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Uworld Gaby > Step3 32 > Flashcards

Step3 32 Flashcards

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1
Q

Psoriatic arthritis (5) and soft tissue and nails (4) characteristics

A 
ARTHRITIS
Asymmetric Olygoarthritis or
Symmetric polyarthritis (similar to RA)
Can include DIP joints
Sacrilitis and spondilitis
Arthritis multilans

NAILS AND SOFT TISSUE
Dactylitis (sausage)
Enthesitis
Nail pitting/onycholysis
Pitting edema of hand and feet
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2
Q

Serologic testing in Psoriatic arthritis

A

Negative rheumatoid factor and CCP

positive in 10%

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3
Q

Treatment of Psoriasis

A

Limited (10% skin involvement): topical steroids or vitamin D derivatives (calcipotriene)

Systemic treatment:
Methotrexate, cyclosporine, retinoids
Biologics

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4
Q

Management of nipple discharge

A
  1. Physical exam:
    abnormal: imaging, biopsy, tests
    normal: step 2
  2. US +/- mammogram (If >30yo)
    abnormal: percutaneous biopsy
    normal: Step 3
  3. Galactorrhea workup
    abnormal: treat accordingly
    normal: reassurance and observation

Patients super bothered by symptoms? consider duct extraction

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5
Q

X-ray findings of lead poisoning

A

Lead lines:

Opacification of metaphyseal plate

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6
Q

Treatment for lead poisoning

A

Chelation if lead >45

Succimer
Adetate calcium sodium (EDTA)

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7
Q

Manifestations of lead poisoning

A

Asymptomatic

Abdominal pain/constipation

Lead level as low as 10-20:
Cognitive impairment/behavioral problem (eg. ADHD)

Lead >70
Hemolytic anemia

Lead >100
Encephalopathy (AMS, seizures)

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8
Q

Diagnosis of multiple sclerosis

A

T2 MRI lesions disseminated in time and space: periventricular, juxtacortical, supratentorial, and spine

CSF:
oligoclonal IgG band
Usually reserved for patients with unclear diagnosis on MRI

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9
Q

Clinical features of MS

A 
Onset 15-50
Optic neuritis
Intranuclear ophthalmoplegia
Motor symptoms (weakness)
Sensory symptoms (paresthesias)
Shooting pain down the spine
Worsening symptoms in hot weather
Bladder/bowel dysfuntion
Fatigue
Transverse myelitis (UMN symptoms)
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10
Q

Treatment of MS exacerbation

A

Steroids (oral equal to IV unless…)

IV prefered if patient has optic neuritis as oral medication can worsen the condition

Can taper to oral after IV

Plasmapheresis if no response to steroids

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11
Q

Treatment for MS

A

Exacerbation: steroids

Control: decrease frequency of exacerbations
B-interferon
Glatiramate acetate

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12
Q

MS and pregnancy

Clinical manifestations
Treatment
Delivery
Risk of child

A

Continue maintenance treatment unless the patient is being treated with teriflunomide and mitoxantrone are teratogenic

Usually less symptomatic during pregnancy and worse after postpartum

Increased risk of assisted delivery (vacuum. c-section)

Increased risk for child to have MS

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13
Q

Treatment for depression in MS

A

SSRI or SRNI

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14
Q

Treatment for urinary incontinence in MS

A

Schedule voiding
Fluid restriction
Anticholinergic medication:Doxybutinine, tolterodine (for urgency)

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15
Q

Treatment for spasticity in MS

A

Muscle stretching
Massage
Physical therapy
Muscle relaxants: Baclofen, tizanidine

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16
Q

Treatment for fatigue in MS

A

Sleep hygiene
Amantadine
Stimulants: methylphenidate, modafinil

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17
Q

Treatment for neuropathic pain MS

A

Gabapentin or duloxetine

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18
Q

Diagnosis of HCV infection

A

Antibody testing first:

Positive result:
Confirm with RNA test (NAT- nuclear acid test)

Positive result:
Treat with antiviral meds

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19
Q

Patients at risk for Influenza complications

A

> 65

Pregnant patient up to 2 weeks postpartum

Other comorbidities (diabetes, COPD, CAD)

Obesity

Immunocompromised

Nursing care facilities

Native Americans

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20
Q

CURB 65

A 
Confusion
Urea >30
Respiration >30
BUN: BP>90/60
>65

0-1: Outpatient
2: Ward
>3: ICU

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21
Q

Important clinical features of ADHD

A

> 6 months

In more than 2 settings (eg. school and home)

Symptoms appear before age 12

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22
Q

Treatment of ADHD

steps before medication and scalation

A

<6 years: parent-patient CBT

> 6 years or CBT failure:
Methylphenidate or amphetamine with prior cardiac exam and history. EKG if any hx or physical fidings
Atomoxetine
Alpha 2 adrenergic

If one stimulant fails (doesn’t work or too many side effects) after max dosing, switch to a different stimulant or a different medication

Titration of medication is done on a weekly basis. If no response after a couple of weeks.. switch

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23
Q

AV nodal blocker

Study These Flashcards
A

Beta-blocker

CCB

Adenosine

Digoxin

24
Q

Treatment of WPW

Study These Flashcards
A

Acute setting: Procainamide, ibutilde, amiodarone

Radiofrequency catheter ablation

25
Medication to avoid in a patient with multifocal atrial tachycardia
Beta-blockers: MAT is associated with COPD and B blocker can worsen their condition
26
Medical error that reaches the patient but causes no harm
Near miss
27
Treatment for narrow complex tachycardia
Adenosine (short live, helps uncover underlying rhythm) DO NOT USE IN WPW
28
Hypercalcemia workup
1. Confirm hypercalcemia Recheck Ca Correct for albumin/measure ionized Ca 2. Measure PTH High: PTH related (1 or 3 hyperparathyroidisms, familial hypercalciuric hypercalcemia, lithium) Low: step 3 3. Measure PTHrP, 25-hydroxyvitamin D, 1,25 dihydroxyvitamin D, chest x-ray (granulomatous disease), urine protein electrophoresis for MM
29
PTH related hypercalcemia Dxx
1 or 3 hyperparathyroidisms Familial hypercalciuric hypercalcemia Lithium
30
non-PTH related hypercalcemia Dxx
``` Malignancy Vitamin D toxicity Granulomatous disease Drug-induced (thiazide) Milk alkali syndrome Thyrotoxicosis Immobilization Vitamin A toxicity ```
31
Cancer that produces PTHrP
SCC renal and bladder breast and ovary
32
Mechanism of Hypercalcemia in Multiple myeloma Lymphoma
Multiple myeloma: Osteolytic lesions Lymphoma: Elevated 1,25-hydroxyvitamin D
33
They give you the sensitivity and specificity of a test and ask you to calculate the PPV or NPV. What other data do you need, why? Practice an example
You need the prevalence of the disease because predictive values are modified by prevalence Use a hypothetical sample of 1000 The prevalence will be the total of people with the disease (out of 1000) Multiply total people with the disease by the sensitivity and you will have the True positives Work from there
34
Blurry vision in a diabetic patient
Swelling of the optical nerve: - Secondary to osmotic changes (uncontrolled hyperglycemia, more acute) - Treat hyperglycemia Diabetic retinopathy: TAKES YEARS TO DEVELOP - Vitreous hemorrhage, retinal detachment, macular edema - Treat with angiography, laser coagulation
35
Central retinal vein vs. artery occlusion main differences
Arterial: Cherry spot on the fovea Retinal swelling Venous: (looks more dramatic) Vein dilation Swallen Disc Hemorrhages
36
Diagnosis and Treatment for mucormycosis
Sinus endoscopy with biopsy and culture Amphotericin B
37
Treatment for onychomycosis
Oral terbinafine or itraconazole
38
B12 deficiency manifestations
Subacute combined degeneration: Dorsal column symptom Lateral corticospinal tract: UMN symptoms Spinocerebellar: ataxic gait Dementia
39
Why is there elevated bilirubin in B12 deficiency
Ineffective erythropoiesis Cells die in the bone marrow, This is not intravascular hemolysis
40
Factors that increase risk of malignancy in solitary nodules (7)
``` >2cm Advanced age Smocking history Family history of lung cancer Female Upper lobe location Spiculated ```
41
Definition of solitary nodule (lung)
< 3cm (>3 is a mass) Surround by parenchyma No associated lymphadenopathy Rounded opacity
42
Approach to a solitary nodule
1. Review previous Xrays: No change >2-3 years: follow up Change or no previous studies available: CT 2. CT High risk: Surgical resection Intermittent risk: biopsy if possible Low risk: Serial CT scans ``` High risk: >2cm Advanced age Smocking history Family history of lung cancer Female Upper lobe location Spiculated ```
43
Cervical insufficiency vs. threatened abortion vs. preterm labor
Threatened Abortion: vaginal bleeding, close cervix, <20 weeks, fetal heartbeat Cervical insufficiency: painless cervical dilatation, < 24 weeks Preterm labor: <37 weeks with painful contractions
44
Prognosis of cerclage
If prophylactic: (base on history and placed at 12-14 weeks) Somewhat good If place at diagnosis: poor prognosis If membranes are prolapsing: worse prognosis. Membranes prolapsing is a relative contraindiction
45
Order of effective anticontraception
``` Implant: >99% (even more effective than IUD and surgery) IUD: >99% Surgery (male/female): >99% Injection: 94% Combine hormonal contraception: 91% Condom: 82% Withdrawal: 78% ```
46
papillary thyroid cancer management
Depends on size and involvement <1cm with no adenopathies or anything else.. lobectomy. If not... total thyroidectomy adjuvant treatment with radioactive iodine
47
Manifestations of anterior uveitis
Erythema at the limbus (junction of the cornea and the sclera) Constricted pupils Moderate aye pain Blurred vision
48
Approach to suspected Ectopic pregnancy
Unstable: surgery Stable: Algorithm B-hCG value cut off is 3500
49
Approach to elevated AFP in pregnancy
1. Repeat AFP 2. Perform obstetric ultrasound 3. Amniocentesis with AFP +acethylcholinesterase If both are elevated: high positive predictive value for neural tube defects and ventral wall
50
Transfusion reactions that occur within mins-1hr
Acute hemolytic reaction Abdominal pain/flank pain Gross hematuria Dark urine Stop transfusion, give IV fluids
51
Transfusion reactions that occur within 1hr to 6 hrs
Febrile hemolytic TACO: circulatory overload TRALI: lung injury TTBI: transmitted bacterial infection Urticarial Prevent with leukoreduction
52
Transfusion reaction that occurs sec/min within transfusion
Anaphylactic Usually in patients with IgA deficiency Give epinephrine
53
Patients that need radiated RBC transfusion
The donor is a family member Congenital or acquired immunodeficiencies Bone marrow transplant recipients
54
Patients that need leukoreduced RBC transfusion
Previous hx of reaction CMV seronegative at risk infection (eg, aids) Potential transplant recipient Chronically trasfused
55
Patients that need washed RBC transfusion
IgA deficiency Complement dependant autoimmune hemolytic anemia Continued allergic reaction after antihistamine treatment
56
Stress ulcer prophylaxis
``` Any 1 factor: Spinal, head injury, or major burn Mechanical ventilation >48hrs PLT <50k, INR >1,5, PTT x2 normal limit GI bleed or ulcer in the past 12 months ``` ``` Any >2 factors Corticosteroid therapy Occult GI bleed >6 days Sepsis ICU >1 week ```

Uworld Gaby (77 decks)

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