Step3 33 Flashcards
Treatment for lead poisoning (4)
Succimer
Calcium adetate
BAR/Dimecarpol
D-penicillimine
Genitourinary syndrome of menopause
Genital:
Vaginal dryness, burning, irritation,
Sexual:
dyspareunia, lack of lubrication, impaired function, vaginal bleeding
Urinary symptoms:
Urgency, dysuria, recurrent tract infections, incontinence, organ prolapse
Physical findings in Genitourinary syndrome of menopause
Narrowed introitus
Pale mucosa, decreased elasticity, and rugae
Petechia, fissures
Loss of labial volume
Etiology, presentation, and treatment of
OVERFLOW INCONTINENCE
Decrease detrusor activity (neurogenic, diabetes)
Urethral obstruction
Constant dribbling
Incomplete bladder emptying
Catheterization
Trat underlying cause
Risk factors for Iodine-induce hyperthyroidism
Multinodular thyroid
Chronic iodine deficiency
Topical antiseptics
Iodine-induce hyperthyroidism
Presentation (labs, imaging)
Symptoms following iodine exposure: contrast, amiodarone
No extra thyroideal disease (eg. ophthalmopathy)
Low TSH, elevated T3/T4
Negative thyrotropin receptor antibody
Elevated vascularization
Management of Iodine-induce hyperthyroidism
Start with beta-blocker
Antithyroid drugs if prolonged or severe thyrotoxicosis, or older patients with cardiac disease
Management of stool impaction
Manual disimpactation followed be enema or supository
Light criteria for pleural effusion
EXUDATES IF:
Protein fluid/serum: >0.5
OR
LDH: fluid/serum: > 0.6
OR
LDH >2/3 upper limit
Etiology of Transudates vs. Exudates
TRANSUDATE Cirrhosis Heart failure Nephrotic sd Constrictive pericarditis
EXUDATE Infection Cancer Connective tissue disease Pulmonary embolism Pancreatitis Post Coronary artery bypass graft (CABG)
Hepatic hydrothorax
Diagnosis and management
Patient with cirrhosis + pleural effusion
Light criteria: transudate (Protein fluid/serum: <0.5, LDH: fluid/serum: <0.6, LDH >2/3 upper limit)
Treat as ascites due to CHF
Furosemide, spirnolactone, Na restriction
EKG in pericarditis
Diffuse PR depressions and ST-segment elevation
When do you see pericarditis after an MI?
Peri-infarction: <4 days
Dressler: late
Anytime between 1 day to 3 months
Common complication after an MI
Day, artery involved and manifestation
pg 37
Treatment for peri-infarction pericarditis
High dose aspirin (analgesic and anti-inflammatory effect)
It is thought to interfere less in cardiac healing compared to NSAIDs, also. NSAIDs increase the risk of septal rupture
Lesion to the vagus nerve
Palatal and pharyngeal paralysis
Nerve that can be damaged during endarterectomy
Hypoglossal: tongue deviation toward the side
Vagus: palatal and pharyngeal paralysis
Recurrent laryngeal: vocal cord paralysis
Approach to Psychosis in a patient with Parkinson’s
- Try to reduce the dose
- Add antipsychotic: 2ns generation. Olanzapine and quetiapine preferred.
or
Pimavanserin (Sertonin 5-H2A receptor inverse agonist)
Agranulocytosis meds
Can Cause Pretty Major Collapse of Granulocytes
Clozapine Carbamazepine Propylthiouracil Methimazole/Mercaptopurine Colchicine Gancyclovir
Skin reaction with sulfa drugs
Photosensitivity (Stop, use sunscreen, avoid sun)
OR
Generalized dermatitis
Drugs associated with Steven-Johnson
PCP LAPSE
Phenytoin Carbamazepine Phenobarbital Lamotrigine Allopurinol Penicillin Sulfas Erythromycin
Description of lichen planus
6P’s
Planar Polygonal Papules Plaques Pruritic Purple
Flexural surface
+/- white lace
Common association with Lichen Planus
Hep C
Thiazides
Quinines
Beta-blockers
Maybe hx of trauma on the site on lesion
Treatment for CROUP
Laryngotracheitis
Mild: humidified air +/- inhale corticosteroids
Moderate/Severe: inhaled racemic epinephrine + corticosteroids (oral or IM)
Croup vs. Epiglottitis
Croup:
Barking cough, inspiratory stridor
Low-grade fever
Epligotitis:
More acute onset
Tripod, drooling
High-grade fever
Treatment:
Croup: humidified air +/- inhale corticosteroids. Inhaled racemic epinephrine + corticosteroids (oral or IM)
Epiglottitis: ABCs, antibiotics, intubation
Causes of pseudo resistant hypertension
Medication non-adherance (>40% of medication failure) Suboptimal medication Whitecoat hypertension Non-adherence to lifestyle modifications Inaccurate medications
Indications for cystoscopy
Gross hematuria with no evidence of renal disease
Microscopic hematuria with no evidence of renal disease but increased risk of malignancy
Recurrent UTI
Irritative symptoms without infection
Abnormal imaging or cytology
Signs of obstruction
Iodine uptake in the different thyroiditis
Subacute thyroiditis (hyper): low intake
Painful/tender
Goiter
Painless thyroiditis (hyper): low intake
Painless
Small thyroid
Hashimoto (hypo): variable
Painless
Diffuse goiter
UTI in pregnancy
Asymptomatic or cystitis:
Amoxiclav
Cephalexin
Fosfomycin
Pyelonephritis:
IV ceftriaxone, cefepime
Once afebrile for 48hrs: switch to orals for 10 to 14 days
Daily suppression therapy: up to 6 weeks postpartum (low dose cephalexin or nitro)
Treatment for Raynaud phenomenon
CCB
Dyhydropirdine: nifedipine, amlodipine
Non-D: Diltiazem
Verapamil doesn’t work as well
Hepatorenal sd when it comes to fluid repletion
It does not respond to fluids
Treat with octreotide + midonine
Actinic keratosis is a precursor of what type of cancer?
SCC
Description of Basal cell carcinoma
Pearly papule with telangiectasias
if ulceration, think SCC
