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Uworld Gaby > Step3 26 > Flashcards

Step3 26 Flashcards

1
Q

Clinical features and management of vaso-occlusive crisis in sickle cell

A

Acute severe pain >1 location
+/- fever
May be triggered (eg. dehydration)

Analgesic (NSAIDs, opioids)
Hydration
+/- Blood transfusion

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2
Q

Which opioid is contraindicated in children?

A

Codeine

Contraindicated in children <12 years

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3
Q

Clinical presentation of acute chest syndrome

A

New infiltrate + 1 of the following

  • Increased work of breathing
  • Hypoxemia
  • Temp >38.5
  • Chest pain
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4
Q

Management of Acute chest syndrome

A

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

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5
Q

Definition of likelihood ratio

A

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

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6
Q

Test property that it is not modified by incidence

A

Likelihood ratio

Sensitivity and specificity

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7
Q

Verification bias

Definition
Fix

A

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

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8
Q

Observer bias

Definition
Fix

A

Occurs when the observer collecting data is influenced by knowledge of patient hx or something else

FIX:
Double blind

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9
Q

Selection bias

A

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

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10
Q

Serum sickness-like reaction

Etiology
Clinical presentation
Treatment

A

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

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11
Q

Types of hypersensitivity

A

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

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12
Q

Potter sequence

A 
Pulmonary hypoplasia
Oligohydramnios
Twisted face (Flattened facies)
Twisted skin
Extremity defects
Renal failure
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13
Q

Hallmarks of posterior urethral valve

A

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

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14
Q

Risks for postoperative urinary retention

A 
>50 yoa
Surgery >2hrs
Fluids >750ml
Regional anesthesia
Neuro disease
Underlying bladder disease
Previous pelvic surgery
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15
Q

Acute cholangitis presentation and management

A

Fever, RUQ pain, jaundice
+/- hypotension, AMS

Empiric atb: piperacillin/tazobactam, cipro + metro
IV fluids
ERCP

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16
Q

Things doctors can accept to attend a conference

A

If lecturing/ faculty
Travel and honoraries
Need to disclose before the presentation starts

If attending just attending…
Cant anything

17
Q

What other conditions are associated with bicuspid aortic valve

A

Aortic root dilation
Aortic aneurysm
Aortic dissection
Infective endocarditis

(Associated with Turner)

18
Q

Assessing decision-making capacity

A

Communicates a choice

Understands information provided

Appreciates the consequences

The rationale for his/her decision

19
Q

Therapy for Obsesive compulsive disorders

A

Exposure and response prevention therapy (cognitive-behavioral therapy)

SSRI (all of them) if therapy doesn’t help

OR

Clomipramine (TCA)

20
Q

Premature ejaculation’s pharmacologic treatment

A

SSRI due to their potential to delayed ejaculation

21
Q

When is the safety profile of a drug best mesured?

A

During post marketing surveillance

22
Q

Dark colored urine

A

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

23
Q

Treatment for PID

A

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

24
Q

Treatment of Infectious mononucleosis

A

NSAIDs
Tylenol
Avoid sports for 3 week, 4 if contact sport

Steroids if airway obstruction

25
Q

Management of acute symptomatic HBV infection

A

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

26
Q

Risk for developing chronic HBV and HCV

A

HBV:
Perinatally acquired infection: 90%
1-5 years: 20-50%
Adults: <5%

HCV: 75-85%

27
Q

Treatment for bacterial vaginosis

A

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)

28
Q

Complication of severe colitis

A

Toxic megacolon
(especially patients with a history of ulcerative colitis

Abdominal pain, distention, fever, toxic appearance

Diagnose with Abdominal x-ray

Pneumoperitoneum if perforation

29
Q

Test of choice in toxic mega colon

A

Abdominal x-ray

30
Q

Management of toxic megacolon

A

X-ray for diagnosis

  1. NPO, bowel rest, nasogastric tube/ICU
  2. Hold morphine/anticholinergics
  3. IV fluids
  4. High dose corticosteroids (if no infection as the cause)
  5. ATB if concerning for infection

DO NOT GIVE 5-ASA

Uworld Gaby (77 decks)

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