Amboss Flashcards
Eosinophiliuria
in patients with allergic intersitial nephritis this is caused by a hpersensitivity reaction to drugs like PPIs, NSAIDS, antibiotics and diuretics.
tx: discontinue PPI and give fluids
symptoms: microscopic hematuria, maculopapular rash, flank pain, increased creatinine and eosinophilia
osteoarthritis
pain and stiffness that worsenes with activity, it can affect the knee, hands, and hips the most
of the hands the PIP and DIP joints are most affected
herberden and bouchards nodes
nephritic syndrome
inflammatory damage to the glomerular capillary wall
leads to GBM disruption and decreased glomerular filtration rate with retention of water and salt
symptoms: peripheral edema, JVD, pulmonary edema, mild proteinuria, RBC casts
constrictive pericarditis
reduced ventricular filling and reduced cardiac output most of the times caused by tuberculosis but other causes like cardiac surgery, radiation therapy, viral infections can cause it
rigid pericardial sac (calcified sac)
signs of pericarditis
pericardial known ( high pitched, early diastolic sound that sounds like a premature S3)
fatigur, dyspnea, JVD,positive hepatojugular refluc , kussmaul sign, hepatomegaly
risk factors for esophageal adenocarcinoma
obesity, smoking, achalasia, high animal protein diets
eosphageal adenocarcinoma is located where
distal 1/3 of the esophagus
smoking and achlasia also increase the risk of what cancer
esophageal squamous cell cariconoma
what are the risk factors for cyrptococcous neoformans?
immunosppressed- HIV
symptoms that point towards cryptococcous neoformans
fever, fatigue, headaches, increased intracranial pressure, indica ink stain with prominent capsules
the onset of cyrptococcal neoformans in HIV patients is CD4 counts of what
less than 100 cells
in patients with blunt trauma to the head and neck what should be assumed?
cervical spine injury
in a patient that does not respond to questions but is conscious raises suspicion for what
that is airway is compromised and a cervical collar should be utilized to immobilize the cerival spine
in managing trauma patients what should you do
ABCDE
Airway
breathing
circulation
Disability (glascow scale)
Exposure (looking for occult injury
what are the two most common causes of urethritis?
gonorrhea and chlamydia
what are the signs of a chlamydia urethral infection?
usually asymptomatic but can cause clear urethral discharge
it is hard to stain because it is intracellular so only neutrophils indicating bacteria would be present
screen with DNA amplification
symptoms of gonorrhea urethritis
purulent discharge with gram negative or intracellular diplococci
common adverse affect of tetracyclines
photosensitivity ( tetracycline)
how do tetracyclines cause photosensitivity?
the drug metabolites will interact with UV light leading to a photochemical reaction with the formation of free oxygen radicals and damage to areas exposed to the sun
what are other adverse effects of tetracyclines?
discoloration of teeth, growth inhibition, hepatotoxicity, and damage to mucus membranes (esophagitis)
what tests confirm the presence of chlamydia trachomatis?
nucleic acid ampliification testing or first void urine
treatment of chlamydial infections
azithromycin (single dose) and one week of doxycycline
treatment of cryptococcous neoformans
amphotericin B and flucytosine for 2 weeks
oral flucanazole 8 weeks after then a lower dose flucanazole for 12 months to finish it off
peptic ulcer symptoms
epigastic pain that improves with food intake
endoscopic findings of duodenal ulcer?
mucosal breach in the anterior duodenum
hypertrophic brunner glands
anterior duodenum ulcers most common complication?
perforation into the peritoneal cavity
posterior dudodenal ulcers most common complication
massive bleeding (hematemesis) due to it being adjacent to the gastrododenal artery
Arteriovenous fistulas cause a decrease in?
peripheral vascular resistance
-shunt from high pressure to low pressure venous system
decreases in vascular resistance result in what symptoms?
elevated heart rate, decreases effective circulating volume and activation of the RAAS system
RAAS system causes retention of water and socium and increased cardiac filling pressures with elevated cardiac output- high output cardiac failure
treatmement of an AV fistula causing high output cardiac failure
immediate surgical division of the fistula to reverse current symptoms
what are common causes of high output cardiac failure
pregnancy, anemia, AV fistulas, hyperthroidism, wet beriberi
symptoms of bronchiectasis
chronic cough, copious amounts of sputum, dyspnea, hemoptysis (blood tinged sputum), coarse crackles on auscultation
symptoms of bronchiectasis exacerbate with?
acute respiratory tract infections
CXR signs of bronchiectasis
bronchial wall fibrosis (tram-track opacities)
the diagnosis of bronchiestasis is confirmed with?
CT scan that shows honeycombing, bronchi dilation and signet ring sign
treatment of bronchiectasis
exacerbation: sputum culture and empiric antibiotics
long term: smoking cessation, vaccinations
cholecystitis is usually caused by?
passage of gallstones into the cystic duct
symptoms of cholecystitis ?
cystic duct obstruction can lead to inflammation of the gallbladder causing RUQ pain, nausea, fever
HIDA scan of cholecystitis
delayed or absent radioactive tracer in the gallbladder
what is a HIDA scan primarily used for?
diagnose cystic duct obstruction
what labs are cholestatic (hepatic and common bile duct related)
ALP, GGT, Billirubin
antimicrobial prophylaxis for the prevention of infective endocarditis is recommended for high risk patients like who
people with prosthetic heart valves, history of infective endocarditis, congenital heart defect
what is the antiobiotic regimen for antimicrobial prophylaxis
oral amoxicillin administered 30-60 minutes prior to the procedure
what is the treatment of choice in acute severe pain from postoperative, malignancy, acute pancreatitis, burn injuries?
patient controlled anaglesia (hydromorphone, fentanyl)
*pumps include a lockout period where no further anaglesic can be given and respiratory depression does not occur
is there a link between opiods and aggravation of pancreatitis/worsen clinical outcomes
no
opiods can cause sphincter of oddi dysfunction but it will not aggravate pancreatitis
what medication is indicated for the immediate control of symptoms in patients with hyperthroidism?
beta blockers (propranolol)
what is streptococcous sanguinis
viridans streptococci that can cause subacute IE on damaged heart valves
***mutans too
what is the treatment of choice for infective endocartditis caused by HACEK organisms
3rd generation cephalosporins like ceftriaxone
intermittent catherterization is indicated in what kind of incontinence
overflow
what is overflow incontinence
urinary retention that is caused by a dysfunction of the bladder wall (underactive detrusor or spinchter)
people with diabetes can have neuropathy of the bladder and cannot sense bladder fullness
increased post residual void volume
what are the treatment options for overflow incontinence
behavioral changes, intermittent catheritization, triggered voiding, bethancol (muscarinic agonist)
oxybutynin is used for which incontinence
urge incontinence
what is oxybutynin
a M3 receptor antagonist that relaxes the detrusor muscle
what is urge incontinence
the sudden urge to urinate and leakage
cough, fever, decreased appetite, night sweat, hilar lymphadenopathy in the immunocompromised
pulmonary tuberculosis
tuberculosis pleurisy
pleuritis chest pain, lymphocyte predominant exudative pleural effusion, high adenosine deaminase
(inflammation of the plerua that occurs with tuberculosis )
symptoms and signs of emphysema
dspnea, productive cough, expiratory wheezing, low FVC/FEV1 ratio
DECREASED DLco (diffusion capacity of carbon monoxide)- loss of gas exhange and diffusion area
an FEV1: FVC ratio of less than 70% and reduced FEV1<80 percent is indicative of
obstructive lung disease
nonsmokers and individuals less than 50 who present with COPD and emphysema should be tested for?
alpha- 1 antitrypsin deficiency
clinical signs of infective endocarditis
fever, janewway lesions (macules/papules on the palms and soles) petechiae, a new heart murmur, hematuria (>3rbc on urinalysis ), roth spots (retinal hemorrhages with white centers)
neurological complications of infective endocarditis
ischemic stroke, intracerebral hemorrhage, cerebral microabcesses (septic emboli)
treatment of infective endocarditis
empiric antibiotic treatment with 3 sets of blood cultures
CT non-contrast
**thrombolytic therapy is not recommended due to risk of cerebral hemorrhage)
all patients with new-onset symptomatic afib should be evaluated for?
potential causes of arrythmia (TSH levels)
Dry cough that is worse when lying down, fine inspiratory crackles at the lung bases, and an S3 gallop on auscultation in a patient with multiple risk factors (e.g., hypertension, smoking, coronary artery disease) suggests?
congestive heart failure
Pulmonary edema usually indicates?
severe or decompensated heart failure
bronchial asthma is what
airway hyperresponsiveness and bronchial obstruction
symptoms of bronchial asthma
dry cough, nocturnal and exercise induced exacerbation, end expiratory wheezing
obstructive lung disease pattern
DLco is normal
does bronchial asthma get worse or better with methacholine challenge
worse!!!
improves with inhalation of a bronchodilator like albuterol
what is a subphrenic abcess
a collection of pus that collects between the spleen, diaphragm, and liver….this is seen 10 days after surgery
abdominal pain, fever, N/V
postoperative pneumonia
a post operative complication that happens 3-5 days after surgery
inspiratory crackles, fever, pleuritic chest pain (worse on inspitation), productive cough
what can maintain and improve lung function after surgery by keeping alveoli open?
Incentive spirometry and deep breathing exercises
early mobilization, and postoperative pain control
- decrease the risk of atelectasis and pneumonia (postoperative pulmonary complications)
what are the preoperative measures to reduce pulmonary complications?
smoking cessation, oral care, treatment of optimization for chronic lung disease
what is the first line treatment for patients with CAP with P. Aerginosa
cefepime and levofoxacin
microbiology for psuedomonas
gram-negative rod
seminomas contain?
syncytiotrophoblasts
seminomas secrete
B-hCG
treatment of seminoma
radical inguinal orchiectomy
yolk sac tumors produce?
a-fetoprotein
seminoma pathology
clear cytoplasm and central nuclei
what treatment is indicated for any testicular mass that has features that suggest an underlying malignancy?
radical inguinal orchiectomy
RIO is the first step in management as it is necessary to confirm the diagnosis
the testicular lymphatic channels travel in the spermatic cord and drain into the ?
retroperitoneal LNs (para-aortic LNs)
Sporothrix schenckii
dimorphic fungus
in patients with upper airway obstruction or will need long term mechanical ventiliation what is the best procedure to do?
tracheostomy
what is a severe complication of thrombolytic therapy
intracerebral hemorrhage (hemorrhagic stroke and increased ICP)
if intracerebral hemorrhage is suspected what shoud you do
discontinue thrombolytic therapy
emergent CT scan
consult neruosurgery
thrombolysis reversal agents could be considered
what are thrombolysis reversal agents
antifibrinolytics, FFP, cyroprecipitate
what is the best initial step in the treatment of patients with biopsy confirmed acute renal allograft rejection
pulse steroid therapy (methyloprednisolone)
what type of graft rejection can be reversed
acute transplant rejection
what is the first line imaging modality in someone with symptomatic carotid artery stenosis
duplex ultrasonography of the neck
in patients with carotid artery stenosis what will the ultrasound show?
focally increased velocity of blood flow
*can quantify the degree of stenosis
treatment of carotid artery stenosis
antiplatelet therapy, statin therapy, blood pressure control, lifestyle changes (smoking cessation, weight control, regular exercise)
in carotid artery stenosis when is carotid revascularization with carotid endarterectomy indicated?
in patients with symptomatic disease and severe stenosis (>70%)
with is heparin induced thrombocytopenia (HIT)
an autoantibody mediated platelet activation disorder
there are antibodies against the platelet factor 4 and heparin complex that causes platelet activation and increases the risk of clots
mesenteric vein thromobsis
how does thrombocytopenia occur in HIT
immune complexes remove platelets by macrophages and platelet consumption
in patients with HIT , heparin should be replaced with?
direct thrombin inhibitor (argatroban)
which has a higher risk of unfractionated heparin or low molecular weight heparin
unfractionated heparin
a patient that presents with splenomegaly, mild anemia, thrombocytosis, and leukocytosis should raise awareness for what
CML
in CML what is the leukocytosis
> 100,000 with basophilia
how can you differentiate CML from other forms of leukemia and leukemoid reaction
low leukocyte alkaline phosphatase
Papillary thyroid carcinoma
peak incidence 30-50 years old
most common type of thyroid cancer
spread via lymphatics
painless cervical lymphadennopathy
no family history
microcalcifications (hyperechogenic punctate regions)
anaplastic thyroid carcinoma
aggressive , rare
spreads via lymphatics
older patients (60)
medullary thyroid carcinoma
rare
family history (MENII)
50-60 years old
porecelain (calcified) gallbladder is associated with?
cholelithiasis and chronic gall bladder inflammation
what is the risk of a porcelain gallbladder
gallbladder adenocarcinoma
what is the treatment of a porcelain gallbladder
cholecystectomy
oliguria + increased BUN and creatinine
AKI
AKI that presents with hypovolemia, and a bun creatinine ration >20:1 is what kind
prerenal
sodium concentration in prerenal AKI
less than 20mmol/L
explain how prerenal AKI causes decreased urine sodium concentration
prerenal AKI is caused by hypoperfusion
this causes the kidneys to respond by reabsorbing lots of sodium and that sodium is then followed by water causing the urine to have low sodium and be concentration
intrinsic AKI urine sodium levels
reduced reabsorption of sodium due to damage to the tubular system
urine sodium >40
what is a good indicator of organ perfusion after burn incidents?
urine output
fluids should be tirated to maintain a urine output of 0.5ml
treatment of thrombotic thrombocytopenia purpura
plasma exchange therapy which will remove the autoantibodies against ADAMTS13 and replaces the ADAMTS13 protein that can then cleave vonwillebrand factor
labs in familial hypocaliuric hypercalemia
PTH is on the high end of normal
Ca+ is elevated
Urine Calcium/Creatine ratio<0.01
**asymptomatic, decreased in CaSR
labs in primary parahyperthyroidism
increased PTH
increased Calcium
Increased urinary calcium/creatinine ratio >0.02
what are some potential side effects of familial hypocalciuria hypercalcemia
pancreatitis and chondrocalcinosis
FHH is a mutation in?
calcium sensing receptor
what is a myasthenic crisis
this is when a person with MG has severe respiratory muscle weakness leading to respiratory failure
increasing bulbar muscle weakness (inability to cough up sputum)
worsening vital capacity
hypoxia
shallow respirations
what is a myesthenic crisis precipitated by
infection, medications etc.
treatment of myasthenic crisis
intubation to protect the airway
Theraputic Plasma exchange to reduce the level of pathological autoantibodies + Corticosteroids
HOLD acetylcholinesterase inhibitors (pyridiostigmine)
symptoms of motor parkinsonism
bradykinesia, rigidity, and tremor
drug induced parkinsonism drugs
antipsychotics (decrease dopamine), antiemetics like metaclopramide and procholrperazine
what do you do if a patient has parkinsonism like symptoms and is on a drug that can cause these symptoms?
discontinue the drug
the diagnosis of idiopathic parkinsonism cannot be made if you are on one of these drugs
after discontinuation symptoms should resolve in 3 months
what is supraventricular tachycardia
any tachycardia that originated above the bundle of HIS
narrow QRS complex and missing P waves , they are hidden in the ORD complex can be retrograde
R-R is constant
what are the types of supraventricular tachycardias (7)
sinus tachycardia
multifocal atrial tachycardia
atrial flutter
a fib
atrioventricular nodal reentrant tachycardia
AV reentrant tachycardia
junctional tachycardia
what is paroxysmal supraventrical tachycardias
supraventricular tachycardias with abrupt onsent and offset (AVNRT, AVRT, atrial tachycardia and junctional tachycardia)
treatment of supraventricular tachycardias
use vagal manuvers (carotid sinus massage, valsalve, eyeball pressure)
OR IV adenosine
how do adenosine and vagal maneuvers help Supraventricular tachycardias?
they slow down conduction through the AV node and can aid in unmasking hidden P waves
what is painless (silent) thyroiditis
a variant of chronic autoimmune thyroiditis that has a brief hyperthyroid phase
small nontender goiter, low radioiodine uptake and positive TPO
what is chronic autoimmune thyroiditis
predominant hypothyroid
diffuse goiter with positive TPO
usually increased radiodine uptake
a patient with nausea, trouble swallowing, chest pain and a retrocardiac air-fluid level has what
a paraesophageal hiatal hernia
what is a sliding hernia?
when the gastroesophageal junction and cardia herniate into the chest
cause GERD like symptoms
what is a paraesophageal hital hernia
when the gastric fundus herniates into the chest it causes severe symptoms like N/V, dysphasia, chest pain etc.
diagnosis of hernias are confirmed with?
upper endoscopy or barium swallow
treatment of hiatal hernias
sliding: treat reflux symptoms
paraesophageal: surgery
ACS due to unstable angina or non-ST segment elevation MI is managed how?
antiplatelet (clopidegrel)
anticoagulant (heparin)
beta blockers
nitrates
and statins
NOT STRESS TESTING UNTIL ACS IS RESVOLVED
first line treatment for any type of urinary incontinence is?
bladder training and pelvic floor exercises
urge incontience is detrusor _
overactivity
the detrusor muscle is mediated by the _ nervous system
parasympathetic
to help urge incontinence you should use
antimuscarinic medications (oxybutynin)
or B3 agonist: mirabegron
what is diabetic nephropathy
irreversible injury to glomerular basement membrane and surrounding structures due to metabolic byproducts of chronically elevated blood glucose
perisitent proteinuria
what are common findings in someone with lymphoproliferative disorders on chemotherapy
thrombocytopenia and anemia
treatment of chemotherapy induced anusea and vomiting
serotonin 5HT (receptor antagonists)- odansetron
low side effect profile
parapneumonic effusions
effusions due to pneumonia
uncomplicated parapneumonic effusion
sterile exudate in the pleural space
pH is greater than 7.2
complicated parapneumonic effusion
bacterial invasion in the pleural space
low ph <7.2
low glucose
high WBC
what is the next best step for a patient with severe asthma exacerbation with an elevated PaCO2
endotracheal intubation
high Paco2 indicated impeding respiratory failure
stess incontinence treatments
sling, pessary, pelvic floor exercises
Euythroid state
elevated T4 with normal TSH
what increases thyroid binding globulin
estrogens and acute hepatitis
how does estrogens and acute hepatitis increasing TBG cause an increase in total T4
increased TBG will bing T4 but to maintain a euthyroid state there would be an increase in total T4
free level of T4 is normal
normal TSH, normal free T4, high total T4
things that decrease TBG
androgenic hormones, high dose glucorticoids, chronic liver disease, hypoproteinemia
low TSH, high free T4
infectious keratitis
corneal opacification and ulceration that is an opthalmologic emergency
bacterial keratitis
mucopurlent drainage and ulceration of the corena most commonly caused by staph aureus and psuedomonas aeruginosa
contact lens use causing bacterial keratitis is mostly caused by?
psuedomonas aeruginosa
treatment of bacterial keratitis
topical antibiotic drops - empiric fluroquinolones
a patient with cirrhosis, lethargy, confusion, and asterixis has?
hepatic encephalopathy
heptaic encephalopathy is
impaired CNS function in people with cirrhosis from ammonia neurotoxicity
patients with hepatic encephalopathy on diuretics can develop
low intravascular volume despite having total volume overload
treatment of hepatic encephalopathy
volume resuscitation and repletion of hypokalemia along with serum ammonia lowering medications ( lactulose)
a postoperative patient with bilateral asymmetric ptosis that improves with the application of an ice pack raises suspicion for?
myasthenia gravis (antibody blockade and degeneration of acetylcholine receptors at the NMJ)
hallmark presentation of myasthenia gravis
fatigable weakness (eyes, bulbar muscles, extremities)
weakness in MG can be precipitated by?
infections, pregnancy, surgery, medications, nondepolarizing neuromuscular blocking agents
the diagnosis of MG can be supported with?
it is confirmed with?
ice pack test (improvement in ptosis)
confirmed with acetylcholine receptor antibody testing
is qualitative HBsAb alone sufficient to determine immunological protection against HBV ( means patient was immunized but never contracted it)
no
patients can have positive HBsAb but insufficient HBsAB titers
if HbsAb is positive what should you do next
check for titers
if titers are > 10 then you do not need any prophylaxisis
if titers are <10 you need hepatitis B immunoglobulin and repeat HBV vaccination
why can niacin cause pruritus and flushing
it causes vasodilation and drug induced release of histamine and prostaglandins
take with low dose aspirin to combat these symptoms
what is acute respiratory distress syndrome
direct or indirect pulmonary injury that leads to the release of proteins, inflammatory cytokines and neutrophils into the alveolar space. Protei, fluid and surfactant all leak out causing pulmonary edema
pulmonary edema causes decreased gas exchage and hypoxemia with a V/Q mismatch
lack of surfactant causes decreased lung compliance
hypoxemia causes pulmonary artery vasocostriction and intubation causes further ateriole compression causing pulmonary artery hypertension
clinical findings of acute respiratory distress syndrome
respiratory distress, bilateral alveolar infiltrates, crackles, hypexemia
PaO2 and FiO2 in ARDS
decreased PaO2 and increased FiO2 to maintain oxygenation
PaO2/FiO2 is decreased
a patient with a Hx of chrons disease that had bowel resection that now has bone pain and muscle weakness, on X ray he has osteopenia and psuedofractures
diagnosis?
osteomalacia
what is osteomalacia?
reduced mineralization of osteoid at bone forming sites
osteomalacia is common in patients with?
malaborptive disorders. (chronic vitamin D def)
symptoms of osteomalacia
asymptomatic or generalized bone pain and muscle weakness
labs in osteomalacia
increased alkaline phosphatase (bone remodeling)
decreased vitamin D
decreased calcium
decreased phosphorus
increased PTH
x ray findings in osteomalacia
psuedofractures- looser lines
cortical thinning
concave vertebral bodies
pulmonary involvement in systemic sclerosis has what 2 manifestations
pulmonary arterial hypertension
intersitial lung disease
signs of SS with pulmonary hypertension
normal lung sounds, dyspnea, exertional syncope
normal FEV1 and FEVc
decreased DLCO
limited SS
right sided heart failure ( right side deviation on EKG, JVD, loud P2)
*narrowing of the lumen of the pulmonary arteries
intersitial lung disease findings in a patient with SS
diffuse SS (organ scarring)
alveolar basement membrane inflammation and fibrosis
restrictive lung patter
velcro like rales, cough, dyspnea
symptoms of chronic pancreatitis
intermittent epigastric/abdominal pain that is intermittent and relieved when leaning forward
pancreatic inflammation that causes exocrine or endocrine functinonal damage- diarrhea, steatorrhea, weight loss
pancreative calcifications
first line imaging for a patient with chronic pancreatitis
CT scan or X-ray showing pancreatic calcifications
optic disc in glaucoma
enlarged cup/disc ration >0/6
increased cup size
loss of peripheral vision
thinning of disc rim
what is open angle glaucoma
atrophy of the optic nerve head due to increased intraocular pressure
patient with cough, fever, leukocytosis, mild hyponatermia and a right lower lobe infiltrate has?
community acquired pneumonia
patients with community acquired pneumonia are risk stratified using?
CURB65
inpatient treatment of community aquired pneumonia is treated how
sputum culutre and blood culture taken
empiric treatment with beta lactam plus macrolide (ceftriazone + azithromycin)
outpatient treatment of CAP includes
healthy patients: amoxicillin or doxy
comorbid conditions: beta lactam + macrolide OR fluroquionolone
intermittent claudication, diminished pulses and low ankle brachial index is concerning for
peripheral arterial disease (athersclerosis of large arteries)
smoking is sthe strongest risk facts
PAD has an increased risk for
CAD/MI/Stroke
leukemoid reaction has high
leukocyte alkaline phosphatase
CML has low
leukocyte alkaline phosphatase
what is the next best step when an X-ray finds a lung lesion
compare to previous lesions if there are any
if no history of lesion or growth get a CT
aquagenic pruritis, facial plethora, and increased hematocrit raise suspicion for?
polycythemia vera
what is polycythemia vera
chronic myeloproliferative disorder that causes an increased RBC mass
causes thombotic complications
what thrombotic complication can be seen from polycythemia vera
budd chiari syndrome
what is budd chiari syndrome
hepatic venous outflow obstruction due to thrombosis
clinical signs of budd chiari
vague abdominal discomfort, ascites, hepatoslenomegaly, elevations in liver transaminases, billirubin and alkaline phosphatase
how do we diagnose budd chiari syndrome
abdominal ultrasound
dialysis related amyloidosis is?
decreased clearance of Beta 2 microglobulin that depostis and causes
shoulder pain/hypertrophy, carpal tunnel syndrome and bone cysts
what is shock liver (ischemic hepatic injury)
rapid and significant increase in transaminases due to hypotension
hypotension can be caused by septic shock or heart failure
can carbon monoxide poisoning cause a heart attack?
yes
CO binds hemoglobin at greater affinity than oxygen which creates
carboxyhemoglobin
symptoms of CO poisoning
drowsiness, elevated lactate, arrythmias, myocardial ischemia , pulmonary edema
how to diagnose CO poisoning
co-oximetry of arterial blood gas showing elevaed carboxyhemoglobin
treatment of CO poisoning
100% O2 in a nonrebreather facemask (hyperbaric oxygen)
individuals with secondary polycythemia vera and no evidence of hypoxia should undergo?
CT scan (to evaluate for renal cell carcinoma)
(elevated EPO, only HCT increased)
colon cancer screening for people with ulcerative colitis
start screening 8-10 years after disease diagnosis
colonoscopy every 1-3 years
colon cancer screening for first degree relative with colorectal cancer or high risk adenomatous polyp
colonoscopy at age 40 or 10 years prior to the age of diagnosis in the first degree relative
repeat every 5 years
repeat every 10- if the first degree relative was diagnosed later than the age of 60
colon cancer screening for average risk people
start at age 45
colonscopy every 10 years
gFOBT or FIT every year
FIT-DNA every 1-3 years
CT colonography every 5 years
flexible sigmoidoscopy every 5 years
MOA of warfarin
inhibits the synthesis of vitamin K dependent factors which include: II, VII, IX, X, protein C and S
necrotizing malignant otitis externa
severe ear pain with granulation tissue in the external auditory canal that is caused by psuedomonas aeruginosa
can cause cranial nerve neuropathies
RF: diabetes, elderly, aural irrigation
treatment: IV antipsueduomonal antibiotics and surgical debridement
what causes otitis externa most commonly
psuedomonas
next common is staph aureus
treatment of otitis externa
topical fluroquinolone and glucocorticoid
vesicular ear rash and ipsilateral facial droop
herpes zoster oticus (varicella zoster virus reactivation)
can cause loss of taste, hearing, taste
treatment of herpes zoster oticus aka ramsay hunt
antiviral medications like valacylovir
chrons disease of the gi tract predisposes people to what
abscess, fistula, fissures
rectovaginal fistulas ( foul tan discharge coming from the vagina)- passage of flatus from the vagina
treatment of a rectovaginal fistula
surgical correction
patients diagnosed with an STD are at increased risk of coinfection with other sexually transmitted pathogens and should be tested for what other pathologies?
chlamydia trachomatis, HIV, and treponema pallidum (syphillis)
