Step3 37 Flashcards
Approach of hypospadias
If testicles are present, no other studies are needed. Just do surgery
If no testicles:
Look for a uterus
Karyotyping
Renal US if cardiac anomalies, cleft palate, etc
Thrombocytopenic thrombotic purpura vs. Autoimmune thrombocytopenic purpura
Thrombocytopenic thrombotic purpura presents with evidence of HEMOLYTIC ANEMIA
Autoimmune thrombocytopenic purpura has isolated thrombocytopenia. Anemia secondary to bleeding (iron deficiency)
Treatment of Thrombocytopenic thrombotic purpura vs. Autoimmune thrombocytopenic purpura
Thrombocytopenic thrombotic purpura:
Plasma exchange best initial treatment
Steroids may be added to decrease thrombus formation
Autoimmune thrombocytopenic purpura
Asymptomatic and >30.000 = no treatment
Symptomatic or <30.000 = Steroids (High dose IV for 4 days followed by 2 months of oral prednisone and then taper)
IVIG + paltelates if hemorrhage
Epidemiology of Autoimmune thrombocytopenic purpura
After a recent viral infection
HCV, HIV, CLL
Autoantibodies
Clinical manifestations of miliary tuberculosis
Constitutional: fever, weight loss, malaise, night sweats
Pulmonary: cough, dyspnea, pulmonary pattern
Reticuloendothelial: hepatosplenomegaly, mildly elevated LFTs.
CNS: meningitis and tuberculomas
Diagnosis of miliary tuberculosis
Liver biopsy (best), bronchial or bone marrow biopsy
AFB, NAAT
Blood cultures are low yield
Legionella presentation
High fever with GI symptoms followed by respiratory symptoms and low Na
Hx of hospital or Cruise
Epidemiology of rotavirus
<2 years old
Preschool attendance, other kids with symptoms
Watery diarrhea + fever
Medications of glaucoma and mechanism of action
LATANOPROST
Prostaglandin agonist: increase uvoscleral outflow
TIMOLOL (bb) and AZETAZOLAMIDE (cai)
Improve aqueous humor inflow
PILOCARPIN
Muscarinic agonist. Trabecular outflow
Open vs. Closed-angle glaucoma
Open: Gradual onset of peripheral visual lost Frequent lens changes, Increase optic cup/disc ratio Usually both eyes
Close:
Sudden onset of pain, conjunctival redness, corneal opacity, mid-dilatation of pupil
Triggered by darkness (vs. migraines… light)
Headache, nausea, vomiting
Usually one eye
Diagnosis of Parvo Infection in pregnancy
Acute:
IgM antibodies (immunocompetent)
If IgM is negative but highly suspicious.. then
NAAT or B19 DNA (immunocompromised)
Chronic:
IgG
Fetus:
PCR of amniotic fluid for B19 DNA
Fetal follow up:
Serial ultrasounds
Middle cerebral artery Doppler measurements (for anemia)
Fetal sequelae for Parvo Infection
Hydrops fetalis
Anemia (Intrauterine transfusion if severe)
Fetal demise
Prevention of aspiration pneumonia in patients on mechanical ventilation
REDUCE RISK OF ASPIRATION
Minimize sedation (daily interruptions)
Semirecumbant positicion (30-45 degrees)
Tube with subglottic drainage
REDUCE COLONIZATION
Avoid prophylactic antibiotics
Avoid PPIs except in patients with high risk for ulcers
Antiseptics for oral decontamination
Change circuit if evidence of contamination
Indications for strep ulcer prophylaxis
Qid 6120
4 each
Dietary modifications that prevent renal stones
High fluid intake
Reduce oxalate in diet
Reduce sodium diet: increases Na and Ca reabsorption, decreases Ca excretion and stone formation
Diet low in oxalate (spinach, peanuts cashew, potatoes)
Diet high in calcium: calcium binds with oxalate in the gut impeding absorption and reducing Calcium oxalate stones
Reduce animal protein: animal protein increases urinary Ca levels and reduces citrate (citrate binds calcium and reduces stones formation)
