Step3 1 Flashcards
Clues to renal hypertension (5)
Resistant (>3 treatments with no improvement)
Malignant hypertension
Before 25 or after 55
Pulmonary edema with elevated BP
Elevation of creatinine after ACEI initiation
Prefered drugs for Hyperthyroidism
Methamizol > Propylthiouracil (less hepatotoxic)
In pregnancy:
Propylthiouracil due to teratogenic effect of methimazole.
Indications for pretreatment for hyperthyroidism before definite treatment
All patients before surgery
Older patients and those with high cardiovascular risk (diabetes, PAD, CAD,) before iodine
Thyroid nodule algorithm
Physical exam and ultrasound, history, risk factors
Pathologic? FNA
Normal: next step
TSH:
Normal or Elevated: FNA
Low: Iodine uptake
cold: FNA
hot: Treat hyperthyroidism
FNA results: No diagnosis: repeat FNA in 6 weeks Bening: serial follow up Suspicious for follicular neoplasm: complete thyroidectomy Malignancy: Total thyroidectomy
Contraindications of exercise in pregnancy
Cervical insufficiency (preterm labor in current pregancy, PPRM)
Underlying conditions that can worsen with exercise: anemia, heart, Hypertensive disorders of pregnancy, restrictive lung disease, severe heart disease
Risk of bleeding: placenta previa, persistent 2nd or 3rd trimester bleeding
Adolescent pregnancy: maternal and fetal complications (10)
Maternal: Preeclampsia Hydatidiform mole Anemia Surgical vaginal delivery Postpartum depression
Fatal:
Low birth weight, preterm labor
Gastroschisis, omphalocele
Perinatal death
Breech presentation: risk factor (4)
Oligohydramnios
Multiple gestations
Placenta previa
Advanced maternal age
Risk factors for gestational diabetes (5)
Obesity History of PGD Family history Multiple gestation Maternal age >25
Risk factors for placenta previa (4)
Previous placenta previa
Hx of surgery
Multiple gestation
Advanced maternal age
What modifies predictive values on a test?
When can/cannot use predictive values on a test. Why?
Prevalence modifies predictive values
OK: cohort studies
NOT OK: case-control studies
Risk factors for iron deficiency in young children:
<1yoa
Late introduction of solid food
Exclusively breastfed after 6months
Soy, cow, goat milk
> 2yoa
24oz/d milk
Diet low in iron-rich food
Virus associated with aplastic anemia
Parvo 19
Management of pharyngitis
Centor criteria (exudates, lymphadenopaties, fever, no cough)
> 3: Test for ASTO
If 4: consider empiric treatment
<3: no test or treatment needed
If positive:
Treat with penicillin, azithromycin, or cephalosporin for people allergic to penicillin but not anaphylactic
Hypoglossal nerve injury during neck surgery
Deviation of the tongue towards the side of the lesion
Conditions associated with Down Sd. (6)
Cardiac cushion defect Alzheimer's disease Leukemia Depressives disorders ADHD Seizure disorders Celiac disease
Treatment for Actinic Keratosis
5FU or Imiquimod
Liquid nitrogen works for single lesions
Indication for biopsy in a patient with actinic keratosis (7)
Unsure about diagnosis Lesion >1cm Tender Indurated Ulcerated Fast-growing Does not respond to treatment
Indication for statin therapy
CAD or equivalent
>75: moderate intensity
<75: high intensity
LDL>190: high intensity
Diabetic >40:
>20% 10 year cardio risk: high intensity
<20% 10 year cardio risk: moderate intensity
10-year cardiovascular risk >7.5
Atorvastatin H: 40-80 M: 10-20
Rosuvastatin H: 20-40 M: 5-10
Sinvastatin M: 20-40
Pravastatin M: 40-80
Risk Factors for Otitis Media in children (4)
Second-hand smoking
Absence of breastfeeding (even after 6months)
Daycare attendance
Pacifier use
Contraindication of VZV vaccine (6)
Anaphylactic reaction to neomycin Anaphylactic reaction to gelatin Immunocompromised: Hematologic or solid tumor Severe HIV infection Prolonged immunosuppressant therapy Congenital immunodeficiency
Management of seronegative VZV patients with vaccine contraindication that had contact
Immunoglobulin administration
after 6months
Risk factors for acute opioid intoxication (3)
Substance abuse
Hospitalization (especially for surgery)
Renal or liver failure
Clinical manifestation of opioid intoxication (6)
Somnolence, altered mental status Miosis (1mm), pinpoint Respiratory depression (shallow and bradycardia) Respiratory acidosis Hypothermia Decreased bowel sound
Management of Opioid overdose
Naloxone (repeat if necessary)
Airway management
Exclude other cause of altered mental status like hypoglycemia
Opioid withdrawal
Anxiety, insomnia, anorexia, diaphoresis, mydriasis,
Flu-like symptoms (fever, rhinorrhea, piloerection,)
Yawning, myalgias
Super awful but usually not life-threatening
Drug with life-threatening withdrawal
Bs
Benzos
Barbituric
Booze
Indications for CT scan for minor head trauma
3 categories, 13 total
High-risk patients:
Coagulopathy
High energy injury mechanism
High-risk signs and symptoms: Vomiting, headache, seizure Signs of basilar fracture (racoon eye, mastoid ecchymosis, CSF leak) Retrograde amnesia >30min before the accident LOC or AMS Glasgow <14 Suspicion of depressed skull fracture Neurological deficit
Cancer associated with acromegaly. Screening recommendations
Colon cancer
Screen for polyps every 3-5years
Sarcoidosis mnemonic
Granulomas Non-caseating aRthritis Uveitis Erythema nodosum/ ACE elevation Lymphadenopaties Idiopathic Negative TB test Gammaglobulinemia D (Elevated calcium)
Treatment and long term prognosis of sarcoidosis
Asymptomatic: no treatment
Symptomatic: corticosteroids for 12-24 months
Usually does not recur
Management of shoulder dystocia
BE CALM
Breath, don't push Elevate legs Call for help Apply suprapubic pressure Large vaginal opening (episiotomy) Maneuvers
Common Pathogen in corneal foreign bodies
S. aureus
Also:
Strep
Haemophilus
Pseudomonas (especially in contact lenses)
