Step3 44 Flashcards
Cardiac defect in newborns with diabetic mom
Presentation and management
Prognosis
Transient Hypertrophic Cardiomyopathy
Respiratory distress, tachycardia, and hypoxia—> heart failure
Spontaneous resolution even if symptomatic
Treat with B-blocker and fluid management if the patient is symptomatic
Echocardiogram findings disappear after 1 year
Approach to hematochezia algorithm
pg. 146
Rosacea
Clinical presentation
Management
“Adult acne”
Facial erythema with telangiectasias
Papulopustular rosacea
Phymatous
Ocular: blepharitis, chalazion, stye
Avoid triggers: alcohol, stress, spicy foods, and sun
Topical metronidazole
Oral doxy or metronidazole for ocular and pustular
Phases of clinical trials
Preclinical: laboratory and animal models
Phase I: n= 20-100
Healthy individuals
Pharmacodynamics and pharmacokinetics of the drug
Side effects, max dose, toxicity
Phase II: n= few 100s
Affected individuals
Optimal dosing, adverse effects, efficacy
Phase III: n= 300-3000
Compare new treatment with standard
Phase IV:
Postmarketing surveillance
Things that you can see doing stratification on a study
Confounding: when there is no difference between groups. This is associated with both, the exposure and the outcome
Effect modification: when you notice a difference between groups (eg. age modifies the presentation of Reye sd)
What is the best way to let a patient know that there has been a breach of confidentiality
A written letter (vs. email or verbal) is the prefered method
Causes and management of Neonatal polycythemia
Increased erythropoiesis:
Maternal diabetes, smoking, hypertension, IUGR
Metabolic: hyper and hypothyroidism
Transfusion: delayed cord clamping, twin-twin transfusion
Genetics: trisomy 16,18,21
MANAGEMENT Take a venous sample to confirm IV fluids Insulin Partial exchange transfusion (if symptoms of hyperviscosity)
Treatment for Postpartum endometritis
Coverage for gram +, gram - and anaerobic
clindamycin + gentamicin
Risk factors for postpartum endometritis
Prolonged rupture of membranes Operative vaginal delivery C-section (especially after membrane rupture and labor initiation) GBS +, bacterial vaginosis Intrammniotic infection <37 weeks and >42 weeks
Effects on intensive glycemic control in Diabetes in the cardiovascular system
What do you do to prevent cardiovascular complications?
Improvement in microvascular complications: retinopathy and nephropathy
No improvement in macrovascular complications and mortality
Blood pressure control
Lipid-lowering therapy
Aspirin
Smoking cessation
Epstein anomaly
Atrialization of the right ventricle
Related to lithium during pregnancy
Management of Acute manic episode in bipolar disorder
Name all the drugs
Lithium or valproate
If the patient is still manic, add an antipsychotic.
Severe manic episodes need to be treated with a mood stabilizer + antipsychotic. Changing for another 1st line does not help
Lithium
Valproate
Lamotrigine: for depressed phase and maintenance. Not for acute manic
Carbamazepine
When do you treat herpes zoster, why?
<72hrs since lesions appear
Prevents new lesions, transmission, and possibly pain
Analgesic is also necessary (NSAID if <4m)
Management of disseminated VZV infection
Hospitalize for IV treatment
Contact and airborne precautions (isolation)
Ideally, only staff with known immunity to VZV should take care of the patient
Complications of hyperthyroidism
Arrhythmias, cardiomyopathies
Osteoporosis
