High Yield Flashcards
Triad of paroxysmal nocturnal hemoglobinuria
DX and TX
- Hemolytic anemia- dark cola colored urine in AM
- Venous thrombosis of large vessels
- Pancytopenia–> hypercoagulable
DX: flow cytometry, ACQUIRED SC mutation
Tx Eculizumab
What is Plummer-Vinson syndrome
dysphagia + esophageal webs + atrophic glossitis + Fe def.
What is SIADH and what electrolyte abnormalities are a result
excess ADH–> free water retention–> impaired water excretion
- hyponatremia (isovolemic hypotonic hyponatremia)= no signs of edema
- increased urine osmo. ( concentraed urine despite decrease serum osmo)
Treatment of:
- Diptheria
- Botulism
- Tetanus
- Gas gangrene (myonecrosis)
- Listeriosis
- Antrax
- Syphilius
- Lyme disease
- RMSF
- Toxoplasmosis
- Pin worms (enterobiasis)
- MAC
- Rabies
- Hookwork
- diptheria antitoxin + PCN or Erythromycin x 2 weeks
- boatulism antitoxin + resp. support (add PCN G if wound botulism only)
- Tetanus Ig + Metronidazole (or PCN)
- IV PCN + IV clindamycin, debridement
- IV ampicillin (+ Gentamicin if meningitits)
- Ciprofloxacin
- PCN G
- Doxy, Amoxicillin in <8 and preg, (add IV ceftriaxone if severe)
- Doxy
- sulfadiazene (or clindamycin) + pyrimethamine (w/ folinic acid/leucovorin)
- Albendazole
- Clarithromycin + Ethambutol
- Rabies vaccine (day 0,3,7,14 +/- 28 if immunocomp.) + rabies Ig
- Albendazole
CXR: honeycombing, diffuse reticular opacities, ground glsas
idiopathic pulmonary fibrosis
-restrictive pattern
Describe findings of Obstructive shock
- CO: decreased, SVR: increased, PCWP: increased*
- cool, clammy skin
- Respiratory distress*
Describe hypertrophic cardiomyopathy murmur changes with different positions
- Decrease w/ increased venous return: squatting, laying down, handgrip
- increase w/ decreased venous return: valsalva, standing, exertion, amyl nitrate
What is Wegners
small vessel vasculitis w/ granulomatous inflammation and necrosis of nose, lungs and kidneys
- Upper resp./nose sx- refractory sinusitis or saddel nose deformity
- Lower resp. tract sx- cough, hemopytsis
- Glomerulonephritis- crescent shape RPGN
+C-ANCA
TX: corticosteroids + cyclophosphamide
Clinical manifestations of DI
- polyuria + polydipsia
- hypernatremia (increased serum osm)
- dehydration, hypotension
SE of phenytoin
- rash (erythema multiform/SJS)
- gingival hyperplasia
- hirsutism
- hypothension
- arrhythmias (esp. w/ rapid administration)
- nystagmus
SE of Lithium
- hypothyroidism
- hypoNa+
- increased urination and thirst
- DI
- hyperparathyroidism
- seizures
- arrhythmias
Tamoxifen vs Raloxifene
Tamoxifen (E. antagonist of breast and uterus)
- increased risk of endometrial CA and hyperplasia
- reduce breast CA*
- slows progression of osteoporosis
Raloxifene (E. antagonist of breast)
- reduce breast CA
- slows progression of osteoporosis
CXR: pleural plaques/thickening, intersitital fibrosis, MC in lower lobes
asbestosis
Describe findings of Septic shock
(type of distributive shock)
- CO: increased, SVR: decreased, PCWP: increased or decreased
- warm extremities, flushed
- brisk cap refill with wide pulse pressures and bounding pulses
Tx of Rheumatic fever
- ASA +/- corticosteroids in severe cases
2. PCN G
CXR: peribronchial fibrosis, bronchial wall thickening, “tram track” bronchials,
bronchiectasis
*foul smelling sputum, hemoptysis
MC- H. influenza, if CF= pseudomonas
- transmitted by raw pork, boar, or bear
- myositis, eosinophilia*, periorbital edema
- larvae in striated muscles
Trichinosis
TX: self limiting–> albendazole if severe
Sx of anterior cerbral artery stroke
- contraleral sensory/motor LE>UE–> abnormal gait
- face spared
- impaired judgement, confusion, personality change (flat affect)
- urinary incontinence
SE of 2nd generation antipyschotics agents
dopamine antagonist and serotonin antagonist
- EPS sx (less w/ Clozapin and Quetiapine) overall less than 1st geneartion
- increased prolactin (less)
- weight gain w/ Olanzapine
HIV drug SE
- ____= vivid dreams, depression, neuro disturbances
- __ = renal stones
- ___= bone marrow suppression
- ___= pancreatitis and periphearl neuropathy
- Efavirenz
- Indinavir
- Zidovudine
- NRTIs (truvada)
What vaccines are contraindicated with:
- Bakers yeast
- eggs
- gelatin
- thimerosal
- Neomycin and streptomycin allergy
- Hep B
- Influenza,
- influenza, varicella
- multi-dose vx
- MMR and inactivated polio
MOA and SE of thiazolidinediones (pioglitazone, rosiglitazone)
MOA: increased insulin sensitivity at peripheral receptor site
- fluid retention and edema/CHF
- cardiovascular toxicity w/ rosiglitazone- MI
Uses of carbamazepine
seizures, bipolar, trigeminal neuralgia, Central DI
TX of central DI
- desmopressin/DDAVP
2. carbamazepine
Describe findings of Cardiogenic shock
- CO: decreased, SVR: increased, PCWP: increased*
- cool, clammy skin
- Respiratory distress*
*only shock where you give small amounts of isontonic fluids for tx
- tight, shiny thickened skin
- calcinosis cutis, raynauds, esophageal motility disorder, claw hand (sclerodactyly) telangiectasia
Scleroderma
DX: + anti-centromere Ab, + anti-SCL Ab
TX: dMARDs, corticosteroids
Crohns or US?
- stovepipe sign vs string sign
- cobblestone vs pseudopolyps
- P-ANCA vs ASCA
- mucosa + submucosa
- LLQ, colicky pain vs RRL, crampy pain
- toxic megacolon vs. granulomas
- Wt loss vs tenemus, urgency
- stove= UC, string= C
- cobble= C, pseudo= UC
- ANCA= UC, ASCA= C
- Mucosa + sub= UC, transmural= C
- LLQ= UC, RLQ= C
- toxic megacolon= UC, granuolmas= C
- wt. loss= C, tenesmus, urgency= UC
How do you treat active TB?
- Isoniazide + rifampin + ethambutol (or streptomycin) + pyrazinamide for 6 months total (PZA can be stopped after 2 months)
- respiratory isolation for 1st 2 weeks of tx
What type of breathing pattern?
- periods of deep breathing alternating w/ periods of apnea, smooth increases in rate of breathing w/ smooth gradual decrease w/ periods of apnea
- irregular respirations w/ quick shallow breaths of equal depth with irregular periods of apnea
- rapid continuous respiration
- Cheyne-Stokes (HF, Resp. depression, uremia, brain damage)
- Biot’s (opioid-induced resp. depression, CNS depression)
- Kussmaul’s (metabolic acidosis, DKA, renal failure)
pemphigus vulgaris vs bullous pemphigoid
PV: autoimmune d/o secodary to desmosome distruption
+anti-desmosome/anti-epthelial Ab (HSN type 2)
+ Nikolsky and rupture easily
TX: HD corticostoroids–> methotrexate
BP: autoimmune subepidermal blistering in elderlies (HSN type 2)
tense bullae that dont rupture easily
- Nikolsky
TX: corticosteroids
- anti-dsDNA
- anti- centromere Ab
- anti-Mi2 Ab
- anti-smooth muscle Ab
- anti- endomysial Ab
- anti-mitochondrial Ab
- perinuclear anti-neutrophil cytoplasmic Ab
- anti- signal recognition protein (SRP)
- anti- cyclic citrulinatal peptide (CCP)
- SLE
- scleroderma
- dermatomyositis–> aloso Gottrons papules
- autoimmune hepatitis
- celiac
- PBC
- PSC
- polymyositis
- RA
What can cause nephrogenic DI
lithium, amp B, hypercalcemia and hypokalemia, ATN, hyperparathyroidism
Sx of Lacunar infarct
- pure motor MC
- ataxic hemiparesis and clumsiness Leg>arm
- dysarthria
- Hx of HTN
Tx of heparin induced thrombocytopenia
- stop heparin
2. Direct thrombin inhibitors (argatroban or bivalirudiin)
What meds are:
- direct thrombin inhibitors
- direct Factor Xa inhibitors
- antiplatelet
- Indirect thrombin inhibitors
- Inhibitors of Vit. K dependent clotting factors (10, 9, 7, 2)
- Dabigatran (pradaxa), argatroban, bivalirudin
- rivaroxaban (xarelto), apixaban (eliquis)
- clopidogrel, ticagrelor (brillinta)
- heparin
- warfarin
SE of rifampin
- thrombocyotpenia
- orange colored secretions
- GI upset, flu-like sx
- hepatitis
SE of phenobarbital
- depression
- osteoporosis
- irritability
Where is the herniation?
- lateral hip/thigh/groin pain, sensory loss on bottom on foot btwn 1st and 2nd toe, weak big toe dorsiflexion, , heel walking harder than toes
- posterior calf pain, plantar foot surface, plantar flexion, toe walking harder than heel, loss of ankle jerk
- anterior thigh pain, sensory loss to medial ankle, weak ankle dorsiflexion, loss of knee jerk and weak knee extension
- L5 (L4-L5)
- S1 (L5-S1)
- L4 (L3-L4)
SE of 1st generation antispychotic agents
dopamine antagonist
- EPS sx (dyskinesia (torticollis–> give diphenhydramine IV), tardive dyskinesia, parkinsonism),
- Neuroleptic malignant syndrome (hyperthermia)–> give bromocriptine
- Prolong QT, arrhythmias
- increased prolactin**
- weight gain
Describe the findings of Hypoadrenal shock
(type of distributive shock)
- CO: decreased, SVR: decreased, PCWP: decreased or decreased
- hypotension refractory to fluids or pressors
- low serum glucose