Step 2 Ck - Classic/relevant Treatments

Front 1

Acute tx of severe or symptomatic Hypercalcemia

Back 1

IV fluids 1st, xxxTHEN loop diuretics (but IV fluids 1st)xxx

CORRECTION from world 2633:

Immediate tx:
-Normal saline hydration plus Calcitonin
-Avoid loop diuretics unless fluid overload (CHF) exists as well

Patients with severe hypercalcemia are typically volume-depleted (b/c hypercalc. causes increased natriuresis)

Long-term tx:
-Bisphosphonates

Front 2

Croup

Back 2

nebulized Racemic Epinephrine

Front 3

Postpartum Endometritis

Back 3

Clindamycin and Gentamicin

(polymicrobial infection)

Front 4

Ethylene glycol poisoning

Back 4

❖ Fomepizole (comp inhibitor of alcohol dehydrogenase, so it stops the conversion of ethylene glycol to its toxic metabolites (glycolate & oxalate) which are what's causing all the renal damage and metabolic acidosis)

❖ Sodium Bicarbonate to alleviate the acidosis

❖ Hemodialysis in the case of acidosis &/or end-organ damage

Front 5

Tourettes' syndrome w/ severe symptoms

Back 5

The typical antipsychotics Pimozide or Haloperidol

Front 6

Torsades do pointes

Back 6

IV Magnesium

(even if Mg level is normal)

Front 7

DKA

Back 7

IV Fluids, Potassium, and Insulin

(Even if a pt is not hypokalemic at the time of presentation, there is still usu a potassium depletion that will require potassium supplementation. If you start an insulin drip on someone who has normal or low potassium, the insulin will cause the K+ to go into the cells, causing an even more severe hypokalemia which can lead to deadly arrhythmias!)

Front 8

A-fib with RVR (Atrial fibrillation with tachycardia present)

(irregularly irregular, absent P waves,and narrow QRS's)

Back 8

If hemodynamically STABLE (no hypotension, altered mental status) ➔ Rate control with either B-blocker or non-dihydropyridine CCB (diltiazem or verapamil) or Digoxin

If hemodynamically UNSTABLE ➔ DC Cardioversion

Front 9

Tx for Hep C with evidence of disease
(elevated liver end, detectable HCV RNA, and histo evid. from biopsy)

Back 9

Interferon-alpha and Ribavirin

Front 10

Primary Biliary Cirrhosis

Back 10

Ursodeoxycholic acid

(relieves sx and lengthens transplant-free survival time)

tx is liver transplant for severe dz

Front 11

Prophylactic Rx for 6 months after Gastric bypass surgery

Back 11

Ursodeoxycholic acid
(to decrease risk of gallstone disease/choecystitis, since up incidience post surgery b/c rapid wt loss increases the conc of bile and promotes the formation of stones)

Front 12

Initiation of HAART therapy in patient with HIV

Back 12

When CD4 < 350

(can at other levels but this is the grade 1A recommendation)

Front 13

HER-2/neu receptor (+) breast cancer

Back 13

Trastuzumab (anti-HER-2/neu receptor antibody = Herceptin)

Front 14

Tx for Tuberculous Meningitis

Back 14

typical 4 drug therapy--RIPE--
+ Corticosteroids
(in children and adults, not newborns)

Front 15

Asymptomatic bacteriuria in pregnancy

Back 15

Amoxicillin, Cephalexin, or Nitrofurantoin

(Contraindications during preg include: TMP-SMX, Fluoroquin's, & Tetracyclines

Front 16

Tx of early stage Parkinson's dz, in a younger patient, where tremor is the only symptom

Back 16

Trihexyphenidyl (an anticholinergic agent)

Front 17

Treatment for Ascites (stepwise approach)

Back 17

1) Sodium & water restriction
2) Spironolactone
3) Furesemide/loop diuretic (no more than 1 L/day of diuresis)
4) Frequent abdominal paracentesis (2-4 L/day, as long as renal fxn is ok)

Front 18

Tx for Acute Heart Failure

Back 18

"LMNOP"
Loop diuretics
Morphine
Nitrates
Oxygen
Pressors/Positioning

Front 19

Tx for Acute MI (or suspected/possible MI)

Back 19

"MONA BASH"

Morphine
Oxygen
Nitroglycerin
Aspirin/Antiplatelet

β-blocker
ACE Inhibitor
Statin
Heparin

Front 20

Prophylaxis for HIV pt with CD4 < 50

Back 20

Azithromycin or Clarithromycin (for prophylaxis against Mycobacterium avium complex (MAC))

Front 21

Histoplasmosis

Back 21

Itraconazole

(better than fluconazole)

Front 22

Central Retinal Artery Occlusion (CRAO)

Back 22

Ocular massage and high-flow oxygen administration

ocular massage dislodges the embolus to a point further down the arterial circulation and improves retinal perfusion

Front 23

Tx for SIADH

Back 23

Initial tx = FLUID RESTRICTION (to allow serum sodium concentration to rise).

If severely symptomatic or fluid restriction does not correct sodium, then hypertonic saline can be used +/- loop diuretics

technically demeclocycline can also be used to inhibit ADH effects but rarely used because can be nephrotoxic

Front 24

1st line tx's for bipolar disorder (4)

Back 24

Lithium, lamotrigine, olanzapine, and quetiapine

Front 25

Tx of Laryngomalacia

Back 25

No medical/intervention treatment, as it usually resolves by 18 months of age. Instruct parents to hold the child in an upright position for 30 min after feeding, and to never feed the child when he is lying down.

Front 26

Tx for Rheumatoid Arthritis

Back 26

As soon as dx made, start a DMARD--Methotrexate is initial drug of choice along with anti-inflam

Start on a DMARD asap following dx, rather than just using an anti-inflam drug, b/c better outcomes are achieved by early compared with delyed intervention with DMARDs.

Treatment options:
-Nonbiologic DMARDs DMARDs: MTX, Sulfasalazine, Hydroxychloroquine, Minocycline, leflunomide
-Analgesics (from acetaminophen to narcotics)
-NSAIDs
-Glucocorticoids
-Biologic DMARDs (TNF inhibitors--Etanercept, Infliximab, Adalimumab; IL-1 rec antagonist--Anakinra; Monoclonal antibodies--Rituximab; and biologic response modifiers--Abatacept

Front 27

Tx for Absence seizures (2)

Back 27

Ethosuximide or Valproic acid

Front 28

Recommended therapy for an acute bacterial exacerbation of COPD

(i.e. acute COPD exacerbation due to concamitant infectious bronchitis)

Back 28

-Supplemental oxygen

-Inhaled Bronchodilator (albuterol)

-Inhaled anticholinergics (ipratropium)

-Broad-spectrum antibiotic coverage
-2-week oral steroid taper (b/c it is proven to shorten hospital stays and prolong intervals between exacerbations)

Front 29

Definitive treatment for hyperthyroidism/Graves' disease for the best long-term outcome

Back 29

Radioactive iodine therapy

Contraindications for radioablation are Pregnancy and Very severe opthalmopathy

Front 30

PCOS--when should Metformin be used

Back 30

Metformin is indicated in PCOS patients who have Impaired Glucose tolerance (insulin resistance)...as seen as > 140 on a two-hour glc tolerance test

Front 31

Narrow-QRS-complex Tachycardia (Supraventricular arrhythmias)

Back 31

Adenosine

*needs review*

Front 32

Tx for Acne based on type (step-wise approach) and what each type means:

Back 32

Mild acne: OTC Benzoyl Peroxide and Topical Retinoids
(non-inflammatory comedones)
Mild-to-Moderate: + Topical antibiotics
(inflammatory acne)
Moderate-to-Severe+ + Oral antibiotics
(papular & inflammatory acne)
Severe acne: Oral Isoretinoin
(nodulocystic acne & scarring)

Front 33

Tx of Frostbite

Back 33

Rapid Rewarming with WARM WATER

(extremity should be immersed in warm water which is continously circulated; no infusions)

Front 34

Tx for Cluster headache

Back 34

-Longterm prophylaxis: VERAPAMIL is the DOC for tx of cluster headaches of duration longer than 2 mo

-For acute episodes: sumatriptan and oxygen, and ergots

Front 35

Tx of ABPA (Allergic BronchoPulmonary Aspergillosis)

Back 35

Oral Corticosteroids

Front 36

Rosacea

Back 36

Topical Metronidazole

Front 37

Acute Asthma Exacerabation

Back 37

Oxygen

Short-acting bronchodilators

Systemic (oral or IV) corticosteroids

Front 38

Cat bite

Back 38

Amoxicillin/Clavulanic acid prophylaxis

(if allergic to PCN, then use doxycycline)

Front 39

Clostridium difficile colitis

Back 39

If mild-to-mod: Oral Metronidazole

If severe (fever, WBC>15,000, creat > 1.5x baseline): Oral Vancomycin