Step 3 Unforgettables

Front 1

If you have a pregnant patient with Graves disease that needs to remain on medications, which ones should she get during her pregnancy?

Back 1

FIRST trimester- use PTU because methimazole can cause scalp defects, tracheoesophageal fistula

SECOND & THIRD trimesters- switch to methimazole b/c PTU carries a risk of liver failure

Front 2

preferred therapeutic intervention for hemachromatosis

Back 2

repeated phlebotomy6

Front 3

h. pylori treatment

Back 3

amoxicillin TID
clarithromycin
omeprazole

or

metronidazole and omeprazole

Front 4

treatment for acute STEMI

Back 4

HAMBO
Heparin
Aspirin 325
beta blocker
Morphine (or nitrates) if pain
Oxygen

and of course, take em to the cath lab

Front 5

if a patient recovering from a recent MI presents to you with pericarditis, why should you NOT give them NSAIDs?

Back 5

because it can interfere with scar formation in the post MI period

Front 6

what two imaging modalities can tell you if pancreatic cancer is resectable

Back 6

helical CT through the pancreas
Endoscopic ultrasonography

Front 7

someone with polycytemia vera has an increased risk of acquiring what hematologic problems?

Back 7

CML
myelofibrosis
AML

Front 8

if someone has heparin induced thrombocytopenia, what is the next anticoagulant of choice?

Back 8

lepirudin
argatroban
danparoid sodium

do not choose warfarin

Front 9

if your HIV patient contracts TB, what is the adjustment that must be made to their RIPE treatment and why?

Back 9

replace rifampin with RIFABUTIN because the latter can interact with HIV meds

Front 10

when you treat someon with acute hep A infection, what else needs to happen?

Back 10

Give hep A immunoglobulin to close contacts

Front 11

variceal upper GI bleeds can be treated with what 4 options?

Back 11

octeotide
sclerotherapy
band ligation
TIPS- transjugular intrahepatic portosystemic shunt

Front 12

what is used for variceal bleed ppx?

Back 12

nonselective beta blocker- propanolol

Front 13

a pregnant woman has elevated levels of T3 and T4 on labs. Does she have hyperthyroidism?

Back 13

No because when you're pregnant, hcg has thyroid stimulating properties.

also you have elevated levels of TBG- the increase in T3, T4 causes negative feedback and slightly lower TSH levels but not < 0.01 which would be super low

Front 14

breast cancer screening guidlines

Back 14

mammography every 2 years
for women age 50-74

evidence for reduced mortality is weaker in women age 40-49 so clinical considerations come into play

Front 15

in a child with suspected intussusception, when is air contrast enema contraindicated?

Back 15

if there are signs of strangulated bowel or perforation, or if the child is "toxic" appearing

Front 16

a newly diagnosed HIV patient has an RPR titer of 1:64. He is asymptimatic. What is the next step in management?

Back 16

Do an LP
-if he's this far gone he likely has tertiary syphiliis

Front 17

how do you treat primary or secondary syphilis?

Back 17

penicillin G 2.4 million U IM ONCE
(if pt allergic to penicillin you can give doxycycline or ertyhromycin for 2 weeks)

- if disease has been going on for over a year, give 3 doses of IM penicillin a week apart

Front 18

how do you treat neurosyphilis?

Back 18

penicillin G IV for 2 weeks

Front 19

anti microsomal antibodies are the same as?

Back 19

anti- TPO (thyroid peroxidase)
this is when you're testing someone for why they have hypothyroidism

Front 20

anti-smooth muscle antibodies test for what condition?

Back 20

autoimmune hepatitis

Front 21

antimitochondrial antibodies test for what condition?

Back 21

primary biliary cirrhosis
(more ALP elevation than transaminitis)
- think young female

Front 22

actinic keratosis should automatically make you think of

Back 22

squamous cell carcinoma of the skin

Front 23

how is factitious disorder different from malingering?

Back 23

in factitious disorder, the person feigns illness just to be a patient rather than having another external incentive

Front 24

someone comes to you complaining of edema, low urine output, smokey brown. 10 days ago they had flu like sxs and throat pain
1. diagnosis?
2. what lab abnormalities do you expect?
3. treatment

Back 24

1. post streptococcal glomerulonephritis
2. low complement levels, elevated ASO titer, hypertension, red cells/casts on UA
3. tx is supportive care. almost everbody has complete revovery

Front 25

a young man comes to the ER complaining of flank pain and red urine. He had a flu like illness with throat pain 3 days ago.
1. diagnosis?
2. what lab abnormalities?
3. treatment

Back 25

1. IgA nephropathy
2. may see increased serum IgA level, mesangial IgA deposits on renal biopsy
3. tx- glucocorticoids for certain pts, no real definitive tx. can also try fish oil and ACEi

Front 26

a young woman comes to you complaining of fatigue, pruritis, and fat malabsorption

1. diagnosis?
2. lab abnormalities? hint: special antibody
3. treatment?

Back 26

1. primary biliary cirrhosis
autoimmune destruction of intrahepatic bile ducts
2. increased bilirubin, markedly elevated ALP, antimitochondrial antibody
3. treat with ursodeoxycholic acid, fat soluble vitamins, for the itching give chlestyramine, and eventually transplantation

Front 27

what is an important-to-know complication of the TIPS procedure for portal hypertension?

Back 27

it can increase the rate of encephalopathy

Front 28

what study provides a definitive diagnosis of cardiac tamponade and what do you see on the study?

Back 28

echocardiogram
you see right atrial and right ventricular collapse during DIASTOLE

Front 29

when a patient is in cardiac tamponade, cardiac catheterization would show what finding?

Back 29

equalization of pressure in all chambers during diastole

Front 30

anti-pseudomonals

Back 30

ciprofloxacin
piperacillin
ticarcillin
ceftazidime

Front 31

comorbidities of tourettes

Back 31

ADHD
OCD

Front 32

a nurse gets a needle stick from an HIV+ patient with an undetectable viral load?
does she need post exposure ppx? If so, with what?
Would this change if the pt had a high viral load?

Back 32

YES, she still needs ppx cuz it was blood

for a low viral load, a 2 nucleoside reverse transcriptase inhibitors for 4 wks

if the viral load is high, do 2 NRTIs + a protease inhibitor

start ppx within 2 hrs of exposure

Front 33

what is quadruple therapy for H. pylori infection?

Back 33

tetracycline
bismuth
ppi
metronidazole

used when someone fails the typical triple therapy