6 Flashcards Preview

step3 > 6 > Flashcards

Flashcards in 6 Deck (32)
Loading flashcards...

Treatment of pneumocystis jirovecii pneumonia (likely in setting of HIV)

- adjunctive treatment with corticosteroids if alveolar to arterial gradient is greater than 35mmHg or arterial oxygen tension of 70 or less in patients on RA


Clinical findings of drug induced lupus, and diagnostic test?

- multisystem involvement: fever, malaise, myalgia, arthralgia/arthritis, serositis (pleuritis, pericarditis) and/or hepatomegaly/splenomegaly
- test for ANA and anti-histone antibodies


which drug induces lupus?

- procainimide
- hydralazine
- minocycline
- TNF-alpha; etanercept, infliximab


Steps in diagnosing c.diff

1. enzyme immunoassay or PCR (more sensitive) for toxins A and B
2. negative lab testing and clinically high suspicion then proceeds to colonoscopy or limited sigmoidoscopy to document pseudomembranous colitis


Management of recurrent UTI in young women

- prophylactic abx: fluoroquinolones, TMP-SMX, nitrofurantoin
- abdominal US only if there's obstruction or nephrolithiasis


How to diagnose brain death (neurologic exam?)

- clinical/imaging of brain damage
- absence of confounding factors
- hemodynamic stability
- absence of cortical and brainstem function (pupillary, oculocephalic, oculovestibular (caloric), corneal, gag, sucking, swallowing, and extensor (posturing)
- reflexes can still be present, but originating from peripheral nerves


Most common risk factors of carpel tunnel syndrome

- diabetes
- RA
- hypothyroidism
- others: wrist trauma, ESRD, obesity, pregnancy, acromegaly, menopause


Treatment of carpel tunnel syndrome

- splint
- if splint fails, then corticosteroids injection
- surgery only if hypothenar eminence, motor weakness


3 important clinical criteria for diagnosing ankylosing spondylitis

- lower back pain and stiffness for >3 months that improves with activity
- limitation on ROM of lumbar spine
- limitation of chest expansion relative to normal values
- ddx with x-ray of sacroiliac spine


Most common extraarticular manifestations of ankylosing spondylitis

- acute anterior uveitis
- aortic regurg, MVP
- apical pulmonary fibrosis
- IgA nephropathy
- restrictive lung disease


Treatment of bacterial enteritis in children, when is abx recommended and when is it not?

- oral rehydration
- abx recommended in immunocompromised kids, age <3 months, cholera, invasive disease (sepsis, osteomyelitis, meningitis)
- abx not recommended in e.coli O157:H7 infx due to HUS


Presentation of tinea versicolor and diagnosis, treatment

- noninvasive fungal infection, multiple small macula that vary in color.
- TV ddx by KOH prep which will show yeast and hyphae
- treatment: topical antifungal


Intermittent episodes of chest pain, dysphagia, and "corkscrew" esophagus on barium swallow. Ddx?

diffuse esophageal spasm
can sometimes present without corkscrew.
normal relaxation of LES


Signs of chronic lithium toxicity >1.5mEq

neuromuscular excitability


treatment of lithium toxicity

- IV hydration
- bowel irrigation
- if >4mEq or >2.5mEq with renal failure then HD


In patients with PE, if low grade fever is present and WBC is elevated, what should you do?

- get blood culture but don't start empiric abx therapy as low grade fever is normal with PE


Necessary step in managing hypothermic patients with hypoventilation, hypoxemia and AMS

- intubation
- active rewarming measures; if severe hypothermia (<82F) then warm humidified oxygen and warm peritoneal lavage. Otherwise, warm IV fluids with 1-2 C/hour.


Severe PID treatment (usually gonorrhea and chlamydia)

- IV cefoxitin and IV doxy
- IV ceftriaxone and IV doxy


When is hypothyroidism treatment warranted?

In the presence of:
- sx of hypothyroidism
- antithyroid antibodies
- abnormal lipid profile
- ovulatory and menstrual dysfunction


Treatment of recurrent c.diff

- first recurrence: metronidazole for nonsevere, vanc for severe
- second: pulsed tapering oral vanc 6-7 weeks
- subsequent relapses: fidaxomicin, fecal microbiota transplant


genital warts turning white with acetic acid application, ddx? treatment?

condylomata acuminate
- trichloroacetic acid application, then surgery if not effective


carbamazepine SE

- bone marrow suppression: neutropenia, aplastic anemia, thrombocytopenia
- hyponatremia, SIADH
- glaucoma
- anticholinergic effects


What medications are indicated for diabetic patients with renal failure/metabolic acidosis?

piloglitazone, rosiglitazone, acarbose, repaglinide are alternatives
need to stop metformin and glyburide


what is melasma?

acquired hyperpigmentation disorder that occur in sun-exposed areas
*risk increases during pregnancy, resolves spontaneously


Clinical features of ITP

- antecedent viral infection
- asymptomatic petechiae and ecchymosis
- mucocutaneous bleeding
- normal spleen size
- large platelets


Treatment of ITP

- platelets >30,000 w/o bleeding: observe
- platelets <30,000 OR bleeding: IVIG or steroids
- recurrent episodes: splenectomy


When is CBC w/ diff and blood culture required in newborns with GBS? When is observation for 48 hours required?

- preterm (<37 weeks)
- prolonged rupture of membranes (>18 hours)
- 48 hours obs if abx ppx given within 4 hours of birth (ampicillin, cefazolin or penicillin) or the opposite of the above


PFT results for asthma, and for asymptomatic asthma

- asthma: reduced FEV1/FVC, normal or elevated TLC and DLCO
- asymptomatic asthma: may have normal PFT, need methacholine challenge


acute abdominal pain, significant tenderness and guarding, lies perfectly still. Ddx and best initial test?

Bowel perforation with peritonitis
chest x-ray and abdominal x-ray


Metoclopromide, D2 receptor blocker, has what SE?

- akathisia
- dystonia
- parkinson like sx