IM mix UWQ - may31st 2021 Flashcards
anaphylactic reaction.
-> occurs seconds to minutes after initiation of transfusion due to massive histamine release
sym?
rx?
respiratory distress (eg, dyspnea, hypoxia) -> bronchospasm
angioedema
hypotension
rx: IM Epi
IgA def inc risk
Acute hemolytic transfusion reaction from ABO incompatibility
sym?
- > hypotensive
- > fever,
- > flank pain
- > hemoglobinuria.
Febrile nonhemolytic transfusion reaction
sym?
most common adverse reaction to transfusion
- > within 1-6 hours of transfusion.
- > leukocytes release cytokines
- > transient fevers, chills, and malaise.
NOT resp distress, shock
hepatic encephalopathy triggered by: recent initiation diuretics
-> lead to low Intravascular voln
rx?
K repletion + lactulose, rifaximin
neomycin if unable to tolerate rifaximin
fibromyalgia (FM)
rx?
1st rx: Tricyclic antidepressants (eg, amitriptyline)
2nd line:
-> Serotonin
- > norepinephrine reuptake inhibitors (eg, duloxetine, milnacipran)
- > pregabalin
MG
moa?
- > autoantibodies (originating in the thymus) directed against nicotinic acetylcholine receptors at the NMJ
- > decrease available receptor available
- > impaired action potential propagation and muscle weakness.
Lambert-Eaton syndrome (LES)
moa?
decreased acetylcholine release from the presynaptic terminal of motor neurons
Achalasia
moa?
degeneration of neurons within the myenteric plexus
uncoordinated peristalsis and failed relaxation of the lower esophageal sphincter (LES)
Norovirus
etio: chronic diarrhea in immunocompromised patients (eg, HIV, solid-organ transplant)
sym?
symptoms are typically brief (eg, 1-2 days)
Neisseria gonorrhoeae
sym?
- > pharyngitis
- > pharyngeal edema, erythema –> versicupustular rash at distal ext (2-10 lesions)
- > nontender cervical LAD
- > pelvic inflammatory disease
rx: 3rd gen cephalosporin IV
dx: screen for chlamydia
EBV
CMV
sym?
tender cervcial LAD
min ventilation = ?
min vent= respiratory rate x tidal volume
-> inc ventilation
acute viral hepatitis
-> fever, jaundice, indirect hyperbilirubinemia
lab?
inc AST, ALT >1000 U/L
HAV:
-> etio: day care
- Budd-chiari syndrome:
- -> RUQ pain, ascites, HSM
- rupture hepatic adenoma: OCP
- > RUQ pain, hemorrhagic shock, fever, liver enz elevated, anemia, hypotension, tachycardia
MM
RCC
often spread to spine
XR?
pure Osteolytic lesions
ALP normal
acne mechanica
moa?
sym?
pressure or friction is applied
Recurrent mechanical pressure damages pilosebaceous follicles
-> obstruction, comedone formation, and acneiform lesion
Irritant contact dermatitis
sym?
erythema, edema, vesicles, bullae
- > lichenification (in chronic cases),
- > burning or stinging sensation
affects exposed skin (eg, hands);
-> axillary involvement is uncommon.
acute calcium pyrophosphate dihydrate (CPPD) crystal arthritis (pseudogout)
XR?
- > onset at age >65
- > monoarticular arthritis
- > chondrocalcinosis (calcification of articular cartilage)
- > inflammatory effusion (15,000-30,000 cells/mm3)
- > rhomboid-shaped
- > weakly positively birefringent CPPD crystals.
Plantar fasciitis
sym?
subacute to chronic pain on the plantar surface of the hindfoot.
-> Inflammatory features
acute exacerbation of COPD (AECOPD)
lab?
rx?
Noninvasive Positive pressure ventilation:
- > decreases work of breathing
- > improves alveolar ventilation
- > decrease in RR and (PaCO2),
- > with an increase in tidal volume, minute ventilation, and arterial oxygen tension (PaO2).
Invasive mechanical ventilation
indicated in?
more severe condition
hypercapnic patients
- > poor mental status (eg, somnolence, lack of cooperation, inability to clear secretions)
- > hemodynamic instability
- > profound acidemia (pH <7.1).
colon ca screening earlier
etio?
dx?
rx?
hx abdominal radiation -> 4 times the risk of colon ca
- > Lynch syn: germline DNA mismatch repair gene –> colorectal ca, endometrial ca, ovarian ca
- > FAP
dx: colonscopy
rx: ASA/ NSAIDS, high fiber diet
Age-related macular degeneration (AMD)
vision?
- > progressive and bilateral loss of central vision.
- > Peripheral fields maintained
exam:
- > drusen deposits
- > degeneration and atrophy of the central retina (macula)
- >retinal pigment epithelium
- >Bruch’s membrane
- > choriocapillaries.
Tumor lysis syndrome
induce:
- > AKI
- > electro imbalance
- > cardiac arrhythmia
lab?
etio?
rx?
cytotoxic chemotherapy or immunotherapy
lab:
inc PO4, K, UA
dec Ca
rx: IV fluid
- > allopurinol, rasburicase, febuxostat
Leucovorin
moa?
rx?
rx:
methotrexate or other folic acid antagonists
-> prevent adverse events from damage to rapidly dividing cells in the gastrointestinal system and liver.
N-acetylcysteine
rx?
moa:
antioxidant precursor to glutathione
rx:
acetaminophen poisoning and acute liver failure.
Raynaud phenomenon
common related to?
african american
sign?
lab?
rx?
CREST syndrome
-> vasospastic angina
Pulmonary arterial hypertension (PAH)
–> hyperplasia intimal smooth muscle layer
Asso with: interstitial lung disease
sign:
-> Left parasternal lift, right ventricular heave
-> Loud P2
-> right-sided S3
-> Pansystolic murmur of tricuspid regurgitation
JVD, ascites, peripheral edema, hepatomegaly
lab:
- > anti-Scl 70 topoisomerase 1 ab (diffuse)
- > anti-RNA polymerase III ab (diffuse)
- > anticentromere ab ) limited)
rx: CCB
resting tremor
dx?
rx?
PD
- > improves with action
- > 5-7 Hz freq
- > inv one hands first than bilateral hands
rx:
Trihexphenidyl (antiAch)
Younger age <65 yo
action tremor
dx?
rx?
essential tremor with action
rx:
beta blockers + primidone ( anticonvulsants)
clonazepam (lims)
lymphoma
sym?
mao: BM infiltration dx
- > generalized lymphadenopathy
- > splenomegaly,
- > constitutional symptoms
first-line treatment for chemotherapy-induced nausea?
Serotonin (5HT) receptor antagonists (eg, ondansetron)
-> target 5HT3 receptor
Rx?
help reduce motion sickness
primary anticholinergic
-> treat vomiting: scopolamine
refractory vomiting
rx?
Dopamine antagonists such as metoclopramide and prochlorperazine
promote gastrointestinal motility
rx?
Erythromycin
- > antibiotic, motilin receptor agonist
- > help treat nausea secondary to gastroparesis.
organophosphate poisoning
sym?
antidopt?
Muscarinic:
Diarrhea/diaphoresis Urination Miosis Bronchospasms, bronchorrhea, bradycardia Emesis Lacrimation Salivation
Nicotinic:
muscle weakness, paralysis, fasciculations
rx:
- > Atropine reverses muscarinic symptoms
-> Pralidoxime reverses nicotinic and muscarinic symptoms (administer after atropine)
anticholinergic toxicity
antidopt?
sym:
- > flushing, mydriasis, anhidrosis, fever, urinary retention
physiostigmine
-> AchEase inhibitor
Primary biliary cholangitis
sym:
-> insidious onset of fatigue & pruritus
- > Progressive jaundice, hepatomegaly, cirrhosis
- > Cutaneous xanthomas & xanthelasmas
lab?
rx?
asso with?
lab: Antimitochondrial antibody
rx: Ursodeoxycholic acid (delays progression)
inc risk:
-> Malabsorption, fat-soluble vitamin deficiencies
- > Metabolic bone disease (osteoporosis, osteomalacia)
- > Hepatocellular carcinoma
Ascending cholangitis is associated with primary sclerosing cholangitis (PSC)
asso with?
asso with:
IBD, UC, CRC
controlling confounding
allow ?
randomization distribution of all potential confounders even
Poor sleep hygiene
rx?
rx:
- >avoiding late afternoon naps
- > nicotine, caffeine
- > alcohol, and heavy meals in the evening.
glucagonoma, a pancreatic neuroendocrine tumor
sym?
-> unregulated release of glucagon >500pg/ml
-> weight loss
-> Necrolytic migratory erythema: erythematous papules
large, indurated plaques with central clearing
-> Diabetes mellitus/hyperglycemia
Gastrointestinal symptoms
humoral hypercalcemia of malignancy (HHM) due to?
parathyroid hormone-related protein (PTHrP) by malignant cells
squamous cell
renal + bladder, breast, ovarian ca
lab:
- > dec PTH
- > inc PO4 excretion
- >
breast, MM
lab?
osteolysis inc
- > dec PTH
- > dec vit D
sarcoidiosis
lymphoma
lab?
inc ca absorption
-> inc 1,25 OHD3
- > dec PTH
- > inc PO4
-> inc Vit D
Milk-alkali syndrome
lab?
excessive Ca intake
- > hypercalcemia
- > met alkalosis
- > AKI
- > HCO3 inc
AIN
lab?
sym?
- > acute renal failure
- > fever, disseminated maculopapular rash
- > a recent history of para-aminobenzoic acid analogue antibiotic (sulfonamide)
- > white blood cell (WBC) casts
- > esinophiluria
sym:
arthralgias
sym appears after 5 days
Renal vein thrombosis (RVT) + other thromboembolism
biopsy?
moa?
sym?
Bx:
membranous glomerulopathy
moa:
loss antithrombin III
inc urine
increase risk of venous / arterial thrombosis
AR
dx?
dx: echocardiogram
** diastolic / continuous murmur are pathologic !!!
sound:
early and gradually decreasing (decrescendo) diastolic murmur @ left sternal border 3-4th ICS
-> begins immediately after A2 (aortic component of the second heart sound)
how to increase PPV testing?
PPV = TP/TP + FP
dep on prevalence in the POPULATION
-> increase dx prevalence -> more TP, few TN
transverse myelitis
etio?
sym?
HIV
sym:
- > sensory level loss
- > flaccid paralysis
- > NO fever
- > acute Urinary retention
- > motor wkness
scleroderma renal crisis
hist?
diffuse :
schistocytes + thrombocytopenia
Burr cell (echinocytes) / spur cell (acanthocytes)
indicate?
RBC
etio: liver disease / ESRD
howell jolly bodies
indicate?
basophilic remnants nucleus -> splenectomy / functional asplenia
target cell
ind?
RBC -> bull eye appearance
thalassemia / Chronic liver dx
contact lens asso keratitis
dx?
pseudomonas/ serratia keratitis
rx: ER
sym:
corneal perforation, scarring, permenant vision loss
episcleritis
etio?
sym?
sym: localizes / patchy
mild pain/ discharge
asso with:
RA
RRR = (rate control - rate Rx) / rate control
rate control = #/total population of control
rate rx= #/ total pop intervention
Sporotrichosis
sym?
rx?
Sporothrix schenckii is a fungus found in decaying vegetation and soil.
sym:
- > A papule forms at the site of entry and soon ulcerates, draining an odorless, nonpurulent fluid.
- > Several proximal lesions may develop along lines of lymphatic drainage
rx: itraconazole
ARDS
PaO2 <60mmHg (hypoxia)
PaO2 > 90 (hyperoxia)
Adjusting Oxygenation!!!
rx?
etio:
sepsis, lung injury, trauma, pancreatitis
moa: intrapulmonary shunt effect
- > neutrophil lung inflammation
–> dec lung COMPLIANCE!! -> inc work breathing
–> severe V/Q mismatch: severe hypoxemia
–> inc hypoxic pul vasoconstriction: inc RV afterload + acute Pul HTN
–> dec SVR: reduced after load
PEEP improve O2 by propping alveoli OPEN
Increase PEEP >10cm H2O -> reduce shunting
risk: barotrauma
** FiO2 <60% to avoid potential o2 toxicity –> PaO2 > 90 mmHg
ARDS
adjust ventilation!!!
PaCO2/ Ph –> inc/ dec
inc PaCO2 + Ph <7.25
–> resp acidosis
rx: inc: RR and TV
- PaCO2 dec + Ph >7.45
- -> resp alkalosis
rx: dec TV, dec RR
multiple sclerosis
sym?
CSF?
-> neurologic deficits disseminated in space and time –> eg, trigeminal neuralgia, spastic lower limb paralysis, left upper limb sensory loss
CSF:
-> oligoclonal bands
HIV prophylaxis?
- PCP: CD4< 200/mm3
- > TMP-SMX - toxoplasmosis:
- > TMP-SMX - Primary prophylaxis against MAC
- > (azithromycin) is no longer required.
–> No other primary prophylaxis is routinely given
-> patients in Histoplasma-endemic areas with CD4 counts ≤150/mm3 given prophylactic itraconazole.
Mixed cryoglobulinemia associated with hepatitis C
sym?
- > immune complex deposition in small blood vessels, -> endothelial injury and end-organ damage.
- > palpable purpura, arthralgias, and glomerulonephritis
porphyria cutanea tarda
moa?
sym?
moa:
inhibit uroporphyrinogen decarboxylase
sym:
- > abdominal pain and neuropsychiatric manifestations (eg, psychosis, neuropathy)
- > photosensitivity with blisters
RF:
HCV, estrogen, Etho
rx:
phlebotomy
hydrochloroquine
Laxative abuse
lab?
hypotension, hypovolemia
eg. bisacodyl, senna, glycerol
- > for constipation ( GI loss)
Diuretic abuse
lab?
lab:
- > hyponatremia, and hypokalemia
- > Urinary sodium and potassium will be elevated ( cuz inc excretion)
CMT diarrhea
rx
loperamide/ diphenoxylate -atropine
IV fluid and electrolyte repletion
pancreatitis related steatorrhea
rx ?
pancrelipase
warfarin-induced skin necrosis
moa?
sym?
moa:
-> Warfarin inhibits production of vitamin K–dependent clotting factors II, VII, IX, and X, pn C, pn S
sym:
- > transient hypercoagulable state.
- > increases the risk for venous thromboembolism and skin necrosis,
Factor V Leiden mutation
sym?
- > risk for venous thromboembolism (deep venous thrombosis or pulmonary embolism)
- > increases the risk for cerebral, mesenteric, and portal vein thrombosis
upper GI bleeding with AMS
rx?
prevent aspiration –> endotracheal intubation
rx: prophylactic ab + octreotide
spontaneous bacterial peritonitis
dx?
diagnostic paracentesis
polymyalgia rheumatica (PMR)
sym?
asso with?
lab?
rx?
-> Age >50
Subacute-to-chronic (>1 month) pain in the shoulder and hip girdles
- > asso with: GCA
- > Morning stiffness lasting >1 hour
- > Constitutional symptoms (eg, malaise, weight loss)
- > Elevated ESR >40 mm/h
- > elevate CRP
rx:
low dose glucocoticoids
delirium
rx?
inc risk for?
agitation
rx:
haloperidol
risk : cognitive decline
NNT = ?
ARR= ?
1/ ARR
ARR = Rate control - Rate rx
eg. 0.1 = 0.16- x x = 0.06 rate Rx Rate rx = # inf/ n 0.06 = 12 / n n = 200
bronchiolitis obliterans
moa?
proliferative narrowing med + small bronchioles
asso with:
Rheumatologic dx
Hodgkin lymphoma CMT/ RT
inc risk?
- > Secondary CA: radiation exposure -> hema Ca
- > CVD
bact meningitis
ICP
etio?
rx?
MC:
-> step pn, Neisseria meningitis, listeria
- > GN rods
rx: VNC ( Ceph resistant) + AMP (listeria) + cefepime (4th gen cover most bact + pseudomonas)
lights criteria?
- pleural fluid Pn/ serum pn ratio >0.5
- pleural LDH/ serum LDH > 0.6
- pleural fluid LDH > 2/3 upper limit
exudates:
- > infection
- > CA
- > RA
MS
heart sound?
echo?
risk?
rx?
dx:
-> Opening snap with middiastolic rumble at the apex
- > Echocardiography: ↑ transmitral flow velocity
- -> irregular irregular rhythm + absent P wave ( AFib)
- > Lt atrial dilation –> acute decompensated HF
risk:
higher thrombogenic risk
rx: anticoagulants
addison dx
lab?
primary: autoimmune adrenalitis (TB, histoplasmosis), inf, Ca
-> dec aldo, dec cortisol (hypoglycemia) + peripheral eosinophilia
-> Increase ACTH
XR: miliary TB
sym: inc all 3 layers (adrenal cortex)
- > hypovolemia, hyperkalemia, hypoNa (( dec aldo))
- > hyperpigmentation
secondary (central axis ): chronic glu rx, infiltrative dx (sarcoidosis)
- > dec cortisol, dec ACTH
- > normal ALDO
Takayasu arteritis
moa?
chronic vasculitis affects aorta
-> cell -mediated inflammation
seperation anxitey dx
asso with?
somatic sym + functional impairment
Tardive dyskinesia
sym?
rx?
abnormal involuntary movements of the face, lips, tongue, trunk, or extremities result of prolonged exposure to antipsychotic medication.
rx: causative medication should be tapered and discontinued.
** akathisia: restlessness, inability to sit still –> rx: Beta blocker
Small cell lung Ca
sym?
inc ACTH ectopic:
- > hypercortisolism
- > WG, hyperglycemia
CKD -> IDA
rx?
microcytic anemia -> EPO + iron IV
-> IDA is the most common cause of inadequate response to ESAs in patients on dialysis.
Sjögren syndrome
autoimmune dx : lymphocytic inflammatory infiltrate exocrine glands
sym?
dx?
exocrine:
-> Keratoconjunctivitis sicca
-> Dry mouth, salivary hypertrophy
Xerosis
extraglandular:
-> raynaud phenomenon
dx:
+ anti-Ro (SSA), + anti-La (SSB)
-> salivary gland bx with focal lym sialoadenitis
age-related sicca syndrome (ARSS)
dx?
sym:
- > older women with dry eyes and mouth
- > exorcine output from lacrimal and salivary glands decline with age
- > atrophy , fibrosis, ductal dilation of the glands
- > impaired vision
