USMLE STEP 3 Flashcards
Pertussis treatment
azithromycin or clarithomycin; start prophylactic treatment in everyone > 6 months
Erythromycin side effect in children
Risk of hypertrophic pyloric stenosis
Definitive treatment of hemochromatosis
deferoxamine
Causes of hemochromatosis
Primary (HFE gene) and secondary (requiring frequent blood transfusions)
Atraumatic hip pain in children
transient synovitis most common cause
Legg Calves Perthes
avascular necrosis of the femoral head
Hemodynamically unstable w/ no known source after EGD?
Angiography. If HDS, consider colonoscopy
If patient is having left lower quadrant pain and low grade fever, is colonoscopy indicated?
No, colonoscopy is contraindicated for risk of colonic perforation in diverticulitis
Risk of injured structures in lateral horizontal eyelid laceration?
orbital septum and levator palpebrae
Risk of injured structures in medial horizontal eyelid laceration?
Canaliculi, punctum and nasolacrimal duct injury
Proper timing of intercourse for conception?
Days 9 - 16
Infertility definition
> 12 months for < 35 yo; > 6 months for > 35 yo
When to get chromosomal analysis for infertility?
Patients with oligospermia or azoospermia on semen analysis or in women w/ > 3 spontaneous abortions
Chronic pain, immobile uterus, and pelvic nodularity are indicative of what?
Endometriosis; consider pelvic laparoscopy for improvement of fertility
Serum ascites albumin gradient
= serum albumin value - ascites albumin value
Portal hypertension is indicated by what?
SAAG > 1.1; but can also be seen with:
CHF
cirrhosis
alcoholic hepatitis
Budd-Chiari
Differential for SAAG < 1.1
malignancy of abdominal organs
tuberculosis
nephrotic syndrome
pancreatitis
serositis
Hypoparathyroidism treatment
Calciferol (25-OH-vitamin D); calcitriol (1,25-vitamin D); CalciFERol is preferred because it has been shown to be effective and is cheaper
Hypoparathyroidism pathology
Low PTH -> lack of conversion of 25-OH-vitamin D to 1,25-vitamin D -> high urinary exceretion of calcium and lack of phosphorous secretion
Organs important for vitamin D synthesis
Liver (25 position) is step 1 of hydroxylation and kidney is step 2 (1 position)
Next step in treatment of hypoPTH patient already receiving calcium and vitamin D
Consider addition of thiazide to
1) decrease urinary calcium
2) increase serum calcium
Risk of oxybutynin
anticholinergic effects -> delirium and falls; risks also present in patients with mysathenia gravis and glaucoma
Valproate pregnancy effects
neural tube defects, craniofacial abnormalities, microcephaly, growth retardation, cleft lip, limb defects, genital abnormalities
Bipolar patients contraindicated drugs
antidepressant monotherapy