Step3 34 Flashcards
Clinical manifestation of Lyme disease
-EARLY
Localized: erythema migrans
Disseminated: arthralgias, av block, bells palsy, peripheral neuropathy, flue-like symptoms, lymphadenopathies
-LATE
Arthritis and subacute encephalitis (memory loss, mood change)
Treatment for Lyme
Oral: Doxycycline (azithromycin if <8 yo or allergic); Skin or mild
IV: Cardiac/Neuro: ceftriaxone, cefotaxime, IV penicillin
Hypertrophic cardiomyopathy vs. Athletes’ heart (6 items)
HCM: Family history EKG: Q waves, LVH criteria Atrial enlargement Small or normal LV cavity Wall thickness >15 Abnormal systolic function
ATHLETE'S HEART NO family history EKG: NO Q waves, YES LVH criteria NO atrial enlargement Enlarge LV cavity Wall thickness <15 Normal systolic function
Etiology of sick sinus syndrome
Age-related degeneration/fibrosis of the conduction system
Infiltrative disease (eg. sarcoidosis)
EKG findings on Sick sinus sd.
Sinus pauses (late P waves)
Sinus bradycardia
Sinoatrial nodal exit (drop P wave) (eg. a fib.)
Treatment of sick sinus syndrome
Pacemaker
+/- antiarrhythmic medications (if tachyarrythmias)
What is the physiologic explanation of a Delta wave on EKG?
Preactivation of the ventricle due to an accessory pathway
Common medications that cause hypertension
NSAIDs: sodium retation and increased GFR
Tylenol if >3gr/day
Stimulants (methylphenidate, cocaine), decongestants: vasoconstriction and increase heart rate
Hormonal contraceptive: increase angiotensin production
Antidepressants (SNRI velafaxine, TCAs): various effects (sympathetic stimulation)
Steroids: activation of mineralocorticoid receptor, Na retention
Cardiac syncope dxx
Hx of dyspnea on exertion?
Aortic stenosis
Sudden onset on a patient with CAD or MI?
Ventricular arrhythmia
Patient with tachy-bradycardia with drop P on EKG?
Sick sinus sd
Evidence of AV block or Branch block on EKG?
Transient AV block
Prolonged QT, hypokalemia
Torsades
Pleural effusion after Coronary bypass graft
Very common
Usually left-sided
Small <25%
No treatment needed
Indications for electroconvulsive therapy and contraindications
Treatment-resistant
Psychotic features
Emergency conditions
Pregnancy
Refusal to eat or drink
Imminent suicide
NO contraindications.
Consider the risk in patients with cardiovascular disease, recent MI, brain occupying lesion, recent stroke, unstable aneurysm
Treatment for giardiasis
Tinidazole
What is pharyngeal cobblestone?
Lumps and bumps in the back of the throat.
Associated with allergies
Medication use in allergic rhinitis and its side effects
Intranasal corticosteroids: epistaxys
Pseudoepinephrine: hypertension
Antihistamines: sedation, urinary retention
Ipratropium and Dephinedramine: closed-angle glaucoma
Systemic steroids: hypertension, gastritis (in combination with NSAIDs)
What do have to do if you modify a study that has been already approved by the Institutional review board
Resubmit the entire new thing for approval
Why would a metanalysis find a statistical significance when all of the other previous studies did not?
By increasing the sample, you increase the change of a study to find smaller changes in the effect
These changes may be clinically irrelevant in real life
Approach to treatment of heart failure in pregnancy
- Preload: furosemide (early) and nitrates
- Afterload: hydralazine
- Demand: beta-blockers, digoxin
ACE/ARAII are contraindicated as the cause fetal renal toxicity, spironolactone causes fetal feminization early in the pregnancy
Mnemonic for treatment of acute pulmonary congestion due to heart failure
LMNOP
Loop: furosemide Morphine Nitrates Oxygen Position
Situations where a Mallory-Weiss tear can occur. Risk factors
INCREASED INTRA ABDOMINAL PRESSURE
Vomiting
Wrenching
Weight lifting
Straining
RISK FACTORS
Alcoholism, hernia hiatal
Endoscopic findings of a Mallory-Weiss tear
LONGITUDINAL tear
Dxx of infectious esophagitis
Candidiasis: Yellow-white plaques adherent to the mucosa +/- oral thrush. FLUCONAZOLE
Herpes: Small, deep ulcerations, multinucleated giant cells with intranuclear inclusion on biopsy + Tzank smear. ACYCLOVIR
CMV: large, linear, superficial ulcerations, intranuclear AND intracytoplasmic inclusions
Ascertainment bias
When someone is influenced by the knowledge of an intervention/ past history /
Fix with: blinding
Clinical features and treatment of Conduct disorder
<18 yo and symptoms >1 year
Violation of social norms
Destruction of properties
Stealing, lying
Violent toward people or animals
CBT
Parents training
Approach to hip dysplasia
Consult orthopedics
Pavlik harness x 3 months (position in flexion and abduction)
Vertigo, tinnitus, and hearing loss differential diagnosis
Single episode and history of recent viral infection: Vestibular neuritis (hearing loss is +/-)
Chronic and multiple episodes
ear fullness
Meniere
What are categorical levels of a variable
Used for qualitative variables where different levels are represented by a specific category
eg. Blood type (1 variable) has 3 levels
eg. Medication (1 variable) different doses or presentation
Characteristic of ecological studies
They do not measure individuals, but measure at the community level instead
Clinical presentation and treatment of interstitial cystitis
UTI-like symptoms >6 weeks
Negative UA
Pain relieved with urination, worst when bladder is full
Dyspareunia
No curative treatment
Amitriptyline, Petosan polysulfate sodium
Analgesics
Patient with SLE that wants to get pregnant.
Recommendations
Medication contraindicated:
Methotrexate, cyclophosphamide, leuflonide, mycophenolate
Ok: hydroxychloroquine (do not stop if already taking it)
Wait 6 months of no active disease to try
Neonatal Lupus
Due to elevated anti-Ro/anti-La antibodies in the mother even if the patient is asymptomatic
Congenital complete heart block, as well as hepatic, hemato, and dermatologic complications
Roseola infantum
Herpes 6
High fever and no other symptoms for 3-4 days
Maculo popular rash appears after fever breaks and last <24 hrs (appears in the chest and spreads)
Common electrolyte disturbance in patients with schizophrenia
Hyponatremia
Usually related to psychogenic polydipsia in delusional patients trying to purify themselves or hallucinations asking them to do it
Maybe secondary to medication side effect
