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189 Cards in this Set
- Front
- Back
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medication for n/v which causes eps?
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reglan
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labs needed after incidental adrenal mass found? 3
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catecholamines
electrolytes dexmethasone suppression test |
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when should you surgically remove an adrenal mass? 3 criteria
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- functional mass
- signs of malignancy - > 4cm |
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mechanism of dz in TSS?
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exotoxin production
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drug of choice for htn in scleroderma
give 2nd choice too |
1. ace-i (captopril)
2. ccb will also help raynaud's but aren't first line. |
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tx for localized, moderate and severe psoriasis involving nail and joints?
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localized-- betamethasone
moderate-- puva severe with nail/ joint involvement-- mtx |
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mngt of staff exposed to newly dx'd pt with tb with a neg ppd?
what if ppd is +? |
repeat in 3 months
if + start INH |
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tx for severe mono
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corticosteroids
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next step after abnormal catecholamines levels found in pheos?
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give alpha blockade then mri
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electrolyte imbalance caused by vit b12 tx in pernicious anemia?
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hypokalemia
increase k+ uptake by new rbcs deplete it |
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battery of tests for suspected lead toxicity?
what if pt needs chelation? |
cbc, iron studies and retic count r/o iron def
if chelation needed: cmp, ua |
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3 or more polyps, villous features and > 1cm in size..what screening?
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colonoscopy in 3 yrs
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in immunosuppressed pt, pulm sxs w/ sinus sxs. dx?
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aspergillosis
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after a neurological exam c/w brain death, which is the next step to confirm?
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apnea test
high co2 > 60 low ph < 7.28 |
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when do u know dka has resolved? 4 criteria
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1 glc < 200
2 anion gap wnl 3 hco3 ~ 18 4 hungry pt |
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mngt of dvt after first episode vs recurrent dvt?
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warfarin or lwmh for at least 3 mo after first event.
(can dc warfarin at six mo depending on bleeding risk) recurrent dvt warrants life long tx |
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3 main physical findings of pseudo-tumor cerebri
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1 ha
2 visual loss/ obscurations 3 pulsus synchronous tinnitus (pulse tempo like whooshing sound in pt's ear) |
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tx of choice for ocd
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psychotx
med of choice is ssri |
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dx?
w/u? tx? |
paget's dz of bone (cottom wool on ct with bone thickening)
ca++ and akp levels biphosphonates |
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causes of mat?
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- hypoxia
- copd - electrolyte imbalances (k+, mg+) - heart dz (cad, vpt, htn..) - meds (theophylline..) |
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indications for TIPS
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failure of emergent or recurrent endoscopy to resolve variceal bleeding
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pt with joint pain with sclerotic lesions and bowing of long bones..dx?
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paget dz
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which med to control tourette's tics?
which med if a/w ocd or impulsive disorder? |
tics--dopamine blockers (fluphenazine, pimozide..)
ocd--ssris |
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Serious complication fo Erb's palsy?
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diaphragmatic paralysis 2/2 phrenic nerve involvement
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how often should baby be fed?
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2-3 hrs
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effective lenght of tx for latent tb?
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9mo inh
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mngt of warfarin in s/o hit
2 points |
- stop warfarin with heparin (warfarin alone induces venous necrosis)
- wait till plts go > 150k to restart while pt on nonheparin drug. |
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failure to pass stool in newborn w/ ground glass mass or soap bubble sign on abd xr?
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cystic fibrosis
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lung nodules in an RA pt?
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caplan 's syndrome
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mngt for hiv pt dx'd with syphilis of unknown date?
whats the tx? |
- do csf to assess for neurosyphilis
- im pnc x 3 wks |
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mngt of papillary ca of thyroid?
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1 u/s of thyroid and nodes
2 if node < 1cm--> lobectomy - if node > 1cm--> thyroidectomy |
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mngt of breast cyst?
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1 aspirate
2 no residual mass?--> check if recurred with u/s 4-6 wks 3 all other mngt is mm and excision |
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hiv pt who develops thrombocytopenia. whats the tx?
what condition of immunocompetent hosts is this similar to? |
1 start azt (zidovudine)..increases plt production
2 itp |
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f/u of viral load?
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6-8 wks until undetectable; then q3mo
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fetal heart condition a/w maternal dm?
px? |
- hcom
- self-limited |
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dx?
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poison ivy dermatitis
(linear vesicular lesions with serous fluid) |
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pt with sjogren's and submandibular mass. what ca?
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b-cell nonhodgkin's ( sjogren's causes b-cell activation)
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pt p/w late onset dm and this rash..dx?
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glucagonoma
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1- when should you suspect physiologic jaundice in newborn?
2- difference btn g6pd def and hemoglobinopathies in newborn? |
1- after 24 hrs of birth
2- hemoglobinopathies don't present early after birth bc fetal hmg predominates * suspect hemolysis in newborn with unconjugated jaundice in first 24 hrs of life |
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age appropriate for heimlich maneuver?
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> 1 yo
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1- bp after tpa?
2- when is it ok to begin dvt ppx after tpa? |
1- = or < 180/105
2- after 24 hrs of tpa |
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GBS ppx in pregos?
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pnc 4 hrs before delivery
* asxs infants can be observed wo tx |
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pt w h/o hashimoto's and enlarged thyroid.. dx?
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thyroid lymphoma
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mngt of torsades in stable and unstable pt?
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- stable--> mg+
- unstable--> unsynchronized cardioversion |
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difference btn GBS, botulism and tick paralysis..
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1. tick!
2. GBS takes longer (days-weeks) vs. TP (hrs-days); csf normal in TP. 3. botulism--> descending paralysis, cn affected and pupillary dysfunction. |
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recommended lenght of therapy w/ ssri depending on depressive episodes?
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- one episode.. can dc after 6mo-1 yr
- 2 or +.. for life |
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pt with prolonged malnutrition is fed. she then develops volume overload, low k and mg.. dx?, tx?
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refeeding syndrome
tx: correct low phosphate |
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pt who p/w hypertension, dm, osteoporosis, and emotional lability and the low k is found..dx?
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r/o cushing's
dexamethasone suppression test. |
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pt w/ anxiety and insomnia takes natural supp. then develops high lfts..which supp?
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kava
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side effect of ginko biloba?
side effect of ginseng? |
- bleeding
- psychosis and SJS |
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tx for cryptococcal meningitis?
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amphotericin B and flucytocine for 2 weeks..then switch to fluconazole if there's improvement
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indications for cytoscopy and stone removal?
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stone> 10mm
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knee injury a/w dashboard trauma in mva?
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pcl tear
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side effect of isotretinoin?
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teratogenic
high trigs |
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which vessel involved in diverticular bleed?
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artery of vasa recta
*venous bleeding is a/w hemorrhoids |
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bitemporal hemianopsia with hyperpigmentation after adrenectomy bl...dx?
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nelson syndrome
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tx for warts contraindicated in pregnancy, bleeding, mucosal application and dm?
2- first line medical tx for warts? |
1- podophyllin
2- trichloroacetic acid |
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criteria for parathyroidectomy in asxs pt?
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1- 1mg > normal
2- dexa < - 2.5 3- renal failure |
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diabetes
skin pigment liver dz think.. |
hemochromatosis
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when do you use dopamine?
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cardiogenic shock and hypotension
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pts for whom bariatric sx is recommended?
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bmi > 40
bmi > 35 with comorbidities |
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side effect a/w saw palmetto?
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htn
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- prematurity
- gross motor delays (crawls but then doesn't walk) - scissoring gait dx? test to confirm? |
1- spastic cerebral palsy
2- mri |
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pt p/w hyperthyroid sxs but RAIU is low..dx?
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silent thyroiditis
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1- tx for tca induced arrhythmia?
2- tx for cardiotoxic effects of tcas? |
1- lidocaine
2- nahco3 |
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1st and 2nd line tx for skin squamous cell ca?
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1st = xrt
2nd = 5-FU |
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approach to pt w/ delayed gastric emptying? 3 steps
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1- r/o obstruction--> egd
2- r/o compressing masses-->ct 3- r/o neuropathy--> gastric emptying scan |
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pt w/ elevated lfts but almost normal akp and bilirubin..dx?
next test? |
dx: autoimmune hepatitis
test for ana and anti-smooth ab |
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pt p/w ascending paralysis, sensory loss and bladder dysfunction..
dx? next step? |
dx: transverse myelitis
do MRI to r/o cord compression * guillain barre does not have sensory loss |
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hiv drugs side effects:
nrtis (didanosine, azt, abacavir..) as a class? as individuals? nnrtis (efavirenz, nevirapine..) as a class? as individuals? pis as class (indinavir..) |
nrtis as a class = lactic acidosis
didanosine--> pancreatitis zidovudine--> anemia/ neotropenia abacavir--> hypersensitivity nnrtis as class = SJS efavirenz--> teratogenic neVirapine--> liVer toxicity pis = gi intolerance / lipodystrophy iNdinavir--> reNal toxic |
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test for young pt who p/w with seborrheic dermatitis?
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check hiv
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pt w/ peripheral nerve problems (bell's), with erythema nodosum and hypercalcemia..think of?
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sarcoid
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return of period after stopping ocp?
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90-3 mo beyond that needs w/u for amenorrhea
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kid who was playing w/ cats, p/w localized LAD an fever..dx?
tx? |
cat scratch dz
tx: azythromycin |
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how is cat scratch dz different from toxo? 3
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1- toxo most commonly with cervical LAD
2- toxo p/w eye involvement but uveitis 3- mostly asx in immunocompetent pts (unlike CSD = fever) |
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tx for brain mets?
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xrt
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pt with recent hospitalization, nm or high tsh, low t3 and normal t4..think?
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euthyroid sick syndrome
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mngt of hyperthyroidism in pregnancy?
what if pt doesnt know she is pregnant? |
- PTU in first trimester
- methimazole after 2- if taking MMI, switch to PTU |
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tx to prevent cluster ha long term?
short term? tx acute epidoses? |
verapamil
2- steroids 3- sumatriptan |
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pt w/ h/o multiple births, Dysuria, Dyspareunia and Dribbling urine..dx? next step?
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dx: urethral diverticulum
step: transvg u/s |
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when should you choose ablation of a cervical neoplasia? 3
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1- normal colposcopy
2- glandular lesion 3- no invasion *o/w LEEP |
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pt w/ bacteremia, in icu..bullae--> ulceration with necrosis
dx? |
ecthyma gangrenosum
look for pseudomonas |
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purulent ulcer with violaceous borders?
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pyoderma gangrenosum
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lesions running along lymphatic channels in an outdoorsy pt?
tx? |
sporotrichosis
tx: itraconazole |
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pt w/ maxillofacial procedure who p/w painless mass w/ sinus tracts?
tx: |
actinomycosis
tx: penicillin |
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when is the tx for asx bacteriuria indicated? 3
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- pregnancy
- urology procedures - hip replacement (foley will be needed) |
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3 drugs that can cause isolated elevations of cr 2/2 decreased secretions by tubules?
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- cimetidine
- probenecid - tmp |
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contraindications for mmr vx 5
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- pregnancy
- immunocompromised or given ivig - thrombocytopenic s/p vx - severe fever - all to neomycin or gelatin |
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- malabsorptive diarrhea
- abd pain - migratory arthralgias dx? dx test? tx? |
dx- whipple's dz
test- small bowel bx tx: rocephin or pnc |
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3 parameters to determine liver failure (ESLD)
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- INR
- BIL - Cr |
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htnsv of choice for pt taking lithium?
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ccb and bb
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parameters for parathyroidx based on ca++ and 24hr urine ca++?
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ca++ > 11.5
24hr urine Ca++ > 400 |
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why is gastrin not recommended in pt with hyperca++ and ppi tx? mngt?
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hypercalcemia rises gastrin levels as well as ppi tx
- pt must be off ppi x 2 weeks and nml ca++ before checking gastrin if looking for men1 |
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clinical manifestations of ileus? 4
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3-5 d of:
- po intolerance - diffuse abd pain - no flatus - n/v and bloating |
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2 parameters to use vanco po instaed of flagyl po?
when do you add flagyl iv? |
1. wbc > 15k
2. cr > 1.5x nml - when there's ileus |
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toc for akathisia?
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bb (propanolol)
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mngt of salmonellosis?
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supportive
no need for abx |
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when are abx indicated in salmonellosis?
abx of choice? |
- children < 1yo
- immunosuppressed - elderly> 50 w/ artherosclerotic dz (prevent bacteremia and endocarditis) - cipro, bactrim or rocephin |
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when is phototx in infant indicated?
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total bili btn 15-20
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how to differentiate btn folate and b12 def?
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homomcysteine and mma level high in b12 def
- only hmocysteine high in folate def |
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condition to which pt with subchorionic hematoma is at risk?
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spontaneous abortion
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in a patient with hyperca++ and nml pth. how do you know is familial hypercalcemia?
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low urine ca++. hence name Hypocalaciuric
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m/s condition a/w gonococcal arthritis?
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tenosynovitis
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pt gets stuck w/ hiv needle..mngt depending on vl?
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low vl--> 2nrtis x 4wks
high vl--> 2nrtis + 1 pi x 4wks |
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well's criteria? 5
score? |
- dvt sxs 3pt
- recent sx or > 3d immobile - hr>100 - hemoptisis - ca - score>4 bad |
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difference btn acute glaucoma and uveitis?
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glaucoma
- halos - n/v - increased pressure uveitis - irregular pupil - wbc on anterior chamber by slit lamp |
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clinical features of allergic broncho-pulmonary aspergillosis?
dx approach? tx? |
- h/o asthma or cf
- coughing blood or brownish plugs/sputum - cxr shows upper lobes infiltrates dx: 1- skin test..serum aspergillus igE if +..if cxr neg---> hrct scan tx: glucocorticoids (prednisone..) can add itraconazole but not 1st line |
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toc for postherpetic neuralgia?
alternative tx? |
tca (amytriptyline)
gabapentin if tca ci'd |
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pt w/ mono who needs a node bx?
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if lad persists for > 4 wks
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toc for pid
alternative tx |
- cefoxitin + doxy x 14 d
- clinda + gentamycin x 14 d in pnc all |
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presenting sxs of Li toxicity? 2
precipitants? 3 |
- gi sxs (n/v/d)
- neuro deficits p/ later when Li crosses bbb - diuretics, aceis and nsaids |
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mngt of acute arterial occlusion of the ext?
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1- a/c w heparin
2- angiography for tpa vs sx |
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blood tests to determine sle activity? 2
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- complements
- anti-dsdna |
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pt p/w exertional sob, fatigue, syncope, ruq pain, peripheral edema, poor apetite..prob dx?
mngt? |
dx: phtn
1- tte 2- cath 3- vasoreactivity test (adenosine..) 4- if reactive..ccb / not reactive..endothelin bosentan or pde5 |
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pt w/ high h/h..work up?
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1- repeat lab
2- check ep- low? PV --> check jak - high? ct or pulseox (rcc or osa) |
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difference btn amebiasis vs hydatid cyst?2
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- hydatid often asx unless mass effect or ruptured cyst (bilary obstruction...) while ameba p/w fever, diarrhea and ruq pain.
- hydatid cyst are a/w dogs...ameba with mexico travel |
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ataxia, lethargy, tachycardia with this rash in teenager..dx?
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inhalant abuse
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tx options for testicular ca?
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orchiectomy
then: - surveillance if stg 1 - ctx - rxt if refuses ctx and noncompliant for surveillance |
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clinical features of macular degenaration? 4
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central vision problems:
- trouble reading, driving - pt needs more light - lines get distorted - scotomas |
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w/u for hyperaldosteronism
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- aldosterone concentration / plasma renin ratio
- nacl challenge test - ct |
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1- presentations which give concern for endometrial ca? 3
2- approach for dx? |
- any postmenopausal woman w/ uterine bleeding
1. - premenopausal women > 45yo w menometrorrhagia - women w/ opposing estrogen states (obese, anovulatory) who persist having bleeding 2. pvu/s before bx..bx can be f/u by d/c |
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mngt for pt w/ hyperuricemia wo sxs?
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none
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newborn that gets cyanotic with breastfeeding and improves with crying..dx? test?
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- choanal atresia
- nasal catheter can't pass |
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mngt of lead poisoning depending on severeity?
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mild <44 no tx just remove from source
moderate btn 45-69 gets succimer po severe > 70 gets iv dimercaprol or edta |
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test sequence for pcp dx?
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- sputum induction
- bal - bx ---> helpful if pt had pentamidine ppx |
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s/p renal transplant pt develops renal failure. bx shows basophilic inclusions..dx?
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bk virus nephropathy
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vent settings for ARDS tx? 3
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low tv
high peep high rr |
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u/s surveillance for aaa?
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3-4 cm ---> q2-3 yrs
> 4cm ---> q6-12mo |
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abx for skin mrsa infections? 3
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- tmp-smx
- doxy - clindamycin |
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pt w/ h/o ibd who has increased akp and lft..dx?
- typical presentation? |
1ry sclerosing cholangitis
- asx..if sxs, fatigue and itching |
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a pt tx'd for depression who develops new onset dm and high bmi/ obesity..which drugs? 3
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- olanzapine
- risperdal - quetiapine |
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mngt with rhogam?
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mom (-) ---> give at 28wks
mom (+) --> no need. baby has to be checked for hdn mom (-) w/ blood mix during labor ---> another dose |
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when do you screen for dm in pregnancy?
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24-28 wks
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kid p/w fracture after minor fall, found to have splenomegaly, anemia and low plts..dx?
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gaucher dz
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dx criteria for pcos? 3
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- menstrual iregularities
- hyperandrogenism - evidence of polycystic ovaries on u/s |
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- indications for mv replacement in mvr?
- f/u for noncandidates for sx? |
- severe mvr w/ sxs
- asx mvr w/ new onset afib, lvh or phtn - tte q2 yrs |
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indications for 3% ns?
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- na < 120
- seizures, ams - h/o marathon runner, ectasy or polydypsia |
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drug to prevent gouty attack after initiation of allopurinol?
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colchicine
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pt whom inr can be at goal btn 2-3 after mechanical valve replacement? 3
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- lv normal size
- normal ef - nsr |
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pt w/ h/o iv drug use who p/w sob and cough. cxr has this nodular opacities..dx?
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septic pe
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methods for the dx of schistosomaisis..2
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- urine showing eggs
- cytoscopy with bx if urine test neg |
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features of drug induced sle..3
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- fever
- arthralgias/ myalgias - NO renal, hematologic or cns problems unlike clinical SLE |
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eye pain s/p 12-24 hr of trauma, visual disturbance. on pe hypopion and retinal vessels nonvisualized..dx?
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endophthalmitis
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pt c/o large floater like a house fly going in and out of central view..dx?
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retinal detachment
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mngt of sarcoidosis with hilar lad and en. 2 points
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- hilar lad and en require no tx if asx. only pulmonary sx are tx'd with strd
- if strd fail, use mtx |
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pancreatitis inducing drugs (DIIVA)
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- Diuretics
- IBD .. sulfazalazine - Immunosuppresors..azathioprine - Valproate - Abx..(metronidazole, tetracycline) |
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tx of choice for catatonic schizophrenia?
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benzos
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most common complication of TURP?
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retrograde ejaculation
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features of hemochromatosis 7
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- joint pain mainly on 2nd and 3rd mcp
- decreased libido - tanned skin - new dx dm - hepatomegaly - restrictive cmp - pseudo-gout features like: hooked osteophytes and rhomboid crystals on joint tap. |
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vx avoided if egg allergy?
difference btn reactions to eggs w/ vx? who cannot receive live vx? |
- influenza and yellow fever
- hives only? ---> can give inactivated vx - asthma, pregnancy, immunosuppressed |
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mngt of siadh
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restrict h2o----> salt tablet and diuretics----> demeclocycline or lithium
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pt w/ h/o iud has Actinomyces on pap smear,,mngt?
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only tx if sxs present.
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tx for hyponatremia in asx pt w/ edematous state?
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main tx is h20 restriction
- 3% ns only if sxs and na < 120 *edematous state means: chf, cirrhosis... |
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main clinical features of Pick's dz 4
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- social inhibition (inapropriate comments, incontinece)
- dont care about condition rather than not knowing - repetitive and stereotyped behavior (same foods, same phrase..) - uncommon amnesia at presentation |
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pt is using black cohosh for pms. what side effect?
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hypotension
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pt with venous insufficiency starts taking horse chesnut. what side effect?
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bleeding, like gingko
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agent to tx htn in aortic dissection?
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bb
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drugs and presentation of drug induced lupus
3drugs 4 sxs |
drugs:
procainamide hydralazine penicillamine sxs: fever myalgias arthralgias rash (discoid rare) |
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1st and 2nd tx for hemochromatosis
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1. biweekly phlebotomy
2. deferoxamine chalation |
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how to differentiate tsh pituitary tumor from thyroid hormone resistance syndrome?
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- resistance syndrome presents as hypothyroid state rather than thyrotoxic
- elevated alpha subunits are characteristic of pituitary adenomas |
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when it's not necesary to taper steroids? 3
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- tx < 3weeks
- < 5mg - every other day dosing |
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differences btn necrotizing fasciitis and clostridial cellulitis? 3
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1. in NF pain is disproportional to skin changes vs CC where pain isnt a significant finding.
2. NF has blue/gray patches with possible blisters vs CC has drainage of foul smelling d/c 3. NF involves the deep tissues (fascia/muscle/fat) vs CC only the skin |
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indication for orchiopexy in undescending testes?
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indicated if no descent by 6 mo
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pt presents w/ bone pain and low dexa scan values. pth is high and po4 is low. ca is wnl..
dx? why is ca normal? |
dx: vit D def.
- ca is low bc pth increases bone resorption to maintain ca levels |
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drugs for recent MI pts 5
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1. asa + plavix
2. BB 3. ACEI 4. statin 5. add k sparing diuretic if ef < 40% |
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drugs that cause digoxin toxicity? 4
clinical features? 4 |
drugs:
- amiodarone - verapamil - quinidine - spironolactone sxs: - n/v - fatigue/ poor apetite - color changes - st depression on ekg |
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3 most common causes of MAT?
toc for copd pts? |
1- hypoxia
2- copd 3- electrolyte imbalance - verapamil for copd/ bb first line for noncopd |
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mngt of acute cholangitis? 4 steps
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1. ivf, cx, abx
2. ercp 3. biliary drainage (if ercp fails..no stones) 4. elective cholex..no need for urgent cholex |
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in botulism, when do you use equine immunoglobulin vs human?
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equine --> foodborne and wound botulism
human--> in infants to avoid anaphx and allergies |
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rational for urinary retention post op? 2
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1. anesthesia
2. ivf bolus can overdistend bladder so it cant contract |
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interaction between li and hctz?
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hctz increases levels of li by dumping na so the body reabsorbs na with li.
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meds assoc/ w digoxin toxicity? 4
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- verapamil
- amiodarone - quinidine - spironolactone |
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pt just had a molar preg evacuated. whats the counsel and f/u?
when do you stop surveillance? mngt if abnormal test in surveillance? |
- advise to use contraception
- f/u bhcg x 1wkly - stop surveillance after 3 normal consecutive bhcg's - if high bhcg--> ctx |
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pt has sarcoid by cxr..how do you confirm dx?
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- lung bx
- if unclear, do liver * dont do liver first 2/2 morbidity and other granulomatous dz make hard to distinguish |
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what risk factors for lead poisoning? 3
when do you begin to treat? mention mono and dual tx.. |
- house built < 1978
- pica - immigrant poor child - at blood lead level > 45 ---> succimer - at > 70 ---> dual tx (dimercaprol + edta) |
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pt with dementia and frquent falls due to instability..dx?
causative agent if pt hallucinations get worse? |
- lewy body dementia (classic-hallucinations)
- check if given dopamine agonist (can exacerbate hallucinations) |
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asthmatic pt with > 20% decreased peak flow from baseline..dx?
tx? |
asthma exacerbation
tx: oral or iv steroids |
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pt has pernicious anemia. what would you see on egd?
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- absent rugae on stomach
2/2 autoimmune metaplastic atrophic gastritis |
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pt p/w le nodules and hilar adenopathy on cxr. explain tx?
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- no tx is needed as this signs are c/w good chance of spontaneous remission.
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pt for which hep B tx is reserved? 3
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- immunosuppressed
- severe hepatitis/ failure ( poor anticoagulation...) - concomitant hep C |
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doc for chronic prostatitis, alternative regimen and lenght of tx?
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- quinolones
- bactrim - 6-12 wks |
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tx for narcolepsy?
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methylphenidate
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pt has hiv and syphilis of unknown onset? next step?
whats the tx for syphylis infection? |
- check csf to r/o neurosyphylis
- benzathine x 3 wks |
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pt overdoses on sulfonyureas. injection of dextrose doesnt help. what drug is indicated?
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octreotide.
* can decrease insulin release |
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drugs that intervene in the metabolism of warfarin? 5
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- quinolones
- amiodarone - fluconazole - cephalosporins - erythromycin |
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maintenance of a pt with chronic afib wo heart dz?
what if pt has lvh? what if pt has chf? what if pt has no chf? |
- flecanide
- amiodarone if lvh or chf - no chf?.. sotalol |
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pt w/ addison's, dm1 and thyroid dz..dx?
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schmidt's syndrome.
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drugs ass/w worsened psoriasis? 4
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- acei
- bb - nsaids - li |
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when is a fna indicated in presence of thyroid mass? 3
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- mass on u/s w/ a normal tsh
- mass suspicious for ca - high tsh with a cold/hypofnx nodule after iodine scintigraphy |
