Step3 14 Flashcards
MRI findings in spinal stenosis
Osteophytes at facet joints
Hypertrophy of the ligamentum flavum
Protrusion of intervertebral disc
Management of neonatal clavicle fracture
Reassurance
Pain control
Long sleeve shirt pin to a 90 degree angle
Mechanism of infection in toxoplasmosis
Undercook meat
Unwashed produce (contaminated soil)
Cat feces
Clinical features of congenital toxoplasmosis
Triad:
Chorioretinitis
Diffuse intracraneal calcification
Hydrocephalus
Microcephaly or macro (severe hydrocephalus)
Nonspecific: jaundice, hepatosplenomegaly, rash, growth restriction
Treatment for congenital toxoplasmosis
Pirymethamine
Sulfadiazine
Folinic acid
ToRCHeSZ
CNS manifestations
Toxoplasma: intracranial calcifications, hydrocephalus, microcephalus (unless severe hydrocephalus)
Rubella: deafness, encephalitis
CMV: periventricular calcification, microcephaly
Herpes: severe CNS infection
HIV: recurrent infections
Syphilis: non?
Zika: microcephaly, ventriculomegaly, intracranial calcifications
Management of inguinal hernia
Surgery
1-2 weeks after birth
Causes of osteonecrosis (2 main, 9 other)
Steroids
Alcohol
Others:
SLE, Sickle cell, antiphospholipid sd., chronic renal insufficiency and hemodialysis, Gaucher’s disease, HIV infection, following renal transplant, Caisson disease
Avascular necrosis clasification and management
Stage 1: normal Xray, MRI: dead bone
Stage 2: dead bone on Xray
Stage 3: femoral head collapse
Stage 4: stage 3 + cartilage damage
Treatment:
Core decompression for stage 1 and 2
Total hip replacement
Labs findings in PSGN
Urine:
+ protein, +blood, +RBC cast
Blood:
Elevated creatinine
Low C3
Positive ASO titter
Prenatal testing (timing, advantage, disadvantage)
First trimester combine test
10-14
Nuchal translucienty
B-HCG
Protein A (pregnancy associated protein
9-13 weeks
Early screening
Not diagnostic
Prenatal testing (timing, advantage, disadvantage)
Cell free fetal DNA
> 10 weeks
High sensitivity and specificity for aneuploidy
Not diagnostic
Prenatal testing (timing, advantage, disadvantage)
Chorionic villus sampling
10-13 weeks
Diagnostic for Karyotyping
Invasive, increase risk of spontaneous abortion
Prenatal testing (timing, advantage, disadvantage)
Second trimester quadruple screening
B-hCG, Inhibin, AFP, striol
15-25
Screening for neural tube defects and aneuploidy
Not diagnostic
Prenatal testing (timing, advantage, disadvantage)
Amniocentesis
15-20
Diagnostic for karyotype
Increase risk of fetal injury, rupture of membrane, pregnancy loss
Prenatal testing (timing, advantage, disadvantage)
Second trimester US
15-20
Evaluates fetal growth, fetal anatomy and confirms placental position
Not sensitive for all defects, some findings have no significance
Diagnostic test for Pheochromocytoma
24hr urine metanephrines and catecholamines
Plasma fractionated metanephrines (less specific)
24hr urine vanimandelic acid (less sensitive/specific)
Decongestionants and TCAs need to be stopped 2 weeks before test
Sd associated with pheochromocytoma
Fx of Pheochromocytoma
MEN2
NF1
VHL
Pheochromocytoma workup
Suspicious=> Urine and plasma metanephrines and cathecholamines
Negative: Recheck during spell
Positive==> MRI/CT abdominal
=== Positive==> Alpha and beta block, genetic testing, surgical evaluation, MIBG scan if tumor >5Cm
=== Negative ==> MIBG scan, whole body scan, PETscan, octreotide scan
Quad study prenatal screening
Trisomy 18 AFP: low B-hCG: low Estriol: low Inhibin: normal H-hCG: low
Trisomy 21 AFP: low Estriol: low hCG: high Inhibin: high H-hCg: high
Neural tube defect AFP: elevated Estriol: espina bifida normal, anencephaly low hCG: normal Inhibin: normal H-hCg: not used
Elevated AFP in pregnancy
Neural tube defect Abdominal wall defect Incorrect dating (most common) Fetal death or distress Multiple gestation
What is MIBG scan
Metiliodinebenzilguanidine scan it is a functional scan
Used in diagnosis of neuroendocrine tumors because MIBG resembles norepinephrine and is taken up by tumors that secrete this
Use to diagnosed malignant tumors (usually >5cm) or tumors that are not seen in regular MRI or CT
Younger patients and those with family hx need this scan do to increase risk of malignancy
Chromogranin A
Secreted by 80% of neuroendocrine tumors
Not specific for pheochromocytoma
4 complications during adrenalectomy for pheochromocytoma and treatment
Hypertensive crisis: treat with IV nitroprusside, phentolamine, nicardipine
Hypotension: treat with bolus of normal saline
Hypoglycemia: intravenous dextrose
Cardiac arrhythmias: lidocaine of esmolol
Metoclopramide MOA and side effect
D2 receptor blocker
Use for nausea
Causes extrapyramidal symptoms
(akathisia, parkinsonism, dystonia)
Absolute contraindication of combined hormonal contraceptive (12)
Migraines with aura Hypertension (160/110) Heart disease Hx. Stroke Hx. of thromboembolic disease Diabetes with end organ damage Post partum <3 weeks Smoking >15/day + >35 years Recent surgery/immobilization Antiphospholipid antibody sd. Breast cancer Cirrhosis and liver disease
