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Uworld Gaby > Step3 23 > Flashcards

Step3 23 Flashcards

1
Q

Diagnosis of renal artery stenosis

A

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

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2
Q

Management of hyperthyroidism in pregnancy

A

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

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3
Q

Interpretation when comparing confidence intervals

A

Overlapping does not mean that is not statistically significant

Not overlapping means there is a significance

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4
Q

What is multiplicity or multiple testing problem

A

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

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5
Q

Dihydropyridine CCB common side effects

A

Edema (arteriole vasodilation, increased hydrostatic pressure)
flushing, headache

Combine with ACEI (postcapillary dilatation, can normalize hydrostatic pressure) to decrease edema

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6
Q

Presentation, labs, and treatment of

Autoimmune thrombocytopenia

A

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

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7
Q

Why does O2 sat. improves when O2 is administered in a patient with COPD

A

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

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8
Q

Acne treatment with absolute contraindication during pregnancy

A 
Oral retinoid (category x)
(tazarotene, isotretinoin)

Category D:
Doxycycline

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9
Q

Risk factors and clinical features of peripartum cardiomyopathy

A

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

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10
Q

Management of peripartum cardiomyopathy

A

Deliver according to mom hemodynamic status
Treat as left ventricular heart failure
Anticoagulation

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11
Q

Risk of recurrence of peripartum cardiomyopathy

A

LVEF <20% at diagnosis

Persistent left ventricular systolic dysfunction

Follow-up with serial echocardiograms for a few years

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12
Q

Ophthalmologic condition related to cat scratch disease

A

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

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13
Q

Mechanism of injury of the ACL

A

Rapid deceleration or direction changes
Pivoting on lower extremity with foot planted

common in soccer, basketball, tennis

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14
Q

Diagnosis and treatment of ACL fracture

A 
Presentation:
POP sound
Severe sudden pain
Hemarthrosis
Joint instability

MRI

RICE (rest, ice, compression, elevation)
+/- surgery

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15
Q

Patellofemoral syndrome

A

Pain over anterior knee

Associated with overuse

Reproduced by extension of the knee with pressure over the patella

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16
Q

Normal fluctuation of weight in a newborn

A

Drop in 10% during the first week.

Surpass birth weight by week 2

17
Q

Medical treatment for gastroparesis

A

Erythromycin

Metoclopramide

18
Q

Medication that causes dystonia. Treatment

A

Antipsychotics

Dopamine antagonists like metoclopramide

TREATMENT
Benztropine or dephindramine

19
Q

Extrapyramidal symptoms treatment

A

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

20
Q

Complications of polymyositis/dermatomyositis

A 
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

21
Q

High-risk antibiotics for C. difficile (5)

A 
Clindamycin
Fluoroquinolones
Carbapenem
3rd and 4th gen cephalosporin
Monobactam
22
Q

Low-risk antibiotics for C. difficile (4)

A

Macrolides
Aminoglycosides
TMP-SMX
Tetracyclines

23
Q

Treatment for C. difficile infection

A

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

24
Q

Treatment for bipolar disorder in pregnancy

A

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

25
Q

Medication that interferes with folate metabolism

A

Methotrexate
TMP-SMX
Phenytoin

26
Q

Drug of choice for folic acid deficiency anemia

A

Folinic acid

27
Q

Aspect of patients with peritonitis

A

Tend to lie motionless to limit peritoneal irritation

28
Q

Best first study for suspicion of perforated viscus

A

Upright abdominal/chest x-ray

if unclear

CT

29
Q

Management of a perforated ulcer/viscus

A

IV fluid

Broad-spectrum ATB (coverage against gram -)

PPIs

Surgery (for all patients)

30
Q

Frist-line drug for treatment of postpartum depression in lactating patients

A

Sertraline
Paroxetine

Patients treated with antidepressants during pregnancy should keep the medication/dose while lactating

31
Q

Presentation of Complex regional pain syndrome

A

Pain out proportion, swelling, vasomotor changes after injury

Type 1: without nerve damage
Type 2: with nerve damage

Stage 1: burning pain, edema, vasomotor changes
Stage 2: progression of edema, skin thickening, muscle wasting.
Stage 3: limited range of motion, bone demineralization on x-ray

32
Q

Diagnosis and treatment of Complex regional pain syndrome

A

Autonomic testing that measures increased resting sweat

OR

MRI looking for stage changes
Stage 1: burning pain, edema, vasomotor changes
Stage 2: progression of edema, skin thickening, muscle wasting.
Stage 3: limited range of motion, bone demineralization on x-ray

TREATMENT:
Regional anesthesia
Autonomic nerve block

33
Q

Clinical presentation of Primary biliary cirrhosis

A

Women of northern European heritage

Asymptomatic OR

Pruritus
Inflammatory arthritis
Skin hyperpigmantation
RUQ discomfort
Xanthelasmas and xanthomas
34
Q

Diagnosis and treatment of primary biliary cirrhosis

A

Elevated ALT and AST
Elevated GGT

Positive antimitochondrial antibody (perform liver biopsy if this is negative)

TREATMENT
Ursodeoxycholic acid
Liver transplant (curative but may recur)

35
Q

B1 deficiency

A

Thiamine

Wet Beri Beri: dilated cardiomyopathy, polyneuropathy
Wernie-Korsakove: hepatic encephalopathy, cognitive impairment, ataxia, oculomotor dysfunction, amnesia-)

36
Q

B2 deficiency

A

RIBOFLAVIN

Angular cheilosis and stomatitis

37
Q

B3 deficiency

A

Niacin

Pellagra
Dermatitis, Diarrhea, Dementia

Uworld Gaby (77 decks)

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