Cumulative Review Flashcards
Calcineurin Inhibitors
Cyclosporine
Tacrolimus
Major side effects of Cyclosporine
Nephrotoxicity Hyperkalemia Hypertension Gum Hypertrophy Hirsutism Tremor
Major side effects of Tacrolimus
Nephrotoxicity
Hyperkalemia
Hypertension
Tremor
Fleshy immobile mass on the midline hard palate
Torus Palatinus
Congenital
May increase in size over time
No intervention necessary unless it becomes symptomatic
Niemann-Pick Vs. Tay-Sachs
Niemann-Pick - Sphingomyelinase Deficiency
Tay-Sachs - Beta Hexosaminidase A deficiency
Baby meets milestones
Within first 6 months, regresses from milestones
Cherry red macula
Feeding difficulty/hypotonia
Areflexia = Niemann-Pick (Sphingomyelinase deficiency)
Also has hepatosplenomegaly
Hyperreflexia = Tay-Sachs (Beta Hexosamindase deficiency)
Someone is resuscitated with 1/2 NS
Think iatrogenic hyponatremia
Treat with hypertonic saline & close monitoring of lytes
Flu Vaccine guidelines
Annually in all adults
IM inactivated is more effective than live attenuated
Td booster guidelines
Every 10 years
Tdap as one-time dose in place of Td
Pneumococcal vaccine guidelines
All adults >=65 get PCV13 (conjugate), then PPSV23 (polysaccharide) later
Also true for adults < 65 with high-risk comorbid conditions: CSF Leaks Sickle Cell Disease Cochlear Implants Asplenia Immunocompromised
Adults <65 with conditions increasing the risk of invasive pneumococcal disease: Heart or lung disease Diabetes Smoking Chronic liver disease
Start with PPSV23 alone, then do the PCV13 PPSV23 sequence after 65
Cat bite care
Irrigation & ceaning
Augmentin (PPX for pasturella)
Tetanus booster (if not up to date)
Avoid closure
School-age child comes in with viral symptoms and proteinuria but no hematuria
Repeat urine dipstick on 2 separate occasions
Probably transient proteinuria or orthostatic proteinuria, but if still positive 2 more times, investigate for significant renal disease
Meningococcal vaccine guidelines
Primary vaccination at age 11 - 12
Booster at age 16 - 21
High Risk:
Complement deficiency
Asplenia
College students in residential housing (age <= 21)
Military recruits
Travel to endemic environments (Africa, Mecca, Saudi Arabia)
Patients receiving TNF antagonists should not get
Live-Attenuated Vaccines:
Varicella
Influenza (intranasal)
MMR
Yellow fever vaccination
Required for some countries in central africa
If allergic to eggs, or immunocompromised, must get a documented medical waiver instead, and be counseled on mosquito protection
Properties of a confounder
It is linked to the exposure
It is linked to the outcome
Pericardial thickening & calcification
Sharp X & Y descents
Constrictive pericarditis
TB causes this in Africa, India & China
First line therapy for narcolepsy
Modafinil (nonamphetamine, promotes wakefulness)
Most common cause of aplastic crisis in sickle cell anemia patients?
Parvovirus B19
PAS-positive material in the lamina propria of small intestine
Whille's Disease Tropheryma Whillelii (Bacillus)
Arthralgias Weight Loss Feber Diarrhea Abdominal Pain
Patient presents with iron deficiency anemia
Do endoscopy to look for source of bleeding
Tricuspid valve infective endocarditis in IVDU
Throws septic emboli with staph aureus
Pulmonary infiltrates, abscesses, infarct, gangrene, cavities
Transaminitis
Macrocytosis
Early morning waking
Alcohol use disorder
Recurrent sinopulmonary infections (sinusitis, pneumonia)
Recurrent GI infections (giardia)
Associated with autoimmune diseases & atopy
Selective IgA deficiency
Transfusions lead to anaphdylaxis from Ab against IgA
Temperature in neonatal sepsis
High OR Low
Causes of amaurosis fugax
Temporal Arteritis
Carotid Atherosclerosis
Kid has a virus
Kid gets Aspirin or other NSAIDs
Kid gets Reye syndrome
Microvesicular fatty infiltration of the liver. Causes acute liver failure: Transaminitis Coagulopathy Nausea/Vomiting Hypermmonemia Encephalopathy
Sensory loss
Rest pain
Muscle weakness
Immediately threatened limb
Start anticoagulation
Alkalosis has what effect on calcium?
More is bound to albumin
Functional hypocalcemia even though total body calcium is normal.
Stroke in an IVDU
Think endocarditis, especially if there is a fever
Antiplatelet therapy is only good for patients with atherosclerotic disease, so no need to put them on that therapy.
Tick bite in the south
Fever, malaise, AMS
Transaminitis & high LDH
Leukopenia and/or Thrombocytopenia
Ehrlichiosis
Give empiric doxy while awaiting confirmatory testing
Diagnosis is clinical, but can be confirmed by seeing:
Intracytoplasmic morulae in WBC
Also can confirm with PCR
Treatment for Ehrlichiosis
First Line - Doxycycline
Second LIne - Chloramphenicol
Appearance of a TOA on ultrasound
Complex multiloculated adnexal mass
CRP & CA-125 will be elevated
Leukocytosis
Lymphadenopathy that is small, mobile, nontender, soft
Will regress on its own within several weeks. Observe.
Only evaluate with CBC, viral titers, inflammatory markers if the LAD persists
Risk factors for neonatal respiratory distress syndrome
PREMATURITY
Male Sex
Perinatal Asphyxia
MATERNAL DIABETES (Delays maturation of surfactant production)
C-section without labor
Mechanism of maternal diabetes leading to fetal underdevelopment of surfactant
Maternal hyperglycemia triggers fetal hyperglycemia
Hyperinsulinism antagonizes cortisol
Sphingomyelin can’t mature, and surfactant needs that.
High Sed Rate Positive Rheumatoid Factor Nonspecific infectious symptoms Cardiopulmonary symptoms Immune-complex glomerulonephritis Painful hand nodes
Infective endocarditis
Peripheral Neuropathy
Heart Failure
Wernicke-Korsakoff Syndrome
Thiamine Deficiency
Whole grains, meat, fortified cereal, nuts, legumes
Angular cheilosis Stomatitis Glossitis Normocytic anemia Seborrheic dermatitis
Riboflavin Deficiency
Dairy, eggs, meat, green vegetables
Dermatitis
Diarrhea
Delusions/Dementia
Glossitis
Niacin Deficiency
Meat, whole grains, legumes
Cheilosis Stomatitis Glossitis Irratibility Confusion Depression
Pyridoxine Deficiency
Meat, whole grains, legumes, nuts
Megaloblastic anemia
Neural tube defects
Folate Deficiency
Green leafy vegetables, fruit, meat, fortified cereal/grains
Megaloblastic anemia
Confusion
Paresthesias
Ataxia
Cobalamin Deficiency
Meat, dairy
Punctate hemorrhage
Gingivitis
Corkscrew hair
Scurvy
Citrus fruits, strawberries, tomatoes, potatoes, broccoli
Causes of normal anion gap metabolic acidosis
Diarrhea Fistulas Carbonic anhydrase inhibitors RTA Ureteral diversion Iatrogenic
Non-anion gap metabolic acidosis
Preserved kidney function
RTA
Type 4 RTA
Hyperkalemic RTA
Metabolic acidosis
Preserved renal function
Poorly controlled diabetes
Elevated T4
Normal TSH
T4-binding globulin is increased
Could be from estrogen (OCPs, pregnancy, HRT, hepatic dysfunction, tamoxifen)
Preterm labor < 32 weeks
Betamethasone
Tocolytics
Magnesium sulfate
Penicillin if GBS positive or unknown
Reversible causes of asystole/PEA
Hypovolemia Hypoxia Hydrogen ions Hypokalemia (or hyperkalemia) Hypothermia
Tension pneumothorax Tamponade Toxins (narcotics, benzos) Thrombosis Trauma
12 month milestones
Gross motor:
Stands well
Walks first steps
Throws a ball
Fine:
2 finger pincer grasp
Language: First words (other than mama and dada)
Social:
Separation anxiety
Follows 1-step commands with gestures
18 month milestones
Gross Motor:
Runs
Kicks a ball
Fine:
Builds a tower of 2 - 4 cubes
Removes clothing
Language:
10 - 25 words
Identifies at least 1 body part
Social:
Understands “mine”
Begins pretend play
2 year milestones
Gross Motor:
Stairs w/ both feet on each step
Jumps
Fine:
Builds a tower of 6 cubes
Copies a line
Language:
50+ words
2-word phrases
Social:
Follows 2-step commands
Parallel play
Begins toilet training
3 year milestones
Gross Motor:
Stairs with alternating feet
Tricycle
Fine:
Copies circle
Uses utensils
Language:
3-word sentences
Speech 75% intelligible
Social:
Knows age/gender
Imaginative play
4 year milestones
Gross Motor:
Balances & hops on 1 foot
Fine:
Copies a cross
Language:
Identifies colors
Speech 100% intelligible
Social:
Cooperative play
Side effects of Beta-2 Agonists
Hypokalemia (Drive potassium into cells)
Tremor
Headache
Palpitations
Why does polycythemia in the neonate lead to respiratory distress?
As hematocrit rises, so does viscosity of blood. It can’t reach vital organs, and it also leads to hypoglycemia and hypocalcemia from increased cellular uptake
Mediastinal mass
Bronchogenic cyst (benign) Tracheal tumors Pericardial cysts Lymphoma Lymph node enlargement Aortic aneurysms of the arch
Where are neurogenic tumors in the mediastinum found?
Posterior mediastinum
Meningocele Enteric cysts Lymphomas Diaphragmatic hernias Esophageal tumors Aortic aneurysms
Fanconi Anemia
AR or XLR
Chromosomal breaks on genetic analysis
Aplastic anemia Progressive bone marrow failure Short stature Microcephaly Abnormal thumbs Hypogonadism Hypopigmented/hyperpigmented areas Cafe au lait spots Large freckles Strabismus Low-set ears Middle ear abnormalities
Acquired causes of aplastic anemia
Drugs Toxins (benzene, glue, etc) Idiopathic Viral infections Immune disorders Thymoma
Most common congenital cause of aplastic anemia
Fanconi Anemia
AR or XLR
Chromosomal breaks
Genes involving DNA repair are implicated
Things that make Crohns different from UC
Crohns: Multiple portions of the GI tract Noncaseating granulomas Rectal sparing Fistula formation
Toddler hematochezia
Hemorrhoids Infectious colitis Intussusception Meckel's diverticulum Inflammatory bowel disease
Technetium-99m Pertechnetate Scan
Scan to detect Meckel’s!
Waldenstrom macroglobulinemia
Lymphoplasmocytic malignancy Excessive monoclonal IgM End organ damage >10% clonal B cells by bone marrow biopsy Hyperviscosity syndrome comes with it
Diplopia Tinnitus Headache Dilated/segmented funduscopic findings Neuropathy Infiltrative disease (hepatosplenomegaly, anemia, thrombocytopenia)
Hyperviscosity Syndrome
UTI with alkaline urine
Proteus (most common)
Klebsiella (also possible)
Elevated risk for struvite stones (magnesium ammonium phosphate)
Wallenberg Syndrome
Hoarse voice and falling to the right
Lateral medulla
Ipsilateral horner’s syndrome
Contralateral hemianesthesia in the body (ipsilateral in the face)
Eczema
Microthrombocytopenia (small platelets, low count)
Recurrent infections
Wiskott-Aldrich Syndrome
XLR in WAS protein gene
Impaired cytoskeleton changes in leukocytes & platelets
Treatment is stem cell transplant
RLQ pain & tenderness that isn’t appendicitis but is infectious
Psoas abscess
Abdominal CT scan to diagnose
Cardioversion vs. Defibrillation
Cardioversion is synchronized to the QRS complex, appropriate for persistent tachyarrhythmia causing hemodynamic instability
Defibrillation gives electricity at at a random point in the cycle. Appropriate for VFib or pulseless VTach
Electrolytes of Tumor Lysis Syndrome
Increased:
Potassium
Phosphorous
Uric Acid
Decreased:
Calcium (bound by phosphate that is released)
Leads to AKI (uric acid and calcium phosphate deposition) & cardiac arrhythmias
Prophylaxis = Allopurinol or rasburicase, IV Fluids
Treatment = Continuous telemetry, aggressive electrolyte management
Jaundice
Nontender, but palpable gall bladder (Courvoisier’s sign)
L supraclavicular adenopathy
Pancreatic adenocarcinoma
Abdominal untrasound first
Then abdominal CT
ERCP has very high sensitivity & specificity, but is so invasive that it only should be done if CT is nondiagnostic.
Infant with: Growth failure Recurrent respiratory infections Greasy stool Bruises
Cystic Fibrosis!
Pancreatic insufficiency leads to malabsorption and Vitamin K deficiency
Patient has Hodgkin’s Lymphoma and is cured. Now has a pulmonary mass on CXR. What is it?
Second malignancy
Having hodgkin’s gives you an 18.5 fold chance of developing another malignancy in your life
Prinzmetal angina
Vasospastic angina
Recurrent angina during rest or sleep
ESRD patient needs bridge to warfarin. What do you use?
Unfractionated heparin. LMWH is too associated with bleeding.
