deck 34 Flashcards
initial therapy for atrial fibrillation due to hyperthyroidism
beta-blockers
potassium in patients with hyperosmolar hyperglycemic state
1) pts have a total body potassium deficit (glucose induces osmotic diuresis which sucks potassium out) (same is true for DKA)
2) problem with this is that insulin can abruptly lower serum potassium levels and cause severe hypokalemia
common cause of hypocalcemia in alcoholics
hypomagnesemia (causes decreased release of PTH and PTH resistance).
other impt cause of hypercalcemia
prolonged immobilization (due to increased osteoclastic activity)
treatment of hypercalcemia 2/2 immobilization
bisphosphonates
problem with pulse ox for CO poisoning
may appear normal because it can’t differentiate carboxyhemoglobin from oxyhemoglobin
exam finding suggesting CO poisoning
bright cherry lips
thyroid tumor and elevated calcitonin?
medullary thyroid cancer
next step after medullary thyroid cancer is diagnosed
screen for pheochromocytoma prior to thyroidectomy with plasma fractionated metanephrine assay
diabetes and polyneuropathy pathophys
- microvascular injury + demyelination + oxidative stress + deposition of glycosylation end products
- this leads to a length-dependent axonopathy
- clinical features depend on the type of nerve fibers involved
- small fiber injury is characterized by positive symptoms (pain, paresthesias, allodynia)
- large fiber involvement is characterized by predominance of negative symptoms (numbness, loss of proprioception and vibration sense, diminished ankle reflexes)
primary hyperaldosteronism lab profile
HTN + mild hypernatremia + metabolic alkalosis + suppressed plasma renin (this is because of feedback inhibition in response to aldosterone secreting tumor)
management of caustic ingestion with sodium or potassium hydroxide (lye)
endoscopy to assess severity of damage
arsenic sources
pressure-treated wood + pesticides
arsenic poisoning presentation
painful sensorimotor polyneuropathy + hypo and hyper pigmented skin lesions + pancytopenia + mild transaminase elevation
patient populations with atypical ACS symptoms
women + elderly + diabetics
common atypical ACS presentations
dyspnea + epigastric pain + N/V
type 1 MEN
primary hyperparathyroidism + pituitary tumors + GI/pancreatic endocrine tumors
thyroid storm presentation
tachycardia + HTN + arrhythmias + high fever +tremor + AMS + lid lag
hypothermia management
mild with passive rewarming, severe with active rewarming (heated blankets) + heated peritoneal irrigation (internal warming)
methanol intoxication
vision loss + coma
PE in methanol intoxication
optic disc hyperemia
how to differentiate methanol vs. ethylene glycol poisoning
methanol damages the eyes, ethylene glycol damages the kidneys
how to differentiate postpartum adrenal insufficiency
- can be due to adrenal or pituitary disease
- hyper pigmentation + signs of mineralocorticoid deficiency suggests primary rather than secondary AI
meningococcal vaccination
- all adolescents at age 11-12
- booster at 16
- especially important in sub-saharan africa
vaccination and TNF-alpha antagonists
can’t use live vaccines
adult Tdap vaccination
- every 10 years
- if never received or vaccine history unknown, Tdap should be given followed by Td every 10 years
vitamin deficiency with carcinoid
Niacin. This is because increased production of serotonin from tryptophan (required for niacin synthesis) results in niacin deficiency
features of vertebral osteomyelitis
- most cases chronic and insidious with minimal symptoms
- fever not often present
- exquisitely tender to gentle percussion
- often normal white count
- high ESR
source of B12
dairy products
when to scan pyelo patients
persistent symptoms despite 48-72 hours of therapy OR complicated pyelo
aldosterone antagonists
spironolactone, eplerenone
thiazide mechanism
block sodium-chloride symporter
OI prophylaxis for patients who’ve had solid organ transplantation
- *bactrim for pneumocystis pneumonia
- Many patients also require CMV prophylaxis with ganciclovir or valganciclovir
p jirovecii diagnosis
need bronchoalveolar lavage/respiratory secretions using microscopy with specialized stains (can try induced sputum but may need bronchoalveolar lavage)
typical symptoms of hypercalcemia
abdominal pain + constipation + polydipsia
bacteria involved in puncture wound through SOLE of a shoe
pseudomonas (likes warm, moist environment)
strep throat vs. mono
- mono causes generalized lymphadenopathy unlike sore throat
- mono persists for longer (2 weeks)
presentation of hypothyroid myopathy
myalgias + proximal muscle weakness + elevated CK level + additional features of hypothyroidism (fatigue, delayed reflexes)
management of post exposure HIV prophylaxis
3-drug antiretroviral therapy for 1 month. start therapy ASAP
presentation of disseminated gonococcal infection
mono arthritis and/or tenosynovitis + dermatitis (erythematous papule and pustules) + asymmetric migratory polyarthralgias
hep A vaccine recommended for
gay men + chronic liver disease + travelers to countries where hep A is prevalent
DKA management
1) NS
2) regular insulin
3) serial BMPs
4) treat underlying factor
best antibiotic to cover oral bacteria
amoxicillin-clavulanate
esophageal perforation presentation
chest pain + subcutaneous emphysema + left-sided pleural effusion
causes of esophageal perforation
endoscopy + severe retching + penetrating trauma
esophageal perforation diagnosis
contrast esophagram
how does vasodilator stress testing work
adenosine causes an increase in blood flow in normal coronary arteries and a relatively small increase in blood flow in stenotic coronary arteries. Difference in blood flow allows for diagnosis of obstructive CAD due to reduced uptake of isotope in ischemic myocardium
effect of CKD on phosphate
hyperphosphatemia
common cause of male pattern hair loss in women
PCOS
actinic dermatitis
skin damage from sun
