Step3 27 Flashcards
Receiving operating characteristics
Chart with sensitivity and specificity of a test
The area under the curve measures accuracy
Look at the graph on page 121 Step2 Ck
Main difference between ALS and Cervical spondylosis with compressive myelopathy
If bulbar involvement is present.. Cervical spondylosis is excluded
Bulbar symptoms: difficulty swallowing, decreased tongue mobility, difficulty speaking
Important features of ALS
Asymmetrical progressive motor weakness.
May present with difficulty breathing due to diaphragmatic paralysis
LMN: fasciculation, hyporreflexia, atrophy
UMN: spastic paralysis, hyperreflexia, Babinski, pronator drift
Bulbar involvement: dysphagia, decreased tongue mobility, difficulty speaking
ALS number 1 differential diagnosis
Cervical spondylosis with myelopathy
Prognostic factors of schizophrenia (6)
GOOD Female Later onset Sudden onset with identifiable trigger Short duration of active symptoms No family history Mostly positive symptoms
BAD
The opposite
TSH levels during pregnancy
First trimester: 0.1-2.5 (suppressed due to effects of B-hCG, B-hCG stimulates the thyroid to produce hormone)
Second trimester: 0.2-3
Third trimester 0.3-3
Management of hypothyroidism in pregnancy
Increase dose by 30%
Check every 4 weeks
Target TSH depends on the trimester
First trimester: 0.1-2.5
Second trimester: 0.2-3
Third trimester 0.3-3
Indications for stress ulcer prophylaxis
ANY ONE OF THESE
Platelets: <50k INR:>1.5 PTT: x2 normal limit
Head trauma, spinal cord injury, burn
Mechanical ventilation >48hrs
GI bleed or ulceration in the past 12 months
ANY TWO OF THESE Corticosteroids ICU >7 days Occult GI bleed >6days Sepsis
Give PPIs or H2 inhibitors (May increased the risk for C. difficile infection)
Odd ratio formula
A: exposed and sick
B: exposed and not sick
C: not exposed and sick
D: not exposed and not sick
OR= A/B divided by C/D AxD/BxC
TB diagnosis test
Advantage and disadvantage
Tuberculin
Cant distinguish latent vs. active
Need the training to interpret
Not the best with vaccinated people
Quantiferon:
Easy blood drawn
Cant distinguish latent vs. active
Smear
Fast, simple, can be used as a treatment response
Cant distinguish from Non-TB mycobacteria
Culture:
Goold standard,
difficult to grow
3-8 weeks
Nucleic acid amplification
Can diferenciate latent vs. actice
Can diferenciate type of Mycobacterium
Can be positive after treatment
Smear first (if negative, can’t rule out)
Culture
Amplification test
Management of hypertrophic cardiomyopathy
Negative inotropic fr symptomatic patient with an elevated left ventricular outflow gradient
B-blocker (first line)
Verapamil
Dysopiramide
Non-REM sleep disorder
Night terrors: cant be calmed down, unresponsive
Sleepwalking: blank staring, cant be aroused
The patient almost never recalls
Amnesia of episode
For night terrors give benzos before bed if episodes are too frequent and distressing
Usually self limiting (in a few years)
Recommend good sleep hygiene
Dxx of Non-REM sleep disorders
Non-REM:
Sleepwalking
Sleep terror
Confusional arousal
Nightmare disorder:
Occurs during REM
Detailed recall
REM sleep disorder
Enactment, easyly arousable
Sleep-related seizures
Nocturnal panics
Ileus vs. Small bowel obstruction
ETIOLOGY
Ileus: recent surgery, hypokalemia
Small bowel: previous surgery (years ago)
ABDOMINAL EXAM:
Ileus: posible distention hypoactive sounds
Obstruction: distention, hyperative bowel sound
DILATED BOWEL
Ileus: small and large
Obstruction: small is the only dilated
Treatment for opioid-induced ileus
Methylnaltrexone
Block mu receptors in the gut without blocking analgesic effect
