Step 3 Flashcards
Radioactive iodine uptake of Subacute thyroiditis, iodine exposure, exogenous use
low
Trich features
Pear shaped, ph greater than 4.5
Number needed to treat
NNT= 1/control group event rate-experimental group rate
Treat TB pregnancy
INH, ridampin and ethambutol for 2 months then inh and rifampin for 7 months
Case control
Participants into groups based on WHO HAS DISEASE!!!. Then assessed for risk factors
Factorial study design
Study type that utilizes 2+ interventions and all combos of the interventions
Cushing syndrome sx
Hypertension, hyperglycemia, mood swings, osteopenia, hypokalemia and metabolic alkalosis
Screen for Cushing
Overnight dexamethasone suppression test or measurement of 24 hour urinary free cortisol
Ssri for adolescent
Fluoxetine
Sx for craniopharyngioma in adult vs child
Adult is sex dysfx and just is growth failure
Ppx for pertussis in household
Everyone even if vaxed. Azithro
Follow up for Barrett esophagus
No dysplasia 3-5 years, low grade dysplasia 6-12 mo. High grade eradication therapy
Polycythemia in newborns risk factors
Post term, SGA, infant of DM, monochorionic twins, and chromosome abnormalities
Primary hyperparathyroid labs
High calcium and low phosphate
PCA aneurysm findings
CN 3 palsy. Ptosis and anusocoria.
Erysipelas def and tx.
Caused by strep pyogenes. Fever with rapid erythema well demarcated borders. Tx with a penicillin
Treat tet spell
Increase SVR, Knee to chest position
VACTERL
vertebrae, anal, cardiac, trachea esophageal, renal, radial bone, limb defects
Treat tic paralysis
Remove tic
Previously vaccinated person exposed to rabies
Only a 2 dose booster of vaccine.
Complications of MRSA bacteremia
Metastatic infections: heart valves, lungs, osteoarticilar, particularly vertebral osteomyelitis
Indications for thrombolysis in Pe
Hemodynamic instability, severe right ventricular dysfx, large clot burden, free right side cardiac thrombus
Management of partial Kawasaki, fever for 5+ days and <=3 sx
Get CRP and ibuprofen and re examine next day
How long no live vaccines after tax Kawasaki
11 months
Scrombroid poisening def, sx, tx
Def: ingestion improperly stored seafood. Sx: flush, abdominal cramps, HA, palpitations, diarrhea. Tx: self limit
Hypoglycemia s/e diabetes Med
Sulfonureas and meglitinides
Rheumatic fever, good pasture, ITP, myasthenia gravis, graves, pemphigud vulgaris
Type II hypersensitivity
Transient erytheoblastopenia of childhood
Normocytic, normochromic anemia in healthy toddler. Tx supportive unless Hgb 5>
Size concerning for melanoma
6 mm
First step in eval hypercalcemia
PTH even if suspect malignancy
Initial test to determine if patient has excess androgen production due to adrenal neoplasm
DHEAS
What use prostaglandin E1 for and s/e
Used to keep PDA open in ductus dependent heart diseases. S/e apnea, bradycardia, hypotension
Prsentation of Guillian Barre
Ascending weakness and arreflexia
SAAG Formula and causes
SAAG=Serum albumin-ascitc albumin. Greater than 1.1: portal HTN: CHF, cirrhosis, alcoholic heptitis
Less than 1.1: no PH: peritonial carcinomastosis, peritoneal TB, nephrotic syndrome, pancreatitis
Age to refer for orchiopexy for indescended testes
6 mo
Tx optic neuritis
IV steroids, oral has risk of recurrence
Tx muscle spacity in MS
Baclofen or tizanidine
Def and eval of delayed puberty in boys
Lack of testes enlargment by age 14; bone age and FSH, LH, Testosterone
Histrionic personality disorder
Excessive superficial emotion, attention seeking, secual behavior
Define second atage labor arrest
No fetal descent after nulli pushes for 3+ without or 4+ with epidural
Tx latent syphillis
3x weekyl pennicillin G
Tx of asymptomatic lead
5-44: nothing
45-69: meso-2,3-dime (DMSA)
70+: dimercaprol + EDTA
LH in central vs perioheral precocious puberty
High in central low in peripheral
Relative risk equation
Risk of outcome in exposed group/risk of outcome in nonexposed
SIADH assoc with which lung cancer
Small cell
Calcium-albumin correction
Calcium decrease 0.8 for every 1 decrease in albumin
Complications of hyperthyroid
Arrhythmia, cardiomyopathy, osteoporosis
Treat BV
Clinda or metro
What is raloxifene
Selective estrogen modulator for breast cancer chemo and osteoporosis
Treat mastitis
Dickoxacillin or cephalexin
Tx first line fir breast abscess
Fine needle aspiration
Positive predictive value equation
PPV= TP/(TP+FP)
Length time bias
When survival benefits of screening test are overstated cause of detection of lots of slowly progressive benign cases
Suspect PJP and Sputum negative
BAL
Abx for PPROM
Amp + azithro
Migrating polyarthalgia, tenosynovitis, dermatitis (pustular lesions)
Disseminated gonnococcal infection
Dyspepsia without other sx
H pylori testing
Proximal muscle weakness, high CK and inflammatory markers
Polymyositis
Pulm complications of polymyositis
Interstitial lung disease, infection, drug induced pneumonitis, resp muscle weakness
Abdominal pain, fat malabsorption, alcohol intake
Chronic pancreatitis, confirm with MRCP
Dx urethral diverticulum
MRI or tranvag Us
FOOSH fxs
Colles (distal radial)(deformity)
Scaphoid (pain in snuffbox)
When tx asymptomatic subclinical hypothyroid besides AB?
Abnormal lipids, sx, or menstrual dysfx
Relative risk reduction
(Risk in unexposed- risk in exposed)/ (risk in unexposed)
Eval gynecomastia
Look at photo
Mechanism of organophosphate poisening
Cholinergic tox by acetylcholinesterase inhib
Dialectal Behavioral therapy for…
Borderline
When get carotid endarterectomy
70+%, >5 yr life, symptomatic
Relative risk
Incidence in exposed/incidence in nonexposed
Cover for in CF
Pseudomonas
Complications of multiple myeloma
Hypercalcemia, renal insuff, infections, lytic lesions, thrombosis, hyoervoscity (rare)
Hypothyroid in pregnancy and tx
See pic
Midline neck mass moves with swallowing
Thyroglossal duct cyst
Parhophys and tx renal osteodystrophy from secondary hyperparathyroid
CKD cause less phos filtration and elevated phos snd low calcium, then elevated PTh. Tx wtih phos restrict
Analgesic nephropathy sx
Hematuria, pyuria, proteinuria, renal colic
Normal caloric response
Deviation of eye to side of stimulus, saccadic correction to midline
Risk for reactive arthritis
Greater in HLA B27 And also salmonella and chlamydia
Management if NSTEMI/Unstable angina
See photo
bilateral polyspike and slow wave activity
juvenile myclonic epilepsy
sx of endometriosis
pelvic pain, DEEP dyspareunia, dysmennorrhea, dyschezia
when do c/s for HIV
viral load >1000
define allergic bronchopulm aspergillosis
hypersensitivity disorder in asthma and CF; reccurent fleeting infiltrates and central bronchiectasis
acute, monocular vision loss, cherry red macula on fundoscopy
central artery occlusion
size of nodule that needs mangament or surveilence
> 0.8 cm
screening for diabetic kidney disease
urine albumin/creatinine ratio
Rule of 10s for reconstruction of cleft lip
10 lbs, 10 weeks, 10g hemoglobin
Sx of HIT
Thrombocytopenia and arterial and venous thrombus
Switch to for HIT
Direct thrombin inbunitor (argatroban, bivalirudin) or fondaparinux
Right ventricular strain on EKG
RBBB, atrial arrythmias, Qwaves or St change in infeior leads
tx catatonia
benzos
AKI in TLS
Ca-Phos stone formation
when get cold agglutinin hemolytic anemia
after a viral infection
boy with hemolytic anemia
G6PD
early systolic murmur at appex
mitral regurg
MOA of loop diuretics
block Na-K-2Cl transporter in loop of Henle
calcium and thiazide
reabsorb more so more in serum less in urine
sx of aspirin OD
n/v, tachypnea, lactic acid, hyperthermia, AMS
death in tuberous sclerosis
seizure, aspiration pneumonia, obstructive hydrocephalus
what is pyelophlebitis
infection of portal vein thrombosis, complication of appendicitis
tx pagets
bisphosphates
presbycusis
hearing loss elderly
3+ months of dysuria, pain with ejac, perianal pain and tx
chronic prostatitis (tx with tamsulosin)
what screen for in patients with primary biliary sclerosis
osteoporosis
what is scleroderma renal crisis and tx?
severe HTN and renal failure, ACE and nitropruside
psych med complications
see pic
Exam findings for severe AS
Soft single heart sound, delayed and dimished carotid pulse, loud and late peak systolic murmur.
Rate ratio
Incidence in intervention/incidence in control
Number needed to harm
1/(rate in treatment-rate in placebo)
Tx post op a fib after cardiac surgery
Most spont convert. However can reccur
asymmetry in a funnel plot suggests…
publication bias
positive and negative likelihood ratio
+LR= sensitivity/(1-specificity)
-LR=(1-sensitivity)/specificity
korsacoff MRI finding
mammilary body atrophy
when switch to subQ insulin in DKA
able to eat, glc <200, anion gap <12, and bicarb >15
who gets ppx for n. mening
household, roomates, child care, directly exposed to secretions, seated next to for >8 hr
calcifications in nodule that raise susp for malignancy
eccentric, reticular, punctate
Proximal muscle weakness, CK, skin
Dermatomysostis
Extrarenal manifestations of ADPKD
Cerebral aneurysms, helatic and pancreatic cysts, mitral valve prolapse, aortic tegurg, colonic diverticula, ventral and inguinal hernias
Screen for ADPKD
US for patients above 18
Soinal cord level of cremasteric reflex
L1-2
supra INR
<4.5 nothing
4.5-10: low dose oral vit K
10+: high dose oral vit K
Bleeding: iv vit K and PCC
1st step for pancreatic cyst
US with aspiration
what fluids non infectious for HIV
stool, urine, vomit,vtears as long as not bloody
When treat with fibrates for hypertrigly.
> 880
Type 1 error=
False positivie
Late in life depression at risk for
Alzheimers
Herbal meds and their side effects
See pic
Labor cannot progress without
Adequate contractions every 2-3 mins
Antipsychotics with worst parkinson risk
Haloperidol-risoeridone-olanzipine
Schistosomiasis sx and tx
Dysuria, urinary freq, hematuria, perioheral eosinophillia, praxiquantel
how does octreotide help variceal bleed
lower elevated portal venous pressure that causes varcieals
primary and secondary prevention of variceal hemmorrhage
propanolol
physical activity and insulin
reduce prior to activity
LCIS if found on FNA next step and why
excisional bx because could be DCIS or other cancer
meds cause pseudo tumor and findings on fundoscope
isotretinoin and minocycline; flame hemmorrhages, venous engorge, hard exudates
gram stain for G vs C
G: leukocytes with intracellular gram neg diplococci
C: leukocytes with no organisms
CHD risk equivalent
Noncoronary athersclerosis, DM, CKD
Relative risk
Risk exposed/risk unexposed
Attributable risk percent
ARP=(RR-1)/RR
Population attributable risk percent
PARP=(risk in total pop-risk in unexposed)/risk in total
Most common parhogen of nec fasc
Group A strep
Tx CAP
Ctx and azitrho, no anaerobic coverage even if aspiration
____ challenge for asthma
methacholine
what NOT to use orally for tinea versicolor
terbinafine and grisefulvin
When total thyroidextomy for papilary thryroid cancer
> 1 cm, tukor extension, distant met, or radiation exposure
Clinical benefit of medication equation
Possible benefit-possible harm
Intention to trrat primciple
Participants analyzed in groups they were randomized even if dropped out or fucked up
CKD cardio findings
LVH and anemia
Pempjigoid gestationis def
Automimmune urticarial papules and plaques vesicles and bullar. Periumbilical
Hematuria, abdominal mass, erythrocytsosis
RCC
Tx tines pedis
Topical terbinafine, azole or oral terbinafine or azole
Erythetamous mass from rectum with concentruc rings
Rectal prolapse
What hematoma not good in head injury <2 yeats
Nonfrontal scalp hematoma
Good prognostic factors for schizophrenia
Late onset, female, acute onset with precipitant, positive sx, no fam hx
def of neg and pos likelihood ratios
-: probability neg result in cancerous tissue compared to normal
+: probability of pos result in cancerous tissue compared to normal
reflexes and electrolytes
hypocalcemia=hyperactive
hypermagnesemia=hypoactive
hypophos= hypoactive
sensitivity help
rule out disease
tsh in hypothyroid
high
pregnancy complications for subclinical hypothyroid
recurrent miscariges, PEC, preterm birth, low birth weight, and placenta abruption
acute cholangitis sx
fever, RUQ pain, jaundice, confusion
odds ratio equation
see pic
clinical features of cervical insufficiency
2+ prior painless 2nd trimester pregnancy losses, painless cervical dilation
interpret hazard ratio
<1 means less likely to occur in treatment than event group
>1 means more liekly
Hirschaprung dx
Suction bx
Primary hyperparathyroid indications for surgery
Age <50, symptomatic, calcium >1 above normal, urine >400
High dose statins
Atorvastatin 40-80 or rosuvastatin 20-40
Palpable breast mass
Photo
Hyperkalemia EKG
See pic
Tx pertusis
Macrolides
Bleeding from fibroids
Regular and heavy
Hyoercalcemia EKG
Short QT
What is electrical alternans and when does it happen
Cardiac tamponade, alternating amplitude in QRS complexes
Pain and stiff without weakness
PMR
When initiate discussion about renal replacement therapy
GFR <30
What can Factor V ledien lead to
Protein C resistance
When bariatric surgery
BMI more than 40
myopathies and ESR and CK
see pic
urine chloride distinguish causes of metabolic alkalosis
low= gastric losses high= diuretic use
cohort vs case control
cohort prospective, case control retrospective
erythropoetin and polycythemia
if low: primary/PV
if high: secondary
autoimmune metaplastic atrophic gastritis caused by and lead to
caused by: autoimmune aggression against gastric mucosa
lead to: pernicious anemia
warfarin effected by meds increase INR and decrease
increase INR “a”s + flagyl + quinolones
MOA of carbidopa
decrease peripheral conversion of levodopa to dopamine
tx allergic bronchopulmonary aspergillosis
prednisone and if not work itraconazole or voriconazole
selection bias
inappropriate selection or poor retention of subjects
what is sheehan syndrome
pan hypopituitarism due to ishcemic necrosis after a postpartum hemmorrhage
drugs affect lithium levels
thiazides, NSAIDs, ACE and ARB,tetracycline, Flagyl
when do dialysis for lithium
> 4
schizoaffective
2+ weeks psychotic sx without mod sx
Mentzer index and significance
MCV/RBC; >13 is iron def anemia, less is thalassemia
target for treating graves in pregnancy
hyperthyroid state
markers for autoimmune hepatits
ANA and anti-smooth muscle AB
traumatic LP ratio
1 WBC per 750-1000 RBCs
toxic nodule characteristics
increased idioine uptake in nodule, decreased in rest
valve for IV drug user endocarditis
tricuspid
first line therapy for MDD with psychotic features
Electroconvulsive therapy
meds for heart failure during preg
BB, digoxin, hydralyzine, nitrates, loop diuretics
erythema infectiosum
parvo reticulated rash
low T4 and normal/low TSH
central hypothyroidism
silicosis in what lobes of lung
upper
hyperchloremia, hypokalemia non anion gap met acidosis, hypercalciuria
Distal RTA Type 1
painful vs painless genital ulcers
painful: HSV, chanchroid (H. ducry)
painless: Syphillis charcre, lymphavenereum-chlamydia (then turn painful buboes)
manifestations of stongyliodes
pulm: cough and wheeze, GI: n/d, skin: linear erythetamous
AIN drugs
PPI, NSAIDs, penicillins, diuretics
lights criteria
pleural/serum protein >0.5
pleural/ serum LDH >0.6
pleural LDH >2/3 upper lim normal serum
chronic open angle glaucoma presentation
progressive loss of peripheral vision and increased cup to disk ratio
fever cough rhinorrhea, then cephalocaudal rash and conjunctivia
measles
criteria for BiV pacer
LVEF <35%, CHF sx, and left bundle branch block >150 ms
