step 3 27 Flashcards
Critical illness neuropathy
- Limb and respiratory muscle weakness in patients with mulit-organ system failure or severe sepsis
- Difficult to wean off of the ventilator and usually have severe encephalopathy or coma.
major depressive disorder vs. grief
- MDD = must meet 5 of 9 symptoms
- grief = thoughts of dying involve wish to join the diseased, functional decline less severe, sadness more specific to thoughts of the deceased, active suicidality uncommon. Can have transient hallucinations.
management of grief
- express empathy, counsel patient
clinical features of hirschprungs
- bilious vomiting
- abdominal distension
- failure to pass meconium
- explosive expulsion of gas and stool during rectal exam
first step with suspected pyelo
renal US
treatment of acute prostatitis
bactrim or quinolone (need good tissue penetration) for 6 weeks
esophageal coin ingestion management
- IF less than 24 hours and asymptomatic, observe and repeat xray in a day
- IF ingested over 24 hours ago or symptomatic, flexible endoscopy (can erode esophagus and perf esophagus)
AAA indications for repair
- symptomatic
- size
- rate of growth (more than 0.5 cm over 6 month period)
normal CVP
10
indications for parathyroidectomy with hyperPTH
1) symptomatic hypercalcemia
2) Complications (t-score greater than negative 2.5, CKD, nephrolithiasis-calcinosis)
3) Increased risk of complications (moderate to severe hypercalcemia) (calcium greater than 1mg above normal or urinary calcium excretion greater than 400 mg/day)
4) Age under 50
management of hyperparathyroidism with no indication for surgery
Regular follow-up with serum calcium, creatinine, and DXA
medical term for child abuse
nonaccidental trauma
management of nonaccidental trauma
skeletal survery
CT head
fundoscopy
fractures that are pathognomonic for nonaccidental trauma
- posterior rib fractures
- metaphyseal corner (“bucket-handle”) fractures
returning to work-sex after MI
IF low risk – regular activity 2 weeks after initial event
IF intermediate risk (stable angina, incomplete revascularaization, LFEF less than 40%), then stress test
IF high risk (unstable angina, CHF, arrhythmias), evaluate and stabilize before returning to work.
diabetes statin indication
age 40-75 with diabetes
statin intensities
All high intensity, unless age 75 with heart disease or diabetic with ASCVD risk less than 7.5
high intensity statin meds
ONLY
Atorva 40-80
Rosuvastatin 20-40
Breast mass workup in woman over 30
Mammography…
IF benign or indeterminate then get US
IF concerning for malignancy, core needle biopsy
low back pain management
NSAIDS + close observation
MRI only if red flags, progressive neuro deficits, suspicion for infection or cancer, or pain persistent for 3+ months
presentation of retained products of conception
- hemorrhage unresponsive to uterine massage or oxytocin (retained products of conception cause uterine atony, leading to large, boggy uterus)
presentation of anal carcinoma + clinical features
- verrucous, ulcerated anal lesion
- caused by HPV so patients usually have history of anal sex, genital warts, men who have sex with men, or HIV
presentation of inhalant toxicity in teenagers
- lethargy
- ataxia, poor coordination, altered, LOC
- last 15-45 minutes
- looks like alcohol or benzo intoxication but is brief
lung disease in sarcoidosis
- predominantly upper lobes + ILD + hilar lymphadenopathy
- on CT – ground-glass opacities, fibrosis, bronchovascular irregulariites
