Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Uworld Gaby > Step3 38 > Flashcards

Step3 38 Flashcards

1
Q

Antibiotic treatment for skin infections

A

Cellulitis: GAS + MSSA
Non-purulent: Clindamycin, amoxicillin + TMP-SMX, amoxi +doxy or linezolind

Purulent: (GAS + MRSA)
Clinda, TMP-SMX, Doxy, Linezolid

SEVERE:
IV vanc or clynda, (doxy or TMP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ventilation settings for a patient with ARDS.

What is the goal?

A

Ventilation (CO2)
Low tidal volume: 6-8 cc/kg

RR: <35

Oxygenation
High PEEP: 10-20 mmH2O
Plateau pressure: <30
High O2: Up to 60% of FiO2

GOAL:
PaO2: 55-80
SatO2: 88-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When do you initiate an extubation trial

A

When the patient has:

Good ventilation: pH >7.25

Good oxygenation:
PEEP < 8 mmH20 (no need to go <5)
FiO2: <40%

Improvement of the underlying cause

Hemodynamic stability

Ability to initiate spontaneous breathing (breathing trial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment for subclinical hypothyroidism

A

Q: 6001

or pg 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is abdominal imaging indicated in a patient with C. diff infection?

A

Evidence of severe disease:
WBC >15000
Creatinine >1.5

Fulminant:
Apparent shock
Ileus

Severe abdominal pain

If there is evidence of perforation or toxic megacolon, surgical management is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hormone levels in functional amenorrhea

A

Secondary to stress (eg. anorexia, exercise, chronic illness)

Elevated ghrelin, NPT, CRH, GABA, N-endorphins, and low leptin inhibit GnRH…. then everything else is low

Low GnRH, FSH, LH, estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment for osteoporosis/osteopenia in patients with functional amenorrhea

A

Weight gain

Decreased exercise (vs. increase in regular osteoporosis)

Vitamin D supplementation

If treatment fails… estrogen supplementation may be indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acalculous cholecystitis

Risk factors

A

Critically ill patients, decreased motility (no obstruction)

Fever, abdominal pain, jaundice, the elevation of LFTs, bilirubin, and ALP

Treat with:
Antibiotics
Cholescystostomy (drain)
Cholecystectomy if perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal Non-stress test vs. non-reactive

A

2 accelerations lasting >15sec in 20min
>15pbm if >32 weeks
>10pbm if <32 weeks

Non-reactive:
Insufficient accelerations in 40min period
Perform biophysically profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of a non-reactive result during a fetal non-stress test

A

Baby is sleeping

Fetal acidemia

<32 weeks gestation

Maternal sedation, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Biophysical profile

Parameters and interpretation

A 
TWO POINTS EACH
Fetal tone
Breathing
Movements
Amniotic fluid
Non-stress testing

8-10: reassuring
6: if pregnancy is at term, deliver
0-4: emergency, deliver is the cause can not be explained or corrected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Medications to prevent Opioid-induced constipation

A

Senna/docusate

Laxative: lactulose

Methylnaltrexone is not used for prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Active vs. Latent TB on x-ray

A

Latent: fibronodular scar with calcification, no lymphadenopathies or infiltrates

Active: infiltrate, pleural effusion, cavitation, hilar lymphadenopathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment for latent TB

A

Isoniazid + rifapentine: 3 months (not good for HIV patients

Rifampin: 6-9 months

Isoniazid: 4 months

Active: combination (4) for 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Approach to uterine inversion

A

Stop oxytocin (need to relax uterus to reposition)

Watch for atony and severe hypotension

Treat atony with:
Uterine massage
Uterotonics again (misoprostol, methylergonovine) 
Packing and balloon
Uterine artery embolization (if stable)
Emergency laparotomy if unstable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Uterine atony management

A 
Treat atony with:
Uterine massage
Uterotonics again (misoprostol, methylergonovine) 
Packing and balloon
Uterine artery embolization (if stable)
Emergency laparotomy if unstable
17
Q

Management of hospital delirium

A

Reduce noise, increase lightning during the day
Have someone familiar in the room
Avoid room changes
Decrease polypharmacy
Early mobilization, little use of physical restraints
Early volume repletion for patients with dehydration
Hearing and visual aids
Aggressive chronic disease management
Electrolyte and metabolic surveillance

18
Q

Indication for Fibrinogen administration in CID

A

Cryoprecipitate when Fibrinogen <100

19
Q

Heparin-induced thrombocytopenia type 1

A

Thrombocytopenia <2 days of Heparin treatment

Nadir of 100000

20
Q

Heparin-induced thrombocytopenia type 1 vs. type 2 treatment

A

Type 1:
No treatment needed

Type 2
Heparin discontinuation
Platelet 4 antibody testing
Alternative: argatrovan, vivalidurin

21
Q

Endocrine manifestation of molar pregnancy. Why?

A

Hyperthyroidism

The alpha unit of hCG is similar to TSH and stimulates hormone production

22
Q

Clinical presentation of molar pregnancy and management

A

Extremely elevated hCG

Exaggerated pregnancy symptoms
Hyperemesis gravidarium
Preeclampsia
Uterus bigger than gestational age

Hyperthyroidism

Abnormal bleeding

Extreme ages <15 or >35

Management:
Dilatation and curetage
Contraception for >6 months
Beta-blocker if hyperthyroidism

23
Q

Frailty

Definition
Clinical presentation
Assessment
Management

A

Progressive vulnerability to adverse outcomes

Fatigue
Resistance (weakness, decrease motor strength)
Ambulatory dysfunction
Illnesses (>5) 
Loss of weight

Review daily activities
Lab testing (to rule out anything)
Mobility test: get up and go

Structured exercise program
Nutrition and Vit. D
Eliminate unnecessary medications

24
Q

Risk factors for mucormycosis

A

Diabetic (especially ketoacidosis)

Hematologic malignancies with bonemarrow transplant

25
Q

Patients that easily develop hypophosphatemia during hospitalization. Why? Clinical manifestations

A

Alcoholics

Phosphate is usually depleted due to malnutrition.

When patients receive glucose, insulin production increases, and PO4 is driven to the intracellular space.

Weakness, hyporeflexia, paresthesias, ileus, metabolic encephalopathy when PO4 is <1

26
Q

Risk and protective factors of epithelial ovarian cancer

A 
Nullyparity
Infertility
Hormone replacement therapy
Early menarche, late menopause
BRCA 1 and 2 mutation
Family history
Lynch sd.
PCOS
PROTECTIVE:
OCPs
Breastfeeding
Multiparity
Salpingoophorectomy
27
Q

Clinical presentation and management of Splenic sequestration in sickle cell

A

Left abdominal pain
Acute splenomegaly
Anemia
Hypotension

Begin with isotonic fluids, follow with RBC transfusion to baseline. (DONT OVER TRANSFUSE)

28
Q

Approach to a patient with symptoms of BPH

A

Prostate palpation
Neuro (perineal reflexes, sensation)
PSA
UA (look for signs of infection or bladder cancer)

If everything is normal, start a-blocker (finasteride)

29
Q

Pupil in anterior uveitis vs. acute angle-closure glaucoma

A

Anterior uveitis: usually miotic

Acute angle-closure glaucoma: mild dilatation

30
Q

What is important about the prevalence of a positive HLA-B27 marker

A

90% of people with Ankylosing spondylitis have it

Only 5% with it, have Ankylosing spondylitis

This means a positive test doesn’t mean you have if you don’t have symptoms

31
Q

Relationship with marker and severity in RA

A

Having positive markers makes the disease worse.

Positive CCP is associated with more aggressive disease

Seronegative RA is less aggressive

32
Q

Definition and causes of neonatal polycythemia

A

Ht: >66% or Hb: >22 mg/dl

Causes:
Increased erythropoiesis: maternal diabetes, maternal hypertension, smoking, IUGR
Endocrine: baby hyper or hypo tyroid
Genetics: Trisomy 16, 18, 21
Erythrocyte transfusion: twin-twin transfusion, delay clamping

33
Q

Etiology of otitis externa

A

Pseudomonas (most common)

S. aureus

34
Q

Treatment of acute otitis externa

A

Topical antibiotics (eg. ciprofloxacin +/- steroids)

ofloxacin
or
cipro/dexa

Uworld Gaby (77 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions