5/17 Flashcards
What is dumping syndrome? Who gets it?
Posgastrectomy patients get poops and farts as well as palpitations and sweating after eating
What causes dumping syndrome
Rapid emptying of hypertonic gastric contents into duodenum and small intestine, causing fluid shifts stimulating vasoactive peptides and autonomics
retropertineal hematoma presentation after cardiac cath
Sudden hemodynamic instability and ipsilateral flank or back pain
3 big drugs for interstitial nephritis
Penicillins, cephalosporins, and sulfonamides
1st line therapy for PMDD
SSRIs
Pregnancy excercise
> 30 min daily at low or moderate activity
Type I vs II RTA issue
Type 1: poor hydrogen secretion into urine
Type 2: Poor bicarb reabsorption
RTA tx
Oral bicarb replacement
3 big complications of orbital cellulitis
- Orbital abscess
- Intracranial infection
- Cavernous sinus venous thrombosis
What is Trypanosome cruzi
Protozoan
Laryngomalacia vs Vascular ring
LM: Worsens in supine and improves in prone (4-8 months)
VR: Improves w/ neck extension, ass w/ cardiac abnormalities
What part of adrenal gland is pheo in
Adrenal medulla
3 big in Cushin’s
Hypertension
Hyperglycemia
Weight gain
Two first line tx for tine corporis
Topical clotrimazole or terbinafine
Topical nystatin for
Candidal skin infections
2 big things pt’s with nephrotic syndrome at increased risk for
Atherosclerosis (hyperlipidemia) AV thrombosis (loss of antithrombin III)
When to get vaccines for splenectomy
Either 2 weeks before or 2 weeks after
What is most commonly associated w/ splenic abscesses
Infective endocarditis
Guardia tx
Metronidazole
PE of methanol ingestion
Optic disc hyperemia
Most 1st degré AV blocks w/ normal QRS occur due to
Conduction delay in the AV node and need no further eval
Who gets FSGS
AA and Hispanics
Fat people
HIV and heroin
Who gets membranous nephropathy
Adenocarcinoma
NSAIDS
Hep B
SLE
Who gets membranoproliferazive glomerulonephritis
Hep B and C
Lipodystrophy
MCD associated w/ what cance
Lymphoma
Def of chronic bronchitis
3 consecutive months of productive cough in 2 successive years
What is essential in distinguishing dementia from normal changes of aging
Impairment of daily functioning
Why can folic acid make B12 def worse
B12 used in processes other than RBC making, so the folate uses whats left in making RBCs to correct anemia first
B-blocker OD presentation
Bradycardia and hypotension –> cardiogenic shock
Hypoglycemia
Wheezing (bronchospasm)
B-blocker OD tx
Glucagon (also good for CCB OD)
Big drugs that precipitates myasthenic crisis
Fluorquinolones
Amingoclycosides
B-blockers
What is spared in polymyositis
respiratory muscles
Most significant complication of IIH
Blindness
Why put the women in left lateral decubitus position for abrubtion
To displace the uterus off the aortocaval vessels and maximize cardiac output
Heat stroke vs Heat exhaustion
Stoke: thermoregulation failure w/ CNS dysfunction
Exhaustion: Due to inadequate fluid and salt replacement (T
Think what w/ sudden onset pleural effusion w/ exudate and blood
PE
Primary murmur of TOF
Harsh, systolic ejection murmur over left upper sternal border from pulmonary stenosis
What age for S aureus in CF
Under 20 (highest around 10 years0 Older than that think pseudomonas
Xray of jejunal atresia?
Risk factors?
xray: Tripple bubble and gasless colon
Risks: prenatal exposure to cocaine and other vasoconstrictive drugs
First step if COPD exacerbation not getting better
Noninvasive positive pressure ventilation
Persistent pneumothorax and air leak in pt w/ BAT following chest tube likely
Tracheobronchial rupture
What does alveolar hypoventilation refer to
Uniform fall in inspired O2 in all regions of the lung (narcotic overdose, neuromuscular weakness)
4 big causes of V/Q mismatch
- Obstructive lung dz
- Atelectasis
- Pulmonary edema
- Pneumonia
Shunt that doesn’t correct w/ O2 besides cardiac
Extensive ARDs
What should be done if fetal movement decreases
NST (also done in high risk pregnancies starting at 32-34 weeks)
Reactive NST
At least 2 accelerations of 15 above baseline lasting 15 seconds each in 20 minutes
Pt’s w/ positive RET mutation detected should get what
Total thyroidectomy
Xray of rotator cuff tear may show what
Underlying calcific tendinitis
2 big risks for untreated hyperthyroidism
Rapid bone loss from increased osteoclastic activity in bone cells and cardiac tachyarrhythmias
“Blood and thunder” appearance on ophthalmoscope in what
Central retinal vein occlusion
Pt’s w/ non-inflammatory chronic pancreatitis are what
Afebrile and have irritative voiding symptoms
What alleviates pain in chronic pancreatitis
Sitting up or leaning forward
COPD exacerbation ABG
Respiratory acidosis and hypoxia
CHF exacerbation ABG
Hypocapnia and respiratory alkalosis
Suspect what in patients w/ hemolytic anemia and thrombocytopenia
TTP
Hypovolemic hypernatrema fluid flowchart
IV NS until euvolemic, then 5% dextrose in water, then free water
Kleptomania tx
CBT
Tx for UGIB
Supplemental O2
Bowel rest
IV fluids
IV PPI for acid suppression
Vaccine exception for premies
weight should be > 2 kg (4.6) before first hepatitis B vaccine
POV dx
- Increased serum FSH and LH levels
- Decreased estrogen levels
How can hypomagnesemia cause hypocalcemia
By inducing PTH resistance as well as decreasing PTH secretion
see in alcoholics
Why does it take awhile for Ca to raise after treating low Mg
PTH levels increase rapidly but resistance persists despite improvement in mag levels
What provides relief in epiglottidis
Keeping neck hyperextended
Why are G6PD levels normal in acute episode
G6PD def RBCs are hemolyzed early and reticulocytes (normal G6PD levels) are abnormally high
Two path features of C diff
Enterotoxin A: Watery diarrhea
Cytotoxin B: Colonic epithelial cell necrosis and fibrin deposition
Attributable risk percent formula
(RR-1) / RR
When surgery in pt’s w/ native valve infective endocarditis
- Significant valvular dysfunction
- Persistent/difficult to treat infection
- Recurrent embolism
Why hyponatremia in Addisons
Volume contraction (mineralocoritocoid def) and increased vasopressin secretion (lack of cortisol suppression)
Why pain relief in NO after MI
Dilation of veins and decrease in ventricular preload
Worsening postprandial pain that leads to avoidance of food characteristic of
Chronic occlusion of visceral arteries
Stepwise approach for treatment of ascites
- Na and H2O restriction
- Spironolactone
- Loop diuretic
- Frequent abdominal paracentesis (if renal function okay)
What do peptic structures cause
Symmetric and circumferential narrowing of the involved esophagus w/ dysphagia for solids but no weight loss
How can TMP-SMX cause hyperkalemia
Due to blockade of the epithelial Na channel in collecting tubule, also inhibits Cr secretion leading to falsely elevated level
What Ab can cause QT prlongation
Macrolides (also cholestasis)
How can long term analgesics cause CKD
Tubulointerstitial nephritis and hematuria due to papillary necrosis
Mammogram ages
50-75
What is elevated in intrahepatic cholestasis of pregnancy
Bile acids and LFTs
will have intense pruritus - esp on palms and soles
What should you not do in congenital diaphragmatic hernia
bag and mask (intubate instead and place ng tube)
How can CDH cause polyhydramnios
Result of esophageal compression
Who gets worse Babesiosis dz
Those over 40
Those without a spleen
Immunocompromised
Babesiosis tx
Quinine-linda
or Atovaquone-azithro
What is phyllodes tumor
Rare breast mass that presents as a unilateral, smooth painless and mobile firm breast mass (large fibroadenoma)
What can help distinguish peritonsillar abscess from epiglottitis
Deviation of the uvula and unilateral lymphadenopathy
Fetal hydantoin syndrome
Small body size
Microcephaly
Digital and nail hypoplasia
Cleft palate and rib abnormalities
5 big features of billiard atresia
- Jaundice
- Echoic stools or dark urine
- Hepatomegaly
- Inc direct bili
- Mild LFT elevation
MC congenital heart defect in down’s PTs
Complete AV septal defect
In B12 and folate def, what does replacing only folic acid do
Corrects megaloblasosis but leads to rapid progression of neurologic symptoms
Gallbladder imaging of pancreatic Ca
Intra and extra hepatic biliary tract dilation
CNs in the cavernous sinus
III, IV, V and VI
Eye manifestation of SS
Keratoconjunctivis sick (dry eyes, irritation, and photosensitivity)
Chronic epigastric pain that suddenly worsens and becomes diffuse w/ pneuomperitoneum concerning for
Likely perforated PUD
Cholestasis and biliar dilation
Dilated: extra hepatic
Not dilated: intrahepatic
Stains for ALL
PAS (in lymphoblasts)
TdT
Polymyositis dx
Muscle biopsy
What causes MVP
Myxomatous degeneration the mitral valve leaflets
Change after hyper filtration in DM II nephropathy
Thickening of the glomerular basement membrane
Osteomalacia vs Osteoporosis
Osteomalacia will have bone pain and muscle weakness
Xray will show decreased bone density with thinning of cortex and pseudo fractures
“Steppage gait” MCC
L5 radiculopathy or neuropathy of the common peroneal nerve
