Step3 UWorld Flashcards
(47 cards)
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
