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189 Cards in this Set

  • Front
  • Back
medication for n/v which causes eps?
labs needed after incidental adrenal mass found? 3
dexmethasone suppression test
when should you surgically remove an adrenal mass? 3 criteria
- functional mass
- signs of malignancy
- > 4cm
mechanism of dz in TSS?
exotoxin production
drug of choice for htn in scleroderma
give 2nd choice too
1. ace-i (captopril)
2. ccb will also help raynaud's but aren't first line.
tx for localized, moderate and severe psoriasis involving nail and joints?
localized-- betamethasone
moderate-- puva
severe with nail/ joint involvement-- mtx
mngt of staff exposed to newly dx'd pt with tb with a neg ppd?
what if ppd is +?
repeat in 3 months
if + start INH
tx for severe mono
next step after abnormal catecholamines levels found in pheos?
give alpha blockade then mri
electrolyte imbalance caused by vit b12 tx in pernicious anemia?
increase k+ uptake by new rbcs deplete it
battery of tests for suspected lead toxicity?
what if pt needs chelation?
cbc, iron studies and retic count r/o iron def
if chelation needed: cmp, ua
3 or more polyps, villous features and > 1cm in size..what screening?
colonoscopy in 3 yrs
in immunosuppressed pt, pulm sxs w/ sinus sxs. dx?
after a neurological exam c/w brain death, which is the next step to confirm?
apnea test
high co2 > 60
low ph < 7.28
when do u know dka has resolved? 4 criteria
1 glc < 200
2 anion gap wnl
3 hco3 ~ 18
4 hungry pt
mngt of dvt after first episode vs recurrent dvt?
warfarin or lwmh for at least 3 mo after first event.
(can dc warfarin at six mo depending on bleeding risk)
recurrent dvt warrants life long tx
3 main physical findings of pseudo-tumor cerebri
1 ha
2 visual loss/ obscurations
3 pulsus synchronous tinnitus (pulse tempo like whooshing sound in pt's ear)
tx of choice for ocd
med of choice is ssri
paget's dz of bone (cottom wool on ct with bone thickening)
ca++ and akp levels
causes of mat?
- hypoxia
- copd
- electrolyte imbalances (k+, mg+)
- heart dz (cad, vpt, htn..)
- meds (theophylline..)
- hypoxia
- copd
- electrolyte imbalances (k+, mg+)
- heart dz (cad, vpt, htn..)
- meds (theophylline..)
indications for TIPS
failure of emergent or recurrent endoscopy to resolve variceal bleeding
pt with joint pain with sclerotic lesions and bowing of long bones..dx?
paget dz
paget dz
which med to control tourette's tics?
which med if a/w ocd or impulsive disorder?
tics--dopamine blockers (fluphenazine, pimozide..)
Serious complication fo Erb's palsy?
diaphragmatic paralysis 2/2 phrenic nerve involvement
how often should baby be fed?
2-3 hrs
effective lenght of tx for latent tb?
9mo inh
mngt of warfarin in s/o hit
2 points
- stop warfarin with heparin (warfarin alone induces venous necrosis)
- wait till plts go > 150k to restart while pt on nonheparin drug.
failure to pass stool in newborn w/ ground glass mass or soap bubble sign on abd xr?
cystic fibrosis
cystic fibrosis
lung nodules in an RA pt?
caplan 's syndrome
mngt for hiv pt dx'd with syphilis of unknown date?
whats the tx?
- do csf to assess for neurosyphilis
- im pnc x 3 wks
mngt of papillary ca of thyroid?
1 u/s of thyroid and nodes
2 if node < 1cm--> lobectomy
- if node > 1cm--> thyroidectomy
mngt of breast cyst?
1 aspirate
2 no residual mass?--> check if recurred with u/s 4-6 wks
3 all other mngt is mm and excision
hiv pt who develops thrombocytopenia. whats the tx?
what condition of immunocompetent hosts is this similar to?
1 start azt (zidovudine)..increases plt production
2 itp
f/u of viral load?
6-8 wks until undetectable; then q3mo
fetal heart condition a/w maternal dm?
- hcom
- self-limited
poison ivy dermatitis
(linear vesicular lesions with serous fluid)
pt with sjogren's and submandibular mass. what ca?
b-cell nonhodgkin's ( sjogren's causes b-cell activation)
pt p/w late onset dm and this rash..dx?
pt p/w late onset dm and this rash..dx?
1- when should you suspect physiologic jaundice in newborn?
2- difference btn g6pd def and hemoglobinopathies in newborn?
1- after 24 hrs of birth
2- hemoglobinopathies don't present early after birth bc fetal hmg predominates
* suspect hemolysis in newborn with unconjugated jaundice in first 24 hrs of life
age appropriate for heimlich maneuver?
> 1 yo
1- bp after tpa?
2- when is it ok to begin dvt ppx after tpa?
1- = or < 180/105
2- after 24 hrs of tpa
GBS ppx in pregos?
pnc 4 hrs before delivery
* asxs infants can be observed wo tx
pt w h/o hashimoto's and enlarged thyroid.. dx?
thyroid lymphoma
mngt of torsades in stable and unstable pt?
- stable--> mg+
- unstable--> unsynchronized cardioversion
difference btn GBS, botulism and tick paralysis..
1. tick!
2. GBS takes longer (days-weeks) vs. TP (hrs-days); csf normal in TP.
3. botulism--> descending paralysis, cn affected and pupillary dysfunction.
recommended lenght of therapy w/ ssri depending on depressive episodes?
- one episode.. can dc after 6mo-1 yr
- 2 or +.. for life
pt with prolonged malnutrition is fed. she then develops volume overload, low k and mg.. dx?, tx?
refeeding syndrome
tx: correct low phosphate
pt who p/w hypertension, dm, osteoporosis, and emotional lability and the low k is found..dx?
r/o cushing's
dexamethasone suppression test.
pt w/ anxiety and insomnia takes natural supp. then develops high lfts..which supp?
side effect of ginko biloba?
side effect of ginseng?
- bleeding
- psychosis and SJS
tx for cryptococcal meningitis?
amphotericin B and flucytocine for 2 weeks..then switch to fluconazole if there's improvement
indications for cytoscopy and stone removal?
stone> 10mm
knee injury a/w dashboard trauma in mva?
pcl tear
side effect of isotretinoin?
high trigs
which vessel involved in diverticular bleed?
artery of vasa recta
*venous bleeding is a/w hemorrhoids
bitemporal hemianopsia with hyperpigmentation after adrenectomy bl...dx?
nelson syndrome
tx for warts contraindicated in pregnancy, bleeding, mucosal application and dm?
2- first line medical tx for warts?
1- podophyllin
2- trichloroacetic acid
criteria for parathyroidectomy in asxs pt?
1- 1mg > normal
2- dexa < - 2.5
3- renal failure
skin pigment
liver dz
when do you use dopamine?
cardiogenic shock and hypotension
pts for whom bariatric sx is recommended?
bmi > 40
bmi > 35 with comorbidities
side effect a/w saw palmetto?
- prematurity
- gross motor delays (crawls but then doesn't walk)
- scissoring gait
test to confirm?
1- spastic cerebral palsy
2- mri
pt p/w hyperthyroid sxs but RAIU is low..dx?
silent thyroiditis
1- tx for tca induced arrhythmia?
2- tx for cardiotoxic effects of tcas?
1- lidocaine
2- nahco3
1st and 2nd line tx for skin squamous cell ca?
1st = xrt
2nd = 5-FU
approach to pt w/ delayed gastric emptying? 3 steps
1- r/o obstruction--> egd
2- r/o compressing masses-->ct
3- r/o neuropathy--> gastric emptying scan
pt w/ elevated lfts but almost normal akp and bilirubin..dx?
next test?
dx: autoimmune hepatitis
test for ana and anti-smooth ab
pt p/w ascending paralysis, sensory loss and bladder dysfunction..
next step?
dx: transverse myelitis
do MRI to r/o cord compression
* guillain barre does not have sensory loss
hiv drugs side effects:
nrtis (didanosine, azt, abacavir..) as a class? as individuals?
nnrtis (efavirenz, nevirapine..) as a class? as individuals?
pis as class (indinavir..)
nrtis as a class = lactic acidosis
didanosine--> pancreatitis
zidovudine--> anemia/ neotropenia
abacavir--> hypersensitivity

nnrtis as class = SJS
efavirenz--> teratogenic
neVirapine--> liVer toxicity

pis = gi intolerance / lipodystrophy
iNdinavir--> reNal toxic
test for young pt who p/w with seborrheic dermatitis?
check hiv
pt w/ peripheral nerve problems (bell's), with erythema nodosum and hypercalcemia..think of?
return of period after stopping ocp?
90-3 mo beyond that needs w/u for amenorrhea
kid who was playing w/ cats, p/w localized LAD an fever..dx?
cat scratch dz
tx: azythromycin
how is cat scratch dz different from toxo? 3
1- toxo most commonly with cervical LAD
2- toxo p/w eye involvement but uveitis
3- mostly asx in immunocompetent pts (unlike CSD = fever)
tx for brain mets?
pt with recent hospitalization, nm or high tsh, low t3 and normal t4..think?
euthyroid sick syndrome
mngt of hyperthyroidism in pregnancy?
what if pt doesnt know she is pregnant?
- PTU in first trimester
- methimazole after
2- if taking MMI, switch to PTU
tx to prevent cluster ha long term?
short term?
tx acute epidoses?
2- steroids
3- sumatriptan
pt w/ h/o multiple births, Dysuria, Dyspareunia and Dribbling urine..dx? next step?
dx: urethral diverticulum
step: transvg u/s
when should you choose ablation of a cervical neoplasia? 3
1- normal colposcopy
2- glandular lesion
3- no invasion

*o/w LEEP
pt w/ bacteremia, in icu..bullae--> ulceration with necrosis
pt w/ bacteremia, in icu..bullae--> ulceration with necrosis
ecthyma gangrenosum
look for pseudomonas
purulent ulcer with violaceous borders?
purulent ulcer with violaceous borders?
pyoderma gangrenosum
lesions running along lymphatic channels in an outdoorsy pt?
lesions running along lymphatic channels in an outdoorsy pt?
tx: itraconazole
pt w/ maxillofacial procedure who p/w painless mass w/ sinus tracts? 
pt w/ maxillofacial procedure who p/w painless mass w/ sinus tracts?
tx: penicillin
when is the tx for asx bacteriuria indicated? 3
- pregnancy
- urology procedures
- hip replacement (foley will be needed)
3 drugs that can cause isolated elevations of cr 2/2 decreased secretions by tubules?
- cimetidine
- probenecid
- tmp
contraindications for mmr vx 5
- pregnancy
- immunocompromised or given ivig
- thrombocytopenic s/p vx
- severe fever
- all to neomycin or gelatin
- malabsorptive diarrhea
- abd pain
- migratory arthralgias
dx test?
dx- whipple's dz
test- small bowel bx
tx: rocephin or pnc
3 parameters to determine liver failure (ESLD)
- Cr
htnsv of choice for pt taking lithium?
ccb and bb
parameters for parathyroidx based on ca++ and 24hr urine ca++?
ca++ > 11.5
24hr urine Ca++ > 400
why is gastrin not recommended in pt with hyperca++ and ppi tx? mngt?
hypercalcemia rises gastrin levels as well as ppi tx
- pt must be off ppi x 2 weeks and nml ca++ before checking gastrin if looking for men1
clinical manifestations of ileus? 4
3-5 d of:
- po intolerance
- diffuse abd pain
- no flatus
- n/v and bloating
2 parameters to use vanco po instaed of flagyl po?
when do you add flagyl iv?
1. wbc > 15k
2. cr > 1.5x nml

- when there's ileus
toc for akathisia?
bb (propanolol)
mngt of salmonellosis?
no need for abx
when are abx indicated in salmonellosis?
abx of choice?
- children < 1yo
- immunosuppressed
- elderly> 50 w/ artherosclerotic dz (prevent bacteremia and endocarditis)

- cipro, bactrim or rocephin
when is phototx in infant indicated?
total bili btn 15-20
how to differentiate btn folate and b12 def?
homomcysteine and mma level high in b12 def
- only hmocysteine high in folate def
condition to which pt with subchorionic hematoma is at risk?
spontaneous abortion
in a patient with hyperca++ and nml pth. how do you know is familial hypercalcemia?
low urine ca++. hence name Hypocalaciuric
m/s condition a/w gonococcal arthritis?
pt gets stuck w/ hiv needle..mngt depending on vl?
low vl--> 2nrtis x 4wks
high vl--> 2nrtis + 1 pi x 4wks
well's criteria? 5
- dvt sxs 3pt
- recent sx or > 3d immobile
- hr>100
- hemoptisis
- ca

- score>4 bad
difference btn acute glaucoma and uveitis?
- halos
- n/v
- increased pressure

- irregular pupil
- wbc on anterior chamber by slit lamp
clinical features of allergic broncho-pulmonary aspergillosis?
dx approach?
- h/o asthma or cf
- coughing blood or brownish plugs/sputum
- cxr shows upper lobes infiltrates

1- skin test..serum aspergillus igE if +..if cxr neg---> hrct scan

tx: glucocorticoids (prednisone..) can add itraconazole but not 1st line
toc for postherpetic neuralgia?
alternative tx?
tca (amytriptyline)
gabapentin if tca ci'd
pt w/ mono who needs a node bx?
if lad persists for > 4 wks
toc for pid
alternative tx
- cefoxitin + doxy x 14 d
- clinda + gentamycin x 14 d in pnc all
presenting sxs of Li toxicity? 2
precipitants? 3
- gi sxs (n/v/d)
- neuro deficits p/ later when Li crosses bbb

- diuretics, aceis and nsaids
mngt of acute arterial occlusion of the ext?
1- a/c w heparin
2- angiography for tpa vs sx
blood tests to determine sle activity? 2
- complements
- anti-dsdna
pt p/w exertional sob, fatigue, syncope, ruq pain, peripheral edema, poor apetite..prob dx?
dx: phtn
1- tte
2- cath
3- vasoreactivity test (adenosine..)
4- if reactive..ccb / not reactive..endothelin bosentan or pde5
pt w/ high h/ up?
1- repeat lab
2- check ep- low? PV --> check jak
- high? ct or pulseox (rcc or osa)
difference btn amebiasis vs hydatid cyst?2
- hydatid often asx unless mass effect or ruptured cyst (bilary obstruction...) while ameba p/w fever, diarrhea and ruq pain.
- hydatid cyst are a/w dogs...ameba with mexico travel
ataxia, lethargy, tachycardia with this rash in teenager..dx?
ataxia, lethargy, tachycardia with this rash in teenager..dx?
inhalant abuse
tx options for testicular ca?
- surveillance if stg 1
- ctx
- rxt if refuses ctx and noncompliant for surveillance
clinical features of macular degenaration? 4
central vision problems:
- trouble reading, driving
- pt needs more light
- lines get distorted
- scotomas
w/u for hyperaldosteronism
- aldosterone concentration / plasma renin ratio
- nacl challenge test
- ct
1- presentations which give concern for endometrial ca? 3
2- approach for dx?
- any postmenopausal woman w/ uterine bleeding
1. - premenopausal women > 45yo w menometrorrhagia
- women w/ opposing estrogen states (obese, anovulatory) who persist having bleeding

2. pvu/s before bx..bx can be f/u by d/c
mngt for pt w/ hyperuricemia wo sxs?
newborn that gets cyanotic with breastfeeding and improves with crying..dx? test?
- choanal atresia
- nasal catheter can't pass
mngt of lead poisoning depending on severeity?
mild <44 no tx just remove from source
moderate btn 45-69 gets succimer po
severe > 70 gets iv dimercaprol or edta
test sequence for pcp dx?
- sputum induction
- bal
- bx ---> helpful if pt had pentamidine ppx
s/p renal transplant pt develops renal failure. bx shows basophilic inclusions..dx?
bk virus nephropathy
vent settings for ARDS tx? 3
low tv
high peep
high rr
u/s surveillance for aaa?
3-4 cm ---> q2-3 yrs
> 4cm ---> q6-12mo
abx for skin mrsa infections? 3
- tmp-smx
- doxy
- clindamycin
pt w/ h/o ibd who has increased akp and lft..dx?
- typical presentation?
1ry sclerosing cholangitis
- asx..if sxs, fatigue and itching
a pt tx'd for depression who develops new onset dm and high bmi/ obesity..which drugs? 3
- olanzapine
- risperdal
- quetiapine
mngt with rhogam?
mom (-) ---> give at 28wks
mom (+) --> no need. baby has to be checked for hdn
mom (-) w/ blood mix during labor ---> another dose
when do you screen for dm in pregnancy?
24-28 wks
kid p/w fracture after minor fall, found to have splenomegaly, anemia and low plts..dx?
gaucher dz
dx criteria for pcos? 3
- menstrual iregularities
- hyperandrogenism
- evidence of polycystic ovaries on u/s
- indications for mv replacement in mvr?
- f/u for noncandidates for sx?
- severe mvr w/ sxs
- asx mvr w/ new onset afib, lvh or phtn

- tte q2 yrs
indications for 3% ns?
- na < 120
- seizures, ams
- h/o marathon runner, ectasy or polydypsia
drug to prevent gouty attack after initiation of allopurinol?
pt whom inr can be at goal btn 2-3 after mechanical valve replacement? 3
- lv normal size
- normal ef
- nsr
pt w/ h/o iv drug use who p/w sob and cough. cxr has this nodular opacities..dx?
pt w/ h/o iv drug use who p/w sob and cough. cxr has this nodular opacities..dx?
septic pe
methods for the dx of schistosomaisis..2
- urine showing eggs
- cytoscopy with bx if urine test neg
features of drug induced sle..3
- fever
- arthralgias/ myalgias
- NO renal, hematologic or cns problems unlike clinical SLE
eye pain s/p 12-24 hr of trauma, visual disturbance. on pe hypopion and retinal vessels nonvisualized..dx?
pt c/o large floater like a house fly going in and out of central view..dx?
retinal detachment
mngt of sarcoidosis with hilar lad and en. 2 points
- hilar lad and en require no tx if asx. only pulmonary sx are tx'd with strd
- if strd fail, use mtx
pancreatitis inducing drugs (DIIVA)
- Diuretics
- IBD .. sulfazalazine
- Immunosuppresors..azathioprine
- Valproate
- Abx..(metronidazole, tetracycline)
tx of choice for catatonic schizophrenia?
most common complication of TURP?
retrograde ejaculation
features of hemochromatosis 7
- joint pain mainly on 2nd and 3rd mcp 
- decreased libido
- tanned skin
- new dx dm
- hepatomegaly
- restrictive cmp
- pseudo-gout features like:
hooked osteophytes and rhomboid crystals on joint tap.
- joint pain mainly on 2nd and 3rd mcp
- decreased libido
- tanned skin
- new dx dm
- hepatomegaly
- restrictive cmp
- pseudo-gout features like:
hooked osteophytes and rhomboid crystals on joint tap.
vx avoided if egg allergy?
difference btn reactions to eggs w/ vx?
who cannot receive live vx?
- influenza and yellow fever
- hives only? ---> can give inactivated vx
- asthma, pregnancy, immunosuppressed
mngt of siadh
restrict h2o----> salt tablet and diuretics----> demeclocycline or lithium
pt w/ h/o iud has Actinomyces on pap smear,,mngt?
only tx if sxs present.
tx for hyponatremia in asx pt w/ edematous state?
main tx is h20 restriction
- 3% ns only if sxs and na < 120
*edematous state means: chf, cirrhosis...
main clinical features of Pick's dz 4
- social inhibition (inapropriate comments, incontinece)
- dont care about condition rather than not knowing
- repetitive and stereotyped behavior (same foods, same phrase..)
- uncommon amnesia at presentation
pt is using black cohosh for pms. what side effect?
pt with venous insufficiency starts taking horse chesnut. what side effect?
bleeding, like gingko
agent to tx htn in aortic dissection?
drugs and presentation of drug induced lupus
4 sxs

rash (discoid rare)
1st and 2nd tx for hemochromatosis
1. biweekly phlebotomy
2. deferoxamine chalation
how to differentiate tsh pituitary tumor from thyroid hormone resistance syndrome?
- resistance syndrome presents as hypothyroid state rather than thyrotoxic
- elevated alpha subunits are characteristic of pituitary adenomas
when it's not necesary to taper steroids? 3
- tx < 3weeks
- < 5mg
- every other day dosing
differences btn necrotizing fasciitis and clostridial cellulitis? 3
1. in NF pain is disproportional to skin changes vs CC where pain isnt a significant finding.
2. NF has blue/gray patches with possible blisters vs CC has drainage of foul smelling d/c
3. NF involves the deep tissues (fascia/muscle/fat) vs CC only the skin
indication for orchiopexy in undescending testes?
indicated if no descent by 6 mo
pt presents w/ bone pain and low dexa scan values. pth is high and po4 is low. ca is wnl..
why is ca normal?
dx: vit D def.
- ca is low bc pth increases bone resorption to maintain ca levels
drugs for recent MI pts 5
1. asa + plavix
2. BB
4. statin
5. add k sparing diuretic if ef < 40%
drugs that cause digoxin toxicity? 4
clinical features? 4
- amiodarone
- verapamil
- quinidine
- spironolactone

- n/v
- fatigue/ poor apetite
- color changes
- st depression on ekg
3 most common causes of MAT?
toc for copd pts?
1- hypoxia
2- copd
3- electrolyte imbalance
- verapamil for copd/ bb first line for noncopd
mngt of acute cholangitis? 4 steps
1. ivf, cx, abx
2. ercp
3. biliary drainage (if ercp stones)
4. elective need for urgent cholex
in botulism, when do you use equine immunoglobulin vs human?
equine --> foodborne and wound botulism
human--> in infants to avoid anaphx and allergies
rational for urinary retention post op? 2
1. anesthesia
2. ivf bolus can overdistend bladder so it cant contract
interaction between li and hctz?
hctz increases levels of li by dumping na so the body reabsorbs na with li.
meds assoc/ w digoxin toxicity? 4
- verapamil
- amiodarone
- quinidine
- spironolactone
pt just had a molar preg evacuated. whats the counsel and f/u?

when do you stop surveillance?

mngt if abnormal test in surveillance?
- advise to use contraception
- f/u bhcg x 1wkly

- stop surveillance after 3 normal consecutive bhcg's

- if high bhcg--> ctx
pt has sarcoid by do you confirm dx?
- lung bx
- if unclear, do liver
* dont do liver first 2/2 morbidity and other granulomatous dz make hard to distinguish
what risk factors for lead poisoning? 3

when do you begin to treat?

mention mono and dual tx..
- house built < 1978
- pica
- immigrant poor child

- at blood lead level > 45 ---> succimer
- at > 70 ---> dual tx (dimercaprol + edta)
pt with dementia and frquent falls due to instability..dx?

causative agent if pt hallucinations get worse?
- lewy body dementia (classic-hallucinations)

- check if given dopamine agonist (can exacerbate hallucinations)
asthmatic pt with > 20% decreased peak flow from baseline..dx?
asthma exacerbation

tx: oral or iv steroids
pt has pernicious anemia. what would you see on egd?
- absent rugae on stomach
2/2 autoimmune metaplastic atrophic gastritis
pt p/w le nodules and hilar adenopathy on cxr. explain tx?
- no tx is needed as this signs are c/w good chance of spontaneous remission.
pt for which hep B tx is reserved? 3
- immunosuppressed
- severe hepatitis/ failure ( poor anticoagulation...)
- concomitant hep C
doc for chronic prostatitis, alternative regimen and lenght of tx?
- quinolones
- bactrim
- 6-12 wks
tx for narcolepsy?
pt has hiv and syphilis of unknown onset? next step?

whats the tx for syphylis infection?
- check csf to r/o neurosyphylis

- benzathine x 3 wks
pt overdoses on sulfonyureas. injection of dextrose doesnt help. what drug is indicated?
* can decrease insulin release
drugs that intervene in the metabolism of warfarin? 5
- quinolones
- amiodarone
- fluconazole
- cephalosporins
- erythromycin
maintenance of a pt with chronic afib wo heart dz?

what if pt has lvh?

what if pt has chf?

what if pt has no chf?
- flecanide

- amiodarone if lvh or chf

- no chf?.. sotalol
pt w/ addison's, dm1 and thyroid dz..dx?
schmidt's syndrome.
drugs ass/w worsened psoriasis? 4
- acei
- bb
- nsaids
- li
when is a fna indicated in presence of thyroid mass? 3
- mass on u/s w/ a normal tsh
- mass suspicious for ca
- high tsh with a cold/hypofnx nodule after iodine scintigraphy