Kaplan 1 Flashcards
Tx of asymptomatic & symptomatic HOCM
o Symptomatic = BB & CCB(Verapamil)
o Asymptomatic = avoid competitive exercise
SVT
what is it? tx?
Supraventricular Tachycardia – 150 bpm + - Narrow QRS complex on ECG - Management: o 1. Vagal maneuvers (carotid massage, gagging, ice to face, bearing down) = decrease AV nodal conduction o 2. Adenosine o 3. CCB > Digoxin > BB
pt with SHORTEN P-R INTERVAL & SLURRED UPSLOPE OF THE QRS COMPLEX & BROAD QRS INTERVAL.
dx? tx if stable? what if unstable?
Wolff-Parkinson-White(WPW) Syndrome –
- “SHORTEN P-R INTERVAL & SLURRED UPSLOPE OF THE QRS COMPLEX(delta wave) & BROAD QRS INTERVAL”
- ACUTE management if unstable = Synchronized Cardioversion
- Stable = procainamide > amiodarone
1st line tx in HTN emergency
IV nitroprusside
Whats the diff between Adjustment disorder and Acute distress disorder?
Adjustment: develops as a result to an identifiable stressor w/in 3 months of exposure
Acute Stress: extraordinalry and potentially life-threatening stressor. Event is RELIVED in dreams and waking thoughts. sx include re-experiencing, avoidance, hyperarousal lasting <1m
ideal solution for dehydration
½ NS(0.45% NaCl) + 5% dextrose is ideal
**For every 3mEq/L that serum sodium is elevated = 1L of water deficit
MCC in Polycythemia Vera?
thrombosis
Formula for rehydration of a burn pt? what type of solution do u give them?
- MUST GIVE RINGER’S LACTATE!
o 4 cc/kg x total burned SA = amount given
Only give ½ within the first 8 hours
WBC cut off for dx of septic arthritis?
WBC > 50K
VACTREL
- Vertebral defects
- Anal Atresia
- Cardiac defects
- TE fistula
- Esophageal abnormalities
- Renal anomalies
- Limb anomalies
Bacterial vs Viral Pneumonia
- Viral Pneumonia : mononuclear shit, low fever, low sputum
- Bacterial Pneumonia: neutrophils, high fever
Pt w/fever, abdominal pain and pain over liver. he is a recent immagrant form mexico. dx? tx?
Liver Abscess/Entamoeba Histolytica
- Often seen in patient with “mexico connection”
- SX: fever, abdominal pain & tenderness over liver
- DX: U/S & SEROLOGY
- TX: can be treated with METRONIDAZOLE ALONE & doesn’t require drainage
hormones levels in levothyroxane abuse
o Low TSH, low RAIU, low TG(TBG) & elevated T4
TB PPD positive test measurements
tx?
5mm = + in steroid users or HIV 10mm = + in homeless, immigrants, alcoholics, heathcare workers, and prisoners 15mm = + in all others
tx: INH 9m in +PPD & -CXR; if both + do 4 for 2 then 2 for 4
Treatment of Hypergemesis Gravidarum
o 1: avoid triggers + ginger lollipops or tea, acupressure or acupuncture, saltines, small frequent meals
o 2: Pyridoxine-doxylamine(vitamin B6)
o 3: Promethazine or diphenydramine(antihistamine)
o 4: metoclopramide (D-agonist)
o 5: ondansetron(5HT)
Whats a leukamoid reaction? how can this be differentiated from leukemia?
Leukemoid Reaction = SIGNIFICANT increase in early neutrophil precursors in the peripheral blood.
- Seen with trauma
- Marked LEFT SHIFT
- > 50,000L leukocytes
- Elevated LAP differentiates this from leukemia
bartonella lymphadenitis vs francisella lymphadenitis
Bartonella Henselae
- Cat scratch disease = MCC of CHRONIC LYMPHADENITIS in children
- SX:
o Enlarging, localized lymph node with increasing erythema of the overlying skin
o Tender lymph node
o MC effects axillary, cervical, submandibular and preauricular nodes
- DX: warthin-starry stain
Francisella Tularensis = Tularemia
- SX:
o Ulcerative lesion at the site of inoculation with regional lymphadenopathy
- RF: contact with blood-sucking insects, live or dead wild animals
What is dumping syndrome? cause? tx? sx?
Dumping Syndrome
- Due to dumping of hyperosmolar chime into the small intestines causing loss of pyloric regulation resulting in fluid shifts and painful bowel distension
- SX: sweating, dizziness, abdominal pain, diarrhea, palpitations, facial flushing after eating
- Tx: eating smaller meals with less fat
Lady wants to know if her baby is gonna be a downsie. whats the earliest test that cna tell her dis? weeks?
- CVS(10-12 wks) > Amniocentesis(15-20 wks)
Alkaline Phosphatase is elevated with what shit?
ALP = Liver(elevated GGT too) & Bone
PKU vs Maple syrup urine disease
Phenylketonuria: - AR disease, results from a hydroxylation of phenylamine to tyrosine - SX: o Mental retardation o Projectile vomiting o Fair-skin, fair-haired o Photosensitivity o Eczematous or seborrheic rash o MUSTY OR MOUSY ODOR Maple Syrup Urine Disease - AR defect in Branch-chain amino acid metabolism - SX: o Vomiting o Refusal to feed o Dehydration o Hypoglycemia o Acidosis ketosis o Neurological shit o MAPLE SYRUP-LIKE ODOR
Necrotizing Fasciitis vs Cellulitis
sx? tx? rf for nec fas?
- NECROTIZING FASCIITIS(infection of fascia = right ontop of blood vessels) = BULLAE + CANT MOVE limb bc its so painful
o SX:
Bullae, severe pain(cant move so painful)
Oozing, crepitus
Rhabdomyolysis
HIGH fever + pt is toxic
o TX:
MUST DO SURGERY to remove necrotic shit + IV Abx(IV abx will not be enough alone must do surgery)
o RF: DM, ummunocompromised, alcoholism, vascular insufficiencies, organ transplants & neutropenia or recent surgery - Cellulitis = red skin
o SX:
Erythema, swelling
Mild pain
Fever
Dermis + subq infection
Why hyperparathyroidism due to renal failure? how do you tx this?
- Ex: kidney failure causing GFR < 25-40 = kidneys can no longer excrete P = P binds free Ca & decreases vita D production = hypocalcemia. Elevated P causes increase in PTH = increases bone reabsorption = osteodystrophy
o TX: supplementing Ca will decrease PTH levels and
What is Enthesopathy?
- Enthesopathy = inflammation and tenderness at insertion sites of tendons and ligaments to bones = seen with HLAB27s = ankylosing spondylitis and reactive arthritis
Whta si Lhermitte sign?
- Lhermitte Sign = electric shock-like pain that radiates down the spin with flexion of the neck. Seen with pt who have multiple sclerosis or with tumors of cervical disc
Patient on PEEP suddently gets tachy after 2 days? what do you need to R/O 1st?
pneumothorax
What is an intra-aortic balloon pump? How does it work? what does it do?
Intraaortic balloon pump – device that goes into the aorta to increase CO &coronary blood flow.
- Mechanism – deflates in systole = increases forward blood flow & reducing afterload via vacuum effect. Inflates in diastole & increases blood flow to the coronary arteries.
45 yo man w/progressive blurry vision, difficulty speaking, difficulty swallowing for 1 day. N, constipation, dry eyes. 2 ppl in his office have same sx. Bilateral ptosis & garbled speech. Dx?
Botulism = descending paralysis
dafuq is a bone scan?
Bone Scintigraphy/Bone Scan – great for detecting cancer that has spread to the bone.
- Uses radiotracers to provide image
calculating % of the body burnt?
o Head = 9
o Each arm = 9 =18 for both
o Lower limbs = 18 each
o Abdomen = 18 for 1 side = 36 for the whole thing
whats the only antidepressant approved for bulimia ?
fluoxetine = SSRI
Nonalcoholic Fatty Liver Disease
associations? sx? cause?
Nonalcoholic Fatty Liver Disease: hepatic steatosis on imaging or biopsy, exclusion of significant alcohol use, Exclusion of other causes of fatty liver
- Associated:
o Metabolic syndrome! (obesity, insulin insensitivity, T2 DM and hyperlipidemia)
- SX:
o Mostly asymptomatic
o Metabolic syndrome
o +/- steatohepatitis = AST/ALT ratio <1
o Heperechoic texture on U/S
- TX: Diet & Exercise + consider bariatric surgery if BMI > 35
- Notes:
o NAFLD can be due to increased transport of FFA from adipose tissue to the liver, decreased oxidation of FFA in the liver, or decreased clearance of FFA from the liver(due to decreased VLDL production).
o FREQUENTLY RELATED TO PERIPHERAL INSULIN RESISTANCE LEADING TO INCREASED PERIPHERL LIPOLYSIS, TG SYNTHESIS, HEPATIC UPTAKE OF FFA.
6 week neonate is eating plently but isnt gaining weight like they should. has poorly formed and bulky stools. what can you do to help him?
- Poor weight gain? = due to poor absorption of fats due to decreased bile acids initially tx by substitution medium-chain triglycerides(MCTs) for long chain triglycerides(LCTs).
Tx of ascending Cholangitis
Ascending Cholangitis – biliary stasis + superinfection
- TX: IVF, Ceftriaxone, Metronidazole & ELECTIVE SPHINCTEROTOMY as long as patient is stable.
Opioid Addict who has been clean fair 2 yrs comes in after car crash with fractured femur. He was given ketorlac but is still in pain what do u give?
Ketorlac=NSAID. Give him morphine. He needs it
What’s unique about meningococcal meningitis?
12-15 hr onset = sudden! Mostly neutrophils + petechiae
Presbycusis
Senorneural hearing loss that is normal with age. ~6th decade. Bilateral high frequency hearing loss = trouble hearing in crowds
Healthy 85 yo man had supine bp 160/85 and standing bp 135/70. Y?
Decreased baroreceptor responsiveness that can be normal with age
Pt has transient vision loss that is related to changes in head position.
Papilledema
Anterior vs posterior uveitis sx
Anterior: eye pain and redness
Posterior: painless, floaters, reduced visual acuity
Pt with HTN, microhematuria and bilaterally enlarges kidneys. Most likely dx?
ADPKD
66 yr old women, agitation, restlessness, poor sleep, HA, weight gain(13lb over 3m), smoker, bp 150/110, facial plethora adn scattered bruises on extremities, low K elevated Na, glucose 205. cause of HTN?
cushing syndrome!!!
cortisol = BIIG; bone dec, immuno decrease(decreased LT & PG), insulin resistance & gluconeogenesis
Obesity Hypoventilation Syndrome(OHS)
what may you see this with?
may be seen with obstrutive sleep apnea.
*fat person = restriction of thorasic cavity due to fat = HYPOVENTILATION = kidneys will RETAIN BICARB + DEC Cl = compensatory metabolic alkalosis
what can be given to patient with uric acid kidney stones to prevent stones?
hydration, alkalinization of urine + low purine diet!
alkalinize urine with POTASSIUM CITRATE
if tick has been attached for less than —- hrs you do not need to give lyme PEP.
36
pt with hashimotos starts PTU & MM. 2 weeks later comes in with fever + sore, red throat. what do u do?
STOP DRUGS & check WBCs = could be agranulocytosis
