Step 2 Flashcards pt. 2
role of hCG during pregnancy
preserves corpus luteum during early pregnancy to maintain progesterone secretion until the placenta is able to produce progesterone on its own
salvage therapy
Treatment for disease when the standard therapy fails
schizophrenia CT findings
increased ventricular size on CT
screening for 0-5 year olds
strabismus, amblyopia, and refractive errors
sepsis ppx for splenectomy
anti-pneumococcal, H flu, and menin vaccines before operation, daily PO PCN 3-5 years s/p
serum sickness-like reaction
hypersensitivity reaction 1-2 weeks after administration of certain drugs (PCN, amox, TMP-SMX)
severe pre-eclampsia
BP>160/110, protein excretion >5g/24hrs
SGA complications
hypoxia, polycythemia, hypoglycemia, hypothermia, and hypocalcemia
shizoaffective disorder
presence of mood symptoms during the course of schizophrenia like symptoms
shown to reduce the morbidity and mortality of measles
vitamin A
sickle cell aplastic crisis
acute severe anemia with low/absent retics
side effect: dihydropyridine Ca channel antagonists
peripheral edema
single most preventable cause of fetal growth restriction in the US
smoking
steps in suspected meningitis in children
blood cx, lumbar puncture then abx
Stepwise treatment for ascites
1) sodium and water restriction, 2) spironolactone, 3) loop diuretic, 4) frequent abdominal paracentesis
steroid induced folliculitis
monomorphous pink papules and absence of comedones
susceptibility bias
type of selection bias where treatment regimen is selected based on severity of their condition; negates the benefits of randomization
tacrolimus toxicity
same as cyclosporin but no hirsutism or gum hypertrophy
tamoxifen MOA
selective estrogen receptor modulator (antagonist in breast, partial-agonist in endometrium and osteoclasts)
TB chemoppx for positive PPD
isoniazid for 9 months
test for macular degeneration
grid test, lines appear curved
tetanus ppx: minor/clean wound who has >3 toxoid doses
none
tetanus ppx: minor/clean wound who is unimmunized, uncertain or <3 toxoid doses
tetanus toxoid only
tetanus ppx: severe/dirty wound who has >3 toxoid doses
toxoid if latest booster given >5 years ago
tetnus ppx: severe/dirty wound who is unimmunized, uncertain or <3 toxoid doses
toxoid and Ig
thalassemia trait labs
microcytic anemia with mild reticulocyte elevation; RDW, MCHC, TIBC and ferritin levels normal
The rest of descent
Lack of changing two hours for primigravid patients or one hour from multigravida patients
thyroid hormone changes during pregnancy
increased total T3/T4 (normal free) from HCG stim of TSH receptors and increased TGB concentration
timing for gestational diabetes
24-28 weeks
to differentiate saline responsive/resistant metabolic alkalosis
saline responsive has a chloride <20
To familial disorders of conjugated hyperbilirubinemia
Dubin-Johnson and rotor syndrome
torus palatinus
congenital, benign bony growth of midline suture of the hard palate
toxicity: cyclophosphamide
hemorrhagic cystitis, bladder carcinoma, sterility, and myelosuppression
toxoplasmosis dx
multiple ring enhancing lesions, serology NOT specific
triad of congential rubella
sensorineural deafness, cardiac malformation, and cataracts; usually only occurs if infected first 4 weeks)
trimethoprim electrolyte disturbance
hyperkalemia, blocks epithelial sodium channel in the collecting tubes
Turcot’s syndrome
association between brain tumors and FAP or HNPCC
tx: absence seizures
ethosuxamide or valproic acid
tx: Actinomyces
Penicillin, high-dose for 6 to 12 weeks
TX: acute aortic dissection
Beta blockade
tx: acute limb ischemia
IV heparin then definitive tx (surgical, finbrinolysis, embolectomy)
tx: acute MS flare
IV corticosteroids
tx: amebic liver abscess
PO metronidazole
tx: asymptomatic bacteriuria in pregnancy
7 days nitrofurantoin, amoxicillin, or first generation cephalosporin
tx: benign intracranial HTN
acetazolamide
tx: bipolar maintainence
moderate: atypical antipsychotics or monotherapy lithium or valproate
severe: combo lithium or valproate plus atpyical antipsychotic
…
tx: blastomycosis
itraconazole or amphotericin B
tx: candida vulvovaginitis
azole anti-fungal
TX: cat scratch disease
usually resolves but can use 5 days of azithromycin
tx: central precocious puberty
r/o CNS lesion, GnRH agonist to prevent premature fusion of the epiphyseal plates
tx: chalmydia
1 dose azithromycin or 7 day course of doxycycline
TX: chronic hep B
Persistently elevated ALT levels, detectable serum HBS AG, HBE AG, and HPV DNA; treatment with interferon or the lamivudine
TX: clubfoot
Stretching and manipulation of the foot followed by plaster cast, knowledgeable splints, we’re taping
TX: cradle cap
moisturizers, antifungals and topical steroids
tx: dermatitis herpetiformis
gluten free diet and dapsone
tx: DUB moderate, no active bleeding
progestin
tx: DUB, mild
iron supplementation
tx: DUB, moderate with uncontrolled bleeding or severe
estrogen
TX: dumping syndrome
Dietary changes, octreotide in resistant cases
tx: empiric neutropenia with fever
ceftazidime or cefepime
tx: endometrial hyperplasia without atypia
cyclic progestins
TX: esophageal coins
Observed for 24 hours, if symptomatic remove with flexible endoscopy
tx: ethylene glycol poisoning
fomeipzole or ethanol
tx: excessive feto-maternal hemorrhage in the setting of Rh - mother
need to adjust and correct the dose of rho-gam
tx: fibromusclular dysplasia of renal artery
stent placement
tx: first line asymptomatic bacteruria during pregnancy
amoxicillin, nitrofurantoin, and cephalexin
tx: gastric mucosa-assocaited MALT
antibiotic therapy for the eradiction of H pylori
tx: GERD in infants
thickened feeds, positioning to decreased intraabdominal pressure
tx: hairy cell leukemia
cladribine
tx: HELLP syndrome
delivery if after 34 weeks, steroids/lung development if stable and under 34 weeks
tx: histoplasmosis
itraconazole
tx: HIV dysphagia
empiric fluconazole
tx: HIV dysphagia non-responsive to fluconazole
IV gancyclovir
tx: hypercalcemia of immobilization
hydration, bisphosphinates
tx: immune thrombocytopenia
corticosteroids for plt <30,0000
tx: induce ovulation in PCOS
clomiphene citrate (estrogen analog)
tx: inevitable abortion
suction curretage and rho-gam if Rh-negative
tx: infant VSD
is small, observation (will sound much harsher)
TX: inflamed, fluctuant lymph nodes
dicloxacillin, cephalexin or clindamycin
tx: inpatient opiod withdrawal
oral or IM methadone
tx: intrauterine fetal demise, coagulation abnormalities
induction of labor, low fibrinogen and platelets can indicate DIC
TX: isolated duodenal hematoma
Conservatively with nasogastric suction and parenteral nutrition
tx: kawasaki’s
ASA and IVIG w/in 10 days to prevent cardiac complications
tx: lichen sclerosis
high-potency topical steroids
TX: local impetigo
Topical mupirocin or oral erythromycin
TX: Lyme Disease in children
Amoxicillin <8 years old
tx: malignant otitis externa
ciprofloxacin
TX: mastitis
Dicloxacillin or cephalosporins, continue breast-feeding from the affected breast
tx: meniere’s disease
environmental and dietary modifications; low sodium diet
tx: minimal change disease
empiric steroid therapy in any child with suggestive presentation
tx: minor cat bites
amoxicillin/clavulanate for 5 days
tx: morton neuroma
bilateral inserts
tx: mucormycosis
aggressive surgical debridement plus early systemic chemotherapy
tx: multiple brain mets
palliative whole brain radiation
tx: narcolepsy
psychostimulants, scheduled daytime naps, combination antidepressants and psychostimulants
tx: neonatal chalmydial conjunctivitis
PO erythromycin
tx: neonatal gonococcal conjunctivitis
IV/IM ceftriaxone/cefotaxime
tx: nocardia
TMP-SMX
TX: overflow incontinence from epidural anesthesia
Intermittent catheterization
tx: pertussis
macrolide antibiotics
tx: polymyalgia rheumatica
low dose prednisone
tx: post partum endometritis
IV clindamycin and gentamicin
tx: pseudomonas
cefepime or pip/tazo
tx: pulmonary edema from MI
diuretics necessary adjunct
tx: RA
DMARD should begin ASAP, in active disease MTX the drug of choice
tx: relapsing-remitting MS
Beta-interferon or glatiramer acetate
TX: RV infarct
Fluid resuscitation, nitrates should be avoided
tx: SCC of vagina in poor surigcal canditate
radiation, highly effective
tx: SCFE
immediate surgical screw fixation
tx: second line treatment depression
different SSRI (same class)
tx: septic abortion
abx and gentle suction curettage (vigorous curettage associated with perforation)
tx: severe SIADH
hypertonic saline
tx: SIADH asymptomatic
fluid restriction and/or salt tablets
TX: Sickle cell stroke
Exchange transfusion acutely
TX: sinus braducardia
atropine–>pacing–>permanent pacemaker
tx: symptomatic gallstones but no surgery
ursodeoxycholic acid; dissolves small radiolucent stones
TX: symptomatic moderate or severe hypercalcemia
saline, calcitonin, and bisphosphonate
TX: symptomatic Paget’s disease of the bone
Oral or IV amino bisphosphonates
tx: syphilis in those allergic to PCN
2 weeks doxycycline or one dose azithromycin
tx: tinea versicolor
selenium sulfide
TX: Tourette’s syndrome
Typical antipsychotics such as haloperidol pimozide
tx: trigeminal neuralgia
carbamazepine
tx: uric acid stones
alkalinization of urine >6.5 with oral potassium bicarb or citrate
tx: vaginismus
relaxation, Kegel exercises, insertion of objects to encourage desensitization
TX: WPW
cardioversion or anti-arrhythmics like procainamide
tx: X-linked agammaglobulinemia
IVIG
tx:diabetic gastroparesis
prokinetic agents (metoclopramide, erythromycin, cisapride)
tx:severe manic episode while being treated with mood stabilizer
aggressive combination of anti-psychotics and mood stabilizers in the hospital setting
type 4 RTA pathophysiology
aldosterone deficiency or insensitivity, usually in the setting of diabetic nephropathy
type of antibiotic: amikacin
aminoglycoside: nephrotoxic and drug levels must be monitored
type of bilirubin that appears on urine dipstick
conjugated
type of crystals in cystinuria
hexagonal crystals
underlying malignancy of padget’s disease of the breast
adenocarcinoma
vaccinations for HIV patients
influenza, TDAP, S. pneumo, hep A and hep B
vaccinations for patients with chronic liver disease
hep A/B, influenza, pneumovax
Valkmann’s ischemic contracture
final dequel of compartment syndrome in which dead muscle has been replaced with fibrous tissue
vessels that bleeding during Mallory-Weiss tears
submucosal arteries of the distal esophagus and proximal stomach from increased intragastric pressure during vomiting
VSD murmur
pansystolic murmur loud is that the left lower sternal border plus diastolic flow murmurs at the apex
vulvar lesions that respond to trichloroacetic acid or podophyllin
HPV
Waterhouse-Friderichsen syndrome
meningococcemia with sudden vasomotor collapse and skin rash due to adrenal hemorrhage
weber test
tuning fork on middle of forehead; look where it localizes
weight goal by 1st brithday
triple birth weight
well known complication of giant cells/temporal arteritis
aortic aneurysms
what composes the cauda equina
spinal nerves before they exit the spinal canal
what primidone can precipitate when treating essential tremor
AIP, manifests as abdominal pain, neurologic and psychiatric symptoms
when not to treat for GC/chlamydia simultaneously
when only one is confirmed by NAAT
When to include prednisone to PCP treatment
When PaO2 is < 70
when to suspect hemochromatosis
new onset diabetes, arthropathy, and hepatomegaly
when to suspect trophoblastic disease
pregnant patients with severe vomiting
when to tx HCV
elevated ALT, detectable HCV RNA, and histologic evidence of chronic hepatitis
when to tx parkinson’s with trihexyphenidyl
younger patients where tremor is the primary symptom
why CXR in children <2 look abnormal
thymic shadow
why infants born to mothers with Graves are at risk of thyrotoxicosis
passage of thyroid stimulating Igs across the placenta
why normal pregnancy has compensated respiratory alkalosis
Stimulatory effect of progesterone on the medullary respiratory center
why there is malabsorption in Zollinger-Ellison syndrome
inactivation of pancreatic enzymes from increased stomach acid production
winter’s formula
PaCO2 = 1.5(HCO3-) + 8
Wiskott-Aldrich pathophysiology of thrombocytopenia
decreased platelet production
injury associated with anterior shoulder dislocation
axillary nerve/artery
HA, binocular palsies, periorbital edema, hypo/hyper-esthesia; can become bilateral; can be precipitated by uncontrolled infection of the skin
PR: venous sinus thrombosis
hematologic complication of EBV infection
hemolytic anemia 2-3 weeks s/p symptom onset
tx: BCC
Mohs surgery; 1-2mm of clear margins
accumulated molecule in 21-hydroxylase deficiency
17-hydroxyprogesterone, presents with virilization and salt wasting
dx: PKU
Guthrie test, qualitative coloration test
subperiosteal hemorrhage; hours after birth; limited to one cranial bone
PR: cephalohematoma
abnormal thyroid function test in acute, severe illness
PR: sick euthyroid syndrome
tx: infections caused by a human bite
amox-clav; covers gram +, gram -, and anaerobes
sx <2 night time awakenings, normal FEV1, no limitations to activity
PR: mild intermittent asthma
how to remove a tick
tweezers as close to the skin ASAP
> 40, indolent progressive anterior hip pain, worsened by activity, relieved by rest; non-tender, no systemic sx
PR: DJD
RQ for carbohydrate metabolism
1
RQ for lipid metabolism
0.7
RQ for protein metabolism
0.8
2-5 y/o; localized abdominal mass, hematuria
PR: Wilm’s tumor
1 year old; abdominal mass, fever, hepatomegaly, HTN; crosses the midline
PR: neuroblastoma
G6PD deficiency levels
during hemolytic episode, may be normal
toxicity: didanosine
pancreatitis
toxicity: abacavir
hypersensitivity
toxicity: NRTIs
lactic acidosis
toxicity: NNRTIs
Stephen’s Johnson syndrome
toxicity: nevirapine
nephropathy
toxicity: indinavir
crystal induced nephropathy
