Step3 48 Flashcards
What will be the easiest way to find the test with the hights PPV or NNV when you are giving a bunch of options
For PPV: look for the test with the highest specifity
Rule in or out a disease with a Sensitivity or Specificity
SnNOUT: sensitivity rules out. A negative result on a highly sensitive test: rules out
SpIN: specificity rules in. A positive result on highly specific test: rules in
Approach to dysentery
Stool culture, Shiga toxin, fecal leukocyte
CT if suspicious for ischemic colitis
Endoscopy if IBD is suspected
Treatment for Urogenital gonorrhea
Ceftriaxone only
Before it was cef + azy.. new guidelines recommend cef only
Empiric treatment for Urethritis
Ceftriaxone + doxycycline
Treatment for Legionella
Fluoroquinolone or azithromycin
Patient with hematuria and eosinophiluria
Think parasitic infection (schistosomiasis) if the patient comes from 3rd world country
Management of a pregnant patient with a GBS + culture during 1st trimester`
Treat now: amoxicillin or cephalexin
Culture 1 week after treatment is finished
Prophylactic penicillin during labor
Metabolic disorders that cause prolonged QT
Hypothyroidism
Starvation
Low K, Mg, Ca
Cardiovascular causes of long QT
Ischemia
AV block
Sinus node dysfunction
Other causes of long QT
not medications, metabolic or cardiovascular
Hypothermia
Intracranial disease
HIV
Antiarrhythmics causes of long QT
Sotalol, amiodarone, flecainade
Pressures in the atria and ventricle in cardiac tamponade
They tend to equalize
Solid breast mass evaluation
pg. 385 and 386
Patient with 2 months of psychotics symptoms and drug use
Diagnosis?
Discontinue drugs to see if they are the cause of the psychosis
Fetal fibronectin
If positive in a patient <34weeks, it means an increased risk of preterm delivery
Presentation of amniotic fluid embolism
Cardiogenic shock
Hypoxemic respiratory failure
CID
Coma or seizures
Shoulder pain with passive and active motion
Adhesive capsulitis, usually related to stiffness
Treat with “range of motion” exercises
Clinical presentation and management of chronic urticaria
Pruritic, round, serpentiginous plaques >6 weeks Individual lesions last <24 hrs 80-90% Idiopathic 50% presents with angioedema
Diagnosis:
Clinical
Lab workup to rule out any other association: CBC, BMP, ESR, LFTs, UA
Skin biopsy if systemic symptoms, rash >24hr
Treat with:
Second generation antihistamine: eg, cetirizine
Avoid aggravating conditions: NSAIDs, heat
Treatment of acute vs. chronic urticaria
Acute:
Mild: 2nd gen antihistamine (cetirizine, loratadine)
Moderate: add 1st generation (hidroxixine)
Severe: add oral glucorticoids
Chronic: (>6 months)
Step1: 2nd gen antihistamine (cetirizine, loratadine)
Step2: try any of the following increase dose add 1st generation (hydroxyzine) add leukotriene inhibitor add oral glucocorticoids
Step3:
Change the medication
Hydroxychloroquine, tacrolimus, omalizumab
Most patients have spontaneous resolution in 2-5 years
Diabetes diagnosis
Symptomatic patients with: (only one time)
A1c >6.5
Random or glucose tolerance >200
Fasting >126
Asymptomatic patients with positive tests need to repeat the same test
If there are discrepancies after second test, do a different one
Methemoglobinemia
Etiology
Presentation
Treatment
Anestetics: benzocaine,
Dapsone
Nitrates (in infants)
Elevated O2 sat. gap: Pulse oxy is usually around 85%, meanwhile ABG sat is a lot higher (measures O2 but no effective O2)
Cyanosis (10% of hemoglobin)
Hypoxia (20% of hemoglobin)
AMS, seizures, deaths (>50%)
Treat with methylene blue
Methemoglobinemia is the treatment for cyanide poisoning
Medical futility
Continue treatment that can have no beneficial effect (eg. give dialysis to an uncouncious patient who will die from cancer in the next few days)
It is different from poor prognosis
Anticoagulation therapy for patients with aortic mechanical valve replacement
Aspirin AND Warfarin
No risk factors
INR 2-3
Risk factor: a fib., history of thromboembolism or hypercoagulable state, severe LV dysfunction EF<30, mechanical mitral valve
INR 2.5-3.5
Age for Tdap vaccine
2,4,6 m
4 years
every 10 years
When the patient has a wound:
If the last dose >10 years ago and the wound is clean
If the last dose was >5 years ago and the wound is dirty
If <3 doses or unknown immunization + IVIG (if dirty)
Extraarticular manifestations of Ankylosing spondylitis
Anterior uveitis
Aortic regurge
Pulmonary fibrosis, restrictive lung disease
IgA nephropathy, nephrotic syndrome
Atlantoaxial subluxation: cord compression
Cauda equina
Xrays use as control for Ankylosing spondylitis
Lateral cervical
AP spinal
Pelvic: Sacroiliac joint, hip joints
ESR can also be use
