7/20/16 Flashcards
what should you think about if a pt on chemo has unilateral tinnitus and hearing loss?
cisplatin toxicity
what is the most common cause of nephrotic syndrome in adults? esp African Americans? what are the other associations?
focal segmental glomerulosclerosis (FSGS); also associated with obesity, HIV, and heroin use
what nephrotic syndrome is associated with adenocarcinoma (breast, lung)? what are the other associations?
membranous nephropathy; also associated with NSAIDs, hepatitis B, SLE
nephrotic syndrome associated with hepatitis C
membranoproliferative glomerulonephritis (also associated with hepatitis B)
if a pt has nephrotic syndrome AND hepatitis B, what is the ddx?
membranous nephropathy (most common), membranoproliferative glomerulonephritis (much less common), polyarteritis nodosa
what are the two nephritic syndromes (hematuria + proteinuria) seen after upper respiratory infections? how can you differentiate between them?
poststrep glomerulonephritis and IgA nephropathy; IgA nephropathy can be seen in a few DAYS after URI, whereas PSGN is seen 1-2 WEEKS after URI
what are the two major problems that come with nephrotic syndrome?
INFECTION (loss of immunoglobulins) and THROMBOSIS (loss of antithrombin and plasminogen)
what dx should be suspected in a pt after thoracic trauma that develops an airspace opacity on CXR and findings consistent with alveolar fluid (focal bronchial breath sounds) within the first 24 hours?
pulmonary contusion (blood is filling up alveoli)
what are the major differences between Cushing’s syndrome and PCOS?
Cushing’s syndrome causes proximal muscle weakness and easy bruising (due to catabolic effects of excess glucocorticoids on muscles and subcutaneous connective tissue). Both cause menstrual irregularities, obesity, and signs of androgen excess
bilious vomiting in a neonate with rightward displaced duodenum on upper GI series
midgut volvulus
in what pts do you need to add listeria coverage for meningitis? what is the abx regimen?
adults over 60 years old or immunocompromised = add AMPICILLIN (to CEF AND VANC)
early decrescendo diastolic murmur
aortic regurgitation
where is the murmur of aortic root dilation best heard?
right sternal border
what is the difference in presentation between epidural abscess and Pott disease (TB involving vertebrae)?
epidural abscess causes ACUTE back pain, whereas Pott disease causes chronic back pain of INSIDUOUS onset
tx for epidural abscess?
vancomycin (to cover staph aureus and MRSA) and surgical drainage to minimize permanent neurologic sequelae
signs of viral pharyngitis vs strep pharyngitis
viral: cough, rhinorrhea, conjunctivitis, ulcers (herpangina caused by Coxsackie)
strep: exudates, edema, palatal petechiae
otalgia (ear pain), hearing loss, pustule progressing to painful ulcer, hematuria and proteinuria
wegeners granulomatosis (aka granulomatosis with polyangiitis), a necrotizing vasculitis
what are the EKG changes seen in hyperkalemia?
flattening of P wave, widened QRS, and tall peaked T waves, prolonged PR interval
treatment for acute hyperkalemia causing EKG changes
calcium gluconate
tx for acute COPD exacerbation
albuterol, ipratropium inhaler, and SYSTEMIC GLUCOCORTICOIDS
what is the pathogenesis of DKA?
main cause is insulin deficiency, which leads to increased lipolysis of peripheral fat stores secondary to high catecholamine levels. these fatty acids are delivered to the liver and broken down into ketones. ketone accumulation results in the clinical manifestations of DKA.
important consideration when managing fluids in DKA
pts with DKA are susceptible to developing CEREBRAL EDEMA if too much volume is given or is given too quickly. IV fluids and insulin can decrease serum glucose and plasma osmolality, promoting osmotic water movement into the brain.
how to give fluids in DKA
10 mL/kg saline bolus given gradually over an hour, and then REGULAR IV INSULIN drip with ISOTONIC fluids containing POTASSIUM
tx for opioid withdrawal, opioid overdose
opioid withdrawal: methadone, buprenorphine
opioid overdose: naloxone
elderly pt with lymphocytosis, mild thrombocytopenia and anemia, lymphadenopathy, hepatosplenomegaly = dx and unique peripheral smear finding, confirmational test
CLL; smudge cells (fragile lymphocytes); flow cytometry on peripheral blood showing MONOCLONAL B CELL LYMPHOCYTES
Auer rods = dx, what cell type is most prominent
AML; neutrophils
post-op toxic shock syndrome: classic clinical picture and timeline
pt with vaginal or nasal packing, occurs within 24-48 hours of surgery
management of suspected PE in pregnant patients with normal CXR
V/Q scan first, if high pretest probability of PE, only a NORMAL V/Q scan rules out PE. low- or moderate-probability V/Q scan results require further testing with CT ANGIOGRAM.
Wells criteria
3 pts: sx of DVT, alternative dx less likely than PE
1.5 pts: HR greater than 100, immobilization or surgery in the past month, previous DVT or PE
1 pt: hemoptysis, malignancy
more than 4 = PE likely, get spiral CT scan (not D-dimer)
what HIV drug causes insomnia and vivid, bizarre dreams? name the drug and its class.
efavirenz (NNRTI)
side effect(s) of abacavir
LACTIC ACIDOSIS, HEPATITIS, hypersensitivity
side effect(s) of didanosine
PANCREATITIS
tx for pts with urge incontinence who fail bladder training
oxybutynin, an antimuscarinic (anticholinergic) medication that relaxes the detrusor muscle and reduces spasm
sx of Henoch Schonlein purpura
GI: pain, bleeding
Skin: palpable, nonblanching, symmetric purpuric lesions (lymphocytoclastic vasculitis and IgA deposits on biopsy)
Joint: arthralgia
Renal: hematuria
what is the test used to determine the necessary dose of RhoGAM after delivery of an Rh-positive fetus to a Rh-negative mother?
kleihauer-betke test
cocaine intoxication: are pupils dilated or constricted? tx?
dilated; acute intoxication is treated supportively and withdrawal is self-limited, long-term tx is 12-step and individual therapy
opioid overdose: are pupils dilated or constricted?
constricted
what are the endocrine sx of graves disease?
hyperglycemia, hypercalcemia (due to increased bone turnover), bone loss, menstrual irregularities
how do triptans work to abort migraines? why should they never be given with ergot derivatives?
they are powerful vascular serotonin agonists that cause vasoconstriction and decreases neurogenic inflammation. ergot derivatives also work on serotonin receptors and combination can cause severe, prolonged vasoconstriction resulting in elevated BP, MI, or even stroke
what opthalmologic pathology causes progressive loss of peripheral visual fields? central vision loss?
progressive loss of peripheral visual fields: open angle glaucoma
central vision loss: macular degeneration (pigment accumulation in the retina)
elderly pt with vision worse at night, glare while driving at night, trouble reading fine print
cataract (opacification of lens)
in DIC, is fibrinogen elevated or decreased? LDH? reticulocyte count?
fibrinogen is decreased, LDH is increased, and reticulocyte is increased (microangiopathic hemolytic anemia)
what nephrotic syndrome is associated with HIV infection? Hep B?
HIV: FSGS
HepB: membranous nephropathy
what are the similarities and differences between Bartter’s/Gitelman syndrome and surreptitious vomiting?
they all cause hypokalemia, alkalosis, and normotension. the only way to distinguish between them is urine chloride. pts with Bartter’s/Gitelman syndrome have HIGH URINE CHLORIDE.
defects seen in lateral medullary infarction (Wallenberg syndrome)
vertigo with falling to side of lesion, vertical and horizontal nystagmus, loss of pain and temperature in ipsilateral face and contralateral body, hoarseness, and ipsilateral Horner’s syndrome (miosis, ptosis, anhidrosis)
defects seen in medial medullary syndrome
paralysis of contralateral limbs, tongue deviation toward lesion
what is the only acute drug intoxication that causes nystagmus?
PCP intoxication
what are the unique sx of cannabis intoxication?
hallucinations, social withdrawal, paranoia, conjunctival injection, impaired time perception
causative agents in acute vs subacute prosthetic joint infection, what are the time ranges?
within 3 months: Staph aureus
more than 3 months later: Staph epidermidis
what is the most common valvular abnormality detected in pts with infective endocarditis?
mitral valve prolapse with coexisting mitral valve regurgitation
abx for aspiration pneumonia
common abx options for anaerobic coverage include metronidazole with amoxicillin, amox-clav, and clindamycin
what vasodilator can cause cyanide toxicity? what are the sx?
nitroprusside; metabolism of nitroprusside releases nitric oxide (which stimulates arteriolar and venous vasodilation) and CYANIDE IONS. presents with SEIZURES, lactic acidosis, altered mental status, and coma
how long after the last drink do alcohol withdrawal seizures occur?
12-48 hours
what dx should you suspect in a pt with sudden onset chest pain, ST elevation in II, III, and aVF, a holosystolic murmur at apex, and bibasilar crackles?
acute inferior MI with papillary muscle displacement, leading to acute mitral regurgitation and pulmonary edema
what are the CXR abnormalities seen in aortic rupture?
widened mediastinum and left-sided hemothorax
pathogenesis and tx of organophosphate poisoning
organophosphate poisoning inhibits acetylcholinESTERASE, leading to sx of cholinergic excess (think of the PARASYMPATHETIC NS = bradycardia, miosis, bronchorrhea, muscle fasciculations, salivation, lacrimation, diarrhea and urination). ATROPINE should be given immediately (competes with acetylcholine at muscarinic receptors)
ventricular tachycardia can be caused by what cardiovascular medications and how?
loop diuretics cause hypokalemia and hypomagnesemia, which can both lead to VTach. digoxin can also cause arrhythmias such as VTach, and if given with loop diuretics, the hypokalemia can potentiate the side effects of digoxin
what are the sx of bath salts intoxication?
severe agitation, combativeness, psychosis, delirium, myoclonus, seizure with PROLONGED DURATION (DAYS TO WEEKS, VERY UNIQUE!)
medication used for Parkinson disease in younger pts where tremor is the primary sx
trihexyphenidyl (anticholinergic)
what test must you order in a POSTmenopausal pt with an ovarian mass/cyst on ultrasound?
CA-125 level. if elevated, get a CT scan
