Step3 43 Flashcards
Metabolic effects of second-gen. antipsychotics
Hyperglycemia (including new-onset diabetes)
Weight gian
Dyslipidemia
Higher risk with clozapine and olanzapine
Definition of resistant depression
No response to two trials of antidepressant therapy
Add an antipsychotic
PDA dependent congenital heart disease
Transposition of the great arteries
Aortic coarctation
Tricuspid atresia
Total anomalous venous return
Hypoplastic left heart sd. (no murmurs heard)
Tetralogy and Troncus arteriosus are cyanotic but no PDA dependent. (Usually, a murmur is heard)
Patient on TNF-inhibitor with rapidly progressing symptoms of pneumonia, hypoxia, and cavitary lesion in the lower lobe
What’s the most likely causal organism?
S. aureus
TB is more subacute with upper lobe cavitary lesions
consider invasive aspergillosis as the differential diagnosis
CT: nodules with halos
TNF inhibitors “side effects”
Serious infections Skin reaction Neutropenia Injection site reactions Demyelinating disease Heart failure Autoimmunity induction
Indications for RohGAM vaccine
Rh (-) mother with a possible Rh + child that has not been sensitized
28 weeks and after birth if the child is Rh +
Sensitized moms should no get the vaccine (is too late)
Check the baby for anemia and hydrops fetalis
Gaucher disease
Glucorebroside deficiency
Accumulation in macrophages
Splenomegaly>hepatomegaly
Bone infiltration:
- —-Anemia, thrombocytopenia
- —-Bone pain (osteopenia, increased risk of fractures)
Failure to thrive, delayed puberty.
Phenylketonuria
Phenylalanine hydroxylase def.
Tyrosine becomes essential
Musty body odor
Intellectual disability
Fair hair, skin, blond, blue eyes, eczema,
Signs and symptoms suggestive of pulmonary hypertension
Right heart failure symptoms
Dyspnea, elevated JVD, lower extremity edema
Right heart enlargement: parasternal hive
Tricuspid regurge
Esophageal compression due to atrial enlargement, elevation of the main bronchus
Indication for glucose challenge test in pregnancy
2nd trimester (all patients)
1st trimester for patients with risk factors (BMI >30, prior gestational diabetes)
Indications for Mitral valve surgery
SEVERE CHRONIC MITRAL INSUFFICIENCY
Repair > Replacement
Primary: Any patient with LVEF 30-60% Consider if successful repair is possible in patients with: --Asymptomatic and LVEF >60% --Symptomatic and LVEF <30%
Secondary (CAD, Ischemia)
Medical management
Management of an umbilical hernia in a newborn
If asymptomatic…
Wait until 5 years to do surgery
Anatomy of femoral hernias
Below inguinal ligament
Medial to the femoral vein (VAN med-lat)
Diagnostic features of PCOS
2 out of 3
Oligomenorrhea
Hyperandrogenism
Multiple cysts on ovaries
Renal manifestations of fat atheroembolism
Elevated creatinine
Eosinophilia/eosinophiluria
