EOR 2 Flashcards
Dilated CM
- systolic dysfunction
- 50% idiopathic, infective myocarditis, ETOH, beriberi, chagas, doxorubicin
- mitral regurge murmur
- tx w/BB, ACEI, VAD to transplant
HOCM
- diastolic dysfunction, sudden death in teens
- (Valsalva increases sound and squatting decreases it)
- asymptomatic tx w/BB/verapamil, severe add diuretic
- may need myectomy, transplant
Restrictive CM
- diastolic dysfunction
- caused by amyloid,sarcoid, idiopathic
- tx w/diuretic, ACEI, transplant
acute vs suvbacute IE cause
acute-S. Aureus
subacute-S. Viridans
Duke Criteria
Major: Positive blood culture (2 separate cultures drawn >12 hours apart) Evidence of endocardial involvement Positive ECHO- oscillating intracardiac mass on valve or supporting structures, abscess, new partial dehiscence of prosthetic valve or new valve regurgitation
Minor Predisposing heart condition or IVDA
Fever (38 degrees) Vascular phenomena- major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway lesions Immunologic: glomerulonephritis, Oslers nodes, Roth spots, rheumatoid factor Microbiologic: + blood culture but not meeting major criterion
Echo: consistent with endocarditis but not meeting major criterion
roth spots vs janeway lesions
roth spots-retinal hemorrhage
janeway-palms/soles
Beck;’s triad for pericarditits
- Hypotension with narrow pulse pressure
- JVD
- Muffled heart sounds
how does pericarditis present
sharp chest pain relieved leaning forward
QRD alternans from heart swinging
tx w/NSAIDS and colchicine
erythema multiforme
Acute self limiting type 4 hypersensitivity reaction. MC in young adults 20-40y/o
-Skin lesions evolve over 3-5 days and persist about 2 weeks
-Associated with HSV and meds (sulfa drugs, beta lactams, phenytoin, phenobarbital) malignancies,
autoimmune
how does erythema multiforme present
Target lesions are classic, dull, dust violet, purple/blue/red, macules/vesicles or bullae in the center surrounded by
pale edematous rim and a peripheral red halo. Often febrile.
SJS vs TEN
SJS describes cases where total body surface area of blistering and detachment are <10%
TEN is used to describe cases w/ >30% detachment
drugs that can cause SJS
sulfonamides, allopurinol, antiepileptics
(lamotrigine, phenytoin, carbamazepine), oxicam NSAIDs, beta lactam and other abx,
and nevirapine
Bright cherry-red, Small – pinhead size to about one quarter inch (0.5 centimeter) in diameter Smooth, or can stick out from the skin
cherry angioma
no tx needed
dilation of small superficial vessels and capillaries that cause numerous flat
red marks on the hands, face and tongue
telangectiasia
bullous pemphigoid
-Chronic widespread autoimmune blistering skin disease primarily of the elderly
- Type 2 HSN autoimmune attack on the epithelial basement membrane causing subepidermal blistering
- tense bullae that don’t rupture easily, blister roof contains epidermis, NEGATIVE NIKOLSKY
tx w/steroids
Pemphigus Vulgaris
Oral mucosal membrane erosions and ulcerations before painful flaccid skin bullae, ruptures easily, leaving painful erosions that bleed easily
+ nikolsky sign
tx w/steroids
metformin
decreases hepatic production of glucose
stop if creatinine ?1.5
sulfonylureas
stimulates pancreatic beta cell insulin release
glyburide, glipizide
Thiazolidinediones
increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells “glitazones”
GLP-1 agonists
lowers blood sugar by mimicking incretin - causes insulin secretion and
decreased glucagon and delays gastric emptying
DDP-4 inh
inhibits degradation of GLP-1 so more
circulating GLP-1
“gliptans”
SGLT2 inh
increased urinary glucose excretion
Cranial nerve 8- schwannoma. Benign tumor of the schwann cells, which produce myelin sheath
acoustic neuroma
- Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise
Vestibular neuritis & hearing loss/tinnitus (cochlear involvement)
labyrinthitis, MC from a viral infection
Celiac
-Small bowel Autoimmune disorder to rye, wheat, and
barley
-dermatitis herpetiformis is seen
how to test for Celiac
Serum immunoglobulin A (IgA) endomysial antibodies and IgA tissue transglutaminase (tTG) antibodies.
Sensitivity and specificity > 95%
intussusception
- common 6-18 months
- preceded often by viral syndrome
- vomiting, abdominal pain, passage of blood per rectum
how to dx/tx intussception
- barium enema
- may show spring-coil sign
MCC LBO
adhesions
colon cancer in older folks
Most common cause of painless rectal bleeding in the pediatric population
polyps
how to tx cryptorchidism
orchiopexy ideally before 1 year old hCG or GRH hormones can be used to induce descension. May be used prior to surgery but not often
done
is a condition in which urine flows retrograde, or backward, from
the bladder into the ureters/kidneys
vesicoureteral reflux
This results from autoimmune antibody formation against host platelets. Occurs in acute
form and chronic form.
Clinical features: Petechiae and ecchymosis on the skin Bleeding of mucus membranes No splenomegaly
immune thrombocytopenia purpura
Plt <20K
tx w/steroids, IVIG
- rare disorder of platelet consumption
- hemolytic anemia, thrombocytopenia, acute renal failure, fever, fluctuating, transient neurologic signs
thrombotic thrombocyopenia purpura
↓ Platelets + anemia + renal failure
HUS
VWD
missing or defective von Willebrand factor (VWF), a clotting protein. VWF binds factor VIII, a key clotting protein
hemophila A
factor VIII deficiency
x-linked recessive
prolonged PTT
hemophilia B aka christmas disease
factor IX deficiency
hemophilia C
factor XI deficiency comon in AJ
how to tx botulism
hospitalization
antitoxin does not treat, but prevents further damage
From contaminated water, fish, shellfish, street vendor food Clinical features: diarrhea RICE WATER
vibrio cholera
BLOOD AND MUCUS (PUS) IN STOOL
shigella
tx w/bactrim
Infection occurs from consuming food products with organisms: poultry, reptiles and amphibians
(pet turtle)
salmonella
how to tx diphtheria
diphtheria equine antitoxin, removal membrane direct laryngoscopy, PCN or
erythromycin, isolation
JONES criteria for rheumatic fever
requires 2 major or 1 major plus 2 minor
Major ● Carditis ● Chorea ● Erythema marginatum ● Polyarthritis ● Subcutaneous nodules Minor ● Arthralgia ● Elevated ESR or C-reactive protein ● Fever ● Prolonged PR interval (on ECG)
group of clinical syndromes characterized by motor and postural dysfunction due
to permanent and non-progressive disruptions in the developing fetal brain
cerebral palsy
MC type is spastic syndrome
dx via cranial MRI
Autoimmune, inflammatory demyelinating disease of the CNS of idiopathic origin with axon
degeneration
MS, MC type is relaxing remitting
Slow nerve impulses weakness numbness pain and vision loss
LLhermites
lightning shock pain
pulfrich effect
sense of disorientation in moving traffic
uhthoffs
worsening of symptoms with heat
Autoimmune disorder causes decrease in acetylcholine receptors at post synaptic junction
MUSCLE WEAKNESS AND FATIGABILITY IMPROVES WITH REST,
Myasthenia Gravis
how to tx MG
ACHase inhibitors like pyridiostigmine and neostigmine
Excessive anxiety and worry about daily events and activities (job, school, work, marriage) for at least 6
months
GAD
Period of extreme anxiety that peaks 10 minutes declines within 30 minutes, RARELY LASTS FOR LONGER than 1 HOUR
panic attack
MC mental disorder
phobia
Chronic progressive interstitial scarring from persistent inflammation resulting in loss of pulmonary function w/ restrictive component
idiopathic pulmonary fibrosis
-CXR: bilateral reticular opacities in periphery
and lower lobes- honeycombing
PFT of IPF
normal to increased FEV1/FVC ratio; RV decreased; VC decreased;
Multisystem disorder characterized by alveolitis followed by epithelioid granulomas •
Associated with inclusion bodies such as Schaumann’s bodies and asteroid bodies •
NON-CASEATING GRANULOMAS, HILAR ADENOPATHY • Most common African
Americans; young people (< 40 y/o); females
Sarcoidosis
Chronic progressive disease with multisystem involvement of pulmonary and GI tract which
ultimately results in death
Autosomal recessive on chromosome 7
o Defect of the CFTR gene amusing alterations of salt and water movements across
membranes –> abnormally thick secretions
cystic fibrosis
how to tx cystic fibrosis
o aimed at pulmonary, GI, nutritional, infectious disease
o Exacerbations: antibiotics with augmented airway clearing
Pseudomonas infections: tobramycin or aztreonam and Azithromycin
o Enzyme replacement for pancreatic insufficiency
o High fat diet
hyaline membrane disease
Surfactant production begins 24-48 weeks- by 35 weeks, enough surfactant is produced
-CXR will demonstrate diffuse bilateral atelectasis causing a “ground glass appearance” and air bronchograms
nephrotic syndrome
Heavy proteinuria >3.5 g/14 hours
Hypoalbuminemia <3 g/dl
Minimal change disease aka Nil’s
M/C Cause of NS in KIDS <10 and can follow a viral URI
In adults, its M/C associated with NSAIDs
proteinuria w/no hematuria
membranous nephropathy
M/C primary cause of NS in adults,
M/C/C of ESRD in USA(second being HTN)
diabetic nephropathy
acute renal failure
Low GFR with accumulation of nitrogenous wastes
HPV strains
16 and 18 cause cancer
6 and 11 cause warts
cervical cancer screening guidelines
First PAPat theage of 21regardless of sexual activity (no pap indicated prior to that)
Age less than 30:do not screen withHPV testing
Age 21-65:Screen with PAPevery 3 years
Age 30-65:Screen with PAP and Cytologyevery 5 years
Age > 65:Screen with adequate prior screening: do not screen
when to start HPV vaccine
11-12
Pregnant woman + trauma + PAIN =
abruptio placentae
Bright red vaginal bleeding that PAINLESS, 3rd trimester
placenta previa
Beta hcg level above which IUP should be visualized on US
1000-1500 on transvaginal
4000-6500 on transabdominal
Methotrexate in patients with <5000 hcg and ectopic mass <3-4 cm
Premature cervical dilation especially in the 2 nd trimester that leads to spontaneous
abortions
incompetent cervix
painless dilation of cervix
tx w/Weekly injection of 17-alpha-hydroxyprogesterone
postpartum hemmorhage
Blood loss > 500 mL in vaginal delivery > 1,000 for C-section following delivery (difficult to quantify)
MCC pospartum hemorrhage
uterine atony
because normally the uterus should contract
therefore compressing blood vessels and preventing bleeding, over distension,
Oxytocin use during labor, uterine exhaustion, retained placenta or blood clots, full
bladder, uterine infection, cervical or vulvar or vaginal lacerations, and
coagulopathy
PROM
Premature rupture denotes spontaneous rupture of fetal membranes before the onset of
labor
-alkaline ph is amniotic fluid
PPROM
Preterm (<37 weeks) premature rupture of membranes
-risk of oligohydramnios
prolonged rupture of membranes
Rupture of membranes that lasts > 18 hours
-risk of chorioamnionitis
how to manage PROM
-tocolytics (terbutaline, nifedipine, indomethacin, Mg Sulfate)
< 34 weeks give steroids
give rhogam to…
RH - moms at 28-30 weeks
HTN meds for AA
thiazide or CCB
HTN meds for DM or chronic kidney disease
ACE/ARB
tx of choice in uncomplicated HTN
thiazide diuretic
prevents kidney water/Na reabsorption at DCT
dihydropyridines
potent vasodilators (little effect on cardiac contractility) -nifedipine/amlodipine
non-dihydropyridines
affect contractility and conduction
- verapamil/diltiazem
- used for prinzmetal angina also
A1 blockers
“azosin”
good for HTN w/BPH
nitroglycerin
-increase blood supply
-decrease cardiac work, deny preload
C/I w/PDE5 inhibitors
1st line tx for chronic angina
BB
ASA inhibits
thromboxane A2