Step3 19 Flashcards by Gaby Matamoros

Serum cancer for liver cancer

AFP

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Very low-risk prostate cancer classification

AFP <10 (o PSA… no me acuerdo)

Normal palpation

Gleason score less or equal than 6, <3 cores affected (50% involvement in each affected core)

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Management of prostate cancer

Very low risk and low risk:
Surveillance with PSA every 3-6 months
Repeat biopsy after the first year

(If progression during surveillance, go to next step)

Moderate/High risk:
Radiation or surgery

Anti-androgen therapy recommended for metastatic disease only

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Inhalants intoxication

Transient euphoria
Lethargy
Loss of coordination
Loss of consciousness

Last 15-45 min.. return to baseline

Other symptoms:
Arrhythmias, seizure, dangerous behavior,

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Dxx in chest Xray:

Silicosis
Asbestosis
Berylliosis
Coal worker pneumoconiosis

Silicosis:
Small (<1cm) nodular lesion, eggshell calcification

Asbestosis:
Linear opacities at the base and interstitial fibrosis. Pleural calcification

Berylliosis:
Diffuse infiltrates, hilar adenopathies

Coal pneumoconiosis:
Small nodular opacities in the upper lobe

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Risk of hormone replacement therapy. When is it ok to prescribe?

Increases risk of:
CAD, stroke, DVT, breast cancer, endometrial cancer (if estrogen-only, and the patient has a uterus), liver disease

It is usually safe in “younger women” (50-60)

Personal Hx of any of these conditions is a contraindication

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Medications that can interfere with statin use

Macrolides
HIV protease inhibitors
Gemfibrozil
Cyclosporin

Interfere with CYP3A4… Statin accumulation can increase the risk for statin induce myositis

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What liver enzyme can be “elevated” in a patient with rhabdomyolysis

AST

Is not coming from the liver but from the muscle

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Pneumococcal vaccine in adults

23: 1 dose after 65 yoa
If the patient received a dose before 65, vaccinate again with 23 (5years after first)

13:
1 dose of 13 and a dose of 23 one year later

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Biggest risk factor for bladder cancer

Smoking

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Rubber contact is a risk factor for which cancer

Lung
Blader
Leukemia

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Clinical presentation and management of inflammatory breast cancer

Lymphadenopathy
Erythema
Piel de Naranja
Nipple retraction, bleeding,

Diagnose with core biopsy

Radical mastectomy (breast conservation is not an option)
Chemo and radiation

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Prefered location of 5 main types of lung cancer

Small cell and SCC: central

Adenocarcinoma and Large cell: peripheral

Bronchial carcinoid: no specific location

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Secondary malignancies related to Hodking Lymphoma

Lung
Breast
Thyroid
Bone
GI

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Clues for enterovesical-fistula

Multiple urinary infections
Mixed bacteria
Pneumaturia

If IBD
Chronic diarrhea, abdominal pain
(Chrones > Ulcerative)

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Management of patients with candiduria

Infection vs. colonization

Sings of infection: at least 1
Symptoms (dysuria, urgency, etc)
Sign of infection: (fever, leukocytosis)
Neutropenia

If 1 or more: treat with fluconazole or anphotericin B

If only colonized: change catheter, reduce ATB use as much as possible
Hematuria and pyuria can be normal in a patient with a catheter

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Risk factors for endometrial cancer

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Obesity
PCOS
Tamoxifen
Nullyparity
Early menarche or late menopause

THINK ENDOMETRIAL CANCER IN A FAT PATIENT WITH ABNORMAL BLEEDING (sudden onset/intermenstrual)

Evaluation and management of lead poisoning

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Severe: >70
Moderate: 45-69
Mild: <44

Repeat test in 1 month

Notify authorities if >15
Screen in patients with houses built before 1950

Treat with succimare
(DMSA)

Clinical presentation of retroperitoneal bleeding

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Pt. on anticoagulation

Sudden lower quadrant abdominal pain or back pain, psoas sign

Hemodinamicaly instability

Best test: CT scan

Particular thing about Pneumocystis pneumonia

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Dyspnea and Hypoxia

Management of Pneumocystis pneumonia

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TMP-SMX

Blood gas analysis
If: O2 pressure <70 or A-a gradient >35.. give steroids
O2 sat <92 could also be considered

Hold Antiviral meds until the infection is clear

Clinical presentation of osteoarthritis of the hip

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Hip worsens with use during the day
Absence of pain at rest
Decreased range of motion

Best initial test for hip pain

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Xray

Best antihypertensive for this comorbidity

GOUT

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ACEI. ARB

Do not use diuretics

Best antihypertensive for this comorbidity OSTEOPOROSIS

Thiazide

Best antihypertensive for this comorbidity CKD

ACEI or ARB

Complications of varicocele

Subfertility Testicular atrophy

Diagnosis of varicococele

Clinical: tortuose mass, increases with Valsalva, standing US: preferred CT: if right-sided. Think CANCER

Management of varicocele

Plexus vein ligation if the patient is young NSAID and support if older and do not desire more children

Clinical findings of choanal atresia

Single: Chronic discharge, symptoms during childhood Both: loud breathing, cyanosis that worsens with feeding and improves with crying, symptoms right after birth

Diagnosis of choanal atresia

First: try to insert nasogastric catheter If it can't go through, Confirm with CT or nasal endoscopy

Hematochezia evaluation algorithm

Patient stable? - -Yes: colonoscopy - ---Source not found? GED - -----Source not found? Obscure GI bleed evaluation (capsule endoscopy, repeat upper/lower endoscopy) - -No: fluids, consult surgery, GED - ---Source not found? Patient stable? - -----Yes: Colonoscopy - -----No: Angiography - --------- Source not found? Obscure GI bleed evaluation (capsule endoscopy, repeat upper/lower endoscopy)

Signs and symptoms suggestive of upper GI bleed

Melena, hematemesis Hemodynamic instability Orthostasis BUN/Cr 20:1

PTHrP secreting tumors

SSC, gynecological, breast, kidney, bladder

Renal effects of severe hypercalcemia

Impaired ability to concentrate urine Diluted urine (nephrogenic diabetes insipidus) Can cause hypotension if low oral intake, vomiting

Timeline for percutaneous cardiac intervention. When do you do it?

12 hours from symptoms onset 90 min door to needle if the facility has PIC 120 min if the patient needs to transfer

Management of Acetaminophen intoxication

0-4 hrs after ingestion: Activated charcoal At 4hrs take acetaminophen levels and decide if patient needs antidote (N-acetylcysteine) >4hrs Take acetaminophen levels Give N-acetylcysteine empirically Also take: ALT, AST, BUN, Creatine

Development of symptoms after acetaminophen ingestion

0-24hrs: Asymptomatic 24-72hrs Elevation in ALT AST 72-96hrs: Transaminase peak: >10000 If severe: elevated PT, PTT, hypoglycemia, lactic acidosis, elevated bilirubin, kidney injury 4-14 days: Recovery

Bacterial endocarditis prophylaxis

Rheumatic heart disease Prosthetic valve Defective valve in a transplanted heart Congenital heart defect - -Unrepaired cyanotic - -Repaired but with some residual defect - -Prosthetic material less than 6 months

Antibiotic use for endocarditis prophylaxis

Gums or Bronchial procedure (strep) amoxicillin Skin procedure:(staph) vanco Change of cardiac prosthetic material (staph) Vanco GI or GU procedure (enterococcus) ampicilin

Step3 19 Flashcards

(40 cards)