Step3 47

Question 1

TB treatment and side effects

Answer 1

Isoniazid:
Liver: elevate LFTs
Discontinue if elevation is >5x the upper limit in asymptomatic patients or 3x in symptomatic (with normal baseline)
For patients with abnormal baseline: discontinue if symptoms develop or if there is an increase 2-3x
Nervous system: Ataxia, peripheral neuropathy. Give pyridoxine

Rifampin

Ethambutol: Ocular toxicity

Pyrazinamide: Uric acid elevation

Question 2

Criteria for coronary bypass grafting

Answer 2

2 groups:

A. Patient with refractory angina despite maximal medical therapy

B. Patient in whom revascularization will improve long-term survival

• Involvement of the left main art.
• Multivessel disease (including proximal left ant. descending) along with systolic dysfunction

If single vessel or 2-vessel not including the LAD… stent

Question 3

Evaluation of suspected gastroparesis

Answer 3

First step: rule out obstruction
Upper endoscopy, barium swallow with CT, MRI if extrinsic compression is suspected

Step 2: to confirm
Nuclear Gastric emptying study

Question 4

Treatment of gastroparesis

Answer 4

Small frequent meals, low fat, soluble fiber

Erythromycin/metoclopramide

Gastric electric stimulation, jejunal feeding tube for refractory cases

Question 5

Orders for Vaginal discharge

Answer 5

Wet mount
Vaginal ph >4.5 suggest bacterial, <4.5 candidiasis
Vaginal culture, clamydia
UA

Question 6

Benzos withdrawal

Answer 6

Tachycardia, hypertension, pyrexia

Anxiety, irritability

Insomnia, restlessness

Delirium, psychosis

Tremors

Seizures, coma

Question 7

Requirements to keep the viability of organs on a brain-dead person

Answer 7

1. Euvolemic: give desmopressin to treat Central Diabetes insipidus that developed after brain death.
   Give fluids
2. Normal BP: give fluids +/- pressures to ensure perfusion
3. Keep patient warm

Question 8

Antihypertensive medications that are safe with Lithium

Answer 8

CCB
Loop diuretics

ARA/ACEI: decrease GFR, increase Lithium

Thiazides: Decrease Na reabsorption in the distal tubules causing increase absorption of Na and Li in the proximal

Spironolactone increases Li levels, amiloride decreases Li levels

Question 9

Clinical presentation and management of congenital hypothyroidism

Answer 9

Usually diagnosed in newborn screening

PRESENTATION
Asymptomatic at birth
<1month: jaundice, poor feeding, hypothermia
1-4 months: failure to thrive, constipation

MANAGEMENT:
Repeat test to confirm
Start treatment immediately: <2 weeks of age to prevent intellectual disabilty
Order thyroid US
Refer to endocrinology

Question 10

Physical exam of physiologic genum varum

Answer 10

Symmetric

Joint does not protrude to the side while walking

<6cm of separation between patellas

Normal stature

No leg discrepancy

Question 11

Drugs that cause agranulocytosis

Answer 11

General Collapsed After Close Car Accident

Gancyclovir
Colchicine
Antithyroid (propylthiouracil > methimazole)
Clozapine
Carbamazepine
Granulocyte

Question 12

What do you need to watch out for on a patient on Clozapine

Answer 12

Agranulocyte count

Weekly for 6 months
Every other week for another 6 months
Every 4 weeks thereafter