IM 2 Flashcards
compare CML to LR
LR has HIGH alk phsophatase score, greater proption fo late neutrophil precursors, lack of absolute basophilia
tx of hepatic encephalopathy
lactulose
AMS, nystagmus and ataxia in alcoholic
thiamine deficiency with wernicke encephalopathy
why glucagon in tx of BB or CCB OD
incrased cAMP, corrects refractory hypotension if pt doesn’t initially respond to atropine and fluid boluses
phenytoin toxicity
horizontal nystagmus, ataxia, N/V, AMS
old person on a medication with recent addition and now new sx
think medication interaction
isolated thyrombocytopneai, mucocutaneous bleeding, easy bruising, IgG autoantibodies against platelet membrane glycoproteins
ITP
ADAMTS13
TTP = thrombocytopenia + MAHA
degeneration of GABA producing neurons in caudate nucleus and putamen
HD
rectangular, envelope-shaped calcium oxalated crystals in pt with AMS
eythlene glucol poisoning
pt presents with concern of dropping left face. how to differentiate peripheral vs central nerve lesions?
central = upper facial muscles are spared due to compensation from the unaffected hemisphere peripheral = bell palsy = weakness of the entire half of the face
screening and dx test for MM
screen = serum or urine protein electrophoresis, free light chain analysis diagnosis = BM biopsy
following MI, develops sx of HF, refractory angina, ventricul arrythmias, functional MR, mural thrombus and ECT shows persistent ST elevation and deep Q waves
ventricular aneurysm, late MI complication
presentation of MR after MI
due to papillary muscle rupture, 2-7 days post MI, presents dramatically with acute, severe MR (hypotension, pulmonary edema, cardiogenic shock)
what are untreated hyperthyroid pts at risk of?
rapid bone loss from increased osteoclastic activity, cardiac tachyarrhythmias, including afib
microcytic anemia, HTN, neprhopathy, hyperuricemia, basophillic stippling on peripher smear
lead toxicity, tx is EDTA chelation
anti-TPO antibodies
Hashimoto’s thyroiditis; also associated with increased risk of miscarriage
anti-mitochondrial Ab
primary biliary cholangitis
phenytoin can lead to megaloblastic anemia and gingival hyperplasia due to impaired absorption of _____
folic acid
vitamin B1
thiamine
HIV pt with severely advanced disease (CD4<100) and lung symptoms
progressive disseminated histoplasmosis; get urine or serum histoplasma antigen assay
fevers, chills, malaise, weight loss, cough, dypsnea, mucocutaneous lesions, LAD in pt with HIV
disseminated histoplasmosis; tx is amphotericin
HTN, mild hypernatremia, metabolic alkalosis, suppressed plasma renin activity
primary hyperaldosteronism
how to distinguish benzos from opioid OD
benzo = lack of severe respiratory depression and pupillary constriciton
leaning on elbows, decreased sensation over the 4th and 5th fingers, weak grip
ulnar entrapment
antiGBM
goodpasture’s syndrome
hemolysis (elevated bili and LDH), cytopenias, hypercoagulable state (venous thrombosis), flow cytometry with absence of CD55 and CD59
paroxysmal noctural hemoglobinuria
____ is an impt cause of RHF, characterized by progressive peripheral edema, scites, elevated JVP, pericardia knock, and pericardial calcifications
constrictive pericarditis
middiastolic sound
pericardial knock
fever, generalized muscle rigidity, autonomic instability, mental status changes
neuroleptic malignant syndrome - typically due to dopamine antagonists
why infxns in MM
hypogammaglobulinemia
in what cond’ns should hospitalized pts be taken off metformin
acute renal failure, liver failure, or sepsis; all increase risk of lactic acidosis
monotherapy for bipolar
lithium, valproate, quetiapine, lamotrigine
recommended therapy for severe bipolar
dual therapy = lithium/valproate + second generation like quetiapine/lamotrigine
first line tx for mania
olanzapine (antipsychotic), lithium, valproate (anticonvulsant mood stabilizer)
this antipsychotic can be administered IM and has acute onset of action, making it ideal for tx of acutely manic/behavioral agitationJJj pts
olanzapine
these two rxs can be used for tx of drug-induced parkinsonism (type of EPS)
benztropine and amantadine
what type of EPS does propranolol tx
akathisia
what class of psychiatric rx can lead to galactorrhea, menstrual irregularities and infertility?
antipsychotics (block dopamine 2 receptors, leading to resultant prolactin increase)
name some antipsychotics
haloperidol, fluphenazine, risperidone, paliperidone, aripiprazole
MUDPILES
Methanol Uremia DKA Paraldehyde Isoniazide Lactic acidosis Ethylene glycol (anti-freeze; see crystals) Salicylates
Non Gap Acidosis
Diarrhea (poop out bicarb = metabolic acidosis)
Abuse/overuse of diuretics
RTA
numbness, prolonged QT
hypocalcemia
bones, stones, groans, shortened QT
hypercalcemia
what to check if concerned about CO poisoned?
carboxyhemoglobin, tx is 100% O2
young person who clots
Factor V Leiden
normal platelets but increased bleeding and PTT
vWD
tx of burns, doesn’t penetrate eschar, can cause leukopenia
silver sulfadiazene
this topical rx for burns also doesn’t penetrate eschar, but causes hypokalemia and hyponatremia
silver nitrate
of the three topical tx for burns, this one does penetrate eschars
mafenide `
what will kill you from electrical burn
arrhytmia, look at EKG
urine + for blood but no RBCs
myoglobinuria, MUST CHECK K in evaluation of rhabdo as arrhtyhmia can kill you
GCS < 8
intubate
trauma, blood at urethra, high-riding prostate
evaluate with retrograde urethrogram, followed by retrograde cystogram if negative.
bugs of nec fasc
strep and clostridium
POD 3-5 with fever
pneumonia, UTI
POD 1 with fever
atelectasis, nec fasc, malignant hyperthermia
POD 7 with fever, salmon colored fluid from incision
dehiscence, return to OR
post gyn surgery with unexplained fever
think about thrombophlebitis, given heparin and abx
is a person with a crhonic ulcer at risk of squamous cell carcinoma due to continual skin remodeling?
yes
popcorn calcification in lung
hamartoma, benign
what do we give octreotide for
carcinoid, VIPoma, bleeding varices
RUQ pain, high bili and alk phos
choledocolithiasis
large hydatid liver cyst + eosinophilia
echinococcus, albendazole and surgery to remove entire cyst (the other liver cyst with entamoeba histolytica you do not drain/do surgery)
IBD that involves terminal ileum, can mimmic appendicitis, skip lesions, transmural inflammation, fistulae, biopsy with granulomas
chrons
IBD with continuous lesions, associated with pANCA, increased risk of colon cancer and primary sclerosing cholangitis, tx with colectomy
UC
get this test if pt with known vascular disease c/o butt, thigh and calf pain with walking
ABI, nl is < 1
pituitary adenoma, parathyroid hyperplasia, pancreatic
islet cell tumor.
MEN 1
neck mass anterior to SCM
brachial cleft cyst
what type of rx to avoid in pt with BPH
anticholinergics, make urinary retention worse