deck 38 Flashcards
diverticulosis diagnosis
CT scan
diverticulosis GI presentation
acute diverticulosis more associated with N/V than diarrhea
management of gonorrhoea infection
Need to also screen for syphilis, hep B, chlamydia (high rate of coinfection)
secondary syphilis presentation
fever/malaise + widespread lymphadenopathy + diffuse maculopapular rash that begins on trunks and EXTENDS to extremities, including palms and soles + grey, mucous patches in mouth
cause of gallstones in TPN patients
gallbladder stasis
cause of mitral valve abnormality in HOCM
presence of systolic anterior motion of mitral valve leads to anterior motion of mitral valve leaflets toward the inter ventricular septum
- contact between the mitral valve and the thickened septum during systole leads to LV outflow tract obstruction
classic de quervain tenosynovitis pt
mother holding infant with thumb outstretched
de quervain tenosynovitis presentation
- tenderness in radial side of wrist at base of hand
- tenderness with passive stretching of tendons by grasping flexed thumb into palm
initial management of lumbosacral radiculopathy
- NSAIDS or acetaminophen. NO IMAGING.
most common findings of x ray in its with cervical spondylosis
osteophytes
amyloidosis etiology
- *can also be secondary to chronic inflammation (eg chronic infections, IBD, RA)
drug used for treatment and prophylaxis of amyloidosis
colchicine
most common condition associated with dermatomyositis
malignancy (over 15% of patients)
most common cause of primary adrenal insufficiency
autoimmune (over 90%) in developed world
key distinguishing features between primary and secondary adrenal insufficiency
hyperkalemia + hyperpigmentation
demographic most effected by pernicious anemia
whites of northern European ancestry
length of time it would take for vegan to develop b12 deficiency
4-5 yrs of pure vegan diet (very high total body store)
preferred treatment of vasospastic angina
CCBs (dilitazem, amlodipine)
presentation of mild primary hyperparathyroidism
mild, asymptomatic hypercalcemia
how to distinguish between exogenous thyroid intake vs. thyroiditis
serum thyroglobulin level (low with exogenous uptake, high with thyroiditis)
well known complication of giant cell or temporal arteritis
aortic aneurysm
major concern with hydroxychloroquine
retinal toxicity
most common pathologies seen with analgesic nephropathy
papillary necrosis + chronic tubulointerstitial nephritis
metabolic side effects of thiazide duiretics
hyperglycemia, increased LDL cholesterol and triglycerides, hyperuricemia,
hyponatremia, hypokalemia, hypomag, hypercalcemia
presentation of amyloidosis
asymptomatic proteinuria + nephrotic syndrome + waxy skin + anemia + easy bruising + hepatomegaly
cardiac amyloidosis presentation
CHF manifestations (progressive dyspnea, lower extremity edema, JVD, ascites) + LVH and non dilated LV cavity, especially absent HTN history
why do high dose steroids cause adrenal insufficiency?
1) central mechanism. steroids act on pituitary to decrease release of ACTH.
why do you get muscle weakness in cushings syndrome?
cortisol catabolizes skeletal muscle, leading to muscle atrophy.
tachycardia-mediated cardiomyopathy pathophys
Chronic tachycardia causes LV dilation and myocardial dysfunction. This leads to LV dysfunction with decreased ejection fraction.
treatment of tachycardia-mediated cardiomyopathy
aggressive rate control OR restoration of normal sinus rhythm
why is adenosine used for narrow complex tachycardia?
1) slows sinus rate + increases AV nodal conduction delay + can cause a transient block in AV node conduction
2) allows you to identify P waves to clarify diagnosis of A flutter or atrial tachycardia.
3) can terminate PSVT by interrupting the AV nodal reentry circuit
what does SVT refer to?
any tachycardia originating above His-bundle (sinus tachycardia, multifocal atrial tachycardia, a flutter, a fib, AVNRT, AVRT, junctional tachycardia)
supraventricular arrhythmias on ECG
- narrow complex
- no regular P waves (buried in QRS complexes,
- retrograde P waves: seen in beginning or end of QRS complex
what is torsades de pointes?
polymorphic v tach occurring in the setting of a congenital or acquired prolonged QT
torsades de pointes management
1) if hemodynamically unstable, then immediate defib
2) if stable, then IV mag sulfate
aortic regurg murmur
early diastolic
perivalvular abscess setting
patient with infective endocarditis who develops a new conduction abnormality (AV block) (abscess extends into adjacent conduction tissues) (usually happens in aortic valve in IV drug abusers)
fluid dynamics of acute MR
leads to excessive diastolic volume overload, which causes elevated left ventricular end diastolic pressure. This elevated filling pressure is reflected back in the left atrium and pulmonary circulation and is responsible for signs/symptoms of acute pulmonary edema and CHF
ECG with myocarditis
nonspecific ST segment changes
signs of RV failure
elevated JVP RV 3rd heart sound tricuspid regurg hepatomegaly hepatojugular reflex lower extremity edema, ascites, pleural effusions
hearing loss in HIV patient
serous otitis media (lymphadenopathy or obstructing lymphoma leads to auditory tube dysfunction)
AAA screening recommendation
aged 65-75 active or FORMER smokers with one time abdominal ultrasound
carotid endarterectomy indications
patients with symptomatic carotid artery stenosis of 70-99%
a fib with RVR definition
a fib with pulse over 100
BNP value for CHF
high sensitivity
cord compression management
IV glucocorticoids without delay, then get MRI
