Step3 21 Flashcards
First-line medications for migraine prevention
Beta-blocker
Valproate
TCAs
EHEC diarrhea presentation
Bloody diarrhea and abdominal pain without fever
Exposure to animals and /or undercook meat
Best strategy to prevent lung injury in an intubated patient with ARDS
Low tidal volume
Effects of mechanical ventilation on BP
Mechanical ventilation increases intrathoracic pressure
Collapses capacitance veins (inf. vena cava)
Decreases venous return
Decreases right heart preload
HYPOTENSION
Give IV fluids
Medications that cause pill esophagitis
Management
Tetracyclines NSAIDs K Fe Biphosphonates
Stop medication
Risk factors for developing fetal neural tube defects
Low folic acid intake
Medications: methotrexate, antiepileptics
Diabetes
Previous pregnancy with NTD
Prevention of neural tube defects
FOLIC ACID *at least 1 month before pregnancy
Regular population: 0.4 mg/day
High risk: 4mg/day Low folic acid intake Medications: methotrexate, antiepleptics Diabetes Previous pregnancy with NTD
Screening for Neural tube defects
AFP
Second-trimester ultrasound (to check on elevated AFP or even as first test)
Amniocentesis: if ultrasound fails
Positive AFP and cholinesterase
Rheumatoid arthritis medications safe in pregnancy
Hydroxychloroquine
Stop methotrexate 3 months prior to trying pregnancy
Normal vitamin B level
200-900
Clinical presentation
HEMOCHROMATOSIS
Skin, GI, Endocrine, Infecto, Cardiac, Mus/Ske
Skin: bronze diabetes
GI: Elevated liver enzymes, hepatomegaly (early), cirrhosis (late). Risk for Hepatocellular carcinoma
Endocrine: diabetes, hypogonadism (low libido), hypothyroidism
Mus/Ske: arthrarlgias, chondrocalcinosis
Cardiac: dilated or restrictive cardiomyopathy, conduction abnormalities
Infection: increased risk for listeria, yersinia, Vibrio vulnificus
Classic vignette for a patient with Hemochromatosis
Patient with diabetes and decreased libido
Elevated iron, ferritin, and transferrin
Diagnosis of hemochromatosis
Iron panel (elevated)
LFTs: elevated (mild)
Definitive diagnosis: gene testing
HFE
Treatment for bulimia
Cognitive-behavioral therapy first
Fluoxetine
(Hospitalize if severe or risk for suicide)
Bupropion can cause seizure in a patient with Bulimia
Important complications of nephritic sd
Thromboembolic events
Infection caused by typical organisms (not opportunistic)
Fetal complications of maternal hyperglycemia
first trimester
Cardiac defects
Neural tube defects
Small colon syndrome
Spontaneous abortion
Fetal complications of maternal hyperglycemia
second and third trimester
Macrosomia –> shoulder distosia –> injury
Organomegaly
Neonatal hypoglycemia
Polycythemia
Deliver before week 39 if hyperglycemia is under control; if not, deliver <39 weeks
C-section if >4.5kg
Myopathies that elevate CK
Statin-induced
Inflammatory
Hypothyroid myositis
Myopathies that elevate ESR
Inflammatory
Polymyalgia rheumatica
Glucocorticoid-induced myopathies
Normal CK and ESR
Painless proximal muscle weakness (legs>arms)
Description of Lichen Planus
Planar
Polyglonal
Purple
Pruritic
Papule
Fetal complications of parvo infection in pregnancy
Hydrops
Anemia
Fetal demise
Diagnosis of Parvo infection in a normal person and during pregnancy
Normal person:
B19 IgM (acute) or B19 IgG (passed) in immunocompetent
NAAT or B19 DNA in immunocompromised
Fetus:
B19 PCR of amniotic fluid
Management of intrauterine parvo infection
Doppler ultrasound (middle cerebral artery for anemia) Serial ultrasound for hydrops
Look for fluid accumulation in >2 pockets (eg. ascites, pleural effusions)
Management of COPD exacerbation (7)
Oxygen: target 88-92 Steroids Bronchodilators Antibiotics (if >2 cardinal symptoms) Oseltamivir if suspicious for Influenza Non-invasive ventilation Intubation if above fails
