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5 star topics Flashcards

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1
Q

Valves open during systole

A

Aortic, pulmonic

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2
Q

Valvular lesions producing systolic murmurs

A

MR, TR, AS, PS, Mitral valve prolapse

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3
Q

Valves open during diastole

A

mitral, tricuspid

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4
Q

Valvular lesions producing diastolic murmurs

A

MS, TS, AR, PR

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5
Q

Murmurs and sounds heard best with patient in left lateral decubitus position

A

Mitral murmurs

Left sided S3, S4 heart sounds

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6
Q

Cardiac auscultation findings considered benign when there is no evidence of disease

A

Split S1
Split S2 on inspiration
S3 under 40 yo
early, quiet systolic M

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7
Q

Causes of aortic stenosis

A

Congenital bicuspid valve - about 40 yo
Senile calcifications - over 60 yo
Rheumatic heart disease
Tertiary syphilis - aortitis (tree barking of aorta and dilation of aortic root -> AS, AR, dissection)

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8
Q

Presentation of aortic stenosis

A

Dyspnea (CHF)
Syncope
Angina
-all with exertion

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9
Q

Physical exam findings with aortic stenosis

A

Ejection click
Systolic ejection murmur “crescendo-decrescendo” heard at RUSB
Murmur radiates to neck/carotids

Valsalva will decrease the murmur

Peripheral pulses are weak and prolonged/delayed “pulsus parvus et tardus”

Next step: ECHO

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10
Q

Treatment of aortic stenosis

A

aortic valve replacement if symptomatic

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11
Q

Causes of Mitral regurgitation

A 
MV prolapse
Rhematic heart disease
infective endocarditis
papillary muscle rupture
LV dilation (from ischemic heart disease or dilated cardiomyopathy)
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12
Q

Presentation of MR

A

often asx
Fatigue
Exertional dyspnea
A fib with LA dilation

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13
Q

Physical exam findings of MR

A

holosystolic murmur heard at apex, may radiate to axilla

Next step ECHO

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14
Q

Treatment of MR

A

Vasodilators for LV dysfunction
Anticoagulate patients with Afib or hx of rheumatic heart disease
Mitral valve repair

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15
Q

Mitral valve prolapse

A

Large billowy leaflets into atrium

Midsystolic click with late systolic crescendo murmur

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16
Q

Causes of aortic regurgitation

A

Infective endocarditis
Rheumatic heart disease
Tertiary syphilis - aortitis (tree barking of aorta and dilation of aortic root -> AS, AR, dissection)

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17
Q

Presentation of Aortic regurgitation

A

usually asx until severe

Dyspnea, heart failure

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18
Q

Physical exam findings of aortic regurgitation

A

Wide pulse pressure - normal SBP, DBP way off
Bounding pulses
de Musset sign - rhythmic bobbing of head
Rumbling, early diastolic murmur heard at RUSB or Left side of sternum

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19
Q

Treatment of aortic regurgitation

A

Medical management of HF - ACE-i, Bb, spironolactone

Aortic valve replacement

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20
Q

Causes of mitral stenosis

A

Mainly rheumatic heart disease

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21
Q

Presentation of mitral stenosis

A

Dyspnea and CHF - may be exacerbated by pregnancy 2/2 expended blood volume, increased HR and SV -> increased CO

Afib d/t dilation of LA

Most patients have concomitant mitral and/or tricuspid regurgitation

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22
Q

Physical exam findings of mitral stenosis

A

Opening snap after S2

Rumbling, late diastolic murmur at apex

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23
Q

Treatment of mitral stenosis

A

Balloon valvuloplasty

diruetics for CHF sxs prior to valvulopasty
Anticoagulation pts with Afib

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24
Q

Presentation of shock

A 
Hypotension
\+/- tachycardia
\+/- cool, clammy, cyanotic skin
Decreased urine output - monitor closely
AMS - monitor closely
Metabolic acidosis - d/t anaerobic metabolism - check lactic acid level and BMP for anion gap
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25
Q

Mechanisms, causes, and treatment for Hypovolemic shock

A

Mech: decreased intravascular volume

Cause: hemorrhage - trauma, GI bleed; burns; GI losses - prolonged V/D

Tx: IVF, blood transfusion, tx underlying cause

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26
Q

Mechanisms, causes, and treatment for Cardiogenic shock

A

Mech: pump failure

Cause: acute MI, dilated CM, arrhythmia, ruptured septum, papillary muscle rupture

Tx: Dobutamine (beta 1 effect); intra-aortic balloon pump
Caution IVF can lead to pulmonary edema

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27
Q

Mechanisms, causes, and treatment for Obstructive shock

A

Mech: Extracardiac causes of pump failure; decreased venous return and decreased preload

Cause: Tension PTX -> decreased preload; hemothorax; PE; cardiac tamponade

Tx: Tx underlying cause; pericardiocentesis for tamponade; chest tube for PTX

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28
Q

Mechanisms, causes, and treatment for Septic shock

A

Mech: peripheral VASODILATION due to infection

Cause: infection

Tx: IVF, NE if IVF fails, Abx

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29
Q

Mechanisms, causes, and treatment for Anaphylactic shock

A

Mech: peripheral VASODILATION due to severe type 1 hypersensitivity reaction

Cause: allergic reaction

Tx: Epi - vasoconstrict, increase CO = increased BP, airway dilation; IVF; airway management - O2, ET; diphenhydramine, H2 blocker

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30
Q

Mechanisms, causes, and treatment for Neurogenic shock

A

Mech: peripheral VASODILATION and BRADYCARDIA due to autonomic dysregulation

Cause: CNS injury

Tx: IVF, vasopressors, atropine for brady

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31
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for hypovolemic shock

A

MAP - low - hypotension

SVR - increased

HR - increased

PCWP - low

PCWP after fluid challenge: unchanged or increased

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32
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for cardiogenic shock

A

MAP - low - hypotension

SVR - increased

HR - variable

PCWP - increased

PCWP after fluid challenge: higher, not volume issue

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33
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for Obstructive shock d/t lung cause (tension PTX, hemothorax, PE)

A

MAP - low - hypotension

SVR - increased

HR - increased

PCWP - low or normal

PCWP after fluid challenge: unchanged or increased

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34
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for Obstructive shock d/t cardiac tamponade

A

MAP - low - hypotension

SVR - increased

HR - increased

PCWP - increased

PCWP after fluid challenge: increased

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35
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for Septic shock

A

MAP - low - hypotension

SVR - low - vasodilation

HR - increased

PCWP - normal

PCWP after fluid challenge: increased

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36
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for Anaphylactic shock

A

MAP - low - hypotension

SVR - low - vasodilation

HR - increased

PCWP - normal

PCWP after fluid challenge: increased

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37
Q

Hemodynamics (MAP, SVR, HR, PCWP, PCWP after fluid challenge) for Neurogenic shock

A

MAP - low - hypotension

SVR - low - vasodilation

HR - increased

PCWP - normal

PCWP after fluid challenge: increased

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38
Q

Normal PR interval

A

conduction delay through AV node

less than 1 large box (200 ms)

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39
Q

P wave

A

atrial depolarization

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40
Q

QRS

A

ventricular depolarization

normal 3 small boxes - less than 120 ms = narrow

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41
Q

ST segment

A

ventricles depolarized

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42
Q

T wave

A

Ventricular repolarization

Peaked - hyperkalemia
flat - hypokalemia

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43
Q

U wave

A

papillary or purkinje repolarization

prominent in hypo/hyperkalemia, hyperthyroidism

44
Q

First degree block

A

PR greater than 0.2sec (large box)

Causes: AV node disease, increased vagal tone, drugs increasing refractory time of AV node (b-blockers, CCB, digoxin)

Tx: usually asx, not needed

45
Q

Second degree Mobitz type I block (Wenckebach)

A

Progressively lengthened PR interval until blocked QRS occurs then resets

normal, athletes, older, other heart dz

Causes: AV node disease, drugs

Tx: adjust medications, pacemaker for symptomatic bradycardia - usually asx

46
Q

Second degree Mobitz type II block

A

Cause: infra nodal conduction problem - bundle of His, Purkinje fibers

randomly blocked QRS without PR interval changes

Can progress to third degree AV block

Tx: pacemaker - usually asx

47
Q

Third degree block

A

Absence of conduction between atrium and ventricles

Dizziness, syncope, hypotension

Avoid B-blockers, CCB, digoxin

Tx: ventricular pacemaker

48
Q

Paroxysmal supraventricular tachycardia

A

HR >100, arising from atria or av junction
Narrow QRS
D/t re-entry anomaly

young patients

  • palpitations
  • CP
  • sudden tachy
  • SOB
  • syncope

Tx: carotid massage, valsalva, IV adenosine, CCB, B-blocker, cardioversion, catheter ablation

49
Q

Multifocal atrial tachycardia (MAT)

A

supra ventricular origin
Older patients - COPD exacerbations

Several foci initiating signals
-> P waves with variable morphology, at least 3 different
Tachycardia

Tx: CCB - verapamil, diltiazem; b-blockers, correct hypokalemia above 4, correct hypomagnesemia over 2, catheter ablation

50
Q

Bradycardia

A

less than 50 ppm (up to 60)
Caused by increased vagal tone or nodal disease

MC: elderly, hx of CAD, b-blockers, CCB

asx or weakness, syncope, fatigue

Tx: stop precipitating medications, pacemaker - sxs frequent or severe

51
Q

AV nodal re-entry

A

fast and slow conduction system at AV node

Fast goes quick to ventricles and retrograde through slow pathway to AV node -> conduction loop

52
Q

AV re-entry (WPW syndrome)

A

separate accessory conduction path
MC - Bundle of Kent

Return to AV node

WPW associated with delta wave - upstroke prior to QRS
-tachycardia, narrow QRS

53
Q

Common causes of upper GI bleeding

A

proximal to the ligament of trietz

MC: PUD - gastric more likely to bleed than duodenum
Esophagitis
Esophageal varices

Mallory-Weiss tears
Gastritis
Gastric/duodenal cancers

54
Q

Common cases of lower GI bleeding

A

Distal to ligament of trietz

Vascular malformations - angiodysplasia, AVM
mesenteric ischemia
Meckel’s diverticulum (secretes gastric acid)
Colon CA
Diverticular disease
UC
Hemorrhoids

55
Q

Signs of Upper GI bleed

A

hematemesis - ongoing
coffee ground emesis
melena
+/- BRBPR - laxative effect

56
Q

Signs of lower GI bleed

A

hematochezia - rapid or heavy
BRBPR
Melena

57
Q

Hemodynamic instability

A

S/S: hypotension, tachycardia

Start IVF right away
Substantial loss -> anemia
Can have stable Hct d/t loss of both RBC and plasma

58
Q

Steps in management of acute upper GI bleed

A

assess hemodynamic stability
Admit to ICU - NPO
Type and screen 2 units RBC

Labs: CBC, PT/PTT, BUN, Cr - hypovolemic/reabsorption of bili elevates BUN -> >20:1
-give FFP if PT/PTT elevated

If bleeding source uncertain consider NG lavage

Medications:
IV PPI
If variceal bleeding - octreotide - decreases splanchnic blood flow to GI tract

EGD

59
Q

Steps in management of acute lower GI hemorrhage

A

Assess hemodynamic stability - usually stable
Type and screen 2 units of PRBCs

Labs: CBC, PT/PTT, BUN, Cr

NG lavage and/or EGD to r/o massive upper GI bleed prn
Colonoscopy up to terminal ileum
-if not diagnostic or not feasible - too much bleeding and bleeding persists ->
-angiogram (AVM)
-Radionuclide scan - “tagged RBC scan” to localize to quadrant
-Capsule endoscopy

60
Q

Main risk factors for colorectal cancer

A

adenocarcinoma

Adenomatous colon polyps
hereditary syndromes
FHx of colon cancer
Previous colon cancer
UC > Crohns
AA - younger
Low fiber/high fat diet
etOH
Smoking
DM
61
Q

Familial adenosis polyposis

A

Hundreds of adenomatous colon polyps - shag carpet

Mutation Adenomatous Polyposis Coli (APC) gene

tumors:
stomach/duodenal polyps
osteomas
fibromas
lipomas
medulloblastomas

Tx: ppx subtotal colectomy before 25

62
Q

Hereditary nonpolyposis colon cancer (HNPCC) aka Lynch syndrome

A

cancers arise from basically normal appearing colonic mucosa - not polyps

cancers develop early 40s-50s

Cancers form in proximal colon - right side

63
Q

Peutz Jegher’s syndrome

A

hamartomas in GI tract

Pigmented lesions on lips and oral mucosa

64
Q

Colon cancer screening guidelines

A

Average risk: - start t 50 yo
colonoscopy q10 yr
Flex sig q 5 yr
Fecal occult blood test annually

CT colonography if positive -> colonoscopy

Screening stops when patient’s life expectancy is less than 5 years or age 75 whichever comes first

If polyps - screen 3-5 yr with colonoscopy
FHx - age 40 or 10 yr before age of family member

65
Q

S/S of colon cancer

A

GI bleeding:
hematochezia - left sided cancer
Melena - right sided cancer
Iron def. anemia

Change in stool caliber - left sided
-pencil thin or flat ribbon like

Bowel obstruction - constipation, abdominal distension, N/V

Apple core lesion on barium enema

66
Q

Staging colon cancer

A

CT chest, abd, pelvis

No LN involvement - stage I, II
-> resect

Regional LN involved - Stage III
-> resect, adjuvant chemo

Distant mets - IV
-> palliative chemo

MC mets - liver, lung

MC chemo - 5-FU

67
Q

Post-treatment surveillance for colon cancer

A

CEA - q3-6 mo for at least 3 years
CT Chest/Abd q1 yr for at least 3 years - pelvis iv rectal CA
Colonoscopy at 1 yr, then q3-5 yr depending on findings

68
Q 
Iron deficiency anemia iron studies
Serum iron
Transferrin (TIBC)
% transferrin saturation
Ferritin
A

Serum iron low
Transferrin (TIBC) high
% transferrin saturation low less than 12 %
Ferritin low

69
Q 
Anemia of chronic disease
Serum iron
Transferrin (TIBC)
% transferrin saturation
Ferritin
A

Serum iron low
Transferrin (TIBC) low normal
% transferrin saturation normal >18%
Ferritin normal or high

70
Q 
Lead poisoning
Serum iron
Transferrin (TIBC)
% transferrin saturation
Ferritin
A

Serum iron normal or elevated
Transferrin (TIBC) normal of low
% transferrin saturation normal
Ferritin normal or high

71
Q 
Sideroblastic anemia
Serum iron
Transferrin (TIBC)
% transferrin saturation
Ferritin
A

Serum iron high
Transferrin (TIBC) low
% transferrin saturation normal or high
Ferritin high

72
Q 
Hemochromatosis
Serum iron
Transferrin (TIBC)
% transferrin saturation
Ferritin
A

Serum iron high
Transferrin (TIBC) low
% transferrin saturation high
Ferritin high - if normal r/o hemochromatosis

73
Q 
Thalassemia
Serum iron
Transferrin (TIBC)
% transferrin saturation
Ferritin
A

Serum iron normal or high
Transferrin (TIBC) normal
% transferrin saturation normal
Ferritin normal or high

74
Q

Tension headache

A

MC type of headache
Associated with fatigue and stress

Typically bilateral, band squeezing
Frontal or occipital location, may involve neck
No aura, photophobia, phonophobia, or nausea/vomiting

no testing

Tx:
NSAIDs
Second line: dihydroergotamine or sumatriptan
-vasoconstrictors - avoid in CAD, Prinzmetal angina, pregnant

75
Q

Migraine headache

A

Young adult female
Triggered by: fluctuations in estrogen, OCP’s, tyramine or nitrate rich foods (chocolate, cheese, processed meats, aged foods, old bananas)

Throbbing unilateral headache
Nausea/vomiting
Photophobia and/or phonophobia
Visual aura - streaks of light or blurring (increased risk of stroke)

Tx:
Mild: NSAID or acetaminophen
Mod-Sev:
-PO tryptan (sumatripin) + naproxen
Dihydroergotamine (DHE 45)
Antiemetics - chlorpromazine, prochlorperazine, metoclopramide
76
Q

Migraine prophylaxis

A 
TCAs - amitriptyline, nortriptyline
B-blocker - propranolol, metoprolol
Anticonvulsant - valproic acid, topiramate, gabapentin
Verapamil
Naproxen
77
Q

Cluster headache

A

Young male smokers

Headache occurs same time daily for weeks, may stop for several months
Severe unilateral periorbital headache
Conjunctival injection
Lacrimation
Nasal congestion +/- nasal discharge
Partial Horner syndrome - ptosis and miosis without anhydrosis

Tx: 100% O2 - 6+L/min on nonrebreather for 20+ min
Sumatriptan (or other triptan)
Dihydroergotamine (DHE 45)

78
Q

Headache features suspect of brain tumor

A

Mild headache progressively worsening over days to weeks
New onset after age 50
Papilledema
Associated seizures, confusion, altered mental status
Abnormal neurologic signs and symptoms - numbness, weakness
Disturb sleep or presents immediately upon awakening
Vomiting proceeds headache
known systemic illness - cancer, HIV, or collagen vascular disorder

79
Q

idiopathic intracranial hypertension (IIH)

A

Young obese female
Daily pulsatile headache - worse at night or early morning
Nausea/vomiting
Retroocular pain worsened by eye movement
Papilledema and elevated ICP
Most worrisome sequelae is vision loss

CT normal
CSF: elevated pressure (over 200 in nonobese, over 250 in obese)

R/O other pathology with CT and MRI 
DC inciting agents - excess Vit A, Accutane, long term tetracyclines
Weight loss
acetazolamide - first line
Invasive treatment options:
Serial LP
Optic nerve sheath decompression
Lumboperitoneal shunting - CSF shunt
80
Q

Trigeminal neuralgia

A

Compression of the trigeminal nerve root

Lightning like unilateral facial pain
Worsened by any stimulation
Not associated with neurological defects

Carbamazepine - first line
Other options: oxcarbazepine, lamotrigine, baclofen
Surgical decompression or rhizotomy

81
Q

Epidural hematoma

A

Laceration of middle meningeal artery

Presentation:
Trauma -> lucid interval -> lethargy, confusion, or obtundation
Headache
Vomiting
People abnormalities
Focal neurological deficits - hemiparesis, seizures

CT head w/o contrast - biconvex (Lens shaped) hematoma
Avoid LP - risk herniation

Tx:
Lower ICP - elevate head of bed to 30, hyperventilate, mannitol
Craniotomy to drain hematoma

82
Q

Subdural hematoma

A

Rupture of bridging veins

Presentation:
Headache - gradually worsens over days to weeks
Mental status changes
somnolence

CT w/o contrast - Crescent shaped hematoma

Tx:
Craniectomy and surgical drainage - if deteriorating
Supportive care monitoring - if stable

83
Q

Subarachnoid hemorrhage - presentation causes

A

Causes:
Rupture of arterial saccular aneurysm - berry aneurysm
-Assoc with ADPKD and Ehler’s Danlos
-MC location - anterior communicating a. and posterior communicating a.

Rupture of AVM
Trauma

Presentation:
“worst headache of my life” - thunderclap, sudden
Preceded by sentinel headache - severe recurrent headaches in weeks prior to major hemorrhage
Neck pain, nausea/ vomiting, +/- fever

CT w/o contrast - blood in CSF
LP - bloody
-Xanthochromia (yellow CSF) - recent bleeding
MRA or angiography to identify site of bleeding

84
Q

Subarachnoid hemorrhage - management

A

Stop all anticoagulants, reverse anticoagulation

Keep SBP less than 150 if cognitive function intact until aneurysm is clipped or coiled to prevent replating

  • if cerebral perfusion not adequate, lowering BP Will increase risk of infarction
  • Labetalol preferred
  • avoid nitroprusside and nitroglycerine - can increase ICP

Nimodipine (CCB) - prevent vasospasm

Prevent physiologic derangements that may worsen brain injury:

  • avoid hypoxia and hyperglycemia
  • maintain normal pH, euvolemia and normothermia

Definitive treatment: surgical clipping/ coiling

85
Q

Parenchymal brain hemorrhage

A

MC caused by hypertension
Brain tumors, AVMs, anticoagulation
Drugs- cocaine, amphetamines

Presentation:
Focal motor/sensory deficits
Headache
Nausea/vomiting
Seizures
Mental status changes

CT w/o contrast - bleeding within brain parenchyma
MRA or CTA - identify site of bleed

Tx:
Supportive
Control ICP
Maintain SBP less than 200
Surgical decompression only for large hemorrhages with elevated ICP to prevent uncal herniation
86
Q

Major risk factors of breast cancer

A 
Female
FHx
BRCA 1/2
Estrogen exposures 
-early menarche
-late menopause
-fewer pregnancies
-less time breastfeeding
-older age at first live birth
Obesity
Advanced age
87
Q

Clinical features suggesting breast cancer

A 
Fixed, immobile breast mass
Peau d'orange
New nipple retraction
Dimpling
Axillary LAD
MC - upper outer quadrant

Mammo - hyperdense regions and/or microcalcifications

88
Q

Most common sites of breast cancer mets

A

bone, liver, lungs, brain

89
Q

Ductal carcinoma in situ

A

arises from ductal hyperplasia
Malignant cells fill the duct lumen but do not penetrate the BM
eventually -> invasive ductal carcinoma

Tx: lumpectomy +/- radiation
consider mastectomy in high risk

90
Q

Lobular carcinoma in situ

A

Arises from lobules but does not penetrate BM
LCIS high risk for invasive cancer than DCIS
ALWAYS ER and PR positive (more treatable)

Tx: observation + tamoxifen if low risk of invasion, no change in survival
consider ppx b/l mastectomy

91
Q

Invasive ductal carcinoma

A

75-80%

arises from ducts, penetrates the BM, invades adjacent tissue

Rock-hard breast mass with sharp margins, fixed, immobile

Stellate border on mammo or bx

Tx: early focal - lumpectomy and radiation
Multifocal - mastectomy
Sentinel LN bx
Mets or large tumor >1 cm - chemo

92
Q

Invasive lobular carcinoma

A

arises from breast lobule and invades adjacent tissue - less fibrotic response

often multifocal and/or b/l
Slower growing, slower to met

Signet ring cells or single-file rows of cells

Tx: early focal - lumpectomy and radiation
Multifocal - mastectomy
Sentinel LN bx
Mets or large tumor >1 cm - chemo

93
Q

Inflammatory carcinoma

A

invasion of dermal lymphatics -> inflammatory changes

erythema, wamth, pain, peau d’orange, nipple retraction, dimpling

Rapid growing, poor prognosis

mimics mastitis - often treated for first and refractory

94
Q

Signet ring cells

A

Kruckenburg tumors - GI adenocarcinoma - mets to ovary

Invasive lobular carcinoma

95
Q

Paget disease of breast

A

form fo ductal carcinoma - malignant cells infiltrate the epidermis

Eczema-like patches on nipple and areola
may indicate underlying cancer in breast parenchyma

Bx: cells interspersed - surrounded by clear halo

Mammo/US -> bx

96
Q

Treatment considerations in breast cancer

A

ER and PR positive - treat with tamoxifen

Over expression of HER2 - treat with trastuzumab (herceptin) - get baseline ECHO - causes reversible cardiotoxicity

BRCA mutations - b/l ppx mastectomy and oophorectomy recommended
-60-80% risk of cancers

97
Q

ddx for p-ANCA

A

eosinophilic granulomatosis with polyangiitis
Pauci immune rapidly progressive glomerulonephritis
microscopic polyangiitis
ulcerative colitis
primary sclerosing cholangitis (PSC)

98
Q

Physiologic jaundice

A

Increased RBCs at birth and fragile fetal RBCs -> increased heme breakdown and increased bilirubin

Natural deficiency of UDP glucuronosyltransferase -> decreased conjugation of bilirubin

Increased enterohepatic circulation of bilirubin

Bilirubin rises between 48-96 hours to 7-9

decreases around day 10

99
Q

Breast milk jaundice

A

enzyme in breast milk
increased intestinal absorption of bilirubin
bilirubin does not go down after 2 weeks

100
Q

breastfeeding failure jaundice

A

Not feeling well or not producing milk
Baby dehydrated
No bowel movements
-> no bilirubin excreted in bile

101
Q

Hemolytic disease causing hyperbilirubinemia

A

Isoimmune-mediated hemolysis - ABO or Rh incompatability

Maternal antibodies attack fetal RBCs causes hemolysis

More severe hyperbilirubinemia -> kernicterus

102
Q

Treatment of hyperbilirubinemia

A

benign causes - no treatment, correct feeding issues

Pathologic:
phototherapy - converts bilirubin to lumirubin
IVIG for ABO or Rh incompatability
Exchange transfusion

103
Q

Crigler-Najjar types 1 and 2

A

Type 1 - no activity of UDP glucuronosyltransferase, needs phototherapy and liver transplant

Type 2: milder - no treatment or phenobarbital to stimulate UDPGT

104
Q

Gilbert syndrome

A

Decreased production of UDP glucuronosyltransferase
Jaundice during times of stress
No Treatment

105
Q

Biliary atresia

A

No bilirubin excretion

conjugated hyperbilirubinemia

106
Q

Characteristics of Pathological newborn jaundice

A

Any jaundice in the first 24 hours
Rising total bilirubin by more than 0.5/hr
Rise in total bilirubin more than 5/day
Direct (conjugated) bilirubin >20% of total bilirubin or >1.5
Total bilirubin higher than 13 in term neonates
Jaundice appearing after 2-3 weeks of age

107
Q

Diagnostic criteria for major depressive disorder

A

At least 5 of 9 in 2 weeks with impaired ability to function:

1 of these required:
Depressed mood
Interest diminished “anhedonia”

Guilt or worthlessness
Sleep disturbance
Concentration impairment
Appetite or wt changes
Psychomotor agitation or retardation
Energy loss (fatigue)
Suicidal ideation (recurrent thoughts of death)

“DIGSCAPES”

DIT Level 2 (49 decks)

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