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Uworld Gaby > Step3 32 > Flashcards

Step3 32 Flashcards

1
Q

Psoriatic arthritis (5) and soft tissue and nails (4) characteristics

A 
ARTHRITIS
Asymmetric Olygoarthritis or
Symmetric polyarthritis (similar to RA)
Can include DIP joints
Sacrilitis and spondilitis
Arthritis multilans
NAILS AND SOFT TISSUE
Dactylitis (sausage)
Enthesitis
Nail pitting/onycholysis
Pitting edema of hand and feet
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2
Q

Serologic testing in Psoriatic arthritis

A

Negative rheumatoid factor and CCP

positive in 10%

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3
Q

Treatment of Psoriasis

A

Limited (10% skin involvement): topical steroids or vitamin D derivatives (calcipotriene)

Systemic treatment:
Methotrexate, cyclosporine, retinoids
Biologics

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4
Q

Management of nipple discharge

A
  1. Physical exam:
    abnormal: imaging, biopsy, tests
    normal: step 2
  2. US +/- mammogram (If >30yo)
    abnormal: percutaneous biopsy
    normal: Step 3
  3. Galactorrhea workup
    abnormal: treat accordingly
    normal: reassurance and observation

Patients super bothered by symptoms? consider duct extraction

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5
Q

X-ray findings of lead poisoning

A

Lead lines:

Opacification of metaphyseal plate

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6
Q

Treatment for lead poisoning

A

Chelation if lead >45

Succimer
Adetate calcium sodium (EDTA)

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7
Q

Manifestations of lead poisoning

A

Asymptomatic

Abdominal pain/constipation

Lead level as low as 10-20:
Cognitive impairment/behavioral problem (eg. ADHD)

Lead >70
Hemolytic anemia

Lead >100
Encephalopathy (AMS, seizures)

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8
Q

Diagnosis of multiple sclerosis

A

T2 MRI lesions disseminated in time and space: periventricular, juxtacortical, supratentorial, and spine

CSF:
oligoclonal IgG band
Usually reserved for patients with unclear diagnosis on MRI

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9
Q

Clinical features of MS

A 
Onset 15-50
Optic neuritis
Intranuclear ophthalmoplegia
Motor symptoms (weakness)
Sensory symptoms (paresthesias)
Shooting pain down the spine
Worsening symptoms in hot weather
Bladder/bowel dysfuntion
Fatigue
Transverse myelitis (UMN symptoms)
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10
Q

Treatment of MS exacerbation

A

Steroids (oral equal to IV unless…)

IV prefered if patient has optic neuritis as oral medication can worsen the condition

Can taper to oral after IV

Plasmapheresis if no response to steroids

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11
Q

Treatment for MS

A

Exacerbation: steroids

Control: decrease frequency of exacerbations
B-interferon
Glatiramate acetate

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12
Q

MS and pregnancy

Clinical manifestations
Treatment
Delivery
Risk of child

A

Continue maintenance treatment unless the patient is being treated with teriflunomide and mitoxantrone are teratogenic

Usually less symptomatic during pregnancy and worse after postpartum

Increased risk of assisted delivery (vacuum. c-section)

Increased risk for child to have MS

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13
Q

Treatment for depression in MS

A

SSRI or SRNI

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14
Q

Treatment for urinary incontinence in MS

A

Schedule voiding
Fluid restriction
Anticholinergic medication:Doxybutinine, tolterodine (for urgency)

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15
Q

Treatment for spasticity in MS

A

Muscle stretching
Massage
Physical therapy
Muscle relaxants: Baclofen, tizanidine

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16
Q

Treatment for fatigue in MS

A

Sleep hygiene
Amantadine
Stimulants: methylphenidate, modafinil

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17
Q

Treatment for neuropathic pain MS

A

Gabapentin or duloxetine

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18
Q

Diagnosis of HCV infection

A

Antibody testing first:

Positive result:
Confirm with RNA test (NAT- nuclear acid test)

Positive result:
Treat with antiviral meds

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19
Q

Patients at risk for Influenza complications

A

> 65

Pregnant patient up to 2 weeks postpartum

Other comorbidities (diabetes, COPD, CAD)

Obesity

Immunocompromised

Nursing care facilities

Native Americans

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20
Q

CURB 65

A 
Confusion
Urea >30
Respiration >30
BUN: BP>90/60
>65

0-1: Outpatient
2: Ward
>3: ICU

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21
Q

Important clinical features of ADHD

A

> 6 months

In more than 2 settings (eg. school and home)

Symptoms appear before age 12

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22
Q

Treatment of ADHD

steps before medication and scalation

A

<6 years: parent-patient CBT

> 6 years or CBT failure:
Methylphenidate or amphetamine with prior cardiac exam and history. EKG if any hx or physical fidings
Atomoxetine
Alpha 2 adrenergic

If one stimulant fails (doesn’t work or too many side effects) after max dosing, switch to a different stimulant or a different medication

Titration of medication is done on a weekly basis. If no response after a couple of weeks.. switch

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23
Q

AV nodal blocker

A

Beta-blocker

CCB

Adenosine

Digoxin

24
Q

Treatment of WPW

A

Acute setting: Procainamide, ibutilde, amiodarone

Radiofrequency catheter ablation

25
Q

Medication to avoid in a patient with multifocal atrial tachycardia

A

Beta-blockers:

MAT is associated with COPD and B blocker can worsen their condition

26
Q

Medical error that reaches the patient but causes no harm

A

Near miss

27
Q

Treatment for narrow complex tachycardia

A

Adenosine (short live, helps uncover underlying rhythm)

DO NOT USE IN WPW

28
Q

Hypercalcemia workup

A
  1. Confirm hypercalcemia
    Recheck Ca
    Correct for albumin/measure ionized Ca
  2. Measure PTH
    High: PTH related (1 or 3 hyperparathyroidisms, familial hypercalciuric hypercalcemia, lithium)
    Low: step 3
  3. Measure PTHrP, 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, chest x-ray (granulomatous disease), urine protein electrophoresis for MM
29
Q

PTH related hypercalcemia Dxx

A

1 or 3 hyperparathyroidisms

Familial hypercalciuric hypercalcemia

Lithium

30
Q

non-PTH related hypercalcemia Dxx

A 
Malignancy
Vitamin D toxicity
Granulomatous disease
Drug-induced (thiazide)
Milk alkali syndrome
Thyrotoxicosis
Immobilization
Vitamin A toxicity
31
Q

Cancer that produces PTHrP

A

SCC
renal and bladder
breast and ovary

32
Q

Mechanism of Hypercalcemia in

Multiple myeloma
Lymphoma

A

Multiple myeloma:
Osteolytic lesions

Lymphoma:
Elevated 1,25-hydroxyvitamin D

33
Q

They give you the sensitivity and specificity of a test and ask you to calculate the PPV or NPV.

What other data do you need, why?

Practice an example

A

You need the prevalence of the disease because predictive values are modified by prevalence

Use a hypothetical sample of 1000

The prevalence will be the total of people with the disease (out of 1000)

Multiply total people with the disease by the sensitivity and you will have the True positives

Work from there

34
Q

Blurry vision in a diabetic patient

A

Swelling of the optical nerve:

  • Secondary to osmotic changes (uncontrolled hyperglycemia, more acute)
  • Treat hyperglycemia

Diabetic retinopathy: TAKES YEARS TO DEVELOP

  • Vitreous hemorrhage, retinal detachment, macular edema
  • Treat with angiography, laser coagulation
35
Q

Central retinal vein vs. artery occlusion main differences

A

Arterial:
Cherry spot on the fovea
Retinal swelling

Venous: (looks more dramatic)
Vein dilation
Swallen Disc
Hemorrhages

36
Q

Diagnosis and Treatment for mucormycosis

A

Sinus endoscopy with biopsy and culture

Amphotericin B

37
Q

Treatment for onychomycosis

A

Oral terbinafine or itraconazole

38
Q

B12 deficiency manifestations

A

Subacute combined degeneration:
Dorsal column symptom
Lateral corticospinal tract: UMN symptoms
Spinocerebellar: ataxic gait

Dementia

39
Q

Why is there elevated bilirubin in B12 deficiency

A

Ineffective erythropoiesis

Cells die in the bone marrow,

This is not intravascular hemolysis

40
Q

Factors that increase risk of malignancy in solitary nodules (7)

A 
>2cm
Advanced age
Smocking history
Family history of lung cancer
Female
Upper lobe location
Spiculated
41
Q

Definition of solitary nodule (lung)

A

< 3cm (>3 is a mass)
Surround by parenchyma
No associated lymphadenopathy
Rounded opacity

42
Q

Approach to a solitary nodule

A
  1. Review previous Xrays:
    No change >2-3 years: follow up
    Change or no previous studies available: CT
  2. CT
    High risk: Surgical resection
    Intermittent risk: biopsy if possible
    Low risk: Serial CT scans
High risk:
>2cm
Advanced age
Smocking history
Family history of lung cancer
Female
Upper lobe location
Spiculated
43
Q

Cervical insufficiency vs. threatened abortion vs. preterm labor

A

Threatened Abortion: vaginal bleeding, close cervix, <20 weeks, fetal heartbeat

Cervical insufficiency: painless cervical dilatation, < 24 weeks

Preterm labor: <37 weeks with painful contractions

44
Q

Prognosis of cerclage

A

If prophylactic: (base on history and placed at 12-14 weeks)
Somewhat good

If place at diagnosis: poor prognosis

If membranes are prolapsing: worse prognosis. Membranes prolapsing is a relative contraindiction

45
Q

Order of effective anticontraception

A 
Implant: >99% (even more effective than IUD and surgery)
IUD: >99%
Surgery (male/female): >99%
Injection: 94%
Combine hormonal contraception: 91%
Condom: 82%
Withdrawal: 78%
46
Q

papillary thyroid cancer management

A

Depends on size and involvement

<1cm with no adenopathies or anything else.. lobectomy. If not…

total thyroidectomy
adjuvant treatment with radioactive iodine

47
Q

Manifestations of anterior uveitis

A

Erythema at the limbus (junction of the cornea and the sclera)

Constricted pupils

Moderate aye pain

Blurred vision

48
Q

Approach to suspected Ectopic pregnancy

A

Unstable: surgery

Stable:
Algorithm
B-hCG value cut off is 3500

49
Q

Approach to elevated AFP in pregnancy

A
  1. Repeat AFP
  2. Perform obstetric ultrasound
  3. Amniocentesis with AFP +acethylcholinesterase
    If both are elevated: high positive predictive value for neural tube defects and ventral wall
50
Q

Transfusion reactions that occur within mins-1hr

A

Acute hemolytic reaction

Abdominal pain/flank pain
Gross hematuria
Dark urine

Stop transfusion, give IV fluids

51
Q

Transfusion reactions that occur within 1hr to 6 hrs

A

Febrile hemolytic

TACO: circulatory overload

TRALI: lung injury

TTBI: transmitted bacterial infection

Urticarial

Prevent with leukoreduction

52
Q

Transfusion reaction that occurs sec/min within transfusion

A

Anaphylactic

Usually in patients with IgA deficiency

Give epinephrine

53
Q

Patients that need radiated RBC transfusion

A

The donor is a family member

Congenital or acquired immunodeficiencies

Bone marrow transplant recipients

54
Q

Patients that need leukoreduced RBC transfusion

A

Previous hx of reaction

CMV seronegative at risk infection (eg, aids)

Potential transplant recipient

Chronically trasfused

55
Q

Patients that need washed RBC transfusion

A

IgA deficiency

Complement dependant autoimmune hemolytic anemia

Continued allergic reaction after antihistamine treatment

56
Q

Stress ulcer prophylaxis

A 
Any 1 factor:
Spinal, head injury, or major burn
Mechanical ventilation >48hrs
PLT <50k, INR >1,5, PTT x2 normal limit
GI bleed or ulcer in the past 12 months
Any >2 factors
Corticosteroid therapy
Occult GI bleed >6 days
Sepsis
ICU >1 week

Uworld Gaby (77 decks)

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