Step3 15 Flashcards
Characteristic of brain metastasis on imaging studies
Multiple
Well circumscribed
Significant size of edema compared to the size of the lesion
Heart conditions seen in SLE
CAD: chronic inflammation increases risk for cardiovascular disease (accelerated atherosclerosis)
Pericarditis (due to serositis). Usually associates with other serositis (dyspnea due to pleural efusion)
Risk factors for spontaneous abortions
Advanced maternal age
Previous abortion
Substance abuse disorder
Follow up intervals for colonoscopy after polypectomy (6)
> 10 polyps: <3years
1-2 adenomatous (<1cm): every 5 years
Any > 1cm or villous or 3-10: every 3 years
Small hyperplastic: every 10 years
Adenocarcinoma (minimal invasion and >2mm of margin): 2-3 months
Large sessile polyp (>2cm) removed by piecemeal excision: 2-6 months
Neuroleptic malignant sd. vs Serotonin sd
NMS: antipsychotic
Serotonin sd.: SSRI, SNRI
both can cause fever, diaphoresis, tachycardia, rhabdomyolysis, renal failure
NMS: rigidity (Treat with dantrolene)
Serotonin sd.: myoclonus, hyperreflexia
Antibiotics of meningococcal prophylaxis
rifampin: 4 doses orally
cefuroxime: IM one dose, safe in pregnancy
ciprofloxacin: one oral dose, not in kids
Who needs prophylaxis against meningococcus?
Super close contacts
Anyone in contact with patients fluids
> 8hr sitting together (airplane)
Inclusion criteria for thrombolytic in stroke
3-4.5 hrs since onset of symptoms
Ischemic stroke with measurable neuro deficits
Absolute contraindication for thrombolytic in stroke (8)
Hemorrhage or multifocal >33% of the hemisphere
Arterial puncture on a noncompressible site (<7 days)
Recent head trauma <3 months
BP >185/110
Hx. of intracranial hemorrhage, neoplasia, or vascular malformation
Recent spinal/intracranial surgery
Patient on anticoagulation. INR >1.7 PT>12 PTT elevated, PLT <100.000
Glucose <50
Relative exclusion criteria for stroke (6)
Rapid improving neurological symptoms Pregnancy MI in the past 3 months GI or GU bleed un the past 21 days Major surgery/trauma in the past 14 days Seizure at onset of stroke
Main cause of death after stroke
DVT - Pulmonary embolism
Especially on hemiparetic side
Permissive hypertension
Up to 220/120 mmHg
If anticoagulation… do no let it go over 185/105
Myocardial infarction EKG criteria
New ST elevation in 2 consecutive leads
- > 1mm in all leads
- > 1.5mm in women, >2mm in man >40 or >2.5mm in man <40 in lead V2 and V3
New LBBB with symptoms of acute coronary sd
+/- reciprocal st depresion
Timing of diagnosis of ADHD
<12 years of age
symptoms going for >6 months
UFH vs LMWH in DVT
When do you use them?
Full dose UfH in DVT
LMWH in prevention
Medications given to a patient with an MI
Nitrates: except if right heart failure. Watch out for hypotension
Double antiplatelet: aspirin + P2Y receptor blocker
Statins
Beta-Blocker: cardioselective. Except if patient is in Heart Failure
Anticoagulation: warfarin, heparin
Statins: atorvastatin, sinvastatin
Coronary reperfusion
Effects of statin therapy after an MI
Plaque stabilization
Reduce inflammation
Atherosclerosis regression
Risk factors and clinical manifestation of Malignant Otitis external.
Risk Factors:
Advanced age
Diabetes
HIV and other immunodeficiencies
Clinical presentation Pain Erythema Granulation tissue Purulent discharge
Etiology of Malignant Otitis externa and treatment
How do you follow response to treatment?
Pseudomna >95%
IV Antipsudomonal antibiotics first
Fluoroquinolones
Penicillins (piperacillin)
Ceftazdime
Use CRP/ESR as reference for disease activity
Switch to oral once they have normalized
Ramsay Hut Sd.
Varicella-zoster uticus
Diagnosis and treatment of scabies
Scraping and light microscopy
5% permethrin cream
Most reliable method for confirmation of proper endotracheal tube placement
Capnography:
1) Rectangular waveform with 4 phases
2) Litmus paper that changes color when exposed to CO2 (from purple to yellow)
