Inpatient Medicine Flashcards
Anti-Hu Antibodies
small cell lung carcinoma
encephalopathy/neuropathy
Anti-NDMA
encephalopathy
autoimmune or paraneoplastic
Hutchinson’s sign
vesicle on nose
may indicate ophthalomogical zoster
Leimerre Syndrome
- septic emboli in IJV
- sore throat, tonsillar abscess
- fusobacterium
- thrombophlebitis, septic pulmonary emboli, septic arthritis
Shingles treatment timeline
start if less than 72 hour or new lesions erupting
otherwise limited benefit
VAP
48-72h after endotracheal intubation
Definitive Infectious Endocarditis
2 major
1 major + 3 minor
5 minor
Saddle Nose in GPA
bone and cartilage destruction
Osler Nodes
subcutaneous violet nodules on pads of fingers and toes
Rhythm complications of endocarditis
AV or complete block, or BBB
due to paravalvular extensions
Janeway Lesions
nontender erythematous macules on palms and soles (clots in capillaries)
Hep C Antibody Positive w/ Positive RNA
acute or chronic infection
Hep C Antibody Positive w/ Negative RNA
cleared infection or false positive
Classic Leukomid Reaction
WBC more than 50k, early precursors
HAP- Risk Factors for MRSA
- IV antibiotic use in last 90 days
- Hospital w/ more than 20% MRSA isolates
- High risk for mortality
Acute DHF, preload reduction
diuretics
nitrates
When to consider cardioverter-defibrillator (ICD) in HF
EF at or below 35%
HF in African americans, consider…
hydralazine isosorbide dinitrate
Cardiac resynchronization therapy in HF
ef below 35% + QRS more than 120 + LBBB
or 150 w/o LBBB
Causes of hypovolemic hyponatremia - RENAL
Nephropathies
ATN recovery
Causes of hypovolemic hyponatremia - NONRENAL
Dehydration
Vomiting/Diarrhea
MEN type 1
parathyroid, pancreatic islet cell tumors, pituitary tumors
Men type IIA
MTC
pheo
hyperparathyroidism
Men type IIB
MTC
mucosal neuromas
marfonid like habitus
pheo
Aspergillus- clinical syndromes
allergic bronchopulmonary aspergillus
pulmonary aspergilloma (fungus ball)
invasive aspergillus
air cresent sign =
aspergillus fungal ball
Aspergillus Rx
IV amph or vori
Cryptococcus Rx
fluconazole for mild
severe: amph+flucytosine x 2 weeks then fluconazole
Cryptococcal Meningitis
india ink w/ encapsulated organisms
latex agglut w/ cryptococcal antigen
Pigeon Dropings
cryptococcus
Histoplasmosis Rx
PO itraconazole
Amph B if severe
Differential of High Ferritin
HLH - hemophagocytic lymphohistoryctosis
Hemochromatosis
Still’s Disease
Thrombotic Thombocytopenia Purpura
Fever, AMS, thrombocytopenia, AKI, MAHA
Most common form of erythema multiforme
HSV
Hepatopulmonary Syndrome
platypnea
orthodeoxia
dx w/ echo w/ bubble to see transplumonary shunting
treatment myxedema coma
IV steroids
IV synthroid
thyroid storm treatment
propranolol
PTU or methimazole
steroids
Diagnosis of Cryptococcoal Pneumonia
culture in immunocompetent persons
serum antigen in immunocompromised
Adrenal Incidentaloma workup
- BMP for glucose, potassium
- Low dose cortisol stimulation test
- consider PRA/PAC if HTN or hypokalemia
Erhlichiosis tick
lone star tick
Erhlichiosis possible lab abnormalities
leukopenia, thrombocytopenia
transaminitis
peripheral blood smear- buffy coat
rocky mountain spotted fever rash
maculopapular 4 days following exposure
progresses to petechiae or purpura
starts and wrists and ankles, spreads centrally and to palms and soles
E/e’ ratio
greater than or equal to 15 in DHF
E/A
greater than 2
hematuira
greater than 3 RBC
Loop diuretic side effects
OH DANG
Ototoxicity, hypokalemia, dehyadration, allergy (sulfa), Nephritis (AIN), Gout
Mentzer Index
MCV/RBC
more than 13 - IDA
myxedema coma treatment
IV synthroid
IV steroids
HIT treatment
Direct thrombin inhibitors
Factor Xa inhibitor
Contraindications to TIPS
pulmonary HTN, heart failure
Main Indications for TIPS w/ data that shows efficacy
recurrent/uncontrolled variceal bleeding
refractory ascites
Hydralazine + CAD/Angina
increases arterial vasoconstriction –> worsening chest pain
use in combination with nitrate
Susceptibility of Clindamycin
check if organism is susceptible to erythromycin
Autoimmune Pancreatitis- IgG
IgG4
transmission of hepatitis B and C
B: paraenterally, sexually, perinatal
C: parenterally»_space;> sexually + perinatal
Acute Liver Failure Definition
coagulopathy + encephalopathy
When to fluid restrict cirrhortics
if sodium less than 130 (dilutional hyponatremia) and/or ascites
Cirrhosis, ratio of spirolactone and lasix
40mg:100mg
Indications to discontinue BB in cirrhosis
SBP less than 90
Na less than 120
AKI
Treatment of Varices
IV antibiotics, ceftriaxone
IV octreotide
Variceal Prevention with beta blockers
primary and secondary prevention
window period is with mod-to-large varices w/o bleeding
SBP Organisms
E coli
Strep Pneumo
Klebsiella
SBP Diagnosis
PMN > 250
SBP Treatment
third generation cephalosporin
albumin to prevent HRS on d1 and d3
Stigmata of Liver Disease
caput medusa
spider angiomas
gynecomastia
palmar erythema
Lung Cancer- Common Metasasis
Brain
Bone
Adrenal Glands Liver
Nerve Palsies associated with lung cancer
phrenic nerve: hemidiaphragmatic paralysis
Recurrent laryngeal nerve: hoarseness
Horner Syndrome
apical tumor invading CERVICAL SYMPATHETIC chain
Anhidrosis (no sweating)
Miosis
Ptosis
Pancoast Tumor
Tumor of C8, T1-T2 nerve roots
Shoulder/arm pain, UE weakness
+/- Horner Syndrome
Paraneoplastic Syndromes associated with lung cancer
Small cell: ACTH, SIADH
NSCLC/Squamous: PTH
Hypertrophic pulmonary osteoarthropathy
bone pain, associated with SCC
Eaton-Lambert Syndrome
small cell lung cancer
similar to MG, muscle weakness, decreased deep tendon reflexes
Risk Factors for Pancreatic Cancer
Smoking»_space;>
Chronic Pancreatitis
Alcohol
Syndromes associated with Pancreatic Cancer
Migratory thrombophlebitis
Courvoisier sign
Aldosterone: what causes excretion, function
- Stimulated by angiotensin (RAAS)
- Acts on distal tubules and collecting ducts
- Reabsorb Na
- Excretion of K
RAAS activated by
low sodium
low blood pressure (decreased RBF)