Form 2 Block 3 - Created Aug 7 Flashcards
why hepatic encephalopathy occurs
infection, hypovolemia, GI bleed, metabolic abnormalities, sedative use (like opioids or benzos)
tx of hepatic encephalopathy
eliminate offending cause and give lactulose or lactitol; rifaximin is 2nd line
antidepressant discontinuation syndrome presentation
fatigue, HA, dizzy, chills, N, muscle aches/pains; psych sxs such as dysphoria, irritable, anxiety; tremor, paresthesias, “electric shock” sensations; setting of missed doses
tx of antidepressant discontinuation syndrome
restart med; taper over 2-4 wks if pt wants to stop med
tx of hypercalcemia of malignancy from bone mets
short-term: IVF and calcitonin
long-term: bisphosphonates
medical tx of primary hyperparathyroidism
cinacalcet
clinical features of PCP
violent, dissociation, hallucinations, amnesia, nystagmus, ataxia
clinical features of LSD
visual hallucinations, euphoria, dysphoria/panic, tachycardia/HTN
clinical features of cocaine
euphoria, agitation/psychosis, chest pain, seizures, tachycarida/HTN, mydriasis
clinical features of methamphetamine
violent, psychosis, diaphoresis, tachycardia/HTN, choreiform movements, tooth decay
clinical features of marijuana
increase appetite, euphoria, dysphoria/panic, slow reflexes, impaired time perception, dry mouth, conjunctival injection
clinical features of heroin
euphoria, depressed mental status, miosis, resp. depression, constipation
Light criteria for exudative pleural effusion
any of the following:
A. (pleural protein/serum protein) >0.5
B. (pleural LDH/serum LDH) >0.6
C. pleural LDH 2/3 upper limit of normal of serum LDH
common conditions causing exudate versus transudate
exudate - TB, pna, cancer, CT dz, PE, pancreatitis, post-CABG
transudate - cirrhosis, nephrotic syndrome, heart failure, constrictive pericarditis
presentation suggestive of COPD
progressive SOB and chronic cough, significant smoking hx, obstructive scooped out pattern on spirometry, (FEV1/FVC) ratio <0.7
pattern on spirometry of interstitial lung disease
restrictive or witch hat look
MCC of sick sinus syndrome
degeneration of cardiac conduction system
2 groups at greatest risk of getting Pneumocystic jirovecii
1) advanced HIV and 2) those on chronic glucocorticoids + immunosuppressant (both immunocompromised overall)
HIV - sxs develop over wks
steroids - fulminant respiratory failure, dry cough, and fever
what meds can cause HTN
NSAIDs, glucocorticoids, stimulants, decongestants, OCPs, TCAs, SNRIs
how to prevent vertical transmission of HSV
start acyclovir at 36 wks GA and continue until delivery; if at delivery pt has prodromal sxs or active genital lesion, then do Csxn also
when is hypospadias surgically corrected
age 6 months
tx of ITP
- obs if plt’s >30k
- steroids if plt’s <30k
- bleed - IVIG and plt’s
presentation of open-angle glaucoma
loss of peripheral vision and enlargement of optic cup (increased cup to disc ratio); IOP may not be elevated; common in elderly and Afr.Am.
presentation of macular degeneration
painless, progressive loss of central vision; drusen present
presentation of HTN retinopathy
blurry vision; AV nicking, copper or silver wiring, exudates, retinal hemorrhages
presentation of angle-closer glaucoma
acute ocular pain, HA, V, loss of visual acuity; red eye with corneal opacification and a nonreactive, dilated pupil
what to do if pregnant woman has possible exposure to parvovirus B19 or has symptoms suggestive of it
check B19 antibodies
IgG(+) - Mom immune
IgM(+) - active infection -> close watch of fetus
pt has a calcium type kidney stone - ways he can help prevent recurrence
increase fluids and calcium; limit oxalate, sodium, and animal protein in diet
preventive care for patient with sickle cell disease
- med - PCN (Px against encapsulated bugs)
- vaccines - routine, PPSV23, flu, early meningococcus
- imaging - transcranial doppler u/s to assess risk of stroke
presentation of generalized anxiety disorder
excessive worry >6 mo.; restless, feeling on edge, fatigue, difficulty concentrating, irritable, muscle tension, sleep disturbance; stomachaches, HA’s, perfectionism
risks associated with the different types of twins
di-di: risks with all twins
mono-di: twin-twin transfusion
mono-mono: cord entanglement and conjoined twins
cardiovascular complications seen in obstructive sleep apnea
resistant HTN, coronary artery disease, arrhythmias, and heart failure; if pt has any of these in combo with snoring and daytime sleepiness, do a sleep study!
