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Flashcards in Second half Deck (21):
1

What is the ddx for acute drop in hgb in kids with SSD?

1.) Aplastic crisis: retic down
2.) Splenic sequestration: retic up

2

What are the features of nonbacterial chronic prostatitis and tx?

Lower abdominal, perineal, or genital pain. > 20 WBCs/hpf on urinalysis after DRE, no need to massage. CULTURE NEGATIVE. Tx with sitz bath and anti-inflammatory.

3

Who needs Neisseria meningitidis ppx when exposed and what is the ppx?

PPx with cipro. PPx close contacts...defined as >8h exposure in close proximity (3 ft) to the affected patient or direct exposure to respiratory secretions within 7d of onset of sxs. Persons include household members, roommates, child care center workers, persons exposed to ETT secretions/involved in mgmt, airline travelers seated next to an affected person for 8+ hours.

4

How is delayed puberty diagnosed and what are the considerations?

14 years of age with no testicular enlargement or diameter<2.5 cm. 5 years delay without onset of testicular enlargement is another criterion. First step in work up is determining bone age with wrist XR as constitutional delay is number one cause. Bone age older or equal to chronological age warrants work up for endocrine or chromosomal disorders.

5

Path, key features and tx of primary biliary cholangitis?

Caused by T cells attacking intrahepatic bile ducts leading to fibrosis. Middle age N.European women. Alk phos elevation is key. Sxs include fatigue, pruritis, steatorrhea, HLD and xanthelasmata. Dx with AMA and bx. Osteoporosis frequently develops.

6

What is the pathophysiology of a diverticular bleed?

Outpouching herniates the muscular layers making it easier for a penetrating artery to be exposed and eroded.

7

Who warrants closer CRC screening and what is their schedule?

First-degree relative before 60 years or more than 2 first-degree relatives at any age. Screen at 40 or 10 years before the age of cancer diagnosis, repeat q3-5 years.

8

When is genetic testing for breast cancer recommended?

2 first-degree relatives with breast cancer, including 1 before age 50.
3 first or second degree relatives with breast cancer.
1st or 2nd degree relative with breast and ovarian.
1st degree with bilateral breast cancer.
Breast ca in male relative.
Ashkenazi Jewish women with 1st/2nd degree relative with either breast or ovarian.

9

What is Turner's syndrome, associated defects, and recommended screening at dx?

45XO, often short stature and hypogonadism. Associated defects including hearing/visual loss, cardiac defects, horseshoe kidney, and autoimmune endocrinopathy (especially PHT). At dx, test hearing/vision, get TTE, renal u/s, and TSH.

10

When do we hold metformin?

Everything is targeting risk reduction for lactic acidosis. Acute kidney injury (Cr > 1.5), hepatic dysfunction, etoh abuse, sepsis, or CHF. If undergoing contrast load with iodine, then hold day of regardless of b/l Cr and resume 48 hours later/

11

Most common extrarenal manifestation of ADPKD?

Hepatic cysts.

12

Who do you screen and dx ADPKD?

Family members since its AD, use ultrasound, 3-5 cysts is required for dx.

13

What are the essentials of juvenile myoclonic epilepsy?

Healthy adolescent presenting with upper extremity morning myoclonus and subsequent generalized tonic-clonic seizure. Sleep deprivation and etoh are common precipitants. EEG is classic for bilateral poly-spoke with slow wave discharges. Tx with valproate.

14

Early signs of compartment syndrome?

POOP, ext tightness, weakness, pain with passive muscle stretch

15

How does CKD affect Ca/phos metabolism?

CKD leads to increased phos from decreased filtered load, which leads to calcium binding, reducing serum Ca, and increasing PTH. CKD also impairs production of 1,25-OH-VitD which leads to decreased Ca absorprtion. Over time this may result in secondary hyperparathyroidism. If Ca is rising after that along with bone specific alk phos, then tertiary hyperPTH should be suspected.

16

What causes dig toxicity? What are its features?

Verapamil, quinidine, amiodarone. Nausea, vomiting, confusion, visual disturbances, arrhythmias.

17

What's the deal with B-HCG and intrauterine pregnancies?

Ultrasound cannot confirm intrauterine pregnancy below b-hcg of 1500. You have to monitor for normal increases of =/> 35% every 48 hours. If not, it is ectopic.

18

When do you stop oral contraceptives and start folate?

1 month or more prior to date of conception. Take 0.4 mg folic acid daily or 4 mg in high risk women.

19

What key drugs interact with warfarin to increase INR?

MTZ, quinolones, azoles, amiodarone, APAP.

20

What neck circumference is a risk factor for OSA?

17 in or 43.2 cm.

21

What AEDs reduce OCP efficacy?

Phenytoin, carbamazepine, ethosuximide, phenobarb, topiramate.