Step3 26 Flashcards
Clinical features and management of vaso-occlusive crisis in sickle cell
Acute severe pain >1 location
+/- fever
May be triggered (eg. dehydration)
Analgesic (NSAIDs, opioids)
Hydration
+/- Blood transfusion
Which opioid is contraindicated in children?
Codeine
Contraindicated in children <12 years
Clinical presentation of acute chest syndrome
New infiltrate + 1 of the following
- Increased work of breathing
- Hypoxemia
- Temp >38.5
- Chest pain
Management of Acute chest syndrome
Most commonly triggered by fat embolism (adults) or infection (kids)
Azithromycin (mycoplasma) + ceftriaxone (s. pneumonia)
IV Fluids
Analgesic
Transfusion if O2 <92%, severe anemia or worsening symptoms despite treatment
Definition of likelihood ratio
Is the probability of a given result in a patient with the disease compared to the probability of getting the same result on a patient without it
Test property that it is not modified by incidence
Likelihood ratio
Sensitivity and specificity
Verification bias
Definition
Fix
Occurs when the gold standard test is only used in selected patients (eg. only patients with a positive test undergo liver biopsy (gold standard)
Fix:
Perform gold standard on patients with negative test results
Observer bias
Definition
Fix
Occurs when the observer collecting data is influenced by knowledge of patient hx or something else
FIX:
Double blind
Selection bias
Occurs in the manner participants are selected or lost during the trial
Susceptibility bias is a type of selection bias (one group is sicker than the other)
FIX:
Randomization
Serum sickness-like reaction
Etiology
Clinical presentation
Treatment
Etiology: Type III hypersensitivity
Immune complex deposition
Antibiotics (beta-lactam, sulfa)
Hep B
Clinical presentation 1-2 weeks after exposure, malaise Fever Rash (urticaria, maculopapular, petechial) Poliarthralgias
Treatment:
Remove offending agent
Supportive care
Steroid or plasmapheresis if severe
Types of hypersensitivity
Type 1: anaphylactic
Type 2: antibodies against an organ
Hemolytic anemias, Goodpasture, rheumatic fever, erythroblastosis
Type 3: immune complex
A lot of the glomerulonephritis, polyarteritis, SLE,
Type 4: delayed (cell-mediated)
TB skin test, erythema multiforme, contact dermatitis
Potter sequence
Pulmonary hypoplasia Oligohydramnios Twisted face (Flattened facies) Twisted skin Extremity defects Renal failure
Hallmarks of posterior urethral valve
Exclusively in boys
Distention and thickening of the bladder wall
Dilatation of proximal urinary system
Voiding cystourethrogram
Dilatation of proximal urethra makes the diagnosis
Vesicoureteral reflux and ureter dilatation is possible
Risks for postoperative urinary retention
>50 yoa Surgery >2hrs Fluids >750ml Regional anesthesia Neuro disease Underlying bladder disease Previous pelvic surgery
Acute cholangitis presentation and management
Fever, RUQ pain, jaundice
+/- hypotension, AMS
Empiric atb: piperacillin/tazobactam, cipro + metro
IV fluids
ERCP
Things doctors can accept to attend a conference
If lecturing/ faculty
Travel and honoraries
Need to disclose before the presentation starts
If attending just attending…
Cant anything
What other conditions are associated with bicuspid aortic valve
Aortic root dilation
Aortic aneurysm
Aortic dissection
Infective endocarditis
(Associated with Turner)
Assessing decision-making capacity
Communicates a choice
Understands information provided
Appreciates the consequences
The rationale for his/her decision
Therapy for Obsesive compulsive disorders
Exposure and response prevention therapy (cognitive-behavioral therapy)
SSRI (all of them) if therapy doesn’t help
OR
Clomipramine (TCA)
Premature ejaculation’s pharmacologic treatment
SSRI due to their potential to delayed ejaculation
When is the safety profile of a drug best mesured?
During post marketing surveillance
Dark colored urine
Uranalysis
Complete/intact RBC: it is not glomerular disease
Look for trauma or exercise explanation
Exercise induced hemoglobinuria: diagnosis of exclusion. Fallow up in 1 weeks to see if hematuria disappeared
Treatment for PID
cefoxitin+doxi (inpatient according to first aid)
clinda + genta (inpatient acording to first aid)
ceftriaxone + azythro
ceftriaxone + doxi
Use azyhtro instead of doxi in pregnancy
Treatment of Infectious mononucleosis
NSAIDs
Tylenol
Avoid sports for 3 week, 4 if contact sport
Steroids if airway obstruction
Management of acute symptomatic HBV infection
If severe infection.. hospitalize
If patient is stable… outpatient with close follow up
LFTs normal by 2-8 weeks
Surface antigen should be cleared by 6 months
Symptoms resolution depends on initial presentation (days to months)
Antiviral medication has not been proven to better outcomes
Risk for developing chronic HBV and HCV
HBV:
Perinatally acquired infection: 90%
1-5 years: 20-50%
Adults: <5%
HCV: 75-85%
Treatment for bacterial vaginosis
Metronidazole or clindamycin
Both safe in pregnancy
Treat symptomatic patients only, as there is no evidence that treatment prevents complications
(preterm labor, abortion, increase risk for HIV, Herpes 2, gonorrhea, chlamydia)
Complication of severe colitis
Toxic megacolon
(especially patients with a history of ulcerative colitis
Abdominal pain, distention, fever, toxic appearance
Diagnose with Abdominal x-ray
Pneumoperitoneum if perforation
Test of choice in toxic mega colon
Abdominal x-ray
Management of toxic megacolon
X-ray for diagnosis
- NPO, bowel rest, nasogastric tube/ICU
- Hold morphine/anticholinergics
- IV fluids
- High dose corticosteroids (if no infection as the cause)
- ATB if concerning for infection
DO NOT GIVE 5-ASA
