ABEM Recert Exam pt. 5 Flashcards
Microscopic polyangitis (MPA): si/sx
Glomerulonephritis
Pulmonary hemorrhage
Microscopic polyangitis (MPA): Rx
Steroids
Wegner’s granulomatosis: New name
Granulomatosis with polyangitis
C-ANCA: What is it seen with?
Granulomatosis with polyangitis (formerly Wegner’s granulomatosis)
Granulomatosis with polyangitis: Pathophysiology
Necrotizing vasculitis affecting lungs and kidneys
Formerly called Wegner’s granulomatosis
Goodpasture’s syndrome: Pathophysiology
Lung and kidney involvement
HSP: Pathophysiology
Arteriole vasculitis
HSP: Typical patient affected
Males 6-11yo
HSP: When does it usually occur?
After a viral syndrome
Acute retroviral syndrome: si/sx
Flu-like illness 1-2 weeks after exposure to HIV
When does HIV seroconversion occur?
4-6 weeks after exposure
Most common intracerebral mass in HIV (+) patient
Toxoplasmosis
PCP: What is it now called?
Pneumocystis jiroveci
Leading cause of AIDS mortality
Pneumocystis jiroveci (formerly called PCP)
Which transplant(s) doesn’t have potential for rejection?
Bone marrow is only one
BUT, can have life-threatening graft-vs-host disease
Rheumatic Fever: How to dx
Jones criteria
2 major & 1 minor OR
1 major & 2 minor
Jones criteria: Major
JONES Joint involvement (polyarteritis) O (looks like heart) Myocarditis Nodules, subcutaneous Erythema marginatum Sydenham chorea
Kawasaki’s disease: Phases
- Acute phase, lasts 1-2 weeks, CRASH
- Subacute phase, lasts 2-4 weeks (Thrombocytosis, desquamation of rash, resolution of fever)
- Convalescent phase (2+ months) coronary artery aneurysms
Bacterial tracheitis: Who does it usually affect?
Ages 1-5 yo
Upper c-spine injuries are (MORE/LESS) common in kids
Upper more common
Lower c-spine injuries are (MORE/LESS) common in kids
Lower c-spine injuries are more common in >8yo and adults (kids have large, floppy heads)
Waddles triad: What is it & when is it seen?
Injuries seen from pedestrian getting hit while crossing the road:
- Femur fracture
- Chest/upper abdominal injury
- c/l head injury
Massive hemothorax in kids: Definition
> 10 ml/kg initial output from chest tube
OR
2 ml/kg/hr ongoing output from chest tube
RBCs and FFP: Transfusion does in kids
10 ml/kg
Simple febrile sz: Definition
Age 6mo - 5y
Lasts
Differential dx for altered MS in newborns
THE MISFITS Trauma Hypovolemia Electrolyte abnormalities Metabolic abnormalities Inborn errors of metabolism Sepsis Formula (over/underdilution) Intestinal cautastrophies Toxins Seizures
Leg-Calve Perthes disease: Who is it seen in?
Age 5-9yo
Boys > girls
Leg-Calve Perthes disease: Definition
AVN of the femoral head
Salter-Harris fracture classification
I: physis (growth plate) SLIPPED II: metaphysis only (ABOVE) III: epiphysis only (LOWER) IV: metaphysis, physis, and epiphysis (THROUGH) V: crush of physis (ERADICATED)
MCC of death in US
Ischemic heart disease
Most common valve affected in endocarditis
Mitral vavle (unless IVDA, then tricuspid)
MCC of valvular heart disease
Rheumatic fever
MCC of post partum hemorrhage
Uterine atony
MCC of pneumonia
Strep pneumo
MCC of upper GI bleed
PUD
MCC of lower GI bleed
Upper GI bleed, then diverticulosis
MCC of surgical abdomen in the elderly
Cholecystitis
MCC of pancreatitis
Gallstones & alcohol
MCC of SBO in adults
Adhesions
MCC of large bowel obstructions in adults
Cancer
MCC of bowel obstruction in pregnancy
Cecal volvulus
MCC of hernia in women
Inguinal (not femoral)
MCC of bowel perforation
Diverticulitis
MCC of bowel obstruction in kids 3mo - 6y
Intussusception
MCC of diarrhea
Viral (norovirus in adults, rotovirus in kids)
MCC of diarrhea in HIV
Cryptosporidium
MCC of travelers diarrhea
E coli
MCC of death in sickle cell patients
Infection
Most common inherited coagulation disorder
von Willebrands
Most common vision threatening infection in HIV
CMV
Most common AIDS defining condition in US
PCP pneumonia (now called pneumocystis jeroveci)
MCC of hypercalcemia
Primary hyperparathyroidism
MCC of septic joint
Staph
Most common STD in US
Chlamydia
Most common type of kidney stone
Calcium oxalate
Most common site of kidney stone impaction
UVJ
Most common gynecologic cancer
Uterine
Most common abdominal organ injured in blunt trauma
Spleen
Most common abdominal organ injured in penetrating trauma
Liver
MCC of pericarditis
Viral
Most common area for mandible fracture
Body
Most common surgical abdomen in all age groups
Apendicitis
MCC of peds death over 1 yo
Trauma
MCC of maternal death in pregnancy
Trauma
MCC of sepsis in elderly
Urosepsis
Tox substances not bound by charcoal
Caustics Hydrocarbons (e.g. gasoline) Lithium Iron Cyanide Alcohols Acids/alkalais
Contraindications to charcoal
Caustics
Ileus
Obstruction
When to use multidose charcoal
Extended release meds Salicylates Theophylline Phenobarbital Carbemazapine
Cyanide OD: Rx
Sodium nitrite
Sodium thiosulfate
Hydrocobalamin
When to use whole bowel irrigation
Extended release Body packers Bezors Iron Lead Lithium
Ethylene glycol antidote
fomepazole (4MP)
alcohol
dialysis
Methanol OD antidote
fomepazole (4MP)
alcohol
dialysis
Nitrites antidote
Methylene blue
Organophosphates OD: Rx
Atropine
2-PAM
What antidote is contraindicated with which anticholinergic OD
Physiostigmine contraindicated in TCA overdose
How to calculate osms
2xNa + Glucose/18 + BUN/2.8 + ETOH/4.6
Should be 280-295
How to evaluate lateral neck xray in kids
Anterior to C3-4 should be
What should osmolar gap be?
INH OD: Rx
Pyridoxine (B6)
Iron OD: Rx
Deferoxamine
Anticholineric toxidrome: si/sx
Blind as a bat Hot as a hare Mad as a hatter Red as a beet Dry as a bone
What drugs is dialysis good for?
BLIST MED Barbituates Lithium INH, Iron Salicylates Theophyline Methanol Ethylene glycol Depakote
Arsenic OD: Rx
BAL, DMS
Barbituate OD: Rx
Alkaline diuresis
Dialysis
Carbamate antidote
Atropine
Mercury antidote
BAL, DMS
Methemoglobin antidote
Methylene blue
Rank the alcohols in terms of toxicity
- Methanol
- Ethylene glycol
- Ispropyl alcohol
- Ethanol
Radio-opaque drugs
CHIPES Cholorhydrate Heavy metals Iron Phenothyazines Enteric coated Solvents
Indications for dialysis
AEIOU Acidosis Electrolytes Ingestions Overload Uremic symptoms