Step3 8 Flashcards
Orthostatic proteinuria
Clinical presentation
Pathophysiology
Diagnosis
Treatment
Incidental finding of protein in urine.
Exaggerated response to the upright position. Increased glomerular capillary resistance
Protein/Creatinine ration supine vs. standing or
Split 24hr urine (day vs. night)
No treatment needed. Reassurance
Alopecia Areata
Clinical presentation
Management
Prognosis
Smooth and discrete areas of hair loss. No scaling or inflammation
High rate of recurrence
Intralesional or topical steroids
Patient education: Hair growths back to normal even without treatment. Can recur. Hair growth seen 4-6 weeks after treatment
Anticholinergic intoxication
Medication that causes (6)
Presentation (7)
Antihistamines, antipsychotics, atropine, jimson weed, scopolamine, TCAs
Hot as a hare, red as a beet, dry as a bone, mad a hatter, blind as a bat
Fever, flushing, dry mucus membranes, psychosis, mydriasis; also tachycardia and urinary retention
Cholinergic intoxication
Medication that causes (4)
Presentation (7)
Muscarine containing mushrooms, pilocarpine, pyridostigmine, organophosphates
DUMBELS Diarrhea Urination Miosis Bronchorrhea, Brocospasm, Bradycardia Emesis Lacrimation Salivation
Indication for thrombolysis in PE
Hypotension (systolic <90)
AND
Low bleeding risk
Indication for thrombectomy in PE
Thrombus potentially causing deadly shock within hours
or
Failed thrombolysis with persistent hypotension
Marfan vs. Homocystinuria
Homocystinuria presents with venous thromboembolism and intellectual disabilities
Lens dislocation:
Down: Homocystinuria
Up: Marfan
Eye symptoms in Marfan vs. Homocystinuria
Lens dislocation:
Down: Homocystinuria
Up: Marfan
Allergic Bronchopulmonary Aspergillosis
History
Asthma
Cystic fibrosis
Allergic Bronchopulmonary Aspergillosis
Imaging
Recurrent fleeting infiltrates (transient infiltrates in different part of the lungs
Bronchiectasis
Allergic Bronchopulmonary Aspergillosis
Diagnosis
Positve Aspergillus skin test or IgE
Elevated serum IgE
Eosinophilia
Allergic Bronchopulmonary Aspergillosis
Treatment
Steroids
Itraconazol or variconazol
Others:
Omalizumab (monoclonal antibody against IgE)
Amiodarone effects on thyroid hormone (labs) and management (4)
1) Decreased conversion T4-T3
Normal/High TSH / Elevated T4 / Low T3
No treatment needed
2) Inhibition of thyroid hormone synthesis
High TSH / Low T4
Treat with Levothyroxine
3) Amiodarone induced thyrotoxicosis Type 1 (iodine-induced increased in levothyroxine)
Low TSH / High T4/T3 / Decreased iodine uptake / Increased vascularity on ultrasound
Treat with antithyroid medication
4) Amiodarone induced thyrotoxicosis Type 2 (Destructive thyroiditis)
Low TSH / High T3/T4 / Undetected iodine uptake Decreased vascularity on ultrasound
Treat with glucocorticoids
Pediatric septic arthritis pathogens and treatment
< 3 months:
S. aureus, GBS, anaerobes
vancomycin + cefotaxime
> 3 months
S. aureus, GAS
vancomycin
Clinical diagnosis of Pediatric septic arthritis (4)
Criteria for diagnosis: (>3 is indication for aspiration) Fever No weight bearing Leukocytosis CRP >2 or ESR >40
Sings and symptoms
Fever, limited range of motion, refuse to bear weight,
Cervical cancer screening
IMMUNOCOMPROMISED
At onset of sexual activity
Pap + HPV co testing
Cervical cancer screening according to age
<21 no testing
> 21-29: Cytology every 3 years
> 30-65:
Cytology every 3 years
Pap + co-test every 5 years
Primary HPV test every 5 years
> 65:
No screening if negative on previous screens and low risk
Hysterectomy:
No screening if negative on previous screens and low risk
Acute Epididymitis
Etiology
Presentation
Work up
Treatment
<35: chlamydia, gonorrhea
>35: bladder outlet obstruction (coliform bacteria)
Pain (posterior), swelling, erythema
Pain improves with elevation
Dysuria/polyuria if coliform bacteria
Urinalysis and culture
NAAT for chlamydia and gonorrhea
Doxy +/- ceftriaxone for gonorrhea
Levo if no high risk for gonorrhea
Preeclampsia prevention
High risk (6) Moderate (3)
Aspirin in high risk patients after week 12
High risk Chronic Kidney disease Chronic Hypertension Preeclampsia in previous pregnancy Diabetes Autoimmune disease Multiple gestation
Moderate:
Obesity
Advanced maternal age
Nulliparuty
Unilateral benign breast disorder
Fibroadenoma rubery
Usually upper quadrant
Cyclic
Breast cyst
+/- tenderness
They are both well-circumscribed, firm, mobile
What would get injured if you try to grab a knife?
Tendons
Arteries and veins run on the side of the hand
Pathophysiology of pernicious anemia (4)
Antibodies against parietal cells and intrinsic factor
AMAG: Autoimmune metaplastic atrophic gastritis
Atrophy of parietal cells (mainly in body and fundus see as absent rugae)
Intestinal metaplasia
Inflammation
Diagnosis of pernicious anemia
Low B12
Antibodies against intrinsic factor (first line)
Antibodies against parietal cells (not too specific)
Shilling test: more complicated, second line if Ab IF is negative
A. fib mnemonic
PIRATES
Pulmonary disease Ischemia Rheumatic heart disease Anemia / Atrial myxoma Thyrotoxicosis Ethanol Sepsis
Management of Afib
Stable
Rate control: B-blocker, CCB (diltiazem, verapamil) digoxin
Anticoagulation with warfarin or NOVAC (apixaban, dabigatran, rivaroxaban, edoxaban)
Intussusception age of presentation
<2 years
Risk factors for stress hyperglycemia (5)
Fever >39 ICU Severe illness Sepsis CNS infection
Urinary incontinence in the elderly (4)
GENITOURINARY
Detrusor malfunction (hyperactivity or decreased tone)
Obstruction (prostate/cancer)
Weakness of urethra or pelvic floor
Fistula
Urinary incontinence in the elderly (4)
NEUROLOGIC
Multiple sclerosis
Dementia
Spinal cord injury
Disc herniation
Urinary incontinence in the elderly
POTENTIALLY REVERSIBLE (8)
Delirium Infection (UTI) Atrophic (urethritis/vaginal) Pharmacological (a-blockers) Psychologic (depression) Excessive urine output (Diabetes, CHF) Restricted mobility Stool impaction
McCune-Albright
Pathophysiology
Clinical presentation
Continued activation of G proteins
Elevated TSH: thyrotoxicosis
Elevated ACTH: Cushing sd.
Low LH/FSH
Precousios puberty
Cafe Au lait spots
Fibrous dysplasia of the bone
Breast and axillary and pubic hair development
Precocious puberty algorithm
Advanced bone age
Basal LH
If High: central
If LOW
GnRH Stimulation test
LH high: Central… Brain MRI
LH low: peripheral… Abdominal ultrasound
