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Medicine > step 3 27 > Flashcards

step 3 27 Flashcards

1
Q

Critical illness neuropathy

A
  • 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.
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2
Q

major depressive disorder vs. grief

A
  • 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.
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3
Q

management of grief

A
  • express empathy, counsel patient
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4
Q

clinical features of hirschprungs

A
  • bilious vomiting
  • abdominal distension
  • failure to pass meconium
  • explosive expulsion of gas and stool during rectal exam
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5
Q

first step with suspected pyelo

A

renal US

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6
Q

treatment of acute prostatitis

A

bactrim or quinolone (need good tissue penetration) for 6 weeks

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7
Q

esophageal coin ingestion management

A
  • 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)
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8
Q

AAA indications for repair

A
  • symptomatic
  • size
  • rate of growth (more than 0.5 cm over 6 month period)
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9
Q

normal CVP

A

10

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10
Q

indications for parathyroidectomy with hyperPTH

A

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

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11
Q

management of hyperparathyroidism with no indication for surgery

A

Regular follow-up with serum calcium, creatinine, and DXA

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12
Q

medical term for child abuse

A

nonaccidental trauma

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13
Q

management of nonaccidental trauma

A

skeletal survery
CT head
fundoscopy

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14
Q

fractures that are pathognomonic for nonaccidental trauma

A
  • posterior rib fractures

- metaphyseal corner (“bucket-handle”) fractures

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15
Q

returning to work-sex after MI

A

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.

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16
Q

diabetes statin indication

A

age 40-75 with diabetes

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17
Q

statin intensities

A

All high intensity, unless age 75 with heart disease or diabetic with ASCVD risk less than 7.5

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18
Q

high intensity statin meds

A

ONLY
Atorva 40-80
Rosuvastatin 20-40

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19
Q

Breast mass workup in woman over 30

A

Mammography…
IF benign or indeterminate then get US
IF concerning for malignancy, core needle biopsy

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20
Q

low back pain management

A

NSAIDS + close observation

MRI only if red flags, progressive neuro deficits, suspicion for infection or cancer, or pain persistent for 3+ months

21
Q

presentation of retained products of conception

A
  • hemorrhage unresponsive to uterine massage or oxytocin (retained products of conception cause uterine atony, leading to large, boggy uterus)
22
Q

presentation of anal carcinoma + clinical features

A
  • 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

23
Q

presentation of inhalant toxicity in teenagers

A
  • lethargy
  • ataxia, poor coordination, altered, LOC
  • last 15-45 minutes
  • looks like alcohol or benzo intoxication but is brief
24
Q

lung disease in sarcoidosis

A
  • predominantly upper lobes + ILD + hilar lymphadenopathy

- on CT – ground-glass opacities, fibrosis, bronchovascular irregulariites

25
Q

management of inguinal hernias in kids

A
  • if not incarcerated, surgery within 1-2 weeks (can incarcerate quickly in kids)
  • if incarcerated, admit for surgery
26
Q

treatment of menopausal symptoms

A

short term (3-5 years) combined estrogen/progresterone

27
Q

contraindications to HRT

A

coronary heart disease
active liver disease
breast cacner history
VTE-stroke history

28
Q

statin-induced myositis presentation + common situation

A
  • generalized weakness, body aches, muscle tenderness + severe elevation of CK
  • precipitated by use of CYP3A4 meds (cyclosporine, macrolides)
29
Q

shingrix indications

A

immunocompetent individuals over the age of 60

30
Q

meningococcal vaccination indication

A
  • age 11-12, booster at age 16-21
31
Q

hep B indications

A
  • chronic liver disease

- high-risk groups (men who have sex with men, IVDU, health care workers)

32
Q

management of person who doesn’t sign advanced directive?

A
  • can’t be honored. oral advanced directives can only be honored if patient if given in presence of two witnesses
33
Q

DIC coag features

A

elevated PTT + PT + thrombocytopenia

34
Q

new a flutter diagnosis

A

3 weeks of anticoagulation before ablation or attempted pharmacologic or electrical cardioversion (high risk of systemic anticoagulation)

35
Q

management of suspected LGIB with active bleeding

A

Consider angiography or nuclear medicine studies

36
Q

common etiologies of recurrent cellulitis

A

Tinea pedis
Lymphedema
Chronic venous insufficiency

37
Q

uterine fibroids treatment

A

hormonal (OCP’s) or surgery

38
Q

first line for HTN in gout patients

A

ARB’s (losartan has a mild uricosuric effect)

39
Q

first step in suspected retroperitoneal hemorrhage

A

CT scan

40
Q

retroperitoneal hemorrhage presentation

A
  • patient on anticoagulation
  • severe lower quadrant abdominal or back pain
  • positive psoas sign on exam
  • There’s a large amount of soft tissue in the retroperitoneum so you can bleed out heavily into it.
41
Q

management of patient bleeding on warfarin

A

Stop warfarin and give vitamin K + FFP

42
Q

criteria for decision-making capacity

A

3 C’s: comprehension, consequences, and choice (comprehension of condition and treatments, understanding of consequences of accepting and refusing treatment, and communicates clear and consistent choice).

43
Q

other things that count for MDE criteria

A

depressed mood, weight loss

44
Q

how to manage depression in bipolar

A

need both mood stabilizer + antidepressant (it’s monotherapy that’s dangerous)

45
Q

PCI timeframe recommendation for STEMI

A

within 90 minutes of medical contact

within 12 hours of symptom onset

46
Q

management of STEMI patient requiring emergency PCI

A

Pretreat with antiplatelet + anticoagulant therapy

47
Q

intussuception mangement

A

FIRST: Stabilize with IV fluids
Second: enema reduction with air or saline enema

48
Q

white coat HTN management

A

24-hour BP monitoring

49
Q

when patients should be educated on RRT

A

GFR below 30

Medicine (71 decks)

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