More Step 2 Ck Flashcards
Mom at 27 weeks gestation is now in labor. She had routine prenatal care during pregnancy.
How do you manage?
🔑 27w gestation = pre-term labor (∴ anything less than 34w is preterm labor)
🔑 The aim of preterm labor management is to delay DELIVERY and protect fetus— so give tocolytics
Also must give
1. IM betamethasone (prevent NRDS)
2. Magnesium (neuro protect)
⦙ no required intrapartum GBS prophylaxis because she has prenatal care (so GBS status is NOT unknown)
Mom at 27 weeks gestation is now in labor. She did not have routine prenatal care during pregnancy.
How do you manage?
🔑 27w gestation = pre-term labor (∴ anything less than 34w is preterm labor)
The aim of preterm labor management is to delay DELIVERY and protect fetus— so give tocolytics
Also must give
1. IM betamethasone (prevent NRDS)
2. Magnesium (neuro protect)
3. Intrapartum PENICILLIN prophylaxis (no prenatal care = unknown GBS status)
Mgmt spinal cord compression
IV glucocorticoids first
Then to MRI
Age of presentation of CVID
Normally age 20-40
But possible in anyone 10+
Management for ITP
1ˢᵗ IVIG (for 2-3d)
2ᴺᵈ prednisone
3ʳᵈ splenectomy
She’s for types of leukemia
Lymphoid leukemias — extreme ages old/young
Myeloid — middle age (40-60)
Auer rods
AML (specifically APML)
[note: t(15;17) translocation)
Leukemia treated with tyrosine kinase inhibitor
CML
[Note: Philadelphia chrom t(9;22) —> BCR-ABL fusion protein —> ↑s tyrosine kinase activity)
Leukocyte alkaline phosphatase (LAP)
↓ in CML
Compare
to
↑ in leukemioid reaction
CML
- middle age
- ↓ LAP
- Philadelphia chromosome t(9;22) translocation —> BCR/ABL fusion protein —> ↑ tyrosine kinase activity
- tx with tyrosine kinase inhibitor
Possible cardiac manifestations of Turners (4)
1) aortic dissection (severe CP)
2) aortic-root dilation (aortic regurgitation)
3) bicuspid aortic valve (aortic stenosis)
4) coarctation of the aorta,
MCC meningitis in a neonate (first 28 days of life)
Group b strept (s. Agalactiae)
Too 3 bugs causing meningitis in someone 60+ yo
1) s.pneumoniae
2) haemophilus influenziae
3) Listeria
Mechanism of celiacs to secondary hypeR-parathyroidism
Celiacs —> malabsorption of vits ADEK —> vitD deficiency —> impaired calcium absorption (↓ serum calcium) —> ↑ PTH (compensatory)
(Note: final calcium level will be mildly ↑ or normal, due to compensation)
Causes of secondary hyperparathyroidism
Chronic renal failure or other causes of vit D deficiency (like malabsorption: celiacs, chronic pancreatitis, cystic fibrosis, sprue)
Lab values in secondary hyperparathyroidism
Calcium — mildly raised or normal
Phosphate — high if CKD, low if other vitD deficiency
Vitamin D — low (primary disturbance)
Placental abruption
- present with 3rd trimester vag bleeding (only 80%) ⎮📍🌟20% have a concealed abruption (NO visible bleeding)
- risk factors: cocaine, 📍 tobacco, HTN/📍 preeclampsia
- 📍 high frequency contractions (< every 2-3 min apart)
- 📍 tender firm uterus!
CMV treatment
Ganiciclovir
Intussusception
- age 6-36 months old
-preceding viral infection —> cause inflammation of intestinal lymphoid tissue (Peyers Patches) serve as lead point
-pain abdomen — (pain is intermittent/episodic and colicky)
-📍draws legs up to chest. - May vomit (first non-bilious, may become bilious with further obstruction)
- gross bloody currant jelly stool
- Possible palpable sausage shaped abdo mass.
-U/S: shows “Target sign ” (this confirms the dx) & prompts immed tx with *AIR (or water-sol contrast/barium) ENEMA!
Indications that a chronic ulcer is complicated by osteomyelitis (6)
-(1)chronic (present for *4+ weeks), or treatment-resistant (nonhealing) ulcer
-(2) local signs of infection (erythema, pus
-(3) large size *(📍2-cm), or deep (depth >3cm)
-(4) exposed bone tissue, or able to touch bone on bone-to-probe test
- (5) systemic signs (fever)
- (6)mark↑ESR
Ulcer at the lateral malleolus and shin
Arterial ulcer
Which ulcer is exudative, arterial or venous?
Venous
Which ulcer (arterial or venous) has irregular borders and which looks “punched-out”
Irregular borders (venous)
“Punched-out” (arterial)
Pathophysiology of amenorrhea during breastfeeding
Lipid screening
- start at age 35 (for men) & 40/45 (women)—> continue to monitor every 3-5y — until reach age 75
- Consider earlier screening if family history of dyslipidemia or early MI, 🚬
TCA toxicity
TCA toxicity management
Acute dystonia treatment
Benztropine or diphenhydramine
Pityriasis Rosea
NBS for a new thyroid nodule with ↓TSH
Radioactive iodine uptake/ iodine 131 scintigraphy
Prochlorperazine
Antiemetic with D2 blocking activity (significance: can cause NMS)
Promethazine
Antiemetic with D2 blocking activity (significance: can cause NMS)
Antiemetics that can cause NMS (D2 blocking activity)
Metoclopramide
Prochlorperazine
Promethazine
Which is seen in Crohns vs UC for the following:
Fissure
Stricture
Abscess
Fistula
Crohns — fissure, stricture, fistula
UC— abscess
Tx for BPH
(1) alpha-1 blockers (tamsulosin, prazosin, dozazosin)
- quickly improves urine flow by relaxing smooth muscle
-Note: caution prazosin/doxazosin cause orthostatic hypOten
Long term— 5-alpha-reductive inhibitor (finesteride, dudasteride)
- for those with enlarged prostate experiencing urinary sx
- improves sx over several months by shrinking prostrate over time!
Ogood shlatter
- adolescent athlete
- anterior knee pain
- tibial tubercle traction apophysitis
Which leukemia is contrasted with leukemiod reaction.
How?
CML — has ↓LAP
Pre-renal AKI values for the following:
FeNa+
Urine Na+
FeNa+ (<1)
Urine Na+ (<20)
