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IM & Step 2 > MKSAP 5 > Flashcards

MKSAP 5 Flashcards

1
Q

What is the recommended treatment for peritonsillar abscess?

A
  1. Amoxicillin-sulbactam OR
  2. Parenteral Penicillin G + Metronidazol
    * Clindamycin for penicillin allergic
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2
Q

Treatment of RMSF?

A

Doxycycline

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3
Q

What is familial Mediterranean fever? & 5 features

A 
Autosomal recessive disorder in pts of jewish, turkish, arabic or armenian, 95% present before age 20, features:
1.  1-3 day periods of fever
2.  serositis
3. abdominal pain
4. pleuritis
5. synovitis
also see elevated ESR & leukocytosis
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4
Q

what drugs cause neuroleptic malignant syndrome?

A
  • haloperidol & fluphenazine msot common
  • all drugs that cause central dopamine receptor blockade
  • occurs within 2 weeks of initiating the drug
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5
Q

what drugs cause malignant hyperthermia?

A

exposure to volatile inhalation anesthetics (halothane, isoflurane, enflurane, desflurane, etc) and the depolarizing muscle relaxants succinylchoine and decamethonium

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6
Q

what is malignant hyperthermia?

A

inherited skeletal muscle disorder that leads to a hypermetabolic state when exposed to gas anesthetics and mm relaxants

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7
Q

when should you use activated protein C in pts sepsis?

A

when sepsis is severe and APACHE score >25

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8
Q

what is a relative contraindication for administering activated protein c in pts w severe sepsis?

A

platelet count <30,000

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9
Q

what virus is the most common cause of pharyngitis?

A

rhinovirus

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10
Q

what is Lemierre syndrome?

A

septic thrombophlebitis of the internal jugular vein, unilateral neck swelling
- caused by fusobacterium necrophorum (also increasing cause of pharyngitis in adolescents)

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11
Q

Sensitivity and specificity for GABHS pharyngitis RADT?

A 
sensitivity = 80-90%
specificity = 95%
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12
Q

treatment of strep pharyngitis?

A

10 day course of penicillin or erythromycin if allergic

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13
Q

what are the 3 diagnostic criteria for bacterial sinusitis?

A
  1. Symptoms lasting >7 days
  2. Facial Pain
  3. Purulent nasal discharge
    (should have >2)
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14
Q

First line agents for bacterial sinusitis?

A
  1. Amoxicillin
  2. Doxycyline
  3. TMP-SMX
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15
Q

Sensitivity & Specificity of tympanic membrane immobility in otitis media?

A

Sens: 89%
Specificity: 80%

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16
Q

what are the centor criteria? (4)

A
  1. Fever
  2. Tonsillar exudates
  3. Tender anterior cervical lymphadenopathy
  4. Absence of cough
    - used to diagnose GABH strep pharyngitis, 0-1 = no RADT or tx, 2 = RADT then tx, 3-4= neg RADT, obtain throat clx
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17
Q

how do u treat asymptomatic bacteriuria in a pregnant woman?

A

ampicillin

or amoxicillin or nitrofurantoin

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18
Q

how do you treat recurrent UTIs in an otherwise young, healthy woman?

A

TMP-SMX 180-800mg BID for three days when symptoms occur

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19
Q

how do you cover for both gonorrhea and chlamydia?

A

Ceftriaxone + either doxycycline or asithromycin

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20
Q

How does disseminated gonococcal infection present? tx?

A
  • may cause septic or sterile immune mediated arthritis and tenosynovitis and frequently involves the knees, hips and wrists
  • Dermatitis = sparse peripheral necrotic pustules
  • tx = ceftriaxone (or 3rd gen ceph)
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21
Q

when do you add corticosteroids to TMP-SMX for the treatment of PJP PNA in pts w HIV?

A

when theres evidence of hypoxia:

- arterial PO2 35mmHg

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22
Q

Symptoms of prosthetic joint infection?

A

paid can be the only sx! fever and leukocytosis are frequently absent

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23
Q

what do you use to treat diabetic nephropathy?

A

ACE inhibitor (or ARBs)- lower blood pressure, decrease proteinuria, and slow disease progression

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24
Q

how is VRE transmitted??

A

via direct contact

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25
Q

what are 3 airborne bugs? ie airborne precautions (not just droplet)

A
  1. TB
  2. Measles
  3. Varicella
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26
Q

what are the Rome III criteria for IBS?

A
  1. Pain relieved w defecation
  2. Onset assoc with change in stool frequency
  3. Onset assoc w change in the consistency of the stool
    * requires at leads 2 occurring for 3 months in a 12 mos period
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27
Q

metformin is contraindicated in what pts?

A

pts with renal insufficiency: Cr >1.4 women and >1.5 men

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28
Q

when should pts with IBD initiate screening for colorectal cancer?

A

after 8 years disease duration

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29
Q

how do you confirm the diagnosis of patellofemoral pain syndrome?

A

reproducing the pain by firmly moving the patella along the femur

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30
Q

what is patellofemoral pain syndrome?

A

most common cause of chronic knee pain in active adults

  • pain by going down stairs
  • knee stiffness and pain at rest when knee is flexed for a while
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31
Q

How do you diagnose PCOS? (must have 2 of 3 features)

A
  1. Ovulatory dysfunction
  2. Laboratory or clinical evidence of hyperandrogenism
  3. US evidence of polycystic ovaries
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32
Q

what lab values do you see in PCOS?

A
  • Increased testosterone (rarely greater than 150 though) and dehydroepiandorsterone
  • LH: FSH > 2:1
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33
Q

what are the 4 symptoms of drug induced lung toxicity?

A
  1. Fatigue
  2. Low-grade fever
  3. Cough
  4. Peripheral eosinophilia
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34
Q

why does alcohol intoxication lead to rhabdo?

A

hypyophosphatemia

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35
Q

besides the liver, what else releases AST?

A

heart and skeletal muscle

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36
Q

what do you see on peripheral blood smear in a pt with HUS?

A

schistocytes

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37
Q

ICD therapy is indicated in what type of pts?

A
  • left ventricular ejection fraction less than 35%
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38
Q

what do you see on radiograph of Rheumatoid arthritis?

A

erosions of cartilage and bone and joint space narrowing

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39
Q

elevated rheumatoid factor is increased in RA and what else?

A

most notably Hepatitis C (and other autoimmune disorders and infections)

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40
Q

what kind of pleural effusion does TB present with?

A
  • lymphocyte predominant

- exudative effusion

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41
Q

treatment of inflammatory cystic and pustular acne?

A

oral antibiotics

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42
Q

When using NPPV in COPD exacerbation, who is a candidate?

A
  1. Pts with moderate to severe dyspnea
  2. Use of accessory respiratory muscles
  3. Respiration rate greater than 25/min
  4. pH less than 7.35 with Pco2 greater than 45mmHg
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43
Q

what are the contraindications to using NPPV in COPD exacerbation?

A
  1. Impending respiratory arrest
  2. Cardiovascular instability
  3. AMS
  4. High aspiration risk
  5. Production of copious secretions
  6. Extreme obesity
  7. Surgery/trauma/deformity of the face or upper airway
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44
Q

what is the first line therapy for induciton and maintenance of remission in mild to moderate ulcerative colitis? MOA?

A

Mesalamine: 5-ASA, anti-inflammatory drug that’s gut specific

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45
Q

what improves mortality in patients with hypoxic COPD?

A

continuous oxygen therapy (min of 15hrs/day)

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46
Q

when is an MRI indicated in a pt with a herniated lumbar disk?

A
  1. evidence of motor impairment
  2. No response to therapy
  3. Symptoms increasing
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47
Q

at what BNP level would you suspect acute heart failure?

A

BNP >100

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48
Q

what’s the common presentation of platelet related bleeding disorder?

A
  • occurs immediately after injury

- effects the mucous membranes or skin ie petechiae

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49
Q

whats the common presentation of coagulation related bleeding disorder?

A
  • delay in onset
  • deep tissue bruises: ecchymoses
  • hemarthroses
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50
Q

what antibodies are found in antiphospholipid antibody syndrome?

A

anticardiolipin antibody or lupus inhibitor assay

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51
Q

how soon does acute dystonia reactions occur in pts starting neuroleptics/antiemetics/serotoninergics?

A

usually occurs within 5 days

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52
Q

What are three drugs you can use to treat acute dystonia?

A
  1. Diphenhydramine
  2. Benztropine mesylate
  3. Biperiden
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53
Q

c-ANCA and anti-proteinase-2 antibodies

A

Wegener’s granulomatosis

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54
Q

in compensated metabolic alkalosis, for ever 1 meq/L increase in serum bicarb, the Pco2 is expected to increase by what?

A

0.7mmHg

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55
Q

how do you calculate the anion gap?

A

Na- (Cl + Bicarb)

normal anion gap <12 +-2

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56
Q

what is the MOA of bisphosphonates?

A

theyre pyrophosphate derivatives that bind to the bone surface and inhibit osteoclastic bone resorption

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57
Q

when should you start tx with high dose corticosteroids in pts with SLE?

A

when theres a strong suspicion for lupus nephritis

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58
Q

what physical exam finding suggests anserine bursitis?

A

focal tenderness o the upper inner tibia about 5cm distal to the medial articular line of the knee

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59
Q

treatment of anserine bursitis?

A

corticosteroid injection at the bursal site

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60
Q

what labs could you see in RMSF?

A
  1. Thrombocytopenia
  2. Relative Leukopenia
  3. Elevated Transaminases
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61
Q

what does A flutter look like on EKG?

A

saw-tooth pattern in the inferior leads II, III, aVF

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62
Q

what is the classic triad of acute anterior uveitis?

A
  1. Pain
  2. Sensitivity to light
  3. Blurred vision
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63
Q

what infection is most commonly associated with DIC?

A

gram negative sepsis

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64
Q

What is the first line tx for limited stage SCLC?

A

Chemotherapy: platinum agent (carboplatin or cisplatin) and etoposide or irinotecan

RT

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65
Q

whats the mechanism behind hypocalcemia in acute gallstone pancreatitis?

A
  • generates free fatty acids that avidly chelate insoluble calcium salts in the pancreatic bed = saponification
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66
Q

in pts who have had a TIA or stroke, what is the LDL cholesterol goal?

A

<100mg/dL

The goal in CAD equivalent diseases

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67
Q

when should a person receive the pneumococcal dose and how often?

A

If pt is before the age of 65 when they receive their first pneumococcal vaccine, then they should receive a one-time revaccination dose 5 years after the first dose

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68
Q

what are anti-cyclic citrullinated peptide antibodies?

A

highly specific for rheumatoud arthritis

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69
Q

treatment of an acute pseudogout attack?

A

NSAIDs but corticosteroids or colchicine would be appropriate alternative choices

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70
Q

What types of pts benefit from antibiotics during a COPD exacerbation?

A
  1. Pts with severe COPD exacerbations
  2. On mechanical ventilation
  3. Moderate-Severe COPD exacerbation characterized by increased: dyspnea, sputum volume/purulence, or need for hospitalization
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71
Q

What is Long QT Syndrome?

A
  • congenital or acquired
  • sx = syncope and cardiac arrest due to torsades de pointes v tach
  • Risk factors = female, hypokalemia, hypomagnesemia, structural heart disease, previous QT interval prolongation, and hx of drug induced arrhythmia
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72
Q

how does hypercalcemia occur in sarcoidosis? tx?

A
  • activated macrophages in granuloma tissue cause unregulated production of 1alpha hydroxylase activity
  • this increases the production of 1,25 vit D -> increased GI absorption of Ca
    tx: Corticosteroids via decreasing the number of activated macrophages
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73
Q

Pneumonia + GI symptoms + Hyponatremia

A

Legionella

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74
Q

What are the two types of diabetic retinopathy?

A
  1. Nonproliferative: ie hard exudates, microaneurysms, and minor hemorrhages- not assoc w vision loss
  2. Proliferative: cotton wool spots & neovascularization- assoc w vision loss
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75
Q

how do you save vision in diabetic retinopathy?

A

Laser photocoagulation

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76
Q

How does microscopic colitis present?

A
  • nonbloody diarrhea
  • colonoscopy shows normal mucosa macroscopically
  • microscopically shows increased intraepithelial lymphocytes
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77
Q

what is the first line medication for essential tremor?

A

propanolol

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78
Q

when can the screening interval of pap smears be increased to every 3 years?

A

women older than 30 with three previous normal annual pap smears

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79
Q

What are the characteristics of MGUS?

A
  1. Low serum monoclonal protein (M-protein) <3.0 grams
  2. Less than 10% plasma cells in bone marrow
  3. Absence of lytic bone lesions, anemia, hypercalcemia, or renal insufficiency
    * the higher the M protein level, the greater the risk
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80
Q

What is AL Amyloidosis?

A
  • monoclonal plasma cell dyscrasia in which secreted immunoglobulin is deposited as fibrils in the kidneys, heart, and peripheral nerves
  • detection of monoclonal immunoglobulin in serum, blood or tissues differentiates AL from other forms of amyloidosis
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81
Q

What is lymphoplasmacytic lymphoma?

A

associated with a monoclonal serum paraprotein of IgM (waldenstrom’s macroglobulinemia) not IgG

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82
Q

What are the confirmatory tests for SLE?

A
  1. Anti-doublestranded DNA antibody testing (specificity 75-100%)
  2. Complement levels of C3, C4 and total hemolytic compliment CH50
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83
Q

in pts w SLE, a positive anti-SS-A antibody is associated with what?

A

subacute cutaneous lupus erythematosus

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84
Q

Anti-SSA and anti-SSB?

A

Sjogrens syndrome

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85
Q

Positive rheumatoid factor could mean what? (3 things)

A
  1. SLE
  2. RA
  3. Chronic infections: including chronic active hepatitis C virus infection
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86
Q

Muddy brown casts on urinalysis?

A

Acute tubular necrosis

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87
Q

What drugs are commonly known to cause Acute tubular necrosis? (3)

A
  1. Cisplatin
  2. IV Aminoglycosides (tobramycin)
  3. Radiocontrast
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88
Q

Physical Manifestations of Acute interstitial Nephritis? (4)

A
  • Rash
  • Pruritis
  • Eosinophilia
  • Fever
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89
Q

UA of Acute Interstitial Nephritis shows what? (4)

A
  1. Pyuria
  2. Leukocyte casts
  3. Microscopic hematuria
  4. Tubular-range proteinuria
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90
Q

When do you do a methacholine challenge in pts?

A
  • suspected asthma who have episodic symptoms and normal baseline spirometry (metacholine induces bronchoconstriction)
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91
Q

False positive methacholine tests are seen in what 5 populations?

A
  1. Allergic Rhinitis
  2. COPD
  3. CHF
  4. CF
  5. Bronchitis
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92
Q

When should you initiate prophylactic meds in pts with migraines? What meds are these?

A
  • Pts who experience >2 migraines per week
  • Use propanolol, topiramate, valproic acid, amitriptyline, metoprolol, timolol, and extract from the plant Butterbur root
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93
Q

What extract can be used in migraine prophylaxis?

A

Butterbur rootPetasites hybridus

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94
Q

The presence of what is associated with an increased risk of ILD in pts w dermatomyositis/polymyositis?

A

Presence of Anti-Jo-1 antibodies

* ILD is one of the leading causes of death in these pts

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95
Q

How do you diagnose radiation proctitis?

A

= endoscopic findings of mucosal telangiectasia

- biopsy shows submucosal fibrosis and arteriole endarteritis

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96
Q

What is radiation proctitis?

A
  • occurs in pts receiving pelvic radiation
  • acute = within 6 weeks of therapy
  • sx = diarrhea and tenesmus
  • proctitis is due to direct radiation injury to the rectal mucosal, resolves when therapy is dc’d
  • chronic proctitis = months to years after and assoc w worse prognosis
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97
Q

what is the initial treatment of idiopathic DVT (or dvt w a transient risk factor)?

A
  1. Immediate acting anticoagulant such as unfractionated heparin, LMW heparin, or fondaparinux for ~5 days
  2. Plus Warfarin (usually 5mg)
    - overlap drugs until INR reaches therapeutic range >2 measured on 2 occasions approximately 24 hours apart
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98
Q

What are the contraindications to giving the zoster vaccine?

A
  1. Pts with active, untreated TB
  2. Pregnant women
  3. Immunocompromised patients
  4. Pts receiving chemo, radiation therapy, or large doses of corticosteroids
  5. Pt living w an immunocompromised person
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99
Q

What is the classic triad of thrombotic thrombocytopenic purpura?

A
  1. Microangiopathic hemolytic anemia
  2. Thrombocytopenia with normal coagulation
  3. CNS Symptoms
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100
Q

What lab values do u see in microangiopathic hemolytic anemia?

A
  1. Schistocytes (erythrocyte fragments) on peripheraml smear
  2. Reticulocytosis
  3. Elevated LDH level
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101
Q

What pt populations are assoc with Listeria monocytogenes meningitis?

A
  1. Extremes of age (neonates and pts >50)
  2. Alcoholism
  3. Malignancy
  4. Immunosuppression
  5. Diabetes
  6. Hepatic and renal failure
  7. Iron overload
  8. Collagen Vascular diseases
  9. HIV Infection
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102
Q

what is the response to vasopressin in pts with central versus nephrogenic DI?

A

In CDI- urine osmol will increase and volume will decrease

NDI: no effect of vasopressin

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103
Q

Medications used to treat nephrogenic DI?

A
  1. Hydrochorothiazide
  2. Amiloride
  3. Prostaglandin inhibitors ie NSAIDs (indomethacin)
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104
Q

3 Causes of Acromegaly? aka overproduction of GH

A
  1. Pituitary adenoma (most common)
  2. Lymphoma (rare, ectopic production of GH or GHRH)
  3. Bronchial Carcinoid: rare, ectopic production of GH or GHRH
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105
Q

what are the best initial and most accurate tests done to diagnose acromegaly?

A

Best initial: IGF-1 levels

Most Accurate: glucose suppression test, normally glucose should suppress growth hormone levels

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106
Q

3 Medications used to tx Acromegaly? MOA?

A
  1. Cabergoline: DA agonist inhibits GH release
  2. Octreotide: Somatostatin inhibits GH release
  3. Pegvisomant: GH receptor antagonist, inhibits IGF release from livver
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107
Q

What calcium channel blocker raises prolactin level?

A

verapamil

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108
Q

What 6 medications cause hyperprolactinemia?

A
  1. Antipsychotics
  2. Methyldopa
  3. Metoclopromide
  4. Opioids
  5. TCAs
  6. Verapamil
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109
Q

what medication can cause hypothyroid?

A

Amiodarone

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110
Q

Why is propanolol used in acute hyperthyroidism/thyroid storm?

A
  • blocks target organ effects by inhibiting peripheral conversion of T4 -> T3
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111
Q

whats the best initial treatment for pts w graves ophthalmopathy?

A

steroids!

112
Q

What is the MOA of thiourea drugs? major side effect?

A

aka methimazole (preferred) & PTU

  • blocks thyroid hormone production via inhibiting thyroperoxidase
  • SE = agranulocytosis
113
Q

when do you biopsy a thyroid nodule?

A

When thyroid nodules >1cm and there is normal thyroid function

114
Q

how does hypercalcemia present cardiovascularly?

A

short QT syndrome

hypertension

115
Q

why do you get peptic ulcers in hyperparathyroidism?

A

bc calcium stimulates gastrin release

116
Q

what are the best initial tests for the presence of hypercortisolism?

A
  1. 24-hour urine cortisol (more specific)

2. if thats not the answer, then: 1mg overnight dexamethasone suppression test

117
Q

what can cause a false positive 1 mg dexamethasone suppression test?

A
  1. Depression
  2. Alcohol
  3. Obesity
118
Q

what are common causes of Addison disease? (4)

A
  1. Autoimmune destruction of the gland (80%)
  2. Infection (TB)
  3. Adrenoleukodystrophy
  4. Metastatic cancer to the adrenal gland
119
Q

What electrolyte abnormalities do you see in Addison disease?

A
  1. Hyponatremia

2. Hyperkalemia

120
Q

What two rashes do NOT spare the nasolabial folds?

A
  1. Rosacea

2. Seborrheic dermatitis

121
Q

what are gottron papules?

A

purplish plaques on the dorsal hands, more prominent over the joints
- seen in dermatomyositis

122
Q

what 3 antibodies are seen in autoimmune hepatitis?

A
  1. ANA
  2. Anti-smooth muscle ab
  3. Anti-LKM1 (liver kidney microsome type 1)
123
Q

pt has an incidental finding of adrenal adenoma- what two tests should you get?

A
  1. Plasma metanephrines

2. Overnight dexamethasone suppression test

124
Q

what is rhinophyma?

A

the presence of a bulbous, red nose - variant of rosacea

125
Q

vertebral osteomyelitis: most common bug?

A

staph aureus, but must send for blood cultures before treating!

126
Q

When is antibiotic endocarditis prophylaxis recommended?

A
  1. Prosthetic cardiac valves
  2. Hx of prior infective endocarditis
  3. cardiac transplant recipients with known valve abnormalities
  4. Unrepaired congenital cyanotic heart diseases
  5. Complex congenital heart disease with residual abnormalities
127
Q

when is it appropriate to obtain an endometrial biopsy?

A
  • in pts older than 35yrs with abnormal uterine bleeding
128
Q

what test do you do in a pt with renal dysfunction who has a high probability of PE?

A

VQ scan (avoid the contrast of CT angio)

129
Q

what are the HR ranges for :

  1. V tach
  2. Torsades
  3. V Fibb
A
  1. V tach: 140-250bpm
  2. Torsades: 200-300bpm
  3. V Fibb: >300bpm
130
Q

Sudden development of hypophosphatemia causes what 4 symptoms?

A
  1. Confusion
  2. Rhabdomyolysys
  3. Hemolytic anemia
  4. Severe muscle weakness (can lead to resp failure)
131
Q

What is the classic triad of TTP? pentad?

A
  1. Microangiopathic hemolytic anemia (schistocytes or erythrocyte fragments)
  2. Thrombocytopenia w normal coagulation
  3. CNS symptoms
    pentad includes
    - fever
    - renal failure
132
Q

what deficiency is seen in TTP?

A

ADAMTS13

133
Q

what is Evans syndrome?

A

Combination of

  1. Coombs positive warm autoimmune hemolytic anemia- microspherocytes on smear
  2. ITP
134
Q

what is the progression of treatment in OA?

A
  1. Acetaminophen->
  2. NSAIDs: ibuprofen ->
  3. Intra-articular corticosteroid or hyaluronan injections
135
Q

symptoms of multiple myeloma? 6

A
  1. Hypercalcemia
  2. Diffuse Osteopenia
  3. Anemia
  4. Leukopenia
  5. Renal insufficiency
  6. Hx of encapsulated organism related pneumonia
136
Q

conversion of IV to oral morphine?

A

multiple by 3- 10mg of IV = 30mg PO

137
Q

what is orthostatic proteinuria and what is it associated with??

A
  • increase in urinary protein excretion only in the upright position
  • mostly seen in young adults, UA is otherwise normal, benign condition, resolves spontaneously
  • Associated with Nutcracker syndrome: entrapment of the left renal vein between the aorta and SMA
138
Q

Contraindications to estrogen replacement therapy in postmenopausal women?

A
  1. Undiagnosed vaginal bleeding
  2. Breast ca or other hormone sensitive cancers
  3. Hx of venous/arterial thrombosus
  4. Liver dysfunction or disease
139
Q

treatment of graves??

A
  1. Methimazole (fewer side effects than PTU)

2. Atenolol (tachy)

140
Q

what meds are used in the treatment of acute gout attacks?

A
  1. Indomethacin (NSAIDs)
  2. Colchicine (most effective w/in 24hrs of onset)
  3. Steroids
141
Q

What meds are used for pts who have recurrent gout attacks/uric acid tophi/renalstones?

A
  1. Allopurinol
  2. Febuxostat
    - xanthine oxidase inhibitors reducing uric acid levels
142
Q

one strange use of morphine?!?!

A
  • effective in treating cancer-related dyspnea and end stage cardioplmonary disorders
143
Q

severe explosive psoriasis in a young adult

A

think HIV, cd4 usually less than 200

144
Q

new onset back pain and fever

A

think vertebral osteomyelitis: get a MRI of spine, will also see elevated ESR

145
Q

What are cameron lesions?

A

linear gastric ulcers or erosions in the hiatal hernia sac, usually an incidental finding but some can cause chronic/acute blood loss

146
Q

dark blue or black berry-like lesion that are mostly symmetric, elevated and one color

A

nodular melanoma

147
Q

what is podophyllin?

A

powder made from the american mayapple used against HPV induced genital wards bc it contains antiwart lignans: antimitotic agent that leads to cell death

SE: enteritis and severe depression, teratogenic

148
Q

what is the MOA of glucocorticoids used in epidural spinal cord compression (usually from malignancy)?

A
  • decrease vasogenic edema (caused by obstructed epidural venous plexus)
  • this helps alleviate pain and restore neurologic function
149
Q

How does dipyridamole work in a stress test to diagnose ischemic heart disease?

A
  • its a coronary vasodilator
  • infusion into a non CAD pt increases coronary BF 3-5x above baseline
  • in a pt w CAD, the diseased vessels distal to the obstruction are already maximally dilated and their ability to increase myocardial perfusion is limited
  • redistribution of coronary BF to non diseased areas occurs and the perfusion of diseased segments diminishes = coronary steal phenomenon
150
Q

what is aspirin sensitivity syndrome?

A
  • pseudo-allergic reaction
  • ASA induced prostaglandin/leukotriene misbalance (via COX inhibition) leading to nasal polyps and bronchoconstriction
  • tx: leukotriene receptor antagonists
151
Q

Signs of cardiac tamponade? 4

A
  1. JVD
  2. Distant heart sounds
  3. Pulsus paradoxus
  4. Hypotension
152
Q

What’s CHADS2?

A 
calculates risk of having a stroke or thromboembolic event
CHF
HTN
Age >75
DM
Stroke or TIA hx
153
Q

Management of CHADS2 score of:
0
1
2

A 
0 = no anticoagulation
1= anticoagulation>ASA
2-6 = Anticoagulation
154
Q

what cardiac problem can cause hemoptysis?

A

mitral stenosis/acute pulmonary edema

155
Q

What 3 systemic diseases can cause hemoptysis?

A
  1. Wegener’s granulomatosis
  2. Goodpasture’s syndrome
  3. SLE: vasculitis
156
Q

whats the difference between bronchiectasis and chronic bronchitis?

A

bronchiectasis is more likely associated with a hx of recurrent resp tract infections and chronic cough with daily production of copious mucopurulent sputum

157
Q

what drug should be used to slow progression of diabetic neuropathy?

A

ACE inhibitors: reduces urinary albumin excretion and the decline in Cr clearance

158
Q

what is the MOA of Theophylline?

A

methylxanthine phosphodiesterase inhibitor that causes bronchodilation

159
Q

What are the 4 most common causes of priapism?

A
  1. Sickle cell disease and leukemia: children and adolescents
  2. Perineal or genital trauma: results in laceration of the cavernous artery
  3. Neurogenic lesions: spinal cord injury, cauda equina compression
  4. Medications: trazadone and prazosin
160
Q

What is the Hawthorne effect?

A

study bias:
the tendency of a study population to affect the outcome because they are aware that they are being studied leading to a conscious change in behavior

161
Q

what is empyema? tx?

A
  • intrapleural collection of pus (purulent pleural effusion)
  • bacterial seeding of a parapneumonic effusion in the setting of bacterial pneumonia
    tx: drainage and abx
162
Q

What is Hamptom’s hump?

A

a wedge shaped opacity in the infarcted segment of the lung (in pulmonary infarction)

163
Q

what is the pathophys behind membranoproliferative glomerulonephritis?

A
  1. caused by IgG antibodies (termed C3 nephritic factor) directed against C3 convertase of the alternative complement pathway-> leads to persistent complement activation and kidney damage
164
Q

Anti-GBM antibodies?

A

Goodpasture’s syndrome

165
Q

what is presbycusis?

A

sensorineural hearing loss that occurs in adults with advanced age

166
Q

What are the contraindications of radioactive iodine treatment?

A
  1. Pregnancy

2. Very severe ophthalmopathy

167
Q

what is pulsus paradoxus?

A

an exaggerated decrease (>10mmHg) in the systemic arterial blood pressure with inspiration
- seen in cardiac tamponade

168
Q

what disorder is associated with warfarin-induced skin necrosis?

A

protein c deficiency

169
Q

tx of warfarin induced skin necrosis?

A

vitamin K!

170
Q

what is the usual cause of renal artery stenosis in young adults?

A

fibromuscular dysplasia

171
Q

what is the definitive diagnosis of Wegener’s (granulomatosis with polyangiitis?

A

biopsy from site of active disease (nasopharyngea)

172
Q

what is the most common malignant tumor of the eyelid?

A

Basal cell carcinoma (and most common malignancy of mankind)

- specifically on lower eyelid

173
Q

how do you describe basal cell carcinoma?

A

slow growing nodules with a pearly quality and a rolled border

174
Q

what arrhythmia is most specific for digoxin toxicity?

A

Atrial tachycardia with AV block

175
Q

how can dihydropyridine CCBs be harmful in STEMI?

A

they are contraindicated in STEMI bc they cause vasodilation and reflex tachycardia which ca worse cardiac ischemia

176
Q

when does heparin induced thrombocytopenia/thrombosis present?

A

5-10 days after initiation of heparin therapy

*however if pt recently exposed to heparin the onset of HIT may be ~10 hours

177
Q

After pregnancy is excluded, the initial evaluation of secondary amenorrhea includes what 3 labs?

A
  1. FSH (>20 suggests ovarian failure)
  2. TSH
  3. Prolactin
178
Q

treatment of toxoplasmosis in HIV pt?

A

Sulfadiazine plus pyrimethamine and folinic acid

179
Q

how does one diagnose polycythemia vera?

A
  1. Hct >60% in males or >56% in women in the absence of secondary causes
  2. Presence of splenomegaly
    - JAK2 mutation present in 95% of patients
180
Q

what are the 3 criteria for diagnosing pericarditis? (must have 2/3)

A
  1. Pleuritic chest pain
  2. Friction rub
  3. Diffuse concordant ST segment elevation on ECG
181
Q

how should you interpret the results of a TB test in a pt who received the BCG vaccine?

A

with the same criteria as those who didnt receive it

182
Q

who do you give prophylactic INH for 0 months

A
  1. Pt who use prednisone (>15mg) or any other immunosuppressive agent
  2. Who have 5mm or more of induration on TB testing
183
Q

What are the cutoffs for a + TB test?

A
  1. 5mm = in pts at high risk (HIV, immunosupp, close contact, cxr consistent w/ prior, those taking prednisone)
  2. 10mm= those who have immigrated to the US from high risk countries in the past 5 years, IV drug users, prisoners, health care workers, pt with silicosis, DB, cancers
  3. 15mm = low risk pts
184
Q

tx of choice for trochanteric bursitis?

A

corticosteroid injections

185
Q

what 4 patient populations do you treat salmonella gastroenteritis?

A
  1. 50 yrs
  2. Severe illness requiring hospitalization
  3. Known or suspected atherosclerotic plaques or endovascular or bone prostheses because of seeding of salmonellae
  4. Immunocompromised
186
Q

what is the most predictive risk factor for osteoporosis in women?

A

weight below 70kg (154 lbs)

187
Q

who gets the pneumococcal vaccine before the age of 65?? (4 populations)

A
  1. Live in long term care facilities
  2. Have chronic illnesses
  3. Who are Alaskan natives or American Indians
188
Q

what is the only drug approved by the FDA as first line tx of moderate to advanced Alzheimer dementia?

A

Memantine: N methyl d aspartate receptor antagonist

- improves cognition and global assessment of dementia

189
Q

what drugs cause drug induced lupus? how does the presentation differ from SLE?

A
  • TNF-alpha inhibitors cause it (infliximab)

- Presentation is similar, mainly cutaneous and pleurocardial involvement (renal and neurologic are extremely rare)

190
Q

definitive diagnosis of polyarteritis nodosa?

A

sural nerve biopsy or kidney angiography

191
Q

what does kidney angiography show in polyarteritis nodosa?

A

microaneurysms or a beaded pattern with areas of arterial narrowing and dilation

192
Q

serum ferritin levels lower than ___ to ___ may reflect iron deficiency anemia in pts with inflammatory states

A

100-120ug/L

193
Q

when a primary percutaneous coronary intervention lab is not available, what should you do in the case of STEMI?

A
  • thrombolytic agents within 12 hours after the onset of the chest pain
194
Q

What drugs can cause toxic epidermal necrolysis (TEN)?

A
  1. Sulfonamides
  2. Barbiturates
  3. Phenytoin
  4. NSAIDs
195
Q

what is the difference between toxic epidermal necrolysis and SJS?

A

SJS = 30% of body surface involved

196
Q

what is a common finding in exfoliative dermatitis?

A

gynecomastia

197
Q

Tamoxifen has been shown to increase the risk of what two types of uterine cancers?

A
  1. Endometrial

2. Uterine sarcoma

198
Q

what does disseminated gonococcal infection look like? aka triad

A
  1. Tenosynovitis
  2. Dermatitis (vesiculopustular, few in #, rarely involves face)
  3. Migratory asymmetric polyarthralgias
199
Q

Describe the characteristics of V tach?

A

widened QRS complex and a ventricular rate that is greater than 100/min

200
Q

When should you drain a parapneumonic effusion via chest tube?

A
  1. Loculated pleural fluid
  2. Pleural pH 1000
    • Gram stain
  4. Gross pus observed in the pleural space
201
Q

what types of heart block should you put in a pacemaker?

A
  1. Intermittent 3rd degree
  2. Type II AV block
  3. Alternating bundle branch block
202
Q

When should you initiate corticosteroids in a pt with ITP?

A

who have symptomatic bleeding and platelet counts below 50,000 or those with severe thrombocytopenia and platelet counts below 15,000

203
Q

What are the EKG findings of Wolff-Parkinson White Syndrome?

A
  • short PR interval
  • delta wave
  • tachycardia
204
Q

how do you administer insulin in a pt with DKA?

A

insulin drip

205
Q

At what triglyceride level would you be concerned about hypertrigliceridemic pancreatitis?

A

> 1,000mg/dL

206
Q

what lab results will you see in von willebrand disease?

A
  1. Prolonged bleeding time
  2. A borderline elevated aPTT
  3. A low factor VIII level
207
Q

inheritance of von willebrands disease?

A

autosomal dominant

208
Q

what is the function of von willebrands factor??

A

supports platelet adhesion and serves as a carrier protein for factor VIII

209
Q

How do you diagnose antiphospholipid antibody syndrome?

A
  • hx of thrombotic event (including recurrent fetal loss) w/:
  • persistent lupus anticoagulant or
  • elevated levels of IgG anticardiolipin or B2 glycoprotein I antibodies
210
Q

what 3 drugs are associated with antiphospholipid antibody syndrome?

A
  1. Hydralazine
  2. Procainamide
  3. Phenothiazines
211
Q

What do factor V leiden mutation and prothrombin G20210A mutation lead to?

A
  1. Factor V Leiden: resistance to activated protein C

2. Prothrombin G20210A: increase in prothrombin antigen and activity by ~30%

212
Q

In patients with nonvalvular AFibb, what is the target INR with warfarin?

A

INR 2.0-3.0

213
Q

how do you know when to start a pt w a fibb on anticoagulation?

A 
use CHADS2!!
CHF
HTN
Age >75
DM
Stroke/TIA

score 0 = no anticoag
score 1-2 = assessed on individual ASA vs warfarin
score >3 w hx stroke/TIA = anticoag w warfarin
score 6 = warfarin!!

214
Q

what med is used to tx malignancy related hyperuricemia to prevent tumor lysis syndrome?

A

rasburicase

215
Q

MOA of Acetazolamide and metabolic/electrolyte side effects?

A
  • acts in PT as a carbonic anhydrase IV inhibitor
  • this impairs bicarbonate reabsorption but not diluting capacity
  • SE: Hypokalemia and metabolic acidosis
216
Q

how does lyme carditis present?

A
  • acute onset, high grade (grade III) atrioventricular conduction defects
  • may be assoc w myocarditis
217
Q

difference between mobitz type I and type II av block?

A
  • Mobitz type I (Wenckebach): Progressive PR intervals until a dropped beat, does not progress to complete heart block
  • Mobitz type II: a dropped beat without progressive PR interval prolongation, usually assoc w a BBB, typicall progresses to third degree heart block
218
Q

first line treatment for tx postmenopausal women with osteoporosis?

A

Bisphosphonates-

  1. Alendronate & Risedronate: reduce risk of fractures, but can aggrevate GERD, so then use:
  2. Once yearly IV Zoledronate (or use if contraindicated)
219
Q

Contraindications to oral bisphosphonates?

A
  1. Esophageal stricture

2. Achalasia

220
Q

What is teriparatide and when is it used?

A
  • Recombinant human PTH is reserved for treating patients at high risk of fracture ie those with a T score below -3.0 with a hx of vertebral fracture and contraindications to hisphosphonate use
221
Q

Calcitonin levels are elevated in what to patient populations?

A
  1. Medullary thyroid cancer

2. C-cell hyperplasia (bc secreted by parafollicular C cells)

222
Q

what is the imaging modality of choice for diagnosing nephrolithiasis?

A

noncontrast helical abdominal CT

223
Q

uric acid stones are related to use of what drug?

A

idinavir

224
Q

what are the 3 criteria for initiating treatment of hyperuricemia in a pt with symptomatic gout?

A
  1. Presence of tophi or renal stones
  2. Multiple attacks of acute gout
  3. Hx of decreasing time period between gout attacks
225
Q

what 2 medications raise uric acid levels?

A
  1. Thiazide diuretics

2. low-dose salicylates

226
Q

what’s assoc with anti-cyclic citrullinated peptide antibodies?

A

rheumatoid arthritis

227
Q

epiric therapy of acute bacterial meningitis in an older adult should include what 3 abx?

A
  1. Third generation cephalosporin
  2. Vancomycin
  3. Ampicillin
228
Q

what is the primary cause of morbidity in pts w systemic scleroderma?

A

pulmonary disease: PAH is most common

229
Q

What is Factor H deficiency?

A
  • Factor H (a protein in the complement pathway) normally protects cells from damage by the alternative complement pathway
  • deficiency allows C3 to potentiate autoantibody-mediated or immune complex mediated injury to glomerular cells, leading to exposure of subendothelium and activation of both platelets and coagulation
230
Q

What do you see in urinalysis of Acute Interstitial Nephritis?

A
  1. Leukocyte casts

2. Eosinophils (bc its a hypersensitivity reaction)

231
Q

what are the diagnostic criteria for hyperglycemic hyperosmolar syndrome? (5)

A
  1. Plasma glucose level >600
  2. Arterial pH greater than 7.30
  3. Serum bicarb >15mg/dL
  4. Serum osmolality >320
  5. Absent urine or serum ketones
232
Q

What is the initial management in pts w hypergylcemic hyperosmolar syndrome?

A

IV Fluids w 0.9 NS- until BP is restored and urine output is established

233
Q

What medication is used to tx Raynaud’s in whom cold avoidance does not provide sufficient relief?

A

Dihydropyridine calcium channel blockers: Amlodipine

can also use peripherally acting alpha-1 blockers, phosphodiesterase inhibitors, and endothelin receptor antagonists

234
Q

What are the symptoms of systemic sclerosis with limited cutaneous involvement (CREST) and how does this differ from diffuse cutaneous systemic sclerosis?

A

CREST: Calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiectasias
- differs bc limited involvement manifests as skin thickening distal to the elbows and knees whereas diffuse involvement is assoc w skin thickening proximal to elbows and knees

235
Q

Steps of management of acute esophageal bleeding (3)

A
  1. Rapid volume replacement with PRBCs
  2. Esophagogastroduodenoscopy and band ligation
  3. IV Octreotide: reduces portal venous blood inflow through inhibition of the release of vasodilatory hormones and controls bleeding
236
Q

how does joint involvement of rheumatoid versus osteoarthritis differ?

A
  • both can involve the proximal interphalangeal joints of the hands
  • metacarpophalangeal joint involvement occurs in RA
  • Distal interphalangeal joints occurs in OA
237
Q

the is first line tx for mild alzheimer dementia?

A

Acetylcholinesterase inhibitor: donepezil, rivastigmine, and galantamine

238
Q

Diffuse parenchymal lung disease is most likely in patients with systemic sclerosis who develop what?

A

antitopoisomerase I antibody (anti-Scl-70)

239
Q

what is hepatopulmonary syndrome?

A
  • manifests as:
    1. dyspnea at rest or on exertion
    2. Platypnea
    3. hypoxemia
    in the setting of chronic liver disease (clubbing, cyanosis, and hypoxemia + liver disease on PE)
  • results from pulmonary vascular dilatation with intrapulmonary shunt and V/P mismatch which may worsen when the individual is in an upright position leading to orthodeoxia and platypnea
240
Q

what are orthodeoxia and platypnea?

A

Orthodeoxia: fall in partial pressure of oxygen when sitting upright

Platypnea: dyspnea worse when sitting upright

241
Q

what is the followup for a pt at low risk for malignancy and an incidentally noted pulmonary nodule on CT?

A
  • if <4mm = no followup
242
Q

what is a keratoacanthoma?

A

an epithelial neoplasm that is characterized by rapid growth over 2-6wks

  • a crater like configuration, hard erythematous nodule with a keratotic center
  • typically occur on sun damaged skin, usually in older persons w a peak age of 60 years
  • capable of spontaneous resolution
243
Q

First line therapy for hepatic encephalopathy?

A

lactulose

244
Q

PFTs of neuromuscular respiratory failure?

A
  1. Increased residual volume/TLC ratio
  2. Normal FEV1/FVC ratio
  3. Low maximum respiratory pressures
  4. Normal DLCO

ie ALS or myasthenia gravis

245
Q

how does a VSD following a STEMI present? (4)

A

usually within 2-7days following MI

  • Respiratory distress
  • Hypotension
  • New systolic murmur
  • palpable thrill
246
Q

what other syndrome is associated with Giant cell arteritis?

A

polymyalgia rheumatica is present in ~33% of patients

247
Q

What is the grind test?

A

movement of the thumb in a circular motion ellicits pain in osteoarthritis

248
Q

What are heberden nodes?

A

boney enlargement of the distal interphalangeal joints seen in OA

249
Q

what are bouchard nodes?

A

boney enlargement of the proximal interphalangeal joints seen in OA

250
Q

what action makes lateral epicondylitis worse?

A 
wrist extension
(there is no limitation of motion or inflammation of the elbow joint)
251
Q

What is sinoatrial node dysfunction?

A

comprises a collection of pathologic findings (sinus arrest, sinus exit blocks, and sinus bradycardia) that result in bradycardia
- symptomatic sinus node dysfunction is an indication for pacemaker placement

252
Q

What are 3 antianginal meds?

A
  1. Beta blockers
  2. Ca Channel blockers
  3. Nitrates
253
Q

What are vascular-protective meds in CAD? (3)

A
  1. ASA
  2. ACEinhibitors
  3. Statins
254
Q

What is red man syndrome?

A

most common adverse reaction to vancomycin

- flushing + erythema + pruritis of the upper body, neck, and face

255
Q

If a pt is symptomatic from premature ventricular contractions, what can be used as first line therapy?

A

Beta blocker: ie metoprolol

CCB:verapamil

256
Q

what is the classic triad of a right ventricular myocardial infarction?

A
  1. Hypotension
  2. Clear lung fields
  3. Elevated CVP
    however most predictive finding is ST-segment elevation on R sided lead V4R
257
Q

Best initial treatment of right ventricular myocardial infarction?

A
  • Volume expansion: improves the hemodynamic abnormalities
  • reperfusion therapy
  • ionotropic support (IV dobutamine) in pts whose hypotension is not corrected after 1L of saline infusion
258
Q

Tetanus booster vaccination can be omitted in what two pt types presenting w a wound?

A
  1. Pts who rcd a tetanus booster within the past 5 years

2. Pts w clean minor wounds who have received vaccination within the past 10 years

259
Q

what are the two types of microscopic colitis?

A
  1. Collagenous: avg 60 yrs old, W>M, see increase in collagen beneath lining of the colon
  2. Lymphocytic: avg 70 yrs old, increased number of lymphocytes
260
Q

Initial therapy of microscopic colitis?

A
  1. Loperamide
  2. Diphenoxylate
  3. Bismuth subsalicylate
261
Q

what is the most common cutaneous manifestation of IBD? how does it present?

A

erythema nodosum: small, equisitely tender nodules on the anterior tibial surface, usually preceded by a prodrome of fever, malaise, and arthralgia
- seen more commonly in Crohns

262
Q

what are the cutaneous manifestations most commonly seen in Crohns versus UC? celiac disease?

A

Crohns: erythema nodosum
UC: pyoderma hgangrenosum
Celiac disease: dermatitis herpetiformis

263
Q

jaundice, pruritus, and elevated alk phos in a pt w ulceratiave colitis?

A

primary sclerosing cholangitis

264
Q

imaging modality to detect vertebral osteomyelitis?

A

MRI of Spine

265
Q

How do you diagnose hepatocellular carcinoma without a liver biopsy?

A
  • screening abdominal US is + and AFP >500ng/mL
266
Q

what 3 meds reduce morality in patients with NYHA III or IV heart failure?

A
  1. ACE inhibitors
  2. Beta blockers
  3. Spironolactone
267
Q

in PUD from H pylori, what is triple therapy?

A
  1. PPI
  2. Amoxicillin
  3. Clarithromycin
268
Q

what are two anticholinergic agents that are effective for treating urge urinary incontinence?

A
  1. Tolterodine

2. Oxybutynin

269
Q

for how long do you treat depression?

A
  • maintenance w an antidepressant drug for 4-9 months after remission of symptoms
270
Q

What is Naltrexone and what is it used for?

A
  • an opioid receptor antagonist

- effective in short term treatment as well as in decreasing the frequency of relapse

271
Q

in what patients do you initiate 2 antihypertensive meds?

A
  1. Pts w stage 2 HTN

2. Those whose blood pressure is greater than 20 systolic or 10 diastolic above target

272
Q

what is IV fomepizole used for?

A

treatment of ethylene glycol and methyl alcohol poisoning

273
Q

what is a poor prognostic sign in COPD?

A

unexplained weightloss

274
Q

Mnemonic for new onset urinary incontinence?

A 
DIAPERS:
Drugs
Infection
Atrophic vaginitis
Psychological (depression, delirium, dementia)
Endocrine (hyperglycemia, hypercalcemia)
Restricted mobility
Stool impaction
275
Q

What statistical value changes with disease prevalence?

A

predictive value: as the prevalence of disease decreases- the PPV decreases and NPV increases, whereas as the prevalence of a disease increases the PPV increases and NPV decreases

276
Q

what is the target BP for pts with DM2 or nondiabetic CKD in the absence of proteinuria?

A

130/80 mmHg

IM & Step 2 (4 decks)

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