4 Flashcards
management of cocaine-induced angina
IV benzos: improve agitation, reduced myocardial O2 demand, alleviate CV symptoms (lower BP/HR)
also ASA, nitro, CCBs (vasodilate)
NO B-blockers
if PaCO2 acutely rises from 40 to 65 mmHg what would you expect the pH to be
about 7.20 (decreases .08 for every 10 mmHg increase in PaCO2)
if pH closer to normal, consider compensation by increasing renal HCO3- retention in the chronic setting (COPD) as it takes about 48 hrs
lymphadenopathy in strep vs mono
strep: cervical
mono: typically cervical but may be generalized
acute HIV vs mono
presentation may be similar but in acute HIV rash + diarrhea are common, tonsillar exudates are not usually present (opposite for mono)
labs in cases of recent atheroembolism
eosinophilia, eosinophiluria, low complement
CMV retinitis presentation, complications, and treatment
blurred vision, floaters, photopsia (flashes)
blindness, retinal detachment
yellow/white fluffy hemorrhagic lesions along vasculature (vs toxo: eye pain, decr. vision; doesn’t follow vasculature)
valganciclovir, if near fovea or optic nerve add intravitreal injections
how is bone loss a complication of untreated hyperthyroidism?
^T3–>^osteoclast activity–>^Ca2+–>decr. PTH secretion–>decr. renal Ca2+ reabsorption–>^Ca2+ in urine, net wasting
also decr. conversion to active vit D (1,25OH–>25-OH)–>decr. GI Ca2+ absorption and decr. renal Ca2+ reabsorption
complications of Graves but not toxic adenoma (both hyperthyroid)
fetal hyperthyroidism: TSH receptor (TSHR) Abs cross placenta
proptosis, impaired ocular movement, ocular irritation/redness/vision loss from infiltrative process
acoustic neuroma symptoms
vertigo, UNILATERAL tinnitus, sensorineural hearing loss
similar to Meniere (+aural fullness)
causes of aortic stenosis
if >70: senile calcific aortic stenosis
bicuspid aortic valve, and lastly rheumatic heart disease
how you get cyanide poisoning vs methemoglobinemia
cyanide poisoning: smoke inhalation injury (also CO poisoning); binds to Fe3+ in cytochrome oxidase a3 in mitochondrial ETC–>blocks oxidative phosphorylation–>anaerobic metabolism–>lactic acidosis
methemoglobinemia: exposure to oxidizing agents: dapson, nitrates, topical/local anesthetics)
Fe2+–>Fe3+ resultes in left shift of O2 dissociation curve–>reduced delivery
cyanide poisoning tx
hydroxocobalamin or sodium thiosulfate: directly nine cyanide molecules
OR induce methemoglobinemia with nitrites to increase ferric iron (Fe3+) which binds cyanide
first step if suspect TTP?
peripheral blood smear, may show signs of intravascular hemolysis (schistocytes)
tx: plasma exchange +/- steroids
is RAAS activated or inactivated in CHF?
activated in order to maintain CO and systemic pressure
-leads to vasoconstriction of efferent (leaving) renal arteriole in order to maintain GFR
suspect what in pt with RHF following placement of implantable pacemaker or ICD
tricuspid regurgitation
lesions in toxo vs PML vs primary CNS lymphoma
toxo: MULTIPLE ring-enhancing, spherical lesions in the basal ganglia
progressive multifocal leukoencephalopathy (PML):
NON-ENHANCING and do not produce mass effects
primary CNS lymphoma: SOLITARY, weakly ring-enhancing periventricular mass
presence of what in the CSF is specific for primary CNS lymphoma?
EBV DNA
what is relative risk? (RR)
risk of an outcome in an exposed group / risk of an outcome in an unexposed group
initial management of relatively young pt. presenting with sciatica
NSAIDs or acetaminophen as XR will not likely change initial management (if no risk factors for osteoporosis and no inciting events)
MRI not indicated unless alarm symptoms (saddle anesthesia, fever, IVDU (epidural abcess))
tx of basal cell carcinoma depends on lesion type and location
low-risk/nodular lesions on trunk/extremities: electrodessication and curettage (ED/C) or surgical excision with 3-5mm margins
high-risk lesions or on face: Mohs procedure
low-risk superficial lesions or actinic keratosis: topical 5-fluorouracil or imiquimod
radiation occasional if unable to undergo sx excision, systemic chemo if widely metastatic BCC
recurrent high fevers, arthritis/arthralgias, salmon colored maculopapular rash, ESR may be ^
Adult Still disease
modified Duke criteria
major:
- blood cx + for S. viridans, S. aureus, Enterococcus
- echo showing valvular vegetation
minor:
- predisposing cardiac lesion
- IVDU
- temp 38+
- embolic phenom (infarcts, myc. aneurysm, Janeways)
- immunologic phenom (Oslers, Roth spots)
- +blood cx other than typicals
definite IE: 2 major OR 1 major + 3 minor
possible IE: 1 major + 2 minor OR 3 minor
what is enthesitis and what condition is it seen in ?
tenderness at tendon insertion sites
may be isolated heel pain
ankylosing spondylitis, psoriatic arthritis, reactive arthritis
other findings: loss of spinal mobility, pain improves with activity
deficiencies in primary vs secondary adrenal insufficiency
primary (adrenal prob): loss of glucocort/mineralcort/androgen secretion
secondary (pit prob): only loss of glucocort/androgen, mineralcort preserved as it is controlled by RAAS
will not see hyponatremia, hyperkalemia, hypotension, hyperchloremic acidosis, hyperpigmentation
