Step3 10 Flashcards
Lab test for Rheumatoid Arthritis
Rheumatoid factor
Cyclic citrulinated peptide antibody
ESR/CRP
Palpable breast mass algorithm
<30: Ultrasound +/- mammogram
Cystic: aspirate if patient wants
Complex cyst/solid mass: Core biopsy
> 30: Mamogram +/- ultrasound
Suspicious for malignancy? Core biopsy
Lab workup for lupus
- ANA: highly sensitive
- anti-dsDNA: highly specific
- anti-Sm: highly specific
Antihistone may be positive in drug induced lupus and primary SLE
Antiphospholipid (anticardiolipin)
Decreased C3, C4, CH50 during flare-up
Diagnosis criteria for SLE
4 out of 11 DOPAMINE RASH Discoid rash Oral Ulcers Photosensitivity rash Arthritis Malar rash Immunologic criteria (Anti-Sm, anti-dsDNA) NEurologic or psychiatric symptoms Renal disease ANA + Synovitis Hematologic disorders (thrombocytopenia, hemolytic anemia, leukopenia)
Disease-modifying anti-rheumatoid drugs
Methotrexate Sulfasalazine Hydroxychloroquine Leuflonide Azathioprine anti-TNF (etanercept, infliximab, adalimumab)
Significance of elevated inflammatory markers in rheumatoid arthritis
Active disease
Needs disease-modifying drugs
Other clinical manifestations of Rheumatoid arthritis outside de M/E system
Pleuritis, pulmonary fibrosis, pericarditis, myocarditis, vasculitis
Diagnostic criteria for rheumatoid arthritis
Arthritis >3 joints
Rheumatoid nodules (mostly on ankle)
Labs: Elevated ESR/CRP. Rheumatoid factor, Anti-cyclic citrullinated peptide
Xray: symmetrical joint space narrowing, osteoporosis near the joint
Aspiration: inflammatory fluid
Vitamin deficiency caused by Isoniazid
B6
Pyridoxine
Peripheral neuropathy, irritability, convulsion
Methotrexate side effects
Folate deficiency
Pneumonitis, pulmonary fibrosis
Myelosuppression “High dose)
Pancreatitis
Awake intubation
For people with difficult airway access like anaphylactic shock
Ketamine: provides dissociation, amnesia, analgesia while maintaining airway tone and protective reflexes
Dxx of painless hematochezia in children
Meckel diverticulum
Vascular malformation
Clinical presentation of ehrlichiosis
Flu-like symptoms: fever, myalgias, chills
Confusion
Rash uncommon (Rocky Mountain spotted fever without the spots)
Labs in ehrlichiosis
Leukopenia, thrombocytopenia
Elevated LFTs, LDH
Intracytoplasmic morula
PCR for Ehrlichia
Labs in Rocky Mountain spotted fever
Leukopenia, thrombocytopenia
Serum antibodies
Like erlichia
Prenatal first visit labs (11)
Rh(D) and antibody Hemoglobin/hematocrit, MCV HIV, HBV, Syphilis Rubella/Varicella immunity Urine culture Urine protein Pap smear if necessary Chlamydia if high risk
Second-trimester prenatal labs
When to get them
24-28 weeks
Hemoglobin/hematocrit, MCV
Rh(D) antibody (if patient is negative)
Glucose tolerance test
Diagnosis of gestational thrombocytopenia (6)
Asymptomatic PLT 70000-150000 2nd-3rd trimester No hx of thrombocytopenia No associated hx of thrombocytopenia Resolves after delivery
NO TREATMENT NECESsARY
When is an epidural contraindicated in patients with low platelet count
<70000
If rapidly decreasing (Severe preeclampsia)
If evidence of platelet dysfunction (easy bruising, bleeding)
Uterine neoplasia associated with tamoxifen use
Premenopausal
Endometrial polyps
Postmenopausal
Edometrial hyperplasia/carcinoma
Endometrial sarcoma
Net clinical benefit
Compare best possible outcome minus worst
Important features of randomized clinical trials
Randomization
Blinding
Intention to treat
Cocaine use
Cardiovascular Physiologic effects (4)
Coronary vasoconstriction
Hypertension and tachycardia
Increased platelet activity and thrombus formation
Cocaine use
Cardiovascular clinical presentation (3)
Myocardial ischemia/infarction
Aortic dissection
Neurologic ischemia/stroke
Cocaine use
Treatment for cardiovascular manifestations
Benzos and nitroglycerin
CCBs for persistent chest pain
Phentolamine for presistent hypertension
PCI for Myocardial infarction
Sjogren sd. antibodies
Anti Ro-SSA
Anti La-SSB
Clinical Manifestations of Sjogren sd. (5)
Dry mouth, dry skin, dry eye
Salivary gland hypertrophy
Vasculitis
Complications of Sjogren Sd.
B cell non-Hodgkin lymphoma
Dental caries
Management of dumping sd
Small frequent meals
High protein - low carb diet
Octreotide if everything fails
Why not metoclopramide use in dumping sd
Metoclopramide increases contraction of the lower esophageal sphincter and increases gastric emptying
Name of NRTIs and side effects (6)
Tenofovir: renal toxicity
Zidovudine: myopathy, bone marrow suppression
Lamivudine: diarrhea, nausea, headache
Emtricitabine: diarrhea, nausea, headache
Abacavir: hypersensitivity reactions (fever, chills. dyspnea)
Didanosine: pancreatitis
Hospice care criteria
<6 months prognosis
Patient’s or surrogate’s decision to forgo medical treatment
Cardiac and vascular causes of hemoptysis
Mitral stenosis, acute pulmonary edema
Pulmonary embolism
Arteriovenous malformation
Management of carotid art. stenosis
70%-99% and symptomatic… surgery
Uworld CK: asymptomatic and 80-90%… surgery
PLUS: life expectancy >5 years
Aspirin and statins
Preterm birth prevention
Hx of preterm labor?
NO: TVUS-CL
- –Cervix
- —-Normal: Regular prenatal care
- —-Short: intravaginal progesterone
YES:
- Progesterone injection + TVUS-CL
- —- Normal: Serial TVUS until week 24
- —- Short: cerclage + serial ultrasound until week 24
