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208 Cards in this Set
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What are the indications for carotid endarterectomy?
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Strong recommendation: 70-99% w/ symptoms
moderate recommendation: 50-69% occluded w/ symptoms 80-99% occluded w/o symptoms |
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What changes in Platelet ct, BT, PT, PTT...
HUS or TTP Hemophilia A or B VonWilderbrand's dz |
PC (L) BT (H)
PTT (H) BT (H) PTT (H) |
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What is the most likely cause of aortic stenosis in a 50 yr old patient?
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Congenital bicuspid aortic valve
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What are the classic findings of Henoch-Schonlein Purpura?
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4 things...
palpable purpura on lower extremitiy (not d/t thrombocytopenia), GI Sxs, and Renal dz, Arthritis |
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What is the treatment for acute mesenteric ischemia?
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Dx: Angiogram
Tx: Heparin, or enoxaparin. Papoverine to decrease arterial vasospasm Embolectomy if d/t embolism bowel resection |
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A 50 y/o M with a 25 year pack hx presents woth his second bout of pneumonia in the last 6 mo. CXR reveals a lobar consolidation in the same location as the previous pneumonia. What is the next step in the mgmt of this pt?
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tx pneumonia
CT the chest (recurrent pneumonia in the same location is a reg flag for CA) |
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What is the treatment for cluster headaches
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100% O2
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What is the empiric tx for a brain abscess?
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Drain the abscess
Antibiotics (If from neurosurg use vanc and ceftazodine) Corticosteroids |
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what is the TX fir hyperparathyroidism d/t parathyroid hyperplasia
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remove 3.5 glands, put a clip on the last .5 or move it to the arm.
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What is the common complaint of a pt with retinal detachment?
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Sudden painless onset of flashing lights, Numerous floaters, and window shade pulled over their eye
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What complication may arise from performimg an LP in a pt with elevated intracranial pressure?
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Uncal Herniation of brainstem
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What is the tx for an MI d/t cocaine overdose?
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Ativan to calm the pt, and Ca channel blockers for rate control
Beta Blockers are your 1st for an MI, but with cocaine, if you take out the B2 vasodilation and you are left with Alpha1 vasoconstriction. So BB will raise BP |
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Why is thiamine given in a glucose infusion to alcoholics with hypoglycemia?
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glucose in the absence of thiamine in an alcoholic can worsen wernike's encephalitis
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Whats the diff?
schizotypal schizophrenia schizoaffective schizoid schizophreniform brief psychotic disorder |
Strange, dress like a pickle, personality disorder
+ and - sxs, Lasts longer than 6mo, interferes with life Schizophrenia + mood disorder Schizoids avoid - voluntary social withdraw Shorter than 6mox shorter than 1mo |
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RBC pathology
a/w EBV (in africa) Reed-Sternberg cell, cervical lymphadenopathy, night sweats Bence-Jones proteins, Osteolytic lesions, high calcium Most common lymphoma in the US |
Burkitts
Hodgekins Multiple Myeloma DLB |
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What type of leukemia...
MC neoplasm in kids MC leukemia in adults Philidelphia chromosome Smudge cells |
ALL
CLL CML CLL |
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What changes in Platelet ct, BT, PT, PTT...
DIC Warfarin use End stage liver dz Aspirin use |
PC(L) BT(H) PT(H) PTT(H)
PT(H) PTT(H) PT(H) PTT(H) BT(H) |
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What is the MCC of aortic regurg in a 70 yr old patient?
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senile (degenerative) calcification
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What are Ranson's criteria in determining the prognosis in patients with acute pancreatitis
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Increased mortality if 3 or more...
Admission (GA-LAW) Serum glucose>200 serum AST>250 serum LDH>350 Age>55 WBC>16,000 48hrs (Calvin HOBBS) Calcium<8 Hct>10% O2<60 BUN>5 Base deficit Sequestration of fluid >6L |
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When is rifampin prophylaxis indicated in cases of bacterial meningitis?
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close contact with Nisseria meningitis, or HiB meningitis
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What imaging study is used to Dx a DVT?
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Compressive venous ultrasound
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Which class of antihypertensive is contraindicated in the following patients?
COPD bilateral RAS pregnancy Advanced renal failure Gout |
Non-selective Beta blocker
ACE-I/ ARB ACE-I/ ARB If hyperkalemia dont use ACE-I/ ARB, potassium sparing diuretics Diuretics (HCTZ, chlorthalidone) |
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What is the tx for cluster head aches?
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100% O2
dihydroergotamine |
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High potency neuroleptics
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more EPS, less anticholergic, more acute dystonia
haloperidol, fluphenazine, thiothixine, droperidol |
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What is the TX for benign paroxysmal positional vertigo (BPPV)?
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Eppley manuver
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A child presents to the ER with mental status changes, hypoglycemia and lesions suggestive of chickenpox. What is the most likely diagnosis?
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Reye's syndrome.
Mental status changes, hypoglycemia, and hx of chicken pox. The parents likely gave the kid aspirin |
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In which immunodeficiency is there an absence of thymic shadow on newborn CXR?
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DiGeorge syndrome, and also SCID (d/t adenosine deaminase deficiency)
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What are the symptoms of a lacunar stroke?
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5 categories
pure motor hemiparesis pure sensory defect ataxic hemiparesis sensorimotor stroke sx dysarthria clumsy hand syndrome |
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What is the DDX for dislocation of the lens of the eye?
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Alports, Homocystinuria (down), marfans (up)
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RBC pathology
Translocation 14:18 Translocation 8:14 Translocation 9:22 |
Follicular
Burkitts CML |
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What type of leukemia....
*Peripheral cells are PAS+ and TdT+ *Peripheral blasts are PAS-, MPO+ and have auer rods Pancytopenia in a Down syndrome pt |
ALL
AML ALL |
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Compare the serum iron, ferritin, and transferrin levels in IDA to AoCD?
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IDA: serumFe (L) F(L) Tf(H)
AoCD: serumFe(L) F(H) Tf(L) |
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What is the classic but rare EKG finding in pulmonary embolism
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S1Q3T3
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What is the treatment for....
Enantomoebia Histolytica Giardia Lamblia Salmonella Shigella Campylobacter |
Enantomoebia Histolytica: Metronidazole
Giardia Lamblia: Metronidazole Salmonella: Fluroquinolones, TMP-SMX Shigella: Fluroquinolones, TMP-SMX Campylobacter: Erythromycin |
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What is the treatment for acromegaly?
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surgical resection, external beam radiation
Octreotide (somatostain analog) Cabergoline (DA agonist) |
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What radiographic study is used to Dx injury to the urethra?
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RCUG
retrograde cysto-urethrogram |
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What heart sounds are considered benign when there is no evidence of disease?
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Early quiet systolic in an asymptomatic patient, split S1, split S2 on inspiration
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what potency are these?
chlorpromazine, thioridazine |
Low potency neuroleptics, more anticholinergic, less EPS. avoid in pts with dementia
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List as many SSRI's as you can
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Fluoxetine, Fluvoxetine, Citalopram, Escitalopram, Paroxetine, sertraline
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What is the most effective way to prevent bacterial meningitis in newborns?
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Penicillin or Ampicillin during delivery to GBS (agalactae)
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A post-op patient has poor urine output, a BUN of 85, creatinine of 3, and clear lungs. What is the enxt step in the management of this patient?
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IV fluids
Facts: pt has azotemia... is post op...has a BUN:Cr > 20 = prerenal azotemia. The clear lungs signify that the pt is not fluid overloaded and can tollerate fluid |
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what medications and interventions are used in the treatment of cerebral palsy to alleviate contractures and improve function?
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Dantrolene, baclofen, benzos, botox, nerve blocks
Physical therapy, surgical |
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What is the treatment for macular degeneration? what is the treatment for retinal detachment?
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Macular degeneration: Vitamins C, E, zinc. (alpha interferon)
Retinal detachment: surgery |
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RBC pathology
MC form of hodgekin lymphoma "Starry sky pattern" d/t phagocytosis of apoptotic tumor cells High H&H, pruritis, burning in hands and feet Blood smear (hair like projects), splenomegally |
Nodular sclerosing
Burkitts Polycythemia vera Hairy Cell |
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what is the next step in the mgmt of testicular torsion confirmed with US?
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manual detorsion with bilateral orchoplexy
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What medications are necessary in patients with end stage renal disease?
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vit D
Phosphate binders Baby aspirin, statins EPO (goal Hgb is 11-12) |
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What is the most likely cause of secondary HTN....
Hypertension in arms, low BP in LE Proteinuria Hypokalemia |
Aortic Coarctation - turner's
Renal disease Hyperaldosteronemia |
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Which type of lung cancer is a/w the following paraneoplastic syndromes?
↑ACTH Glucocorticoid excess -->cushings syndrome ↑PTH related peptide --> hypercalcemia ↑ADH --> SIADH --> hyponatremia Antibodies to presynaptic Ca channels --> Lambert-Eaton syndrome |
Small cell
Squamous cell Small cell Small cell |
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What infectious food agent most likely corresponds to:
Food poisoning as a result of mayonaise sitting out too long Rice water stools diarrhea transmitted from pet feces Diarrhea from reheated rice Most common cause of "traveler's" diarrhea |
staph aureus
cholera yerisinia enterolytica B. cereus ETEC |
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What are the symptoms of a basilar skull fx?
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battle sign, racoon eyes, bleeding behind the TM, CSF leakage from nose or ears
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What heart defect is a/w the following disease?
Chromosome 22q11 deletion Down syndrome Congenital rubella Turner's syndrome Marfan's syndrome |
Catch 22- DiGeorge: Truncus arteriosis/ Tetrology of fallot
Downs: Endocardial cushion defect Rubella: PDA, Pulmonary artery stenosis Turner's: Coarctation Marfan's: Aortic regurg |
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In which pt populations are -triptan drugs contraindicated?
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Pregnancy, coronary artery dz, prinzmetal angina
Triptans cause vasoconstriction |
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what potency are these?
malindone, loxepine, trifluperazine |
moderate potency neuroleptics:
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List as many TCAs as you can
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Imi-Nor-Ami-Des-Clo-Dox
Imipramine, Amitriptyline, Desipramine, Clomipramine, Doxepin, Nortriptyline |
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How do the symptoms of encephalitis differ from that of meningitis?
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Encephalitis has mental status changes and focal neurologic deficits
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Which vaccines should not be given to a patient with HIV?
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Dont give live vaccines to HIV pts.
Live vaccines: Varicella zoster, intra-nasal influenza, oral polio, yellow fever, BCG, anthrax, oral typhoid and small pox. the one exception is MMR, if the pt has CD4>200. Mneumonic for live viruses: Mr.Sabins Small Yellow Chicken influenza, Hep B, and step pneumo should* be given to HIV+, and for MSM also give Hep A |
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what are the two MC primary brain tumors in adults? what are the 3 MC primary brain tumors in children?
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adults: Mets, GBM, Meningioma, Schwanoma (MGM Studios)
children: Astrocytoms, Meduloblastoma, Ependymoma |
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childhood psych
females only. loss of prev acquired language and motor skills impairment in social interactions, comm, play. repetitive behaviors Impairment in social interaction but not avoidance, no language delay Stereotyped hand movement |
Rett's
Autisim Asperger's Rett's |
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What are the classic features that distinguish orbital cellulitis from periorbital cellulitis?
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Orbital: pain w/ eye movement, proptrosis, ophthalmoplegia, double vision
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*What are the causes of hypovolemic hyponatremia?
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Thiazides
Addisons dz Fluid Loss and replacement with water |
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What is the treatment for hyperkalemia?
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Calcium gluconate
give 1amp D50 with insulin, NaHCO3, albuterol nebs Furosemide |
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What is the most likely cause of secondary HTN....
Tachycardia, Diarrhea, Heat intolerance Hperkalemia Episodic sweating, tachycardia |
Hyperthyroidism
RAS/ renal failure Pheochromocytoma |
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Which type of vasculitis....
Weak pulses in upper extremity Necrotizing granulomas of lung and necrotizing glomerulonephritis Necrotizing immune complex inflammation of visceral/renal vessels young male smokers |
Takayasu's
Wegner's Polyarteritis Nodosa Beurger's |
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What infectious food agent most likely corresponds to:
diarrhea after a course of abx diarrhea + recent ingestion of water from a stream Mild intestinal infxn that can become neurocystophsychosis Food poisoning from undercooked hamburger diarrhea from seafood |
C. diff
giardia lamblia, E. histolytica T. solieum EHEC Vibrio |
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What is the drug of choice for trigeminal neuralgia?
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its a TCA....
Carbamazepine |
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What is the next step once a brain tumor has been identified on CT or MRI of the head?
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MCC of brain tumor is Metastasis
So, 1st step is search for the source, Full Body CT |
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ST segment elevation in leads corresponding to the perfusion of multiple arteries
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Acute pericarditis
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What s/e can arise from theophylline overdose?
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seizures, hypotension, cardiac tachyarrythmias
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What mineralocorticoid medications is used in the TX if aldosterone deficiencies such as adrenal insufficiency and 21-hydroxlyase deficiency?
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fludrocortisone
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List as many MAOI's as you can
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Phenylzine, Tranylcipromine, Selegeline
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What is the initial radiologic study in a pt with TIA/stroke symptoms? What radiologic studies need to be performed later to evaluate the underlying cause of the TIA/stroke?
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First do a CT head w/o contrast to r/o bleed.
Then treat with thrombolytic. Later, get an echo to look for vegitations on the valves, a carotid duplex to check to calcifications, MRA/CTA of brain vasculature |
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When should you suspect thrombocytopenia d/t heparin use? What is the most feared complication of Heparin Induced Thrombocytopenia?
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If pt is on heparin and the platelets drop by 50%, suspect HIT.
The most feared complication is hypercoaguable states that result in DVT, PE, stroke. |
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What is the ACLS treatment for V. fib?
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CPR, 360 J shock, epi, CPR, shock epi
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childhood psych
Ignoring the basic rights of others characterized by hostility, annoyance, vindictiveness, disobedience multiple motor and vocal tics impulsive and inattentive 7yo that avoids going to school to stay at home with parent |
Conduct d/o
oppositional defiant d/o terrets ADHD separation anxiety |
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In which patients is bupropion contraindicated
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Seizure pts, eating d/o like bulemia, pts withrawing from etoh or benzos, pts who have had MAOIs in the last 2 wks
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*Fever + Rash + elevated creatinine + eosinophilia
What is the Dx? |
Acute Interstital Nephritis
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What are 4 potassium sparing diuretics?
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spironalactone, epleranone, amelioride, triamterone
spironalactone has anti-androgen effect |
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An elderly female with a hx of cholelithiasis presents with a 5d hx of vauge, recurrent abdominal pain and vomiting. What diagnosis do you immediately suspect?
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Gall stone ileus
Classic! |
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Which type of vasculitis....
Young asain women Young Asthmatics Infants and young children; involved coronary arteries Most Common vasculitis |
Takayasu
Churg-Strauss Kawasaki Temporal/ giant cell arteritis |
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What infectious food agent most likely corresponds to:
Bloody diarrhea from poultry diarrhea + pink eye bloody diarrhea diarrhea in AIDS paitents Dehydrated child with greenish diarrhea in winter months |
Salmonella, campylobacter
Adenovirus E. Histolytica Cryptosporidium Rotavirus |
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What is the tx for NPH?
What is the Tx for pseudomotor cererbi? |
VP shunt
Weight loss, Acetozolamide |
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What are the W's of post-op fever
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Wind (pneumonia, atelectasis)
Water (UTI) Wound (infection) Walking (DVT) Wonder drugs (drug rxn) Sinusitis |
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Cardiac cath shows equal pressures in all heart chambers
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constrictive pericarditis
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Where is the lesion that causes:
Contralateral hemibalismus hemispatial neglect syndrome coma poor repetition |
Contralateral hemibalismus = STN
hemispatial neglect syndrome = RIGHT PARIETAL LOBE coma = RAS poor repetition = ARCUATE FASICULUS |
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What is Todd's paralysis
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Post ictal hemiparesis lasting at least 15hrs, but not more than 24 hrs
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What are the symptoms basilar artery stroke?
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Coma, paralysis, CN deficits, bad things
Pontine ischemia --> CN deficits; contralateral full body weakness; |
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What is the next step in the mgmt of a child with severe asthma exacerbation and persistently low ox sat despite medication?
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Give O2 to greater than 92%
poor oxygenation <92, or unable to speak d/t WOB = inubation |
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Which vasopressor matches the following statement?
theoretically causes renal vasodilation high doses optimize the alpha-1 vasoconstriction ADH analogue best choice for anaphylactic shock best choice for septic shock best choice for cardiogenic shock causes vasoconstriction but with bradycardia |
Dopamine
Epinephrine Vasopressin Epinephrine Norepinephrine Dobutamine Phenylephrine |
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What are the causes of fever in the postop period?
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Wind - atelectasis, pneumonia
Water - UTI Walk - DVT Wound - Infection Wonder - drugs, ABX, Sinusitis |
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What is the Tx for Serotonin Syndrome?
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Stop SSRIs
supportive care, decrease muscle tone with sedation, Benzos |
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*What distinguishes primary biliary cirrhosis from primary sclerosing cholangitis?
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Primary Biliary Sclerosis: + anti-mitochrondrial Ab's, +ANA, F>M, a.w autoimmune d/o
Primary sclerosising cholangitis: (+)pANCA, M>F, a.w UC, Beads on a string with ERCP |
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Sign? Disease?
Deep palpation of RUQ --> arrest of inspiration d/t pain Charcot's triad (Fever, Jaundice, RUQ pain), hypotension, altered mental status? RLQ pain on passive extension of the hip |
Murphy's = cholecystitis
Reynolds pentad = cholangitis Psoas= Apendicitis |
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A pt presents to the ER with a very painful irreducible inguinal mass. What is the next step in the mgmt of this pt?
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surgery consult- incarcerated inguinal hernia
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Which type of vasculitis....
a/w hep B infxn Occulusion of the ophthalmic artery --> blindness Perforation of nasal septum Unilateral headache, jaw claudication |
Polyarteritis nodosa
Temporal arteritis Wegner's Temporal arteritis |
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What are the most common causes of acute pancreatitis
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Gall stones and Alcohol!!
elevated TGs, hypercalcemia, trauma, and Drugs: FAST (Furosemide(and HCTZ), Azothioprine, sulfa, Tetracyclines) |
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What is the Tx for Guillain Barre syndrome?
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Plasmophoresis OR IVIg
supportive care |
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What medication combination is used in the treatment of TB meningitis?
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Rifampin, Isoniazid, Pyrazinamide, Ethambutol
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Chest pain that lessens when the patient leans forward
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acute pericarditis
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Where is the lesion that causes:
poor comprehension poor vocal expression resting tremor intention tremor |
poor comprehension = WERNICKES
poor vocal expression =BROCAS resting tremor = BG intention tremor = CEREBELLAR HEMISPHERE |
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List as many TETRACYCLICS as you can
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Mirtrazepine, Trazedone
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Comparing ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, what are the different BP goals and BP medications?
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Ischemic stroke: <220/120, Labetalol and nicardapine. Do Not Give Nitro's!
Intracerebral hemorrhage: <140-160; Labetalol, can use nitroprusside Subarachnoid hemorrhage: < 150; labetalol, nimodipine. Do Not Give Nitro's! |
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What is the classic presentation of a patient with androgen insensitivity syndrome?
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46XY pt with a defect in androgen receptors. Normal appearing female with a vagina, no female pipes, and has testes.
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what is the next step in the evaluation of penetrating injuries to the different zones of the neck?
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The zones follow the blood flow, so zone 1 is lowest and zone 3 is highest
zone 1: clavicle to cricoid cartilage: CT angiogram zone 2: from cricoid cartilage to angle of mandible: surgical exploration zone 3: CT angiogram, tripple endoscopy |
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What is the next step in eval
Pelvic fx + DPL shows BLOOD Pelvic fx + DPL shows URINE Pelvic fx + DPL shows nothing, + hemodynamic instability Blunt abd trauma + unstable vitals + FAST shows fluid in pelvis |
Emergent laprotomy
Urgent Laprotomy Angiography for Dx and embolisation Urgent laprotomy |
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How is benign paroxysmal positional vertigo diagnosed?
How is it treated? |
Dx: Dix-Hallpike manuver, and Hx
Tx: Eppley manuver |
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*What is the treatment for Whipple Dz?
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TMP-SMX for 1 yr
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Sign? Disease?
RLQ on passive internal rotation LUQ pain and referred left shoulder pain Ecchymosis of the skin on flank Ecchymosis of skin periumbilical |
Obturator sx = appendicitis
kehr's sign = splenic rupture grey turners= pancreatitis cullens = pancreatitis |
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A 4-mo child presents with nonbilious vomiting despite changing formulas from milk-based to soy-based. What is the Most Likely etiology?
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Congenital Pyloric Stenosis
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Which lipid lowering agent...
s/e of facial flushing s/e elevated LFTs. myositis s/e GI discomfort, bad taste |
Niacin
Fibrates AND Statins Cholestyramine (Bile acid binding agents) |
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A COPD pt comes to the ER with tachycardia and hypotension. During evaluation he begins to have seizures. What is the most likely etiology*
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Theophyline overdose
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How do you distinguish Somogyi effect from Dawn Phenomenon?
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Check 3am glucose
somogyi will have low 3am glucose |
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What are the characteristic features of a patient presenting with pericarditis>
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Pleuritic chest pain, dyspnea, cough, pulsus paradoxus, Friction rub, pain relieved by leaning forward, ST-elevation in all leads
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where is the lesion that causes:
hyperorality, hypersexuality, disinhibitied behavior personality changes dysarthria agraphia and acalculia |
hyperorality, hypersexuality, disinhibitied behavior = AMYGDALA (kluver bucey syn)
personality changes = FRONTAL LOBE (picks) dysarthria = CEREBELLAR VERMIS agraphia and acalculia = LEFT PARIETAL LOBE |
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What drugs when combined with SSRI's are known for causing serotonin syndrome
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SSRI's, SNRI's, MOAIs, Levodopa, Meperidine (demerol), Litium, Ampetamines and cocaine, ectasy, LSD, st.John's wort.
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What are the signs/symptoms of a TCA overdose? How is it managed?
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Anticholinergic sxs, cardiotoxicity, CNS toxicity
Managed: Sodium Bicarb |
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What is the MC food borne bacterial GI tract infxn?
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Salmonella
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how can the flushing reaction of niacin be prevented?
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give aspirin with it
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What is the next step in eval
Blunt abd trauma + unstable vitals + FAST shows no fluid in pelvis Blunt abd trauma + unstable vitals + FAST inconclusive Blunt abd trauma + stable vitals Abdominal stab wound + hypotensive or Sx of peritonitis |
angiography with possible embolization. presume retroperitoneal bleed
DPL CT scan Emergent Laprotomy |
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What is the treatment for acute angle closure glaucoma?
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Acetozolamide
Manitol Beta-blockers alpha-adrenergic agents prostaglandin Cholinergic agonists like pilocarpine |
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What type of Hep B exposure?
HBsAg: (-) HBsAb: (-) HBcAB: (+) |
Acute infection in window period
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What x-ray finding is indicative of croup?
epiglotititis? |
Steeple sx
Thumb sx |
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A pt presents to the clinic for follow-up and is found to have a BP of 150/85. You note in the chart that during the last visit 1 mo ago, his BP was 145/90. What is the next step in the mgmt of this pt?
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Retest in 2-4 weeks
Dx requires 3 readings |
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Which lipid lowering agent...
Best effect on HDL Best effect on TGs Best effect on LDL Binds C.diff toxin |
Niacin
Fibrates Statins Cholestyramine |
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What is the ACLS treatment for asystole?
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CPR and alternating Epi and atropine (atropine up to 3mg)
Transcutaneous pacing |
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What type of immunodeficiency increases the risk of anaphylactic transfusion rxn?
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IgA deficiency
these pts have allergy sxs, lots of URIs |
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What is the antidote for
Acetomenophen Lead Cyanide Methemoglobin Opioids |
N-acetyl cystine
PEDS: penicilimine, EDTA, Dimercaprol, Succinylcholine Sodium thiosulfate, hydroxocobalamine, Nitrate Methylene blue, vitamin C Naltrexone, naloxone |
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What is the antidote for antimuscarinic, anticholinergic agents?
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physostigmine
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Atypical antipsychotics
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Olanzapine, Risperidone, airipiprazole, quetiapine, clozapine, paliperidone
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What is the MCC of sensorineural hearing loss?
Conductive hearing loss? |
Sensorineural = Presbycusis
Conductive = Otosclerosis |
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What is the treatment for nephrogenic diabetes insipidus caused by lithium toxicity?
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HCTZ+ AMELIORIDE
HCTZ for Diabetes Insipidus and In the case of Lithium induced DI, Amelioride: closes Na channels in the collecting tubles that are affected by Li+ |
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What is the classic presentation of a pt with hyperprolactinemia?
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Females: gynecomastia, galactorhea, amenorrhea, hypogonadism*
Males: decreased lebido, infertility, impotence |
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what EKG finding is seen in patients with WPW? what causes WPW?
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delta wave on EKG
d/t reentry through an accessory electrical pathway |
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What are the diagnostic JONES criteria for rheumatic fever?
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Group A strep infxn + 2 major + 1 minor
Joints - migratory polyarthritis Heart - pan carditis Nodules - subQ Eryethum marginatum Sydenhams chorrhea |
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What is the antidote?
Anticholinesterase, organophosphates? Mercury Carbon monoxide Heparin Isoniazid |
Pralidoxime and Atropine
Dimercaprol, succimer 100% O2 FFP, protamine sulfate Vit B6 (pralidoxime) |
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What type of heart murmur?
diastolic heard best in left lower sternum that increases with inspiration? Late diastolic murmur with an opening snap? Systolic murmur heard best in the second right interspace? Systolic murmur heard best in the second left interspace |
tricuspid stenosis
mitral stenosis Atrial stenosis Pulmonic stenosis |
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What type of Hep B exposure?
HBsAg: (+) HBsAb: (-) HBcAB: (+) |
chronic infected
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What is the treatment for RSV broncholitis?
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albuterol, or racemic epi
O2 to prevent hypoxia |
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Which glomerular disease....
MC nephrotic in children IF: granular immune complex; LM: hypercellular IF: linear immune complex Kimmelstiel-wilson (nodular glomerulosclerosis) MC nephrotic in adults |
Minimal change
Post-strep GN Goodpasture's Diabetic Membranous |
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What drugs are known for causing elevated PRL levels?
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Phenothiazines, Risperidone, Haloperidol, Methyldopa, Verapamil
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Which antihypertensive drug fits the following s/e
First dose orthostatic hyptension Hypertrichosis Dry mouth, sedation, severe rebound htn bradycardia, impotence, asthma exacerbation reflex tachycardia |
Alpha blockers: Prazosin, Doxazosin
Minoxidil clonidine -Alpha2 agonist Beta-blocker Vasodilators |
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What are the HACEK bacteria
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Culter Negative bacteria that cause infective endocarditis
H.inlfuenza Actinobacter Cardiobacter Eikenella Kingella |
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What are the indications for surgical parathyroidectomy?
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5 reasons
Symptomatic Serum Ca >1 above normal Urine Ca > 400mg Cr clearance down by 30% Bone mineral density T score -2.5 anywhere Younger than 50 yr old |
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What is the antidote for benzos?
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flumazenil
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At what age do physicians begin to dose dexamethasome with or prior to the first does of abx in cases of suspected bacterial meningitis?
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6mo
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What is the MC complication of recurrent otitis media?
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hearing loss
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How do features of acute dystonia differ from that of tardive dyskinesia?
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Acute dystonia is next spasm, torticolis.
TD is repettitive tics, facial movements |
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What lab changes will be seen in a pt with hyperaldosteronemia?
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hypokalemia, hypernatremia, metabolic alkalosis, Increased 24hr urine aldosterone
Aldosterone: conserve Na+, secrete K+, increase water retention to raise BP. Without adequate K+ in the ECF, the H/K exchange pump shuts down and no H is pumped out, leading to a hypokalemia |
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How is the Tx of SVT d/t WPW different from other causes of SVT?
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SVT is treated with adenosine, but if its d/t WPW, then use amioderone and procainimide
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Which heart murmur?
Late systolic murmur heard best at the apex? Diastolic murmur with a widened pulse pressure Holosystolic murmur that is louder with inspiration at the left lower sternum? Holosystolic murmur heard at the apex and radiates to the axilla? |
Mitral prolapse
aortic regurg tricuspid regurg Mitral regurg |
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Whats the Hep B status
HBsAg: (-) HBsAb: (+) HBcAB: (-) |
Vaccinated
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What is Beck's triad
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Tamponade = hypotension, distant heart sounds, JVD
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Which glomerular disease....
EM: loss of epithelial foot processes Nephrotic a/w Hep B Nephrotic a/w HIV Anti-GBM antibodies, hematuria, hemoptysis EM: subendothelial humps and tram-track appearance |
Minimal change
Membranoproliferative Focal Segmental GS Goodpasture's Membranoproliferative |
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Which antihypertensive drug fits the following s/e:
Cough Avoid in pts with sulfa allergy Angioedema Development of drug induced lupus Cyanide toxicity |
ACE-I
Furosemide, HCTZ ACE-I SHIP (Sulfa, Hydralazine, INH, Procanimide) Nitroprusside |
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Which antihypertensive is first line in...
No comorbidities Diabetes Heart Failure BPH LVH |
Thiazide
ACE-I ACE-I/ARB, Beta Blocker Spironolactone Alpha blocker ACE-I/ ARB |
Hydrochlorothiazide
Lisinopril Lisinopril/Losartan, Carvadilol, Spironolactone Prazosin Lisinopril/ Losartan |
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What drugs are most commonly used in renal disease to bind phosphate in order to prevent hyperphosphatemia?
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calcium carbonate or calcium acetate
dont use caclium citrate for the Al affect |
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Name as many NRDI's as you can
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Bupropion (welbutrin) is the only one
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How does the Tx of Acute Distonia differ from Tardive Diskinesia?
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Acute distonia: Diphenhydromine/ benztropine (anticholinergic)
TD: discontinue or change neuoleptic |
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Antidote for Opioids?
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Naloxone, naltexone
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What is the most sensitive and specific lab test for the diagnosis of chronic pancreatitis?
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low fecal elastase levels.
lipase is more specific than amylase, but they may both be low in chronic pancreatitis |
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Whats the Hep B status
HBsAg: (-) HBsAb: (+) HBcAB: (+) |
Recovery
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What is the typical post-op fever work up?
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CBC with diff
UA blood culture, urine culture X-ray |
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Which glomerular disease....
Nephritis, Deafness, cataracts LM: crecent formation in glomeruli LM: segmental sclerosis and hyalinosis Purpura on back of arms and legs, abd pain, IgA nephropathy Positive ANCA Anti-dsDNA antibodies |
Alport's
Crescentic GN (Rapidly progressive) Focal segmental GS Henoch-Scholen Purpura Crecentic GN Lupus |
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What is the Tx for febrile seizures
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Lower the Temp with acetaminophen
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Which antihypertensive is first line in...
Hyperthyroid Osteoperosis Benign Essential Tremmor Post-menopausal Female Migranes |
Beta Blocker
Thiazide Beta Blocker Thiazide to reduce osteoperosis Beta Blocker |
Propanolol
HCTZ Metoprolol HCTZ Propanolol |
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What is the classic presentation of a pt with aspirin overdose?
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Tinnitus, resp alkalosis --> met acidosis
hyperventialation, N/V, abdominal ache |
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Name as many SNRI's as you can
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Venlafaxine, Duloxetine, Milnacipram, Nefazedone
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What EEG pattern is seen in cases of absence seizures?
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3 cycle/sec Spike and Wave
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Antidote for Heparin?
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Protamine sulfate
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What supplements should be given to women on anticonvulsants during pregnancy?
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folate, 4 mg
vit K in the last month to augment coaguability during deliverly |
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*What is the DDx of ground-glass infiltrates on CXR?
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interstitial pneumonia
PCP Pulmonary Edema (CHF, ARDS) Pulmonary hemorrhage Hypersensitivity pneumonitis |
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What is the empiric tx for pneumonia in a 2-month old?
in a 2 year old? |
neonate: GBS, E.coli = amp+ gent
2month: RSV = macrolide +/- cefotaxime 2 year: RSV, step pneumo = Ampacillin, Amoxicillin |
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At what point do patients with chronic COPD qualify for home O2
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O2<88%
pulmonary HTN, peripheral edema, polycythemia What is Dx of pulm htn? Pulmonary pressure >/= 25% of systolic. Should be 1/8th |
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What is the antidote to the following toxin?
Salicylates Beta blockers Digoxin Iron Copper t-PA/ Steptokinase |
Salicylates - activated charcoal, Na-HCO3
Beta blockers - Atropine, Insulin, calcium, glucagon, glucose Digoxin - charcoal, dig Fab. dont give Ca Iron- deferoxime Copper - penicillamine t-PA/ Steptokinase - amino caproic acid |
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An elderly pt presents to the ER with a headache and dilated right pupil. During the history, she reports that she fell at home 5 days ago. What is the most likely Dx?
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Right Sided Subdural Hematoma
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Antidote for Benzos?
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flumazanil
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what is the next step in the mgmt of an AGUS pap smear?
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colposcopy and endocervical curettage.
if they are over 35, or have risk factors for endometrial hyperplasia, then we also do an EMB |
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What medication is used to close a PDA?
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Indomethacin
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What is the initial Tx of a localized non-small cell lung CA?
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Surgical Resection and chemo
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Which blood pressure medications should be avoided in patients with ischemic stroke or subarachnoid hemorrhage because of the increase in intracranial pressure associated with them
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nitroprusside, nitroglycerine
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What medications other than stimulants are used in the Tx of ADHD?
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TCA's, Clonodine, Bupropion
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Antidote for Barbiturate (phenobarbital)?
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give bicarb (HCO3) alkalinize the urine or dialysis
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What complications can arise from electrical burns?
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myoglobinemia --> renal failure
Cardiac dysrhythmias Compartment syndrome Bony injuries |
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What medications are used in the Tx of Tourette's syndrome?
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Fluphenizine, Pemizide, Tetrabenezine*
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Antidote for carbon monoxide?
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100% O2
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What eye abnormality is seen when there is a lesion to the oculomotor nerve III?
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Down and out
Eye is fixed and dilated, loss of psymps |
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What are teh most worrisome side effects of the ADHD drug atomoxetine?
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Increased Suicidal tendency
Liver injury |
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What type of oral contraceptive can be given to lactating women?
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Progestin only
combo OCP supresses lactation |
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What are the differing presentations of
Alzheimers dementia Picks dz Lewy-body dementia? |
Alz: Memory loss
Picks: personality change DLB: Alzheimers with Parkinsons, visual hallucinations, unexpected falls |
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Hypotension + distant heart sounds + distended neck veins
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Becks triad for cardiac tamponade
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What is the definitive Tx for a subdural hematoma?
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burr hole and surgical removal
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What is the definintion of primary amenorrhea?
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absence of menses at age 16 and everything else being normal
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What is the antidote for Tricyclic antidepressants
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Na-HCO3
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What serum lab abnormalities might you see in a pt with bacterial meningitis?
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elevated WBC, left shift, Leukopenia is possible.
30% of pts have a mild hypOnatremia |
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What is the antidote for warfarin
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Vit. K and FFP
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A pt comes to clinic with the complaint of hearing loss and vertigo. On examination of the typanic membrane you note a grayish-white "pearly" lesion involving the TM. what is the Dx?
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Classic CHOLESTEATOMA
desquamated keratin debris within the middle ear |
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what is the antidote for methanol, ethylene glycol (antifreeze)
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fomepazole, etoh
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what is the tx for arsnic?
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dimercaprol, succimer, or penicillamine
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What is the parkland burn formula
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Using lactated ringers: (4mL) (kg) (% burned)
give 1/2 in 8hrs, give 2nd half over 16hrs |
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What are the symptoms of neuroleptic malignant syndrome
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hot, flushed, altered mental status, muscle rigidity, rhabdomyolysis
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What is the tx for neuroleptic malignant syndrome?
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dantrolene, d/c meds, IV cooling
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Ca/ P/ PTH/ Alk Phos
Paget's dz |
Alk-phos: up
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Ca/ P/ PTH/ Alk Phos
Osteomalacia/ Rickets |
vit d deficiency
Ca: down P: down PTH: up |
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Ca/ P/ PTH/ Alk Phos
Chronic renal failure |
vitamin d deficiency, but cant excrete phosphate
Ca: down P:up PTH: up |
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Ca/ P/ PTH/ Alk Phos
osteoperosis |
brittle bones
no change |
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Ca/ P/ PTH/ Alk Phos
osteopetrosis |
rock like bones
no change |
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Ca/ P/ PTH/ Alk Phos
primary hyperparathyroidism |
Ca: up
P: down PTH: up Alk-phos: up |
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Ca/ P/ PTH/ Alk Phos
hypoparathyroidism |
Ca: down
P: up PTH: down Alk-phos: nml |
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Ca/ P/ PTH/ Alk Phos
pseudohypoparathyroidism |
Ca: down
P: up PTH: up Alk-phos: nml |
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