Term
50 yo with diffuse muscle pain involving neck, shoulders and pelvis. Worse in morning.
Labs notable for normal CPK and elevated ESR.
Treatment and important comorbidity? |
|
Definition
Polymyalgia rheumatica.
1) low-dose steroids
2) Giant Cell Arteritis (temporal) |
|
|
Term
| How do you calculate PPV and how does it differ from sensitivity? |
|
Definition
PPV= TP/ TP + FP
Sensitivity= TP/ TP + FN |
|
|
Term
CXR suggests endobronchial obstructive lesion.
What is the appropriate next step in management? What is the best diagnostic test? |
|
Definition
1) Next step is CT chest
2) Diagnostic study is flexible bronchoscopy |
|
|
Term
| What is the best test to rule out osteomyelitis? Describe therapeutic workup. |
|
Definition
1) MRI (best sensitivity and negative predictive value)
2) Get bone culture and start IV antibiotics. |
|
|
Term
Diabetic with bloating and abdominal pain.
What is the diagnostic study of choice for gastroparesis? What is the first treatment step? |
|
Definition
1) Nuclear gastric emptying study
2) Dietary modification-> frequent small meals |
|
|
Term
| What important information does exercise stress testing tell you about cardiovascular disease? |
|
Definition
| Likelihood of cardiac events in coming year, but NOT likelihood of current CAD |
|
|
Term
| Patient with clinical signs and symptoms of erosive joint disease consistent with rheumatoid arthritis has negative RF and anti-CCP tests. No serum evidence of disease is discovered. What do you do? |
|
Definition
| Still treat erosive joint disease in absence of serum markers |
|
|
Term
| What should be given before CT to prevent contrast-induced renal vasoconstriction? |
|
Definition
| Prevent contrast neprhpathy with IV NS or sodium bicarb |
|
|
Term
| How is fecal impaction managed in elderly? |
|
Definition
| Manual disimpaction followed by enema |
|
|
Term
| How is shingles treated? how can one prevent post-herpetic neuralgia, and how is it treated? |
|
Definition
| 7d of oral valacyclovir can prevent it. Treat with Gabapentin |
|
|
Term
| What is the diagnostic study of choice for suspected esophageal perforation? What test should be avoided and why? |
|
Definition
1) Water-soluble esophagram
2) Avoid UGI, risk of worsening mediastinitis |
|
|
Term
| How can you distinguish seborrheic keratosis from actinic keratosis? |
|
Definition
Seborrheic keratoses appear on both covered and uncovered parts of the body, unlike actinic keratosis.
They begin as slightly raised, light brown or yellow spots. Gradually they thicken and take on a rough, warty, and sometimes waxy surface. They soon may darken and may turn gray or black. They are superficial and look as though they were stuck on the skin. |
|
|
Term
| Why might a patient with hepatitis B have fever, arthritis and dermatitis? |
|
Definition
| Serum sickness like reaction (type III hypersensitivity) |
|
|
Term
| What are the first steps in workup of lower back pain without high-risk features? |
|
Definition
1) X ray
2) ESR
If either abnormal, get MRI |
|
|
Term
| What is the management of lead toxicity in infants by level? |
|
Definition
Always confirm capillary blood sample with venous sample.
1) 5-45, repeat in 1 month
2) 45-69, oral therapy (DMSA, succimer)
3) >70, IV therapy |
|
|
Term
| When should subclinical thyrotoxicosis be treated? |
|
Definition
1) Persistent
2) Evidence of cardiac or bone (osteoporosis) involvement |
|
|
Term
| hen should subclinical hypothyroidism get treatment (high TSH, normal T4)? |
|
Definition
1) Positive antibodies
2) Abnormal lipids
3) Ovulatory/menstrual dysfunction
4) Symptoms (tiredness, weight gain, etc). |
|
|
Term
| What electrolyte abnormality is of concern when treatment B12 anemia? |
|
Definition
|
|
Term
| Describe the first 3 steps in workup of pseudo tumor cerebri |
|
Definition
1) Opathalmic exam for papilledema
2) Neuro-imaging
3) LP |
|
|
Term
| Which antibiotics are appropriate for mastitis? |
|
Definition
| Dicloxacillin or Cephalexin (most commonly staph) |
|
|
Term
| What is the first test in workup of suspected breast abscess? |
|
Definition
|
|
Term
| How can chronic pancreatitis be diagnosed? |
|
Definition
|
|
Term
| What is the pathophysiology of hematemesis in bronchiectasis? |
|
Definition
| Mucosal inflammation leads to rupture of superficial blood vessels |
|
|
Term
| When should Warfarin be started after HIT is diagnosed? |
|
Definition
| Wait until platelets recover > 150 (acute loss of protein C activity) |
|
|
Term
| Red, scaly, greasy, itchy, and inflamed skin often on face and scalp. What is the expected course and therapy? which groups are most vulnerable to this disease? |
|
Definition
Seborrheic dermatitis is chronic, relapsing often requiring chronic weekly therapy with topical anti fungal and anti-inflammatory agents
HIV and Parkinson's often have severe disease |
|
|
Term
Dysuria + Dyspareunia + Post-void dribbling in female with anterior vaginal mass on exam.
What test do you order? |
|
Definition
| Urethral diverticulum-> Pelvic MRI or Transvaginal US |
|
|
Term
| True or False: There is no increase in overall mortality or functional disability in most cases of ankylosing spondylitis |
|
Definition
| True. Follow with serial radiographs and ESR |
|
|
Term
45 yoF with facial rash of 6 months' duration that involves the cheeks and nose. Exam with erythematous rash with discrete papules and pustules limited to the cheeks, nasolabial folds, and nose.
What therapy is appropriate? What service should be consulted and why? |
|
Definition
Rosacia
1) Topical MTZ
2) Ophthalmology for chalazion formation |
|
|
Term
| Acute diverticulitis that failed medical management with fluids and ABX after 3d. What do you do? |
|
Definition
| Repeat scan to rule out colonic abscess |
|
|
Term
| How is pelvic organ prolapse managed? |
|
Definition
| Pessary or surgical intervention. Weight loss not appropriate. |
|
|
Term
| How is actinic keratosis managed? |
|
Definition
Remember to distinguish from seborrheic keratosis.
1) Topical 5-FU cream |
|
|
Term
| How can you distinguish between pulmonary contusion and fat embolism after blunt trauma? |
|
Definition
Pulmonary contusion: CXR findings, clear mental status, no rash
Fat embolism: confusion with rash and normal CXR |
|
|
Term
| How can fat embolism be prevented after trauma? |
|
Definition
| Early mobilization and surgical fixation of long bone fractures. |
|
|
Term
| Acute abdominal pain in child after air enema. What do you order? |
|
Definition
| AXR rule out perforation. |
|
|
Term
True or False: Acute HBV in stable patient can be managed outpatient.
True or False: Acutely infected patients need HBV IG |
|
Definition
True
False: No IG or vaccine for acutely infected |
|
|
Term
| How is subchorionic hematoma managed? |
|
Definition
| Expectant. Increase risk of spontaneous abortion. |
|
|
Term
Non-scarring hair loss with well-demarcated, round patches of complete hair loss. Patient also has nail pitting.
How is it managed? |
|
Definition
| Alopecia ariata: Intralesional Steroids |
|
|
Term
| How is acute cocaine chest pain managed? Which drugs should be avoided? |
|
Definition
1) IV benzodizepines
2) Avoid beta blockers
If concern for aortic dissection, get CTA |
|
|
Term
| What is the acute management of Gout? What about if patient is also hypertensive? Renal failure? |
|
Definition
1) NSAID, if contraindicated give Colchicine
2) If hypertensive, give ACE-i/ARB (especially if CKD)
3) Renal failure can't get NSAID or Colchicine, so give intraarticular steroids. |
|
|
Term
| How is Warfarin urgently reversed? |
|
Definition
1) Prothrombin complex (< 10min)
- If unavailable, can use FFP (large volume required)
2) IV vitamin K (12-24h) |
|
|
Term
| Mental status change, autonomic dysregulaion, neuromuscular hyperactivity, recent addition of psychotropic medication. What is the diagnosis? |
|
Definition
1) Serotonin syndrome
**NMS has rigidity, NOT hyperactivity |
|
|
Term
| What are the classic signs of organophosphate poisoning? Management? |
|
Definition
1) DUMBELS
Defecation, Urination, Miosis, Bronchospasm, Emesis, Lacrimation, Salivation
2) IVF, Atropine, Pralidoxime, Charcoal if within 1h |
|
|
Term
| What is used to treat benzodiazepine withdrawal? |
|
Definition
|
|
Term
| What should you be on the look out for in patient with sudden onset hyperglycemia while on TPN? |
|
Definition
| Sepsis until proven otherwise |
|
|
Term
| Which heart defect is associated with right atrial or right ventricular dilation of uncertain etiology? |
|
Definition
|
|
Term
| How do you calculate number needed to treat? |
|
Definition
| 1/ARR, where ARR= CER- EER |
|
|
Term
| How is hydradenitis suppurative (mild, moderate, severe) treated? |
|
Definition
1) Mild: topical abx
2) moderate: Oral abs
3) Severe: TNF-a inhibitor and surgery |
|
|
Term
| Patient presents with nausea/vomiting, tachypnea, combined respiratory alkalosis/lactic acidosis. What are you concerned about and how is it managed? |
|
Definition
| Salicylate toxicity: Sodium Bicarbonate drip |
|
|
Term
| How is lithium-induced hypothyroidism managed? |
|
Definition
| Add levothyroxine. Don't stop Lithium |
|
|
Term
| What are you concerned about in a patient with fever and shoulder pain after abdominal surgery? What do you do to work it up? |
|
Definition
| Sub-phrenic abscess. Get ultrasound |
|
|
Term
| Arthritis with effusion showing leukocytosis and negative cultures after recent infection. HLA B27 is negative. What is your diagnosis? |
|
Definition
| Likely reactive arthritis. Only sometimes has HLA-B27 positive |
|
|
Term
| How is active TB distinguished from latent TB? |
|
Definition
1) 3 negative sputum microscopy smears can rule out active
2) PPD or release assay cannot distinguish |
|
|
Term
| What test should you order if lyme arthritis is suspected? What is the prognosis with oral therapy? |
|
Definition
ELISA, can confirm with WB.
Prognosis is favorable after 28d oral therapy |
|
|
Term
| Bone pain in patient with normal calcium levels and elevated alk phos. How do you treat? |
|
Definition
Paget's, give bisphosphonates
**Remember association with CHF** |
|
|
Term
| How is UTI in pregnancy managed? |
|
Definition
| Fosfomycin, Unasyn or Cephalexin |
|
|
Term
| which features are considered favorable for schizophrenia prognosis? |
|
Definition
| Female, late onset, acute onset, positive symptoms, short duration |
|
|
Term
| How is acute uncomplicated syphilis managed compared to latent (>1y)? |
|
Definition
1) Single dose PCN vs. 3 weeks PCN
**Acute febrile response to infection (Jarisch-Herxheimer) is not preventable, but is self-limited to 48h |
|
|
Term
| In ESRD, how is iron replacement adjusted? |
|
Definition
| Low threshold (Ferritin < 500 or Saturation <30). Ferritin is elevated in inflammatory setting. |
|
|
Term
| How do you calculate relative risk reduction? |
|
Definition
| RRR: (risk in unexposed- risk in exposed)/ (risk in unexposed) |
|
|
Term
Which SE should you worry about in the following anti-seizure meds?
1) Valproic acid
2) Carbamezapine
3) Phenytoin |
|
Definition
1) Thrombocytopenia and Hepatotoxicty
2) Hyponatremia, neutropenia, SIADH in elderly
3) Gingival hyperplasia |
|
|
Term
| What is considered appropriate post-exposure ppx for HIV? |
|
Definition
|
|
Term
| What is the pathophysiology of HIV-related lipodystrophy? |
|
Definition
|
|
Term
| How can subacute thyroiditis be distinguished from graves? |
|
Definition
| decreased iodine uptake vs. increased uptake |
|
|
Term
| What is diagnostic study of choice for suspected megacolon in patient with IBD? What is 1st line therapy? |
|
Definition
|
|
Term
| What is therapeutic order of operations for perforated peptic ulcer? |
|
Definition
|
|
Term
| What organism underlies hand-foot-mouth disease and how is it managed? |
|
Definition
1) Coxsackie virus
2) Pain control and hydration |
|
|
Term
| How do you treat cyanide toxicity associated with Nitroprusside? |
|
Definition
|
|
Term
| Asthmatic child presents with fever, cough, malaise and evidence of bronchial obstruction. What is your next step? |
|
Definition
Allergic bronchopulmonary aspergillosis is possible. Get skin testing for aspergillum and IgE testing.
Treat with systemic steroids and Itraconazole/Voriconazole |
|
|
Term
| How can persistent back pain 2/2 metastatic prostatic cancer be managed? |
|
Definition
|
|
Term
| How is supracondylar humerus fracture managed? What about radial head subluxation? |
|
Definition
1) Splint and immobilize
2) External reduction |
|
|
Term
| Sickle cell patient with new chests infiltrate and hypoxemia. What is management? |
|
Definition
Acute chest syndrome
Ceftriaxone + Azithromycin + Pain control and IVF |
|
|
Term
| Why might you see indirect hyperbilirubinemia in macrocytic anemia? |
|
Definition
| B12 deficiency leads to inefficient erythropoiesis-> indirect hyperbilirubinemia |
|
|
Term
| How is recurrent C. dif managed? |
|
Definition
1) first recurrence retreat with MTX
2) second recurrence or severe disease gets PO Vanco |
|
|
Term
| Describe the first stage of labor and how protracted stage 1 labor is managed. |
|
Definition
1) Latent 0-6cm with slow dilation followed by Active with 6-10cm with > 1cm per 2h
2) Oxytocin infusion and amniotomy |
|
|
Term
| How is HD catheter infection managed? |
|
Definition
| Vanc/Cefepime empirically. Try to leave in cath. |
|
|
Term
| What is the major risk factor for postpartum endometritis and how is it treated? |
|
Definition
1) C section
2) Clindamycin and Gentamycin |
|
|
Term
| First step in management of acute decompensated heart failure in s/o pulmonary edema and hypertension. |
|
Definition
| IV diuretics and IV nitroglycerine |
|
|
Term
| How is opioid withdrawal managed medically? |
|
Definition
| Low-dose methadone or non-opiate clonidine if not available. |
|
|
Term
| How should you treat a patient with severe mania who failed to respond to monotherapy? |
|
Definition
|
|
Term
Small-skin colored papule with indented center sparing palms and soles.
Etiology, transmission and comorbidities |
|
Definition
1) Moluscum (pox virus)
2) Skin-to-skin contact or Fomites
3) Consider HIV testing, if on face especially |
|
|
Term
| Workup for primary amenhorea |
|
Definition
1) Pelvic ultrasound
a. Uterus present: Get FSH. If high (karyotype), if low (cranial MRI)
b. Uterus absent: Karyotype and serum testosterone: XX (mullarian), XY (androgen insensitivity) |
|
|
Term
| What infection is classically associated with left ventricular apical aneurysm? |
|
Definition
|
|
Term
| Which diabetes meds are associated with hypoglycemia? |
|
Definition
1) Sulfonylureas: Glyburide, Glipizide, Glimepiride
2) Meglitinides: Nateglinide, Repaglinide |
|
|
Term
| What is the etiology of hypercalcemia in Sarcoidosis? |
|
Definition
| Overproduction of calcitriol |
|
|
Term
| How do you manage renal crisis and hypertension in Scleroderma? |
|
Definition
| IV Captopril + Ntiroprusside if CNS manifestations of ICP |
|
|
Term
| How is bacterial conjunctivitis managed? What is feared complication? |
|
Definition
1) Macrolide unless contact lens (Pseudomonas)
2) Keratitis-> Urgent optho referral |
|
|
Term
| How can you monitor the progression of SLE nephritis? How is it diagnosed? |
|
Definition
1) dsDNA (high) and complement (low) levels
2) Biopsy (before immunosuppression!) |
|
|
Term
| How does the cardiac toxicity from radiation differ from anthracycline use (doxo/daunorubacin)? |
|
Definition
1) Radiation: diastolic dysfunction with restrictive physiology
2) Anthracycline: dilated CCM with rEF |
|
|
Term
| How should you manage a supratherapeutic INR in patient on warfarin in absence of obvious bleed? |
|
Definition
| Hold warfarin for a few days and monitor INR |
|
|
Term
| Tinea versicolor: diagnosis and treatment |
|
Definition
1) KOH prep for Mallasthesia
2) Topical Ketoconazole |
|
|
Term
| Treatment for diaper dermatitis |
|
Definition
|
|
Term
| True or False: CT screening for lung cancer has high false-positive rate |
|
Definition
|
|
Term
| Febrile infant with UTI. What is next step? |
|
Definition
| Renal bladder ultrasound--> then voiding CUG |
|
|
Term
| First step for workup of pancreatic cyst with minimal malignant potential |
|
Definition
|
|
Term
| Which serum marker indicates prognosis in setting of pulmonary embolism? |
|
Definition
| Troponin leak has worse prognosis from RHF |
|
|
Term
| How should peri-infarction pericarditis be managed? How is this different from viral pericarditis? |
|
Definition
|
|
Term
| How do you treat TCA overdose? |
|
Definition
| IV sodium bicarbonate to treat arrhythmia. |
|
|
Term
| What diagnosis is suggested by decreased passive and active ROM in shoulder. How would your differential change if passive ROM was normal? |
|
Definition
1) Adhesive capsulitis
2) Subacromial bursitis |
|
|
Term
| How is gonococcal conjunctivitis prevents in infants? |
|
Definition
| ALL get ophthalmic erythromycin within hours of birth |
|
|
Term
| How is pediatric sepsis managed <28d vs. > 28d age? |
|
Definition
1) < 28d: E. coli and GBS: ampilcillin + gentamicin or cefotaxime
2) >28d: S. pneumo or N. meningitidis: Ceftriaxone or cefotaxime + Vancomycin |
|
|
Term
| How is chronically urticaria diagnosed and manage? |
|
Definition
1) Clinical diagnosis
2) 2nd generation anti-histamine. Usually resolves within 2-5 years spontaneously |
|
|
Term
| How is Grave's opthalmopathy managed and how is treatment-response tracked? |
|
Definition
1) Iodine ablation and steroids (eyes)
2) Follow T3 and fT4 (NOT TSH) |
|
|
Term
| How is Onychomycosis treated? |
|
Definition
|
|
Term
| How is obstructive urolithiasis managed in setting of infection, AKI or severe pain? |
|
Definition
| Percutaneous nephrostomy or ureteral stent, NOT lithotripsy |
|
|
Term
| Are tendons, arteries, veins or nerves most likely to be injured in digital injuries? |
|
Definition
|
|
Term
| What is your broad differential for abnormal uterine bleeding? |
|
Definition
1) Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy
2) Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic |
|
|
Term
| Retro-orbital pain with positive tourniquet test (petechiae appear within 2 minutes of cuff inflation). What is your biggest worry? |
|
Definition
| Dengue: Circulatory collapse given capillary permeability |
|
|
Term
| Which aneurysm is associated with CN III deficit? |
|
Definition
|
|
Term
| Anti-smooth muscle antibody elevation with positive ANA |
|
Definition
|
|
Term
| Which drugs interfere with folate metabolism? |
|
Definition
|
|
Term
| Which antibiotics are biggest concern for C. dif? |
|
Definition
1) Flouroquinolones
2) Cephalosporins
3) Enhanced spectrum PCNs |
|
|
Term
| 65 yoM with GERD like symptoms new onset. What do you do? |
|
Definition
| > 55 with GERD needs endoscopy regardless of alarm features |
|
|
Term
| What is the greatest risk factor for osteoporosis? |
|
Definition
|
|
Term
| Abdominal pain, fever and night sweats in patient with Celiac Disease. What are you thinking about? |
|
Definition
B symptoms + Abdominal Pain in Celiac
Enteropathy-assocaited T-cell lymphoma in proximal jejunum |
|
|
Term
| Infant with jaundice, poor feeding, hypothermia. What is prognosis? |
|
Definition
| Congenital hypothyroidism, excellent prognosis with treatment. Otherwise permanent neuro sequele. |
|
|
Term
| Treatment for toxic thyroid adenoma |
|
Definition
| Pre-treat with methimazole followed by radioactive I ablation |
|
|
Term
| What are the common causes of viral meningitis in kids and adults? |
|
Definition
1) Kids: Enterovirus or arbovirus
2) Adults: HSV |
|
|
Term
| Red, painful, edematous and elevated rash with sharp demarcation and fever + chills. Diagnosis? |
|
Definition
|
|
Term
| Unilateral horners + headache |
|
Definition
|
|
Term
| Management of early localized lyme disease |
|
Definition
| 14d Doxy without ELISA/WB needed |
|
|
Term
| Which malignancy is associated with Sjogren's? |
|
Definition
|
|
Term
|
Definition
| IV abs and IV albumin (reduce renal impairment) |
|
|
Term
| What elements go into calculation of MELD score? |
|
Definition
| INR, bilirubin, Cr, serum Na |
|
|
Term
|
Definition
- IG for patients without vaccine or unclear history
- Toxoid for dirty wound with vaccine > 5 years ago
- Toxoid for minor wound and vaccine > 10 years ago |
|
|
Term
| What tests are ordered between 24-28w gestation? |
|
Definition
1) H/H
2) Hd/D
3) 50g 1h GCT |
|
|
Term
| What are the signs of colonic ischemia? |
|
Definition
| Colonic distention, edema with friable mucosa |
|
|
Term
| Eye pain and redness with constricted irregular pupil and leukocytes present in anterior chamber. Management? |
|
Definition
Anterior Uveitis (Iritis)
- ABX for infective
- Steroids for non-infectious |
|
|
Term
| What are the baseline caloric and protein nutritional needs? |
|
Definition
1) 30kcal/kg/day
2) 1g/kg/day protein |
|
|
Term
| How is mild vs. severe tinea pedis managed? |
|
Definition
1) Mild topical antifungals
2) Severe oral Terbinafine |
|
|
Term
| How should exposure ppx be changed for a patient on OCPs? |
|
Definition
| NOT rifampin. Use Ceftraixone or Ciprofloxacin instead. |
|
|
Term
| New RBBB in patient with massive PE. What is your suspicion? |
|
Definition
| Tricuspid insufficiency from RH strain |
|
|
Term
| Pregnant women with rash on palms and soles and pruritus. How does this affect prenatal care? How might the presence of a trucal rash preceded by pruritus change your diagnosis and treatment? |
|
Definition
1) Palms/soles: Intrahepatic cholestasis of pregnancy, deliver at 37w due to risk to fetus.
2) Truncal: Pemphigoid gestations: high-potency steroids |
|
|
Term
| What type of fracture is common in FOOSH injury? What is the primary risk factor, complication and treatment? |
|
Definition
1) Colle's fracture of distal radius
2) Osteoporosis
3) Acute carpal tunnel syndrome
4) Conservative |
|
|
Term
| When do infants need iron supplementation? How can iron deficiency anemia be distinguished from thallesmia in infants? |
|
Definition
1) > 6 months
2) Mentzer index MCV/RBC (> 13, iron) |
|
|
Term
| How should iron supplementation be prescribed? What is the first hematological change to expect? |
|
Definition
1) Give between meals with vitamin C to facilitate absorption
2) Increase in reticulocyte count (H/H takes 1 month) |
|
|
Term
| What are alcohol consumption guidelines for males and females? |
|
Definition
1) Female 3/7
2) Male 4/14 |
|
|
Term
| How is chronic prostatis diagnosed? How is it treated? |
|
Definition
1) Urine culture before and after massage, > 20 leukocytes/hpf
2) Alpha blockers, anti-inflammatories and/or psychotherapy |
|
|
Term
| What are the 3 major forms of CAH? |
|
Definition
1) 21 hydroxylase most common: ambiguous genitalia, salt wasting (high K+, hypotensive).
- Elevated 17 hydroxyprogesterone.
- Hydrocortisone +/- fludrocortisone (mineralocorticoid)
2) 11 beta hydroxylase: fluid and salt retention, hypertensive, hyperkalemic)
3) 17 alpha hydroxylase: fluid and salt retention, hypertensive, hypokalemic) |
|
|
Term
| True or False: HIV testing false negatives are common in first 4 weeks after exposure |
|
Definition
|
|
Term
| What types of biopsies are acceptable for sarcoid diagnosis? |
|
Definition
| Lacrimal, parotid, sub-q nodule, LN, lung |
|
|
Term
| What is the standardized mortality ratio? |
|
Definition
Adjusted measure of overall mortality:
observed death in given population/expected number of deaths from reference population |
|
|
Term
| What is "Percentage attributable risk" ? |
|
Definition
| (Risk in total population - Risk of unexposed)/ (Risk in total population) |
|
|
Term
| How is HTN managed in patient on Lithium? |
|
Definition
Avoid thiazides, ACE-i/ARB, K-sparing. Try CCB
Lithium toxicity is precipitated by:
Diuretics
ACE Inhibitors
NSAIDS |
|
|
Term
|
Definition
1) vaccinated individuals with re-exposure
- get booster of vaccine after exposure (2 doses).
2) non-vacinated
- Full 4 dose series otherwise. Can give IG on day 0 only, and only in previously unvaccinated. |
|
|
Term
| Describe the natural course of sarcoidosis with treatment |
|
Definition
| Sarcoid tends to resolve with 12-24 months steroids. Not life-long disease |
|
|
Term
| What is primary prevention? |
|
Definition
| Risk factors are present, but disease is NOT. Management of RF |
|
|
Term
| Macrocephaly and intracranial calcifications |
|
Definition
|
|
Term
| Vesicular lesions on fingers while on topical antibiotics? |
|
Definition
|
|
Term
| What is periodic breathing in infancy? |
|
Definition
| 5-10s pauses in breathing (compared to >20s in apnea of prematurity) followed by rapid shallow breathing. They are benign |
|
|
Term
| What are the 3 major forms of incontinence? |
|
Definition
1) Stress: urethral hypermobility: leakage with coughing, lifting, sneezing
2) Urge: detrusor hyperactivity: sudden, overwhelming urge to urinate
3) Overflow: Impaired destrussor contractility/bladder outlet obstruction: Incomplete emptying and dribbling. |
|
|
Term
| How is Psoriatic arthritis managed? |
|
Definition
|
|
Term
| How is Afib with LV systolic dysfunction managed? |
|
Definition
No Beta blockers
Dofetilide or Amiodarone |
|
|
Term
Side effects of common alternative medicine therapies:
1) Saw Palmetto
2) Gingko/Ginseng
3) Kava Kava |
|
Definition
1) Used for BPH: bleeding risk
2) Used for memory: bleeding risk
3) Used for anxiety/insomnia: liver toxicity |
|
|
Term
Side effects of common alternative medicine therapies:
1) Licorice
2) St. John's Wort |
|
Definition
1) Used for stomach ulcers and bronchitis: hypertension and hypokalemia
2) Used for expression: Hypertensive crisis, serotonin syndrome, anticoagulants |
|
|
Term
| What is the concern of using PPAR-y agonist pioglitazone (TZD for T2DM) in patient with CHF? |
|
Definition
| Fluid retention leading to pulmonary edema |
|
|
Term
| What is the mechanism underlying breast milk jaundice? |
|
Definition
high levels of beta-glucuronidase in milk deconjugates intestinal bilirubin and increases enterohepatic circulation.
NO anemia |
|
|
Term
| How can you diagnose and treat Condylomata acuminata? |
|
Definition
HPV anogenital warts
1) Acetic acid will make turn white
2) Thrichloroacetic acid to treat |
|
|
Term
| How should breast feeding be managed in HIV + mothers? |
|
Definition
1) Poor country can breast feed given water-borne illness risk
2) in Wealthy country use formula |
|
|
Term
| What are the blood pressure goals in the s/o acute stroke? How does thrombolytic therapy modify these goals? |
|
Definition
1) Permissive 220/120
2) If TPA used, keep < 185/105 |
|
|
Term
| How does Chikungunya fever present and how is it managed? |
|
Definition
Central/South America, Aedes mospquito is vector
1) High fevers followed by polyarthralgias, normal labs
2) Supportive care |
|
|
Term
| How does Amiodarone affect thyroid function? What about warfarin dosing? |
|
Definition
1) Lowers T3 by decreasing peripheral conversion.
- No change in therapy is necessary, will improve over time.
2) Decrease Warfarin dose |
|
|
Term
| How is ADPKD screening performed? |
|
Definition
| Renal ultrasound with prior counseling. NOT genetic |
|
|
Term
| How are negative symptoms of SCZ managed? |
|
Definition
|
|
Term
| early, isolated pubic hair development and normal bone age. How is your diagnosis changed if bone age is increased? |
|
Definition
1) Idiopathic premature pubarche
2) CAH non-classical should be considered |
|
|
Term
| How is tertiary hypercalcemia managed in CKD? |
|
Definition
| Autonomous PTH secretion with hypercalcemia and hyperphosphatemia requires Parathyroidectomy |
|
|
Term
| What is the single best intervention to reduce progression of AAA? |
|
Definition
|
|
Term
| what is the predominant cause of death in tuberous sclerosis? What is the appropriate workup? |
|
Definition
Epilepsy
Brain MRI and EEG |
|
|
Term
| How can you distinguish between Polycythemia vera and EPO-secreting tumor? |
|
Definition
| First get EPO level. Will be high in tumor or secondary cause of polycythemia, but will be low in P. vera. |
|
|
Term
| What abx is used to treat cat bites? |
|
Definition
| P. multimode risk, give Augmentin ppx. |
|
|
Term
| How can you most easily distinguish between REM and non-REM sleep terrors? |
|
Definition
Non-Rem: no memory
REM: memory |
|
|
Term
| What kind of rash is characteristic of a Glucagonoma? |
|
Definition
| Scaly rash that clears from center first |
|
|
Term
| What is the primary indication for Cerclage treatment? |
|
Definition
| Cervical insufficiency with prior pre-term births |
|
|
Term
| What are the best serum predictors of pancreatitis severity? |
|
Definition
| Hematocrit and BUN. NOT Lipase |
|
|
Term
| How would you treat a large choroidal melanoma? |
|
Definition
|
|
Term
| Slow-growing, locally aggressive benign neoplasm with high rate of local recurrent (often in abdomen). |
|
Definition
|
|
Term
| Infant with Jaundice and anemia. What is your differential? What do you order? |
|
Definition
1) G6PD: day 2-3 presentation, x-linked (males). Negative direct coombs
2) ABO incompatibility: first 24h life, positive direct coombs. |
|
|
Term
| Why do some patients get diarrhea following cholecystectomy and how can you manage it? |
|
Definition
Bile-salt induced diarrhea
Cholestyramine to bind bile salts |
|
|
Term
Meningitis with following CSF findings
1) Opening pressure 260
2) Leukocytes 40 with 80% lymphocytes
3) Protein high, glucose low
4) Positive india ink test
Management? |
|
Definition
Cryptococcal meningitis
- Elevated opening pressure mild: 250-300
- Low leukocyte count < 50 with lymphocytic predominance
- Elevated protein and low glucose
- Positive india ink or antigen test.
2 weeks amphotericin B and flucytosine followed by 8 weeks with fluconazole high dose followed by low-dose fluconazole for 1 year to prevent reuccrence.
- Delay starting ART for 2-10 weeks because of risk of immune constitution syndrome
- Need serial LPs to reduce elevated ICP |
|
|
Term
| A patient with previously undocumented HIV is diagnosed with Cryptococcal meningitis. When should you start ART? |
|
Definition
| Delay starting ART for 2-10 weeks because of risk of immune reconstitution syndrome |
|
|
Term
| Standardized incidence ratio (SIR) |
|
Definition
observed cases divided by expected cases.
"Is occurrence of cancer in small population high or low relative to what would be expected for larger comparison population?" |
|
|
Term
| Which blood pressure medication is known to cause a photosensitivity rash? |
|
Definition
| Thiazide diuretics: Also hyperglycemia, hyperuricemia, hypokalemia, GI effects and dizziness |
|
|
Term
| How do you calculate + and - Likelihood ratios? |
|
Definition
1)+ Likelihood ratio
- sensitivity/ (1-specificity) or true positive/ false positive
2) – Likelihood ratio
- (1- sensitivity)/ (specificity) or false negative/ true negative |
|
|
Term
| What is the greatest risk associated with hereditary hemochromatosis |
|
Definition
HCC.
Treat with phlebotomy (not improve arthropathy, which can present as Pseudogout) |
|
|
Term
| What is the appropriate management for a pituitary adenoma with elevated alpha subunits and low FSH/LH? |
|
Definition
| Non-functioning adenoma needs transphenoidal resection |
|
|
Term
Name Vaginitis and treatment
1) Thin, off-white discharge with fishy odor, positive whiff test
2) Thick, cottage cheese like
3) Thin, yellow, malodorous |
|
Definition
1) BV: MTZ or Clindamycin
2) Candida: KOH for pseudohyphae, Fluconazole
3) MTZ and treat partner. If pregnant, give single dose and hold breast milk for 24h |
|
|
Term
| How do you treat Syphillis in patient with PNC allergy |
|
Definition
| Desensitize and still give. Azithromycin is second line, but does not cross placenta and will not treat fetal infection. |
|
|
Term
How do you manage each of the following forms of Psoriasis
1) Mild to moderate plaques
2) Severe plaques
3) Facial and intertriginous |
|
Definition
1) Mild to moderate plaques: topical high-potency CS (fluocinonide) and vitamin D derivatives
2) Severe plaques: phototherapy and systemic MTX
3) Facial and intertriginous: Topical tacrolimus and low-potency CS |
|
|
Term
| What is the most common side effect of TURP for BPH? |
|
Definition
|
|
Term
| Palpable purpura, fatigue, arthralgias, elevated RF and hypocomplementemia. What is workup and treatment? |
|
Definition
Mixed cryoglobulinemia: HCV association
1) Order serum cryoglobulin levels
2) Initial immunotherapy with Rituxumab ad Prednisone followed by treatment of underlying condition (HCV usually) |
|
|
Term
| How are Plantar warts treated? |
|
Definition
| Topical Salicylic acid 2-3w |
|
|
Term
| Why might inpatients with vatical bleeds need antibiotic prophylaxis? |
|
Definition
| Prevent hospital acquired infections like SBG (FQ for 7-10d) |
|
|
Term
| Who needs to be screened for Bicuspid aortic valves? |
|
Definition
| AD inheritance. All first degree relatives. |
|
|
Term
| What is the best prognostic indicator of COPD prognosis? |
|
Definition
|
|
Term
| How is Levothyroxine adjusted after papillary thyroid cancer treatment? |
|
Definition
To suppress TSH, always on empty stomach.
Reduces risk of recurrence of TSH suppressed |
|
|
Term
| Soft S2, Delayed and diminished carotid pulse (parvus et tardus), Loud and late-peaking systolic murmur. |
|
Definition
|
|
Term
| What is major SE of Trastuzumab (HER-2 antibody) |
|
Definition
| Reversible cardiotoxicity |
|
|
Term
| Who needs antibiotic ppx for infective endocarditis? |
|
Definition
High-risk cardiac conditions undergoing
1) Dental procedure
2) Respiratory tract procedure
3) Surgical placement of cardiac prosthesis |
|
|
Term
| What conditions are associated with discrete intensely pruritic polygonal violaceous papules on flexural surfaces of extremeties (commonly wrists)? |
|
Definition
Lichen planus, diagnosed on skin biopsy
Liver disease and HCV |
|
|
Term
| How are lytic lesions diagnosed in Multiple Myeloma? |
|
Definition
Technetium 99 scan for blastic lesions (specific, not sensitive)
Skeletal x ray survery for lytic lesions |
|
|
Term
| How is Mucor involving rhino cerebral area treated? |
|
Definition
| Liposomal IV amphotericin B |
|
|
Term
| What medication is necessary at 12w gestation for high-risk pre-eclampsia? |
|
Definition
|
|
Term
| When is GBS ppx administered? |
|
Definition
1) unknown status + < 37w
2) intrapartum fever +/- amniotic membrane rupture > 18hrs. |
|
|
Term
| What is the workup for delayed puberty? |
|
Definition
Lack of testicular enlargement > 4 ml by age 14
Usually from inadequate secretion of testosterone, can be primary or secondary
1) Bone radiograph first
2) FSH/LH/Testosterone.
- Primary: FSH/LH elevated
- Secondary: Low FSH/LH |
|
|
Term
| What is the biggest risk factor for PID? |
|
Definition
| Multiple sexual partners, even more than previous PID |
|
|
Term
| Sudden death following steering wheel injury. What likely happened? |
|
Definition
|
|
Term
| How do you manage dumping syndrome post-gastrectomy? |
|
Definition
| High protein, low carb diet, small frequent meals |
|
|
Term
| Patient develops groin pain after recent cardiac cath. What do you order and what is the biggest risk factor for this condition? |
|
Definition
Pseudoaneurysm->get Ultrasound.
Risk factor is inadequate post-procedural manual compression |
|
|
Term
| How should anti-thyroid drugs be given in pregnancy? |
|
Definition
| PTU 1st trimester and then Methimazole 2nd-3rd (less risk of liver toxicity) |
|
|
Term
| How do you treat Tinea Capitus? |
|
Definition
| Oral Griseofulvin or Terbinafine |
|
|
Term
| When should a skin abscess get hospitalization and IV Abx? |
|
Definition
|
|
Term
| What cardiac abnormality is increased risk in gestational hyperglycemia? |
|
Definition
CHF via glycogen deposition and thickening of IV septum
- Will resolve spontaneously at birth |
|
|
Term
| What is the first test to evaluate infertility? |
|
Definition
|
|
Term
| Who gets treated for Giardia? |
|
Definition
| Symptomatic with positive stool cultures |
|
|
Term
| What are the glucose goals of Gestational diabetes? |
|
Definition
< 95 fasting and < 140 1h post-prandial.
Otherwise start insulin to prevent macrosomia and shoulder dystocia |
|
|
Term
| How is Candida Endopathalmitis managed in Neutropenic patient? |
|
Definition
| vitrectomy and amphotericin B IV necessary for 4-6 weeks. |
|
|
Term
| Apart from limb loss, what is dangerous complication of compartment syndrome? |
|
Definition
|
|
Term
| What is the appropriate abs regimen for CF patient with PNA? |
|
Definition
| Double Pseudomonas coverage with Cefepime and Amikacin, as well as Vanco in s/o MRSA history. |
|
|
Term
| Why is an Intention to treat analysis useful? |
|
Definition
| Preserves randomization, while preventing crossover and dropout |
|
|
Term
| Painless blistering of hands and hyperpigmentation of face in patient with HCV. What do you order? How would you treat? |
|
Definition
porphyria cutanea tarda
- get urinary porphyrins
- treat with phlebotomy or hydroxychloroquine |
|
|
Term
| High T4 and low TSH normal in early pregnancy. Treat? |
|
Definition
| Reassurance appropriate if aysymtpomatic |
|
|
Term
| How is Vasospasm managed medically? |
|
Definition
| Dihydropyridine calcium blockers like Nifedipine or Amlodipine or Diltiazam |
|
|
Term
| What is the treatment of choice for a patient with DVT/PE, without cancer and with low bleeding risk |
|
Definition
|
|
Term
| True or False: If pre-test probability is high for PE, low probability V/Q does NOT rule it out |
|
Definition
| True! Only normal scan will rule it out |
|
|
Term
| What is the appropriate bedside acute eval test for tension PTX? What about normal PTX? |
|
Definition
1) Ultrasound
2) Upright PA view CXR |
|
|
Term
| What is the initial diagnostic test of choice for suspected pHTN? |
|
Definition
|
|
Term
| Which additional drugs might precipitate Doxin toxicity? |
|
Definition
| Verapimil, Quinidine, Amiodarone |
|
|
Term
| What are the most common complications after Donor nephrectomy? |
|
Definition
|
|
Term
| Eval of unilateral and bilateral nipple discharge? |
|
Definition
1) Unilateral < 30: get US +/- Mammogram
2) Unilateral > 30: Get US + mammogram
3) Bilateral: pregnancy test and galactorrhea eval |
|
|
Term
| Under what conditions should C. dif be initially treated with Vanco instead of MTZ? |
|
Definition
1) High WBC > 15k
2) High fever
3) Cr > 1.5x baseline |
|
|
Term
| Which diabetic complications are improved by glycemic control in T2DM? |
|
Definition
| Microvascular: Retinopathy, Nephropathy, Neuropathy. |
|
|
Term
| What is the natural course of infantile hemangioma? |
|
Definition
| Get bigger in first year of life and then spontaneously involute? |
|
|
Term
| When should children be screened for familial dyslipidemias? |
|
Definition
| Parents died early from CAD |
|
|
Term
| How is Giullon Barre syndrome treated? What the effects of treatment? |
|
Definition
Therapeutic plasma exchange or IVIG
Recovery is spontaneous, but therapy speeds it up? |
|
|
Term
| First step in management of acute MI with inferior wall and sinus bradycardia |
|
Definition
1) Atropine
2) IVF after if pre-load dependent
3) IF still resistant- try transcutaneous pacing |
|
|
Term
| When is viral conjunctivitis no longer contagious? |
|
Definition
|
|
Term
| Painless red macules evolve into bullae and finally gangrenous ulcers in patient with chemotherapy-induced neutropenia. Diagnosis? |
|
Definition
|
|
Term
| 1st line treatment in primary dysmenorrhea for sexually active vs. non-active patients |
|
Definition
1) Sexually active: OCP
2) Non-active: NSAIDs |
|
|
Term
| Recurrent PNA patient with Parkinson’s. What test should you order? |
|
Definition
| Aspiration is worry. Think swallowing study |
|
|
Term
| In which patients should you avoid Varencycline? What about Buproprion? |
|
Definition
1) Varencycline: Psychiatric issues
2) Buproprion (weight neutral and no sexual SE): Seizures |
|
|
Term
| Which antidepressant is weight-neutral and lacks sexual SE? |
|
Definition
| Buproprion. Don't give in s/o seizures |
|
|
Term
| What is the work-up for HIV-associated pleural effusion? |
|
Definition
| needs pleural biopsy with histopathological demonstration of granulomas to rule out TB |
|
|
Term
| What is the management of decubitus ulcers that are full-thickness with sub-q fat involvement? |
|
Definition
|
|
Term
| Abrupt onset palpitations with inverted P waves. What is the mgmt? |
|
Definition
| PSVT- vagal maneuvors and adenosine |
|
|
Term
| What is the appropriate screening test for primary nocturnal enuresis > 5 yo |
|
Definition
|
|
Term
| First-line therapy for PCP intoxication? |
|
Definition
|
|
Term
| Pathophysiology and treatment of thrombocytopenia associated with hemolytic anemia and renal failure? |
|
Definition
TTP- often also neural sequelae
1) Treat with plasma exchange.
2) Due to autoantibodies against MMP ADAMS13. |
|
|
Term
| What are the appropriate precautions for disseminated shingles? What about localized? |
|
Definition
1) Disseminated needs contact and droplet
2) Localized just needs standard until lesions crust over |
|
|
Term
| How should anticoagulation be managed in pregnancy? |
|
Definition
1) LMWH 1st trimester
2) Warfarin OK 2-3
3) Unfractioned heparin immediately before delivery (rapid reversal). |
|
|
Term
| How do you treat Catatonia? |
|
Definition
| Benzodiazepine and/or ECT. NOT Benztropine (different mechanism) |
|
|
Term
| Why do you see glandular atrophy is patients with pernicious anemia? |
|
Definition
| Pernicious anemia causes autoimmune metaplastic atrophic gastritis (autoantibodies that destroy parietal cells), leading to glandular atrophy, intentstinal metaplasia and inflammation. Usually primarily in gastric body and fundus (not antrum). |
|
|
Term
| When is a progestin-releasing IUD most appropriate? |
|
Definition
| Contraception in s/o hypercoagulability, high menstrual flow or anticoagulation |
|
|
Term
What is the appropriate medical management of pre-term labor in the following time frames?
1) 34-37w
2) 32-34w
3) <32w |
|
Definition
1) Preterm labor
a. 34-37: steroids
b. 32-34: steroids and tocolytics
c. <32: steroids, tocolytics and MgSO4 |
|
|
Term
| What is the appropriate medical workup for suspected dermatomyositis? How is it treated? |
|
Definition
1) CXR and antibody testing (Anti-RNP, anti-Jo-1, anti-Mi2).
2) If uncertain, EMG and biopsy can be helpful.
3) Treat with steroids and screen for malignancy. |
|
|
Term
| How is AKI 2/2 rhabdo best prevented? |
|
Definition
|
|
Term
| What are the risks of using PPIs? |
|
Definition
| Osteoporosis, C. dif, interstitial nephritis, B12/iron deficiency in long-term |
|
|
Term
| How does CAP management differ for Toddlers and Adolescents? |
|
Definition
CAP in toddlers is S. pneumo and needs high-dose amox.
CAP in older children or with bilateral lung findings (well appearing) need Azithro for mycoplasma |
|
|
Term
| How is Gestational Diabetes managed postpartum? |
|
Definition
| Stop insulin after delivery and then have 2h glucose tolerance test at 6-12w |
|
|
Term
| Fever, cough and conjunctivitis with cephalocaudal spreading rash. Child with incomplete vaccination. Diagnosis and treatment |
|
Definition
| Rubeola (measles). Supportive |
|
|
Term
| How is pseudomembranous pharyngitis managed? What is the most feared complication? |
|
Definition
Also known as Diptheria
1) Culture for res secretions and toxin assay
2) If severe, give antitoxin and erythromycin or PCN G
3) Feared complication is myocarditis |
|
|
Term
| What is the first test to order when working up Restless leg syndrome? |
|
Definition
| Ferritin. Common association with iron deficiency anemia |
|
|
Term
| His patient with papules with central umbilication with small area of central hemorrhage or necrosis. |
|
Definition
| Cutaneous cryptococcal infection |
|
|
Term
| How do you treat Sulfonylurea (glyburide) intoxication? |
|
Definition
| Dextrose and octreotide to decrease insulin secretion |
|
|
Term
| What are you worried about in a patient with prior pancreatitis and gastric varices? What would the treatment be? |
|
Definition
| Splenic vein thrombosis. Splenectomy is curative |
|
|
Term
| How is bleeding in s/o renal failure managed? |
|
Definition
| Platelet dysfunction: Give IV desmopressin to increase release of factor VIII: vWf multimers from endothelium |
|
|
Term
What neonatal infection is this?
Ocular abnormalities, SNHL, cardiac defects (PDA), purpuric lesions (blueberry muffin, nonblaching nodules). |
|
Definition
| Neonatal rubella. CT will be normal, compared to toxo (intracranial calcifications) or CMV (periventricular calcifications) |
|
|
Term
| What is the screening test of choice before clearing for sports in a patient with possible Marfan's? |
|
Definition
|
|
Term
| What kinds of urethral stones can be managed outpatient? |
|
Definition
| <10mm with symptom control after hydration, pain control and alpha blocker |
|
|
Term
| How is primary ovarian insufficiency managed? |
|
Definition
Amenorrhea < 40 years old with increased FSH and low Estrogen
Estrogen therapy (with progesterone if uterus in tact) |
|
|
Term
| Rapid-onset hemarthrosis of knee and feeling of joint instability. Workup and treatment? |
|
Definition
ACL injury
1) MRI
2) RICE +/- surgery |
|
|
Term
|
Definition
| imperforate hymen: treat with hymenectomy |
|
|
Term
| Management of neonatal hyperbilirubinemia (mild, moderate, severe > 20) |
|
Definition
a. Mild- maximize breastfeeding
b. Moderate: phototherapy, formula supplementation, IVF
c. Severe (bili > 20): exchange transfusion. |
|
|
Term
| Acute cholecystitis with inconclusive US. Next step? |
|
Definition
|
|
Term
| GBS positive at 37 weeks. What do you do? |
|
Definition
| Treat with Amox and then using PCN ppx during labor |
|
|
Term
| Hypocalcemia after parathyroidectomy. What is the pathophysiology? |
|
Definition
| Hypoparathyroidism or hungry bone syndrome (bilateral symptoms). |
|
|
Term
| History of peripartum cardiomyopathy. What screening is required for next pregnancy? |
|
Definition
|
|
Term
| History of peripartum cardiomyopathy. What screening is required for next pregnancy? |
|
Definition
|
|
Term
| When should Orchiopexy be performed for undescended testicle? |
|
Definition
|
|
Term
|
Definition
| IVIG or Glucocorticoids when < 30k |
|
|
Term
Anterior knee pain with descending stairs or squatting with subacute-to-chronic course.
Diagnosis and management |
|
Definition
- Patellofemoral pain syndrome.
- Exercise to strengthen thigh muscles |
|
|
Term
Where is pain in following conditions?
1) Patellofemoral pain syndrome
2) Patellar tendonitis
3) Prepattelar bursitis |
|
Definition
1) Diffuse, anterior knee pain with descending stairs or squatting
2) Inferior patellar pain
3) Anterior knee pain in patient who works on knees, highly localized |
|
|
Term
| First test to order after blunt thoracic trauma |
|
Definition
| Ultrasound before CXR: r/o PTX, aortic dissection, hemoperitoneum, pericardial bleed |
|
|
Term
| What is the cardiac risk associated with SLE |
|
Definition
| Premature coronary atherosclerosis (50x increased risk) |
|
|
Term
| What med can be added to patient with hypoparathyroidism treated with Vitamin D and Calcium found to have elevated urinary calcium? |
|
Definition
|
|
Term
| Meconium ileus and large bowel illeus, What is likely diagnosis and workup strategy |
|
Definition
Hirschprung's disease
- Rectal suction biopsy |
|
|
Term
|
Definition
|
|
Term
| Why should patients on levothyroxine be careful with nutritional supplements? |
|
Definition
| Calcium and Iron interfere, take later in day |
|
|
Term
| Most common pathogen cultured from corneal foreign body |
|
Definition
| coagulase negative staph. |
|
|
Term
| When is partial nephrectomy appropriate for management of RCC? |
|
Definition
| Partial nephrectomy for RCC only appropriate for stage 1 (confined to renal capsule) |
|
|
Term
| How can you distinguish Hyperosmolar hyperglycemic state from DKA? |
|
Definition
1) Glucose: Usually > 600 in HHS
2) Serum ketones: Only in DKA
3) Serum Osmolality: >330 in HHS
4) Anion Gap MA: Only in DKA |
|
|
Term
| What are the initial steps in management of DKA? |
|
Definition
1) Insulin: Bolus, then continuous
2) Glucose: Add dextrose when glucose < 250
3) Fluids: IV NS bolus, then 1/2 NS maintenance
4) Potassium: Supplement KCl
5) ICU admission |
|
|
Term
| What are the important initial medications to provide for suspected opiate overdose? |
|
Definition
1) IV Naloxone
2) Activated charcoal (delayed gastric emptying, so effective even late)
3) Consider intubation and ICU admission |
|
|
Term
Peripheral smear findings in:
1) G6PD deficiency
2) Sickle cell anemia
3) Thalassemia |
|
Definition
1) Normocytic with bite cells.
2) sickle shaped RBCs
3) Microcytic, target cells |
|
|
Term
| Which abx are appropriate for staph vs. pseudomonas in cystic fibrosis (oral vs. IV) |
|
Definition
1) Staph
- Oral Augmentin, Cephalexin
2) Pseudomonas
- Oral is Cipro
- IV is Tobra + Zosyn |
|
|
Term
| What is the best way of quantifying volume status in acutely ill, unstable patient? |
|
Definition
|
|
Term
| 22 yo F with hirsutism, obesity and irregular menses. What is your next step? What are the treatment options? |
|
Definition
PCOS
1) Serum testosterone total and free, serum prolactin, LH/FH, pelvic US (string of pearls). Glucose tolerance test.
2) Treatment
- Weight reduction to improve insulin resistance
- Metformin for insulin resistance
- OCPs to antagonize hyperestrogenism
- Clomiphene for infertility |
|
|
Term
| 42yoM admitted with suspected delirium tremens. What is your acute management? |
|
Definition
1) IVF
2) IV thiamine 100mg
3) IV folic acid 1mg, Mg/Phos/Dextrose
4) IV Lorazepman 2-4 mg IV, q15-20min PRN |
|
|
Term
| What is primary differential for infant with jaundice on day 1 of life? |
|
Definition
| Sepsis, Hemolysis, Polycythemia, Hemorrhage |
|
|
Term
| What is the appropriate therapy for minimal change disease? |
|
Definition
1) Albumin and Lasix initially
2) Prednisone (risk of infections, particularly peritonitis, so be aware).
3) High protein diet.
**Worry is infection and thrombosis (high protein)** |
|
|
Term
| Acute single-sided headache, worst of life. What are initial tests and pain mgmt strategy? |
|
Definition
SAH, GCA, Migraine
1) Ct head non-con
2) IV Toradol for pain
3) ESR for GCA |
|
|
Term
| What is management of SAH? |
|
Definition
1) ICU Admission
2) Toradol for pain
3) SBP goal 120-140: res IV labetalol
4) CCB to prevent Vasospasm
5) Once stable, 4-vessel angiogram indicated |
|
|
Term
| What is the test of choice to confirm Grave's disease? What its the treatment of choice? How is progress monitored? |
|
Definition
1) Radioiodine uptake
2) Radioiodine if non-pregnant (PTU in this case).
- Pre-treat with anti-thyroid drugs. Antithyroid drugs stopped 3-5 days prior to ablation.
- Beta blocker for sympathetic symptoms
- Steroids for opthalmopathy
3) q4-6w with free T4 (not TSH) |
|
|
Term
| What are potential toxicities of Succimer therapy and what is it used for? |
|
Definition
Lead chelating agent.
Liver toxicity (get LFTs), Leukopenia (get CBC), GI distress |
|
|
Term
| Describe basics of elevated lead management in child starting with capillary blood lead level |
|
Definition
1) Get venous level
2) If >45, use mono therapy with Succimer (check CBC and LFTs baseline). If >69, needs dual therapy, IV.
3) Re-check in 4-6 weeks and re-treat as necessary (rebound levels from bone stores are common) |
|
|
Term
| Where should you look initially for metastasis in diagnosis of small cell lung cancer? |
|
Definition
1) Brain (MRI)
2) Liver (LFTs, CT A/P)
3) Bone (bone scan) |
|
|
Term
| Describe initial steps of mgmt in patient with suspected meningitis (adult)? |
|
Definition
1) IV access, oxygen, draw blood/urine cultures
2) Start empiric abs (Ceftriaxone, Vancomycin)
3) LP and send CSF for protein, glucose, cell count, cultures |
|
|
Term
What is the appropriate empiric antibiotics for the following age groups of meningitis.
1) < 3 months
2) Immunocompetent 3 month to adult age
3) > 50 years and individuals with alcoholism
4) Neutropenia, post-traumatic, in s/o neurosurgical procedure |
|
Definition
1) Cefoxitin (Gram neg) + Amplicillin (Listeria). Dexamethasone for H. influenza meningitis
2) Ceftriaxone (Neiserria), Vancomycin (MRSA)
3) Ceftriaxone + Vancomycin + Ampicillin (Listeria)
4) Vancomycin + Ceftazedime (poss Pseudomonas) |
|
|
Term
| Neutropenic fever. Empiric therapeutic regimen? |
|
Definition
Cover Pseuodmonas.
1) Monotherapy: Cefepime, Ceftazidime, Imepenem or Meropenem
2) Double Coverage: Aminoglycoside + extends spectrum anti-Psuedomonal PCN
- Add Vanc if no response to therapy in 2-3d.
- Add Amphotericin B if 4-7d no response |
|
|
Term
| ABX for suspected infectious endocarditis? What are the Duke Criteria? |
|
Definition
1) ABX
- Native Valve: Gentamicin + Ceftriaxone
- Prosthetic Valve: Ceftriaxone + Gentamicin + Vancomycin.
- IVDU: Vancomycin + Gentamicin
- Narrow once cultures back.
2) Major (Positive blood cultures, Positive echo)
- Minor (IVDU, fever, embolic phenomena, osler nodes) |
|
|
Term
| Which patients with A fib need anti-coagulation? |
|
Definition
1) Chronic AF
2) Recurrent AF
3) Underlying heart disease even if < 48h |
|
|
Term
| What is the appropriate management of pancreatitis with gallstones on ultrasound? |
|
Definition
| ERCP and biliary sphincterectomy within 72h of presentation to reduce biliary sepsis. |
|
|
Term
| Do patients with active HAV need vaccination after resolution of symptoms? |
|
Definition
| No - lifelong immunity comes from infection |
|
|
Term
| What are the 3 critical medications to start immediately in suspected variceal bleed? |
|
Definition
1) IV PPI (continue 72h following endoscopy)
2) IV Octreotide
3) IV Abx- Ceftriaxone usually |
|
|
Term
| What is your next step in suspected LGIB with negative upper and lower endoscopy? |
|
Definition
| Tagged red blood cell scan (radionuclide imaging study) and/or angiography |
|
|
Term
| What is the pathophysiology underlying rhabdomyelinolysis? |
|
Definition
1) Skeletal muscle injury leads to release of myoglobin and CPK into plasma
2) Myoglobinuria, acid urine pH and renal hypoperfusion 2/2 hypovolemia lead to ppt of heme proteins and cause ATN |
|
|
Term
| What are the major steps in Rhabdomyolysis? |
|
Definition
1) IVF replacement (1.5 L /h)
2) Alkaline diuresis with Mannitol and Bicarbonate, after urine output is established and BP is stable |
|
|
Term
| Why order an ophthalmology consult in a patient about to receive therapy for TB? Why order LFTS? |
|
Definition
Ethambutol, Visual acuity disturbance and Optic Neuritis
Ethambutol, Pyrazinamde (also hyperuricemia), Rifampin and INH (also pyridoxine deficiency) all cause hepatotoxicity. |
|
|
Term
| What is the initial inpatient antibiotic regimen of choice for acute bacterial prostatitis? |
|
Definition
IV Ampicillin and Gentamycin.
Once afebrile and tolerating PO, can use PO TMP-SMX or Ciprofloxacin. |
|
|
Term
| What are the principles of managing SSD crisis? |
|
Definition
1) Morphine
2) Transfusions and q4h H/H
3) IV Cefuroxime and IV Azithromycin
4) IVF |
|
|
Term
| What is the chronic therapy for SCD in children? What are the primary cause of complications and death? |
|
Definition
**Microvascular pulmonary complications**
1) PCN ppx 4 months to 3 years
2) Polyvalent pneumococcal vaccine adults and children
3) Hydroxyurea to prevent vasoocclusive crisis |
|
|
Term
| When is Relative Risk useful, and when is Odds Ratio more appropriate? |
|
Definition
RR for prospective. OR for case-control.
RR= (a/a+b)/(c/c+d)
OR= ad/cb |
|
|
Term
| How does ARR differ from RRR? |
|
Definition
1) ARR: CER-EER
2) RRR: (CER-EER)/(CER} |
|
|
Term
| What is the concern with Plummer Vinson Syndrome? |
|
Definition
| Iron deficiency anemia with cervical esophageal webs has association with Esophageal Cancer |
|
|
Term
| Differential for Dysphagia: Solids + Liquids |
|
Definition
Barium Swallow +/- EGD
1) Achalasia
2) DES
3) Scleroderma |
|
|
Term
| Gastric vs. Duodenal PID. How do you tell between them clinically and which is more concerning? |
|
Definition
Order Gastrin level to r/u ZES. If inconclusive can get secretin-stimulation test
Gastric: worse with food (associated with cancer)
Duodenal: improves with food |
|
|
Term
| Which other conditions are associated with Ulcerative Colitis? |
|
Definition
1) Autoimmune Liver disease
2) Primary Sclerosing Cholangitis
3) Cancer |
|
|
Term
What serology findings do you expect in the following conditions.
1) Window period, Acute HBV
2) Chronic active HBV
3) Immunized HBV |
|
Definition
1) HBcAb IgM only
2) HBsAg, HBeAg, HBcAb IgG
3) HBsAb IgG |
|
|
Term
| Which vasculopathy is associated with HBV? |
|
Definition
Polyarteritis Nodosa
Also watch out for HCC in chronic cases |
|
|
Term
|
Definition
| Interferon + Ribavirin + Sofosbuvir +/- simeprevir (for type 1 genotype) |
|
|
Term
| Why is SAAG useful in working up Ascites? |
|
Definition
1) > 1.1: 2/2 portal HTN
- Cirrhosis, CHF, Hepatin vein thrombosis
2) < 1.1: Not 2/2 portal HTN
- Peritoniitis (TB), cancer, pancreatitis, nephrotic. |
|
|
Term
| How to do you treat Acetaminophen toxicity? |
|
Definition
1) N-acetylcycsteine up to 36h after ingestion if > 150
2) Charcoal or Cholestyramine within 30 min |
|
|
Term
What is the genetic inheritance of hemochromatosis?
How is it treated? |
|
Definition
1) Autosomal recessive inheritance of HFE mutation
2) Treat with phlebotomy |
|
|
Term
| How do you confirm a diagnosis of autoimmune hepatitis? |
|
Definition
| Need a biopsy in addition to antibodies |
|
|
Term
| How is primary biliary cirrhosis diagnosed? What about primary sclerosis cholangitis? |
|
Definition
1) PBC: pruririts, osteoporosis, jaundice
- + AMA, ultimately biopsy needed
2) PSC: RUQ pain and pruritus, associated with UC
- + ASMA, + p-ANCA, need ERCP |
|
|
Term
In which conditions do you find the following hematological abnormalities?
1) Schistocytes
2) Bite cells
3) Spherocytes
4) Target cells |
|
Definition
1) TTP/HUS/DIC
2) G6PD
3) HS or warm autommmune HA
4) Hemoglobinopathy, liver disease, splenectomy |
|
|
Term
| What are the management strategies for Beta thalassemia major and HgH (alpha thalassemia intermedia)? |
|
Definition
1) Beta: Transfusions and chelation, consider step cell t/x
2) HbH: Transfusion, chelation, close observation |
|
|
Term
| What conditions are associated with cold agglutinin autoimmune hemolytic anemia? |
|
Definition
| Mycoplasma infection and Mononucleosis |
|
|
Term
| How do you distinguish TTP from HUS and how do the treatments differ? |
|
Definition
TTP has neurological signs. Both can have ARF, hemolysis and fever.
1) TTP needs plasma exchange
2) HUS needs dialysis |
|
|
Term
| How can DIC be distinguished from TTP based on serology? |
|
Definition
1) DIC has prolonged PT/PTT, elevated D-dimer and decreased fibrinogen
2) TTP has normal PT/PTT, d dimer and fibrinogen |
|
|
Term
| What is the treatment for PCV? |
|
Definition
Serial phlebotomy and daily ASA
Can convert into AML or myeloproliferative syndromes |
|
|
Term
What are the planet count thresholds for transfusion in the following conditions?
1) Asymptomatic
2) Asymptomatic but with fever/sepsis or on heparin
3) Symptomatic
4) Prior to general surgical procedure |
|
Definition
|
|
Term
| What can a mixing study tell you about coagulopathy? |
|
Definition
Ordered in setting of isolated aPTT prolongation (intrinsic, VIII, XI, XI, XII)
Correction with mixing suggests a deficiency, whereas failure to correct suggests an inhibitor |
|
|
Term
| How is a patient with a positive riotocetin cofactor assay treated? |
|
Definition
vWD, autosomal dominant
1) Nothing if asymptomatic and no procedure
2) Desmopressin if bleeding or upcoming surgery |
|
|
Term
| How do you screen for and confirm a diagnosis of Factor V Leiden? |
|
Definition
1) Screen with APC resistance assay (disruption in activated protein C)
2) Confirm with DNA testing |
|
|
Term
| How is hyperhomocysterinemia treated? |
|
Definition
|
|
Term
| What are the metabolic abnormalities associated with tumor lysis syndrome? |
|
Definition
Prevent with IVF and Allopurinol
1) Hyperkalemia
2) Hyperuricemia
3) Hyperphosphatemia
4) HypOcalcemia |
|
|
Term
| What is the diagnostic study of choice for amyloidosis? |
|
Definition
| fat pad aspiration with polarized light microscopy |
|
|
Term
What is the appropriate management for each of the following forms of breast cancer?
1) DCIS
2) LCIS
3) Invasive |
|
Definition
1) Lumpectomy or wide-excision + radiation. If ER/PR +, tamoxifen for 5 years to prevent recurrent.
2) High risk, breast-conserving surgery
3) Sentinal LN biopsy, hormone receptor status, consider adjuvant chemo |
|
|
Term
| How does hormonal therapy for breast cancer differ according to menopausal status? |
|
Definition
1) pre-menopausal: estrogen made in ovaries
- Tamoxifen to block ERs
2) post-menopausal: estrogen in fat and muscle
- Aromatase inhibitors to inhibit peripheral conversion |
|
|
Term
| What serology findings differentiate seminomatous from non-seminomatous testicular cancer? |
|
Definition
1) Non-seminoma: elevated AFP and B-hCG
2) Seminoma: Normal AFP, elevated B-hCG |
|
|
Term
| True or False: Small asymptomatic meningiomas can be followed with serial CT scans |
|
Definition
|
|
Term
| Describe the spectrum of soft tissue infections by which layer of tissue is affected? |
|
Definition
1) Impetigo- epidermis
2) Ersypilas- superficial dermis
3) Cellulitis- complete dermis and sub-q fat
4) Nec Fasc- cellulitis + fascia-> compartment syndrome |
|
|
Term
| What is the first step is suspected osteomyelitis? |
|
Definition
DDX: cellulitis and nec fasc
1) Get plain films (may be normal for 10-14d)
2) If normal, get MRI or bone scan in s/o contradiction
3) If abnormal, get bone biopsy with culture
**delay abx until specimen drawn if possible** |
|
|
Term
| How does the management of septic arthritis differ from osteomyelitis? |
|
Definition
| septic arthritis always requires surgical washout and 4-6w abx, whereas osteomyelitis can sometimes be managed with abx alone |
|
|
Term
| What is the correct order of events for a patient with AMS and suspected bacterial meningitis? |
|
Definition
| Will need a CT given AMS prior to LP, so start blood cultures-->abx-->get CT-->LP |
|
|
Term
| How can you tell TB meningitis from other Bacterial on CSF analysis? |
|
Definition
PMN predominance in normal bacterial vs. lymphocytic in TB.
Otherwise, but can have elevated OP, low glucose and high protein |
|
|
Term
| What are the appropriate abx for adults for suspected meningitis? |
|
Definition
Ceftriaxone and Vancomycin for N. meningitis, H. influenza and MRSA.
>50? Add Ampicillin for Listeria |
|
|
Term
| SE of RIPE therapy for TB |
|
Definition
1) Rifampin: red-orange body fluids, hepatitis
2) INH: peripheral neuropathy (pyridoxine deficiency), hepatitis, SLE-like
3) Pyrazinamide: HyperUricemia, hepatitis
4) Ethambutol: Optic neuritis |
|
|
Term
| Which types of infectious diarrhea can be tx with abx? |
|
Definition
1) Salmonella/Shigella if severe: FQ
2) Campylobacter: Azithromycin
3) Yersinia: FQ or Bactrim if severe
4) MAC: Clarithromycin + Ethambutol, ART
5) Microsporidium: Albendazole and ART |
|
|
Term
| How do you treat Lyme disease? |
|
Definition
| Doxy or Amor, BUT if cardiac/neurological symptoms, treat with Ceftriaxone |
|
|
Term
| Serology finding in CREST vs. systemic sclerosis |
|
Definition
CREST: Anti-centromere
SS: Anti-Topo Scl-70 |
|
|
Term
Renal Cast Match
1) RBC
2) Waxy
3) WBC
4) Coarse, granlar "muddy" |
|
Definition
1) Glomerulonephritis
2) CKD
3) Pyelo or interstitial nephritis
4) ATN |
|
|
Term
| How does mgmt of hypernatremia 2/2 nDI differ from cDI? |
|
Definition
nDI: thiazides, low-salt diet
cDI: Desmopressin |
|
|
Term
| Dietary recommendations for calcium renal stones? |
|
Definition
| NORMAL calcium, low animal Protein |
|
|
Term
What is the significance of the following types of fetal decelerations?
1) Variable
2) Early
3) Late |
|
Definition
1) Umbilical chord compression
2) Fetal head compression (no fetal distress)
- starts and ends with contraction
3) Fetal hypoxia: immediate delivery may be necessary |
|
|
Term
| What are glucose goals for pre-gestational DM in pregnancy? |
|
Definition
1) Fasting morning < 95
2) 2h post prandial < 120 |
|
|
Term
| True or False: Chorioamnionitis is an indication for fetal cesarean delivery. |
|
Definition
| False! Delivery should commence, but c section not necessary. |
|
|
Term
| Which SSRIs should be avoided in breastfeeding mothers? |
|
Definition
| Fluoxetine and Paroxetine. |
|
|
Term
| What are the therapeutic steps for gestational trophoblastic disease (molar or choriocarcinoma)? |
|
Definition
1) D/C
2) Follow Beta-hCG after D & C for progression
3) Pregnancy prevention for 6m to 1y after to ensure accurate hormone monitoring
4) Treat malignancy with chemotherapy and residual uterine disease wit hysterectomy. |
|
|
Term
| Appropriate inpatient abx regimen for PID |
|
Definition
| Cefoxitin + Doxy + MTZ with transition to PO doxy 24h after clinical improvement for total of 14d. |
|
|
Term
| What is the management approach to a hemodynamically stable patient with suspected ectopic pregnancy? |
|
Definition
1) Repeat beta-HCG in 24-48h
2) MTX
3) Laparopscopy or laparotomy for removal vs. expectant management. |
|
|
Term
| What is the leading cause of female infertility? |
|
Definition
| Endometriosis followed by PID |
|
|
Term
| True or False: Fibroadenoma of breast associated with increased risk of carcinoma |
|
Definition
| True. Removal elective, however. |
|
|
Term
| How can you easily tell between the forms of CAH? |
|
Definition
1) 21 hydroxyls deficiency
- Hypotensive, Hyperkalemic, high sex hormones
2) 17 a hydroxylase
- HTN, hypokalemia, low sex hormones
3) 11 b hydroxylase
- HTN, hypokalemia, high sex hormones |
|
|
Term
| What are risk factors for PDA? |
|
Definition
1) Prematurity
2) 1st trimester rubella infection
3) High altitude |
|
|
Term
| SE of Lamotrigine used for Bipolar Depression |
|
Definition
1) SJS
2) Toxic epidermal necrolysis |
|
|
Term
| How is Tourettes treated? |
|
Definition
Multiple motor and vocal tics, associated with OCD
Dopamine receptor antagonists (haloperidol pimozide), clonidine. NOT STIMULANTS |
|
|
Term
| What type of chest effusion indicates need for CT placement? |
|
Definition
1) WBC > 100k or frank pus or gram + fluid
2) Glucose < 40
3) pH < 7.0 |
|
|
Term
| 1dM in ER with bilious vomiting, poor feeding and rectal bleeding. ABG reveals pH 7.0. What is your ER workup? |
|
Definition
IVF, O2, CBC/BMP, CXR
1) AXR- suspected volvulus--->UGI/Barium Enema
2) IV bicarb correct < 7.0
3) Peds surgical consult |
|
|
Term
| Inpatient mgmt of acute diverticulitis |
|
Definition
1) IVF
2) NPO
3) CT abdomen
4) IV MTZ and Cipro x7-10d |
|
|
