Step3 11 Flashcards
Clinical features of OCD
Obsessions:
Persistent, intrusive unwanted thoughts, anxiety-producing
Compulsion
Take up of your time
Do not “solve” the obsession
Treatment for OCD
Cognitive-behavioral therapy
SSRI
Genetics of X linked dominant disorders
All females offsprings of affected men have the condition
Genetics of X linked recessive disorder
50% of male offspring of female carrier have the disease
50% of female offspring of a female carrier are carriers
WOMEN NEVER HAVE THE DISEASE
Genetics of mitochondrial disorders
All offsprings from affected mothers have the condition
Only daughters pass it along
What is MELAS
Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes
Stroke-like episodes: hemiparesis, vision abnormalities (due to mitochondrial dysfunction, not corresponding to artery distribution) Seizure Muscle weakness Hearing loss Lactic acidosis
When do you see hemosiderin-laden macrophages in pulmonary lavage
Diffuse alveolar hemorrhagic sd.
Anti-GMB
Granulomatosis with polyangiitis
Other systemic vasculitides
What do you use a high-resolution chest CT scan for
Diagnosis of interstitial lung disease
Diagnostic study for bronchial obstruction
Bronchoscopy… can take biopsy
What happens if you use too much topical antibiotic
Acute contact dermatitis
Medication that can worsen prostatic hyperplasia
Antihistamines can worsen prostatic hyperplasia
Periodic breathing
<6 months of age
Cycles of:
5-10 sec of breathing pauses
10-15 sec of shallow rapid breathing
Return to normal breath
Reassure parents
Giardiasis clinical presentation
Loose, fatty, foul-smelling stools
Abdominal cramps
Flatulence
Weight loss
Chronic:
Malabsorption (eg. lactose intolerance)
Profound weight loss
Vitamin deficiency
Management of Giardiasis
Hands hygiene with soap and water
ATB for symptomatic/positive test patients (Tinidazole)
Avoid use of recreational water bodies if symptomatic
Secondary cause of hypertension
<20 years of age
Renal parenchymal disease
Coarctation of the aorta
Secondary cause of Hypertension
21-39
Hypo/hyper thyroidsm
Fibromuscular dysplasia
Renal Parenchymal disease
Secondary cause of renal hypertension
40-64
Hyper/Hypo thyroidism
Sleep apnea
Hyperaldosteronism
Secondary cause of renal hypertension
> 65
Renal artery stenosis
CKD
Labs in PCOS
Elevated testosterone
Elevated estrogen
Increased LH/FSH ratio
Comorbidities in PCOS
Endometrial hyperplasia/cancer
Metabolic syndrome
Obstructive sleep apnea
Non-alcoholic steatohepatitis
Treatment of PCOS
Weight loss
Oral contraceptive for menstrual regulation
Letrozole for ovulation induction
Meniere disease triad
Vertigo
Hearing loss
Tinnitus
Treatment for Herpes zoster
Oral valacyclovir 3 times a day for 7 days
Oral acyclovir 5 times a day for 7 days
IV acyclovir for severe infection or immunocompromised
If >72hrs from the onset of symptoms… just analgesia and zinc oxide-based cream
Exposure to VZV in health care personnel
If immune (vaccine or had disease), do nothing
If not immune: give vaccine <5 days from exposure (varicella vaccine, not herpes zoster vaccine)
If immunocompromised or pregnant: immunoglobulin +/- antiviral medication
Mask and glove if patient has disseminate zoster infection
Pain management in Herpes Zoster
Acute (<30days): NSAID, analgesic
Subacute ( 1-4 months): NSAID, analgesic
Postherpetic neuralgia (>4months): TCAs, gabapentin, pregabalin
Cough-variant asthma
Cough is the predominant symptom
May not have wheezing or SOB
Treat as regular asthma
Interpretation of V/Q test
Low pretest + low V/Q prob: PE excluded
Normal V/Q + any pretest prob: PE excluded
High Pretest + high V/Q prob: PE confirmed
Any other combination: do more studies
Wells criteria for Pulmonary embolism
+3
Clinical signs of DVT
Other diagnoses less likely
+1.5
Hx of DVT
Recent immobilization
HR >100
+1
Hemoptysis
Cancer
> 4 PE likely
4 or less PE less likely
REMEMBER
Allergic reaction to contrast is a contraindication for studies
Increased risk of breast cancer in men
Fx with BRCA mutations (think if hx of breast and ovarian cancer in the family)
Klinnefelter sd (extra X chromosome)
Other condition with elevated estrogen to androgen ratio: hepatic dysfunction, marihuana, obesity (very small risk)
