Step3 UWorld Flashcards
Absolute contraindications for OCPs
Migraine with aura >35 yo + >15 cigarettes per day H/o VTE or CVA BP> 160/100 DM with end organ damage
Management of lupus nephritis
Initial: urgent renal biopsy prior to treatment
Therapy is guided by disease classification
Classes I, II: no therapy indicated
Classes III, IV: immunosuppression (glucocorticoids and cyclophos or cellcept)
Class V: may need immunosuppression if proliferative lesions or nephrotic syndrome
Class VI: advanced sclerosis, no immunosuppression
Management of gout. Acute? Chronic? If renal failure?
Acute: Colchicine and Indomethacine
Acute + renal failure: intra-articular steroids
Acute + renal failure + multiple joints: prednisone
Chronic: Allopurinol
Presentation of basilar artery occlusion
Ataxia, incoordination, motor weakness, AMS, facial weakness, dysphagia/dysarthria, gaze paralysis
Mycotic aneurysm
cause?
presentation?
Due to localized vessel wall destruction as a complication of infective endocarditis
Presentation: expanding mass with focal neurological findings or with aneurysm rupture and subarachnoid hemorrhage (HA, lethargy, neck stiffness)
Midsystolic (non-ejection) click followed by systolic murmur that increases with Valsalva
What’s the murmur?
Mitral valve prolapse
Ejection click followed by harsh systolic crescendo-decresendo murmur, radiates to the carotids, decreases with Valsalva
What’s the murmur?
Aortic stenosis
Infant of diabetic mother: first trimester complications
Congenital heart disease Hypoplastic left heart sydrome Neural tube defects Small left colon syndrome Polycythemia Organomegaly Spontaneous abortion
Infant of diabetic mother: second/third trimester complications
Hypertrophic cardiomyopathy
Shoulder dystocia
Macrosomia
Fetal hyperglycemia + hyperinsulinemia
Diastolic low-pitched murmur with opening snap, best heard at apex
What’s the murmur?
Mitral valve stenosis
How do you calculate the sensitivity of a test? What does it refer to?
Sensitivity: ability of a test to correctly identify individuals with a disease. More true positives, fewer false negatives
Sens = TP/(TP+FN)
How do you calculate the specificity of a test? What does it refer to?
Specificity: ability of a test to correctly identify individuals who are WITHOUT disease. More true negatives, fewer false positives
Spec = TN/(TN+FP)
Patient with multiple myeloma presents with nasal/oral bleeding, confusion, HA, dizziness, vertigo, nystagmus, hearing loss and visual impairment. Likely diagnosis? And treatment?
Dx: Hyperviscosity syndrome
Tx: Plasmapheresis
Complications of multiple myeloma?
Hypercalcemia Renal insufficiency Infections Skeletal lesions -> pathologic fractures Hyperviscosity syndrome Thrombosis
Choice of antihypertensive in patient with history of gout?
ARB!
Avoid thiazides, loop diuretics and ASA
Treatment for tinea pedis
Mild: topical antifungals (terbinafine, miconazole, clomitrazole)
Mod/severe (or with nail involvement): oral antifungals (terbinafine, itraconazole, fluconazole)
The use of erythromycin and azithromycin early in infancy is associated with increased risk of developing…?
Pyloric stenosis
Screening for gestational diabetes?
at 24-28 weeks gestation, first do 1hr 50g glucose challenge, if >140BS, then do 3hr 100g glucose tolerance. Positive if 2 of 3 BS levels are elevated.
Presentation: intermittent episodes of abrupt-onset palpitations and a sensation of a racing heartbeat.
EKG: narrow-complex tachycardia with regular R-R intervals and often retrograde p waves
Diagnosis?
Paroxysmal supraventricular tachycardia
EKG: short PR, delta at beginning of QRS, wide QRS
Diagnosis?
Wolff-Parkinson-White, associated with development of AVRT. Increased risk of symptomatic paroxysmal SVT
Management of MI due to cocaine intoxication
Benzos and nitro (BB are contraindicated)
CCBs for persistent chest pain
Phentolamine for persistent HTN
PCI for MI
Toxicities associated with Trastuzumab?
Cardiomyopathy, usually reversible with discontinuation
Pulmonary toxicity
ACS medical management
Dual antiplatelet meds: ASA, plavix/platelet P2Y12 receptor blocker Nitrates Beta Blocker Statin AC (heparin, etc.)
Indications for cardiac re-synchronization with biventricular pacing
LV EF <35%
NYHA class II-IV (presence of ANY Sx)
LBBB with QRS >150msec
Treatment for group 1 (idiopathic) pulmonary hypertension
Dual therapy: Endothelin receptor antagonist (bosentan, ambrisentan) + phosphodiesterase 5 inhibitor (tadalafil, sildenafil)
Characteristics of pain associated with lumbar spinal stenosis
Disappears/decreases when sitting down
Increases with spine extension
Decreases with spine flexion
murmur of VSD?
harsh holosystolic at left 3rd/4th intercostal space, often with palpable thrill
work-up for suspected marfan’s for sports physical clearance?
Echo - r/o aortic root disease
Antibiotics for uncomplicated cystitis in pregnancy?
Nitrofurantoin
Cephalexin
Fosfomycin
Amox-clauv
NO BACTRIM -> NT defects
No tetracyclines, no flouroquinolones
Antibiotics for pyelo in pregnancy?
Ceftriaxone or cefepime until afebrile >48hrs, then switch to oral for 10-14 d
How to confirm diagnosis of sarcoid?
Excisional lymph node biopsy -> see noncaseating granulomas
And rule-out other etiologies (e.g. TB)
Multifocal atrial tachycardia:
Often secondary to?
EKG findings?
Often secondary to: acute exacerbation of underlying pulmonary disease, right atrial enlargement, catecholamine surge (as in sepsis), electrolyte imbalance
EKG findings? P waves of at least 3 different morphologies, irregular R-R intervals, atrial rate >100
Palpable purpura in gravity-dependent areas, abdominal pain, arthralgias in child?
HSP
+ IgA nephropathy, later finding
abdominal pain from small bowel intussusception
Calcium and phosphate derangements in CKD?
1) decreased filtered phosphate -> phosphate retention, binds Ca, lowers free Ca, rise in PTH
2) decreased conversion to 1,25-vitamin D -> decreased intestinal Ca absorption
3) Secondary hyperparathyroidism due to above
4) can lead to autonomous PTH secretion (tertiary hyperparathyroidism) unresponsive to rising Ca -> bone pain, high alk phos -> needs parathyroidectomy
Adverse effects of amiodarone?
Pulmonary toxicity Photosensitivity Skin discoloration Thyroid dysfunction Bone marrow suppression Abnormal LFTs
Most common bug in erysipelas?
Group A strep
Conditions associated with high SAAG?
With low SAAG?
SAAG = serum albumin - ascites albumin
High (>1.1) = CHF, hepatic cirrhosis, alcoholic hepatitis
Low (<1.1) = peritoneal carcinomatosis, peritoneal TB, nephrotic syndrome, pancreatitis, serositis
Early signs of CP?
Work-up recommended?
Delayed disappearance of neonatal reflexes, persistent or asymmetric fisting, hypertonia/spasticity, hyperreflexia, sustained clonus, delayed motor milestones
Recommend MRI brain
Cat scratch disease: presentation and treatment?
Presentation: cutaneous lesion and regional LAD following cat scratch.
Tx: Azithromycin
Treatment of scleroderma renal crisis?
ACE i (captopril, due to rapid onset) +/- IV nitroprusside if in HTN emergency
Treatment of B12 in patients with severe megaloblastic anemia can cause what metabolic derangement?
Hypokalemia, especially within the first 48 hours
Abx choice for human and mammal bites?
Amox/clauv or ampicillin/sulbactam (if IV needed)
Mitral stenosis:
characteristic murmur?
clinical presentation?
Murmur: loud first heart sound and mid-diastolic rumble
Presentation: DOE, orthopnea, PND
Tx for hemodynamically significany bradycardia?
IV atropine
Screening test for Cushing’s?
When to suspect?
Dexamethasone suppression test or 24hr urinary free cortisol
Suspect in: hypertension, hyperglycemia, osteoporosis, mood swings, hypokalemia, metabolic alkalosis
Tx for ITP?
If platelets >30k and no bleeding, ok to observe
If platelets <30k or if bleeding: corticosteroids
Symptoms of digoxin toxicity?
nausea, vomiting, anorexia, fatigue, confusion, visual disturbances, cardiac abnormalities.
Can be precipitated by: verapamil, quinidine, amiodarone
