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Preeclampsia dx? - ✔✔Bp > 140/90 AND proteinuria after 20 weeks gestation Sign of severe preeclampsia? - ✔✔Epigastric pain, vision changes, hyperreflexia, Headache - indicates severe and convulsions are imminent Tx ...

Preeclampsia dx? - ✔✔Bp > 140/90 AND proteinuria after 20 weeks gestation Sign of severe preeclampsia? - ✔✔Epigastric pain, vision changes, hyperreflexia, Headache - indicates severe and convulsions are imminent Txmtnet for severe preeclampsia? - ✔✔Hydralazine to control BP, magnesium, delivery asap What is HELLP syndrome a form of? - ✔✔Preeclampsia Treatment for CHF class 3 with LBBB and EF 25% on maximal therapy? - ✔✔Cardiac resynchronization therapy (gets both ventricles firing) What dietary intervention can reduce the rate of sudden cardiac death? - ✔✔Omega 3 First line medications for descending aortic dissections? - ✔✔Beta blockers to lower HR and BP; nitroprusside can be given but not initially because it could cause reflex tachy Txtment for SVT if adenosine fails? - ✔✔Beta blockers or non DHP ccb Side effect of digoxin tox? - ✔✔Yellow vision Best sodium blockers post MI? - ✔✔Lidocaine and Mexilitine (1B drugs) - Lido has Mexican tacos after MI What can be used after adenosine, CCB and BB fail for SVT? - ✔✔Propafenone or flecainide (1C) Txtment for HTN in blacks? - ✔✔Thiazide and CCB (diltiazem included) What does still's murmur sound like? - ✔✔Systolic murmur sounding like guitar string thrumb Indication for thrombolysis in MI? - ✔✔new onset LBBB Warfarin should keep INR level at what after DVT? What about for mechanical valves? - ✔✔2-3; 2.5-3.5 Benefit of LWMH? - ✔✔Outpt txtment Symptom of CHF in infant? - ✔✔Diaphoresis with feeding Pressure gradient that warrants txtment of aortic stenosis? - ✔✔50 mmhg What does sympatomatic aortic stensosi mean? - ✔✔Abysmal life expectancy Is there a EF threshold for which you cant use beta blockers in HF? - ✔✔No What is contraindication for using Beta blockers in HF? - ✔✔Symptomatic heart block (2nd or 3rd degree duh) or HR < 50 bpm "Heart rate <50 beats per minute (bpm; unless a pacemaker is present). If the patient has a heart rate <50 bpm and a pacemaker is present, proceed with beta blocker therapy and suggest CRT since the patient is likely to become pacemaker dependent." https://www.uptodate.com/contents/use-of-beta-blockers-in-heart-failure-with-reduced-ejection-fraction?search=chf%20beta%20blocker&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2593889026 Can mild asthma and COPD use beta blockers in HF? - ✔✔Yes, as long as theyre monitored How to tell if worsening dyspnea if due to cardiac (eg hf) or pulmonary (eg COPD) etiology? - ✔✔BNP elevation (> 400 means 95% likely to be HF related) Initial HF exacerbation txtment? - ✔✔Loop diuretic What are BNP levels related to? - ✔✔Kidney function (kidneys excrete them, so might be higher in renal failure ... this is just understanding point, dont let it influence testing i think) Is edema part of the criteria for preeclampsia? - ✔✔NO When can periop beta blockers be considered? - ✔✔CAD with risk factors In patients scheduled for noncardiac surgery, we do not start beta blockers to improve short-term outcomes. (See 'Patients without indications for long-term therapy' above.) In patients scheduled for noncardiac surgery who have an indication for long-term beta blocker therapy but who have not yet had such therapy started, we individualize care, taking into account the benefits and risks associated with the preoperative initiation of therapy. (See 'Patients who may require preoperative initiation of therapy' above.) In patients treated with long-term beta blockers for recommended indications, we suggest continuing beta blockade perioperatively (Grade 2B). (See 'Patients taking beta blockers' above.) For those patients in whom beta blockers are continued, issues related to choice of agent, dose, and timing are discussed above. (See 'Patients taking beta blockers' above.) https://www.uptodate.com/contents/management-of-cardiac-risk-for-noncardiac-surgery?search=perioperative%20beta%20blocker&source=search_result&selectedTitle=1~44&usage_type=default&display_rank=1#H362228968 Max target heart rate for elderly exercise program? - ✔✔60-75% When is BNP secreted? - ✔✔Volume overload of ventricles Drugs that reduce mortality in HF? - ✔✔BB, ACE/ARB, hydralazine with nitrate, spironolactone Which drug should be avoided in HF? - ✔✔High dose ASA because it may cause renal fluid retention Rate control for Afib? - ✔✔CCB or BB Do pt with Afib on rhythm control still need anticoagulation? - ✔✔Yes Contraindication for cilostazol? - ✔✔CHF Cilostazol has proven benefit for the treatment of claudication with Food and Drug Administration (FDA) approval for treatment of symptomatic PAD, with a black box warning to avoid its use in patients with heart failure. https://www.uptodate.com/contents/investigational-therapies-for-treating-symptoms-of-lower-extremity-peripheral-artery-disease?search=cilostazol&source=search_result&selectedTitle=2~35&usage_type=default&display_rank=1#H135435783 Drugs that reduce mortality after MI? - ✔✔BB and ACE BP in severe preeclampsia? - ✔✔160/110 with proteinuria or > 140/90 with end organ sxs Systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥110 mmHg and proteinuria (with or without signs and symptoms of significant end-organ dysfunction). Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg (with or without proteinuria) and one or more of the following signs and symptoms of significant end-organ dysfunction: •New-onset cerebral or visual disturbance, such as: -Photopsia (flashes of light) and/or scotomata (dark areas or gaps in the visual field). -Severe headache -Altered mental status. •Severe, persistent right upper quadrant or epigastric pain •<100,000 platelets/microL. renal dysfunction •Pulmonary edema. https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis?search=severe%20preeclampsia&source=search_result&selectedTitle=2~90&usage_type=default&display_rank=2 DVT prophylaxis needed for hip and knee replacements? - ✔✔LMWH or warfarin For initial VTE prophylaxis in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), in whom the risk of bleeding is low, our approach is the following (see 'Low bleeding risk: Pharmacologic prophylaxis (up to 10 to 14 days)' above): •We recommend pharmacologic prophylaxis with or without intermittent pneumatic compression (IPC) devices rather than no prophylaxis (Grade 1B). While many experts combine mechanical and pharmacologic methods in high risk orthopedic patients, few studies have examined the benefits associated with this strategy. •For most patients with THA and TKA we suggest low molecular weight (LMW) heparin or a direct oral anticoagulant (DOAC), rather than warfarin (Grade 2B). When a DOAC is selected, we prefer rivaroxaban or apixaban (rather than edoxaban or dabigatran) since experience is greater with these agents and evidence, on balance, suggests that, at minimum, they have equal efficacy with LMW heparin without any significant increase in the risk of bleeding. https://www.uptodate.com/contents/prevention-of-venous-thromboembolism-in-adult-orthopedic-surgical-patients?search=hip%20replacement%20prophylaxis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H9926118 Side effect of lithium? - ✔✔PTH elevation and hyperCa Which DM drugs decrease gastric empyting? - ✔✔Amylin analogs and GLP-1 analogs and dpp4 inhibitors What are the GLP-1 analogs? - ✔✔Exenatide and liraglutide What are the amylin analogs? - ✔✔Pramlintide Condition precluding metformin? - ✔✔Renal failure What is a reason metformin is chosen over sulfonureas? - ✔✔weight loss - FA1 What is a MOA of metformin that sulfonurea doesn't have? - ✔✔Increases insulin sesntivity How much is given for the 2 hr oral glucose tolerance test? - ✔✔75 g What are the predm lab values? - ✔✔100-125 fasting or 140-199 2 hr What does hypothyroidism do to bone age of peds pt? - ✔✔delays bone age relative to height and chronologic age Complication of long term levothyroxine use? - ✔✔Osteoporosis Indication for parathyroid secreting adenoma removal? - ✔✔< 50, calcium > 1 mg/dl above normal, decreased bone density, renal stone What can angioedema also be called? - ✔✔Angioneurotic edema - contraindication Which newborn jaundice is always pathologic? - ✔✔Direct bilirubinemia When do you not use phototherapy for neonatal jaundice? - ✔✔Conjugated bilirubinemia Midgut volvulus abd xray finding? - ✔✔Double bubble sign Can abd xray be normal in midgut volvulus? - ✔✔Yes Best way to dx midgut volvulus? - ✔✔Upper gi contrast study How to tell pyloric stenosis from volvulus? - ✔✔NONbillous vomiting Does the new rotavirus vaccine (rotateq) increase intussception risk? - ✔✔No -----however looking on uptodate it still is Intussusception is a rare potential adverse effect of oral rotavirus vaccination in some settings; however, the risk of intussusception after rotavirus vaccination is much lower than the risk of severe rotavirus gastroenteritis in children who do not receive rotavirus vaccine. https://www.uptodate.com/contents/rotavirus-vaccines-for-infants?search=rotateq&source=search_result&selectedTitle=2~45&usage_type=default&display_rank=1#H26 When is rotavirus vaccine given? - ✔✔2, 4, and 6 mo of age What can hpylori eradication prevent? - ✔✔Nsaid induced ulcers (does not improve non ulcer dyspepsia, GERD, or prevent gastric cancer in asymptomatic pt) Cause of infantile colic? - ✔✔Unknown Is the BRAT diet effective for childhood diarrhea? - ✔✔No, give em a normal diet When should hepB seroconversion be tested for in a child? - ✔✔9-12 mo Water borne bugs that resist chlorine txted water? - ✔✔Cryptosporidium, giardia, hep A, Entamoeba histalytica Cryptosporidium txtment? - ✔✔Nitazoxanide Who should be routinely screened for hep C? - ✔✔IV drug users Txtment if vaccinated nurse sticks herself with hep B pt? - ✔✔test nurses Ab titers (give IG and booster if low) What is melanosis coli? - ✔✔Dark discoloration of the mucosa of the colon What causes melanosis coli? - ✔✔Fecal stasis or bowel stimulants (like senna) Red flag for irritable bowel syndrome? - ✔✔Night sxs VTE prophylaxis in patient undergoing surgery with h/o VTE? - ✔✔subQ LMWH started 1-2 hrs prior to surgery and 1 day after What are the three types of lesions in the mouth? - ✔✔Hairy nonscrapable leukoplakia caused by EBV, scrapable leukoplakia premalignant condition, and thrush What is dry skin in the elderly called? - ✔✔Xerosis cutis Finding in rosacea? - ✔✔Telangiectasias Which worm that penetrates skin causes skin manifestations? - ✔✔Ancylostoma and necator What does toxocara cause? - ✔✔Visceral involvement Txtment for worms? - ✔✔Bendazoles - worms are bendy What is infection of the nail folds called? - ✔✔Paronychia Who gets paronychia? - ✔✔Workers who are exposed to chemical or wet periods Txtment for paronychia? - ✔✔Avoid exposure and use strong topical steroids First line txtment for eczema? - ✔✔Topical emollients and topical steroids Txtment for leishmaniasis? - ✔✔Amphotericin B or sodium stibogluconate What is the mask of pregnancy called? - ✔✔Melasma or cholasma Txtment for scabies? - ✔✔Permethrin cream What substance is visible on xrays? - ✔✔Glass Most common cause of infection post axillary LN dissection? - ✔✔Non group A strep 15 month old with CAP PNA outpt txtment? - ✔✔High dose amox - card 122 when should solid foods be given to infants? - ✔✔4-6 mo txtment for tibial stress fx? - ✔✔Air cast test to order for older male complaining of low libido and beard growth aka late hypogonadism? - ✔✔Total test (Free test is too expensive) first line txtment for plantar fasciitis? - ✔✔Heel inserts complication of HSV-1 infection in child? - ✔✔Erythema multiforme what determines difference between MGUS and multiple myeloma? - ✔✔Organ sxs in multiple myeloma Cause of Femoral neuropathy? - ✔✔Diabetes Common symptom in polymyalgia rheumatica? - ✔✔Fever Most common electrolyte issue in a cachetic person when they start parenteral feeding? - ✔✔Hypophosphatemia (refeeding syndrome, not just in alcoholics) How to correct hypocalcemia for hypoalbuminemia? - ✔✔Serum calcium plus .8 x 4 minus albumin Management of hoarseness going on for 3 mo? - ✔✔Laryngiscopy What cells does EBV infect? - ✔✔B cells on CD21 What lab finding is in EBV mono? - ✔✔Atypical lymphocytes (t cells) Initial hyperCa management? - ✔✔IV fluids FIRST then bisphosphonates after theyre euvolemic Which surgical fibroid treatment allows pregnancy in future? - ✔✔Myomectomy, not embolization What increases the murmur in HCM? - ✔✔Valsalva because it decreases preload Do PEG tubes improve quality of life for dementia pt? - ✔✔no Initial test for COPD? - ✔✔Spirometry (PFTs) What are PFTs also called? - ✔✔spirometry What does pain with eye movement suggest? - ✔✔Orbital problem or can be seen with optic neuritis too What is screening for colon cancer if first degree relative with cancer before 60? - ✔✔40 or 10 years before fam member and screen Q5 years Side effect of hydralazine? - ✔✔Drug induced pleuritic - lupus Antiarrhymic for wolf Parkinson white? - ✔✔Procainamide What happens if you eat an extra 100 calories a day? - ✔✔Your weight will eventually stabilize and you'll stop gaining Mild INTERMITTENT asthma txtment? - ✔✔Inhaled beta agonist Mild PERSISTENT asthma txtment? - ✔✔Daily ICS plus beta agonist for sxs Moderate persistent asthma txtment? - ✔✔Low dose ICS plus LABA, or moderate dose ICS What medication do you need to stop before doing CT angiography? - ✔✔Metformin - wont be cleared and will build up causing lactic acidosis Txtment for nursing home acquired PNA? - ✔✔Vanco, ceftazidime, levofloxacin Which cephalosporins have pseudomonal coverage? - ✔✔Cefepime and ceftazidime cefoperazone Txtment for nursing home acquired pna not requiring hospitalization? - ✔✔Anti pseudomonas cephalosporin (ceftazadime or cefepime) plus carbapenem or pip/tazo plus cipro/levo or aminoglycosides plus vanco for mrsa coverage ?? what skin/eye complications does pseudomonas causes? - ✔✔ecthyma gangrenosum - immunocomprimised corneal ulcers/keratitis in contact wearers/minor eye trauma Which SSRI is NOT safe in pregnancy? - ✔✔paroxetine medication for osteoporosis if bisphosphonates fail? - ✔✔teriparitide side effect of teriparitide? - ✔✔osteosarcoma culture negative pyuria cause? - ✔✔chlamydia what is apraxia? - ✔✔inability to perform an action what kind of gait is seen in vision impairment? - ✔✔arms and legs abducted what kind of gait is seen in frontotemporal dmentia? - ✔✔magnetic when is "en bloc" turning seen and waht is it? - ✔✔vision impairment and parkinsons multiple small steps to turn are SSRIs good for anorexia? - ✔✔no best anorexia txtment? - ✔✔family based therapy When should oseltamivir phosphate be prescribed for flu? - ✔✔within 48 hours of onset of symptoms is testing to confirm needed before oseltamivir can be given? - ✔✔no - clinical dx only and definitely not needed if someone has type 2 dm medications used to prevent sxs in minor transfusion reactions? - ✔✔acetaminophen benadryl who should use aspirin to prevent CVD? - ✔✔45-79 where benefit outweighs risk of GI bleed wrong - per usptf its 50-59 with 10% 10 year risk The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10% or greater 10-year cardiovascular risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. do you give iron or order ferritin level with a microcystic anemia? - ✔✔give iron first then check ferritin