Need to evaluate for symptoms in 2 or more settings + symptoms present for 6 months + significant functional impairment - need to use ADHD-specific behavior scales by parent and teacher - symptom onset before age 12

step 3 30 Flashcards by Ned Jones

central hypothyroidism

low free T4 + low or inappropriately normal TSH

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management of central hypothyroidism

ACTH stimulation test first, then give levo (levo can accelerate cortisol metabolism and precipitate adrenal crisis in patients with undiagnosed adrenal insufficiency).

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biggest RF’s for CKD progression

hypertension
proteinuria
hyperglycemia

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most effective way to ensure transition of care according to USMLE

oral communication, need to call PCP, provider-to-provider phone call, closed loop

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normal bicarb

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management of breast pain

If noncyclic, unilateral, or focal, imaging

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quasi-experimental study design

nonrandomized study used when not feasible or ethical to conduct a randomized controlled trial

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anorexia nervosa management

FIRST LINE: CBT + nutritional rehab

SECOND LINE: olanzapine

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treatment of menopausal symptoms in patient contraindicated for estrogen

SSRI

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anemia of pregnancy physiology

Pregnant women have mild dilutional anemia because plasma volume increases more rapidly than RBC mass

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bleeding in pregnancy?

Gingival bleeding is common due to hyperplasia and inflammation from hormonal changes

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meds causing AIN

NSAIDS
PPIs
Penicillins
Diuretics

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other features of panic disorder

recurrent and unexpected panic attacks (often with no clear trigger)

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immediate treatment of panic disorder

benzos

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GI disorder associated with trisomy 21

Hirschsprung disease

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transient synovitis vs. septic arthritis presentation

transient synovitis – Well-appearing kid with history of mild infection/URI, with effusion, and able to bear weight
septic arthritis – high fever, ill-appearing,

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first step in pediatric hip pain workup

Ultrasound

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transient synovitis management

NSAIDs

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legg-calve-perthes

chronic condition, non-weight bearing

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ADHD diagnosis

Need to evaluate for symptoms in 2 or more settings + symptoms present for 6 months + significant functional impairment

need to use ADHD-specific behavior scales by parent and teacher
symptom onset before age 12

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First-line treatment for ADHD

stimulants

hypercalcemia of malignancy management

Treat if calcium over 14 or severely symptomatic
long term = bisphosphonates (zoledronic acid)
short term = IV fluids + calcitonin (delay in effect of bisphosphonates)

workup of hypercalcemia of malignancy

PTH + PTHrP + vitamin D (need to differentiate between hormonal induced and bone mets)

most common fetal chromosomal abnormality

trisomy 16

serosanguineous fluid means

bloody

low pleural fluid/serum glucose ratio in pleural effusion suggests

TB Malignancy (cancer cells use up glucose) Rheumatologic (RA, SLE) Esophageal rupture

high pleural fluid/glucose ratio found n

transudative effusions Infections PE

exudative in light's criteria suggested by

The ratio of pleural fluid protein to serum protein is greater than 0.5 The ratio of pleural fluid LDH and serum LDH is greater than 0.6

sarcoidosis pleural effusion features

- exudative with very high lymphocyte predominase

SLE pleural effusion features

- exudative with low glucose level

folliculitis with pool exposure + management

hot tub folliculitis | - stop swimming in pool, self-limiting

COPD on flow-volume loop

- scooped-out pattern on expiratory curve

typical ILD presentation

dyspnea + chronic nonproductive cough

sick sinus syndrome management

- pacemaker

olecranon bursitis initial management

aspiration with fluid analysis (septic bursistis is common) - if mild, treat with oral abx - if immunocompromised or severe, admit for IV abx

When PCP ppx is indicated with chronic steroids

Greater than 1 month of pred greater than 20 mg and another source of immunocompromise (eg on another immunosuppressant)

hypospadias management

surgery by 6 months

caveat about acute otitis media in infants

- presents with nonspecific symptoms (can be fever, vomiting, diarrhea, poor sleep, poor feeding, or decreased appetite) so always do otoscopy as part of full exam

ITP other features

- young women - mucocutaneous bleeding, epistaxis, gum bleeding, menorrhagia, petechiae - can have anemia due to chronic blood loss (eg, menorrhagia)

other ITP causes

HIV, hep C, SLE

TTP presentation

These patients are generally very sick. Life-threatening disorder - Severe thrombocytopenia, hemolytic anemia, organ damage with confusion, neuro deficits, renal disease, GI problems.

infant with watery diarrhea + vomiting?

rotavirus

ovarian cancer workup

US, then surgical exploration (no transdermal biopsy)

management of pregnant woman potentially exposed to parvovirus

serology (many immunocompetent people show no signs of previous infection so test IgG and IgM to test for immunity)

how to reduce risk of ventilator-associated pneumonia

- reduced sedation - put patient in semirecumbent position - drain subglottic secretions

first line for PTSD

SSRI's + CBT

Common complication of lap chole's

Retained CBD stone (choledocholithiasis)

choledocholithiasis presentation

RUQ pain intermittent + N/V + mildly elevated aminotransferases, bili, and alkphos

how to reduce risk of nephrolithiasis

``` Increase fluids Increase calcium intake (calcium binds oxalate in the GI system and prevents GI oxalate absorption) Reduce oxalate (spinach/potatoes/nuts, animal protein (animal protein increases urinary calcium levels and reduces citrate) (citrate binds calcium and prevents stones), and sodium ```

most common cause of stroke in pediatric patients

sickle cell disease