Role of hydroxyurea in SSD
Reduces frequency of vasooclusive episodes, but aren’t used for acute management
Treatment principle for vasooclusive episodes
Pain control - NSAID/Opioids
Fluids
Most effective nonpharm way to decrease BP
> 10kg weight loss
How to make the diagnosis of chronic Hep C
HepC IgG positive
HepC RNA elevated
Just a positive IgG tells you one of 3 things (chronic infection, prior infection that is cleared, or a false positive)
3 meds ischemic stroke patients should get while in hospital
Beta Blocker/Statin
LMWH (reduce risk of developing DVT)
Specific indication for steroids in back pain
Cord compression due to Metastatic disease or trauma
DO NOT GIVE FOR SPINAL EPIDURAL ABSCESS
When to observe vs. treat ITP
No bleeding = observe
Active bleeding = IVIG
Treatment for asx lead toxicity based on lead level
<45 - Repeat level in 1 month
45-69- DMSA, Succimer
>70- Dimercaprol + EDTA
First line for violence and agitation
Benzos (haldol is second line, unless they are acutely psychotic or manic)
Best Tx for post partum endometritis
Clinda and Gent (good gram Pos and Neg)
Tx for chorio
Amp and Gent
Differentiating physiologic jaundice from G6PD
Physiologic jaundice is not associated with anemia…G6PD is
Rapidly progressive goiter in someone with Hashimotos…think
Thyroid lymphoma
All the other thyroid cancers are slow growing, or nodules….lymphhoma is very rapid
When do you need oral meds for tinea infections?
Head, fingers, toes
3 classic skin findings in HIV (usually presenting symptom)
Diffuse seborrheic dermatitis
Diffuse molloscum contagiosum
Sudden onset severe psoriasis
Major side effect of st johns wort
Induces CYP450…makes other meds ineffective
3 medications that reudce levothyroxine absorption
Bile acid binding resins (cholestyramine)
Cation supplements (Fe, Ca)
PPI
Tx for polymyalgia rheumatica
Steroids
Diagnostic test of choice for dermatomyositis
Antibody screening (ANA, Anti Jo 1)
10yr fracture risk cutoff for starting bisphosphonates
20%
First line tx for acute delirium
Halddol
3 “buckets” that cause AMS in elderly
Infection
Medication
Metabolic (thyroid, glucose)
2 pathophysiologic causes of stress incontinence
Uretheral hypermobility
Decreased uretheral sphincter tone
How do you differentiate whether incontinence is due to a problem with uretheral tone or hypermobility?
Hypermobility - pt has chronic increased intrabaomnial pressure (prolapse, weight lifting, old people with less connective tissue)
Decreased tone = neuromuscular damage from vaginal deliveries or traumas
Distinguishing thalassemia from Fe deficiency anemia on a smear
Thalassemia has Target cells
2 most important prognostic indicators in COPD
FEV1»_space;> Age
DSM5 for Adjustment Disorder
Onset within 3 months of stressor
Marked distress/affects daily living
Doesn’t fit criteria for MDD
First line ADHD treatment based on age
<5 = behavior therapy >5= Amphetamines
Pt with pancreatitis develops worsening symptoms 3 days later. First step in workup
CT - looking for abscess, necrosis
