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345 Cards in this Set
- Front
- Back
Possible complication of blood transfusion in patients with shock, hypothermia, renal failure, hepatic failure
|
Hypocalcemia due to impaired ability to metabolize citrate into lactate
|
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Splenic vein thrombosis can be a complication of ___ and causes ___
|
- Chronic recurrent pancreatitis
- Isolated gastric varices (not esophageal), portal hypertension, ascites, splenomegaly with pancytopenia |
|
Test for meniscal injury in knee
|
McMurray maneuver: knee flexed, tibia externally rotated and knee slowly extedned. Positive it there is a click or pop.
|
|
Presentation of fat embolism
|
Respiratory insufficiency, neurological impairment, petechial rash
|
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Treatment for pregnant woman with active TB
|
INH/rifampin/ethambutol
Only add pyrazinamide if concern for MDR-TB because unclear data on safety in pregnancy Do not use streptomycin (fetal ototoxicity) |
|
- Drug that increases risk of gout
- Mechanism |
- Cyclosporine
- Decreasing renal urate excretion |
|
Type of crystals in pseudo-gout
Most commonly affected joint Other name |
Positively birefringent, rhomboid
Knee Calcium pyrophosphate dihydrate deposition dz (CPPD) |
|
Type of crystals in oxalate-induced arthritis
Patients at risk |
Calcium oxalate crystals - bipyramidal, variable birefringence
Patients with ESRD |
|
When to treat subclinical hypothyroidism
|
- Presence of antithyroid antibodies
- Abnormal lipid profile - Symptoms of hypothyroidism - Ovulatory and menstrual dysfunction |
|
Common anticholinergic toxic agents
|
- Tricyclic antidepressants
- Plants including Datura stramonium - Mushrooms |
|
Skin finding in anticholinergic toxicity
|
Dry skin
|
|
Toxic agents causing excessive salivation
|
Pesticides/insecticides (Organophosphates, carbamates)
|
|
Treatment for UTI in pregnant women
|
Cephalexin, amox or nitrofurantoin
|
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Management of pyelo in pregnancy
|
Hosp, IV abx (eg CTX or amp+gent) until afebrile x24-48 hours, then continue PO course x total 10-14 days
|
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MRI findings of PML
|
Non-enhancing, demyleninating lesions with no mass effect
|
|
Anti-pseudomonal antibiotics (8)
|
- Cefepime
- Ceftaz - Amikacin - Imipenem/meropenem - Cipro - Zosyn - Aztreonam - Colistin |
|
Valve problem in Marfan syndrome
|
Mitral insufficiency
|
|
When to treat post-AOM effusion
|
- Bilateral
- Persistent symptoms - Lasts >3 months |
|
2nd line abx for AOM (3)
|
- Augmentin
- Cefuroxime - IM CTX |
|
Management of epidural spinal cord compression
|
High-dose corticosteroids
MRI followed by radiation or surgery |
|
Presentation of scleroderma renal crisis
|
Severe hypertension and renal failure in pt with evidence of underlying scleroderma (e.g. Raynaud phenomenon, GERD)
|
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Treatment of hypertension in scleroderma renal crisis
|
ACE inhibitors (esp captopril)
+IV nitroprusside if CNS manifestations are present |
|
Normal distribution:
% within 1 SD % within 2 SDs % within 3 SDs |
68%
95% 99.7% |
|
Post-exposure prophylaxis for HIV:
- Low viral load - High viral load |
- Two nucleoside reverse transcriptase inhibitors x4 weeks
- " " plus a protease inhibitor |
|
Antihypertensives that are safe to take with lithium
|
Beta blockers
Calcium channel blockers |
|
- Goal blood pressure after tPA for ischemic stroke
- Meds to achieve this |
- 180/105
- IV labetalol, nitroprusside, nicardipine |
|
- Electrolyte derangement associated with surgery, esp major surgery with extensive transfusions
- Manifestations |
- Hypocalcemia
- Hyperactive DTRs, muscle cramps, convulsions |
|
Drugs that can exacerbate psoriasis (5)
|
Beta blockers
ACE inhibitors NSAIDs Antimalarials Lithium |
|
Evaluation of pancreatic cyst
|
Endoscopic ultrasound with aspiration
|
|
Therapy for chronic prostatitis
|
Quinolone or Bactrim x6-12 weeks
|
|
High-grade squamous intraepithelial lesions of cervix include
|
CIN II to III
Moderate and severe dysplasia Carcinoma in situ |
|
- Drugs that cause an isolated increase in serum Cr (3)
- Mechanism |
- Cimetidine, probenecid, trimethoprim
- Decreased tubular secretion of creatinine |
|
Adrenal incidentaloma:
- Initial evaluation - Which to excise |
- Lytes, dexamethasone suppression test, 24-hr urine catecholamine, metanephrine, VMA and 17-ketosteroids
- Functional tumors, malignant tumors, tumors >4cm |
|
Test for CAD in patient unable to exercise
|
Adenosine myocardial perfusion test
|
|
Testing of children with family history of hypercholesterolemia or premature CAD
|
Begin testing at 2 years.
- If relative has TChol >240, get random chol. If <170, repeat in 5 years. If >200, order FLP - If relative has h/o premature CAD, order FLP. |
|
Thyroglossal duct cyst:
- Presentation - Management |
- Midline neck mass that moves with protrusion of tongue
- Pre-op imaging (ideally CT) as this may be the only functional thyroid tissue |
|
- Danger with metformin
- Conditions in which metformin should be avoided (5) - Situation in which to hold metformin |
- Lactic acidosis
- Renal failure, hepatic dysfunction, alcoholism, sepsis, CHF - Administration of IV contrast (or other situation with risk of renal failure) |
|
When to perform correction of cleft lip
|
- 10 lbs
- 10 weeks - 10g Hgb |
|
PE finding suggestive of thyroid as source of esophageal obstructive symptoms
|
Pemberton's sign: facial plethora or neck vein distention when arms raised
|
|
Criteria for resolution of DKA (4)
|
- Glucose <200
- Gap <12 - Bicarb >17 - Ability to eat |
|
Lab/electrolyte findings in adrenal insufficiency
|
- Hyponatremia
- Hyperkalemia - Hyperchloremic metabolic acidosis |
|
What to rule out first (and how) with concern for diabetic gastroparesis
|
Gastric outlet obstruction, with endoscopy or upper GI (then can do scintigraphic gastric emptying study)
|
|
Raloxifene: periop management
|
Stop 4 weeks pre-op, restart post-op once stable with decreased risk of thromboembolism
|
|
Patients with hyperparathryoidism in whom to do parathyroidectomy (5)
|
- Symptomatic
- Ca >1 mg/dL above normal - CrCl <60 mL/min - T-score < -2.5 on densitometry or previous fragility fracture - Age <50 |
|
Initial management of pheochromocytoma
|
Alpha blockade to control HTN and restore intravascular volume x10-14 days before surgery
*Alpha blockade BEFORE beta blockade |
|
Management of intraop hypotension in patient with pheochromocytoma
|
Normal saline bolus
|
|
Use of phentolamine IV bolus
|
HYPERtension during surgery
|
|
Which neonatal head swelling crosses suture lines?
|
Caput succedaneum
|
|
Characteristics of androgen insensitivity (5)
|
- Primary amenorrhea
- Bilateral inguinal masses - Breast development without pubic/axillary hair - Blind vaginal pouch - 46 XY |
|
Achalasia:
- LES tone - Histopath - Peristalsis - Esophagogram - Therapy |
- High tone of LES
- Hypertrophied inner circular muscle; absence/degeneration of ganglia in Auerbach's plexus - Absence of peristalsis - Dilated esophagus with bird's beak narrowing distally - Balloon dilation or surgery |
|
Diffuse esophageal spasm:
- Peristalsis - LES tone - Esophagogram - Treatment |
- High amplitude peristaltic contractions (may be intermittent)
- LES tone normal - Corkscrew esophagogram - Antispasmodics, dietary modulation, psych counseling |
|
Condition with high LES tone
|
Achalasia
|
|
Condition with low LES tone
|
Scleroderma
|
|
Scleroderma in esophagus:
- Peristalsis - LES tone - Esophageal smooth muscle - Symptoms |
- Loss of distal peristalsis
- Low LES tone - Atrophy of esophageal smooth muscle and fibrosis - Reflux esophagitis, stricture |
|
Condition with corkscrew esophagus
|
Diffuse esophageal spasm
|
|
NF1: Diagnostic criteria (7)
|
2+ of:
- First degree relative - >6 CALMs (5mm in children, 15mm in adults) - >2 neurofibromas - Lisch nodule - Optic glioma - Bone dysplasia - Axillary freckling |
|
Management after removal of a large (>2cm) sessile polyp or if there is concern that a large adenoma has not been completely removed
|
Follow-up colonoscopy in 3-4 months
|
|
Time interval for surveillance colonoscopy for most patients after removal of adenomatous polyp
|
3 years
|
|
HIV prophylaxis after sex with an infected person
|
- Within 72 hours
- Two nucleoside reverse transcriptase inhibitors x4 weeks |
|
Nucleoside reverse transcriptase inhibitors for HIV (4)
|
- Zidovudine
- Lamivudine - Tenofovir - Emtricitabine |
|
Side effect of licorice
|
Hypercortisolism (HTN, hypokalemia, metabolic alkalosis)
|
|
Risk with ginkgo
|
Interaction with aspirin or warfarin --> spontaneous bleeding
|
|
Risks with kava
|
- Increased sedation with EtOH/benzos/etc
- Hepatotoxicity |
|
Risk with black cohosh
|
Hypotension
|
|
Risk with horse chestnut
|
Increased risk of bleeding in patients on ASA or warfarin
|
|
Findings in sarcoidosis (5)
|
- Peripheral nerve disease
- Erythema nodosum - Hepatic compromise - Hilar node enlargement - Hypercalcemia |
|
EKG findings in multifocal atrial tachycardia
|
- Narrow QRS
- 3+ morphologies of P waves - Variable PR segments and RR intervals |
|
Causes of multifocal atrial tachycardia (6)
|
- Hypoxia
- COPD - Hypomag - Hypokalemia - Heart disease - Aminophylline, theophylline, isoproterenol |
|
- When to treat MAT with drugs
- Which drugs |
- Once correctable underlying causes have been addressed
- Beta blockers (or verapamil in pts with asthma/COPD) |
|
Nelson's syndrome:
- Patients - Presentation - Treatment |
- Post-bilateral adrenalectomy
- Pituitary enlargement, hyperpigmentation, visual field defect - Surgery and/or radiation |
|
Management of acute arterial occlusion
|
Immediate IV heparin therapy
|
|
Type of inguinal hernia in pediatric patients
|
Indirect, due to failure of processus vaginalis to obliterate
|
|
Meralgia paresthetica
- What is? - Symptoms - Treatment |
- Entrapment of lateral femoral cutaneous nerve
- Area of decreased sensation over anterolateral thigh without weakness or DTR changes - Weight loss, avoid tight-fitting garments |
|
PE findings in obturator nerve lesion
|
- Sensory loss over medial thigh
- Weakness in leg adduction |
|
Typical symptoms in myasthenia gravis
|
Weakness in ocular and bulbar muscles (double vision, ptosis, dysphagia, dysarthria) worsening over the day
|
|
Concern in refractory or rapidly progressive osteoporosis
|
Multiple myeloma
|
|
Skin problem with thiazides
|
Photosensitivity (because are sulfonamides)
|
|
Neuro sx of lithium toxicity
|
Slurred speech
Confusion Tremors Ataxia |
|
Medications that can increase serum lithium levels
|
- Diuretics (incl thiazides)
- NSAIDs |
|
Management of biopsy-proven CIN 1 with satisfactory coloposcopic exam
|
- Repeat cytology at 6 & 12 months
or - HPV DNA at 12 months |
|
Typical presentation of invasive aspergillosis
|
- Fever
- Pulmonary sx - Sinus sx (incl HA and nasal bleeding) |
|
Treat asx carriers of Giardia?
|
Only in outbreak control and for prevention of household transmission by toddlers to pregant women and pts with hypogammaglobulinemia or CF
|
|
Patello-femoral pain syndrome:
- Presentation - Exam findings |
- Anterior knee pain provoked by climbing stairs or prolonged sitting
- Retropatellar pain, crepitation on vigorous patellar compression |
|
Patellar tendonitis
- Other name - Affected patients - Exam finding |
- Jumper's knee
- Volleyball and basketball players - Local infra-patellar tenderness |
|
Symptoms of prepatellar bursitis
|
Anterior knee pain and swelling
|
|
Pathophys of Osgood-Schlatter
|
Epiphysitis of tibial tuberosity
|
|
Symptoms of anserine bursitis
|
Medial knee pain and local tenderness
|
|
Subacute thyroiditis
- Presentation - Pathophys |
- Thyrotoxicosis with low radioactive iodine uptake
- Release of stored thyroid hormone |
|
Treatment of subacute thyroiditis
|
NSAID + beta-blocker
|
|
Management of thyroid nodule
|
Obtain TSH
- If TSH is normal, do a FNAC - If TSH is decreased, do a radioisotope scan. If hot nodule, observation. |
|
Management of papillary thyroid cancer
|
- Near total thyroidectomy
- Then radioactive iodine |
|
Treatments for postherpetic neuralgia
|
- Tricyclic antidepressants (e.g. amitriptyline)
- Topical capsaicin - Gabapentin - Long-acting oxycodone |
|
When to check serologies in baby born to mother with HBV
|
3-4 months after third vaccination dose (or 9-15 months of age)
|
|
Symptoms of Candida endophthalmitis (4)
|
Ocular pain
Photophobia Scotomas Fever |
|
Treatment of candida endophthalmitis with vitreal involvement
|
Vitrectomy and systemic antifungal tx (amphotericin B and/or fluconazole)
|
|
Setting for IgA nephropathy
Symptoms Urine finding |
- Often follows URI
- Gross hematuria, flank pain - Dysmorphic RBCs in urine |
|
Post-strep GN
- Delay between infection and onset - Symptom - Lab findings (2) |
- 10 days
- HTN - Urine RBCs/RBC casts, low complement levels |
|
Metabolic/electrolyte abnormalities with IV pentamidine (5)
|
- Hyperkalemia
- Hypokalemia - Hyperglycemia - Hypoglycemia - Hypocalcemia |
|
Lab tests helpful in diagnosis of RA
|
RF
Anti-cyclic citrullinated peptide (CCP) |
|
Which antibody is specific for SLE?
|
Anti-ds DNA
|
|
DMARDs for RA, incl first choice (6)
|
*Methotrexate
Sulfasalazine Hydroxychloroquine Leflunomide Azathioprine TNF inhibitors (etanercept and infliximab) |
|
CSF findings in MS
|
Elevated IGs, with IGg disproportionately elevated (oligoclonal band)
|
|
Treatment of acute MS exacerbation
|
IV steroids
|
|
Treatment of relapsing or secondary progressive MS, and safety in pregnancy
|
Interferon or glatiramer acetate
Teratogenic, but therapeutic abortion not indicated |
|
Positive prognostic indicators for MS
|
- Early age of onset
- Female gender - Relapsing disease - Sensory or cranial nerve sx (esp optic neuritis) as first presentation |
|
Autoimmune hepatitis:
- LFT results - Antibodies |
- Elevated AST/ALT, normal alk phos and bili
- ANA and anti-SM |
|
Condition with elevated ANA and anti-SM antibodies
|
Autoimmune hepatitis
|
|
Antibodies in PBC
|
Antimitochondrial
|
|
Condition with antimitochondrial antibodies
|
PBC
|
|
LFT result in PBC
|
Elevated alk phos
|
|
T-score cutoffs for
- osteopenia - osteoporosis |
-1.0 to -2.5
< -2.5 |
|
Hemosiderin-laden macrophages seen in
|
Diffuse alveolar hemorrhage syndromes (Wegener's, Goodpasture's, other systemic vaculitides)
|
|
Treatment of PE
- HDS - Unstable |
- Heparin
- IV fibrinolysis |
|
Concern with unilateral headache and Horner's syndrome
|
Carotid dissection
|
|
Initial evaluation for carotid dissection
|
MRA
|
|
In which cardiac patients should beta blockers be started?
|
- Stable angina
- Prior ACS - LV dysfunction |
|
Rx to maintain NSR in pt with paroxysmal afib and structural heart disease
|
Amiodarone
|
|
Treatment of uncomplicated cystitis in healthy nonpregnant woman
|
Bactrim x3 days
If Bactrim allergic: quinolone x3 days |
|
Criteria for complicated cystitis (7)
|
-Male
-Diabetes -Anatomic abnormality -Indwelling catheter -Sx >7 days -Recurrent >65 |
|
Treatment of complicated cystitis
|
Bactrim x7 days
|
|
Treatment of cystitis in pregnancy
|
- Nitrofurantoin x7 days
-If allergic, Augmentin x7 days *Avoid Bactrim (folate antagonist) and quinolones |
|
Initial therapy for UC with mild proctitis
|
Topical 5-ASA (mesalamine suppository)
|
|
Initial therapy for UC with moderate proctitis in order of initiation
|
1) Oral 5-ASA compounds (sulfasalazine, mesalamine)
2) Steroids 3) Immunomodulators (azathioprine, 6-MP) |
|
How long to continue antidepressants in pt with first episode of depression
|
6 months
|
|
Common meds for meningococcal ppx in contacts of pt with meningitis (5)
|
- Oral rifampin*
- Cipro* - CTX* - Sulfonamides - Minocycline |
|
Poor prognostic indicators in PE (2)
|
- Elevated troponin
- Hypotension |
|
First-line tx for conjunctivitis in non-contact lens wearers (3)
|
- Erythromycin ointment
- Sulfa drops - Polymyxin/trimethoprim drops |
|
Treatment for roundworm, hookworm, whipworm, pinworms
|
Albendazole or mebendazole
|
|
Helminths (4)
|
- Ascaris lumbricoides (roundworm)
- Trichuris trichiura (whipworm) - Necator americanus - Ancylostoma duodenale (hookworm) |
|
Rx for pt with asx LV dysfunction to prevent progression to heart failure
|
ACE inhibitor
|
|
Type of cancer associated with Sjogren's syndrome
|
B-cell lymphoma
|
|
Most sensitive test for Vitamin D
|
25,hydroxyvitamin D
|
|
When to give anti-D immune globulin in pregnancy
|
28 weeks
|
|
Tinel's sign
- What? - Seen in? |
- Worsening of median nerve paresthesia with tapping of palmar aspect of wrist
- Carpal tunnel syndrome |
|
Chvostek's sign
- What is? - Seen in? |
- Contraction of facial muscles with tapping of facial nerve
- Hypocalcemia |
|
Treatment of ecthyma gangrenosum
|
IV abx (no surgical debridement)
|
|
Typical regimens for PsA bacteremia
|
Aminoglycoside (tobramycin, amikacin)
plus piperacillin or ceftaz/cefepime |
|
TCA overdose: presentation (4)
|
- Hypotension
- Anticholinergic sx - CNS manifestations - Cardiac arrhythmias |
|
TCA toxicity:
- Treatment of cardiotoxic effects - Treatment of ventricular dysrhythmias |
- Sodium bicarb
- Lidocaine |
|
First step in management of septic shock
|
Fluid resuscitation to CVP of 8-12 mmHg
|
|
Findings in femoral nerve injury (3)
|
- Inability to extend knee against resistance
- Loss of knee jerk reflex - Sensory loss over anterior and medial thigh, medial shin, arch of foot |
|
Nerve injury causing sensory loss over anterior and medial thigh
|
Femoral nerve injury
|
|
Symptoms of sciatic nerve injury (2)
|
- Sensory loss in lower leg
- Loss of ankle jerk |
|
Presentation of common peroneal nerve injury
|
- Acute foot drop
- Weakness in dorsiflexion and inversion - Sensory changes over dorsum of foot and lateral shin |
|
Normal thyroid hormone change in pregnancy
|
Elevated TBG --> elevated total T3 and T4
|
|
Initial labs in pt with c/f lead poisoning
|
CBC, retic, iron, ferritin
|
|
Test for monitoring cardiotoxicity of anthracycline chemo
|
Radionuclide ventriculography (MUGA scan)
|
|
When can a noncontact athlete return to sports after a clavicle fracture?
|
4-6 weeks
|
|
MAOIs (2)
|
Tranylcypromine
Phenelzine |
|
Meds (2) for hypertensive crisis complicated by acute pulmonary edema
|
IV nitroglycerine
IV nitroprusside |
|
Typical finding in patient with posterior communicating artery aneurysm
|
Cranial nerve III palsy
|
|
Symptoms with PICA aneurysm
|
Ataxia
Bulbar dysfunction |
|
Typical symptoms of subarachnoid hemorrhage
|
- Sudden onset headache
- Nausea - Nuchal rigidity |
|
Cluster headache prevention: 1st line and two 2nd line meds
|
1st: Verapamil
2nd: Lithium, pred |
|
Acute management of cluster headache
|
100% O2.
Can also try sumatriptan, ergots, or NSAIDs |
|
Paraneoplastic syndrome with small cell lung cancer
|
SIADH
|
|
Paraneoplastic syndrome with squamous cell lung cancer
|
Parathyroid-like hormone production --> hypercalcemia
|
|
Medications for severe refractory SIADH
|
Furosemide
Then demeclocycline or lithium |
|
Indications for tx of Paget's (6)
|
- Bone pain
- Involvement of weight-bearing bones - Neuro compromise - Hypercalcemia - Hypercalciuria - CHF |
|
Rx for HTN in pt with BPH
|
Alpha-1-block (prazosin, terazosin)
|
|
Positive side effects of alpha-1-blockers
|
Increase insulin sensitivity
Decrease LDL Increase HDL |
|
CSF findings in cryptococcal meningitis (4)
|
- Elevated opening pressures (often >200)
- WBC <50 with mononulear/lymphocyte predominance - Elevated protein - Low glucose |
|
Initial treatment of cryptococcal meningitis
|
Amphotericin B + flucytosine
|
|
Maintenance therapy for cryptococcal meningitis after induction
|
Fluconazole
|
|
Dangerous side effect of nitroprusside
|
Cyanide toxicity
|
|
Presentation of cyanide toxicity (3)
|
- Tachycardia
- Lactic acidosis - Change in mental status, coma, sz |
|
Treatment for cyanide toxicity
|
Sodium thiosulfate
|
|
Effect of OCPs on pt with hypothyroidism
|
- Increased TBG --> increased total T4, decreased free T4.
- May need to increase dose of levothyroxine |
|
Management of intraocular melanoma
|
Surgical enucleation or radiotherapy
|
|
S/S of PBC (6)
|
- Jaundice
- Steathorrhea - Fatigue - Hyperlipidemia withxanthomas - Osteoporosis/osteomalacia - Hyperpigmentation |
|
Medical tx for PBC
|
Ursodeoxycholic acid
|
|
Next step in woman >21 with ASCUS
|
HPV testing; if positive colpo, if negative repeat Pap in one year
|
|
Next step in woman >21 with ASC-H
|
Colpo
|
|
- Pts at high risk for colorectal cancer
- When to do first colonoscopy |
- First degree relative with colorectal cancer or advanced adenoma before age 60
- 10 years before relative's dx or age 40 (whichever earlier) |
|
Drugs (2) used for prevention of esocophageal variceal hemorrhage
|
- Nonselective beta blockers (nadolol, propranolol)
- Oral nitrates |
|
Findings in pseudohypoparathyroidism
|
B cataracts
Calcificiation of basal ganglia Elevated PTH Low Ca High phos (5) |
|
Varenicline
- Mechanism - Use |
- Partial agonist at a subunit of nicotinic acetylcholine receptor
- Smoking cessation |
|
Patients in whom to avoid verenicline
|
Unstable psych sx or h/o SI
|
|
Contraindication to bupropion
|
Seizures
|
|
Strongest known risk factor for male breast cancer
|
Klinefelter's (47 XXY)
|
|
Evaluation of testicular swelling
|
Ultrasound
If suspicious: CT abd/pelvis, AFP, beta hCG If still suspicious: Radical orchiectomy (risk of iatrogenic local spread with testicular biopsy) |
|
Initial treatment of hyperthyroidism with afib
|
Beta-blocker
|
|
Symptom of hyperthyroidism in elderly patients
|
Fatigue
|
|
Most common ophthalmic manifestation of sarcoidosis
|
Anterior uveitis (acute onset of red eye, photophobia, blurred vision, pain)
|
|
Rx for carotic stenosis (2)
|
- ASA
- Clopidogrel |
|
Tx of chlamydia during pregnancy (2)
|
- Erythromycin base (not erythryomycin estolate)
- Azithromycin 1gm |
|
Tx of chlamydia (not in pregnancy)
|
Azithromycin 1gm
Doxycycline 100mg PO BID x7d Quinolone |
|
Symptoms of refeeding syndrome
|
Edema
Heart failure |
|
Echo finding in cardiac tamponade
|
Collapse of RA and RV during diastole
|
|
Normal change in systolic BP during inspiration
|
Drop of 10-12 mmHg
|
|
Blood pressure finding in inspiration in cardiac tamponade
|
Drop of >20 mmHg
|
|
EKG finding in pericarditis
|
Diffuse ST segment elevations in all leads
|
|
Beck's triad
- Seen in what? - What is? |
- Cardiac tamponade
- Hypotension, distant heart sounds, elevated JVP |
|
Factors incorporated in MELD score
|
Bilirubin
INR Creatinine |
|
Treatment of sulfonylurea poisoning
|
1) Dextrose
2) Octreotide (somatostatin analog) if severe |
|
Glyburide
- Class - Mechanism |
- Sulfonylurea
- Increases insulin production |
|
PPX for meningococcal meningitis exposure
|
- Rifampin x4 doses
- Cipro x1 dose if cannot tolerate rifampin (eg on OCPs) |
|
Lab test in Wegener's
|
C-ANCA
|
|
Dz in which C-ANCA is positive
|
Wegener's
|
|
Other name for Wegener's
|
Granulomatosis with polyangiitis
|
|
Most common cause of acquired essential mixed cryoglobulinemia
|
Hepatitis C
|
|
Presentation of mixed cryoglobulinemia (7)
|
- Nonspecific systemic symptoms
- Arthralgias - Palpable purpura - LAD - HSM - Peripheral neuropathy - Renal disease |
|
Tx of Hep C-associated cryoglobulinemia
|
Anti-viral tx for HCV
|
|
Associated problems in Turner's syndrome (4)
|
- Cardiac defects (coarct, biscupid aortic valve, MVP, hypoplastic heart)
- Visual and hearing impairment - Hypothyroidism - Renal malformations (horseshoe kidney) |
|
Rash in RMSF and when it appears
|
- Petechial rash on ankles/wrists --> palms, soles, central body
- 3rd-5th day of illness |
|
Arthropathy of hemochromatosis:
- Joints affected - XR findings - Clinical findings - Fluid examination |
- 2nd and 3rd MCPs
- Osteoarthritic changes - Morning stiffness for <30 min - CPPD crystals |
|
Tx for mucormycosis
|
Debridement & amphotericin B
|
|
Pioglitazone
- Class - Mechanism |
- Thiazolidinedione
- Increases insulin sensitivity |
|
Goal of intention-to-treat analysis
|
Preserve randomization
|
|
Rx for narcolepsy
|
Methylphenidate
Antidepressants |
|
Distinction between Trichophyton tonsurans and Microsporum canis
|
Microsporum canis fluoresces bright green under Wood's lamp
|
|
Presentation of transverse myelitis (4)
|
Usually after a URI
Rapidly progressive paraplegia Sensory loss Pelvic organ dysfunction |
|
First test in evaluation of transverse myelitis
|
MRI
|
|
Biopsy finding in celiac
|
Villus blunting with lymphocytic and plasma cell infiltration
|
|
Biopsy finding in Crohn's
|
Transmural inflammation of mucosa
|
|
Biopsy finding in UC
|
Superficial mucosal inflammation with infiltration of plasma cells
|
|
PE findings of cutaneous cryptococcosis
|
Multiple discrete reddish papules with central umbilication
|
|
Diagnosis of cutaneous cryptococcosis
|
Histopath of biopsy
|
|
Symptom of duodenal ulcer
|
Pain on an empty stomach
|
|
Antipsychotics available in long-acting injectable form (3)
|
- Haloperidol decanoate
- Risperidone - Fluphenazine |
|
Presentation of rupture of chordae tendineae
|
Flash pulmonary edema a/w acute mitral regurg
|
|
Characteristics of acute MR murmur (5)
|
- Systolic murmur in apex, radiating to axilla
- Increased with grip - Decreased with Valsalva - Decreased 1st heart sound - Fourth heart sound |
|
Treatment of acute gout (3)
|
- NSAIDs (1st line)
- Colchicine - Glucocorticoids |
|
Chronic gout treatment
|
Allopurinol
Probenecid |
|
Sources of septic pulmonary emboli (2)
|
- Septic thrombophlebitis
- Tricuspid endocarditis |
|
Medical management of acute aortic dissection
|
- IV propranolol or labetalol
- Can add sodium nitroprusside (never use alone 2/2 reflex sympathetic activation) |
|
Levels in hemolysis of
- LDH - Haptoglobin |
- LDH increased
- Haptoglobin decreased |
|
Treatment of lead poisoning:
- Mild - Moderate - Severe |
- Mild: oral DMSA or d-penicillamine (or no tx)
- Moderate (45-70): oral DMSA or IV EDTA - Severe (l>70 and/or acute encephalopathy): IV dimercaprol and EDTA |
|
Does likelihood ratio change with prevalence?
|
No
|
|
Prophyria cutanea tarda
- Presentation - Associations - Diagnosis - Manageent |
- Painless blisters, fragile skin on dorsum of hands, facial hypertrichosis and hyperpigmentation
- Ethanol, estrogens, Hep C - Elevated urinary uroporphyrins - Phlebotomy, hydroxychloroquine, interferon-alpha for HCV |
|
Skin condition a/w gluten-sensitive enteropathy
|
Dermatitis herpetiformis
|
|
For which mechanical valve pts is the INR goal
- 2-3 - 2.5-3.5 - 2.5-3.5 with low-dose ASA |
- 2-3: AVR with normal rhythm
- 2.5-3.5: MVR, AVR with aFib - 2.5-3.5+ASA: Mechanical valve and systemic embolism despite anticoagulation |
|
MI pts who are candidates for thrombolytic tx
|
- Present within 12 hrs of sx onset
- ST elevations >1mm in two contiguous leads or new LBBB |
|
Medication used in cocaine chest pain
|
Benzos
|
|
Medication to avoid in cocaine chest pain
|
Beta-blockers
|
|
Management of HTN in cocaine chest pain
|
1) Benzo
2) (if needed) Phentolamine (1st choice), nitroprusside, nitroglycerine |
|
Murmur in mitral stenosis
|
Low-pitched rumbling diastolic murmur at apex
|
|
Valvular lesion that can cause hemoptysis
|
Mitral stenosis
|
|
Crescendo-decrescendo murmur
|
Aortic stenosis
|
|
Indications for surgery in AAA (3)
|
- Diameter >5cm
- Symptoms - Rapid enlargement |
|
Post-MI acute pericarditis:
- Time frame - Management |
- 1-4 days post-MI
- Pain control with ASA (usually transient) |
|
Time frame for post-MI chordae tendineae or papillary muscle rupture
|
2-8 days post-MI
|
|
Dressler's syndrome
- Time frame - Mechanism - Presentation (4) |
- Weeks-months after MI
- Autoimmune - Fever, leukocytosis, pleuritic CP, pericardial rub |
|
Acne medication that can cause hypertrigyceridemia and pancreatitis
|
Isotretinoin
|
|
Most deadly toxicity of amiodarone
|
Pulmonary toxicity
|
|
Shampoo ingredients for seborrheic dermatitis (4)
|
- Ketoconazole
- Tar - Zinc pyrithione - Selenium sulfide |
|
Side effects of lindane
|
- Seizures
- Aplastic anemia |
|
Acute treatment of symptomatic tachycardia in hyperthyroidism
|
Beta blocker
|
|
Medical tx of hyperthyroidism (2)
|
Propylthiouracil (PTU)
Methimazole |
|
Max length to use glucocorticoids without having to taper
|
3 weeks
|
|
How long to continue warfarin after 1st episode of DVT
|
3-6 months
|
|
Start ___ before ___ in alcoholics to prevent ___
|
Start thiamine before glucose to prevent Wernicke's encephalopathy from thiamine deficiency
|
|
Electrolyte derangement that can cause paralytic ileus
|
Hypokalemia
|
|
Manifestations of glucagonoma
|
- Mild diabetes
- Painful, itchy erythematous rash with central clearing |
|
Pellagra
- Deficiency of - Manifestations |
- Niacin
- Dementia, diarrhea, dermatitis, stomatitis, cheilosis |
|
Ca/D/PTH in sarcoidosis
|
Incr 1,25-OH D --> incr GI absorption of Ca --> hypercalcemia --> decr PTH, incr urinary calcium excretion
|
|
Treatment of hypoparathyroidism
|
- Ca and 25-OH D
- If low serum Ca and high urine Ca, add thiazide diuretic |
|
Most common cause of nonsustained VTach
|
Structural heart disease
|
|
Valve disease with midsystolic click
|
MV prolapse
|
|
Thyroid condition with elevated serum alpha subunits
|
TSH-secreting pituitary adenoma
|
|
Single most important predictor of adverse cardiovascular outcomes
|
Diabetes
|
|
Test of choice for diverticulitis
|
CT
|
|
Tx of mild diverticulitis
|
Cipro + Flagyl
|
|
Effect of amiodarone on TFTs
|
Decreased conversion of T4 --> T3
Increased T4; decreased T3 |
|
Meds used for diabetic neuropathy (3)
|
- Tricyclic antidepressants
- Duloxetine - Gabapentin and other anticonvulsants |
|
Next evaluation after diagnosis of familial adenomatous polyposis
|
Endoscopy to look for gastric/duodenol adenomas/carcinomas
|
|
Risks with ginseng
|
- SJS
- Psychosis |
|
Treatment C. diff relapses after metronidazole tx:
- First - Second |
- Metronidazole again
- Oral vanco |
|
Tx of acute Hep B
|
Supportive measures
|
|
Marker of high HBV infectivity
|
HB eAg
|
|
Rate of chronic Hep B in
- Infants with acute Hep B - Adults with acute Hep B |
- 90%
- 5% |
|
Management of 3-vessel or left main CAD in diabetic patient
|
CABG
|
|
Biggest risk with compartment syndrome
|
Rhabdo and renal failure
|
|
Management of salicylate overdose
|
Alkalinization of urine
Gastric lavage/charcoal |
|
Management of hyponatremia in advanced CHF
|
Water restriction
|
|
Bile-salt induced diarrhea:
- Seen in (2) - Tx |
- Short gut, s/p cholecystectomy
- Cholestyramine (bile-acid binding resin) |
|
Diagnosis of brain death (correct)
|
- CNS catastrophe
- No confounding factors - Absent cortical and brainstem function --> Then, apnea test |
|
Presentation of acute ischemic colitis
|
Acute abdominal pain followed by bloody diarrhea
|
|
Analgesic nephropathy
- Pathophys - UA findings |
- Papillary damage
- Hematuria, pyuria, proteinuria |
|
Type of endocarditis that can cause conduction system abnormalities
|
Aortic valve
|
|
Management of acute hemolytic transfusion reaction
|
Stop transfusion and hydrate with NORMAL SALINE only
|
|
ATN:
- Presentation - Lab findings (2) |
- Oliguria after a hypotensive episode
- Muddy brown casts, high FENa |
|
FENa in prerenal azotemia
|
Low
|
|
Fluid for oliguric, hyperkalemic, acidotic patient
|
D5W with bicarb at slow rate (e.g. 50 mL/hr)
|
|
Diagnosis of severe C diff colitis
|
Limited sigmoidoscopy of unprepared bowel with minimal air inflation
|
|
Med for tx of SVT
|
Adenosine
|
|
Abx associated with infantile hypertrophic pyloric stenosis
|
Erythromycin
|
|
LDL level at which to start a statin in diabetic pts
|
>100
|
|
When can Pap interval be decreased from every 2 to every 2-3 years?
|
3 consecutive negatives or after age 30
|
|
Rx for early localized Lyme
|
Doxycycline
Amoxicillin Cefuroxime |
|
Tx for H pylori
|
Two weeks of:
- PPI - Clarithromycin - Amoxicillin (metronidazole if allergic) |
|
H. pylori treatment after failure of initial triple therapy
|
Two weeks of:
- PPI - Bismuth - Tetracycline - Metronidazole |
|
FEV1, FVC and FEV1/FVC in asthma
|
FEV1: decreased (more)
FVC: decreased (less) FEV1/FVC: decreased |
|
First-line tx for RLS
|
Dopamine agonists (pramipexole or ropinirole)
|
|
Anti-centromere antibodies seen in?
|
CREST (scleroderma)
|
|
Anti-smith antibodies seen in?
|
SLE (but less sensitive than anti-dsDNA)
|
|
Use of hydroxychloroquine in SLE
|
Pts with arthralgias, serositis, cutaneous manifestations
|
|
Antihypertensive used in opiate withdrawal
|
Clonidine
|
|
Tx of Graves' dz with ophthalmopathy
|
Radioiodine ablation + steroids
|
|
Drug for management of thyroid storm
|
Glucocorticoids
|
|
Mammography guidelines
|
Every two years for women 50-74
|
|
Calculation of plasma osmolality
|
(2 x Na) + (glucose/18) + (BUN/2.8)
|
|
Next step if Pap shows HSIL
|
LEEP or colpo
|
|
Test to confirm suspected 21-hydroxylase deficiency
|
Elevated 17 alpha-hydroxyprogesterone
|
|
Findings in CAH caused by 11-hydroxylase deficiency
|
Hypertension
Hypernatremia Hypokalemia |
|
Window for fibrinolytic therapy after ischemic stroke
|
3-4.5 hours
|
|
Febrile transfusion reaction:
- Cause - Prevention - Distinction from hemolytic reaction |
- Recipient antibodies to donor leukocytes
- Washing cells - Absence of hemodynamic abnormalities and renal dysfunction |
|
CXR finding in pulmonary contusion
|
Homogenous opacification of lung fields not conforming to a specific anatomic segment of the lung
|
|
Most common cause of diverticular bleeding
|
Erosion of the artery
|
|
VZV vaccination of household contact of transplant patient
|
Give vaccine and monitor for rash; isolate if rash appears
|
|
Osteonecrosis of femoral head
- Other names (2) - Patients at highest risk |
- Avscular necrosis, osteochondritis dissecans
- SLE patients on chronic high-dose steroids |
|
Mangement of AVN (osteonecrosis of femoral head)
- Stage 1-2 - Stage 4 |
- Core decompression
- Total hip replacement |
|
Indinavir: class
|
Protease inhibitor
|
|
Side effect of indinavir
|
Crystal-induced nephropathy
|
|
HIV drug that can cause crystal-induced nephropathy
|
Indinavir
|
|
Risk with didanosine
|
Pancreatitis
|
|
HIV med with risk of pancreatitis
|
Didanosine
|
|
Risk with abacavir
|
Hypersensitivity syndrome
|
|
HIV drug with risk of hypersensitivity syndrome
|
Abacavir
|
|
HIV drug class that can cause lactic acidosis
|
NRTIs
|
|
HIV drugs that can cause SJS
|
NNRTIs
|
|
RIsk with nevirapine
|
Liver failure
|
|
HIV drug with risk of liver failure
|
Nevirapine
|
|
Percentage of HbA in:
- Sickle trait - HgbS beta 0 - HgbS beta + |
- 60%
- 0% - 3-25% |
|
Meds that can impair levothyroxine absorption
|
Ca
Iron |
|
Meds for hyperthyroidism in pregnancy
|
Propylthiouracil during 1st trimester (methimazole teratogen)
Can switch back to methimazole during 2nd and 3rd trimesters |
|
Evaluation in patient with B varicocele, R varicocele, or varicocele that does not disappear when supine
|
CT to look for process causing IVF obstruction (e.g. clot, tumor)
|
|
Treatment of symptomatic proximal ureteral calculi:
<10 mm >10 mm |
- Shockwave lithotripsy
- Ureteroscopic removal |
|
Initial evaluation of patient with suspected ankylosing spondylitis
|
X-ray of sacroiliac joint for evidence of sacroiliitis
|
|
Extraarticular manifestations of ankylosing spondylitis (5)
|
- Acute anterior uveitis
- Aortic regurgitation - Apical pulmonary fibrosis - Restrictive lung disease - IgA nephropathy |
|
Lichen planus:
- Lesions - Locations - Diagnosis |
- Pruritic polygonal violaceous papules/plaques
- Flexural surfaces, esp wrists - Skin biopsy |
|
Infectious associated with lichen planus
|
HCV with advanced liver disease
|
|
ART drugs to avoid in pregnancy (2)
|
- Efavirenz
- Delaviridine |
|
HAART regimen
|
- Two NRTIs
- One protease inhibitor or NNRTI |
|
Tx for catatonia in schizophrenia
|
- Benzos
- ECT if benzos fail |
|
Post-exposure rabies ppx for people who have previously been vaccinated
|
Vaccine (no Ig)
|
|
Esophageal adenocarcinoma: location and risk factors
Esophageal squamous cell carcinoma: location and RF |
- Distal, GERD
- Proximal, smoking/alcohol |
|
Drug that must be administered at a 4 hour interval from sildenafil
|
Alpha-blockers (e.g. doxazosin)
|
|
Rx for ALS and class
|
Riluzole (glutamate inhibitor)
|
|
HBV serology in window period
|
Anti-HBc Ab only
|
|
Presentation of Meniere's disease
|
- Periodic vertigo
- Unilateral hearing loss - Tinnitus |
|
Subphrenic abscess: findings
|
- 2-3 weeks after abdominal surgery
- Swinging fever - Leukocytosis - Cough - Shoulder-tip pain |
|
Cancer with increased risk in celiac disease
|
Intestinal T-cell lymphoma
|
|
AK can develop into ___
|
SCC of skin
|
|
Management of venous sinus thrombosis
|
Anticoagulation with heparin, even if an area of hemorrhagic infarction is seen on CT (b/c hemorrhagic foci are 2/2 venous hypertension)
|