step 3 18 Flashcards by Ned Jones

mangement of angioedema with ACEi

switch to arb (low risk of angioedema because do not affect kinin system)

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caveat about synovial fluid analysis with hereditary hemochromatosis

calcium pyrophosphate dihydrate rhomboid shape crystals found in 50% of patients

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other SE of SGLT2 inhibitors

euglycemic diabetic ketoacidosis (euDKA), a recognized complication of sodium-glucose cotransporter-2 (SGLT2) inhibitor (eg, canagliflozin) therapy.

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RFs for spontaneous abortion

prior spontaneous abortion, advanced maternal age, extremes in BMI, and maternal substance abuse.

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when child abuse is right answer

sudden behavioral problems
risky sexual behavior
moving into new home
impaired concentration with declining academic performance

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management of cervical insufficiency

cerclage placement

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positive likelihood ratio formula

sensitivity / (1 - specificity)

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negative likelihood ratio formula

(1 - sensitivity) / specificity

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what qualifies patients as homebound?

use a supportive device (eg, walker, wheelchair) for mobility, are unable to leave home without another person’s assistance, or cannot leave home due to a medical contraindication.

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skilled home health insurances

physical and occupational therapy, medication compliance monitoring, and wound care.

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sulfonylurea overdose management

octreotide (decreases insulin secretion)

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most effective contraceptive

progestin subdermal implant

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management of amputated body part

wrap in gauze, moisten with saline, place in sealed sterile plastic bag
place in container with ice mixed with saline (don’t want it directly on ice which can cause frostbite and severely damage it)

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shin splints (medial tibial stress syndrome) vs. compression fracture

no tenderness to palpation with shin splints

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management of tibial stress fractures

pneumatic splinting, reduced weightbearing, and a graduated exercise program. Most patients may resume full-intensity exercise within 12 weeks,

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treatment of bile-salt induced diarrhea after CCK

bile salt-binding resins such as cholestyramine (binds and sequesters bile salts)

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what are bile salts

conjugated bile acids

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calcification type suggesting benign with lung cancer

Eccentric, reticular, or punctate calcification --=malignant
Popcorn calcification (hamartoma) or concentric, central, or diffuse homogeneous calcification  = bening

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seborrheic dermatitis treatment

Seborrheic dermatitis is a chronic, relapsing condition. Initial treatment can provide significant improvement in symptoms, but patients usually benefit from intermittent re-treatment.

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affect of OCPs on thyroid hormone

increase the serum concentration of thyroid binding globulin (TBG)

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management of patient who takes alternative medication AMA

document in chart and follow patient

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when patients with unknown GBS status get prophylaxis

if the pregnancy is preterm (<37 weeks gestation), if they develop an intrapartum fever, or if they have rupture of membranes >18 hour

abx of choice for intrapartum GBS prophylaxis

penicillin

presentation of autosomal dominant polycystic kidney disease

hypertension, hematuria, proteinuria, renal insufficiency, and/or flank pain

Autosomal dominant polycystic kidney disease management

- rigorous control of BP with ACEi's | - statin

presentation of candidal endopthalmitis

neutropenic patient or patient with central line + fever, eye pain, decreased visual acuity, and funduscopic evidence of focal, glistening, white, mound-like lesions that may extend into the vitreous and cause vitreous haze.

fundoscopic exam with candida

focal, glistening, white, mound-like lesions on the retina that may extend into the vitreous, with resultant vitreous haze.

management of candidal endopthalmitis with vitreous involvement

systemic antifungal medication (eg, amphotericin B), intravitreal antifungal injection, and vitrectomy.

metformin contraindications

renal insufficiency, hepatic dysfunction, alcohol abuse, sepsis, or congestive heart failure (especially with creatinine >1.5 mg/dL)

metformin SE's

gastrointestinal upset (eg, nausea, abdominal pain, diarrhea), decreased intestinal vitamin B12 absorption, and lactic acidosis

management of optic neuritis

IV methylprednisonolone

management of MS exacerbations during pregnancy

steroids

pregnancy complications of MS

modest increase in cesarean section and assisted delivery (eg, vacuum, forceps) rates compared to those without MS

genetics of MS?

3%-23% of MS cases are familial)

how to reduce risk of peripheral edema with CCBs

combination of CCBs with ACE inhibitors is associated with a significant reduction in CCB-associated peripheral edema

management of febrile UTI in infant

If younger than 24 months should undergo renal and bladder ultrasound to evaluate for anatomic abnormalities. Those with recurrent infections or abnormal ultrasound findings should also undergo a voiding cystourethrogram

types of severe malnutrition

Marasmus (wasting) | Kwashiorkor (edematous malnutrition)

management of severe malnutrition

``` Rewarming for hypothermia Antibiotics for presumed systemic infection Rehydration Oral rehydration solution preferred Intravenous fluids if in shock Refeed cautiously ```

severe malnutrition management complications

Heart failure | Refeeding syndrome

complications of donating kidney for donor

Patients have an increased risk of gestational complications after donor nephrectomy compared to pregnancies before the procedure. However, the rate is similar to that of the general population. Thus, should recommend completing childbearing before donating kidney.

workup of hyperthyroidism in pregnancy

just order TSH

Anterior uveitis (iritis) presentation

pain, redness, variable visual loss, and a constricted and irregular pupil. Visualization of leukocytes in the anterior segment confirms the diagnosis.

infectious keratitis presentation

severe photophobia and difficulty in keeping the affected eye open. Penlight examination reveals a corneal opacity or infiltrate.

deal with disclosing HIV status

Physicians are not universally required to disclose the HIV status of patients to involved third parties, although all new cases of HIV must be reported to the local Department of Public Health.

toxo treatment

Pyrimethamine, sulfadiazine, folate

treatment of chronic prostatitis

6 weeks of a fluoroquinolone (eg, ciprofloxacin) or trimethoprim-sulfamethoxazole.

dengue hemorrhagic fever presentation

hemoconcentration, marked thrombocytopenia, prolonged fever, and respiratory/circulatory failure - positive tourniquet test (petechiae after cuff inflation) - spontaneous bleeding

unique features of classic dengue fever

- retro-orbital pain | - rash

normal distribution standard deviation values

"68-95-99.7 rule." 68% of all values are within 1 standard deviation (SD) from the mean; 95% of all values are within 2 SDs from the mean; and 99.7% of all values are within 3 SDs from the mean.

most impt protective factors for suicide

Connection to family, pregnancy, and responsibility for children

use of MELD

determine 90-day mortality in patients with advanced liver disease

MELD components (thus variables associated with mortality)

serum bilirubin, INR, serum creatinine, and serum sodium levels

effects of prolactinomas

galactorrhea in women, gynecomastia in men, and symptoms of hypogonadism in both sexes. Long-term suppression of sex hormone production by prolactinoma in women can lead to osteoporosis.