Step 3 Flashcards
(123 cards)
What vaccines are indicated in newly dx HIV?
- HAV if they are MSM, IVDU, or have chronic liver disease
- HBV if not prev vaccinated
- HPV if between 11-26 yo
- Annual flu
- Meningococcus if between 11-18, living in large groups, or asplenic/complement deficient
- PCV13 once and PPSV23 8 weeks later, 5 years later, and at 65 yo
- Tdap once then Td q10 years
How do you prevent anti-D alloimmunization?
In an Rh(D)-neg mother with pos child, ppx with standard dose anti-D immunoglobulin is administered at 28 weeks and within 72 hours post-partum. Higher doses are needed with massive fetomaternal hemorrhage.
What are the clinical features and dx of Cushing’s syndrome?
Young patients with diabetes, osteoporosis, HTN, and hypokalemia should be considered. Screen with an overnight dexamethasone suppression test or 24-hour urinary cortisol. Suppression test in normal people should push down cortisol to < 3 mcg/dL in the AM.
When would you suspect TB as the cause of a pleural effusion and how would confirm diagnosis?
Someone with risk factors (ie HIV) who has lymphocytic-predominant, exudative effusion that is + for ADA. Confirm with pleural biopsy since cultures are often negative. This is because the effusion is a reaction and not direct infection (ie not empyema)
What are the characteristic CXR findings of sarcoidosis?
Bilateral hilar adenopathy +/- right paratracheal LAD
What are the pulmonary complications of polymyositis?
ILD, infection from immunosuppression, MTX-pneumonitis, and respiratory muscle weakness. ILD is common with anti-Jo antibody and should be differentiated from resp muscle weakness on PFTs. These would show decreased FVC, TLC, DLCO for ILD.
When are abx indicated in COPD exacerbation?
GOLD criteria: increased sputum purulence or volume or increased dyspnea
When is oral vanc recommended for c.diff colitis?
Systemic toxicity: high fever, WBC>15, or Cr 1.5x baseline. Second recurrence of c.diff (failed MTZ twice).
How do you prevent mother-to-child transmission of hep B?
- Immunoglobulin and vax within 12 hours.
- Vax at 2 and 6 months
- Serology at 9 months (3 months after last dose)
What are the risk factors for iron deficiency anemia in children < 2 years of age?
Prematurity, lead exposure, predominantly breast milk after first 6 months,
What are the features of congenital toxo?
Macrocephaly, diffuse calcifications, chorioretinitis, jaundice, growth restriction, HSM; RFs include contaminated raw meat, exposure to cat feces, unwashed fruits/vegetables
What are the similarities and differences between Ehler-Danlos and Marfan?
Both can cause scoliosis and myxomatous valvular degeneration, and chordae tendinae rupture leading to acute MR. EDS however has more connective tissue and skin findings, leading to more velveting finger tips.
Which abx are associated with seizure risk?
B-lactams: PCN, carbapenems, cephalosporins, FQs
When is treatment for subclinical hypothyroidism warranted?
- anti-TPO antibodies
- abnormal lipid profile
- ovulatory and menstrual dysfunction
What is an easy effective way to screen for alcohol abuse?
How many times in the past year have you had 5 or more drinks in one day?
What are the coronary heart disease equivalents?
DM, CKD, noncoronary atherosclerotic disease (PAD, AAA, carotid stenosis, CVA)
What is the most common cause of proteinuria in adolescents and how do you confirm the dx?
Orthostatic proteinuria: confirm with different supine/standing urine spot P:C or split 24-urinary protein collection.
What is labor protraction, its most common cause, and first line treatment?
It is defined during the first stage of labor which consists of the latent and active phase. Latent phase = beginning of reg contractions to 6 cm. Active phase is 6 to 10 cm and rapid cervical change. Protracted labor is dilation that is too slow = 1 cm/2hr during the active phase and most commonly caused by inadequate contractions (> every 2-3 mins). First line therapies are oxytocin and amniotomy.
What is active phase arrest and its treatment?
No cervical change for >/= 4 hours with adequate contractions or >/= 6 hours with inadequate contractions. Tx is c/s.
What is tick paralysis?
Rare life-threatening disorder caused by neurotoxins in tick saliva that are released over 4-7 days of tick attachment. It includes rapidly progressive gait ataxia, ascending paralysis, and absent DTRs. Fever uncommon and meticulous skin exam required to find the tick and remove it.
How do you assess the risk of HIT?
4TS score:
- thrombocytopenia: >50% drop or nadir =/>20k (2 pts), 30-50% drop or nadir 10-19k (1 pt)
- timing: 5-10 days or =1 day if prior hep exposure w/i 30 days (2 pts), consistent drop at 5-10 days but unclear due to missing CBCs or onset after 10 days or =1 if prior exposure 30-100 days ago (1 pt)
- thrombosis: confirmed new thrombosis or skin necrosis or acute system rxn after IV hep bolus (2 pts), progressive or recurrent thrombosis or non-necrotizing lesions or unproven suspected thrombosis (1 pt)
- oTher causes: none apparent (2 pts), possible (1 pt)
Score of 6-8 = high, 4-5 intermediate, 0-3 low
What are indications for voiding cysturethrogram in between 2 months - 2 years of age?
Atypical or complex presentation for UTI
Recurrent febrile UTI
Renal/bladder u/s shows: hydro, renal scarring, high-grade VUR, or obstructive uropathy
What are the key clinical features of ankylosing spondylitis, monitoring, and prognosis?
- LBP/stiffness > 3 months that improves with activity or exercise, limited lumbar ROM, limited chest expansion
- X-rays every 3 months or ESR/CRP
- Good prognosis, no reduction in life expectancy
What are the extra-articular manifestations of ankylosing spondylitis?
Acute anterior uveitis, aortic regurg, apical pulmonary fibrosis, IgA nephropathy, and restrictive lung disease