Step3 12 Flashcards
Diagnostic criteria for multiple myeloma (3 big things)
Monoclonal protein in serum (3g/dl) or urine (IgG or IgA)
(urine may be negative because it only detects albumin)
> 10% plasma cell in bone marrow (>60% without end-organ damage)
End-organ damage: CRAB Calcemia (stone, moan, groan...) Renal insufficiency Anemia (normocytic) Bone symptoms (lytic lesion)
rouleaux formation (not specific.. also in Waldenstrom macroglobulinemia)
+/- elevated ESR
Smoldering myeloma
Pre multiple myeloma
No CRAB symptoms
Diagnostic test for multiple myeloma (5)
Serum protein levels UA (regular UA does not detect MM proteins) Evaluate for CRAB Skeletal survey Bone marrow
Anticoagulation during pregnancy
Warfarin is teratogenic
Initiate LMWH
If the patient has a mechanical valve.. switch to warfarin again
UFH at the end of pregnancy to reduce risk of bleeding
Stop anticoagulation during labor
Anticoagulation in valve replacement
Aspirin for life
If mechanical… warfarin for life
If biological… warfarin for 3 months
Empiric treatment for pediatric pneumonia
Preschool age or focal findings:
——S. pneumonia: amoxicillin
Older child or bilateral pulmonary findings:
—– Mycoplasma: azithromycin
Tuberous sclerosis presentation
Hamartomas Angiofibroma Mitral regurgitation Ash leaf spots Rhabdomyoma Tuberous sclerosis dOminant Mental retardation Angiolipoma (renal) Seizure, shagreen patch
Workup for Tuberous sclerosis diagnosis
Skin evaluation (ash leaf spots and sebaceous adenoma)
EEG: baseline and serial
Imagin: MRI for CNS tumors (giant cell astrocytoma and others)
Echocardiogram: Not really necessary because rhabdomyomas usually form in utero and resolve spontaneously
Dominant cause of deaths in Tuberous sclerosis
Seizure (treatment increases longevity)
Indication for preoperative PFTs
If lung resection to track progress
In COPD to plan optimization if baseline can not be established
In dyspnea on exertion to differentiate cardiac vs. deconditioned (patients that can walk up the stairs do not need this)
6 min walk test for preop evaluation
When is it indicated
Lung resection
Heart surgery
Findings in scoliosis that requires further investigation (4)
Pain (could be a tumor)
Rapidly progressive ( >10 degrees / year)
Neurologic symptoms
Vertebral anomalies on Xray
Medications for rapid-sequenced intubation
Sedative: etomidate, propofol, midazolam
Paralytic agent: succinylcholine, rocuronium
Right heart strain on EKG
New right bundle branch block
Q waves and ST elevation on inferior leads (II, III, aVF)
Atrial arrhythmias
Steps for managing insulin in hospitalized patients (5)
- Classify the type of diabetes (type 1, type 2, stress-induced hyperglycemia)
- Who much is the patient eating at the hospital?
- What is the regimen outside the hospital?
- Stop oral medications
- Select preferred regime
- —– Basal bolus regimen
- —– Sliding scale
- —– Infusion
