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Uworld Gaby > Step3 34 > Flashcards

Step3 34 Flashcards

1
Q

Clinical manifestation of Lyme disease

A

-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)

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2
Q

Treatment for Lyme

A

Oral: Doxycycline (azithromycin if <8 yo or allergic); Skin or mild

IV: Cardiac/Neuro: ceftriaxone, cefotaxime, IV penicillin

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3
Q

Hypertrophic cardiomyopathy vs. Athletes’ heart (6 items)

A 
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
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4
Q

Etiology of sick sinus syndrome

A

Age-related degeneration/fibrosis of the conduction system

Infiltrative disease (eg. sarcoidosis)

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5
Q

EKG findings on Sick sinus sd.

A

Sinus pauses (late P waves)

Sinus bradycardia

Sinoatrial nodal exit (drop P wave) (eg. a fib.)

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6
Q

Treatment of sick sinus syndrome

A

Pacemaker

+/- antiarrhythmic medications (if tachyarrythmias)

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7
Q

What is the physiologic explanation of a Delta wave on EKG?

A

Preactivation of the ventricle due to an accessory pathway

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8
Q

Common medications that cause hypertension

A

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

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9
Q

Cardiac syncope dxx

A

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

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10
Q

Pleural effusion after Coronary bypass graft

A

Very common

Usually left-sided

Small <25%

No treatment needed

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11
Q

Indications for electroconvulsive therapy and contraindications

A

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

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12
Q

Treatment for giardiasis

A

Tinidazole

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13
Q

What is pharyngeal cobblestone?

A

Lumps and bumps in the back of the throat.

Associated with allergies

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14
Q

Medication use in allergic rhinitis and its side effects

A

Intranasal corticosteroids: epistaxys

Pseudoepinephrine: hypertension

Antihistamines: sedation, urinary retention

Ipratropium and Dephinedramine: closed-angle glaucoma

Systemic steroids: hypertension, gastritis (in combination with NSAIDs)

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15
Q

What do have to do if you modify a study that has been already approved by the Institutional review board

A

Resubmit the entire new thing for approval

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16
Q

Why would a metanalysis find a statistical significance when all of the other previous studies did not?

A

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

17
Q

Approach to treatment of heart failure in pregnancy

A
  1. Preload: furosemide (early) and nitrates
  2. Afterload: hydralazine
  3. Demand: beta-blockers, digoxin

ACE/ARAII are contraindicated as the cause fetal renal toxicity, spironolactone causes fetal feminization early in the pregnancy

18
Q

Mnemonic for treatment of acute pulmonary congestion due to heart failure

A

LMNOP

Loop: furosemide
Morphine
Nitrates
Oxygen
Position
19
Q

Situations where a Mallory-Weiss tear can occur. Risk factors

A

INCREASED INTRA ABDOMINAL PRESSURE

Vomiting
Wrenching
Weight lifting
Straining

RISK FACTORS
Alcoholism, hernia hiatal

20
Q

Endoscopic findings of a Mallory-Weiss tear

A

LONGITUDINAL tear

21
Q

Dxx of infectious esophagitis

A

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

22
Q

Ascertainment bias

A

When someone is influenced by the knowledge of an intervention/ past history /

Fix with: blinding

23
Q

Clinical features and treatment of Conduct disorder

A

<18 yo and symptoms >1 year

Violation of social norms
Destruction of properties
Stealing, lying
Violent toward people or animals

CBT
Parents training

24
Q

Approach to hip dysplasia

A

Consult orthopedics

Pavlik harness x 3 months (position in flexion and abduction)

25
Q

Vertigo, tinnitus, and hearing loss differential diagnosis

A 
Single episode and history of recent viral infection:
Vestibular neuritis (hearing loss is +/-)

Chronic and multiple episodes
ear fullness
Meniere

26
Q

What are categorical levels of a variable

A

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

27
Q

Characteristic of ecological studies

A

They do not measure individuals, but measure at the community level instead

28
Q

Clinical presentation and treatment of interstitial cystitis

A

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

29
Q

Patient with SLE that wants to get pregnant.

Recommendations

A

Medication contraindicated:
Methotrexate, cyclophosphamide, leuflonide, mycophenolate

Ok: hydroxychloroquine (do not stop if already taking it)

Wait 6 months of no active disease to try

30
Q

Neonatal Lupus

A

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

31
Q

Roseola infantum

A

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)

32
Q

Common electrolyte disturbance in patients with schizophrenia

A

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

Uworld Gaby (77 decks)

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