Step3 19 Flashcards
Serum cancer for liver cancer
AFP
Very low-risk prostate cancer classification
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)
Management of prostate cancer
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
Inhalants intoxication
Transient euphoria
Lethargy
Loss of coordination
Loss of consciousness
Last 15-45 min.. return to baseline
Other symptoms:
Arrhythmias, seizure, dangerous behavior,
Dxx in chest Xray:
Silicosis
Asbestosis
Berylliosis
Coal worker pneumoconiosis
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
Risk of hormone replacement therapy. When is it ok to prescribe?
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
Medications that can interfere with statin use
Macrolides
HIV protease inhibitors
Gemfibrozil
Cyclosporin
Interfere with CYP3A4… Statin accumulation can increase the risk for statin induce myositis
What liver enzyme can be “elevated” in a patient with rhabdomyolysis
AST
Is not coming from the liver but from the muscle
Pneumococcal vaccine in adults
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
Biggest risk factor for bladder cancer
Smoking
Rubber contact is a risk factor for which cancer
Lung
Blader
Leukemia
Clinical presentation and management of inflammatory breast cancer
Lymphadenopathy
Erythema
Piel de Naranja
Nipple retraction, bleeding,
Diagnose with core biopsy
Radical mastectomy (breast conservation is not an option) Chemo and radiation
Prefered location of 5 main types of lung cancer
Small cell and SCC: central
Adenocarcinoma and Large cell: peripheral
Bronchial carcinoid: no specific location
Secondary malignancies related to Hodking Lymphoma
Lung Breast Thyroid Bone GI
Clues for enterovesical-fistula
Multiple urinary infections
Mixed bacteria
Pneumaturia
If IBD
Chronic diarrhea, abdominal pain
(Chrones > Ulcerative)
Management of patients with candiduria
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
Risk factors for endometrial cancer
Obesity PCOS Tamoxifen Nullyparity Early menarche or late menopause
THINK ENDOMETRIAL CANCER IN A FAT PATIENT WITH ABNORMAL BLEEDING (sudden onset/intermenstrual)
Evaluation and management of lead poisoning
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)
Clinical presentation of retroperitoneal bleeding
Pt. on anticoagulation
Sudden lower quadrant abdominal pain or back pain, psoas sign
Hemodinamicaly instability
Best test: CT scan
Particular thing about Pneumocystis pneumonia
Dyspnea and Hypoxia
Management of Pneumocystis pneumonia
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
Clinical presentation of osteoarthritis of the hip
Hip worsens with use during the day
Absence of pain at rest
Decreased range of motion
Best initial test for hip pain
Xray
Best antihypertensive for this comorbidity
GOUT
ACEI. ARB
Do not use diuretics
Best antihypertensive for this comorbidity
OSTEOPOROSIS
Thiazide
Best antihypertensive for this comorbidity
CKD
ACEI or ARB
Complications of varicocele
Subfertility
Testicular atrophy
Diagnosis of varicococele
Clinical: tortuose mass, increases with Valsalva, standing
US: preferred
CT: if right-sided. Think CANCER
Management of varicocele
Plexus vein ligation if the patient is young
NSAID and support if older and do not desire more children
Clinical findings of choanal atresia
Single: Chronic discharge, symptoms during childhood
Both: loud breathing, cyanosis that worsens with feeding and improves with crying, symptoms right after birth
Diagnosis of choanal atresia
First: try to insert nasogastric catheter
If it can’t go through,
Confirm with CT or nasal endoscopy
Hematochezia evaluation algorithm
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)
Signs and symptoms suggestive of upper GI bleed
Melena, hematemesis
Hemodynamic instability
Orthostasis
BUN/Cr 20:1
PTHrP secreting tumors
SSC, gynecological, breast, kidney, bladder
Renal effects of severe hypercalcemia
Impaired ability to concentrate urine
Diluted urine (nephrogenic diabetes insipidus)
Can cause hypotension if low oral intake, vomiting
Timeline for percutaneous cardiac intervention. When do you do it?
12 hours from symptoms onset
90 min door to needle if the facility has PIC
120 min if the patient needs to transfer
Management of Acetaminophen intoxication
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
Development of symptoms after acetaminophen ingestion
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
Bacterial endocarditis prophylaxis
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
Antibiotic use for endocarditis prophylaxis
Gums or Bronchial procedure (strep)
amoxicillin
Skin procedure:(staph)
vanco
Change of cardiac prosthetic material (staph)
Vanco
GI or GU procedure (enterococcus)
ampicilin
