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185 Cards in this Set

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SVT refractory to carotid massage: what are the medical interventions?
Adenosine.
Then, IV verapamil or beta-blocker
Then, flacainide or propafoneT
Monotherapy for HTN in african americans is most likely to be accomplished by:
Diuretics and calcium channel blockers (HCTZ and diltiazem) as opposed to beta blockers and ACE inhibitors as would be expected in caucasians. It's thought HTN in AA pts is not as much based on angiotensin aldosterone axis as whites.
Which of the following is shown to decrease sudden cardiac death?
-Omega 3 oil
-1 glass of red wine nightly
-increased fiber in the diet
Omega 3 has been shown to decrease all cause mortality, non fatal MIs, and even sudden cardiac death.
The USPSTF suggests who should be screened for abdominal aortic aneurysms?
Males aged 65 to 75 with ANY history of smoking.
How many breastfeedings is normal in a newborn infant?
Typically 8-12 feedings aday.
How does midgut volvulus present?
3 different types of presentation:
1: Sudden onset bilious vomiting, abdominal pain.
2: Hx of feeding problems w/ bilious vomiting appearing to be bowel obstruction.
3: Less common, failure to thrive with feeding intolerance.
Radiographic classic presentation is double bubble sign (one in stomach, one in duodenum), but may be normal.
Upper GI contrast study is gold standard.
How will meckel's diverticulitis present differently from appendicitis?
RLQ pain, vomiting and diarrhea may be seen in both, BUT meckel's may be bloody diarrhea, appendicitis will not be bloody. Also, there may be no fever with meckels.
What is the "gastroenteritis vaccine" and when is it given?
The rotavirus vaccine is given between 6 and 12 weeks (rotaTeq). It's 3 doses at 2, 4, and 6 months. An OLD vaccine, RotaShield, was found to increase risk of intussusception.
Eradication of H pylori will do what to symptoms of GERD?
To risk of PUD bleeding in NSAID patients?
To risk of gastric cancer in asymptomatic patients?
To symptoms in non-PUD dyspepsia?
Reduce bleeding of peptic ulcers in NSAID using patients.
WILL NOT improve GERD symptoms or those of non-ulcer dyspepsia, and will not decrease gastric cancer risk in asymptomatic patients.
When should mamagrams start?
USPSTF recommends at 40, annually. However, other entities recommend at 50.
BRCA 1 and 2 mutations put women at higher risk for:
Breast, ovarian, colon, and other cancers, but NOT uterine or vaginal neoplasms.
HRT puts women at increased risk of:
CAD, stroke, venous thromboembolic disease.
When should women begin PAP smear screening?
Age 21, or 3 years post first sexual activity, which ever is first. Every year, until 3 negatives, then most recommend spacing to every 2-3 years.
HPV vaccine is recommended for who, and for what?
Women aged 9 to 26, regardless of sexual activity. Vaccine against HPV 16, 18, 45, and 56, which can cause neoplasms to develope to cervical cancer.
How is osteoporosis diagnosed/defined? How about osteopenia?
Defined as at or below -2.5 (T score on DEXA scan). Osteopenia is -1.0 to -2.5. Number depicts standard deviations from young adult normal.
Who should get screened for osteoporosis?
Women aged >65, or >60 with risk factors (smoking, steroid use). Also, all those with pathologic fracture history.
Who is advised to receive Ca and Vid D supplementation?
ALL women over the age of 50. 1200mg Ca++ and 400-800 IU Vid D a day.
Top 4 diagnoses for lower back pain in order of most to least common:
1) Lumbar strain
2) Disc herniation
3) Spinal stenosis
4) Degenerative joint disease
Malignancy causing lower back pain presents as:
Pain localized to effected bones, no limb radiation. Dull, throbbing pain, progresses slowly. Increased with recumbancy or cough.
What the hell is spondylolisthesis?
Anterior displacement of vertebra. Pain presents as aching back and posterior thigh, increasing with activity and bending.
Cauda equina syndrome:
Compression of the cauda equina via mass effect of tumor, acute disc herniation, etc. Lower back pain, leg radiation with numbness, perianal numbness, incontenance... Medical emergency.
Compression of various discs show up how?
L3: Decreased patellar tendon reflex, pain in the lateral thigh and medial femoral condyle, trouble with extension of the quadriceps, squat down and rise
L4: Trouble with dorsiflexing ankles and walking on heels.
L5: Decreased medial hamstring reflex; pain in the lateral leg and dorsum of the foot; trouble with dorsiflexion of the great toe and walking on heels.
S1: Decreased Achilles tendon reflex; pain in the posterior calf; sole of the foot and lateral ankle; trouble with standing on toes and walking on toes (plantarflex ankle).
Is x ray indicated for lower back pain?
No, unless there is history of trauma, osteoporosis, steroid use, age <20, >70. Fever, weight loss, cancer history...
Is MRI indicated for lower back pain?
Yes, if neurological deficits, radiculopathy, susptected caude equina, or suspected systemic disease.
Treatments for disc herniation, radiculopathy?
NSAIDs, PT if no Red Flags. Conservative for 4 weeks. Then, corticosteroid injections and surgery can be considered.
Ankle sprains, how are they graded?
Grade 1: minimal pain with weight bearing, stetching/strain of anterior talofibular ligament (ATFL), no tearing.
Grade 2: partial tearing of the ATFL, stretching of the calcaneo fibular ligament (CFL).
Grade 3: rupture of ATFL, CFL, partial tearing of the PTFL.
When should x rays be done of the foot?
If unable to bear weight, tenderness to navicular bone (medial midfoot), lateral midfoot (base of fifth metatarsal), tenderness to medial or lateral maleoli. These are part of the Ottawa Criteria for ankle x rays. Apply rules to adults with no AMS, no multiple injuries.
What is the most aggressive melanoma?
Nodular. It is usually invasive at the time of diagnosis.
What is Lentigo Maligna?
A melanoma subtype, silimar to superficial spreading. Most often in elderly, sun exposed areas. Least common melanoma, but most common in Hawaii.
What is superficial spreading melanoma?
Most common melanoma; 2 phases: horizontal growth and vertical growth phase.
What is Acral Lentiginous melanoma?
Most common melanoma of blacks and asians, often presents under fingernails or palms and soles.
What effect may COCs have on blood pressure?
Increased. Both estrogen and progesterone can elevate BP; usually mild, but may be clinically significant. D/C pills, see BP drop to normal.
What are some side effects of COCs?
Androgenic effects (facial hair, male baldness), estrogenic effects (breast tenderness, fluid retention). Spotting as well, most common reason it is discontinued, though usually normalizes.
T or F: weight gain is a documented side effect of COCs.
False. Often reported, but weight gain has no significant data backing it as a COC side effect.
COCs put you at increased risk for:
VTE.
COCs put you at decreased risk for:
Ovarian and endometrial cancer. NOT vaginal or cervical cancer.
What if a patient misses the one day of active COC?
If sex in prev 5 days, ECP (plan B) and restart COC. If no sex in prev 5 days, take 2 pills and use back up contraception for 7 days.
When are COCs contraindicated?
COC with estrogen AND progesterone are contraindicated in >35 year smokers (VTE). This also goes for vaginal ring and patch with both E and P.
Is progesterone only COCs or patches indicated over other E and P types?
Yes, in increased risk for VTE patients. They should use progesterone only forms of contraception.
Contraindications to ECP (plan B) use:
There are NO contraindications other than allergy to the preparation incredients. No increased risk of VTE with limited dose.
Effectiveness of ECP (plan B):
75 to 80% efective.
T or F: ECP (plan B) does not disrupt an already implanted pregnancy.
True.
Cytogenetic analysis:
This test is used to identify abnormalities in chromosome number, size, and structure. For infants to look for recognizable chromosome syndrome (down), or multiple malformations of unknown etiology, or ambiguous genitalia.
What diet is recommended for young children/infants with diarrhea?
Age approprate diets, continuation of breast mild or formula if applicable. Complex carbs (wheat, rice, potatos) along with lean meats, yogurt, fruits, veggies are well tolerated. Avoid simple sugars (juice, soda) as somotic pull can exacerbate diarrhea. The BRAT diet has not been shown to be very helpful.
When should the BRAT diet be initiated?
Classically it is given to children for diarrhea, however it has NOT BEEN SHOWN to be effective. Bananas, rice, applesauce, toast.
In an elderly individual, how might an appendicitis present?
Only 22% of elderly present with classic SXs, and see 10% reduction in perceived pain per decade over 60. So: have high index of suspicion! Bilateral LQ pain, may have mild fever, anorexia... May be vague.
Murphy's sign:
Abrupt cessation of inspiratory effort during deep palpation of the RUQ. Seen in acute cholecystitis.
Classic presentation of PUD:
Epigastric gnawing pain, often associated with feelings of hunger. May see darker stools (melena). Most common cause: H. pylori, then NSAIDs.
Patient presents with sxs of GERD, without melena, dysphasia, or other alarm symptoms. Should you: test for h pylori? EGD? Barrium swallow? H2 antagonist or proton pump inhibitor trial?
Treat with H2 blocker or PPI, or even a prokinetic. H pylori usually has PUD presentation. EGD is indicated for gi bleeding, weight loss, or dysphagia present.
RUQ pain with positive murphy's, increased liver enzymes... Now what?
ERCP is the gold standard for diagnosing/treating choledocholithiasis. Remember not just cholecystitis, as that would not raise liver enzymes (i think). Do not want cholangitis to set in (suspect with fever, jaundice, RUQ pain or Charcot's triad).
Most common causes of pancreatitis:
Gallstones, then alcoholism (30%), then idopathic; rare is hypercalcemia, hyperlipidemia. Instrumentation as well, as in post ERCP.
What is the Ranson criteria for poor prognsosis in pancreatitis?
Glucose >200, age >55, WBC >16,000, LDH >350, and AST >250.
What criteria reflect the development of complications in pancreatitis (not Ranson's criteria)?
In first 48 hours of admission:
Drop of hematacrit by 10 points.
BUN increase >5
Ca++ <8
Base deficit >4
PaO2 <60
Fluid sequestration >6L
Test needed to diagnose IBS:
None. Criteria for IBS is 12 weeks (non consecutive) in past 12 months of symptoms (pain associated with disturbed defacation). Pain needs 2 of three: relieved with defacation, onset at onset of >frequency, and onset with change in form and appearance of stool.
How often is no etiology found for dyspepsia?
50-60% of the time. Symptoms are typically chronic or recurrent symptoms centered around the upper abdomen. May have heartburn, belching, bloating, possible nausea. Only 25% of pts have ulcer disease, only 15% have GERD.
Who is recommended to get the Hep A vaccines?
Travelers to or workers in endemic areas, health care workers, men who have sex with men,
What is the most common mode of transmission of Hep C?
Injection drug use. It used to be blood and blood product transfusion, but with the routine anti Hep C antibody screening, this has been significantly reduced.
Is breast feeding a risk of maternal-child Hep C transmission?
No. Furthermore, vertical transmission is thought to be only 6%.
A single, 3 cm fluid filled, thin walled renal cyst is found incidentally on imaging. What is the next step? Aspiration/biopsy? MRI? Preop staging?
Nothing, if it meets US criteria of thin walled, homogenous, fluid filled. If cyst appears complex, then renal CT WITH contrast, or MRI after. Renal cysts are seen in 30% of peeps over 50 getting abdominal imagery for other reasons. ADPCKD presents symptomatically, and multiple cysts would be present.
When is intervention indicated for infants with elevated bilirubin levels?
>17 is considered pathologic in full term infants. American academy of pediatrics states >15mg/dL at 25-48hours, >18 at 49 to 72 hours, and >20 at 72 hours or more.
Radiation proctitis: what is it?
Presents often with pain on defacation, diarrhea, sometimes rectal bleeding, months to years after radiation (like prostate treatment). Colonoscopy shows pale mucosa, friability, and telangiectasias.
Treatment for acute thrombosed external hemorrhoid:
Thrombectomy under local anesthetic. Not banding or cryotherapy in the office; that would increase pain of an already very painful problem. Not total hemorroidectomy, it is inappropriate and unnecessary.
What is the best screening test for hemochromatosis? What is the gold standard diagnostic test?
Serum transferrin sturation is the best and most sensitive screening test. Liver biopsy, long considered the gold standard for diagnosing hemochromatosis, is far too invasive. Not total serum iron levels, not TIBC.
What is cholecystitis?
Inflammation of gallbladder from persistent obstruction. Persistent pain is present, not intermittent as with biliary colic.
If cholecystitis is suspected, what is next step?
Ultra sound. Treat with cholecystectomy.
What is biliary colic?
Intermittent obstruction of cystic or common bile duct by stone. Intermittent severe pain. Do and ultra sound!
What are kidney stones most commonly made of?
Ca++ oxalate, or C++ phospate.
How does urolithiasis present?
<12 hours onest. MAY have normal UA RBC content. <5mm, let pass, can use alpha blockers ad steroids to help. >10mm, extracorporeal shock wave lithotripsy, or uretoscopy.
Appendicitis presentation is...?
RLQ pain, may star as vague periumbilical pain. See pain BEFORE emesis. Emesis before pain makes it unlikely.
What is the alvarado score for appendicitis risk?
1-3, low risk. 4-6, med risk. 7-10, high risk. Consists of migratory pain, anorexia, nausea/vomiting, tenderness RLQ, rebound tenderness, fever, leukocytosis, left shift.
70% of intestinal obstruction is from:
surgery. With obstruction of any sort, see distention, hx of constipation, visible peristalsis.
Who should get upper endoscopy for dyspepsia?
Person with new onset and >55 years. If alarm symptoms, like dysphagia, bleeding, weight loss, recurrent vomiting, family hx cancer.
H pylori treatment triple treatment?
PPI, clarithromycin, and amoxicillin (metro if penicillin allergic).
H pylori quad therapy:
Bismuth subsalicylate, PPI, metronidazole, tetracycline.
PAP yeilds atypical squamous cells of unknown significance, and HPV testing is unavailable, in a healthy, normal cycle woman.
Do colposcopy or recheck again in 4 to 6 months.
ASCUS on pap, and HPV testing is positive.
Go right to colposcopy.
ASCUS on pap, and HPV testing is negative...
Repeat PAP in 1 year.
ASCUS on pap in post menopausal woman...
Have the patient use a estrogen topical cream, and repeat in 4 weeks.
Atypical glandular cells on PAP, but not specified if cervical or endometrial, what do? Repeat pap? Endometrial biopsy? Colposcopy?
Colposcopy.
Atypical glandular cells on Pap, endometrial; what's next?
Endometrial biopsy.
PCOS dx, needs 2 of 3 criteria. What are they?
hyperandrogenism, chronic annovulation, polycystic ovaries via US.
Treatment of PCOS?
If insulin resistant, use metformin or TZDs. Clomiphene for infertility, or aromatase inhibitors, or gonadotropins.
What is involved in the PCOS workup?
US of abdomen/pelvis. Free testosterone, TSH. Not estrogen.
Menorrhagia (regular interval, heavy menses) causes:
Leiyomyomata (fibroids), endometrial polyps, coagulopathies.
What is asherman syndrome?
Scarred uterus, may have decreased blood flow during cycle.
Dysfunctional uterine bleeding, how is it managed?
If <35years with no endometrial cancer risk factors, can start therapy w/o workup: usually OCs. If >35, or risk factors for cancer, get US, indo biopsy, Hysterectomy if cancer.
Risk factors for endometrial cancer?
Nulliparity, annovulation, >35, obese. Tamoxefin (SERM). Smoking is NOT a risk factor.
Fibroids that have caused abrutio placentae, what should be done if a second pregnancy is desired?
Myolysis with endometrial ablation? NO; this is an option if pregnancy is not desired.
Uterine artery embolization? NO; no good long term data on fertility.
Observation? NO
Myomectomy? YES
Most accurate measurement in first trimester for gestational age?
Crown/rump length.
Most accurate measurement in 2nd trimester for gestational age?
Biparietal diameter, and femur length.
What are early deccelerations of fetal heart rates caused by?
Vagal response from head compression of the fetus, and are normal?
Variable deccelerations of the fetal heart rate are caused by:
Compression of the umbilical cord between fetal parts and contracting uterus.
Late deccelerations of fetal heart rate is caused by:
Uteroplacental insufficiency, fetal compromise. Is a warning, can lead to fetal acidosis, CNS depression, hypoxia everywhere, really.
CA-125 levels above 100...
Pretty bad, indicative of ovarian cancer. Mass on US >3cm also bad. Septated, also bad.
At 4.5 to 5 weeks pregnancy, what do we see on US and hCG?
Gestational sac may be seen (not yolk sac), with hCG >1000.
At 6 weeks gestation, we see what on US and hCG?
Yolk dac and hCG >2500.
At 7 weeks gestation, what is on US and hCG?
Fetal pole can be seen, hCG at >5000
T or F: In PCOS, the LH/FSH ratio is generally lower than normal.
False. The LH/FSH ratio is elevated, with increased levels of estrogen.
Plan B consists of what?
Levonorgestrel (progesterone). Two .75mg pills given 12 h apart.
Emergency contaception, that is not plan b?
Ethinyl estradiol/norgestrel, 2 pills given, then 2 more later.
Treatment of uncomplicated gonorrhea of the cervix:
What if prego?
Ceftriaxone
Cefixime, 1x 400mg
Quinolones, but if pregnant, no quinolones!
Txt of uncomplicated chlamydia of cervix? What if pregnant?
Azithromycin 1 gram 1x.
Doxy or amoxicillin for 7-10 days.
If pregnant, no tetracyclines!
Varicella vaccines in pregnancy...
Not advised, but no evidence to support poorer outcomes, congenital varicella, etc.
What causes immediate post-partum hemorrhages?
90% of immediate post-partum hemorrhages are caused by uterine atony.
Microcytic anemia with an increased RDW...? Which one?
Iron deficiency.
Microcytic anemia with a MCV decreased out of proportion to the severity of the anemia:
Thallesemia minor. MCV can be in 60s or 50s.
Also, will see a normal RDW, as opposed to increased in iron deficiency.
What is the MCV in sideroblastic anemia?
MCV can be increased, decreased, or normal. Dimorphic RBCs.
Increased TIBC, decreased ferritin suggests...?
Iron deficient anema
Decreased TIBC, normal or elevated ferritin suggests...?
Anemia of chronic inflammation
Macrocytic anemia with neurologic findings...?
Anemia with neurologic components is limited to B12 deficiency.
How do we limit pain crisis in sickle cell disease?
Hydration!
T or F: Alcohol affects B12 absorption or intracellular processing.
False. Alcohol can effect folate intracellular processing.
Definitions of anemia?
Men, hemoglobin <13
Women, hemoglobin <12
Multiple myeloma diagnosis?
Bone marrow biopsy; positive if greater than 10% plasma cells in the marrow.
Esophagitis in HIV patients is caused by:
Herpes simplex, CMV, and candida.
What "routine" test is abnormal in a hemophilia A patient, and what protein is deficient?
aPPT is prolonged. Factor VIII is deficient.
Is HIV absolutely a contraindication to breastfeeding?
Yes.
CMV is not.
Hep A requires IgG to baby and vaccine.
Tuberculosis needs pumping, and feeding by other person.
What is the most sensitive and accurate in predicting bleeding risk post-op in a patient?
Bleeding history. Better than bleeding time, PT, or aPTT.
Treat first stage of lyme disease with what?
Amoxicillin or doxy for 14 to 21 days.
Treat second phase of lyme disease how?
(myalgia, arthralgias, systemic involvement, pericarditis, ras)
IV ceftriaxone, chloramphenicol is another option but not first line.
How does head lice present?
Scalp erythemetous papules, with black bulbs at follicles.
Treatment of headlice as well as scabies?
Permethrine 1%, then 5% if no good.
Scabies present how?
Intensly pruritic lesions on wrists, waist; where ever tight clothing borders skin.
Flea bites are where, typically?
Usually papules in clusters on the lower extremeties.
Bedbugs bite where?
Often on the hands, neck, face.
How to treat pubertal gynecomastia?
Reassurance, usually gone in 1 year. If adult, check TSH, liver function, renal function. Check sex hormones only if progressive. Typically not needed.
What are fibrocystic changes?
Most common cause of breast mass. More common in young women. Mobile, tender, worse w/ menstrual cycle. May aspirate if large. Reassurance only.
Fibroadenomas present how?
Rubbery, mobile, non-tender. Mammograms not recommended in women younger than 30.
When is breast pain worrisome?
New onset in postmenopausal woman, non cyclic, unilateral. Even more concerning if dominant mass and/or discharge: strong suspicion for malignancy.
Tx of cyclic mastalgia?
Better bra, low fat diet, low methylxanthines (caffeine).
NSAID topical diclofenac does well.
Bromocriptine, tamoxifen, danazol (androgen), goserelin (LHrh analouge).
Pathologic reasons for galactorrhea (increased prolactin):
Hypothalamic lesion, stalk lesion.
Pituitary tumor.
Chest wall trauma.
Hypothyroidism.
Renal failure (decreased prolac. clearance)
Breast mass evaluation initial steps after H and P:
Determine if cystic of solid. Aspiratoin can be done in office. All bloody aspirates, and any aspirate in a post-menopausal women not on HRT, should get cytology.
What is the Triple Approach to a breast mass?
CBE, mammography, and FNA. It has a high NPV and high sensitivity. Specificity was only 57%. If any part is (+), then should get excisional biopsy. If negative, CBE frequent.
If aspiration of breast mass is bloody, or if mass persists immediately after aspiration, then what? Triple Approach?
No, in these cases mammoagraphy and excisional biopsy should be recommended.
Breastfeeding mastitis; what do?
Early coverage for GPC should start, with erythromycin being safe. Continue feeding to reduce stasis, and limit potential of abscess formation.
If workup is all negative with galactorrhea (normal prolactin, TSH, MRI, normal renal function, etc), what do?
Dopamine agonist can be used (bromocriptine, cabergoline) if it is bothersome or associated with decreased libido, amenorrhea, infertility.
Lacy white rash on labia minora, no discharge, no other lesions, only puritis. Antifungal therapy did nothing. What is it?
Vaginal lichen planus. Same as oral lichen planus. Unknown cause. No erythema, no discharge. Usually gone in 6-24 mo, no treatment, but corticosteroids topically may reduce itching and improve apearance.
Is injected medroxyprogesterone acetate (Depo-Provera) linked to increased risk of thromboembolic events?
No. However, may see menstrual irregularities, possible weight gain (debatable), increased LDL, decreaesd HDL.
True or False: milk supply adjusts to the infant's demands.
True. Milk supply is modulated dependent on frequency, vigor, and duration of suckling.
Waiting 2 hours before the first breastfeeding to allow for a rested mother improves breastfeeding outcomes, T or F?
False. The first breastfeeding should not be delayed. Also, Vit A and D are shown to have worse outcomes for sore/cracked nipples, and post feeding weighings worsen outcomes for breastfeeding.
What is vaginismus?
An involuntary contraction of vaginal and pelvic floor muscles.
Amenorrhea with both very high LH AND FSH points to what cause? Pituitary adenoma? Hypothalamic amenorrhea? Ovarian failure? PCOS?
All can cause amenorrhea, but this is ovarian failure.
Pituitary tumor typically prolactin.
Hypothalamic amenorrhea usuall induced by weight loss, excessive exercise
Amenorrhea with recent significant weight loss or excessive exercise is what?
Hypothalamic amenorrhea. A diagnosis of exclusion.
Amenorrhea with normal to slightly high LH and tonically low FSH suggests what cause?
PCOS. The LH/FSH level is usually elevated.
Amenorrhea with high prolactin?
Typically prolactinoma of the pituitary.
Secondary amenorrhea workup (not prego), with no H and P findings to help...
TSH, prolactin levels, and progesterone challenge
Decreaed risk of getting ovaran cancer are:
Pregnancies, OCs, breast feeding, etc.
Bordetella Pertussis: first line treatment?
Macrolides, azithromycin. TXSM is 2nd line treatment.
Treatment of hospital acquired pneumonia is:
Ceftazidime and gentamicin are one combo. Must cover pseudomonas, klebsiella, and acinetobacter species.
Acute bacterial sinusitis is typically caused by what organisms?
70% of bacterial sinusitis is caused by Haemophilus influenza or Streptococcus pneumo
Patients with a cough, who should get a chest x ray?
Fever >100, tachypnea, tachycardia, and any two of the following: rales, decreased breath sounds, and no history of asthma.
Rales, crackles, egophony, dullness to percussion.
Signs of pneumonia, though rales and crackles only about 70-80% of the time, and egophony and dullness <1/3 of the time.
Acute rhinosinusitis treatment?
May be viral or bacterial, recommended now to wait for 10 days before abx. Penicillin or amoxicillin for 7-14 days.
Acute bonchitis? How treat?
Give antibiotics. ONLY if patient is wheezing, Beta 2 agonists (albuterol) are also helpful.
Influenza treatment?
Supportive, hydration, acetaminophen, NSAIDS, lozenges.
Oseltamivir or Zanamivir, must be given within 36 hours of symptom onset to be effective. Shortens symptoms by 1 to 1.5 days (yay).
Community aqcuired pneumonia inpatient should be treated with ...?
For inpatient, less severe, use ceftriaxone or amp sulbactam and a macrolide.
For inpatient more severe, fluorquinolones (new ones) can be used if above treatment fails.
CAP outpatient should be treated with?
Recommended a macrolide, doxy, or an oral Beta lactam with good strep pneumo coverage (amoxicillin clavulanate, cefuroxime)
Oseltamivir vs. Zanamivir. Who are they approved for?
Oseltamivir is approved for = to or > 1 year old.
Zanamivir is approved for = to or > 7 years old.
T of F: Use of an incentive spirometer reduces pulmonary complication risk in post-op abdomen surgical patients.
True!
What med is approved for treatment of cough and cold in <2 year children?
None, really. It is recommended to use saline rinse, bulb suction, humidifier, and hydration.
Spirometry suggesting restrictive process is what? If so, what is the next step?
FVC decreased, FEV1 decreased or normal, and FEV1/FVC is > 0.7. If this is the case, patient should undergo full pulmonary function tests with lung vol measurements and diffusion capacity.
Varenicline is what, and what are the side effects?
Nicotine partial agonist. Side effects include mood changes, suicidal ideation, aggressive behavior. Watch out!
Histoplasmosis typically is from where? And how might asymptomatic patients present on radiography?
Midwestern US (Iowa). May see BB sized calcifications in a miliary pattern.
Which is associated with pleural plaques?
Asbestos
Silicone
Radon
Vinyl chloride
Asbestos is; also cancer and mesothelioma.
Silicone and coal dust, pneumocconiosis.
Radon, vinyl chloride, cancer.
New born shows RDS, meconium in amniotic fluid. Hypoxemia. Radiograph shows...?
Patchy atelectasis and consolidation. This is meconium aspiration syndrome. NOT transient tachypnea of the newborn.
New born develops rapid breathing, but no hypoxemia. What is the dx, and what are risk factors?
Transient tachypnea of the newborn. Caused by residual pulm fluid after delivery. Radiograph: fluid in the pulm fissures, homogenous opaque parenchymal infiltrates. At risk if male, macrosomia, c section.
Bronchiolitis (RSV) in babies, how do you treat?
Typically supportive. Ribavirin controversial, only gives slight quicker recovery. Steroids often used, but no evidence to support. Give O2 if below 90%.
Uncomplicated acute sinusitis treatment?
Likely viral, treat with analgesics. Symptoms persist for 10 or more days, abx indicated.
CAP, outpatient (uncomplicated to not need hospitalization), how do you treat?
Macrolide or doxycycline. IF patient has had abx in last 3 mo unrelated, treat with fluroquinolone.
Pleural effusion, with evidence of compression of lung...?
Should decompress to keep from fibrosis or empyema developing. If it is a hemothorax, the re-expansion may 'seal' the bleed.
Emperic treatment for traveler's diarrhea?
Clarithromycin or other fluroquinolones. TMP/SMX or a macrolide are decent alternatives. Typically caused by enterotoxigenic E coli.
Vertigo vs Dysequalibrium
Vetigo: rotational, spinning sensation
Dysequalibrium, sensation of unsteadiness, or loss of balance.
Vestibular neuonitis:
Accoustic neuroma:
Presents as acute onset of severe vertigo lasting several days, symptoms decreasing over several weeks.

Presents as unilateral often have face numbing, progressive over months.
Dix Hallpike maneuver, the nystagmus changes direction and symptoms stay constant on repitition; central or peripheral cause of vertigo?
This move distinguishes from central and peripheral causes of vertigo. If peripheral, would see nystagmus remain in same direction with head direction change, and decrease in severity of vertigo with repetition.
First line treatment of peripheral vertigo:
antihistamines. Meclizine or diphenhydramine.
Which of the following are risk factors for restrictive lung disease? Adult asthma, childhood bronchiolitis, smoking, occupation as a farmer.
Farmer. Cotton dust, grain dust, hay mold. Also silicone, asbestos, coal dust.
B natriuretic peptide is a marker of CHF. What do the levels mean?
0 to 100 is normal, and values <80 have a 99% negative predictive value.
Is eryethema alone enough to dx otitis media?
No. Tympanic bulging, opacity, or decreased mobility would.
How long do we expect to see effusion in the middle ear after treatment of otitis media?
It may take up to 3 months for effusions to resolve.
Treatment of otitis media first line? Second line?
First line is amoxicillin, but if severe (>102 fever) use amoxicillin/clavulanate (90 mg/kg/d in 2 divided doses). Azithromycin is second line, in 1, 3, or 5 day courses.
otitis externa: how should you treat?
Want to limit additional moisture and mechanical inury (scratching). Otic antibiotic and steroid drops are very effective.
Can NSAIDs cause peripheral edema?
Yes.
As does rosiglitazone, calcium channel blockers, hormones, corticosteroids.
Malignant otitis externa: what bug do we classically think of, especially in swimmers or diabetics?
Pseudomonas aruginosa
Unilatteral leg swelling with signs of inflammation (erythema, warmth...). What should you expect? DVT? Vascular surgeon consult?
Treat with antibiotics, most likely a cellulitis.
Bedwetting (enuresis): what is typically the cause?
"Maturational delay." 25% of 5 year olds are enuretic, numbers decrease by 15% yearly. Family history is very contributory, and organic causes are very rare.