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Medicine > step 3 9 > Flashcards

step 3 9 Flashcards

1
Q

CREST vs scleroderma

A

CREST is limited, no join, heart, lung, or kidney involvement

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2
Q

PM/DM orders

A

LFT’s

ANA

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3
Q

clinical significance of anti-Jo-I in PM/DM

A

increased risk of ILD

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4
Q

most common serious threat to life from DM/PM

A

cancer

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5
Q

special features of Takayasu’s arteritis

A

loss or decrease of pulse + TIA/stroke

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6
Q

behcet’s presentation

A

Oral and genital ulcers
ocular involvement
skin lesions
CNS disease

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7
Q

cutoff for synovial fluid cell count in septic arthritis

A

over 50,000 suggests infectious

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8
Q

CCS gout orders

A

joint fluid examination for cell count, culture, protein
serum uric acid
x-ray showing punched-out lesions
Extremity exam for tophi

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9
Q

gout management

A 
Treat flare with NSAIDs
IF refractory → steroids
If single joint → intraarticular
If multiple joints → oral steroids
IF renal insufficiency + within 24 hours of attack --> colchicine
PPX → allopurinol
IF not tolerating → febuxostat
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10
Q

pseudogout clinical presentation differentiators

A
  • knee and wrist involved, no toes
  • slower in onset
  • less severe
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11
Q

gout management

A 
Treat flare with NSAIDs
IF refractory → steroids
If single joint → intraarticular
If multiple joints → oral steroids
IF renal insufficiency + within 24 hours of attack --> colchicine
PPX → allopurinol
IF not tolerating → febuxostat
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12
Q

septic arthritis management

A

ortho consult
tap the joint (arthrocentesis)
Empiric abx → CTX + vancomycin IV

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13
Q

plantar fasciits vs. tarsal tunnel syndrome

A

tarsal tunnel is more painful with use + may need steroids/surgery

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14
Q

CCS sickle cell workup

A

blood cultrues
UA
retics + CBC
CXR

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15
Q

sickle cell management

A 
Pain:
oxygen
IVF with NS
IF fever → *****CTX
L-glutamin
Folate replacement
Tight BP control
Pneumovax
Hydroxyurea (titrate up until fetal Hg is 15%, pain stops, or WBC starts to drop)
Enoxaparin
IF 
drop in Hgb/HCT → consider parvovirus B19 or folate deficiency
severe hyperbilirubinemia OR visual disturbance OR pulmonary infarction OR priapism OR stroke → exchange transfusion
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16
Q

hemoglobin sickle cell disease

A

milder version, only renal problems (hematuria, isosthenuria, UTI’s)

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17
Q

treatment of cold-induced hemolysis

A

rituximab

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18
Q

transfusion reactions

A

Shortness of breath → TRALI → no treatment, resolves spontaneoulsy
Anaphylaxis → IgA deficiency. Confirm + use blood donations in future from IgA deficient donor.
Hemolysis → ABO incompatability
Delayed jaundice → minor blood group incompatability
Bump in temperature → Febrile nonhemolytic reactions .

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19
Q

AML treatment

A

idarubicin (daunorubicin) and cytosine arabinoside

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20
Q

APML treatment

A

ATRA

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21
Q

ALL treatment

A

intrathecal methotrexate

22
Q

agent that extends survival most in CLL

A

fludarabine

23
Q

erythrocytosis system

A

Order ABG to exclude hypoxia → if normal get epo level + hematology consult + nuclear red cell mass test for JAK2 (PV)

24
Q

PV treatment

A 
Phlebotomy
Hydroxyurea
Aspirin daily
IF thrombocythemia → anagrelide
B12 + LAP
25
Q

myeloma treatment

A 
melphalan
steroids
Possibly thalidomide/lenalidomide/bortezomib
Serial BMP’s to monitor for renal failure
IF hypercalcemia → hydration/diuresis
IF bone fractures → bisphosphonates
IF renal failure → hydration
IF anemia → epo
Flu, pneumovax, tetanus ppx
IF young with advanced disease → BMT
26
Q

B symptoms of lymphoma

A

fever, weight loss, night sweats

27
Q

APA syndrome treatment

A

heparin followed by warfarin

28
Q

thrombophilia differential

A

APA syndrome, protein C deficiency, factor V leiden, antithrombin deficiency

29
Q

HIT diagnosis and management

A

diagnostic:
Platelet factor 4 antibodies or heparin-induced antiplatelet antibodies
treatment:
Stop heparin → switch to NOAC

30
Q

reversal drug for warfarin toxicity

A

Prothrombin comple concentrate (PCC) (works faster than vitamin K or FFP)

31
Q

Uremia induced platelet bleeding treatment

A

desmopression

32
Q

ITP management

A

If severe bleeding → IVIG OR RHOGAM FIRST
If platelet count > 50,000 → no treatment
If platelet count <50,000 with minor bleeding → prednisone
If CHRONIC and no response to splenectomy → ROMIPLOSTIM AND ELTROMBOPAG

33
Q

thrombocytopenia management

A

Check to see if on heparin or cirrhotic → If no and generally healthy prob ITP: start prednisone → then Peripheral smear + US of LUQ + test antibodies to glycoprotein IIb/IIIa receptor

34
Q

folliculitis treatment

A

topical mupirocin

35
Q

genital herpes management

A

Treat empirically with acyclovir x 7 days
If diagnosis unclear → tzanck smear
IF recurrent → daily suppressive therapy
IF refractory → foscarnet

36
Q

herpes zoster management

A

diagnose clinically
watch out for complications → pneumonia, hepatitis, dissemination
acyclovir ASAP
Pain management options → *gabapentin, TCA’s, topical capsaicin
IF severe pain + elderly → steroids
IF nonimmune → give zoster immune globulin within 96 hours of exposure

37
Q

genital warts management

A

Clinical diagnosis
IF person concerned about damage to surrounding tissue or pain → imiquimod (takes several weeks though)
IF not concerned and just want to get rid of them → cryotherapy or trichloracetic acid

38
Q

scabies treatment

A

permethrin

39
Q

treatment of pediculosis

A

OTC pyrethrins

40
Q

toxic shock syndrome management

A

ICU transfer
High volume IVF
Pressors → dopamine
ABX targeting MSSA + MRSA → vancomycin + oxacillin/nafcillin/cefazolin

41
Q

staphylococcal scalded skin syndrome treatment

A

Transfer to burn unit

Oxacillin/nafcillin

42
Q

anthrax treatment

A

ciprofloxacin or doxycycline

43
Q

SK management

A

Remove only if cosmetically bothersome to patient with liquid nitrogen or curettage

44
Q

melanoma management

A

BRAF inhibitor + surgery and possible radiation

IF unresectable → talimogene (genetically modified herpes virus)

45
Q

BCC management

A

Shave or punch biopsy

Mohs microsurgery

46
Q

kaposi management

A

HAART, raise CD4 count

If no rise, give liposomal adriamycin and vinblastine

47
Q

koebner phemonenon

A

development of psoriasis at site of skin injury

48
Q

normal anion gap

A

below 16

49
Q

seborrheic dermatitis management

A

hydrocortisone (or other low potency topical steroid on F)
ketoconazole (or selenium sulfide)
zinc pyrithione shampoo

50
Q

contact dermatitis diagnosis and management

A 
Diagnostic:
patch testing 
Treatment:
Antihistamines
topical steroids

Medicine (71 decks)

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