End-o the Line
Oral medication most likely to cause hypoglycemia
What are sulfonylureas? (e.g. glipizide, glimepride)
First-line therapy for hirsutism in women who do not desire pregnancy and for whom cosmetic treatments are not effective.
What is combined oral contraceptives?
Hirsutism is caused by increased androgen production. OCPs decrease androgen production in the ovaries by decreasing LH levels. Antiandrogen treatments such as spironolactone and finasteride are second-line therapies that can be added to the combined oral contraceptives if there is no improvement after the first 6 months
Recommended treatment and duration for patient with L leg cast due to fibular fracture is found to have a L DVT (iliac vein).
What is anticoagulation for 3 months for provoked DVT?
The 2016 CHEST guideline and expert panel report gives a strong recommendation (Grade 1B) to support 3 months of anticoagulation after a first episode of a provoked proximal deep vein thrombosis (DVT). Treatment for 3 months appears to be superior to shorter treatment (6 weeks) with regard to recurrence of DVT. Treatment regimens >6 months for an unprovoked DVT may slightly reduce the rate of recurrence, but this is offset by an increased rate of bleeding and mortality.
This medication would be the most appropriate treatment for a 12-year-old female presenting with cough and slight shortness of breath daily, with night-time awakenings at least 3 nights per week due to the cough.
What is an inhaled corticosteroid? (or inhaled corticosteroid/formoterol)
SABA-only treatment is associated with increased risk of exacerbations and lower lung function, and of asthma-related deaths. For patients with mild to moderate asthma, an ICS/LABA such as budesonide/formoterol as needed was as effective at preventing exacerbations as a daily maintenance ICS + SABA.
15 y/o F cross-country runner with knee pain that has been gradually increasing since the start of the season 3 weeks ago. Pain is anterior, mild swelling, + crepitus, and pain is worse with climbing stairs and running.
What is Patellofemoral syndrome?
Common overuse syndrome, F>M, preferred treatment is quad strengthening exercises
70 y/o M PMH HTN, BPH, depression, T2DM sees you because of increasing fatigue. A CBC, basic metabolic profile, hemoglobin A1c level, free T4 level, and TSH level are all normal, except for a serum sodium level of 125 mEq/L (N 135–145). His serum osmolality is 268 mOsm/kg (N 275–290). His urine sodium level is 50 mEq/L (N <20) and his urine osmolality is 300 mOsm/kg.
Which one of the patient’s medications is most likely to cause this problem?
A) Losartan (Cozaar)
B) Tamsulosin (Flomax)
C) Metformin (Glucophage)
D) Atorvastatin (Lipitor)
E) Sertraline (Zoloft)
What is sertraline?
In patients who are euvolemic but have hyponatremia, decreased serum osmolality, and elevated urine osmolality, the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is likely. Other causes to rule out include thyroid disorders, adrenal insufficiency, and diuretic use. Renal function has to be normal as well. Common drugs that cause SIADH include SSRIs (particularly in patients over 65), chlorpropamide, barbiturates, carbamazepine, opioids, tolbutamide, vincristine, diuretics, and NSAIDs. Treatment of the problem consists of discontinuing the offending drug. Temporary fluid restriction may also be required.
This antithyroid medication is preferred during the first trimester of pregnancy due to a lower risk of teratogenic effects.
What is propylthiouracil (PTU)?
PTU is preferred in the first trimester due to the teratogenic effects of methimazole, but methimazole is preferred in the second and third trimesters due to the hepatotoxicity of PTU.
USPSTF screening guideline for AAA
What is a one-time abdominal ultrasound in 65 to 75 year olds who have ever smoked? (Grade B)
USPSTF lung cancer screening guidelines with low-dose CT for these individuals (age + smoking history)
What is 50 to 80 year olds with a 20-pack-year smoking history who currently smoke or have quit within the past 15 years?
This ligament is the first to be injured with an inversion ankle sprain.
What is the anterior talofibular ligament (ATFL)?
Routine screening for prediabetes and diabetes is recommended in this patient population (age range and criteria)
What are nonpregnant adults ages 35-70 with BMI >= 25?
USPSTF recommends screenings with a fasting glucose level, hemoglobin A1c, or glucose tolerance test as part of cardiovascular risk assessment in adults aged 35 to 70 years who are overweight or obese (Grade B recommendation).
This intervention may also improve urge incontinence and prevent recurrent UTI in postmenopausal women.
What is vaginal estrogen?
Intravaginal estrogen can be used to treat underlying vaginal and vulvar atrophy that can contribute to urinary incontinence.
This medication has the best evidence to reduce hospitalizations and mortality in heart failure with preserved ejection fraction.
What is an SGLT2 inhibitor (empagliflozin/jardiance or dapagliflozin/farxiga)?
Studies of other medication classes with proven benefit for HFrEF(ACEi/ARB, BBs, spironolactone) have not shown the same effects in HFpEF.
Most common cause of stridor in children < 6 months
Laryngomalacia is due to intrinsic defect/delayed maturation of supporting structures of larynx. Stridor is usually worse in supine position or when crying/agitated.
Croup is characterized by low grade fever, barking cough, and inspiratory stridor. Symptoms are usually worse at night.
This common cause of knee pain in adolescents, particularly during growth spurts, involves inflammation of the patellar tendon where it attaches to the tibial tubercle.
What is Osgood-Schlatter disease?
For a thyroid nodule with normal or elevated TSH, this is the recommended diagnostic step if the nodule is larger than 2 cm.
What is fine-needle aspiration (FNA)?
The first step in the evaluation of a palpable thyroid nodule is to obtain a TSH level and perform thyroid ultrasonography (SOR C). If the TSH level is low, a radionucleotide thyroid uptake scan is the appropriate next step to assess for a hyperfunctioning nodule. A hyperfunctioning nodule is much less likely to be malignant. If the TSH level is normal or high, next steps are determined by the size and characteristics of the thyroid nodule on ultrasonography. Fine-needle aspiration (FNA) may be indicated depending on the size and nodule characteristics.
Per ACOG, use of Misoprostol (Cytotec) should be avoided in patients with this obstetric history
What are prior C-sections?
This type of cardiomyopathy is associated with a systolic murmur that increases in intensity during Valsalva maneuvers.
What is hypertrophic cardiomyopathy?
Hypertrophic cardiomyopathy is the most common primary cardiomyopathy and is defined by left ventricular hypertrophy (primarily septal thickening) without cardiac dilation that may cause left ventricular outflow obstruction. It is a potential cause of sudden cardiac death. Many patients are asymptomatic and may potentially only be diagnosed by auscultation of a systolic murmur on examination that increases in intensity during Valsalva maneuvers.
In a 60-year-old male with moderate COPD presenting with SOB and cough with increased sputum volume, this additional factor provides the strongest indication for antibiotic treatment (according to GOLD criteria)
What is increased sputum purulence?
The GOLD guidelines focus on three cardinal symptoms of COPD exacerbations: increased dyspnea (SOB), increased sputum volume, and increased sputum purulence.
2 y/o M brought in by mom for not using his right arm, which he holds partially flexed and pronated at the elbow. The child was unwilling to leave the sand box and a tug of war ensued with mom eventually picking the child by his forearm.
What is radial head subluxation (nursemaid's elbow)?
Radiographs are usually normal, manual reduction is the treatment with either hyperpronation or quick supination plus elbow flexion. Succeeds more than 70% of the time. Child should be using the arm normally within minutes
24 y/o M with extreme weakness, 20 pound weight loss, changes in color of his skin, lightheadedness and dizziness. On exam, you notice hyperpigmentation, BP 90/70. Initial labs significant for sodium 125, Potassium 5.7, serum urea elevated at 9, serum calcium elevated at 12.
What is Addison's disease (adrenal insufficiency)?
Symptoms: weakness, weight loss, hyperpigmentation, hypotension
Labs: hyperkalemia, hyponatremia, increased BUN, hypercalcemia, increased plasma ACTH, and DECREASED SERUM CORTISOL LEVEL.
Confirmatory ACTH stimulation test yield no cortical response.
Breastfeeding can decrease the risk of developing these cancers.
What are breast and ovarian cancer?
Maternal benefits include a decreased risk of developing cardiometabolic disease, including diabetes mellitus, hypertension, and cardiovascular disease; a decreased risk of breast cancer and ovarian cancer; and a decreased risk of postpartum depression.
In addition to LV dysfunction and some pulmonary conditions, BNP may be elevated in any of these 3 conditions (give at least one)
What are Cirrhosis with ascites, primary hyperaldosteronism or Cushing disease?
32 y/o African American M with chronic cough, bilateral hilar lymphadenopathy and pulmonary infiltrates on chest radiograph. Restrictive lung pattern with non-caseating granuloma formation. What is first line treatment for this diagnosis
What are corticosteroids?
Corticosteroids remain the mainstay first-line treatment of sarcoidosis. They have been proven to improve overall disease control, symptoms, quality of life, and pulmonary radiology and/or delay disease deterioration in patients with symptomatic pulmonary sarcoidosis.
According to the Ottawa Ankle Rules, this specific clinical finding indicates the need for ankle radiography in patients with acute ankle injuries.
What is tenderness over the posterior edge or tip of the lateral malleolus (fibula) or medial malleolus (tibia), or inability to bear weight both immediately and in the emergency department (4 steps)?
The Ottawa ankle and foot rules were designed to determine the need for radiographic films in ankle and foot injuries. The instrument has a sensitivity of nearly 100% and a specificity of 30%–40%.