Step 2 Flashcards
(21 cards)
Manage a patient with a history of infective endocarditis before a dental procedure
RX: Amoxicillin and cephalosporins, such as cephalexin, are frequently prescribed. Clindamycin, azithromycin, or clarithromycin are appropriate alternatives in patients with penicillin allergy
Prophylaxis is needed in patients with a prosthetic cardiac valve, a history of infective endocarditis, unrepaired cyanotic congenital heart disease, congenital heart disease repair with prosthetic material or device within the last 6 months, palliative shunts and conduits, or cardiac valvulopathy in cardiac transplant recipients.
Myelodysplastic syndrome can be a late adverse consequence of combination chemotherapy and radiation therapy
Jak-Stat
Patients have signs and symptoms referable to a specific cytopenia (most often, megaloblastic anemia) and bone marrow findings showing a hypercellular marrow with dyserythropoiesis
White coat hypertension
Ambulatory blood pressure monitoring is considered the gold standard for diagnosing this condition
White coat hypertension is characterized by at least three separate office blood pressure measurements above 140/90 mm Hg and at least two sets of measurements below 140/90 mm Hg obtained outside the office, accompanied by the absence of target organ damage
Listeria monocytogenes meningitis
ampicillin (or penicillin G)
In patients who are allergic to penicillin, trimethoprim-sulfamethoxazole is an alternative agent
Manage a patient with ventricular fibrillation arrest in the setting of acute myocardial infarction
Cardiac arrest within the first 48 hours of an acute transmural myocardial infarction does not require secondary prevention therapy other than standard postmyocardial infarction care
Diagnose von Willebrand disease
dx: antigen determination
rx: desmopressin
Von Willebrand disease should be suspected in a patient presenting with easy bruising or mucocutaneous bleeding, or heavy menstrual blood flow, or excessive postoperative bleeding, and a strong family history of a bleeding disorder
Prevent progression of chronic kidney disease
angiotensin-converting enzyme [ACE] inhibitors or angiotensin receptor blockers [ARBs]
The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends a target blood pressure of less than 140/90 mm Hg for patients with kidney disease
Other guidelines suggest a lower blood pressure goal of 130/80 mm Hg in patients with chronic kidney disease and significant proteinuria (eg, 500 mg/d) or with diabetes
Gout
Because gout is associated with hyperuricemia, patients with recurrent episodes (≥2 attacks in 1 year) usually benefit from urate-lowering therapy to prevent both future attacks and occult urate deposition. However, the addition of urate-lowering therapy transiently increases the risk for acute gout attacks for at least 3 to 6 months; accordingly, prophylaxis with an anti-inflammatory agent such as colchicine, at least during that period, is indicated concurrent with urate-lowering therapy
likelihood ratios
LR(+) values of 2, 5, and 10 correspond to an increase in disease probability by 15%, 30%, and 45%, respectively; LR(-) values of 0.5, 0.2, and 0.1 correspond to a decrease in disease probability by 15%, 30%, and 45%, respectively.
Evaluate a patient with a high pretest probability of endocarditis
Transesophageal echocardiography is the initial test of choice in patients who have a moderate or high pretest probability of endocarditis.
Diagnose inflammatory bowel disease
Rx (alarm signs): colonoscopy
Patients with gastrointestinal symptoms and the presence of alarm symptoms (weight loss, anemia, fever, chronic severe diarrhea, family history of gastrointestinal disease) should undergo further evaluation; this recommendation includes evaluation for younger patients with these findings who are at increased risk for inflammatory bowel disease
Diagnose primary Sjögren syndrome (sicca syndrome)
he presence of xerophthalmia and xerostomia accompanied by anti-Ro/SSA and anti-La/SSB antibody positivity and abnormal findings on the Schirmer test have a 94% sensitivity and specificity for the diagnosis of primary Sjögren syndrome.
Manage hyperglycemia in a patient in the medical intensive care unit
the optimal glucose management for critically ill hospitalized patients is unknown, but an insulin drip with a glycemic target plasma glucose level of 140-200 mg/dL (7.8-11.1 mmol/L) is reasonable.
Insulin is the mainstay therapy for the hyperglycemic state in critically ill patients, and oral antihyperglycemic agents, such as metformin (lactic acidosis), should be stopped
Expected Pco2 eq
Expected Pco2 = (1.5 × [HCO3] + 8) ± 2 = 26 ± 2
Anion Gap eq
Anion Gap = [Na+] - ([Cl−] + [HCO − 3])
Anion Gap Metabolic Acidosis: MUDPILERS
Methanol - Uremia - DKA/Alcoholic KA - Paraldehyde - Isoniazid - Lactic Acidosis - Etoh/Ethylene Glycol - Rhabdo/Renal Failure - Salicylates
Non-Anion Gap Acidosis: HARDUPS
Hyperalimentation Acetazolamide Renal Tubular Acidosis Diarrhea Uretero-Pelvic Shunt Post-Hypocapnia Spironolactone
Corrected [HCO3] - Delta gap
Corrected [HCO3] = measured [HCO3] + (measured anion gap – 12)
(AG – 12) \_\_\_\_\_\_\_\_\_\_\_ DELTA GAP (24 - [HCO3¯]) 1. < 0.4 due to a pure NAGMA 2. 0.4 - 0.8 due to a mixed NAGMA + HAGMA 3. 0.8 - 2.0 due to a pure HAGMA 4. >2.0 due to a mixed HAGMA + metabolic acidosis
TTP pentad mnemonic
TTP pentad mnemonic = FAT RN
Fever, Anemia, Thrombocytopenia, Renal, Neuro Symptoms
All features DO NOT need to be present at the same time
Consider diagnosis without the full pentad
Microangiopathic Hemolytic Anemia (MAHA)
Thrombocytopenia
Fever
Renal pathology
CNS abnormalities (headache, seizure, altered mental status, CVA, coma)
Neuro symptoms are often transient, may not be present in ED
TTP pathophys
Insufficient ADAMTS-13 activity allows vWF multimers to accumulate in microcirculation which leads to platelet aggregation/thrombocytopenia and hemolysis of RBCs
Evaluate for ischemia in a patient with new-onset heart failure and a high pretest probability of coronary artery disease
coronary angiography is indicated in the evaluation of new-onset heart failure in patients with angina or new-onset left ventricular dysfunction in the setting of a condition that may predispose to silent ischemia
Diagnose chronic obstructive pulmonary disease (COPD)
Spirometry is essential for diagnosing COPD and assessing its severity. A postbronchodilator FEV1/FVC ratio of less than 70% confirms airflow limitation.
Diagnose Gilbert syndrome
reassurance
Gilbert syndrome is a common and frequently incidentally discovered cause of indirect (unconjugated) hyperbilirubinemia that usually does not require evaluation or treatment.
