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Uworld Gaby > Step3 19 > Flashcards

Step3 19 Flashcards

1
Q

Serum cancer for liver cancer

A

AFP

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2
Q

Very low-risk prostate cancer classification

A

AFP <10 (o PSA… no me acuerdo)

Normal palpation

Gleason score less or equal than 6, <3 cores affected (50% involvement in each affected core)

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3
Q

Management of prostate cancer

A

Very low risk and low risk:
Surveillance with PSA every 3-6 months
Repeat biopsy after the first year

(If progression during surveillance, go to next step)

Moderate/High risk:
Radiation or surgery

Anti-androgen therapy recommended for metastatic disease only

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4
Q

Inhalants intoxication

A

Transient euphoria
Lethargy
Loss of coordination
Loss of consciousness

Last 15-45 min.. return to baseline

Other symptoms:
Arrhythmias, seizure, dangerous behavior,

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5
Q

Dxx in chest Xray:

Silicosis
Asbestosis
Berylliosis
Coal worker pneumoconiosis

A

Silicosis:
Small (<1cm) nodular lesion, eggshell calcification

Asbestosis:
Linear opacities at the base and interstitial fibrosis. Pleural calcification

Berylliosis:
Diffuse infiltrates, hilar adenopathies

Coal pneumoconiosis:
Small nodular opacities in the upper lobe

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6
Q

Risk of hormone replacement therapy. When is it ok to prescribe?

A

Increases risk of:
CAD, stroke, DVT, breast cancer, endometrial cancer (if estrogen-only, and the patient has a uterus), liver disease

It is usually safe in “younger women” (50-60)

Personal Hx of any of these conditions is a contraindication

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7
Q

Medications that can interfere with statin use

A

Macrolides
HIV protease inhibitors
Gemfibrozil
Cyclosporin

Interfere with CYP3A4… Statin accumulation can increase the risk for statin induce myositis

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8
Q

What liver enzyme can be “elevated” in a patient with rhabdomyolysis

A

AST

Is not coming from the liver but from the muscle

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9
Q

Pneumococcal vaccine in adults

A

23: 1 dose after 65 yoa
If the patient received a dose before 65, vaccinate again with 23 (5years after first)

13:
1 dose of 13 and a dose of 23 one year later

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10
Q

Biggest risk factor for bladder cancer

A

Smoking

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11
Q

Rubber contact is a risk factor for which cancer

A

Lung
Blader
Leukemia

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12
Q

Clinical presentation and management of inflammatory breast cancer

A

Lymphadenopathy
Erythema
Piel de Naranja
Nipple retraction, bleeding,

Diagnose with core biopsy

Radical mastectomy (breast conservation is not an option)
Chemo and radiation
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13
Q

Prefered location of 5 main types of lung cancer

A

Small cell and SCC: central

Adenocarcinoma and Large cell: peripheral

Bronchial carcinoid: no specific location

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14
Q

Secondary malignancies related to Hodking Lymphoma

A 
Lung
Breast
Thyroid
Bone
GI
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15
Q

Clues for enterovesical-fistula

A

Multiple urinary infections
Mixed bacteria
Pneumaturia

If IBD
Chronic diarrhea, abdominal pain
(Chrones > Ulcerative)

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16
Q

Management of patients with candiduria

A

Infection vs. colonization

Sings of infection: at least 1
Symptoms (dysuria, urgency, etc)
Sign of infection: (fever, leukocytosis)
Neutropenia

If 1 or more: treat with fluconazole or anphotericin B

If only colonized: change catheter, reduce ATB use as much as possible
Hematuria and pyuria can be normal in a patient with a catheter

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17
Q

Risk factors for endometrial cancer

A 
Obesity
PCOS
Tamoxifen
Nullyparity
Early menarche or late menopause

THINK ENDOMETRIAL CANCER IN A FAT PATIENT WITH ABNORMAL BLEEDING (sudden onset/intermenstrual)

18
Q

Evaluation and management of lead poisoning

A

Severe: >70
Moderate: 45-69
Mild: <44

Repeat test in 1 month

Notify authorities if >15
Screen in patients with houses built before 1950

Treat with succimare
(DMSA)

19
Q

Clinical presentation of retroperitoneal bleeding

A

Pt. on anticoagulation

Sudden lower quadrant abdominal pain or back pain, psoas sign

Hemodinamicaly instability

Best test: CT scan

20
Q

Particular thing about Pneumocystis pneumonia

A

Dyspnea and Hypoxia

21
Q

Management of Pneumocystis pneumonia

A

TMP-SMX

Blood gas analysis
If: O2 pressure <70 or A-a gradient >35.. give steroids
O2 sat <92 could also be considered

Hold Antiviral meds until the infection is clear

22
Q

Clinical presentation of osteoarthritis of the hip

A

Hip worsens with use during the day
Absence of pain at rest
Decreased range of motion

23
Q

Best initial test for hip pain

A

Xray

24
Q

Best antihypertensive for this comorbidity

GOUT

A

ACEI. ARB

Do not use diuretics

25
Q

Best antihypertensive for this comorbidity

OSTEOPOROSIS

A

Thiazide

26
Q

Best antihypertensive for this comorbidity

CKD

A

ACEI or ARB

27
Q

Complications of varicocele

A

Subfertility

Testicular atrophy

28
Q

Diagnosis of varicococele

A

Clinical: tortuose mass, increases with Valsalva, standing

US: preferred

CT: if right-sided. Think CANCER

29
Q

Management of varicocele

A

Plexus vein ligation if the patient is young

NSAID and support if older and do not desire more children

30
Q

Clinical findings of choanal atresia

A

Single: Chronic discharge, symptoms during childhood

Both: loud breathing, cyanosis that worsens with feeding and improves with crying, symptoms right after birth

31
Q

Diagnosis of choanal atresia

A

First: try to insert nasogastric catheter

If it can’t go through,

Confirm with CT or nasal endoscopy

32
Q

Hematochezia evaluation algorithm

A

Patient stable?

  • -Yes: colonoscopy
  • —Source not found? GED
  • —–Source not found? Obscure GI bleed evaluation (capsule endoscopy, repeat upper/lower endoscopy)
  • -No: fluids, consult surgery, GED
  • —Source not found? Patient stable?
  • —–Yes: Colonoscopy
  • —–No: Angiography
  • ——— Source not found? Obscure GI bleed evaluation (capsule endoscopy, repeat upper/lower endoscopy)
33
Q

Signs and symptoms suggestive of upper GI bleed

A

Melena, hematemesis
Hemodynamic instability
Orthostasis
BUN/Cr 20:1

34
Q

PTHrP secreting tumors

A

SSC, gynecological, breast, kidney, bladder

35
Q

Renal effects of severe hypercalcemia

A

Impaired ability to concentrate urine

Diluted urine (nephrogenic diabetes insipidus)

Can cause hypotension if low oral intake, vomiting

36
Q

Timeline for percutaneous cardiac intervention. When do you do it?

A

12 hours from symptoms onset

90 min door to needle if the facility has PIC
120 min if the patient needs to transfer

37
Q

Management of Acetaminophen intoxication

A

0-4 hrs after ingestion:
Activated charcoal
At 4hrs take acetaminophen levels and decide if patient needs antidote (N-acetylcysteine)

> 4hrs
Take acetaminophen levels
Give N-acetylcysteine empirically

Also take: ALT, AST, BUN, Creatine

38
Q

Development of symptoms after acetaminophen ingestion

A

0-24hrs:
Asymptomatic

24-72hrs
Elevation in ALT AST

72-96hrs:
Transaminase peak: >10000
If severe: elevated PT, PTT, hypoglycemia, lactic acidosis, elevated bilirubin, kidney injury

4-14 days:
Recovery

39
Q

Bacterial endocarditis prophylaxis

A

Rheumatic heart disease

Prosthetic valve

Defective valve in a transplanted heart

Congenital heart defect

  • -Unrepaired cyanotic
  • -Repaired but with some residual defect
  • -Prosthetic material less than 6 months
40
Q

Antibiotic use for endocarditis prophylaxis

A

Gums or Bronchial procedure (strep)
amoxicillin

Skin procedure:(staph)
vanco

Change of cardiac prosthetic material (staph)
Vanco

GI or GU procedure (enterococcus)
ampicilin

Uworld Gaby (77 decks)

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