Block 7 IM Flashcards
Workup for PE
Perform dichotomized Well’s criteria:
1) PE most likely dx = 3 pts
2) HR greater than 100 or prior DVT/PE = 1.5 pts each
3) Bedrest over 3 days or surgery in last 4 wks = 1.5 pts
4) Hemoptysis or malignancy = 1 pt each
Less than 4 = low risk, Over 4 = high risk and warrants CTA
Other tests:
D-dimer: Se, not Sp (r/o)
ECG: r/o heart problems, S1Q3T3 and other patterns\
US of leg for DVT r/o
Tx for histoplasma infections?
Amphotericin B for 1-2 weeks until clinical improvement then switch to itraconazole for maintenance therapy more than 1 year duration
Usually opportunistic infection and assoc. with HIV so pt should be started on antiretroviral therapy if warranted.
Caspofungin use
2nd line tx for aspergillosis
Drug that is effective against Cryptococcus
Flucytosine
Spectrum of use for metronidazole
anaerobes and amebiasis
Identify Dx:
Pt over 65, has a swollen red ankle that is painful with all movement, insidious onset, no trauma, no fever, x-ray shows calcification of the articular cartilage.
What crystals would be seen on aspiration of the joint?
Pseudogout: most commonly affects knees and ankles but also large joints of the UE
Chondrocalcinosis establishes the Dx in an inflammatory arthritis
Calcium pyrophosphate crystals (rhomboid shape, positive birefringence)
How is pseudogout diagnosed?
X-ray of an inflammed arthritic jint will show chondrocalcinosis
Aspiration shows calcium pyrophosphate crystals
Patient has non-specific constitutional sx and a red rash consistent with erythema migrans. Dx? Tx? Complications if not treated early? Name of Organism?
Lyme Disease
Dx by rash and Sx
Doxycycline is good choice unless in pregnant women and kids under 8 them amoxicillin is preferred
If not treated can lead to aseptic meningitis, facial palsy, heart block, arthritis
Borrelia bergdorferi
What are the clinical features of MS and what are the most common and second line tests that can be done for Dx?
Features: progressive weakness, upper motor neuron signs, paresthesias and other sensory effects, optic neuritis, onset age 15-50, fatigue, bowel/bladder dysfunction, relapsing-remitting most common type
Dx: T2 MRI showing lesions that vary in time and space
If clinical picture and scans are not classic, an LP can be done which will show Oligoclonal Bands (increased level of IgG), normal cell count with T cell predominance, normal opening pressure, normal total protein
What disease has rapidly progressing ascending weakness after an infection, diminished or no response DTR’s, albuminocytologic dissociation in CSF (high protein but normal cell count)?
Guillain-Barre syndrome
What disease has 14-3-3 protein in CSF? What are the basic clinical signs of this disease?
Prion disease like Creutzfeld-Jakob
Pt usually has rapid decline in mental status like dimentia and behavior changes with startle myoclonus
Describe MEN type 1
Multiple Endocrine Neoplasia Type I
Autosomal dominant
Common presentation is ulcers and Sx of high calcium
Remember the 3 P’s representing the 3 types of primary tumors:
-Parathyroid: hypercalcemia, kidney stones, constipation, polyuria; in 90% of MEN1 patients
-Pancreatic: Glucagonoma, Gastroma (most common), insulinoma; 60-70% of patients
-Pituitary: any type of adenoma; 10-20% of patients
