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371 Cards in this Set
- Front
- Back
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Best test for polyarteritis nodosa? |
Sural nerve biopsy
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Treatment of proteinuria w/ Berger disease? Severe exacerbation?
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ACE-I/ARB; steroids
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Best initial test for PSGN?
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ASO/antihyaluronic acid
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Most accurate test to dx PSGN?
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Biopsy; but not necessary
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Treatment of TTP-HUS?
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DO NOT GIVE ANTIBIOTICS; don't give platelets… ; SUPPORTIVE and plasmapheresis
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Symptoms of cyroglobulinemia?
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Joint pain, neuropaty, purpuric skin lesions, BUT NO GI SX
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Best treatment for proliferative renal disease in SLE?
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Steroids + mycophenolate
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What steroid is used w/ ulcerative colitis?
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Budesanide
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Treatment of amyloidosis?
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Melphalan, prednisone
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What causes non-pitting edema?
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Hyper/hypothyroidism, lymphedema, lipedema, myxedema
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How does the edema of nephrotic syndrome differ from CHF?
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CHF is dependent edema; nephrotic edema can occur anywhere (ex. periorbital)
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When is bacteriuria a SIGNIFICANT finding? Why?
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Pregnant women; 30% of pregnant women with asymptomatic bacteruira develop pyelo
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What test is superior to 24 hour urine protein collection?
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Spot protein/creatinine ratio
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Four indications for dialysis?
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Acidosis, hyperkalemia, encephalopathy, pericarditis
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How do you prevent contrast dye renal toxicity?
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Hydration, bicarbonate, n-acetylcystine
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What is sevelamer?
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Non-calcium containing phosphate binder for CKD
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What is cinacalcet?
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Calcium analog that feedback inhibits PTH release
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What is the side effect of aluminum based calcium binders?
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Dementia, constipation
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How do you treat platelet dysfunction w/ uremia?
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DDAVP
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What is the goal BP for CKD or DM?
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130/80
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Why do you get infection w/ uremia?
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WBCs can't degranulate
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Palpation of liver far below the costal margin indicates hepatomegaly?
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2 cm
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Acute suppurative sialdenitis
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Dicloxaccin, amoxacillin-clavulonate
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Most common risk factor for frozen shoulder?
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DM
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Frozen shoulder symptoms
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Stiffness, loss of active and passive shoulder rotation, severe pain including at night with normal film findings
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How do you differentiate a frozen shoulder from a rotator cuff injury?
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Rotator cuff has normal passive range of motion; frozen has abnormal
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How do you differentiate a frozen shoulder from nerve impingement?
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Impingement will have no change in range of motion and pain with elevation
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Elderly with HIV/steroid use/lymphoma/neonate and acute bacterial meningitis; what tx? Why?
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Add ampicillin to ceftriaxone and vancomycin; listeria is resistant to all cephalosporins
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Who should get antibiotic prophylaxis w/ meninigococcemia?
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Household contacts and those with salivary transfer; NOT routine personal contacts
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How do you know menignits vs abscess vs encephalitis?
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Meningitis: neck pain; encephalitis: acute confusion; abscess: focal neurological signs
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Most accurate diagnostic test for herpes encephalitis?
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PCR
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If you have a patient with HIV who gets a ring enhancing lesion; doesn't get better with pyramethaine-sulfadiazine; dx?
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Primary CNS lymphoma
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First step in management of a HIV negative person with a ring enhancing brain lesions?
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Biopsy
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Test of choice for dxing chronic pancreatitis?
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Secretin stimulation; low bicarbonate secretion
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Most common cause of meningitis in adults?
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Strep. Pneumiae
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DOC for strep pharyngitis?
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Penicillin V
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DOC for strep pharyngitis if they get a rash w/ penicillin? If they get anaphylaxis?
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1st gen cephalosporin; macrolide
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#1 bacterial cause of bronchitis?
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Strep pneumo
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DOC for bronchitis?
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Amoxicillin
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Fever cough and sputum; if fever is high vs low; DX?
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high: abscess; low: bacterial bronchitis
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Single most accurate test for lung abscess? First test?
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Biopsy; CT/CXR
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DOC for outpatient pneumonia?
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Azithromycin / levofloxacin
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DOC for in patient pneumonia
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Azithromycin + Cefotaxamine OR levofloxacin
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DOC for legionella, coxiella, mycoplasma?
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Azithromycin / doxyclcine
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If you're allergic to sulfa, how do you TREAT vs prophylaxis PCP pneumonia?
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Treat: pentamadine; prophylaxis: dapsone/atovaquone
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Best test to dx legionella pneumonia?
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Urine antigen
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Best initial test for TB if positive CXR?
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Sputum culture acid fast stain; then start emperic therapy
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Tx for symptomatic TB? Asymptomatic TB?
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INH/RIF/PZA/ETHAMBUTOL for 2 months, then INH/RIF for 4 months
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When is TB tx longer than 6 months?
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TB osteomyelitis, brain, miliary, pregnant
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Person has +PPD; TX?
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9 months of INH alone
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Diarrhea with hepatitis + bullous skin lesion; DX?
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Vibrio vulnificus
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When should you treat diarrhea? With what?
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Hypotension/blood diarrhea/ systemic sx; CIPRO
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Best test for giadria?
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Postive stool elisa antigen (NOT OVUM & PARASITES)
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Most accurate test for PID? Best initial test?
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Accurate: laproscopy; initial: PREGNANCY TEST
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What type of arthritis is produced by gonorrhea?
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Polyarticualr
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What is the treatment for syphilis if you're allergic to penicillin?
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Primary and secondary: doxy; tertiary: desensitize to penicillin
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Best initial test for herpes?
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Tzanck > culture
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Tx for acycolovir resistant herpes?
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Foscarnet
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Beefy red penis; dx? Tx?
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granuloma inguinale; sulfas
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Tx of UTI in pregnant woman?
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Nitrofurantoin, amox, or macrodantin
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How does erysipelas differ from impetigo?
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Erysipelas blocks the lymphatics; becomes red and tender
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Tx for impetigo?
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Bacitracin or mupirocin
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Tx for cellulitis?
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Dox/clox/ox/nafacillin OR cefazolin/cephalexin
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Tx for tinea versicolor?
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Selenium sulfide or topical antifungal (azole)
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Best initial test for any topical fungal infectoiN?
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KOH prep, culture => TREAT
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Do you culture draining tract of an osteomyelitis?
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No
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Best initial test for osteomeylitis? Best subsequent test if first test is negative?
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X-ray; if negative, then get an MRI (or bone scan if there isn't a MRI option)
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Most accurate test for osteomyelitis?
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Biopsy/culture
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Tx for osteomyelitis - MSSA, MRSA, g- bacilli?
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MSSA: ox/naf; MRSA: vanc/linzeold; g-: ciprofloxacin, levofloxacin
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Most likely person to get a joint infection?
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JOINT REPLACEMENT #1; also people with rheumatoid arthritis or osteoarthritis
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Best intial test for endocarditis?
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BLOOD CULTURE (do not do an echo first!!!)
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Initial tx for endocarditis? What about after you get cultures?
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Vancomycin/gentamicin initially; if MSSA: ox/naf, if MRSA: vanco, if viridans: pen/ceftriaxone
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What are the symptoms of cord compression?
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Exaggerated DTRs, low back pain, TENDERNESS to palpation***
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Patient comes in with back pain, TENDER to palpation, hyperactive DTR; next step in management?
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ADMIN STEROIDS (do not do MRI first!)
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When is a CT myelogram the best answer?
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For low back pain with tenderness when you can't get an MRI
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Best initial test for syringomyelia?
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MRI
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What causes right hemanopsia without macular sparing?
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Loss of the left optic tract or radiation
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Best initial test for person with stroke symptoms? WHY?
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Non-contrast CT (negative in ischemic vs positive in hemorrhagic)
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Risk factors for stroke
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DM, HTN, hyperlipidemia, smoking
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Best initial treatment of an ISCHEMIC stroke? What are conditions?
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tPA <3 hours (NO CONTRADINDICATIONS (history of brain bleeds, major surgery in past 2 weeks, severe HTN)); give ASA if > 3 hours
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Most ACCURATE test for stroke?
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MRI
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Patient develops new ischemic stroke while on aspirin, what do you do next?
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Add dipyridamole or switch to clopidogrel
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What INR do you want for anticoagulation? What is the exception that requires higher INR?
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2-3; metal valve should have 3-4
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What tests besides CT should a person with a stroke get to evaluate source?
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ECHO; EKG; carotid doppler
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What is the clearest indication for carotid endarectomy?
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>70% carotid stenosis (>60% men) + cerebrovascular accident
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Tx for aortic vs mitral stenosis?
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Aortic replacement; mitral balloon
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What heart valve defect presents in pregnancy?
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mitral stenosis
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Does high or low calcium cause seizures?
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Low calcium
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How do you die to hypomagnesemia?
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Ventricular arrhythmia (torsades)
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How does syncope differ from seizures?
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Syncope has no post-ictal period, recovers quickly, no incontinence/tongue biting; seizure: post ictal, slow recovery, incontinence / tongue biting
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When should you do EEG?
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After you exclude cardiac, metabolic, toxic causes of seizure
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Initial tx for status epilepticus?
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Lorazepam => phenytoin => barbituates => propofol/midazolam and intubation (stepwise)
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Should you treat a person with a first time seizure?
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Only if they have family hx, positive EEG, or come in w/ status epilepticus
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What antiseizure medicine causes vertigo and ataxia?
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Phenytoin
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What is the most likely cause of light headedness?
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Presyncope is due to CARDIAC problem
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Two best symptoms to distinguish central vs peripheral vertigo?
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Peripheral: + hearing loss, +tinnitus; both - in central vertigo
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What is the presentation of labyrinthitis?
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Recent viral illness with vertigo/nystagmus/hearing loss/tinnitus; self resolves
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What is the presentation of perilymphatic fistula?
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History of TRAUMA to ear with hearing loss, tinnitus, vertigo/nystagmus
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Initial treatment of vertigo?
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Meclizine
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Initial treatment of Menier's disease?
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Salt restriction and diuretics
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Most accurate test for temporal arteritis? Best initial first step in management?
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Biopsy; give steroids
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Best initial tx for brain tumor before surgery?
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Steroids + mycophenolate
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After you get a non-contrast CT, what test shoud you perform next with a subarachnoid hemorrhage?
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Angiogram
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Peresentation of tension headache?
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Bilateral, band like headache with nausea, NO FOCAL FINDINGS
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Prophylactic tx for migraine/cluster HA?
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Propranolol > CCBs > TCAs/SSRIs/antiseizure medications ; for clusters you can use lithium/steroids
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Abortive therapy for migraine/cluster HA?
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Triptan/ergotamine; 100% O2 for cluster
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Obese young woman with a headache, diplopia, and on oral contraceptives; normal CT and papilledema; dx?
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Pseudotumor cerebri
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Initial tx of trigeminal neuralgia? Secondary treatment if initial tx fails?
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Carbamazapine; rhizotomy (cut the nerve)
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Do you have DTRs with Guillain-Barre?
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No
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What should you monitor to determine whether a person with Guillain-Barre should be intubated?***
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Vital capacity (inspiratory)
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Best initial tx of Guillain-Barre?
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IVIG (better than plasmapheresis)
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Do you use steroids with Guillain-Barre?
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NO!
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Best initial test for Guillain-Barre? Most accurate test?
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LP showing albumin-cell disassociation; electromyelography (EMG)
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Best initial test for myasthenia gravis? Most accurate test?
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Test for anti-NAChR antibodies; electromyelography (EMG)
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Initial tx of myasthenia gravis? If initial tx fails? If second tx fails?
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Pyridostigmine; thymectomy if < ago 60, steroids if > age 60; immunosuppression (azathioprine, cyclosporin)
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Initial tx of acute myasthenic crisis?
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IVIG + plasmapheresis
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Best initial test for multiple sclerosis? Most accurate test?
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MRI is best initial and most accurate
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Best treatment for acute severe MS? Disease modifying therapy (chronic)?
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Steroids; glantiramer/interferon beta
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What is tizandine used for?
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Relieves spastic paralysis
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Best initial tx for Cruetzfeldt-Jacob disease?
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14-3-3 protein in CSF
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What three tests are required for evaluation of dementia?
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TSH/T4, head CT, RPR/VLDR
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First and second most common causes of dementia?
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Alzheimer's disease > multi-infarct dementia
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What questions are asked in the MMSE?
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Date? Can you remember 3 objects after 5 minutes? Reverse 7s, spelling world backwards
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Memantine MOA? Use
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NDMA antagonist; severe alzheimer's disease
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Best initial test for Parkinson's disease?
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There is no test… clinical diagnosis
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What is the vascular presentation of Parkinson's? What do you call this form?
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Orthostatic hypotension; Shy-Drager syndrome
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Initial treatment for mild Parkinson's and < 60 y/o? > 60 y/o?
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< 60: benztropine; > 60 amantadine
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Treatment of severe Parkinson's disease?
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Carbidopa/levodopa; selegiline; encaptone
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What type of tremor is associated with cerebellar disease, parkinson's disaese, and essential tremor?
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Cerbellar: intentional only; parkinson's: resting only; essential: both resting and intention
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Initial tx for restless leg syndrome?
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Prampiexol/ropinirole
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Tx of herpetic keratitis?
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Idoxuridine, trifluridine
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What field of vision is lost in open angle glaucoma?
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Peripheral fields (tunnel vision!) vs central scotoma in ARMD
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Best initila treatment of central retinal artery occlusion?
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Massage therapy + 100% O2
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What causes keratitis/uveitis followed by acute retinal necrosis in a patient with HIV?
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HSV/VZV
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Patient has sudden loss of vision, a fundus that is difficult to visualize, and onset of floaters in one eye; dx?
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Vitreous hemorrhage
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What condition is associated with vitreous hemorrhages
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Diabetic retinopathy
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Patient has a thrombosis of a subclavian line; best initial step in management? Subsequent steps?
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REMOVE THE CATHETER; then do ultrasound and start anticoagulation if +
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If patient has pseudogout, what conditions should you test for?
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Hemochromatosis, hyperparathyroidism, hypophosphatemia, hypomagnesemia
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Initial treatment of uremic pericarditis?
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Hemodialysis
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What bug causes subacute endocarditis post cytoscopy?
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Enterococcus
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What antihypertensive drug has a side effect of peripheral edema?
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CCBs
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What is the initial step in management of aortic dissection? Second step in management?
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Antihypertensive management => transeosphageal echo
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What heart medications demonstrate use depenence?
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Class I antiarrhythmics; effect on QRS compelx changes based on magnitude of heart rate
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Is smoking cessation or cholesterol management most effective in lower risk of AAA?
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Smoking cessation
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Normal JVD?
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3 CM or less
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Tx for pulseless a-fib?
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Chest chompressions (NOT syncrhonized cardioversion)
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What arrhythmia is associated w/ digitalis toxicity? COPD?
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Dig: atrial tach w/ AV block; multifocal atrial tachycardia
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27 y/o woman with HTN; what is the most likely drug to cause this?
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OCP
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How is lidocaine used in a patient with MI? What does it increase the risk of?
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Ventricular arrhythmias; asystole
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What are the top two non-pharmacologic means of decreasing BP?
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Weight loss > DASH diet
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What can cause a mid-diastolic rumble at cardiac apex, low grade fever, fatigability, weight loss, stroke?
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Left atrial myxoma
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What causes isolated systolic hypertension in the elderly?
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Decrease in compliance of arteries
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Initial treatment for hemodynamically unstable SVT?
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DC cardioversion
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Initial treatment for type A vs type B aortic dissection?
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Type A: labetalol then surgery; type B: labetolol only
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Initial treatment of a-fib < 48 hours? > 48 hours?
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DC cardioversion; 3-4 weeks of rate control w/ beta blockers or CCBs and anticoagulation => cardioversion
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Initial treatment for asymptomatic vs symptomatic PVCs?
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Asymptomatic: observation; symptomatic: beta blockers (amiodarone second line)
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Most common cause of death with acute MI?
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Reentrant ventricular arrhythmia (V-fib)
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Initial treatment of premature atrial beats?
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Observation only
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Dilated neck veins, new onset RBBB suggest what?
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Right heart dysfunction due to massive PE
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Effect of septic shock vs cardiogenic shock on PCWP and MVo2?
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Septic: decreaesd PCWP & normla MVo2; cardiogenic: increased PCWP & decreased MVO2
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Initial treatment of cocaine induced cardiac ischemia?
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Benzos, nitrates, aspirin (DO NOT USE BETA BLOCKERS)
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What type of MI presents w/ ST elevation in leads II, III, aVF? What artery?
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Right coronary artery => inferior wall infarct
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QRS peak alternates in hieght over inspiration/expiration; dx?
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Pericardial effusion (likely postviral)
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What causess a pansystolic murmur 3-10 days after MI? 10+ days?
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Papillary muscle rupture; ventricualr aneurysm
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What are the EKG signs of ventricualr aneurysm?
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Persistent ST elevations
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When is clopidogrel given as secondary prevent post MI?
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1) patient can't tolerate clopidogrel; 2) post percutaneous coronary intervention; 3) post UA/NSTEMI
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Besides cardiac tamponade and pericardial effusion, what conditions can cause pulsus paradoxus?
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Tension pneumothorax, severe asthma
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Most sensitive lab value indication of dehydration?
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Elevateed BUN/creatnine ratio
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Best initial treatment of Dressler's syndrome?
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NSAIDS then steroids in refractory cases
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EKG presentation of pericarditis?
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Diffuse ST elevation, AvR depression, PR depression
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Best initial test for AAA?
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Abdominal ultrasound
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When are nitrates and beta blockers contraindicated with an MI?
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Inferior wall MI that primarily affects the RIGHT VENTRICLE; decreased venous return exacrebates symptoms
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Symptoms of a right ventricular infarction?
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JVD, hypotenison, with clear lung fields w/ an inferior wall MI
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Initial treatment of RV infarction?
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Fluid resuscitation
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What is an early deceleration?
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Increased vagal tone due to compression of fetal head; not associated with hypoxia or acedemia
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What is a late deceleration?
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Uteroplacental insufficeincy (maternal HTN, maternal hypotension, diabetes)
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What is a variable deceleration?
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Umbilical cord compression during uterine contraction
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What is an acceleration?
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Increase in FHR stimulation of the sclap and ensures fetal arteirl pH > 7.2; GOOD SIGN
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What is the infectious cause of most acute bronchitis?
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Viral
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Tx of acute bronchitis?
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Bronchodilators, antitussives, analgesics
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If patient has green/yellow sputum, what does this indicate?
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DOES NOT INDICATE BACTERIAL VS VIRAL…
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Initial tx for a mycoardial infarction?
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Morphine, oxygen, nitroglycerin, aspirin, beta blocker, heparin
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LDL goal for person with heart attack hx?
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Less than 70
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What GFR defines ESKD
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< 15 mL/min
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Initial test for person with 3 day history of shortness of breath, rapid weight gain and CKD?
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CXR to confirm pulmonary edema
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pH of bacterial vaginosis?
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>4.5
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Is diverticular bleeding painful or painless?
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Painless
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Does diverticulitis increase the risk of GI cancer?
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No
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Tx of choice of CAP in healthy person?
|
Macrolide
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What is the primary use of trazadone?
|
Sleep aid
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What amount of time determines bereavement vs depressioN?
|
2 months
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What OCPs can be safely used with breast feeding?
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Low dose pure progestins
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What is lochia?
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Yellow-white discharge consitening of blood/dicuda/fibrin following delivery; NORMAL
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When does mensturation begin in a non-breastfeeding woman post partum?
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3 months
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Four causes of postpartum hemorrhage? Most common?
|
TONE (uterine atony), TRAUMA, TISSUE (retained placenta/membranes), THROMBIN (coagulopathies); uterine atony most common
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Tx of post partum uterine atony?
|
Oxytocin injection with bimanual uterine massage; if that fails use methylergonovine if patient doesn't have HTN or PGF2a if patient has HTN
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Patient has a postpartum fever and foul smelling lochia; most likely dx?
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Endometritis
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Normal duration of post-partum blues?
|
10 days
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Are SSRIs safe with breast feeding?
|
Yes
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What does hepatojugular reflux indicate?
|
CHF
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What does Cheyne-Stokes repsiratory indicate?
|
CHF/pulmonary edema
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Initial tx of acute CHF?
|
O2 by nasal canula, then furosemide
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First like tx in a patient with CHF and decreased LV function?
|
Ace-I/ARB
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Patient with CHF is on maximum medical therapy and ejection fraction <35%; next step in management?
|
Cardiac resynchroniszation therapy
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Best screening test for chlamydia?
|
NAAT
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Best initial treatment of isolated systolic HTN?
|
HCTZ >>>> Beta blocker
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What three things should you do BEFORE getting a prolactin level in a woman w/ galactorrhea?
|
Pregnancy test, TSH test (hypothyroid), drug history (antipsychotics)
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What are two causes of BILATERAL carpal tunnel syndrome?
|
Hypothyroidism, acromegaly
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What are three pharmacological treatments of acromegaly?
|
Octreotide; add pegvisomant or dopamine agonists (cabergoline) if not sufficient
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What is the best test for pan-hypopituitarism?
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Test for hormones that are lost first; growth hormone via arginine or insulin induced hypoglycemia
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Sx of pituitary apoplexy?
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Acute onset hypopituitarism in a person with pituitary adenoma; headache, altered mental status
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Sx of empty sella syndrome?
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No hypopituitarism, but pituitary can't be visualized on CT/MRI… due to herniation of dura
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What ion conditions can cause nephrogenic DI?
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Hypercalcemia, hypokalemia
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Tx of nephrogenic DI?
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HCTZ, amiloride, indomethacin
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What psychiatric drug can cause SIADH?
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SSRIs
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Treatment of hyperthyroidism in pregnant women? What if that initial treatment fails?
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Low dose PTU and propranolol; if it fails you CANNOT increase from low doses, must do SURGERY in 2nd trimester
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How do you differentiate Graves from toxic multinodular goiter?
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Graves will have opthalmopathy and pretibial myxedma; toxic multinodular goiter tends to present with new onset A-fib or CHF in an elderly person
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Typical toxic multinodular goiter presentation?
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Disease of elderly; nodular goiter on exam; presents with new onset A-fib or CHF with no pretibial myxedema/exopthalmos
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Required symptoms for thyroid storm?
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Hyperthermia (104F+), CNS manifestation, cardiac manifestations
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Tx of thyroid storm?
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IODINE, PTU/methimazole, beta blockers, dexamethasone, IVF, cooling blankets
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Before you can dx Alzheimer's, what tests must you do to exclude pseudodementia?
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Depression and hypothyroidism
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Presentation of a myxematous coma?
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Chronic hypothyroidism that isn't well controlled; patient will have severe hypothermia
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Tx of myxematous coma?
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T3*** (not just levothyroxine), and T4
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What test can be done to confirm subacute thyroiditis?
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ESR
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What is euthyroid sick syndrome?
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Seen in patient in ICU or very sick (sepsis); have low free T3s but normal TSH
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Are cold or hot thyroid nodules presumed to be cancer until proven otherwise?
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Cold nodules
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How do you confirm that a total thyroidectomy was successful?
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Check thyroglobulin levels
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Patient presents with a thyroid nodule but no other symptoms; next step in management?
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Check TSH to rule out toxic nodule; if normal then do a FNA
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What type of thyroid cancer spreads hematogenously?
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Follicular adenocarcinoma
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Standard treatment of thyroid cancer?
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Total thyroidectomy, then supranormal levels of T4 to SUPRESS TSH levels for 10 years
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Every 1 g/dL drop in albumin has what effect on total calcium levels?
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Drops it by 0.8 mEq/L
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Initial management of symptomatic hypercalcemia? Subequent management?
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IV fluids (they probably have nephrogenic DI!); then furosemide; long term use bisophsophonates (short term calcitonin)
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When patient presents to the hospital with severe symptomatic hypercalcemia what is the most likely etiology?
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Malignancy (hyperparathyroidism doesn't cause severe hypercalcemia)
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Tx of symptomatic vs asymptomatic hyperparathyroidism?
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Symptomatic: surgerical removal; asymptomatic: observe
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What ion imablance causes hypoparathyroidism?
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Hypomagnesemia
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First test to do when patient has hypocalcemia? Second test?
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Check albumin levels (if low albumin, then it's not true hypoclacemia); then check PTH
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Normal albumin, low phosphate, low calcium; DX?
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Vitamin D deficiency
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Normal albumin, high phosphate, low calcium; DX?
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Primary hypoparathyroidism
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When should you start screening for vascular complications of type I vs II DM?
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DM II: immediately at dx; DM I: 5 years after initial dx
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When a patient presents with DKA what tests should you do?
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type I do UA/CXR/blood culture for infection
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When a patient presents with hyperosmolar hyperglycemia what tests should you do?
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type II: EKG (silent ischemia) plus screen for infection (UA/CXR/blood culture)
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Initial management of hyperosmolar hyperglycemia?
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AGGRESSIVE IV fluid; insulin as well but not as important as fluids
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What CN mononeuropathy is associated with DM?
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CN III palsy; presents with ptosis but NO MIOSIS
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How often should a diabetic get eye and foot exams?
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Yearly
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What is the Somogyi phenomenon? What do you do with this patient?
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Rebound morning hyperglycemia due to hypoglycemia throughout night; tx by decreasing the amount of insulin at night
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What is the Dawn effect? What do you do with this patient?
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Morning hyperglycemia due to insufficient insulin; tx by giving more insulin
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Patient presents with morning hyperglycemia; how do you differentiate Somogyi from Dawn effect?
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First cut down the insulin at night to rule out Somogyi; if they continue to have hyperglycemia then it's the Dawn effect (increase insulin)
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Patient takes too much sulfonylurea and develops hypoglycemia; how do you manage their care?
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Must hospitalize overnight since correction of hypoglycemia is not permament; sulfonylureas have 24 hr duration of action
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Best initial test to screen for adrenal pathology?
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24 urine cortisol test
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Tx of congenital adrenal hyperplasia?
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Hydrocortisone + fludrocortisone
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What CBC result is abnormal with hypoadrenalism?
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Eosinophilia
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What's the initial and follow up test for primary vs secondary hypoadrenalism?
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Cosyntropin stimulation test for BOTH
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Best initial treatment of symptomatic vs asymptomatic hyponatremia due to SIADH?
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Hypertonic saline for symptomatic; water restriction for asymptomatic
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What are the first and second most common causes thyroid nodules?
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Colloid nodule > follicular adenomas
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Asymptomatic 40 y/o male presents with hypercalcemia; next step in managemnt?
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Sestamibi scan, then surgical removal
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What are the indications for parathyroidectomy?
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Age < 50, serum calcium > 1 mg/dL above normal, DEXA < T-2.5, reduced renal function
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Initial tx of erectile dysfunction in a diabetic taking doxazosin?
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Sidenafil, but WAIT 4 HOURS BETWEEN TAKING EACH PILL
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Most useful screening test for diabetic nephropathy?
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Random urine microalbumin/creatnine ratio
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Tx for symptomatic vs asymptomatic Paget's disease?
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Symptomatic: bisophsoponates; asymptomatic: observation
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What is the most reliable index for monitoring the response of DKA to treatment?
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Serum anion gap or arterial pH
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Should asymptomatic patients with a long history of smoking be screened by CXR?
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No
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Most likely cause of acquired hypoadrenalism in the world? In the US?
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World: tuberculosis; US: autoimmune
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What causes diabetic foot ulcers?
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Diabetic neuropathy
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What is the age of onset of otosclerosis?
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20-30s, especially females
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What EKG finding is associated with the severity of TCA intoxication?
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QRS widening
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Patient presents obtunted state with bradypnea, hypothermia but NORMAL SIZED PUPILS; dx? Why?
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Opioid toxicity; lack of pinpoint pupils due to co-ingestion of heroin with other substances
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What drug class is most likely to contribute to hypothermia (and disrupt normal thermal regulation)
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Typical antipsychotics like fluphenazine
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Patient overdose on a drug, has wheezing, AV block AND hypotension that does not irmpove with atropine; dx? Tx?
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Beta blocker toxicity; glucagon
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Pain and swelling of posterior malleolus; worse with weight bearing and inversion; plantar flexion causes pain; DX and TX?
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TENDINOPATHY of posterior tibial tendon; TX with immobilization in cast boot for 3 weeks
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Best test for PE?
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CT angiogram
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What is vasa previa?
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frank hemorrhage on rupture of membranes or amniotomy
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how does uterine rupture present?
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fetal distress or demise during active labor
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How does the presentation of placental abruption differ from placenta previa?
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abruption is only 3rd trimester and is PAINFUL; previa can be 2nd or 3rd trimester, and is painless (blood after intercourse common)
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Initial test for diverticulitis?
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Non-contrast CT
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Presentation of anterior vs posterior shoulder dislocation?
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Posteiror: externally rotated; anterior: internally rotated
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What is more common; anterior or posterior shoulder dislocation?
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Posterior
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What imaging test is necessary for dx of anterior shoulder dislocation
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Scapular lateral view; not visible on AP/lateral
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What is the appearance of a schaphoid fracture on X-ray?
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Will appear normal
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What is a boxer's fracture?
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Fracture of 4th/5th metacarpal
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Old man falls; has a shortened and externally rotated leg; dx?
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Fractured HIP; may be due to displaced femoral neck fracture or intratrochanteric fracture
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Patient has displaced femoral neck fracture; tx?
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MUST do hip replacement because it won't heal due to poor blood supply in femoral neck
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Patient has an intratrochanteric fracture; tx?
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Open reduction and pinning; MUST PLACE ON BLOOD TINNERS due to DVT risk from patient being sedentary
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Patient has pain in a knee; click on forcible extension of the knee; dx?
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Tear to the meniscus
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Who should get the pneumococcal vaccine under age of 65?
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Anyone with chronic CV disease, diabetes, lung disease, renal disease
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Who should get get screened for bladder cancer?
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No one
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Treatment for nondisplaced radial head fracture?
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Posterior splint and repeat x-ray in 1-2 weeks
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What is a screening test for rpimary hyperaldosteronism?
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Aldosterone to renin serum ratio
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Gold standard for diagnosis of urolithiasis?
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CT
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Most common initial symptom of Hodgkin's lymphom?
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Painless lympadenopathy
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Flat topped, violaceous lesions on the knuckles; dx?
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Dermatomyositis
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Who should be screend for AAA by ultrasoudn?
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Any male smoker 65-75
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60 y/o male has fatigue, anemia; occult fecal blood test is negative 3x; what do you do next?
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Colonoscopy
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Best initial test for iron deficiency anemia dx? MOST ACCURATE TEST?
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Ferritin; bone marrow biopsy
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What is the most common cause of sideroblastic anemia?
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Alcohol (even more so than lead or ALA synthetase deficiency or B6 deficiency)
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Patient has microcytic anemia with normal iron studies; dx?
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Thalassemia
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Increased hemoglobin A2 and hemoglobin F is in which thalassemia?
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Beta
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What causes dark urine w/ intravascular hemolysis?
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Hemoglobin
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Best intial test for sickle cell anemia? Most accurate test?
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Peripheral blood smear; hemoglobin electrophoresis
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What is isostenosisuria?
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Sickle cell trait; inability to concetrate urine
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Best initial test to dx parvovirus B19?
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PCR for DNA
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Treatment of aplastic crisis in a person with sickle cell anemia?
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IVIG
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What is the treatment of sickle cell with stroke, acute chest syndrome, or priapism?
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Exchange transfusions
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What is prophylaxis for acute chest syndrome?
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Hydroxyurea
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What should you do if a patient with sickle cell comes in with a fever?
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Prophylactic antibiotics
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Treatment of paroxysmal noctunral hemoglobinuria?
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Steroids
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What should you screen for in a patient with PNH?
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Leukemias/lymphomas
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Treatment of aplastic anemia in person >50? <50?
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< 50: bone marrow transplant; >50 cyclosporine and antithymocyte antibody
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Tx of M3 AML?
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All trans retinoic acid, ara-C, daunorubicin
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Tx of ALL?
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Daunorubicin, vincristine, prednisone, asparaginase
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How do you treat replasing AML or ALL?
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Bone marrow transplantation
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How do you treat leukostasis? Sx?
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Hydration and leukopheresis; 240 WBCs, CVAs, dyspnea, priapisms, etc.
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Tx of CLL?
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Fludarabaine
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What is the initial presentation of CML vs CLL?
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Splenomegaly on presentation w/ CML; fatigue and LAD w/ CLL (also older patient has CLL)
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Tx of multiple myeloma if patient is < 70? > 70?
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< 70: kill off marrow with vincristine, adriamycin, dexamethasone and then AUTOLOGOUS STEM CELL TRANSPLANT; > 70: thalidomide
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32 female paitent with a nontender, nonerythematous enlarged neck lymph node; what do you do?
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EXCISIONAL biopsy
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How do you treat stage I and II vs stage III and IV lymphoma?
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I and II: radioation; III and IV (OR ANY STAGE WITH B SYMPTOMS): chemo
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Tx of Hodgkin's lymphoma? NHL?
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HL: adriamycin, bleomycin, vincristine, dacarbazine; NHL: cyclophosphamaude, hydroxydaunorubicin, vincristine, prednisone
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What is stage I? Stage II? Stage III? Stage IV?
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I: one LN group; II: two LN group; III: both sides of diaphragm; IV: metastatic
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What stage does NHL vs HL usually present in?
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NHL: 3 or 4; HL: 1 or 2
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Who do you treat with rituximab?
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B cell NHL
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First line treatment for cancer related anorexia?
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Progestin
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Initial treatment of uremia induced platelet dysfunction?
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Desmopressin
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At what size should asymptomatic cervical lymph nodes be biopsied?
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> 2 cm
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Patient with ESRD remains anemic after erythropoeitin supplementation; next step in management?
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Ferrous sulfate
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Patient with history of prostate cancer presents with acute onset loss of sphincter tone, bilateral lower limb weakness and spasticity; DX? What is the initial and subsequent step in managemnet?
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Thecal sac compression; IMMEDIATELY treat with dexamethasone, then follow up with MRI
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What is the presentation of factor XII vs factor XI deficiency?
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XII: totally asymptomatic; XI: Jew with slight PTT elevation, only symptomatic with EXTREME trauma/surgery
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What is the treatment of a solitary brain mass from non-small cell lung carcinoma? Multiple masses?
|
Single: surgical resection; multiple: whole brain radiation
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Treatment of choice for hairy cell leukemia?
|
Cladribine
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What happens to the G6PD enzyme assay levels during an acute attack?
|
They are NORMAL…
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Treatment of CLL induced autoimmune hemolytic anemia?
|
Prednisone
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What is the management of hemodynamically stable vs unstable pulmonary embolism?
|
Stable: get them on heparin; unstable: tPA
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Patient has a PE but contraindications to anticoagulation therapy; initial tx for hemodynamically stable vs unstable?
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Stable: IVC filter; unstable: embolectomy
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Who tends to get pulmonary embolisms originating from the abdomen?
|
Pregnant women
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How do you prevent post thrombotic syndrome?
|
Compression stockings
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Why does pregnancy increase thrombosis risk?
|
Resistance to protein C, protein S activity decrease, fibrinogen/ factor II/VII increase
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Treatment of fat embolism?
|
NO ANTICOAGULATION; supportive only
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What is the treatment of symptomatic superior vena cava syndrome?
|
Emergent radiation
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How do you dx central vs peripheral lung cancer?
|
Central: bronchoscopy; peripheral: peripheral needle biopsy; followed by excision
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Guy has a lung mass and a pleural effusion; next step in management?
|
Thoracocentesis; will give you ansewr if it's answer and give staging (unresectable)
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Before a patient with lung cnacer goes into surgery, what test do you do first? What's the cutoff for not doing surgery?
|
Pulmonary function tests; < 50%: don't operate
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Patient has dyspnea, fever and elevated WBCS 24 hours after surgery; most likely cause?
|
Atelectasis
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Treatment of atelectasis?
|
Incentive spirometry
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Patient presents with gastroenteritis, recurrent pneumonia in a 32 y/o white female; dx?
|
IGA/IgG deficiency, CVID
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Below what SaO2 is home O2 therapy recommended for COPD?
|
88%
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Patient with with a history of Hodgkin's lymphoma treated w/ radiation presents with a solitary lung mass 15 years later; dx?
|
Lung or breast cancer (secondary malignancy)
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Tx of an acute COPD exacerbation?
|
Antibiotic + albuterol + corticosteroid
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Patient with COPD presents with purpulent sputum, bilatearl linear atelectasis; dx?
|
Bronchiectasis
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Definitive test to dx bronchiectasis?
|
High resolution CT
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Before you intubate a patient with COPD, what should you try first?
|
PEEP
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Where would a bornchogenic cyst be found on a CT?
|
Middle mediastinum
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Where would a thymoma be found on a CT?
|
Anterior mediastinum
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Patient has elevated left main stem bronchus and atrial fribrillation; DX?
|
Mitral stenosis
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What drugs can cause hypoventilation / seizures / coma in a COPD exacerbation?
|
Benzos, opiates
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Patient has hypoxemia, increased A-a gradient, and fails to improve on 100% FiO2; dx?
|
Shunting; due to pulmonary edema, pneumonia, or vascular shunt
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What is a common cause of a posterior rib fracture? Spiral tibial fracture?
|
Posterior rib fracture: child abuse; spiral tibial fracture: "toddler's fracture, common and not due to abuse
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What is the most common lung complications 48-72 hours post surgeries?
|
90% are ATELECTASIS
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Most common noninfectious cause of postsurgical fever?
|
Drug reaction
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|
What is a normal anion gap?
|
6-16 if you don't include potassium
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|
What herbal supplement can interfere with birth control efficacy?
|
St. John's Wort
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Does laying on the back increase or decrease pain associated with a radiculopathy?
|
Decrease
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Best initial treatment for lumbar stenosis? Sciatica?
|
Conservative tx for 1 month; nsaids and exercise
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When do you get an MRI for a radiculopathy?
|
After 1 month of persistent symptoms
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What are red flags for autism evaluation?
|
No babbling or pointing by 12 mo; no single words by 16 mo; no 2 owrds by 24 mo; loss of language or social skills at any age
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What screen test should be done before you dx someone with esesntial tremor?
|
Thyroid studies
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|
Tx of choice for a patient with ADHD/OCD and Tourette's?
|
Clonidine
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|
What is tetrabenzine used for?
|
Dopamine depleting agent that allieviates chorea w/ Huntington's disease
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When should routine DEXA screening be done?
|
< 65 y/o w/ no risk factors, all women > 65
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What is denosumab?
|
Monoclonal antibody that prevents oteoclast differentiation; tx for osteoporosis if pateint can't tolerate bisphosphonates
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Most common cause of bilateral leg edema in a young woman?
|
Idiopathic edema
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Most common cause of bilateral edema in the elderly?
|
Venous stasis
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Most common causes of pitting vs nonpitting edema?
|
Pitting: venous stasis, CHF, nephrotic, cirrhosis; non-pitting: chronic lymhedema, myxedema
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