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
Selecting preferred insulin regime in hospitalized patients (8)
BASAL BOLUS REGIMEN Type 1 (always) Type 2 already in ambulatory regimen Type 2 on sliding scale not well controlled Type 2 recently diagnosed diabetes
SLIDING SCALE
Type 2 controlled with oral medication or diet. May need to add basal bolus if control is not reached
INFUSION
Type 1 During labor or surgery
Type 1 with suboptimal control on basal bolus
Diabetic ketoacidosis
Saw palmetto common use and side effects
Benign prostatic hyperplasia
Bleeding
Clinical feature and diagnostic studies for vaginal diverticulum (4 each)
Clinical presentation:
Postvoid dribbling
Dysuria, dyspareunia
Studies:
Urinalysis /culture
CT of pelvis
Transvaginal ultrasound
Definition of delayed puberty in boys
Absent of testicular enlargement by age 14 (<4mm)
Delayed growth spurt
Evaluation of delayed puberty in boys
FSH and LH
- — Primary: elevated
- — Secondary: low
Xray to determine bone age
Clues to cardiac syncope due to
Aortic Stenosis
On exertion
Murmur (systolic murmur)
Clues to cardiac syncope due to
Ventricular tachycardia
No preceding symptoms
Cardiomyopathy or previous MI
Clues to cardiac syncope due to
Sick sinus sd
Fatigue or dizziness
Sinus pauses on EKG
Clues to cardiac syncope due to
Advanced AV block
AV block on EKG
Clues to cardiac syncope due to
Torsades
No preceding symptoms
Medications that prolonged QT
Hypokalemia / Hypomagnesemia
Clinical presentation, labs, and management of chronic prostatitis/pelvic pain sd
Clinical presentation: >3months
Chronic prostatitis symptoms
Labs: Urinalysis >20leukocytes + negative culture
Treatment: not know good treatment. Try with medication for pain, prostatic hyperplasia, infection
