dec 13 firecracker cases etc Flashcards
cardiac tamponade, compressed right atrium
JVD
cardiac tamponade, compressed left atrium
pulmonary edema
cardiac tamponade preload/etc
decrease preload
decrease systolic stroke volume
diminished CO
cardiac tamponade etiologies
post viral
uremia
neoplastic
acute hemopericardium
blunt/penetrating chest trauma
reputure of free wall of LV following MI
complication of retrograde aortic dissection
Beck’s triad + one more
JVD, muffled heart sounds, systemic hypotension
pulsus paradoxus
Kussmaul sign
JVD with inspiration
constrictive pericarditis
pulsus paradoxus
drop of 10 or more systolic with inspiration
exaggeration of normal physiology
cardiac tamponade - ec ho
severe compression of RA and RV
cardiac tamponade definitive diagnosis
cardiac catheterization
cardiac tamponade treatment
pericardiocentesis
what to avoid in cardiac tamponade
positive pressure ventilation
untreated cardiac tamponade
extra-cardiac obstructive shock
abd aorta screening
65-75
less than 4cm, yearly
4 cm, 6months
5 cm - surgery
achalasia LES
elevated LES pressure
inability to relax LES during swallowing
Waldenstrome macroglobinuria
igm spike
hyperviscosity
organism involved in RHD vegetations
streptoccus mutans
NMS
fever, rigidity, increased CK
treat with dantrolene, bromocriptine
Renal Cell Carcinoma
hematuria
left sided variocele
paraneoplastic symptoms: anemia/eryhtocytosis, leukocytosis
Hep C and pregnancy
low chance of transmission
Proteus UTI
ph >7
struvite stones
cutaneous ulcer + hemoptysis
wegners
chronic pancreatitis
inflamm process
- fibrosis
- calcification
- irreversible damage
number one cause of chronic pancreatitis
alcohol
chronic pancreatiitis risk factors
male, recurrent acute attacks
gallstones, triglycerides
CF, PBC, PSC
difference between acute and chronic pancreatitis
irreversibly of damage
pathogenesis of chronic pancreatitis
repeated bouts of acute pancreatitis
- loss of parencyhma
- duct distortion
- fibrosis
- impaired secretion
duct flow becomes obstructed as a result of
fibrosis
pancreatic concretions
pancreatic concretions
due to increased protein concentration in pancreatic fluid
chronic pancreatitis - s/sx
epigastric pain
steatorrhea
wt loss, nausea
mild fever
gold standard diagnosis for chronic pancreatitis
72 hr quantitative fecal fat determination
chronic pancreatitis complications
fat/fat soluble vit/b12 malabsoprtion
pseudocyst, abscess formation
glucose intolerance
bile duct obstruction
pancreatitic insuff can be due to
cystic fibrosis
cancer causing obstruction (pancratitc)
pancreatic failure
pancreatic insufficiency diagnosis
fecal elastase
<200
pancreatic insuff treatment
pancreatic enzyme supplementation (lipases, proteases, amylases)
low fat diet
treatmetn of chornic pancreatitis
alcohol/smoking cessation
pain control
b12/adek suppl
pancreatic enzyme suppl
chronic pancreatitis - strictures
ERCP to dilate and stent pancreatic ducts
spontaneous ptx
due to rupture of apical blebs
tall, thin, healthy males
secondary spontaneous ptx
underlying path: COPD, trauma, infections
tension ptx
one-way valve effect
air can enter pleural space but not not exit
pressure on mediastinum –> hemodynamic instability
- mediastinal shift, tracheal deviation AWAY
tracheal deviation in tension ptx
AWAY
pneumothorax presentation
Pleuritic Chest Pain, Tracheal Deviation, Hyperresonace, Occurs Suddenly, reduced breath sounds, absent fremitus, x ray shows collapse
ptx diagnosis
chest xray
hyperlucent lung fields due to air accumulation
visceral pleural line
spontaneous ptx - tracheal deviation
spontateous: deviates towards affected lung due to decreased pressure from atelectasis on that side
tension ptx - tracheal deviation
away from affected lung, due to increased pressure on that side
tension ptx symptoms
can also have shock, JVD due to compression of SVC
spontaneous ptx if untreated
progress to tension ptx
large tension ptx
hemodynamic instability due to pressure on great vessels
treatment of small spontaneous ptx
resolves spontenous
o2 can expedite recovery
large, simple pneumothorax treatment
chest tube
treatment of secondary spontaneous ptx
hospitalized and pneumo drained
tension ptx treatment
needle decompression (needle thoracostomy)
needly thoracostomy placement
bottom of 2nd intercostal space at midclavicular line
PCP type of pneumonia
atypical pneumonia with dry cough, diffuse interstitial
PCP histological
fluffy, foamy exudate in alveolar spaces
BAL - silver stain
PCP clinical presentation
HIV cd4 <200
dry cough, fatigue, fevers, chills
- pnemothorax
PCP CXR
diffuse bilateral ground glass infiltrates extending from perihilar region
PCP treatment
tmp-smx
po2 less than 70 give prednisone (21 days)
PCP prophylaxis if sulfa allergic
dapsone (test g6pd def first)
cytoisospora
cd4 <50
diarrhea, wt loss
treat with tmp-smx or cipro
Kaposi sarcoma clinical presentation
rash that is non responsive to treatments
associated with HHV-8
low cd4 count makes visceral involvement more likely
kaposi sarcoma treatment
HAART
chemotherapy for lesions
hemothorax
blood in pleural space
- trauma, pulmonary infarction, TB, malignacy
hemothorax cxr
blunting of costophrenic angles
hemothorax treatment
underlying cause
supplemental o2
chest tube
hemothorax untreated
formation of thrombi and fibrosis
hypomagnesmia
<1.3
impaired intestinal absorption of magnesium in
alcoholics, malabsorption, diarrhea, NG suction
increased renal excretion of magnesium in
increased renal tubular flow such as osmotic diuresis, diuretic use
meds associated with hypomagnesium
aminoglycosides, amph b
cisplatin, pentamidine, cyclosporine
s/sx hypomagnesemia
neuromusculuar and cardiac
neuromuscular symptoms of hypomagnesemia
tremor, ataxia, nystagmus, tetany, seizures
cardiac symptoms of low mag
atrial and ventricular arrhythmias
- especially in pts being treated with digoxin
low mag can also cause
low calcium and potassium
low mag EKG
pr, qt prolong
widened qrs
potential torsades de pointes
mag replacement
asymptomatic - oral
symptomatic - IV mag sulfate, check tendon reflexes
Familial Adenomatous Polyposis
- AD, APC gene
- hundreds of adenomas
- treatment is proctocolectomy
Good Pasture’s symptoms
renal + lung
dysmoprhic RBCs
Good Pastures’ antibody
alpha 3 chain of type IV collagen
pt has LDL >/= 190
high intensity statin
pt has ASCVD 10 year higher than 7.5%
moderate-high intensity statin
pt is 40-75 yr old with DM
high intensity if ASCVD greater tahn 7.5
moderate intensity if ASCVD less than 7.5
pt has clinical atherosclerotic disease
less than or equal to 75, high intensity
older than 75, moderate intensity
crystal induced nephropathy in HIV pts
indinaivr (protease inhibitor)
didanosine
reverse transcripatse inhibitor
pancreatitis
abacavir
NRTI
hypersensitivity syndrome
NRTIs
nucleoside reverse transcripatase inhibitor
lactic acidosis
NNRTIs
SJS
Nevirpine
liver failure, NNRTI
cyclosporine AE
nephrotoxitiy/neurotoxicity
glucose intolerance
gingivial hypertrophy
cafe au lait spots
neurofibromatosis
chagaz dz
megacolon/esophagus + cardiac disease
protozoan
hep c virus type
single stranded RNA flavivirus
initial diagnostic test for hep C
anti-HCV antibody test
test for confirmation of Hep C
qualitative PCR
other tests for Hep C
quantitatie HCV testing
genotype testing
HCV treatment standard of care
pegylated interferon and ribavirin
2014 HCV recommendations
add polymerase inhibitor –> sofosbuvir
time period for spontaneous clearance of HCV
12 weeks
most common causes of digital clubbing
lung malignancy
cystic fibrosis
r to l shunt
Pseudogout
calcium pyrophosphate deposition
rhomboid shaped crystals with positive bireferengence
most common cause of liver malignancy
metastasis
PAD treatment
exercise
antiplatelet
pain relief related to malignacy
start with short acting morphine
HACEK
hameophilus aggregitabcteier(actinobaccilus) cardiobacterium hominis e corrodens kingella kingae
d xylose test
absorption in proximal SI
celiac sprue
widened mediastinum and gi symptoms
esophageal perforation
order water soluble contrast esophogram
rifampin ae
red urin
extramsucular findings of dermatomyositis
interstitial lung dz, dysphagia, myocarditis
association with malignancy
wisconsin
blastomycosis
blastomycosis
lung/tb like symptoms
skin lesions
most common complication of PUD
hemorrhage
cervical sponyldosis xray
bony spurs
sclerotic facet joints
toxo infections in immunosuppressed
pneumonitis
myocarditis
necrotiizing encephalitis
SIADH meds
antidepressants, antipsychotics
narcotics, nsaids
chlorpropamide
antipseudomonal B lactam
cefotaxime, ceftriaxone, or ampicillin-sulbactam
what are ranson’s criteria
WBC count of >16,000 on admission
Age >55, Glucose >200 mg/dL on admission
AST >250 on admission
LDH >350 on admission
what kind of defect is osteoporosis
quantittive
osteoprosis =
loss of osteoid (organic bone matrix)
WHO osteoporosis defintion
L2-L4 2.5 sd below normal
decreased bone mass manifests as`
decreased thickness of cortical and trabecular bone
fewer trabecular interconnections
why is osteoporosis more common in women?
- they have lower peak bone mass
- live longer
- rapid bone loss during menopause secondary to decreased estrogen production
role of genetics in osteoporsis
greater than daily activity or calcium intake
osteoporosis most common patient type
older caucasion postmenopausal woman
decreased peak bone mass
- due to malnutrition
- malabsorptive dz (celiac)
increased resportion
old age (decreased osteoblasts)
sex steroid def
decreased load bearing
glucocorticoid use
lifestyle factors associated with osteoporosis
alcohol
smoking
most common fractures in osteoporosis
vertebral > hip > Colles
hip fractures
femoral head
colles fracture
radial fractue
osteoporosis diagnosis
DEXA
also look for hypothyroidism, hypercortisoloism, hyperPTH, renal/hepatic dysfxn
DEXA scan age
65
treatment of osteoporis
vit d and calcium supplementation
bisphosphonates
osteoporosis - lifestyle adjustments
wt bearing exercise, smoking cessation, limit alcohol, more calcium and vit d
raloxifene
SERM, inhibits bone turnover
anatgnoist to estrogen on breast and endometrial tissue
decrease risk of breast and uterine cancer
increased risk of thromboembolic events
PTH - osteoporosis
pts with one fracture, intolerance to bisphosphonates
osteoblastic activation in periodic doses
DJD also called
osteoarthritis
DJD =
chronic noninflammatory deterioration of articular cartilage
DJD pathophysiological
cartilage deteriorates
lytic lesions with sclerotic edges
DJD most common joints
knee, hand, hip
DJD modificable risk factors
obestiy
trauma
labor-intensive occupations
non-modifiable DJD risk factors
age
family hx
female gender
DJD presentation
joint pain, stiffness
worse with activity, wt bearing
DJD PE findings
decreased ROM effusion malalignment joint creptius DIP, PIP joint osteophytes with MCP sparing
DJD xray
joint space narrowing, osteophytes, subchondral sclerosing, subchondral cysts
DJD first line
acetaminophen if no symptoms of inflamm
NSAIDs
nonoperative DJD treatment
bracing
wt loss if bmi >25
pt
corticosteroid injection
DJD operative treatment
arthrosocopy in degenerative meniscal tears
total joint replacement
causes of pulseless electrical activity
6hs and 5ts
6 h’s
hypovolemia, hypoxia, hydorgen ions (acidosis) hyper/hypokalemia, hypoglycemia, hypothermia
5 t’s
toxins/drugs, tamponade, tension ptx, thrombosis (myocardial or PE), trauma
diffuse esophageal spasm
chest pain and dysphagia
osteomalacia - lab valuves
low ca, phosphate
increased pth, alk phos
osteomalacia - xray
pseudofractures
laryngeal edema
acute onset dyspnea
splenic abscess triad
fever, leukocytosis, LUQ pain
splecic abscess cause
staphylococcus, streoptocccus, salmonella
splenic abscess treatment
bs antibiotics and splenectomy
RA - part of spine invovled
cervical
gastric adenocarcinoma diagnosis
endoscopy/biposy
CT abd/pelvis
hereditary spherocytosis genetics
AD
defective proteins - spectrin, ankyrin
hereditary spherocytosis - defect in RBC
spherical shape, causes them to get stuck in narrow passages of splenic cord –> destroyed = extravascular hemolysis
hereditary spherocytosis presentation
hemolytic anemia
jaundice
splenomegaly, gallstone formation
hereditary spherocytosis labs
anemia, reticulorcytosis
MCHC elevated
increased membrane fragility
hereditary spherocytosis complications
hemolytic crises
leg ulcers
priapism
hypertrophic cardiomyopathy
hereditary spherocytosis treatment
splenectoy
herediatary sphereocytosis supportive care
folic acid
blood transfusions
EPO
abnormal eosin 5-maleimide binding test
hereditary spherocytosis
causes of epididymitis
young - chlyamydia, gonorrhea
old - GNR (e coli)
antiphospholipid lab abnormality
elevated PTT due to phopholipids binding in vitro
PTHrp associated with
squamous cell carcinomas
s sanguininis
viridians group, endocarditis after dental procedures
antithyroidperoxidase antibody
hasiomoto
pneumonia with GI symptoms
legionella!!!
legionella treatment
azithromycin or fluoroquinolone
acromegaly - first test to order
IGF-1
erytheum nodosum differential
streptococcus, TB/histo, sarcoid, IBD
infective endocarditis - what valve
tricuspid
holosytolic murmur that increases with inspiration
paget’s disease treatment
bisphosphonates
vipoma - symptoms
watery diarrhea, flushing
hypokalemia, hypercalecemia, hyperglycemia
pancreatic mass
malt treatment if no metastases
treat for h pylori
omperazole + clarithomycin + amoxicillin
periotonsillar bascess
muffled voice/hot potato voice
unilated LAD
deviated uvula
prevention of uric acid stones
potassium citrate to alkalinize urine
zinc def
alopeica
skin lesions
abnormal taste
cutaneous larva migrans
creeping eruption
sand boxes/beaches
lymph nodes <1 cm
benign
rubella in adults
arthralgia/arthritis
rubella in children
conjunctivitis, coryza, cervical LAD
forschemier spots
cephalocaudal spread of blancing maculopapular rash
ADPCK complications
intracranila aneurysms
valvular heart disease
hepatic cysts, colonic diverticula, abdomainal wall and inguinal hernia
complications of anklyosing spondylitis if present for two decades
osteopenia/osteoporisi
spinal ostemomyelitis physical exam
tender to percussion
reactive arthritis
urethritis, oligoarthirit, conjunctiviti
achilles tendon pain
AVF
high output cardiac failure
conn syndrome
low renin, increased aldosterone
lidocaine in ACS
don’t use
decreases VF but increases asystole
hereditary spherocytosis symptoms
hemolytic anemia
splenomegaly
jaundice
RPGN presentation
acute renal fialure, oliguria, nephritic
How is echocardiography used in cardiac arrest?
distinguish pulseless electrical activity (PEA) that results in myocardial contraction from patients with no mechanical activity
bone marrow biopsy of multiple myeloma patients?
myeloma cells are present on bone marrow biopsy, which are plasma cells in various stages of maturation. They will have acidophilic cytoplasmic inclusions of immunoglobulin called Russell bodies.
What is the role of lidocaine in adult cardiac arrest?
v. fib/v. tach cardiac arrest if amiodarone fails.
What antiplatelet medications are indicated for patients who have received coronary interventions for STEMI?
aspirin and a P2Y12 blocker (ticagrelor, prasugrel)
CO =
SV x HR
SV is and =
LVEDV - LVESV
blood ejected from ventricle during systolic
SV and hypovolemic shock
decrease in SV –> increase in HR
MAP =
average arterial pressure over cardiac cycle
(CO x SVR) + CVP
MAP calculation
1/3 systolic + 2/3 diastolic
main resistance vessels
arterioles
determine SVR
septic shock and CO
decrease in SVR
increase CO
causes of pulsus paradoxus
cardiac tamponade
copd, asthma
arrhythmia in digitalis
atrial tachycardia with AV block
drug that causes prolong QRS during exercise
flecainamide (IC)
Acute infective endocarditis caused by
S. aureus
subacute infective endocarditis caused by
viridans streptococci
s epidermis
enterococci
HACEK
HACEK =
hameophilus, actinobacillus, cardiobacterium, eikenella, kingella
culture negative cause of endocarditis
HACEK
nonbacterial thrombotic endocarditis
sterile vegetations of platelets and thrombi form on valves
highly susceptible to emoblization
marantic endocarditis
NBTE in setting of advanced malignancy
s bovis
infective endocarditis in colon cancer
veridans group
occurs on native valves
sanguinis
infective endocarditis - FROM JANE
fever, roth’s spots, osler’s nodes, murmur
janeway lesions, anemia, nailbed hemorrhage, emboli
roth’s spots
retinal hemorrhages around white spots
osler’s nodes
tender raised lesions on toes and fingers
janeway lesions
nontender erythematous lesions on sole and palm
empiric infective endocarditis therapy
vancomycin + aminoglycoside (gentamicin)
therapy for Viridans, Strep bovis
(Penicillin or ceftriaxone) + gentamicin
or
vancomycin
therapy for staph endocarditis
Oxacillin + gentamicin, or
Nafcillin + gentamicin, or
Cefazolin + gentamicin, or
Vancomycin for patients with penicillin allergy or MRSA endocarditis.
if pt has prosethic valve and endocarditis
need gentamicin and rifampin
antibiotic prophylaxis for infective endocarditis
Congenital cyanotic lesions (ventricular septal defect and atrial septal defects should NOT be treated)
Prior valve repair using prosthetic material (mitral valve prolapse should not be treated)
A prior history of endocarditis
A history of heart transplant
untreated endocarditis
heart failure, abscess formation, emboliation causing end-organ damage
reversible cause of HF
hemochromatosis
cardiac myoxoma
left atrium
constitutional symptoms
diastolic heart sound
embolization
acute limb ischemia after MI
arterial embolus from LV thrombus (order TEE)