Step3 23 Flashcards
Diagnosis of renal artery stenosis
Physical exam:
Asymmetric renal size (1.5)
Abdominal bruit
Labs:
Unexplained raised in creatinine (>30%) after ACEI
Imaging:
Best initial: Doppler ultrasound
CAUTION IN PATIENTS WITH NEPHROPATHY
CT angiogram: risk for contrast-induced nephropathy
MRI angiogram: nephrogenic systemic fibrosis
Management of hyperthyroidism in pregnancy
Labs can resemble thyrotoxicosis
Suppressed TSH
T3 and T4, x1.5 normal range
Propiothyouracil in the first trimester
Methimazole 2nd and 3rd
Metoprolol or propranolol if symptomatic (tachycardia, palpitations). Not atenolol
Interpretation when comparing confidence intervals
Overlapping does not mean that is not statistically significant
Not overlapping means there is a significance
What is multiplicity or multiple testing problem
When testing multiple ends results, there is a higher chance of type I error
Eg. The rate for type I error in a study with 5 different endpoints is 23% vs. the usual <5% for a single end result
Dihydropyridine CCB common side effects
Edema (arteriole vasodilation, increased hydrostatic pressure)
flushing, headache
Combine with ACEI (postcapillary dilatation, can normalize hydrostatic pressure) to decrease edema
Presentation, labs, and treatment of
Autoimmune thrombocytopenia
PRESENTATION
Antecedent of viral infection
Pethechia and purpura
Mucosal bleeding
LABS:
Isolated thrombocytopenia
Negative direct antiglobulin test
TREATMENT
Mild or no bleeding: observe
Moderate or severe bleeding: corticosteroids or immunoglobulin. Consider if platelets <30000
Why does O2 sat. improves when O2 is administered in a patient with COPD
O2 improves oxygenation of lung areas with low V/Q
Perfusion is decreased due to hypoxic vasoconstriction, these areas increase perfusion when O2 is applied.
In areas with dead space due to emphysema, nothing really happens (these areas have high V/Q)
Even though increased O2 increased diffusion capacity of oxygen, this effect has a minor effect on oxygen saturation
Acne treatment with absolute contraindication during pregnancy
Oral retinoid (category x) (tazarotene, isotretinoin)
Category D:
Doxycycline
Risk factors and clinical features of peripartum cardiomyopathy
RISK FACTORS:
Maternal age >30
Preeclampsia/eclampsia
multiple gestation
CLINICAL FEATURES
LVEF <45%
From 36 weeks to 5 months postpartum
No other cause of heart failure
Management of peripartum cardiomyopathy
Deliver according to mom hemodynamic status
Treat as left ventricular heart failure
Anticoagulation
Risk of recurrence of peripartum cardiomyopathy
LVEF <20% at diagnosis
Persistent left ventricular systolic dysfunction
Follow-up with serial echocardiograms for a few years
Ophthalmologic condition related to cat scratch disease
Parinaud sd. or Oculoglandular sd. (convergence nystagmus, upward gaze palsy, pupillary hyporeflexia)
Cervical or periauricular adenopathies
Ipsilateral conjunctival involvement (rare)
Self resolve or treat with azithromycin
Cat bite: amoxicillin-clavulanate
Mechanism of injury of the ACL
Rapid deceleration or direction changes
Pivoting on lower extremity with foot planted
common in soccer, basketball, tennis
Diagnosis and treatment of ACL fracture
Presentation: POP sound Severe sudden pain Hemarthrosis Joint instability
MRI
RICE (rest, ice, compression, elevation)
+/- surgery
Patellofemoral syndrome
Pain over anterior knee
Associated with overuse
Reproduced by extension of the knee with pressure over the patella
Normal fluctuation of weight in a newborn
Drop in 10% during the first week.
Surpass birth weight by week 2
Medical treatment for gastroparesis
Erythromycin
Metoclopramide
Medication that causes dystonia. Treatment
Antipsychotics
Dopamine antagonists like metoclopramide
TREATMENT
Benztropine or dephindramine
Extrapyramidal symptoms treatment
Dystonia (hours): benztropine or dephinedramine
Akathesia (days): beta-blockers
Dyskinesia /parkinsonism (weeks): benztropine or amantadine
Tardive dyskinesia (months): valvenazine/deutetravenazine
Neuroleptic malignant sd. (anytime)
Dantrolene or bromocriptine
Complications of polymyositis/dermatomyositis
PULMONARY COMPLICATIONS: Interstitial lung disease Durg induced pneumonitis (methotrexate) Infections (due to immunosuppressants) Respiratory muscle weakness
Perform pulmonary function test to distinguish a diagnosis
PFT in interstitial lung disease: decreased FEV1, total lung capacity, and diffusing capacity
HEART COMPLICATIONS
Myocarditis
High-risk antibiotics for C. difficile (5)
Clindamycin Fluoroquinolones Carbapenem 3rd and 4th gen cephalosporin Monobactam
Low-risk antibiotics for C. difficile (4)
Macrolides
Aminoglycosides
TMP-SMX
Tetracyclines
Treatment for C. difficile infection
Initial episode: Vancomycin or fidaxomicin
Recurrent: prolonged pulse/taper vanco or fidaxomicin if vanco was used in first episode
Multiple recurrences:
vanco followed by rafaximin or above regime
microbiota transplant
If severe: ileus, hypotension, megacolon
add metronidazole to a max dose of vanco
Consider intracolonic vanco if ileus
Treatment for bipolar disorder in pregnancy
Haloperidol for the acute manic phase
Maintenance:
Consider lithium for severe disease (risk for Epstein anomaly)
Second-generation antipsychotics
Lamotrigine (maybe?)
Carbamazepine and valproate are contraindicated
