5 Flashcards
Viral gastro in children diet
age appropriate with limited sugars and fat
* do not give antidiarrheal medication*
SGLT2 inhibitors
glucosuria->polyuria, UTI, candida
Diagnosing preg hyperthyroidism
TSH (trimester specific)
first: 0.1->2.5
second: 0.2->3
third: 0.3->3
HIV delivery
postpartum drug for baby
feeding
vaginal if VL <1000
zidovudine for >=6 weeks
formula in rich countries, breastfeeding in poor
Type II HIT
Type I HIT
autoantibodies against platelet factor 4, thrombocytopenia and thrombosis
mild, heparin-induced platelet clumping
Nelson’s syndrome
Cushing->bilat adrenalectomy->loss of feedback loop-> pituitary tumor with hyperpigmentation
somatic symptom disorder
preoccupation with 1 or more medically unexplained symptoms
Factorial
> = 2 interventions and all combinations of these interventions
Postop hypoventilation->hypercapnia, hypoxia
obstructive sleep apnea
DM statin
retinopathy screening
ACEI if
40-75 yo, LDL >70
annually from time of diagnosis for DMII
starting 5 years from diagnosis for DMI
hypertensive or nephropathy
tinea versicolor diagnosis
treatment
malessezia, KOH preparations showing yeast and hyphae
topical anti-fungal, if refractory-oral antifungal
Stress test=
exercise ECG (if ambulatory and no significant ECG changes)/ myocardial perfusion imaging/ dobutamine echo
breast cyst
biopsy if complex or bloody
simple: symptomatic: aspirate, if nonbloody-f/u u/s
asymptomatic: observe
Spiral fracture =
abuse
Rifampin in women
Don’t give to people taking OCPs.
use ceftriaxone/Cipro for meningitis prophylaxis
Hernia
surgery, don’t just observe
HIT with PE anticoagulation
direct thrombin
only start warfarin once platelets > 150k
HHS management
aggressive fluid resus, then insulin
Inguinal hernia complications
bowel ischemia or testicular atrophy
Panic disorder vs illness anxiety disorder
actual symptoms
immediate: benzo, long term: SSRI
Multiple regression analysis
removes confounders
Intrinsic mitral valve problem vs valve dysfunction due to LV
primary vs secondary
primary: LVEF <60% is considered impaired
First trimester hyperthyroidism
PTU
Syphilis treatment
Latent
Primary (chancre), secondary (rash)
tertiary (neuro, aortitis)
Any neuro symptoms->LP
3 doses of IM penicillin
1 dose of IM penicillin
10-14 days of IV penicillin
If allergic-doxy, ceftriaxone for tertiary
*febrile reaction to treatment is benign and cannot be prevented.
mass with concentric rings at anus
rectal prolapse->surgery
Trauma imaging
trumped by surgery if patient is unstable
Radiation induced cardiotox
valvular abnormalities, pericardial disease, diastolic dysfunction, coronary disease, restrictive cardiomyopathy
Cholangitis treatment
ERCP, IV antibiotics, treat sepsis
Anterior uveitis (iritis)
pain, redness, visual loss, constricted irregular pupil
leukocytes in anterior segment , hazy flare
increased IOP in acute glaucoma
Diagnosis of acute tension pneumo
bedside ultrasound: no lung sliding
nonacute-upright posterior anterior
Compartment syndrome complication
diagnosis
Rhabdo->renal failure
measurement of tissue pressures
if not improving, fasciotomy
predicting prognosis-surgical intervention
Maintain brain-dead organ donor
euvolemic, normotensive, normothermic
IV fluids, desmopressin, pressor
ulcerating papule that drains clear, odorless fluid
treatment
sporotrichosis
itraconazole
overlapping standard error of measurement bars
not statistically significant
deeply seated painless mass, high rate of recurrence, benign
desmoid tumor
caput succedaneum
scalp swelling above periosteum, crosses suture lines
benign
IRIS
transient worsening of infectious symptoms in HIV after initiation of HAART, self-limited
only discontinue HAART if life-threatening
hepatic encephalopathy can be triggered by overdiuresis
hypokalemia, hypovolemia, metabolic alkalosis
febrile UTI in children <24 mos
renal and bladder u/s
if abnormal/ recurrent infections-> voiding cystourethrogram
if reflux->prophylactic antibiotics
Organic ED
Screen for PAD, if positive also screen for CAD before Viagra
anaphylaxis treatment
IM epinephrine
Cocaine use can cause thrombosis. In persistent symptoms and EKG changes,
cath
Primary dysmenorrhea in non sexually active
Sexually active
NSAID
OCP
Fever+ cough+ coryza+ conjunctivitis+ morbilliform rash face downwards
measles
give vitamin A
extremely elevated opening pressure with molluscum skin lesions
treatment
crypto meningitis, indolent
amphotericin B + flucytosine till asymptomatic and sterile CSF-> oral fluconazole for 8 weeks->then lower dose fluc for a year, serial LPs (VP shunt if refractory)
most reliable method for placement of ET tube
capnography, rectangular waveform with 4 phases
Brain death diagnosis
Clinical criteria: hemodynamically stable, imaging, no confounding factors
Then neuro exam:
Then apnea testing
confirm eradication of h. pylori with
urea breath or fecal antigen testing
NNT
1/ARR
blistering and severe itching
contact dermatitis
acute dystonic reaction treatment
anticholinergics (benztropine) or antihistamines (Benadryl)
*dantrolene is for neuroleptic malignant syndrome
presbycusis environment
noisy, distracting
HIV non transmission body fluids
urine, tears, feces, vomit
Postpartum blues vs depression
antidepressant
2 weeks
sertraline, paroxetine
toxic shock syndrome mechanism
bacterial exotoxin->activation of T cells-> cytokines
Most important factor in periop adverse drug events in the elderly
polypharmacy
Hip fracture in elderly management
early surgery unless demented, nonambulatory or medically unstable
strep pharyngitis treatment
penicillin or amoxicillin
distal radius fracture due to
FOOSH
rapid onset of papules with central umbilication and central hemorrhage/necrosis
treatment
cutaneous crypto, diagnosed by biopsy
IV amphoteric B and oral flucytosine, ff by a year of fluconazole
Protective factors against suicide
connection to family, pregnancy, responsibility for children
Valve INR
Aortic with no risk factors: 2-3
Aortic with high risk factors to form a clot and mitral: 2.5-3.5
Bariatric surgery BMI
> 40 or >35 with complications
fracture following ground level fall
get DEXA
treat if
Fever, sore throat and malaise without URI symptoms
strep pharyngitis
10 days of penicillin to decrease symptom severity and duration, prevent spread to close contacts, prevent complications, acute rheumatic fever
*If history of rheumatic fever-long term abx
Post ortho VTE ppx
8-12 hours post to 10 days
acute limb ischemia surgery warranted
loss of pulses (audible/Doppler)
PAD treatment
cards risk factor management->exercise->cilostazol->revascularization
Sudden death after steering wheel injury
aortic injury
Non purulent cellulitis org
strep pyogenes
HIV lipodystrophy
dorsocervical fat acculumation, abdominal visceral fat, loss of fat in extremities
insulin resistance and dyslipidemia
erythema at limbus, constricted pupil, blurred vision, moderate pain
anterior uveitis
Prevent cluster headaches with
Acute cluster headache
Prevent migraines with
verapamil
autonomic eye symptoms, 100% oxygen by nonrebreather, intranasal sumatriptan
propanolol
constitutional pubertal delay
Kallmann syndrome
familial short stature
delayed secondary sexual features, bone age, short stature, family history of late bloomers
anosmia, micropenis, hypogonadotropic hypogonadism, cryptorchidism
normal bone age
polymyositis antibodies
diagnosis
ANA, anti Jo 1
screen for cancer
muscle biopsy
pulm complications including ILD-get PFTs, high res CT
high suspicion of bacterial meningitis with negative gram stain and culture
treat
acute epididymitis treatment
ceftriaxone + doxy
levoquin if e. coli suspected
cleft lip surgery
recurrence risk
reconstruction at 10 weeks, 10 g of hgb, 10 lbs
10%
CLL
dx
poor prognosis
survival
B cell leukemia
peripheral smear and flow cytometry
LAD, anemia, thrombocytopenia, organomegaly
10 years
chronic myeloid leukemia
treatment
translocation of 9 and 22-> Philadelphia chromosome
bcr/abl
tyrosine kinase inhibitors, bone marrow transplant
Preventing pregnancy
STI treatment in sexual assault
ulipristal
copper IUD is more effective (CI in cervicitis)
G/C, trich, HIV (up to 72 hours)
treatment of herpes zoster
post exposure prophylaxis
infectivity
if rash for <72 hours, 7 days of valacyclovir
if immunized/history: nothing
not: vaccine within 5 days
immunocompromised/pregnant: immune globulin/ valacyclovir
till rash is dry, cover rash, avoid preg/babies/immunocomp
untreated acromegaly
cardiovascular disease (reversible after treatment) and colon cancer, diabetes, respiratory problems
Urgent treatment of depression
ECT, safe in pregnancy
Dupuytren contracture
treatment
thickening of palmar tendons->contracture
elderly white males, DM, smoking ,drinking
modification of hand tools, aponeurotomy, CSI, surgery
Subacute thyroiditis
treatment
post viral, fever, neck pain, tender goiter, elevated ESR
thyrotoxicosis due to release of thyroid hormone->low uptake on scan
self-limited, NSAIDs, beta blocker
if refractory-steroids
RCC management
if within capsule-> partial nephrectomy
capsule to gerota’s fascia-> radical
Chronic/recurrent sinusitis causes
smoke exposure, inadequate treatment, allergic rhinitis, structural abnormalities
Prolonged bleeding in renal dysfunction treatment
desmopressin
PSVT associated with
WPW (short PR, delta wave, wide QRS)
Preeclampsia management
Labetalol/hydrazaline + mag for mother
then induce if >34 weeks
Heart failure with preserved ejection fraction
CHF signs, getting adequate fraction of blood out, not enough due to diastolic failure, LVH, left atrial enlargement
marginal linear densities-kerley B lines-pulm edema
BNP inaccurate in obese (lower)
Prevent fat embolism by
treatment
early immobilization and fixation of fractures
supportive care
febrile nonhemolytic reaction after blood transfusion timeline
prevent by
1-6 hours
leukoreduce
initial flaccid muscles and hyporeflexia, then spastic and hypereflexia+ sensory/motor loss
transverse myelitis
Amiodarone warfarin
decrease warfarin dose by 25-50%
strep pharyngitis treatment
penicillin or amoxicillin
Refeeding (dextrose) in alcoholic
hypophosphatemia->rhabdo
Bacterial conjunctivitis
treatment
complication
mucopurulent discharge, matting, conjunctival erythema
topical erythromycin, polymixin-trimethoprim drops, topical fluoroquinolone in contact wearers
keratitis (photophobia, impaired vision, sensation of foreign object)-refer to ophthalmologist
Eczema exacerbations
topical steroids
cystic fibrosis pna
cover MRSA and pseudomonas
pseudomonas (cefepime, amikacin, carbapenems, ceftazidime, tobramycin, certain fluoros, aztreonam, colistin)
Suspected scleroderma lungs
PFTs to screen for pulm htn/ILD
Warfarin INR management
<5: hold
5-9: low dose vitamin K
>9: high dose vitamin K
any bleeding: IV vitamin K, FFP, recombinant factor, prothrombin
chronic prostatitis (chronic pain) vs chronic bacterial prostatitis
pyuria with no bactiuria vs bactiuria
ADPKD htn
screening
ACEI
>18 yo, with family history, renal u/s
hydrocephalus, intracranial calcifications, hepatomegaly, chorioretinitis, hearing impairment in baby
treatment
congenital toxo (cat feces, contaminated soil, undercooked meat)
pyrimethamine,sulfadiazine, folate
