7/19/16 Flashcards
what dx should be suspected in a pt who develops rapid-onset dyspnea, tachycardia, tachypnea, hypotension, and distention of the neck veins after subclavian central venous catheter placement?
tension pneumothorax
what virus is associated with Kaposi sarcoma?
human herpesvirus-8 (HHV-8)
what fungal infection causes hepatosplenomegaly when disseminated in immunocompromised pts (HIV pts with CD4 count less than 100)?
histoplasmosis
what is the preferred treatment for mild to moderate histoplasmosis?
itraconazole
what should be given when a pt develops serious bleeding due to excess anticoagulation with warfarin? heparin?
warfarin: vitamin K and prothrombin-complex concentrate
heparin: protamine sulfate
describe cyanotic and pallid breath holding spells
cyanotic: crying followed by breath-holding, CYANOSIS, and loss of consciousness
pallid: minor TRAUMA followed by breath-holding, PALLOR, diaphoresis, and loss of consciousness
seizures are associated with withdrawal of what type of medication?
short-acting benzodiazepines (i.e., alprazolam [Xanax])
medication for pt with depression who is fearful of weight gain or sexual side effects or is a smoker trying to quit
bupropion
side effect(s) of bupropion
seizures
side effect(s) of mirtazapine
weight gain, sedation
side effect(s) of trazodone
priapism
side effect(s) of lithium
tremors, weight gain, NEPHROTOXIC, leukocytosis, DIABETES INSIPIDUS
side effect(s) of valproic acid
ACUTE PANCREATITIS, HEPATOTOXIC
side effect(s) of lamotrigine
stevens-johnson syndrome
name SNRIs and their side effects
duloxetine, venlafaxine, desvenlafaxine; hypertension, blurry vision, weight changes, sexual side effects
name some tricyclic antidepressants and list their side effects
hypo/hypertension, dry mouth, constipation, confusion, ARRHYTHMIAS, sexual side effects, weight gain
duration of sx for brief psychosis, schizophreniform, schizophrenia
brief psychosis: 1 day to 1 month
schizophreniform: 1 month to 6 months
schizophrenia: more than 6 months
symptoms and treatment for serotonin syndrome
agitation, hallucinations, HYPERTHERMIA, nausea, diarrhea, shivering, MYOCLONUS (sudden involuntary jerky contraction of muscles); cyproheptadine
mnemonic for atypical antipsychotics
it’s atypical for old closets to quietly risper from A to Z (olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone)
side effect(s) of olanzapine
diabetes, weight gain (avoid in diabetics and obese pts)
side effect(s) of risperidone
increased prolactin, movement disorders
side effect(s) of quetiapine
lower incidence of movement disorders, appropriate to use in pts with preexisting movement disorders
side effect(s) of ziprasidone
increased risk of QT prolongation (avoid in pts with conduction deficits)
side effect(s) of clozapine
agranulocytosis; need to monitor CBC on regular basis, never use as first-line treatment
what type of drug is aripiprazole?
partial dopamine agonist
what is the only antipsychotic in pregnancy category B?
lurasidone
what are the atypical antipsychotics that are least likely to cause weight gain or metabolic syndrome?
aripiprazole, ziprasidone
what atypical antipsychotic should be given in a pt with an existing movement disorder?
quetiapine
what atypical antipsychotic should be avoided in pts with conduction defects?
ziprasidone
compare parkinsonian and benign essential tremors
parkinsonian tremors are improved by action and present at rest, whereas benign essential tremors are seen during goal-directed activities (reaching for an object) and are improved with alcohol
tx for benign essential tremor
propranolol
which types of medications are commonly associated with drug-associated photosensitivity?
tetracyclines (doxycycline), diuretics, antiemetics, antipsychotics
treatment for uric acid stones
alkalinization of urine to pH 6.0-6.5 with oral potassium citrate (uric acid stones are highly soluble in alkaline urine; also, citrate is a stone inhibitor and reduces crystallization)
how do thiazide diuretics affect calcium metabolism?
they decrease urinary calcium excretion (they Keep Kalcium; whereas Loops Lose calcium)
what are the signs (including temperature) of severe hypothermia
less than 82F (28C), coma, cardiovascular collapse, ventricular arrhythmias
which mutations are typically more severe than the others? missense, nonsense, or splice-site?
nonsense/frameshift mutations are typically more severe than missense or splice-site mutations
what class of medication can cause extrapyramidal symptoms other than antipsychotics?
antiemetics (metoclopramide)
symptoms of neurofibromatosis, type 2
bilateral acoustic neuromas, multiple meningiomas, cafe au lait spots, subcutaneous neurofibromas, cataracts
which pneumococcal vaccine should post-splenectomy pts be given?
PCV13 two weeks later, followed by PPSV23 at least eight weeks later
what is pulsus paradoxus and what conditions are associated with it?
exaggerated fall in systemic BP greater than 10 mmHg during inspiration; cardiac tamponade, severe asthma, COPD
brain abscess sx
fever, severe headaches (nocturnal or morning), focal neurologic changes, seizures
what should be given to exclusively breastfed PRETERM infants?
iron (full-term infants are born with adequate iron stores to prevent anemia for first 4-6 months of life)
define hypertensive urgency
severe hypertension (usually greater than or equal to 180/120 mm Hg) with no sx or acute end-organ damage
define hypertensive emergency
severe hypertension with acute, life-threatening, end-organ complications (malignant hypertension or hypertensive encephalopathy)
define malignant hypertension
severe hypertension with retinal hemorrhages, exudates, or papilledema (usually seen in pts with long-standing and uncontrolled HTN)
define hypertensive encephalopathy
severe hypertension with cerebral edema and non-localizing neurologic sx (cerebral edema is due to breakthrough vasodilation from failure of autoregulation; can present with restlessness, confusion, seizures or coma)
what is the recommended maintenance pharmacotherapy for bipolar disorder?
lithium or valproic acid plus an atypical antipsychotic (e.g., quetiapine)
list the most common primary sites of origin of brain metastasis in order of decreasing frequency
lung, breast, unknown primary, melanoma, colon
if there are multiple brain metastases, what cancers should you think of?
lung cancer and melanoma
what mothers should receive GBS prophylaxis with penicillin in addition to those who test positive within 5 weeks of labor?
those with history of GBS bacteriuria or UTI anytime during current pregnancy (regardless of treatment), prior birth to an infant with early-onset GBS disease, or unknown GBS status PLUS less than 37 weeks gestation, intrapartum fever, or rupture of amniotic membranes for more than 18 hours
is the A-a gradient in PE elevated or decreased? what about arterial CO2?
elevated (alveoli are still ventilated but not perfused); decreased due to hyperventilation
what type of cancer is most common on eyelid margin and what dermatologic condition is it often confused with?
basal cell carcinoma, chalazion (painful swelling that progresses to a painless, nodular rubbery lesion)
what does chronic kidney disease do to calcium and phosphate levels and why?
low serum calcium and high phosphate. CKD leads to low levels of activated vitamin D, which leads to decreased intestinal calcium absorption. CKD also causes phosphate retention. low calcium and high phosphate leads to secondary hyperparathyroidism.
what is the BUN:Cr ratio in prerenal azotemia?
greater than 20:1
what medications can cause crystal-induced AKI (renal tubular obstruction)?
SAMP(L)E sale of CRYSTAL jewelry: Sulfonamides, Acyclovir (IV), Methotrexate, Protease inhibitors, Ethylene glycol
what is the purpose of supportive psychotherapy?
build up adaptive defensive mechanisms and reinforce coping skills
what is the purpose of psychodynamic psychotherapy?
exploration of transference (feelings that the pt has toward another person which they unconsciously redirect toward the therapist), break down defense mechanisms
what is the purpose of cognitive behavioral therapy?
identify and challenge maladaptive thoughts, reduce automatic negative thoughts
what medications can cause hypokalemia by increasing potassium entry into cells?
insulin and beta-adrenergic agonists (i.e., epinephrine, albuterol); adrenergic agents also stimulate release of insulin
does acidosis cause hypo- or hyperkalemia?
hyperkalemia
what diuretics cause hypokalemia? what do these diuretics also cause?
loop and thiazide; metabolic alkalosis
loop diuretic side effects mnemonic
OH DANG: Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout
thiazide diuretics side effects mnemonic
HyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia
side effects of methotrexate
macrocytic anemia (inhibits dihydrofolate reductase = interferes with cellular utilization of folic acid!), stomatitis, HEPATOTOXICITY, interstitial lung disease, alopecia, PANCYTOPENIA (check CBC every 3 months)
urethral drainage with catheterization of greater than ______ mL confirms urinary retention
150
what are the indications for statin therapy?
any of the following: clinically significant atherosclerotic disease, LDL greater than 190 mg/dL, age 40-75 with diabetes, and estimated 10-year ASCVD risk greater than 7.5% by pooled cohort equations
what is the Cushing’s triad and what is it a sign of?
hypertension, bradycardia, respiratory depression; elevated ICP
sx of transtentorial (uncal) herniation
ipsilateral hemiparesis (compression of contralateral crus cerebri); ipsilateral mydriasis (pupillary dilation), ptosis, and down-and-out gaze (compression of CN3=oculomotor); CONTRALATERAL hemianopsia (compression of PCA), and altered mentation
what is the etiology of epidural hematomas vs subdural hematomas vs subarachnoid hemorrhage?
epidural: rupture of middle meningeal artery
subdural: rupture of bridging veins
subarachnoid: rupture of aneurysm
what intracranial hemorrhage causes a lens shape on CT? crescent shape?
lens: epidural hematoma
crescent: subdural hematoma
name the paraneoplastic syndromes associated with small cell lung cancer vs. squamous cell lung cancer
small cell: SIADH, Eaton-Lambert syndrome, ACTH
squamous cell: PTHrP
what are the tx options for diabetic neuropathy and their respective considerations?
TCAs (can worsen urinary sx and orthostatic hypotension), gabapentin, NSAIDs (avoid in pts with renal dysfunction)
side effects of PTU and methimazole
both: agranulocytosis
PTU: HEPATIC FAILURE
methimazole: cholestasis
strawberry vs cherry hemangiomas
strawberry = infantile; cherry = elderly
sx of adult Still’s disease
inflammatory disorder wth recurrent high fevers, rash, and arthritis
define the following sx of infective endocarditis: janeway lesions, osler nodes, roth spots
janeway lesions: macular, erythematous, NONTENDER lesions on palms and soles
osler nodes: PAINFUL, violaceous nodules on fingertips and toes
roth spots: edematous and hemorrhagic lesions of the retina
what disease affects the lungs and kidneys?
goodpasture’s disease (IgG antibodies against basement membrane of glomeruli and alveoli)
most common EKG finding in PE
nonspecific ST segment changes
what signs should make you suspect massive PE in a postoperative pt?
hypotension, jugular venous distention, and new-onset right bundle branch block
pathophysiology and sx of creutzfeldt-jakob disease
spongiform encephalopathy caused by a prion; rapidly progressive dementia, myoclonus and sharp, triphasic, synchronous discharges on EEG
which cardiovascular risk factor is most associated with strokes?
hypertension
abx for endometritis
clindamycin and gentamicin
mutations in what genes causes blue sclerae?
type 1 collagen
what type of pts should not use metformin?
renal insufficiency (metformin will accumulate and cause lactic acidosis)
which drug class should be added to metformin in diabetic pts who need to lose weight? what is the serious side effect of this drug class?
GLP-1 agonists (exenatide or liraglutide); acute pancreatitis
mechanism of sulfonylureas in tx of diabetes
increase insulin release from pancreas (leads to weight gain because this drives glucose intracellularly)
which oral hypoglycemic medication class is contraindicated in CHF patients?
thiazoladinediones (pioglitazone); they can increase fluid overload
which oral hypoglycemic medication classes are weight-neutral?
metformin (biguanide), DPP-IV inhibitors
mechanism of DPP-IV inhibitors in tx of diabetes
block the degradation of incretins (GI and GLP), which help to increase insulin release and decrease glucagon release from the pancreas
which oral hypoglycemic medication class has the greatest risk of hypoglycemia?
sulfonylureas
when should insulin be added to metformin for tx of diabetes?
when HBA1C is greater than 8.5%
side effects of insulin therapy
significant weight gain, hypoglycemia
what medication can be given to treat platelet dysfunction in pts with chronic renal failure?
DDAVP (increases release of factor VIII:von Willebrand factor multimers from endothelial storage sites)
first-line tx for prolactinoma
dopaminergic agonists (carbergoline, bromocriptine) will normalize prolactin levels and reduce tumor size
what vitamin deficiency can be caused by carcinoid syndrome?
niacin (vitamin B3); serotonin is synthesized in carcinoid cells from tryptophan, which is also used in production of niacin or nicotinic acid
sx of niacin (B3) deficiency
pellagra (diarrhea, dermatitis, glossitis, angular stomatitis, dementia)
what dx should be suspected when epigastric pain is worse when walking and lying supine and is improved with sitting up or leaning forward?
acute pancreatitis
complications of acute pancreatitis
pleural effusion, acute respiratory syndrome, ileus, renal failure
what is the most common cause of isolated, asymptomatic elevation of alkaline phosphatase in an elderly pt?
paget disease of bone
cancer associated with B12 deficiency
gastric cancer (anti-parietal cell antibodies cause chronic atrophic gastritis)
what are the key differences between sx of ovarian torsion and ruptured ovarian cyst?
ovarian torsion causes nausea and vomiting and shows decreased blood flow on Doppler velocimetry, ovarian cyst rupture usually happens immediately after strenuous or sexual activity
what are the PFT findings associated with restrictive lung disease?
decreased lung volumes, increased FEV1/FVC, low diffusing capacity for carbon monoxide
what is dystonia?
sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures
what is torticollis?
a focal dystonia of the SCM muscle that presents as periodic involuntary head turning and head fixation to one side accompanied by a hypertrophied SCM muscle
