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43 Cards in this Set
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9yo boy 2mo h/o clear rhinorrhea, nasal/orbital itching, dry cough usually after playing with neighbor dog, excoriations external nares=? TM? Differentiate from nonallegic type? |
Allergic rhinitis -avoidance of neighbors dog -if fails, or unable to identify source->nasal corticosteroids first line therapy Nonallergic rhinitis usually later age >20, changes w/ seasons, same tmt |
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70 yo M w/ h/o CAD, MI, CHF, HTN, DM2, had LOC while sitting watching TV, witnessed, no seizure activity, normal exam, CXR, EKG, trops->next step? |
admit for 24hr EKG tele monitoring (since likely due to cardiac arryhthmia and may need), will also need echo to r/o ACS type event |
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Which diabetic meds give you: hypoglycemia? lactic acidosis? hepatotoxicity? Pancreatitis? HA/Nasopharyngitis? Diarrhea/flatulance? polyuria/UTIs? |
1. sulfonylureas and the meglitinides 2. metformin (biguanide) 3. thiazolidinediones (pio/rosiglitazone) 4. GLP1 agonists (exenatide/liraglutanide) 5. alpha-gluc inhib (acarbose/miglitol) 6. SGLT2 inh (canaglifozin) |
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Patient with schizo on antipsychotic w no positive sx of delusions but has flat affect, slow response, disinterest, social withdrawal=? Next step? |
Prominent negative sx -social skills training / psychosocial intervention (found to be better than switiching meds) |
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Patient presents w/ fatigue, loss energy, shaky, loss weight, not hungry, for 2 weeks, smoker, DM2, CHF, CAD w/ coronary stenting one month ago, CXR normal, LFTs normal=? Next step> TMT? |
Iodine induced thyrotoxicosis from iodine administation during coronary angio (will have firm enlarged irregular nontender thyroid and tachy) -Thyroid function tests -control symptoms w/ b blocker and nsaids |
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42yo F w/ R neck pain, cough, SOB x3 days, h/o HTN, obesity, smoker, decreased breath sounds RU lung, CXR w/ R side opacity, Mod swelling erythema neck and R JVD=? Next step? |
Superior vena Cava syndrome (from tumor compression) -CT scan w/ con chest/neck |
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How to evaluate ascitic fluid? Dx based on it? |
SAAG (serum alb-ascit alb gradient)->if >=1.1 then serous from CHF, cirrhosis, ETOH hepatitis, noninfectious/malignant if <1.1 tehn malignancy, peritoneal carcinomatosis, peritoneal TB, nephrotic syndrome, pancreatitis |
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Patient w/ hypercalcemia on routine blood work, asx, Ca 10.9, normal-high PTH, lo urine Ca, normal Vit D, mom had similar thing=? Next step? Why not primary hyperparathyroidism? |
Familial hypocalciuric hypercalcemia (from mutation calcium sensing receptor kidneys) -No treatment (as long as asx and mild) -if primary, would not have low urine calcium (would be greater than 100-200) |
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55yo F w/ 2mo malaise, mild fever, difficulty walking up stairs and rising from chair, weight loss, weakness bilat upper and lower extrem, violaceous papules/plaques dorsum bilat hands=? Lab findings? Associated sx? Dx test? TMT? Associated dz? |
Dermatomyositis (proximal symmetric weakness equal in upper and lower extrem w/ gottron's papules and heliotrope rash/face -hi CPK, aldolase, LDH -interstital lung dz, dysphagia, myocarditis -Do antibody serologies for ANA (first test since positive in 80%) Anti-RNP, Anti-Jo-1, anti-Mi2->CXR to screen for interstitial lung dz->muscle biopsy if all negative/nondiagnostic/EMG -Hi dose steroids + steroid sparing agent) -screen for Cancer (malignancy associated/many) |
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26yo student bit by bat Rabies ppx? |
pre-exposure ppx: vaccine on day 0,7,21, or 28 Post-exposure ppx if never vaccinated: rabies vaccine on days 0,3,7,14 AND rabies IG on day 0 Post exposure ppx if prev vaccinated: only rabies vaccine on day 0 and 3 |
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Steps of evaluating hypokalemia? Sx? |
Measure plasma aldosterone to renin ratio (if >30=excessive ald secretion from adrenal gland)->Conn's Syndrome/Hyperaldosteronism -hypokalemic metabolic alkalosis w/ HTN -confirm with CT adrenals -TMT w/ surgical resection if single adenoma vs. spironolactone for hyperplasia -Patients will also have nephrogenic diabetes insipidus (look for polyuria, polydipsia, normal gluocse), will have motor weakness from hypokalemia |
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nursing staff came in contact with person with active TB infection->steps? |
PPD->if pos->INH 9mos if neg->rpt PPD in 3months to confirm |
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How does sarcoidosis cause hypercalcemia? |
macrophages in the noncaseating granulomas produce 1-alpha-hydroxylase that converts 25vit D to 125 vit D (calcitriol) that increases intestinal absorption of calcium and urine calcium excretion while inhibiting PTH |
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Which childhood vaccines have contraindications? |
Only DTaP (only hold if anaphylaxis on previous DTP or DTaP w/in 5 days or encephaolopathy within 7 days or patient having severe illness currenty |
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Managmenet of lobular carcinoma in situ found in breast core bx? |
excisional bx (nonmalignant but associated with development of invasive breast cancer) -you DO NOT need sentinal node bx until true malignant lesion (not in situ shite) |
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Patient with DM1 poorly controlled with blurry vision, increased urination/thirst/weight loss, eye exam 6 weeks showed no changes in fundus=? TMT? What if exam shows hard exudates, dot hemorrhages, vitreous bleeding? |
Likely macular edema from vascular permeability of retinal blood vessels from developing diabeting retinopathy -Improve glycemic control -diabetic retinopathy->tmt with laser photocoagulation (risk of retinal detachment and blindness) |
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TMT of diaper rash? |
Diaper dermatitis -topical zinc oxide paste |
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67yo M w/ fatigue and lower extrem edema, had CABG and MV repair 7mos ago, w/ parox afib on amiodarone, DM2, smoker, echo shows enlarged atria w/ normal ventricles and EF, mild mitral regure, normal CXR w/ spotty calcifications L , JVD 16 heart border=? Dx findings? TMT? |
Constrictive Pericarditis (with right heart failure) -fatigue, SOB, edema, ascites, up JVD, pericardial knock (mid-diastolic sound), pulsus paradoxus, kussmaul's sign (increased JVP on inspiration) -EKG w/ afib, imaging w/ pericardial thickening or calcifications, JV pulse tracing w/ prominent X and Y descents -tmt w/ supportive care and pericardiectomy if not resolve |
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Mgmt of HSIL in pap smear? |
1. either immediate colposcopy or LEEP/conization 2. if CIN1->f/u colpo and cytology in 6 and 12 mos 2. if CIN2/3->cryotherapy/ablation/LEEP/cold knife->f/u w/ rpt PAP q4-6mos for 2 years (or PAP +colpo or HPV DNA)->if recurrent->hysterectomy 3. if invasive SCC->met eval w/ CT->hysterectomy (+/-rad and chemo if met or +margins) |
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Followup after colonoscopy with polyps found? |
small rectal=10yrs 1 or 2 <1cm tub adenomas=5yrs 3-10 or >1cm or villous/hi grade=3yrs >10=<3yrs large >2cm sessile or adenocarcinoma=2-6mos |
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GBS screening pregnancy? |
rectovag culture at 35-37wks gestation Give penicillin if: -prior birth w/ GBS -GBS bacturia/UTI anytime -GBS + w/in 5wks of labor -unknown GBS status and: <37wks, ROM >18hrs, intrapartum fever |
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Patient with hyponatremia, n/v/confusion, h/o DM2, HTN, drinking lots water 3 days, schizo on chlorpromazine, serum Na 120, urine Na 80, serum osmol 258, urine osmol 400, CXR w/ 3cm hilar mass R=? Workup? Why not other causes? |
SIADH -high urine Na >40, high urine osmol >100, low serum osmol <290 -causes (lung dz, CNS dz, sulfonylureas, carbamazepine, SSRIs /NOT CHLORPROMAZINE, cancer) TMT: water restrict->if sx saline infusion w/ loop diuretics o hypertonic 3% saline, don't correct more than 10-12 mEq in 24hrs or 18 in 48hrs->central pontine myelinosis 1. if hypovol hypoNA (dehydration): will have low urine Na <20 (unless diuretic) 2. if hypervol (edema)->correct underlying cause 3. if psychogenic: will have urine osmol <100 |
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45yo M w/ difficulty walking, decreased balance, shooting/burning pain legs, no other h/o, truck driver, bilateral small pupils reduce to accomodation but not to light, normal muscle bulk, reduced sensation lower extrem and absent reflexes, positive romberg=? Other findings? TMT? |
Tabes Dorsalis from late neurosyphilis and Argyll Robertson Pupils -Syphilis from treponum palidum spirochete starts w/ chancre and adenopathy (darkfield micro->VRDL/RPR dx, tmt w/ single IM penicillin, doxy if allergic)->2ndary syphilis w/ rash, mucus patch, alopecia areata, condylomata (dx w/ RPR and FTA, tmt w/ IM single penicillin)->tertiary w/ tabes, argyll robertson, general paresis, gummas, aortitis (dx w/ RPR & FTA, then LP for neurosyph->tmt w/ IV penicillin, desensitize if pen allergic |
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Why do you treat strep throat? how long? |
po penicillin x10days for decrease sx and duration, prevent rheum fever, prevent spread to close contacts. Does not help post strep glomerulnephritis (and the 10 days is really for the rheum fever since only 1st day will reduce contagion) |
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What is the most likely cardiac anatomic problem to find after a massive PE? |
Tricuspid regurg from tricuspid annulus dilation due to acute RV dysfunction increasing RV size and possible RV thrombus |
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What to do with severe unipolar or bipolar depression or mania in pregnancy when refusing to eat/drink and actively suicidal with psychotic features? |
ECT |
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70yo M w/ pain/stiffness in neck, shoulders, hip x3mos worse in morning lasting 1-2hrs w/ general malaise and weight loss, no synovitis or swollen joings, no tenderness, normal TSH, CK, elevated ESR 85=? Dx tests? TMT? |
Polymyalgia Rheumatica (age >50, bilat pain neck/torso/shoulder/prox arms/thigh/hip >1mo w/ decreased ROM), elevated ESR >40 -low dose prednisone |
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Abx tmt for postpartum endometritis? -most important risk factors? |
Clindamycin and gentamycin (flagyl is contraindicated in breastfeeding moms) -route of delivery (much more common in c-section) |
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Side effect of clozapine? Monitoring? |
Agranulocytosis -weekly CBC for wbc that can be lengthened to one month after initiation |
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TMT for sunburn? |
NSAIDs minimize pain/erythema -oral antihistimines if pruritic |
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Side effects of po isoretinoin? |
Pancreatitis (avoid ETOH) -in women teratogen (not passed by sex) -hepatotoxicity -ocular toxicity -hypertriglyceridemia (which caues pancreatitis) |
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Match the skin condition with the dz: 1Acanthosis nigricans 2Porphyria cutanea tarda 3Multiple skin tags 4Dermatitis herpetiformis 5seborrheic dermatitis 6sudden multiple itchy seborrheic keratoses 7Pyoderma Gangernosum 8Molluscum Contagiosum 9Sudden psoriasis 10Kaposi Sarcoma |
1Insulin resist 2hepC 3insulin resist/preg 4celiac 5HIV 6GI malignancy/colon ca 7IBD/crohns 8HIV 9HIV 10HIV |
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Side effect of isoniazid? Ethambutol? |
Hepatotoxicity (self-limited transaminitis, no sx) -ocular toxicity |
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absolute contraindications to OCPs? |
-migraine w/ aura ->15cigs/day age >35 -stage 2 HTN 160/100 -h/o DVT/PE -h/o TIA/stroke/ischemic heart dz -breast ca -cirrhosis, liver ca -<3wks postpartum |
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55yo bone marrow tplant for aplastic anemia on antimicrobial ppx and had GVHD treated w/ hi dose steroids now w/ fever, cough, chest pain, CXR w/ patchy LUL infiltrate, nasal bleeding, HA=? TMT? |
Invasive aspergillosis (prophyactic fluconazole will not prevent this, more for candida)->respiratory tract, and sinuses typical -amphotericin, voriconazole |
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54yo DM2 w/ skin rash started 3 wks ago on forearm, 4x5cm erythematous, scaly, w/ central clearing slightly elevated, angular cheilosis, lethargy, diarrhea, cramps, facial flushing=? |
Glucagonoma w/ necrolytic migratory erythema (can also come from VIPoma, calcitonin, GLP1 tumors) |
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65yo M w/ 3 years new brown dull oval well-demarcated plaques on back stuck on appearance=? TMT? What if happened over 1 month? |
Seborrheic keratoses, benign epidermal tumor -no tmt needed -Leser-Trelat sign for Lung or GI tumors |
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acute sinus bradycardia after acute inferior MI TMT? what if nonresponsive? |
If symptomatic: give iv atropine (if asx->nothing) -if still brady: transvenous cardiac pacing (bad sign) |
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which lung tumor associated with parathyroid like hormone production and SIADH? |
trick question: small cell=SIADH squamous=PTHrP |
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bipolar patient received IM med to control his verbally threatening behavior, now with neck twisted to side and eyes rolled into head=? TMT? |
Acute Dystonic Reaction (EPS type) -IM diphenhydramine or benztropine (antichol) |
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Patient on warfarin with some life-threatening hemorrhage |
give FFP |
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20yo M w/ dysphagia, fever, drooling, poor coordination, afraid to drink fluids=? TMT? Prognosis? |
Rabies (hydrophobia is diagnostic, ascending flaccid paralysis) -rabies IG and rabies vaccine -coma, resp failure, death w/in weeks |
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Patient started on IV med for treating PCP pna. Hours later, begins seizing->next step? Reason? |
IV pentamidine, do finger stick blood test, causes metabolic alterations |