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Medicine > step 3 21 > Flashcards

step 3 21 Flashcards

1
Q

Treatment of gonorrhea

A

dual therapy (intramuscular ceftriaxone and a single dose of azithromycin) REGARDLESS of chlamydia coinfection status (even if PCR negative). This is to reduce the development and spread of cephalosporin resistance as first-line alternatives to ceftriaxone are quite limited

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2
Q

positive prognostic factors in schizophrenia

A 
Later onset
Female sex
Acute onset with precipitant
Predominantly positive symptoms
No family history
Short duration of active symptoms
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3
Q

deal with guardianship and decision making

A
  • guardian has to be involved in decision making process

- patient not considered competent to make decisions on her own

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4
Q

hepatic hydrothorax management

A

sodium restriction and diuretics; transjugular intrahepatic portosystemic shunt placement may be pursued in refractory cases.

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5
Q

hepatic hydrothorax clinical features

A

cirrhotic + effusion

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6
Q

overtreatment of hypothryoidism can lead to…

A

increased bone loss and atrial fibrillation

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7
Q

lateral medullary infarct (wallenberg syndrome)

A

loss of pain and temperature over the ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vestibulocerebellar impairment (eg, vertigo, nystagmus, ipsilateral limb ataxia), and Horner’s syndrome

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8
Q

acute mitral regurg management

A

Bedside echocardiogram

Emergent surgical intervention

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9
Q

acute MR presentation

A

Rapid onset of pulmonary edema
Biventricular heart failure
Hypotension, cardiogenic shock

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10
Q

gynecomastia differential

A
  • pubertal (palpable subareolar mass)

- pseudogynecomastia (deposition of fat in overweight or obese boys), which will not present as a palpable mass.

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11
Q

gross hematuria workup

A

Computed tomography urogram is recommended for the upper tract; ultrasound is an alternate test, especially for patients with chronic kidney disease.
Cystoscopy is recommended for evaluation of the lower tract, with urine cytology as an alternate test for low-risk patients.

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12
Q

treatment of SCC limited to one vocal cord

A

radiation therapy, laser excision, or partial vocal cordectomy.

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13
Q

Acute hemolytic transfusion reaction management

A

aggressive IVF

stop transfusion

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14
Q

scoliosis

A

lateral curvature of the spine

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15
Q

red flags of scoliosis suggesting further workup

A

Back pain (could be spinal cord tumor)
Neurologic symptoms
Rapidly progressing curvature (>10 degrees each year)
Vertebral anomalies on x-ray

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16
Q

cafe-au lait spot differential

A

normal

neurofibromatosis

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17
Q

methimazole vs. PTU for graves?

A

Methimazole is usually preferred due to the risk of hepatotoxicity with propylthiouracil, although propylthiouracil is recommended in the first trimester of pregnancy due to the teratogenic effects of methimazole

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18
Q

how to monitor thyroid function while using thyroid drugs

A

Serum total T3 and free T4 levels are used to assess thyroid function during treatment with antithyroid drugs. TSH may remain suppressed for several months following initiation of therapy and does not reliably reflect thyroid functional status

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19
Q

splenic sequestration in SCD

A

Splenic vaso-occlusion → rapidly enlarging spleen. Occurs in children prior to autosplenectomy. Reticulocyte count is high.

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20
Q

first line for mild-moderate plaque psoriasis

A

high-potency topical steroids (fluocinonide) twice daily for up to 4 weeks

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21
Q

shortest action acei

A

captopril (NOT ENALIPIRL), captopril and lisinopril are only ACEi’s not administered as prodrugs.

22
Q

Sex after MI?

A

Depends on risk category:

Low-risk patients can perform light-intensity exercise without symptoms and should be able to initiate or resume sexual activity. Examples include those with few CVD risk factors, controlled hypertension, asymptomatic left ventricular dysfunction, or successful revascularization of clinically significant lesions (>50%-60%).

High-risk patients should be referred for a detailed assessment prior to advising on activity. Examples include those with refractory angina, New York Heart Association class IV heart failure, significant arrhythmias, or severe valvular disease.

For indeterminate/intermediate-risk patients, stress testing is recommended to reclassify them as low- or high-risk and to help guide decisions.

23
Q

cryptorchidisim management

A
  • observation before 6 months

- orchiopexy after 6 months

24
Q

cryptorchidism complications

A

Inguinal hernia
Testicular torsion
Subfertility
Testicular cancer

25
Q

BV treatment and if pregnant

A

metronidazole or clindamycin.

26
Q

why BV should be treated in pregnancy

A
  • associated with an increased risk for pregnancy complications (eg, preterm labor). However, treatment has no impact on the incidence of these complications, and pregnant patients with bacterial vaginosis are treated only for symptom management.
  • thus only symptomatic patients need to be treated.
27
Q

CENTOR criteria and interpretation

A

The criteria are tonsillar exudates, tender anterior cervical lymphadenopathy, fever, and absence of cough. Streptococcal rapid antigen detection testing is recommended for patients who have >3 Centor criteria. Patients with <3 criteria are likely to have viral pharyngitis and do not require testing or antimicrobial treatment.

28
Q

problem with abruptio placenta and rhogam

A

need to uptitrate rhogam dose

29
Q

diffuse esophageal spasm presentation + manometry findings

A

disordered and premature simultaneous contractions of the distal esophagus with normal distal esophageal sphincter relaxation as demonstrated by manometry.

  • associated with GERD (inhibitory neurons get damaged)
  • corkscrew pattern on barium swallow
  • may present with chest pain and heartburn
30
Q

diffuse esophageal spasm treatment

A

calcium channel blockers

31
Q

neurologic sequelae of B12 deficiency

A

subacute combined degeneration

32
Q

subacute combined degeneration presentation

A

dorsal spinal column dysfunction (eg, impaired vibration, positive Romberg sign) and lateral corticospinal tract abnormalities (eg, spastic paresis, hyperreflexia), which are fairly specific for SCD

33
Q

preterm labor cutoff

A

37 weeks

34
Q

preterm labor management at 34-36 weeks

A

± Betamethasone

Penicillin if GBS positive or unknown

35
Q

preterm labor management at 32-34 weeks

A

Betamethasone
Tocolytics
Penicillin if GBS positive or unknown

36
Q

preterm labor management before 32 weeks

A

Betamethasone
Tocolytics
Magnesium sulfate
Penicillin if GBS positive or unknown

37
Q

most common factor in predisposing elderly patients to an increased incidence of adverse drug reactions

A

polypharmacy

38
Q

irritant diaper dermatitis vs. candida dermatitis

A

Irritant diaper dermatitis presents with erythema that spares the skinfolds.

39
Q

management of irritant diaper dermatitis

A

frequent diaper changes, avoidance of excessively tight-fitting diapers, exposure of the skin to air, and application of barrier creams (eg, zinc oxide, petrolatum).

40
Q

first steps with suspected child abuse

A

1) perform complete thorough exam with clothes removed

2) hospital admission

41
Q

residual effects of anesthesia presentation

A

severe hypoventilation leading to hypercapnic and hypoxic respiratory failure in the early postoperative period. In such patients, the alveolar-arterial gradient is normal and hypoxemia typically corrects with supplemental oxygen.

42
Q

presentation of post of atelectasis

A

an occur 2-5 days following surgery; however, it is uncommon immediately following surgery. In addition, because atelectasis causes hypoxemia due to intrapulmonary shunting, the hypoxemia fails to correct with supplemental oxygen and the A-a gradient is typically elevated.

43
Q

lesbian women at increased risk of..

A
  • bacterial vaginosis (transferred through vaginal secretions)
  • cervical cancer (lower rates of HPV vaccination, lower rates of screening, and higher rates of smoking and obesity)
  • breast and ovarian cancer
44
Q

major prognostic factor in Primary CNS lymphoma (PCNSL)

A
  • CD4 count (The degree of immunosuppression seems to be the major determinant of the survival in patients with PCNSL)
  • thus starting HAART improves prognosis
45
Q

other presentation of hyperthyroidism in kids

A

sympathetic overactivity and can present with psychological changes (eg, irritability, poor academic performance) in addition to weight loss, tachycardia, hyperreflexia, and lid lag

46
Q

ethics of physician engaging with patients socailly

A

allowed, no issue

47
Q

recommended regimens for meningococcal prophylaxis

A

Recommended regimens include rifampin (600 mg orally twice daily for 2 days), ciprofloxacin (500 mg single oral dose), and ceftriaxone (250 mg single dose).

48
Q

croup management

A

Mild croup is treated with humidified air and corticosteroids;
moderate/severe croup is treated with corticosteroids (reduce edema causing stridor) plus nebulized epinephrine.

49
Q

most common presentation of amiodarone-induced lung disease

A

Chronic interstitial pneumonitis

50
Q

absolute contraindications to OCP’s

A
  • migraines
  • blood pressure >160/100 mm Hg
  • women age >35 who smoke >15 cigarettes per day.
  • Heart disease
  • Diabetes mellitus with end-organ damage
  • History of thromboembolic disease
  • Antiphospholipid-antibody syndrome
  • History of stroke
  • Breast cancer
  • Cirrhosis & liver cancer
  • Major surgery with prolonged immobilization
  • Use <3 weeks postpartum
51
Q

first step in solitary pulmonary nodule workup

A

compare previous x-rays or CT scans, if none CT

Medicine (71 decks)

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