Step3 6 Flashcards
Location of lesion in a patient with constructional and dressing apraxia
Non dominant parietal lobe
Area of supply of the left anterior descending
Apex
Anterior 2/3 of the septum
Anterior wall of the left ventricle
Laboratory test for invasive fungal infections
Beta D-glucan
Etiology of Otitis media + conjunctivitis
Usually non-typeable H. influenzae
Common cause of otitis media
S. pneumonia
Nontypeable H. influenzae
Moraxella
Management of otitis media
Amoxicillin
Amoxiclav
Penicillin allergic:
azytrho or clinda
Treatment for bronchiolitis
Supportive care
Prevention of RSV
Palivizumab for selected infants
<29 weeks
Chronic lung disease of prematurity
Hemodynamically significant heart disease
Complications of Bronchiolitis
Apnea
Respiratory failure
Older infants:
Recurrent wheezing
Antipseudomonal antibiotics
Cefepime / Ceftazidime Amikacin / Tobramycin (aminoglicoside) Carbapenem Aztreonam Colistin Certain fluoroquinolones (eg. cipro) Piperazilin-tazobactoan Tricarcilin-clav.
Other symptoms (4) and laboratory results (7) that might be present in Kawasaki disease
Arthritis, scrotal swelling, pericarditis, and gallbladder inflammation
Labs:
Steril pyuria on clean catch (catheterization bypasses the urethral origin of the pyuria)
Thrombocytosis, Elevated WBC, decreased hemoglobin
Elevated LFTs
Hypoalbuminemia
Hyponatremia
(PCR/ESR)
Treatment of Kawasaki disease
High dose aspirin during the acute phase
IV immunoglobulin
Precautions to take after immunoglobulin therapy
Differ live vaccines for at 11 months
Lifestyle modification effect in hypertension
DASH diet
Drops 12 mmHg
Lifestyle modification effect in hypertension
Weight loss
6mmHg per 10 kg of weight loss
Target: BMI <25
Lifestyle modification effect in hypertension
Low Sodium Diet
< 1.5 - 2.3 g/day
Response vary
5-8 mmHg
Lifestyle modification effect in hypertension
Alcohol intake
<2 drink/day for men and <1 for women
5 mmHg
Lifestyle modification effect in hypertension
Exercise
> 30min a day >5 days a week
7mmHg
Lobular carcinoma in situ
Diagnosis
Management
Surgery
Usually incidental
Needle biopsy ====> exicional biopsy
No radiation or chemo recommended because this is not malignant
May add tamoxifen or raloxifen
Patients may request mastectomy
Management of Ductal Carcinoma In situ
Lumpectomy +/- radiation
Endocrine therapy for 5 years in ER/PR +
Management of invasive breast cancer
With NEGATIVE lymph nodes:
Lumpectomy, breast-conserving surgery, and radiation may be considered depending on tumor size
Chemo to shrink tumor before surgery, adjuvant chemo, hormone therapy
With POSITIVE lymph nodes:
Breast-conserving surgery or modified radical mastectomy, axillary disection, adjuvant chemo, and endocrine therapy
Paget disease of the bone
Clinical presentation
Management
Bone pain
Thicken cortex of the bone and sclerotic lesion on Xray
Hypercalciuria
Heart failure
Studies:
Bone scan: increased uptake
If symptomatic (pain or neuro symptoms) or affects weight bearing bones (eg. femur), treat with bisphosphonate
Pathophysiology of hypercalcemia in Paget
Due to immobilization because of many painful lesions but not because of disease itself
Hyperthyroidism in elderly patients
Apathetic hyperthyroidism:
Lethargy, apathy, decreased appetite. weight loss
Can present with A. fib without tachy due to medications or conductivity issues related to age
Cardiovascular effects of hyperthyroidism
Hypertension
Tachycardia
Widened pulse pressure (increased cardiac output with decreased systemic vascular resistance)
A. fib
Prognosis in COPD
FEV1 and age
After adjusting for age, FEV1 is the most important predictive factor for prognosis
Diagnostic features of Dementia with Lewi Bodies
Core (4)
Fluctuating cognition
REM sleep disorders
Visual hallucinations
Parkinsonism
Diagnostic features of Dementia with Lewi Bodies
Suggestive (2)
Severe antipsychotic sensitivity
SPECT or PET low dopamine transporter uptake in the basal ganglia
Diagnostic features of Dementia with Lewi Bodies
Supportive (5)
Repeated falls Syncope or near syncope Delusions Autonomic dysfunction Depression or anxiety
Pharmachologic treatment for dementia with lewi bodies
Cholinestares inhibitors for cognitive impairment. Donepezil
Levodopa/carvidopa for parkinsonism
Melatonin for REM sleep behavior disorder
Antipsychotics for hallucinations (use low potency, second-generation eg. quetiapine, cloanzapine, )
Predictors of 30 days mortalitye in PE
CLINICAL (8)
Hypotension (Sistolic bp <90) Tachycardia (>110) Hypoxemia (O2 sat <90%) Tachypnea (>30) Hypothermia (36) Age >80 Altered mental status Cancer
Predictors of 30 days mortality in PE
IMAGING
Right ventricular dysfuntion on eco or CT
Predictors of 30 days mortality in PE
LABORATORY
Elevation of troponin or BNP
