Step 3 10/12 Flashcards
4 yo w sickle cell disease bumps knee and develops infection…what abx?
Ceftriaxone and clindamycin for staph aureus as well as salmonella(asplenia) osteomyleitis
Patient with sjogren’s syndrome and focal submandibular mass?
C/f b-cell non-Hodgkin’s lymphona.(polyclonal B cell activation and infiltration of the salivary glands)
45 yo woman BMI 38 and DM with rash on breast?
Intertrigo, likely due to candida.
When do you need to do a glucocoritcoid taper?
If greater than 3 weeks
Acute stress disorder vs PTSD?
Acute stress id order lasts >3 days but <1 month.
POtential problem in case-control studies?
REcall bias
Patient with cough, pleuritic chest pain, and hemoptysis after bone marrow transplant? X-ray with nodules with surrdouning ground-glass opacities?
Aspergillosis. Do BAL and tx with vori
Patient with low-ptiched, rumbling diastolic murmur preceded by an opening snap?
Mitral stenosis, heard beath between the fifth and sixth ribs at the left mid-clavicular line
Treatment of gout in ESRD/post-transplant patients?
Intrarticulr glucocoritcoids
Patient with meningitis sx, no mass on CT, CSF pressure of >250, low leukocyte count with lymphocitic predomoninance, elevated protein and low glucose?
Suspicious for cryptococcus in Hiv patients. May have papulas lesions with central umbilication and are positive for india ink preparation.May need to do serial LPs to reduce elevated pressure.
General treatment for cryptococcal meningitits?
Induction: ampho and fluctyosine for >2 weeks, consolidaiton: hihg dose oral fluconazole for 8 weeks 3. Maintenance: lower dose fluconazole for >1 year to prevent recurrent
Most important factor for appropriate transplant?
HLA and ABO compatibility, living donors.
Turner syndrome heritability?
Random error in cell division, loss of an x chromosome
Man with progressive weakness accompanied by both upper and lower motorn neuron deficits?
Suspect ALS(ocular motilityu, sensory, bowel, bladder, and cognitive functions are preserved)Tx with riluzole: Glutamate inhibitor.
Mom with greenish vaginal discharge 3 months afte rhaving baby? ph.4.5, motiel flagellated organisms.
Single dose oral-metronidazole for trichomoniasis, express and iscard breast milke for 24 hours
persistent,spontaenous,Unilateral nipple discharge?
Do mammography plus ultrasound, likely papillary tumor but could be intraductal carcinoma..
First lab value changes first after treating iron deficiency anemia?
Reticulocyte count
Hypopigmented spots with history of bilateral deafness?
NF-2, autosomal dominat
Newborn with fever and positive leuk esterase, poor appetite, lassitude?
Treat for E.coli UTI and also listeria (ampicillin plus gentamicin/cefotaxime) No cetriaxone or sulfonamide due to risk of hyperbilirubinemia.
Patient with palpable purpura after an URI? Positive stool-guiac?
HSP: IgA deposition, pediatric vasculitis, small bowel intussusception.
Patient with uncontrolled HTN with low renin and low
Licorice inhibits 11-beta-hydroxysteroid dhydrgenase, preventing local conversion of cortisol to cortisone. Excess cortisol binds mineralcorticoid receptors and causes hypertension, hypokalemia, and metabolic alkalosis.
38 yo woman with asthma exacerbation found to have bilateral upper lobe opacities, atelectasis, bronchiectasis?
Do Skin test and blood test for allergic broncoopulmonary aspergillosis. Treat with systemic glucocorticoids wit antifungal (decrease fungal burden and antigenic stimulus.)
Pain control for DM neuropathy besides gabapentin?
TCADS ie duloxetine
Patient with scar tissues after ear piercing that is growin?
tx with intralesional glucocorticoids, may need surgical excision if it reccurs.
When to anticoagulate patient with A fib?
ChADSVASC SCore >2
Woman with >3 UTI in 1 year?
recurrent UTI, use postcoital antibiotic prophylaxis.
Patient with ACS?
Dual antiplatelet therapy (ASA and clopidegrol), nitrates, beta blockers, statins, anticoagulant therapy (heparin)
Woman <30 with mobile breast mass..next step?
Ultrasound. LIkely fibrocystic change, but must rule out malignancy.
38 yo woman with dysuria, dyspareunia, anterior vaginal mass?
Urethral diverticulum, dx with MRI of the pelvis or Pelvic US.
Significant of Kappa statistic?
inter-relater reliability
74 yo M with pain in left hip joint with thickening of his left proximal femur.
Likely Paget’s, treat with bisphosphoate
If patient with SVT, you give adenosine, and they actually have WPW?
Can provoke A fib with RVR and can degenerate into V fib.
82 yo woman with shingles?
Treat with oral valacyclovir if less than 72 hours.
81 yo woman with shingles in the hospital, how to prevent spread?
If desseminated disease, place on contact and airborne precatutions. If localized disease, standard precautions.
Newly pregnant woman with hypothyroidism?
Increase once pregnancy is detected 30% (increased metabolix demands, B-hcg binds TSH receptors and stimulates T3 T4 proudciton and suppress TSH secretion.
CT scan for lung cancer is smoker recommendation?
Patients age 55-80 who have >30 pack-year smoking history and are current smokers or quit within the last 15 years.
2 yo boy abdominal pain and lethargy, nonbilious emeses and drawying up of legs to the abdomen?
Intussusception(RF are recent viral illness pathologic lead point ie HSP, meckels etc): Also, suasage-shpaed mass and “currant jelly” stools. Do radiographs to r/o intestinal perforaiton, do air or water-soluble enema.
Cardiac exercise stress testing?
Prongnostic info: if negative <1 % risk of cardiovascular events within the next year.
When to supplement with iron in a anemic ESRD patient?
transferrin saturation<30, ferritin <500
Child with sickle cell disease with new pulmonary infiltrate on chest x-ray plus hypoxemia?
Acute chest syndrome, treat with ceftriaxone plus aizthromycin
inflammatory acne?
Topical abx ie erythromycin, clindamycin
35 yo woman with hypertension, hyperglycemia, osteoporosis, mood swings, hypokalemia, and metabolic alkalosis?
Do dexamethesone suppression test for cushing’s disease.
27 to with cocaine related chest pain?
GIve lorazepam to reduce symmpathetic outflow and psychomotor agitation. Use phentalomanine if benzo and nitro does not work.
Pain with chest pain and neuro sx after cocaine use?
Suspect dissection of ascending aorta, do CT angiography of the chest.
56 yo man with fatigue, night sweates, arthralgias, one sided pleural effusion wit CAD on hydralazine??
Drug-induced lupus: do ANA,
Stain for patient with diabetes?
Recommended if LDLD >70.
31 yo pregnant women with elevated AFP?
do anatomic ultrasound. Could be due to NTDs, VEntral wall defects, multiple gestation. (Decreased MSAFP due to trisomy 18, 21)
untreated hiv with widespread skin papules with umbilication? also central hemorrhage
cutaneous cryptococcus (kaposi would be red or purple with no necrosis) Dx with skin biopsy (PAS staining)
Hepatitis B vaccination?
0, 2, and 6 months.
CLose contacts of meningitis? (?8 hours of exposure in close proximity, diret exposure to respiratory secretions within 7 days of onset of paient’s symptoms)
give rifampin, cipro of ceftriaxone.
When to begin bone density screening in women?
ag 65. Otherwise encourage calcium 1200 mg and vitamin D 600-800 IU
MCC heart defect down’s syndrome?
Endocardial cushion defect.
Disease in later Down syndrome?
Alzheimers, acute leukemia, ADHD, seizure
When to considere exchange transfusion in hyperbilirubinemia?
> 20 mg/dl
Suspect fibromyalgia?
Do TSH to rule it out.
When to give tetanus vaccine? Immune globulin?
Tetanus with severe/dirty wounds, most recent vaccin >5 years ago and to those with minor, clean wounds who received a booster >10 years ago. IG to those with dirty wounds or with unclear history of tetnanus vacciantion.
MM concern for fx?
to X-ray skeletal survery, other modalities reserved for patients with bone pain and negative x-rays
Adolescent pregnancy?
Risk for preterm birth, low birth wegith, and perinatal mortality, gastrocisis, omphalocele.
When to DC estrogen receptor modulators like raloxifene before surgery?
DC 4 weeks prior to surgery for high rates of VTE
Patient with Hydrophobia?
Think rabies, water triggers pharyngeal spasms that cause patient to be frightened of frinking. Human Rabies is almost always fatal once patient is symptomatic.
Patient with acute MR, pulmonary effusions?
POssible chordae tendinae rupture.
Patient with chordae tendinae rupture and thoracolumbar scoliosis?
Ehlerds danos: joint hypermobility, recurrent junt dislocations, hyperexntesibility skin, delayed healing with atrophic scars (Marfan syndrome will not have skin findings like velvety skin with atrophic scarring)
When is vaginal delivery safe with patients with HIv?
If <1000 copies/ml. Continue triple therapy during pregnancy. NO breastfeeding in resource rich countries.
Most common side effect of isoniazid?
hepatotoxicity. DC if >5 times the ULN. or if with sx and 3 x upper limit of normal. Ocular toxicity with ethmabutol.
When to screen for breast cancer?
age 50, every 2 years. 40 if risk factors.
Plan to give TNF-a, what should you check?
IFN-gamma release for latent tb.
Untreated celiac disease risk>
Enteropathy-associated T-cell lymphoma in proximal jejunum.
4 yo with plt <100,000 and sudden onset of bleedin?
COnsider ITP and give IVIG
Patient with variceal bleed?
Ensure to treat with cipro for 7-10 days to prevent SBP.
Patient in acute decompensated HF non-responsive to diuretic therapy?
Nitroglycerin: decresae in cardiac preload with reduced intracardiac filling presures and improvement in pulmonary edema. Also recommended for flash pulmonary edema
Acute rhinosinisusits but sx persist >10 days?
Acute bacterial rhinosinusisits, treat with amox-clav./
retroorbital pain, hemorrhagic signs, fever after travel?
thinkg Dengue fever and watch out for dengue hemorhagiv fever and cirulatory collapse.
When is delyaed puberty?
Lack of testicular enlargement by age 14. Check LH, FSH, and testosterone.
acute hypoxemi respiratory failure within 6 hours of blood product ?
TRALI…can lead to neurocogititnve defevets for greater than a year after
Patient with multiple transfusions cant find appropriate blood, why?
alloantibodies
GTT during pregnancy?
If >140, 3 hr GTT. load iwth
Pregnancy glucose targets?
fasting <95, 1-hour postprandial <140 2 hour <120
osteoporosis?
T score >-2.5. Tx with biphosphonoates if with fragility fracacutres.
Low Tsh, low t4?
do ACTH sitim test, dont treat with levo in case of adrenal crisis in patients with uncorrected adrenal insufficiency.
Onychomycosis of toes?
KOH preparation or PAS of nail scrapings, treat with terbinafine.
Bad pancreatitis?
Measure BUN, hematocrit. Bad if BUN >20 and if elevated hct >44 (hemoconctration from thrid space losses)
LIkelihood ratio?
sensitivity/(1-specificity)
palpable purpura, elevated rheumatoid factor, hypocomplementemia, kindey failure, weakness?Hep C?
Mixed cryoglobulinemia(vasculitis due to immune compleces within the wall of small and medium-size vessels. Come with chronic hepatitis C. Tx hep c with antiviral and immunosuppressive therapy for cryoglobulinemia.
Renal failure bleeding?
Desmopressin to help with platelet dysfunction.
TSH and OCPs?
INcrease Levo dose due to increase in thyrid-binding globulin from estrogen-containing oral contraceptives.