Week 3 Flashcards by Chris Henderson

Management of SUPRAtherapuetic INR without active bleeding

If <5, hold warfarin

If >5 oral vitamin K

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Patient develops hyperthyroid after CT angio. What happened?

Iodine induced thyrotoxicosis

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Tx for iodine induced thyrotoxicosis

Self limiting once Iodine is discontinued

Methimazole for chronic/refractory cases

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Sx of keratitis

Foreign body sensation, Light sensitivity

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First line for ACUTE reversal of warfarin

Prothrombin complex (FFP is second line due to large volume needed)

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First line tx for prolactinoma

Dopamine agonists (cabergoline, bromocriptine)

Even if they have huge prolacinomas with compressive symptoms, still do meds before surgery

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At what gestational age are tocolytics contraindicated?

34 weeks…after this, there is increaed risk of morbidity

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2 types of tocolytics and when to use each

Indomethacin <32 weeks

Nifedibpine 32-34 weeks

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Triad of Korsakoff psychosis and prognosis

Retrograde/Anterograde amnesia
Confabulation

DOES NOT IMPROVE. unlike werneke encephaloathy

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Classic CT finding in korsakoff syndrome

Disease in the mamillary bodies

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Equalization of right heart pressures on cath: think

Cardiac Tamponade

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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

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Frequent, low amplitude contractions after abdominal trauma or in a cocaine user. Think:

Placental abruption (even without evidence of bleeding…it can be concealed)

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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

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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

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definition of pubertal delay male

testes <4ml by 14yo

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First line tx for cocaine inoxication with signifcant hypertension

Benzos first…phentolamine only if hypertension doesn’t resolve after benzo

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Cocaine overdose develops sharp chest pain…think:

Aortic Dissection

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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

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Tx for salicylate toxicity

Bicarb infusion…alkalinize the urine

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Tumor marker for medullary thyroid cancer

Calcitonin

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Pt has meduallry thyroid cancer removed. Calcitonin still elevated. Why?

They ahve metastatic disease…calcitonin is being produced from somewhere else

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Time difference for post partum blues vs depression

2 weeks

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Criteria for renal US in children with UTI

<2yo with Febrile UTI

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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 >>> 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