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190 Cards in this Set
- Front
- Back
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The first step in treatment of a right ventricular MI
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volume expansion with 1L NS. If that doesn't work then use an ionotrop such as dobutamine.
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Classic Triad of RF infarct
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clear lungs
hypotension increased CVP (R-sided EKG will show ST segment in V4) |
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At what stage does mitral stenosis require mitral valve replacement?
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When regurg is moderate to severe
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Name the valvular disorder: prominant a-wave in JVP, parasternal impulse, ejection click, systolic thrill, early systolic murmur that increases with respiration and RVH and RAD seen on EKG
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pulmonic valve stenosis
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Treatment of a pregnant patient with heart failure: can you give an ACE and a beta blocker?
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NO ACEi or ARB but ok to give beta blocker. Monitor fetus for hypoglycemia and bradycardia
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Primary treatment of a left atrial myxoma
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surgical removal
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Anticoagulation strategy in a patient with thrombotic microangiopathy associated with APLS?
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heparin followed by warfarin
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Diagnosis of APS
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At least one type of antibiody (anticardiolipin or lupus anticoagulant) and at least one clinical feature (venous or arterial thrombosis, recurrent fetal loss, thrombocytopenia)
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Treatment of an acute gout attack in a patient who cannot take NSAIDs or oral steroids
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intra articular injection
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Side effect of colchicine in renal failure patients
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bone marrow suppression
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Is colchicine effective 24 hours after onset of symptoms?
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No
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Name the disease: asthma, allergic rhinitis and eosinophilia
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Churgh-Strauss
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Name the disease: + ANCA, anti-myeloperoxidase
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Churgh-Strauss
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Treatment of Churgh Strauss
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high dose corticosteroids
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Treatment of Churgh-Strauss that involves pulm, GI, CNS, renal or cardiac?
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corticosteroids + cyclophosphamide
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Management of patients with dermatomyositis when refractory to high dose steroids?
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Pan-scan. Note they already should have had age-appropriate screenings because of the increased risk of malignancy in this population.
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Side effect of TNF-alpha inhibitors
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drug-induced lupus
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Treatment of CNS lupus flare
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corticosteroids + cyclophosphamide
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Once remission is achieved with cyclophosphamide therapy, patients with lupus nephritis can be safely switched to...
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mycophenolate or azithiprine. Alt: decrease frequency of cyclophosphamide
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Treatment of early rheumatoid arthritis (2 possible drugs)
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sulfasalazine or hydroxychloroquin
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Which drugs should you avoid in management of RA when the patient drinks or has elevated LFTs?
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Methotrexate or leflunomide cannot be used
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What disease do you suspect in someone who has skin hyperpigmentation and OA of joints not typically seen in OA
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hemachromatosis
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Treatment of sclerodermal renal crisis
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ACEi
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Using corticosteroids to treat systemic sclerosis increases the risk of
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renal crisis
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Treatment of psoriatic arthritis
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methotrexate (treats both bone and cutaneous involvement)
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Mixed Connective Tissue Disease is characterized by features of (4)
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systemic sclerosis (skin thickening, sclerodactaly, digital pitting, lung fibrosis), myositis (serositis, prox mm weakness), SLE (raynaud, glomerulonephritis) and RA (arthritis and arthralgias).
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Name the disease: antiribonucleaprotein antibody
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mixed connective tissue disease
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Hematologic/renal Side effect of cyclosporine and tacrolimus
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microangiopathic hemalytic anemia and acute kidney injury
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Side effect of TMP-SMX
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bone marrow suppression
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Drug for relapsed and refractory MM whose side effect is peripheral neuropathy
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Bortezomib
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Name the disease:
personal and family history of bleeding prolonged bleeding time slightly long aPTT low factor VIII level |
von wIllibrand
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subtype of MDS with elevated platelets and anemia
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5Q- syndrome
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Treatment of choice for 5q- syndrome
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lenalidomide
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Patients with iron deficiency anemia that is severe and no proximal small bowel (usually secondary to surgery) require...
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IV iron supplementation
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Name four scenarios in which you can see erythrocytosis and elevated erythropoeitin levels
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exogenous (i.e. renal cell cA)
pulmonary disease cardiac disease high oxygen affinity Hgb |
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In polycythemia vera, erythropoeitin levels are usually (high, normal or low)?
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low
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Decrease the risk of stroke in sickle cell patients with
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monthly erythrocyte transfusion
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name the disease: menorrhagia, epistaxis, easy bruising, marked thrombocytosis, abnl plt aggregation studies
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ET
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Classic Triad and Pentad of TTP
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Renal Failure
Elevated temperature Neurological symptoms Anemia, hemolytic Low platelets |
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Tx ot TTP
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plasma exchange
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Treatment of pure red cell aplasia due to parvovirus B19
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erythrocyte transfusion + IVIG
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how much does one bag of apheresis platelets increase the platelet count?
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25K
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Anticoagulation used to prevent fetal loss in pregnant patients with APLS?
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heparin (preferably LMWH)
and aspirin |
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Name the disease: a progressively prolonged PT/INR and aPTT (with INR proportionately more prolonged) with a normal thrombin time in a malnourished patient who has recieved antibiotics recently
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vitamin K deficiency
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Can you give hydroxyurea in pregnancy?
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No
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Name the disease:
pancytopenia low retic count hypoplastic bone marrow |
aplastic anemia
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Management of MM
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autologous stem cell transplant
thalidamide + dexamethasone |
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Treatment of MRSA cellulitis & bacteremia in a patient allergic to vanc
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dapto
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Treatment against a mild diabetic foot ulcer should be directed at
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only aerobic gram positive cocci such as staph and strept. No need to cover for anerobes or aerobic gram negative bacilli
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A patient with a diabetic food ulcer that goes to the bone requires
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a bone biopsy - UNLESS the wound culture is growing MRSA, then you treat for MRSA osteo
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Treatment of a brain abscess secondary to dental infection
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PCN G and metonidazole
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Bet imaging modality in a patient with a suspected osteo
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MRI
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skin and soft tissue infection in a post surgical patient post implantable device that has a chronic purulent drainage and lack of common orgs on basic cultures/lack of response to typical antibiotics and purple nodules should be worked up for
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mycobacterium abscesses (RGM)
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fungal infection in immunocompromised host + slender mycelia with acute angle branching that is non aspirgillus suspect
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psuedallescheria or scedosporium
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treatment of psuedallescheria or scedosporium
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vori or posi
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name the disease: widenened mediastinum, box car shaped gram positive bacilli
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anthrax
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treatment of inh anthrax
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doxy or fluorquinolone + (any of the following): PCN, erythromycin, vanc, rifampin, or clinda
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CMV infections occur approximately __ months after transplant in a patient without appropriate prophylaxis
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2-6
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Treatment of kaposi's sarcoma
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HAART, regardless of CD4 count
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treatment of listeria monocytogenes
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PCN or ampicillen + aminoglycoside
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treatment of pulmonary aspirgillosis in an immunocompromised patient
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voriconazole
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What might you suspect in someone with unusual susceptibility to neisserial infections
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classic and alternative lectin pathways of the complement system maybe disordered
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Name the disease: absence of gram negative diplococci and a thin mucoid discharge from the penis
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non gonococcal erethritis
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Treatment of nongonoccoal urethritis
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azithromycin
(alt doxy) |
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diagnosis of histo
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histo urinary antigen
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where does histo come from?
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bird or bat droppings
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what to suspect in a person with multiple episodes of PNA who is otherwise healthy whose CXR shows micronodular interstitial pattern and an exposure history
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hypersensitiveity pneumonitis
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Treatment of "hot tub lung"
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coricosteroids
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what do you suspect in a patient being treated for a parasite such as lyme who is not responding to appropriate treatment?
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They might have a dual or triple infection
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Name the diease: nephropathy in a kidney tranplant patient, decoy cells (intranuclear inclusions)
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BK virus polyomavirus
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Effective and convenient drug for home care in a patient with deep soft tissue infection is:
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ertepeneum
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Treatment of acyclovir-resistant HSV
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foscarnet
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Drugs (3) that can increase cyclosporine levels
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dilt
ofloxacin vori |
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Name the toxic drug:
decreased kidney function tremors nausea, vomitting hypertension |
cyclosporine
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how do you confirm diagnosis of herpes encephalitis
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HSV PCR
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Treatment of a human bite wound to the hand
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anox-clav
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diagnosis of vCJD
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tonsillar biopsy
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the most common cancers in transplant patients
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squamous cell carcinoma (and others of the skin)
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Name the disease: erythematous excoriated papules along clothing lines, occ with central punctum and history of outdoor activity
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chigger bites
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preferred method of biopsy for diagnosis of lentigo maligna
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a broad shallow shave biopsy
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what do you do when someone has urticarial plaques that remain in a fixed position for longer than 24 hours and burn?
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biopsy them as this could be indicative of urticarial vasculitis
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Name the disease: intercellular IgG, Nikolsky sign, autoantibody to desmoglein 3 or 1, acantholytic cells
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pemphigus vulgaris
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Which types of patients are more susceptible to disseminated cutaneous herpes virus infection?
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Patients with atopic dermatitis
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Name the disease: dryness of the eyes, conjunctuval scarring (trichiasis symbepharon) requires diagnosis by conjunctuval biopsy
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ocular cicatricial pemphigoid
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Name the disease; a patient with an underlying systemic illness such as IBD, gets a big ulcer after trauma
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pyoderma gangrenosum
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treatment of pyoderma gangrenosum
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systemic corticosteroids
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treatment of menstrual related migraines
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mefenamic acid
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how do you diagnos cerebral venous sinus thrombosis?
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MRI
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name the disease: proximal mm weakness, dry eyes, dry mouth, constipation, ED, absent deep tendon reflexes in a patient with small cell lung CA
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lambert eaton myasthenic syndrome
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diagnosis of lambert eaton myasthenic syndrome
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EMG testing and autoantibodies to P/Q-type calcium channels
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what do you do with patients who have trigeminal neuralgia at age < 40
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MRI
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treatment of myasthenic crisis
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plasma exchange
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name the disease: rapidly progressive extremity weakness, parasthesias and areflexia
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GB
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What is the BP threshold for IV tPA?
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185/110
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Name the disease: a neurogenerative disorder that causes impairment of multiple neurolgic systems including ANS (orthostatics, ED constipation), extrapyramidal (rigidity, impaired gait) and cerebellum (limb ataxia)
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multiple system atrophy
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what do you do for a patient who remains unresponsive but NOT twitching after resolution of an obvious seizure
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EEG monitoring to make sure they aren't having silent siezure activity
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what is a potential side effect of prochlorperazine
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acute dystonic reaction
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treatment of an acute dystonic reaction
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benztropine or benadryl or biperdin
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name the disease: acute unilateral HA associated with hornor syndrome
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carotid dissection
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treatment of acute carotid dissection
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IV heparin
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what do you do when you have a patient with thunderclap headache with a normal CT?
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LP
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How long to people require therapy when they have juvenile myoclonic epilepsy?
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lifelong
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treatment of fatigue in MS
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amantadine
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treatment of migraine during pregnancy
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metoclopramide
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siezures that present in adulthood are usually
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partial
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siezures where you don't lose conciousness
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simple
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side effect of metoclopramide
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drug-induced parkinsonianism
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imaging modality of choice for suspected brain mets
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gad-enhanced MRI
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how do you treat primary progressive MS?
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there is no treatment
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a headache that is like cluster headache but shorter in duration is called
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paroxysmal hemicrania
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treatment of paroxysmal hemicrania
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indomethacin
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treatment of otitis media in adults
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amox
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acceptible colon ca screening alternatives
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FOBT annually
flex sig q5 with FOBT q3 double contrast barium enema q5 |
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treatment of chronic prostatitis/chronic pelvic pain syndrome
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alpha blockers such as terazosin
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nbame the disease: bilaterally painful red eyes, pain is deep and boring, wakens from sleep, assocaited with photophobia, tearing, may have underlying connective tissue disease, cannot see white under the engorged blood vessels
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scleritis
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frequent or constant pulsatile tinnitus requires
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an ENT eval and CT angio or MRA. IT could be an AV fistula, AV malformation, arterial aneurism, tumor or atherosclerotic disease
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name the disease: tinnitus, sensorineural hearing loss, episodic vertigo
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meniere
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name the disease: pain along the joint line, pop or snap when flexed hip and knee, abduction, externally rotate foot and passively extend knee, severe pain and swelling, pain worse with stairs
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meniscal tear
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First step in treatment in an elderly person with multifactorial dizziness
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PT
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what type of mattress can reduce the incidence of pressure ulcers
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specialized foam mattresses or overlays
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patients who present with acute vertigo who have risk factors for stroke should undergo
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MRI
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name the disease: acute onset of painless visual loss and cha cherry red spot near the fovea
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central retinal artery occlusion
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a healthy young person with anemia and LFTs noted incidentally could indicate
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celiac disease
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what might weight loss drugs contain?
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endogenous thyroid hormone
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Clinical markers that should prompt surgery in an asympomatic patient with severe MR
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L ventircular enlargement or dysfunction
AFib PA pressures >50 or exercise induced elevated PA pressures |
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best treatment options for stage II and III rectal ca (in general)
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surgery PLUS adjuvant chemo
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RSBI
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RR/TV, should be <105
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when a patient is already on metformin and sulfonurea (glimepiride) who won't take insulin the next best agent to add is
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actos (pioglitazone)
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what is the only potential cure for localized pancreatic CA?
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surgery
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what is a complication of longstanding antibiotic therapy for acne?
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gram negative folliculitis
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treatment of gram negative folliculitis
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isoretinoin
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How does CAD in heart transplant patient present?
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atypically - CHF, decr ET, syncope or just MIO
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A brain MRI shows demyelination after the first ever event in a patient, what is his chance of developing MS?
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90%
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name the disease: an inherited musculoskeletal disorder characterized by hypermetabolic state precipitated by exposure to inhaled anesthetics (halothane) or depolarizing mm relaxants (succinylcholine or decamethorium)
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malignant hyperthermia
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how do you distinguish malignant hyperthermia from NMS?
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NMS usually has an exposure history to haldol. MH gets a mixed acidosis.
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How is respiratory bronchiolitis ILD different from ILD?
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smoking history
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how do you treat fundic and body gland polyps?
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they confer no cancer risk so you can leave them there and they usually regress with h. pylori tx
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the most common infection associated with erythema multiforme is
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HSV
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About 1/3rd of patients with abdominal pain with SLE have
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mesenteric vasculitis
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Hypercalcemia associated with sarvoidosis is treated with
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prednisone
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Treatment of non-hodgkin B cell lymphoma
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R-CHOP and involved field radiation
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Which nephropathy may occur secondary to malignancy and is associated with renal vein thrombosis?
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membranous nephropathy
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what is the most common cause of hypercalcemia in the outpatient setting?
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hyperparathyroidism
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to diagnosis osteonecrosis or avascular necrosis of the femoral head
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get an MRI
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which patients are at risk for fulminant hepatic failure secondary to hep E?
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pregnant patients and those with chronic advanced liver disease (usually also have a history of travel to underdeveloped countries)
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treatment of recurrent pericarditis
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colchicine
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if a heart failure patient is unable to tolerate an ACE inhibitor what is a suitable alternative?
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hydralazine and nitrate
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The best way to diagnosis a TB pleural effusion is by
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pleural biopsy
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TB effusions are usually (exudative vs transudative)
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exudative
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how do you calculate an exudative fluid?
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pleural fluid protein/serum protein >0.5 OR pleural fluid LDH >0.67 the upper limit of normal of serum LDH
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treatment of chronic refractory ITP (not responsive to prednisone, IBIG and ritux)
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thrombopoein receptor agonist
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treatment of choice for humoral hypercalcemia of malignancy is
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IV zolendronate & aggressive IV hydration
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name the disease associated with anti-glutamic acid decarboxylase
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LADA (late onset autoimmune diabetes of adulthood)
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TSH goal in a pregnant patient
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1.5x normal
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what drug might someone be surreptitiously or inadvertnetly taking when C-peptide and insulin levels are both high
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sulfonurea
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Management of an unruptured intracranial aneurism that is <7mm
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annual MRI or CTA
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hearing loss and tinnitus that is unilateral suspect
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acoustic neuroma
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what is a pituitary mass that mimics and adenoma, presents later in pregnancy and is associated with adrenocorticotropic hormone deficiency?
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lymphocytic hypophysitis
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how does pituitary tumor apoplexy present?
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severe HA, stiff neck, decr mental status
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what can you do to study pulmonary noduels 1-2cm in diameter
|
transthoracic needle aspiration
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name the disease: mild lifelong asymptomatic hypercalcemia in multiple family members and an inadequately normal PTH
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benign familiar hypocalciuric hypercalcemia
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how do you diagnosis benign familial hypocalciuric hypercalcemia?
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urine calcium to Cr clearance ratio
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name the disease: localized itchiing on the back without evidence of lesions
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neuropathic pruritis (notalgia paresthetica). can also occur on the arms. Usually occurs near the scapula
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name the disease: inflammatory arhtritis that manifests within two months of an episode of bacterial gastroenteritis, nongonoccal urethritis, cervitis, or conjunctuvitis
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reactive arthritis
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what do you do when a patient presents with stage II HTN?
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initiate treatment immediately
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what do you do with incidental discovery of white matter changes on an MRI of an sympomatic patient?
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nothing
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treatment of acute PE
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SQ unfractionate heparin or SQ LMWH or fondaparinox
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name the disease: young woman with progressive daily HA assoc with pulsatile tinnitus and transient visual obscurans and increased opening pressure
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idiopathic intracranial HTN
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treatment of idiopathic intracranial HTN
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acetazolamide
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evaluation of a new onset seizure
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EEG and MRI
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at what BMI are patients elegible for bariatric surgery?
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BMI>40 or >35 with comorbidities
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definition of persistant asthma
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symptoms 2 days/week or 2 nights/month
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treatment of persistent asthma
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inhaled corticosteroid and PRN albuterol
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if an acute angle glaucoma patient cannot tolerate timolol because of asthma flares, what in the world do you do?
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ask their ophthamologist to change them to oph ggts with prostaglandin instead
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what can decrease the risk of calcium oxalate stone formation?
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high calcium diet
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initial treatment of pemphigus vulgaris
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prednisone, initially
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Treatment of persistant H. pylori gastritis (after appropriate treatment with PPI and triple antibiotics therapy) is
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bismuth subsalicylate, metronidazole and tetracycline
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antibiotic resistence with H Pylori is frequently seen with
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clarithromycin
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GI side effect of TMP
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drug-induced liver injury characterized by a cholestatic pattern (elevated alk phos)
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when do you start doing colonoscopopies and how often in patients with UC?
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after 8 years of the diagnosis and then you scope them every 1-2 years
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how do you diagnos gastrinoma?
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gastrin levels
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what is the next step in a patient with a high pre-test probability of GERD who failed to respond to PPI
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ambulatory esophgeal pH monitoring
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what test should you do in someone with a new diagnosis of MALT lymphoma
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H. pylori
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what disease has transmural inflmmation that can extend to muscles and cause abscesses?
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crohns
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in patients whose crohn's disease becomes refractory to immunomodulator therapy, give
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anti-TNF alpha therapy such as infliximab
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name the disease: GERd symptoms, barium esophagography shows a segmented "corkscrew" appearance and manometry shows simultaneous contractions in >20% of swallows
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diffuse esophageal spasm
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treatment of diffuse esophageal spasm
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PPI
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name a late complicatino of bariactric surgery that presents with diarreha, bloating, features of malabsorption
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small intestine bacteria overgrowth
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treatment of a <5mm kidney stone located distally in the absence of pyria
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analgesics and hydration
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lithium-induced nephrotoxicity may manifest as
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DI
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