step 3 19 Flashcards

1
Q

Slipped capital femoral epiphysis management

A

immediate surgical pinning

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2
Q

salicylate toxicity presentation

A

nausea and vomiting, tachypnea with respiratory alkalosis, lactic acidosis, hyperthermia, and altered mental status

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3
Q

most common cause of pathologic nipple discharge

A

papilloma

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4
Q

management of family or parents who want futile care

A

involve ethics committee

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5
Q

AK management

A

Cryodestruction is the most commonly employed method for treating solitary or few AKs. Biopsy is indicated for AK lesions that are >1 cm in diameter, indurated, ulcerated, tender, or growing rapidly, or for those lesions that fail to respond to appropriate therapy.

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6
Q

horner syndrome presentation

A

ptosis, miosis, anhidrosis

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7
Q

preferred initial treatment for preschool-age children with attention-deficit hyperactivity disorder

A

parent-child behavioral therapy

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8
Q

management of failed response to stimulant for ADHD

A
  • switch to different stimulant or switch to a nonstimulant medication such as atomoxetine or an alpha-2 adrenergic agonist.
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9
Q

allergen responsible for most asthma cases

A

house dust mites

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10
Q

management of patient refusing therapy

A

assess decision making capacity

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11
Q

next step after testicle US shows findings concerning for cancer

A

serum tumor markers and screening CT scans is required.

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12
Q

medicare subsections

A

Medicare part A covers primarily inpatient services. Part B covers outpatient services. Part C (Medicare Advantage) allows enrollment in private insurance plans. Part D covers prescription drugs.

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13
Q

PE findings on physical exam

A

loud P2 and pleural friction rub on physical examination, hypoxemia, and small pleural effusion on chest x-ray (commonly due to inflammation from pulmonary infarct),

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14
Q

length time bias

A

survival benefits of a screening test are overstated due to the detection of a disproportionate number of slowly progressive, benign cases.

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15
Q

Indications for coronary revascularization

A

Patients with refractory angina despite maximal medical therapy
Patients in whom revascularization will improve long-term survival. This includes those with left main coronary stenosis and those with multivessel CAD (especially involving the proximal LAD) along with left ventricular systolic dysfunction.

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16
Q

causes of lithium toxicity

A

narrow therapeutic index
volume depletion and drug interactions with thiazide diuretics, ACE inhibitors, and nonsteroidal anti-inflammatory drugs.

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17
Q

management of lithium toxicity

A

dialysis

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18
Q

hypoglycemia workup

A

A serum assay for oral hypoglycemic agents + serum insulin + C-peptide + proinsulin

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19
Q

prenatal lab tests at 35-37 weeks

A

Group B Streptococcus culture

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20
Q

prenatal lab tests at 24-28 weeks

A

Hemoglobin/hematocrit
Antibody screen if Rh(D) negative
50-g 1-hour GCT

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21
Q

labs at initial prenatal visit

A
Rh(D) type, antibody screen
Hemoglobin/hematocrit, MCV
HIV, VDRL/RPR, HBsAg
Rubella & varicella immunity
Pap test (if screening indicated)
Chlamydia PCR
Urine culture
Dipstick for urine protein
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22
Q

biomarker of window period in hep b

A

IgM anti-HBc

23
Q

management of patient with an isolated elevation of anti-HBc

A
  • need to rule out false positive and assess acute infection

- LFT’s + IgM anti-hbc

24
Q

normal findings in acute grief

A

may wish to die to join the deceased and may also experience visions or hear the deceased person’s voice.

25
Q

Normal grief vs depression

A

normal grief can be differentiated from major depressive disorder in that the feelings of sadness revolve around the deceased and are less pervasive, typically occurring in waves following reminders of the person. Guilt and suicidal ideation are less common, and self-esteem is preserved. If thoughts of dying are present, they typically involve joining the deceased. Hearing the voice or seeing images of the deceased are also consistent with normal grief and do not indicate a psychotic disorder. This patient’s depression and thoughts of death revolve around her deceased husband and are not associated with feelings of worthlessness and hopelessness.

26
Q

lactational mastitis treatment

A

oral dicloxacillin and cephalexin.

27
Q

gold standard for hirschprung’s disease

A

Rectal suction biopsy (looking for absence of ganglion cells)

28
Q

hirschprungs vs. meconium ileus

A

hirschprungs has a transition zone between a normal or narrow caliber rectosigmoid (aganglionic segment) and a normally innervated but markedly dilated descending colon (Image).

29
Q

presentations of ED in diabetic patients

A

diminished testicular sensation, bladder dysfunction, and inability to masturbate.

30
Q

management of patient with bee or wasp sting allergy

A

referred to an allergist for venom immunotherapy

31
Q

management of asthma patient with thrush

A

observed for proper use of his inhaler, as the thrush may be a sign that he is using it improperly with a large amount of the medicine depositing in his oropharynx as opposed to passing into his lungs. A spacer device may be helpful for the patient if he is having trouble.

32
Q

strategies for SSRI induced ED

A

switching to the non-SSRI antidepressants bupropion or mirtazapine, augmentation with sildenafil or bupropion, and cautious dose reduction in patients taking high-dose SSRIs.

33
Q

when DEXA screening should happen

A

Bone density screening should begin at age 65 in women without risk factors. Postmenopausal women age <65 may be screened if they have risk factors such as body weight <58 kg (127 lb), chronic steroid use, smoking, malabsorptive disorders (eg, pancreatic insufficiency in cystic fibrosis), and parental history of hip fracture or personal history of low-impact fracture.

34
Q

levothyroxine management for patient with thyroid cancer

A

if large tumor, suppress to low normal, which has been shown to reduce risk of recurrence.

35
Q

otitis externa management

A

For mild OE with minimal erythema and edema, topical acidifiers (eg, acetic acid, Domeboro solution) for 7-10 days are usually adequate. For moderate OE with more significant pain, erythema, and edema (as in this patient), topical antibiotics (eg, ciprofloxacin, neomycin/polymyxin) are recommended.

36
Q

aspiration pneumonitis presentation

A

depressed level of consciousness, a history of vomiting, and respiratory distress shortly after an aspiration event

37
Q

dialysis indications

A

uremia, intractable hyperkalemia, hypervolemia, and metabolic acidosis.

38
Q

what are RCT’s used for?

A

efficacy of drugs and interventions. not powered enough to study for adverse effects, this is what postmarket surveillance is for.

39
Q

breast discharge differential

A

endocrine abnormalities (eg, hyperprolactinemia, thyroid disease), medications (eg, antipsychotics, gastric motility agents), stress, and excessive breast/nipple stimulation.

40
Q

pneumo management

A

If large and due to ventilator – chest tube.

41
Q

pneumothorax management system

A

assess for tension physiology (blood pressure, JVD, tracheal deviation).
If no tension signs → chest tube
if signs of tension → needle decompression

42
Q

restless leg syndrome workup

A

order ferritin (can be symptom of iron deficiency but don’t need to be anemic)

43
Q

management of pregnant patient with history of preeclampsia

A

aspirin is used for preeclampsia prevention and is started at 12 weeks gestation (thought to be due to increased platelet aggregation and vasoconstriction)

44
Q

first step in onychomycosis

A

KOH prep (psoriasis, lichen planus can mimic the appearance of onychomycosis, confirmation with potassium hydroxide (KOH) preparation or culture of nail scrapings is recommended)

45
Q

post MI orders

A

Dual antiplatelet therapy with ASA + clopidogrel or ticagrelor
Beta-blocker
statin
ACEi
Evaluation and risk stratification (eg, transthoracic echocardiogram, myocardial perfusion stress test, possibly coronary angiography).

46
Q

major depressive disorder criteria

A

> 2 weeks of at least 5 of 9 symptoms that include depressed mood plus SIGECAPS: Sleep disturbance, loss of Interest, Guilt, low Energy, impaired Concentration, change in Appetite, Psychomotor retardation or agitation, and Suicidal thoughts

47
Q

how to reduce risk of opioid misuse

A

monitoring state prescription drug-monitoring program databases, performing random urine drug screening, and scheduling frequent follow-up visits.

48
Q

breast cyst management

A
  • if asymptomatic, observe
  • if symptomatic, FNA — if bloody, biopsy, if nonbloody and cyst resolves - repeat US in 4-6 weeks, if persistent biopsy
49
Q

periodic breathing in kids

A

physiologic pattern of breathing in young infants characterized by episodes of alternating pauses (5-10 seconds) in breathing and rapid breathing ( thought to be secondary to recurrent central apnea due to immaturity of the nervous system in infants up to age 6 months. There is no associated cyanosis, change in tone, or abnormal limb/eye movements)

50
Q

how to reduce snoring

A
  • don’t drink before bed

- quite smoking

51
Q

STOP-bang test characteristics

A

poor positive predictive value but high negative predictive value for OSA

52
Q

cutoff for impaired vs normal EF

A

60%

53
Q

definition of primary and secondary mitral valve insufficiency

A
  • mitral valve insufficiency that results from an intrinsic defect of the mitral valve apparatus (eg, leaflets, chordae tendineae)
  • Secondary (or functional) MR refers to that occurring due to a disease process involving the left ventricle (eg, myocardial ischemia, dilated cardiomyopathy).