Step 3 UWorld Flashcards
(48 cards)
5 reasons you would immediately remove a tunneled catheter in an infected patient
- Pus at the site
- Severe sepsis
- Hemodynamics instability
- Evidence of metastatic infection
- No improvement after 72hrs of antibiotics
Next step for infected patient with tunneled catheter who gets worse on day 4 of Vanco with midline low back tenderness
MRI spine
What is associated with restless leg syndrome and what test should you make sure to order?
Iron deficiency anemia
Ferrritin (<75 ng/dL)
How high do you expect aminotransferases to be in viral hepatitis?
> 1000
Concerns with Kava Kava supplement and what its used for>
Used for anxiety
Can cause hepatotoxicty and liver failure
Thiazide side effects
Hypokalemia
Hyponatremia
Hyperuricemia
High glucose and high cholesterol
Concerns with ginko baloba
Increased risk of bleeding due to anticoagulant and antiplatelet effects
Concerns with ginseng
Headache, insomnia, and GI symptoms
Vaginal bleeding and hypoglycemia
Treatment of restless leg syndrome
Dopamine agonists (pramipexole or ropinirole) Alternate: benzos or gabapentin - Alpha -2-delta calcium channel ligands
Concern for subarachnoid hemorrhage. 1st and 2nd step if 1st step is negative
1st Get CT head
If negative get LP. Xanthochromia confirms SAH
In opioid withdrawal why would methadone be preferred over buprenorphine?
Buprenorphine can worsen withdrawal symptoms since it is a partial opioid antagonist.
Why would you choose clonidine over methadone in treating opioid withdrawal?
Methadone requires supervision in an inpatient or outpatient setting. May require official detox treatment
Patient with seizures on phenytoin starts to have horizontal nystagmus. What do you do?
Taper the dose down
How do phenytoin and oral contraceptives interact?
Phenytoin increases the metabolism of oral contraceptives making the risk of pregnancy higher.
Oral contraceptives don’t affect phenytoin levels
How does CKD affect phosphorus, calcium, parathyroid hormone, and vitamin d?
Phosphorus increases - not filtered
Vitamin D decreases - it doesn’t get converted to active vitamin d by the kidney
Calcium decreases - decreased vitamin d leads to decreased calcium absorption in the gut
Parathyroid hormone increases - increases due to low calcium and high phosphorus in order to remove excess phosphorus and break down bone to increase calcium
What happens when secondary hyperparathyroidism continues during CKD?
Tertiary hyperparathyroidism
Calcium and parathyroid levels in tertiary hyperparathyroidism?
Hypercalcemia and very high PTH due to autonomous PTH secretion
3 indications for parathyroidectomy in tertiary hyperparathyroidism
- Persistently elevated calcium, phosphorus, and parathyroid hormone
- Soft tissue calcification or calciphylaxis (vascular calcification with skin necrosis)
- Intractable bone pain or pruritus
2nd and 3rd MCP with narrowing, subchondral sclerosis, curved osteophytes, subchondral cysts, and osteopenia with joint aspirate that has positively birefringent rhomboid crystals
Hereditary hemochromatosis
What do patients with hereditary hemochromatosis have an increased risk of developing?
Hepatocellular carcinoma
STOP BANG survey for obstructive sleep apnea
Snoring
Tiredness (excessive daytime)
Observed apneas
Pressure elevated (bp)
BMI < 35
Age < 50
Neck size. 17 in. for men, 16 in. For women
Gender (male)
For what disease would you use modafinil?
Narcolepsy
Medical treatment for asymptomatic left ventricular systolic dysfunction? 1st and 2nd steps
ACE-I like lisinopril or ARB like losartan. They delay heart failure symptoms and improve cardiac morbidity and mortality
Beta blocker should be added once the ACE-I or ARB is at an appropriate dose
When would you treat an infant with hyperbilirubinemia with exchange transfusion? (3)
- T Bili 20-25
- Worsening hyperbilirubinemia after phototherapy
- Bilirubin induced neuro dysfunction - lethargy
