11.14 Flashcards
obese, 10-16, limp, chronic pain, waddling gait
weakening of femoral physis = anterior displacement of proximal femoral diaphysis w/ posterior slippage of femoral head
SCFE
screening 6 weeks post partum
edinburgh postnatal depressoin scale
decreased lung aeration
flattened facies
limb deformities
pulmonary hypoplasia
oligohydramnios leads to Potter sequences = any condition ass w/ inadequate amniotic fluid levels (urinary tract obstruct, renal agenesis, polycystic kidney disease, preterm rupture of membraneses)
abdominal distension + suprapubic mass = bladder distension resulting from obstruction
cervix <2.5cm at <24 weeks
prior preterm labor + <2.5 cm
vaginal progesterone
if prior preterm delivery: prophylactic cerclage
if prior preterm labor = IM 17 hydroxyprogesterone
MTC = medullary thyroid cancer
neuroendocrine malignancy from calcitonin parafollicular C cells = high serum calcitonin = increased risk of recurrence
acute heart failure + cardiogenic shock after ductus arteriosus closes
aortic coarctation
parallel circuits of systemic and pulmonary blood flow
TGA
what type of hypoxemia does not correct w/ supplemental oxygen
large IP shunt, large dead space ventilation
lightly brushing the skin to the right of th eumbilicis elicits pain
= VZV
tx for splenic abcess
abx + splenectomy bc most pts fail percutaneous aspiration
> 20mmhg difference in SBP between arms + sharp, severe tearing chest or back pain
acute aortic dissection
EKG normal or nonspecific ST/T wave changes
T: morphine, BBs, nitroprusside is SBP<120, emergent surgial repair if ascending
how to tx aortic dissection
if it causes: syncope stroke MI heart failure = surgical repair (means that it involves ascending aorta)
high mortality rate in absence of immediate surgical intervention
otherwise morphine, BB, nitroprusside if only if hypertension
dystonia
akathisia
parkinsonism
tardive dyskinesia
benztropine for the first three
benazines for the last one
benadryl good enough for the first one
xanax * propanalol okay for the second one
COPD causes dead space leading to V/Q mismatch and hypoxia/hypercapnia –> redirection of blood flow to better ventilated alveoli. What happens with o2 administration?
worsens hypercapnia because there is less redirection of blood flow so V/Q mismatch goes up, and the affinity of oxyhemoglobin for CO2 goes down and so does alveolar ventilation
Effect of hypercapnia
cerebral vasodilation = seizures
ureteral filling + dilated collecting system of cystourethrogram
VUR - leads to renal scar formation
tx w/ abx severity + maybe surgical correction
normal lipid panel
Total Cholesterol200mg/dL
TG 150
LDL Less than 100mg/dL
HDL 40mg/dL or higher
DM management
if urine albumin/Cr ratio is <30, then add? Or if >130/80, add?
Lisinopril/arb
if >10 % stroke risk, add daily aspirin
hgb a1c q3mo annual alb/Cr ratio regular screening/lipid panel eye exam 1-3 years annual foot exam
ventricular enlargement + increase in intensity in the white matter diffusely
motor deficits (focal arm/leg weakness or hemiparesis, ataxia, vision abnormalities) + well delineating asymmetric lesions
HIV dementia
PML
can’t fix low potassium
hypomagnesemia
what drugs cause SIADH
carbamazepien SSRIs NSAIDs
pneumonia
Small cell lung cancer
you see Na less than 135, then what?
edema, JVD = diurese
dry MM = saline
euvolemic = fluid restriction
urine Na<20 =
Na>40 =
hypovolemia, bc if sodium is <20 then you are holding onto salt
SIADH, bc urine is concentrated due to ADH causing less water in pee
LV systolic dysfunction leading to CHF
decreased CO/index
increased SVR
increase in LVEDV
heparin induced thrombocytopenia
heparin exposre>5 days +
drop in platelets by 50%
arterial thrombosis
necrotic skin lesions at injection site
anaphylactoid rxn after heparin
serotonin release assay
causes of thrombocytopenia in pregnancy
1) elevated AST/ALT: either A) AFLP if extremely high >1000 B) HELLP if hemolytic anemia C) Pre-ec w/ severe features if no hemolysis but HTN
2) chest pain, PE, leg pain = HIT
3) fever, weakness = TTP
AFLP = low platelets + RUQ pain HELLP = thrombocytopenia
Vitamin K deficiency
increases PTT & PT
first give FFP acutely if bleeeding otherwise vitamin K in 10 hours
damage to one eye after penetrating injury to the other eye
recognition of hidden antigens
when does FH of breast cancer matter
if it is in first degree relative
Rh negative mothers develop anti-D abs in prior pregnancy resulting in attack on Rh positive RBCs
fetal hydrops
Tx for mucopurulent eye discharge >5 days post birth?
<5 days prior to birth?
> 5 days = chlamydia = PO azithromycin
<5 days = gonorrhea = IM CTX
pale limb w/ inability to feel
comparmtnet syndrome
pulseless, paralysis, paresthesia, pain, pallor
BL acidemic acid base status to mildly alkalemic acid base status
if high bicarb, and low potassium, consider contraction alkalosis
irritable infant in the first few days of life = w/ sweating vomiting diarrhea high pitched cry
neonatal abstinence syndrome
fetal hydantoin syndrome
nail digit hypoplasia intellectually disables due to phenytoin
how to tx psychosis
1) second generation antipsychotics (short acting, then long acting only if med nonadherent): olanzapine, risperiodone, ariprazole
2) first generation antipsychotics = haloperidol
3) adjunctive xanax for agitation
appendiceal signs w/ longer course to presenting sx
appendiceal abscess
percutaneous drainage w/ interval appy
nonclassic CAH
hyperandrogenism + elevated 17 hydroxyprogesterone levels
partial deficiency in 21 hydroxylase
hyperandrogenism
difference between virilization + hirsutism?
virilization = clitoromegaly, deepening of voice
what causes virlization
androgen producing adrenal tumor = progressive hirsutism + virilization w/ high DHEAS
