Summary Class notes - STEP 2

- STEP 2
- N/A
- 2015 - 2016
- MD
444 Flashcards & Notes
1 Students
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Summary - Class notes - STEP 2

  • 1436911200 Internal Medicine

  • Management of nephrolithiasis
    1) Imaging: Abdominal CT preferred over KUB
    2) Pain control with NSAIDS or narcotics: Give NSAIDS if patient has good renal function to prevent worsening nausea and vomiting with narcotics
    3) 2L of fluids daily if stone is <5mm, because it can pass spontaneously
    4) Urology referral for anuria, urosepsis, or acute renal failure
  • Management of uncomplicated cystitis
    Trimethoprim-sulfa (3 days), nitrofurantoin (5 days), or fosfomycin (single dose)
    Get urine culture only if fail initial treatment
  • What is complicated cystitis and how is it treated?
    Cystitis with factors that increase risk for antibiotic resistance, such as diabetes, CKD, pregnancy, immunocompromise, UTI, hospital-acquired infection, or infection associated with a procedure or indwelling foreign body.
    Get urine culture prior to treatment.
    Treat with fluoroquinolones in stable patients or IV ceftriaxone in severe cases.
  • Management of pyelonephritis
    Get urine culture prior to treatment
    Treat with fluoroquinolones in stable patients or IV ceftriaxone in severe cases
  • Diagnosis of ureterolithiasis
    Sxs: Severe flank pain that radiates to the groin
    Imaging: US or noncontrast spiral CT
  • What are the causes of asterixis?
    Hepatic encephalopathy, uremic encephalopathy, and CO2 retention
  • Medications that can cause hyperkalemia
    Nonselective beta blockers
    ACE-I, ARB, K-sparing diuretics
  • What is the most common cause of dementia in the US?
  • Causes of hypokalemia
    Potassium-wasting diuretic
  • Symptoms and management of TCA overdose
    Anticholinergic (eg. dilated pupils, ileus, hyperthermia)
    Sodium bicarbonate improves systolic BP, narrows the QRS complex, and decreases the incidence of ventricular arrhythmias
  • Symptoms and complications of giant cell arteritis
    Headache, jaw claudication, muscle fatigue, vision loss, scalp tenderness, aortic aneurysm
  • What is cabergoline?
    Dopamine agonist
  • Manifestations of hyperthyroidism
    Symptoms: Anxiety, insomnia, palpitations, heat intolerance, increased perspiration, weight loss without decreased appetite
    Signs: Goiter, hypertnesion, tremors involving fingers/hands, hyperreflexia, proximal muscle weakness, lid lag, atrial fibrillation
  • Warfarin-induced skin necrosis
    Pain, followed by bullae formation and skin necrosis. Typically on breasts, buttocks, thighs, and abdomen. Administer vitamin K and give heparin until lesions heal.
  • Treatment of primary Raynaud's
    Avoid aggrevating factors (cold, stress)
    Calcium channel blockers (nifedipine, amlodipine)
  • What is secondary Raynaud's phenomenon?
    Etiologies: Connective tissue disease, Occlusive vascular conditions, sympathomimetic drugs, vibrating tools, hyperviscosity syndromes, nicotine
    Presentation: Usually men >40, symptoms of underlying disease, tissue injury or digital ulcers, abnormal nail fold capillary examination
  • Treatment of torsades de pointes
    Unstable patients: Defibrillation
    Stable patients: IV magnesium sulfate, correct underlying cause of QT prolongation
  • Beck's triad of cardiac tamponade
    Hypotension, elevated JVP, and muffled heart sounds
  • What is pyoderma gangrenosum?
    A neutrophilic ulcerative skin disease that forms an expanding, painful ulcer
    Often triggered by trauma
    Usually in individuals with a systemic disorder (eg. autoimmune disease or leukemia
    Diagnose with skin biopsy
    Treat with corticosteroids
  • What areas are the most vulnerable to ischemic colitis?
    The splenic flexure and the recto-sigmoid junction
  • Treatment of dermatitis herpetiformis
    Gluten-free diet and dapsone
  • Treatment of cyanide toxicity
    Hydroxocobalamin, sodium thiosulfate, or nitrites
  • Treatment of MS
    Acute attack: High-dose IV corticosteroids
    Disease-modifying therapy: Interferon beta-1a, recombinant beta-1b, glatiramer acetate, and cyclophosphamide (rapidly progressive MS)
  • Estrogen and thyroid hormone
    Estrogen increases the levels of thyroxine-binding globulin, decreasing the levels of free T4. As a result, higher levothyroxine doses may be needed in hypothyroid patients who are pregnant or on oral estrogen replacement therapy.
  • Treatment of trigeminal neuralgia
    Carbamazepine: Risk of aplastic anemia with prolonged use, so routine CBCs should be done
    Surgical gangliolysis or suboccipital craniectomy are second line
  • Features of aspirin exacerbated respiratory disease
    Asthma, chronic rhinosinusitis with nasal polyposis, bronchospasm or nasal congestion following the ingestion of aspirin or NSAIDs
  • Interstitial cystitis presentation
    Bladder pain with filling, relief with voiding
    Increased frequency and urgency
  • Interstitial cystitis diagnosis and treatment
    Diagnosis: Bladder pain with no other attributable cause for at least 6 weeks and normal U/A
    Treatment: Behavioral modification, amitriptyline
  • Pulsus paradoxus
    Drop in blood pressure >10mm Hg  during inspiration
    Most commonly seen with cardiac tamponade, but can also be seen in COPD or asthma
  • Niacin side effects
    Flushing and pruritus due to prostaglandins
  • pulsus parvus et tardus
    Decreased pulse amplitude and delayed peak
    Seen in aortic stenosis
  • What murmur develops in aortic dissection?
    Early decrescendo diastolic murmur due to aortic regurgitation
  • Common side effect of calcium channel blockers
    Peripheral edema
  • Symptoms and management of TCA overdose
    Anticholinergic (eg. dilated pupils, ileus, hyperthermia)
    Sodium bicarbonate improves systolic BP, narrows the QRS complex, and decreases the incidence of ventricular arrhythmias
  • What is syringomyelia?
    A fluid-filled cavity in the spinal cord that is most commonly caused by Arnold Chiari malformation type 1. It results in loss of pain and temperature sensation.
  • Eye complication in neurofibromatosis type 1
    Optic glioma
  • Hepatic adenoma
    Benign epithelial tumor
    Most common in young and middle-aged women
    Hormonal pathogenesis is suspected, because it is associated with oral contraceptive use, anabolic androgen use, glycogen storage disease, pregnancy, and diabetes
    Biopsy is contraindicated due to risk of bleeding
    Symptomatic adenomas should be resected
  • When can you give live vaccines to patients with HIV?
    MMR and VZV can be given to those with CD4>200
    All other live vaccines (BCG, anthrax, oral typhoid, oral polio, and yellow fever) are contraindicated
  • How is immune clearance determined in chronic HBV?
    Serial ALT and HBeAg every 3-6 months
    ALT should be normal and HBeAg should be negative
  • What needs to be done before starting treatment for HCV?
    Liver biopsy to assess likelihood of response to treatment, stage of disease, rule out other concomitant liver diseases, and guide treatment decisions
  • Adult Still's disease
    Inflammatory disorder characterized by recurrent high fevers, rash, and arthritis
  • Side effects of cyclosporine
    Hypertension: Treat with calcium channel blocker
    Glucose intolerance
    Gingival hypertrophy
    GI manifestations
  • Side effects of tacrolimus
    Glucose intolerance
  • MOA and side effects of azathioprine
    Purine synthesis inhibitor
    Dose-related diarrhea, leukopenia, and hepatotoxicity
  • MOA and side effects of mycophenolate
    Inhibitor of IMPDH involved in purine synthesis
    Bone marrow suppression
  • When is Mohs surgery used in the treatment of BCC?
    BCC on the face or other delicate areas
  • What is a complication of entamoeba histolytica infection?
    Amebic liver abscess: Generally a single cyst in the right lobe
    Treat with metronidazole
  • What is a sensitive laboratory indicator of orthostatic hypotension?
    BUN/creatinine ratio >20 indicating prerenal azotemia
  • Treatment of hyperkalemia
    1) IV calcium gluconate to stabilize the cardiac membrane
    2) Lower serum K by driving it into cells with insulin + glucose, sodium bicarbonate, or beta-2 agonist (eg. albuterol)
    3) Eliminate excess K from body
  • Which cancers are associated with pernicious anemia?
    Intestinal-type gastric cancer and gastric carcinoid tumors due to atrophic gastritis
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Causes of (poly)hydramnios
fetal CNS anomalies
fetal GI tract malformations
fetal chromosomal abnormalities
fetal nonimmune hydrops
maternal diabetes
isoimmunization (eg. Rh factor)
multiple gestation
Fetal complications of parvovirus B19
Causes fetal aplastic anemia by destroying erythroid precursors in the bone marrow
-fetal hydrops: excess fluid located in two or more fetal body cavities, associated with polyhydramnios, parvovirus is the most common infectious cause of nonimmune hydrops
What is the most common cause of nonimmune hydrops fetalis?
fetal cardiac arrhythmia
Management of a pregnant woman infected with parvovirus B19
Weekly fetal ultrasounds and middle cerebral artery Doppler (increased flow velocity indicates fetal anemia) for 10 weeks to assess for fetal hydrops and if found, refer for possible intrauterine transfusion
What does a sinusoidal heart rate pattern indicate?
Severe fetal anemia or fetal asphyxia
What antibody results are expected in someone who is immune to parvovirus B19?
IgM negative
IgG positive
Which abnormality is most likely to be seen on fetal heart monitoring with PPROM?
variable decelerations due to cord compression from oligohydramnios
How is fetal lung maturity determined?
Presence of phosphatidyl glycerol in the vaginal pool of amniotic fluid
Which bug can cause chorioamnionitis without ROM?
listeria (passes through placenta)
When should steroids be given for PPROM?
gestation 24-32 weeks and no signs of infection