95 terms

ABFM prep

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SGLT-2 Inhibitors
Invokana/Farxiga, block reabsorption of glucose in kidney, lead to increase UTI. Decrease weight and BP, increased DKA risk
DPP-4 inhibitors
Januvia/Trajenta - Linagliptin,, dont work well, expensive. GLP-1 enzyme inhibitor - blocks breakdown of GLP1 in the gut
GLP-1 agonist
Byetta, victoza (Liraglutide better for CKD), trulicity. Help insulin seretion in pancrease. Weight loss. Thyroid cancer risk.
Thiazolidinediones (TZDs)
Actos/avandia. Blackbox for CHF. Increase risk of pancreatic and prostate ca, limb fx
Metformin (Glucophage)
Interferes B12 absorption, ONLY ORAL FOR CHILDREN, stop before IV contrast, resume 48hrs, stop Cr 1.4/1.5 men
Stroke score
ABCD2 for ischemic stroke within 48 hrs; Age>60, BP >140/90, Clincal presentation (unilateral weakness 2, isolated speach impairment 1), Duration (>=1 hr 2 points, 10-59 min 1 point), Diabetes (1 point). Score 0-3 low risk, 4-5 med risk, 6-7 high risk. Hospitalize is score greater or equal to 3 who present within 72 hours
Kidney stone diet
Low Na diet, citrate supplementation, high dietary calcium intake (results in GI binding of calcium oxalate, decreasing urinary ca excretion), lower animal protein, increase fluid and fruits/veg
typhoid fever
salmonella typhi after international fever. get from food handlers.
Week 1: relative bradycardia fever
Week 2: rose spots abdomen and trunk
Week 3: HSM, intestinal bleeding/perf
Abx for
Cat scratch
Cat bite
Dog bite
RMSF
Cat scratch - zpack
Cat bite: augmentin
Dog bute: augmentin
RMSF: doxy
Corneal abrasion tx
Contact lens: antipseudomonal RX quinolone or tobra
Trauma/foreign body: erythromycin/polymoxin-trimethoprim
AOM tx
<6 months - RX for all
6-23 months - RX if severe (fever 102.2, mod pain) sx or bilateral AOM
>24 months - treat if severe

Abx: high dose amocil x10 days
Augmentin if had abx within 30 days or if concomittant conjunctivitis (Hflu)
PCN allergy - ceohalosporins
If anaphylaxis - macrolodes, clinda

NO PROPHYLACTIC ANTIBIOTICS FOR RECURRENT AOM
polycythemia vera
Patients have increased gout (negatively birefringent crystals), spleenomegaly, intense pruritis with hot bath, transient visual disturbances, hepatomegaly, thrombosis, erythromelalgia

Major criteria - increased Hg, JAK2 v617F mutation
Minir criteria - low serum epo, trilineage myrloproliferation, endogenous erythroid colony formation

RX - aspirin and phlebotomy for low risk thrombosis
Add Hydroxyurea for high risk (age >=60, hx thrombosis)

Target hct 45-50%
Sensitivity
Sensitivity = TP / (TP + FN)
Specificity (true negative)
Specificity = TN / (TN + FP)
bulimia nervosa
Binge eating followed by compensatiry behaviors. TX CBT, SSRI (fluoxetine)
anorexia nervosa
BMI < 18
intense fear of weight gain
distorted views of body weight and shape
RX CBT, olanzapine
juvenile MTP clonic epilepsy
Valprpic acid RX. 4-6 hz bilateral polyspikr and slow wave discharges, include absence and tonic clonic sz
Rabies PEP (4 dose vaccine and immunoglobulin)
If pet available for quarantine, observe for 10 days and no PEP if healthy animal. If pet not available start PEP. If low risk wild animal (squirrel, chipmunk, mouse, rabbit) no PEP, if high risk wild animal (bat, raccoon, fox, skunk, coyote), euthanize animal check rabies test and start PEP if positive.
Pheochromocytoma
Neuroendocrine tumor in Adrenal MEDULLA, elevated metanephrines and catecholamines, initial RX alpha then beta blockers then surgery
Light's criteria for exudative pleural effusion
Ple prot/ se prot >0.5
OR
Ple LDH/Se LDH >0.6
OR
Ple LDH >2/3 ULN serum LDH

CAUSES: TB (very high total protien >4gm and high LDH >500), pna, cancer, CTD, PE, pancreatitis, post CABG
Slipped capital femoral epiphysis
11-13 girls, 13-15 boys, obese AA with knee pain
Limited internal hip rotation is pathognemonic
Legg-Calve-Perthes Disease
Boys 4-8, hip or knee pain, limping. Avascular necrosis of femoral head
Squamous cell CA esophagus
Black smokers
Esophageal adenocarcinoma
Old white fat GERd
Cipro for pyelo
If high reistance then rocephin or aminoglycoside then oral quinolone
ITP
Isolated TCP, treat if plt<50K. 1st line corticosteroids, IVIG, rituximab. BM biopsy if age>60. Check HIV/HepC in young
HSP
Triad of purpura, arthritis, abdominal pain. Supportive treatment, NSAIDS for abd pain and arthralgias. Steroids if renal inolvement or severe joint swelling. CCB if hypertension.
PNA CURB-65
Confusion
BUN >19
RR>30
BP <90/60
Age >65

If score >=2 then hospitalize and treat with Rocephin and Zithromax

More severe sx Rx Zosyn and Levaquin
Most severe Score 4-5 ICU get levaquin and Vanco
If low score RX Macrolide
If high macrolide resistance or comorbidities use Levaquin
Antibiotics for wounds
Bite of hand, bite by cat, bite near prosthetic joint, crush injury, delayed presentation, puncture wound, underlying DM or immunocompromise
Rubella virus
Fever and occipital or posterior cervical LAD, then rash that sprrads cranial-caudal and spares palms and soles. Women and adolescents can have arthritis
CHA2DS2-VASC
CHF, HTN, Age (75=2, 65=1), DM, CVA 2, Vasc dz, Sex female

NOT FOR VALVULAR AFIB
CAH newborn
Hypovolemic shock, hyponatrenia hyperkalemia hypoglycemia, girls with virilization. Elevated leveks of 17-hydroxyprogesterone due to 21-hydroxylase deficiency.
CURB-65 Scoring
(1 pt for each)
Confusion
Urea >19
RR >30
SBP <90, DBP <60
Age >65

Hospitalize >=2, ICU 4-5
Endocarditis bacteria - source
Strep bovis/gallolyticus - colon
Enterococci - UTI
Staph aureus - IVDU
Eikenella Corredens - Oral flora
Salter harris fractures
Type 1 - straight across
2 - Above
3 - Lower or below
4 - thru and thru
5 - ERasure of growth plate/cRush
Preeclampsia prevention
ASA low dose in women with hx preeclampsia and delivery <34 weeks, or preeclampsia in 2 or more pregnancies
ACA/AHA Statin guidelines
1. ASCVD
2. LDL>190
3. 40-75, LDL 70-189, 10 year risk >7.5%
4. 40-75, LDL 70-189, with DM - MODERATE RISK STATIN
Asceptic olecranon bursitis
Treat with ice compression decreased activity. If not better then aspirate and compress x2 weeks. If still not better then steroid injection.
Hypoparathyroidism sx
Low Ca++: refractory heart failure, tetany, sz, AMS, stridor
Bartonella quintana
Vector=lice, causes trench fever
Trypanosomes cruzi
Causes cardiomyopathy, heart failure, fatal arrythmias
ADA/AHA SBE Prophylaxis guidelines
Prosthetic valves
Hx endocarditis
UnRepaired cyanotic HD or repaired with prosthetic materials
Heart transplant with secondary valve dz
NOT FOR MVP OR MR OR AQUIRED VALVE DZ
Postpartum Hemorrhage
Carboprost - not in asthma
Methylergonovine- not in HTN
Erythema multiforme
Iris-like target lesions on distal extremities. Hypersensitivity reaction to vaccines meds and infections especially HSV. Can use continuous antiviral suppression like acyclovir if recurrent. Treatment mostly supportive
rheumatic fever
Joints
Carditis
Nodules - SQ
Erythrma marginatum
Syndenham chhorea
IBS treatment
Peppermint oil, TCA, fluoxetine paroxetine citalopram, exercise, probiotics, antispamsotics. NOT FIBER
Muscle strength
0 no contraction
1 contraction but no movement
2 movement with gravity neutralized
3 movement against gravity only
4 movement against gravity and some resistance
5 strenth against substantial resistance
cluster headache treatment
Abortive: oxygen and sumatriptan
Prevention: verapamil and lithium
DKA criteria
Gluc>=250
AG >10
PH <7.3
HCO3<=18
Serum and urine ketones

Treat with insulin drip until AG normal and no more ketones
Replace K when <5
Use HCO3 when pH <5 or HCO3<10
Graves disease
TSH recepter stimulating Ab
Hashimoto's thyroiditis
TSH receptor blocking AB, anti-TPO, antithyroglobulin
Lichen planus
Pruritic, purple, polygonal planar papules and plaques (6 P's) - treat with topical steroids, associated with hep c
Acute dystonia tx
Benztropine, diphenhydramine
CMS approved O2 supplement for COPD patients
PaO2 <=55 or O2 sat <=88% on room air AT REST
chronic fatigue syndrome
W/u includes screening for depression sleep disturbance and pain, UA CBC BMP TSH ANA CRP RF Phos. Treatment is GRADED EXERCISE THERAPY OR CBT
Preeclampsia diagnostic criteria
AFTER 20 WEEK GESTATION
BP >140/90 x2 or >160/110
Protein >0.3 gm/24 hrs
TCP
AKI
Pulm edema
Visual/cerebral disturbances
Preeclampsia severe features
Tcp
Increased lfts
Aki
Pulm edem
Visual disturbaces/cerebral changes
Gestational DM Screening
-all pregnant women at 24-28 weeks
- 2 step screen, OGTT >140, 3 hour GTT 2 or more abl: 95,180,155,140
Aortic stenosis echo order
Mild - gradient <20, check q3-5 yrs
Moderate - gradient 20-39, check q1-2 years
Severe - gradient >40, aortic valve area <1, check every 6-12 months if asymptkmatic, AVR if symptomatic or if LVEF <50%
intussusception
telescoping of a segment of the intestine, bloody or currant jelly stools, 6-46 months, vomiting, intermittent pain. US is test of choice. TX water soluble contrast enema.
GBS treatment in pregnant women
Treat any female who is GBS positive,hx GBS baby, unknown GBS AND fever, PTL <37 weeks, PROM >=18 hours

PCN G IV 5 mil units then 2.5 q4. If allergic angioedema/urticaria use clinda (if isolate susceptible to clinda and eocin) or vanco (if resistant to clinda). If not angioedema/urticaria use Cefazolin.
volvulus
twisting of the bowel on itself, causing obstruction, <1 month of age. Bilious vomiting
Positive likelihood ratio equation
sensitivity / (1 - specificity)
Negative likelihood ratio equation
(1-SN)/SP
Asthma classifications
Mild intermittent - <2x/wk sx, <2x/mo nocturnal, FEV1>80%
Mild persistent - >2x/wk but not daily, >2x/mo nocturnal, FEV1>80% predicted
Moderate persistent - daily sx, >2x/wk nocturnal, 60-80% FEV1
Severe persistent- continual sx, <60% FEV1
Asthma in pregnancy
Albuterol: preferred SABA
Budesonide: preferred inhaled corticosteroid
Asthma Moderate
Signs/symptoms daily
Night Awakening >1x/week
but not nightly
Albuterol daily
obstructive sleep apnea
Mild - AHI 5-15
Mod - AHI 15-30
Severe - AHI >30

BiPAP or CPAP for mild wigh comor ifitirs or mod osa
Dengue Fever
Flu-like with myalgias, retro-orbital pain, nreak-bone fever, rash (white islands in a sea of white), hemorrhagic shock TCP
Peri operative anticoagulation
Low surgical risk procedure - nonchange un anticoagulation (cataract, arthrocentesis, endoscopy, dental)

Intermediate risk procedure (gyn, ortho), reduce dose of OAC, perform procedure when INR <1.5

Low thromboembolic risk - stop Warfarin 5 days before, resume when taking po. No bridging.

High Thromboembolic risk (DVT/PE<3 months or with hypercoag state, mechanical HV) - MUST BRIDGE WITH LOVENOX 4 days prior to sx and until INR >=2
Large bowel obstruction
Neoplasm is most common cause
small bowel obstruction
adhesions most common cause
Meckel's diverticulum
rule of 2's: 2 inches long, 2 feet from the ileocecum, in 2% of the population, mean age of presentation is 2, 2x more in males

Painless bleeding due to heterotopic gastric tissue

Check technecium scan
Ogilvie's syndrome
pseudo-obstruction and dilation of the COLON in the absence of any mechanical obstruction; RX neostigmine
pyloric stenosis
olive like mass RUQ, non-bilious, RF erythromycin or zithromax, 3-4 weeks presentation
Necrotizing enterocolitis
X rays will reveal intramural air - pneumatosis intestinalis
cutaneous lupus erythematosus
Spares nasolabial folds
Prolonged QT interval
Hypocalcemia, low mag, low K
Hypothyroidiam
Meds: diuretics (electrolyte changes), zofran, antipsychotics, TCAs, SSRIs antiarrythmic, macrolides, quinolones, antifungals
Lyme prophylaxis criteria
Tick is deer tick (Ioxedes scapularis)
Attached >=36 hours
Prophylax within 72 hours of removal
Local borrelia rate >=20%
No contraindication to doxy (age <8, pregnant, lactating)

RX doxy 200 mg x1
Cortical stroke
Cerebral cortex
Contralateral weakness, spasticity, and sensory loss
Increased DTRs
No CN deficits
Aphasia apraxia agnosia
Hemianopsia
Lacunar stroke
microinfarctions; due to hyaline arteriolosclerosis (hypertension, diabetes)
Pure motor hemiparesis most common syndrome
Broca's aphasia
Impairments in producing spoken language associated with lesions to Broca's area, dominant frontal lobe, left middle cerebral artery cortical stroke
Osgood-Schlatter disease
apophysitis (inflammation of where a tendon meets a bone) in the tibial tuberosity; TX is post-activity icing plus NSAIDS, quad/hip stretchinh
Rosacea
Erythromatotelangiectatic - RX sunscreen, gentle cleansers, avoid flushing triggers (spice, alcohol). Can use topical brimonide if unresponsive
Papulopustular - RX metronidazole, oral antibiotics if more severe
Phymatous
Ocular
Neonatal varicella
high mortality 25%
If mon devlips rash 5 days before or 2 days after delivery:
Isolate infant
Varicella zoster immune globulin
Continue pumped breast milk
RX acyclovir IF SYMPTOMATIC
parathyroidectomy indications
Age <50
Ca>1 above ULN
T score <-2.5
Cr Cl <60
Primary sclerosing cholangitis
association with ulcerative colitis; MCC of cholangiocarcinoma, fatigue and pruritis. Multifocal narrowing of intraheparic and extrepatic ducts
Sinusitis treatment
Augmentin
Quinolones or doxy second line
NO CEPH BACTRIM OR MACROLIDES
PPE
Athletes <160/100 bp can participate
Reiter's syndrome
HLA-B27; Chlamydia urethritis; arthritis; conjunctivitis; Achilles tendon periostitis

Tx: Doxy, nsaids
Lyme disease treatment
Doxycycline bid x2-4 weeks (unless less than 8yo or pregnant, then amoxicillin tid x 2-4 weeks). If allergic to amoxil will get cefuroxime instead.
NNT equation
1/ARR (CER-EER)
relative risk
used in RCT or cohort study, (a/(a+b))/(c/(c+d)) (risk exposed/risk unexposed)
Well's Criteria for DVT
swelling >3 cm compared to the other leg (measured 10 cm below tibial tuberosity) 1
Collateral (nonvaricose) superficial veins present 1
Entire leg swollen 1
Localized tenderness along deep venous system 1
-2 if another dx more likely
ankylosing spondylitis treatment
+anti-inflamatory meds
+physical therapy
+brace