Step 3 UWorld Flashcards
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
What conditions are needed for ABO hemolytic disease?
Infant with A+ or B+
Mom’s with O+ who have A and B antibodies.
Difference between
Provisional tic disorder
Chronic tic disorder
Tourette’s syndrome
Provisional tic disorder- 1 type of tic for < 1 yr
Chronic tic disorder - 1 type of tic for > 1 yr
Tourette’s- multiple motor and greater than 1 vocal tic for > 1 yr
What kind of drug is risperidone?
2nd generation anti-psychotic
What drugs can be used to treat Tourette’s? 4 classes
1st gen anti-psychotic: haloperidol and fluohenazine
2nd gen anti-psychotic: risperidone and aripiprazole
Alpha-2 agonist: guanfacine and clonidine
Dopamine depleter: tetrabenazine
1st line treatment for primary dysmennorhea in non-sexually active and sexually active patients?
Not sexually active - (NSAIDS) naproxen
Sexually active - combined oral contraceptives
First line treatment for onychomycosis
Terbinafine
Itraconazole
Treatment for DVT or PE?
Greater than or equal to 3 months of factor Xa inhibitor like rivaroxaban
Treatment for a woman on menopausal hormonal treatment who develops a DVT
Must stop hormone therapy. Can switch to a SSRI or SNRI
Sickle cell maintenance (4)
1) pneumococcal vaccine
2) Penicillin until age 5
3) Folic acid supplementation
4) hydroxyurea
Sickle cell acute pain crisis treatment
Hydration
Analgesia
+/- transfusion
Septic arthritis lichee criteria (4)
Non weight bearing Fever > 38.5 Leukocytosis ESR > 40 CRP > 2
Infected joint. What antibiotic should you use and why?
Vancomycin to cover staph aureus and streptococci
Diffusely increased thyroidal uptake of radioactive iodine diagnoses what?
Graves’ disease- hyperthyroidism
What is subclinical hyperthyroidism?
Low TSH and normal T3 and T4
How and when do you treat subclinical hyperthyroidism?
Treat with antithyroid medication or radioactive iodine
Treat when TSH < 0.1
Or at increased risk due to
Age >65
Comorbidities like osteoporosis and heart disease
FEV1 FEV1/FVC ratio TLC DLCO In asthma, COPD, restrictive lung disease, and pulmonary arterial hypertension
Asthma
Not active sxs - normal FEV1, FEV1/FVC, DLCO, and TLC
Active sxs - just like COPD. Bronchodilator improves FEV1 by 15%
COPD
Decreased FEV1
Decreased FEV1/FVC
Decreased DLCO ( differs from asthma)
Restrictive lung disease
Decreased FEV1
Proportionally decreased FVC -> normal FEV1/FVC
Decreased TLC
Pulmonary arterial hypertension
Decreased DLCO
Otherwise normal
Most specific findings of cardiac tamponade physiology
Right atrial and right ventricular collapse
Beck’s triad of cardiac tamponade
Hypotension
JVD
Decreased heart sounds
What is the cause of the symptoms in toxic shock syndrome?
Staph TSS toxin-1. Its an exotoxin. Widespread T cell activation due to exotoxin acting as a superantigen
Distinguishing features between PSGN and IgA nephropathy
Timing after an infection
Gross hematuria
RBC casts
Complement levels
10 days after infection for PSGN
Sooner for IgA
Gross hematuria in IgA, but not PSGN
Both have RBC casts
Complement decreased in PSGN and normal in IgA
What is the mechanism of amantadine?
Dopamine agonist
How do you treat an acute dystonic reaction?
Anticholinergics - benztropine
Antihistamines - diphenhydramine
What is the mechanism of amantadine?
Dopamine agonist
How do you treat an acute dystonic reaction?
Anticholinergics - benztropine
Antihistamines - diphenhydramine
