Medicine Flashcards
Differentiate transudate vs exudate
Light’s Criteria
≥ one of following for exudate:
1) pleural fluid protein: serum protein ratio > 0.5
2) Pleural fluid LDH:serum LDH > 0.6
3) Pleural fluid LDH > 2/3rds of upper limit normal
S&S, Management,Rx HSV Encephalitis
S&S: high fever, gustatory hallucinations, confusion
Do lumbar puncture (look for RBCs)
order PCR for HSV protein of CSF and commence IV acyclovir immediately before results come back.
S/E Thiazides
- Mnemonic (HyperGLUC)
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
hypokalemia (due to compensatory aldoseterone release from drop blood volume)
hypotension
Statin Follow-Up
Lipids and Liver enzymes q 4-6 months or if pts complains of jaundice, RUQ pain,dark urine
CK at baseline and if pt complains of myalgia
D/C statin if CK > 10x upper limit of normal
Define Hemochromatosis
excess iron storage, which causes multiorgan system dysfunction with total body stores of iron increased to 20-40 g (normal 1g)
Tetrad Hemochromatosis
The classic tetrad of manifestations resulting from hemochromatosis consists of (1) cirrhosis, (2) diabetes mellitus, (3) hyperpigmentation of the skin, and (4) cardiac failure
New York Heart Assocation Classification HR Failure
Class 1 - No limitation during ordinary activity
Class 2 - slight limitation during ordinary activity
Class 3 - marked limitation of normal activities without symptoms at rest
Class 4 - unable to undertake physical activity without symptoms; symptoms may be present at rest
S/E of CCB
Dizziness, nausea, hypotension, cough, pulmonary edema
(all due to vasodilatory effects)
Treatment of acute pulmonary edema
LMNOP
first treat underlying ppting factors (e.g. ischemia, arrhythmia)
L - Lasix (furosemide) 40-500 mg IV
M -morphine 2-4 mg IV- decreases anxiety and preload (venodilation)
N- nitroglycerin- topical/IV/SL (decreases preload)
0-oxygen
P- positive airway pressure (CPAP/BiPAP)- decreases preload and need for ventilation
P - position - sit patient up with legs hanging down unless patient is hypotensive
5 Most Common Causes of CHF
- Coronary Hrt Disease (60-70%)
- HTN
- Idiopathic (often dilated cardiomyopathy)
- Valvular (AS, MR, AR)
- Alcohol (dilated cardiomyopathy)
What is Metabolic Syndrome
obesity, lipid abnormalities, hypertenion, hyperglycemia
Rx: exercise, weight loss, dietary changes
Orthostatic proteinuria
Benign condition in adolescents and young adults characterized by proteinuria < 2 g in the upright postion and not supine position and normal creatinine clearance.
Viral Meninigits - CSF characteristics
Pressure normal
Glucose normal (low in Bacterial)
Protein elevated
Cell count < 300 (high in bacterial)
Chloride normal (low in tuberculous meningitis)
Best diagnostic test for Vitamin D deficiency
Measure levels of 25 hydroxyvitamin D
3 commonly used analgesics for pain control in the ICU
Fentanyk
Morphine sulphate
Hydromorphone
Antibiotic of choice for bacterial meningitis
Ceftriazone - thrid generation cephalosporin has good penetrance into the CSF and is most likely to hit the offending agent
Analgesic to avoid in geriatric patients
Propoxyphene is to be avoided in geriatric patients as efficacy is similar to aspirin or acetominophen but drug accumulation, ataxia, dizziness, neurotoxic effects result in morbidity
Oxycodone, hydrocodone, hydromorphone and acetominophen are acceptable for use in geriatric patients
Wernicke encephalopathy vs Korsakoff syndrome
Wernicke - psychomotor slowing or pathy, ataxia, impaired consciousness (confusion), opthalmoplegia (horizontal nystagmus, bilateral abducens palsy) - traid in bold
Korsakoff - mental confusion, dysphonia, confabulation and impaired memory of recent events. Can develop after repeated episodes of Wernicke
Treatment - 50-100 mg IM or IV thiamine for several days followed by 10-20 mg once/day until therapeutic dose reached
Best starting dose for Parkinsons
Carbidopa : levodopa
25mg/100mg 3 x/day
DDx of T wave Inversion
myocardial infarction, myocarditis, old pericarditis, myocardial contusion, digoxin toxicity
S&S Celiac disease
- Characteristic bulky, fowl smelling stools
- loss of muscle mass or subcutaneous fat
- Pallor - due to iron deficiency anemia
- bone pain - due to osteomalacia
- easy bruising - due to vitamin K deficiency
- hyperkeratosis - due to vitamin A deficiency
DDx of Erythema Nodosum
NODOSUM
No - no cause - idiopathic (40%)
Drugs (sulfonamides, OCP, etc)
O - Other infections (GAS+)
Sarcoidiosis
Ulcercerative COlitis and Crohn’s (C>UC)
Malignancy (leukemia, Hodgkin’s, lymphoma)
Morphine S/Es and Uses
Uses:
1) Analgesia
2) Treatment of Diarrhea
3) Relief of Cought
4) Treatment of acute pulmonary edema: possibily due to vasodilatory effect
S/E
Miosis
Respiratory Depression (most common acute overdose S/E)
Histamine Release (bronchoconstriction, rash - never give morphine to asthmatic!)
Constipation
Vomiting and Nausea (40% patients)
Of all S/E: tolerance to constipation and meiosis does not develop
Causes Interstitial Nephritis
70% drugs - cephalosporins, penicillins, sulfonamides, sulfomamide containing diuretics, NSAIDs, rifampin, phenytoin, allopurinol
Contraindications to thrombolytics
Absolute
Active Bleeding or diathesis
Significant closed head or facial trauma within 3 months
Suspected aortic dissection
Prior intracranial hemorrhage
Ischemic stroke within 3 months
Relative
Pregnancy
Recent major surgery (< 3 wks)
Traumatic or prolonged CPR
Recent (within 4 weeks) internal bleed
Active peptic ulcer
Poorly controlled hypertension (180/100
Causes of Torsades de Pointes
&
Rx
Etiology
Congentital long QT syndrome
Drugs: class IA (quinidine), class III (sotalol), phenothiazines (TCAs), erthromycin, quinolones, antihistamines
Electrolyte disturbances: hypokalemia, hypomagnesesemia
Nutritional deficiencies: causing above electrolyte problems
Rx:
magnesium sulfphate, temporary pacing, correct underlying cause of prolonged QT, cardioversion if hemodynamically unstable
Drugs that cause lichenoid eruption - planus, puroule, polygonal, pruritic
GOLD
QUINIDINES
THIAZIDES
How do you evaluate severeity of IBD
** Truelove and Witt’s Criteria**
Bowel’s open > 6 times/24 hrs
Plus any one of the following:
□ Hb< 10.5
□ ESR > 30
□ Pulse rate > 90
Temp > 37.5
When to admit someone with syncope for workup
San Francisco Syncope Rule
○ Systolic BP < 90 mmHg
○ Patient c/o SOB
○ Hx of CHF
○ Hct < 30%
○ Abnormal EKG (any non-sinus rhythm or any new change
- >1 predicts serious outcome at 30 days, including death, arrhythmia, MI, PE, Stroke, SAH, need for transfusion, hospital admission –> sensitivity 98%, specificity 56%
If score 0, safe to discharge home with investigation as outpatient
Drug causes of pancytopaenia
cytotoxics
antibiotics: trimethoprim, chloramphenicol
anti-rheumatoid: gold, penicillamine
carbimazole*
anti-epileptics: carbamazepine
sulphonylureas: tolbutamide
*causes both agranulocytosis and pancytopaenia
DDx of Lymphadenopathy
Idiopathic
Infiltration
Primary carcinoma: lymphoma, leukaemia
Secondary carcinoma: e.g.: due to melanoma, thyroid carcinoma, breast, bowel, lung, prostate, kidney, or head and neck cancers
Non-infective
Sarcoidosis
Amyloidosis
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Eczema, psoriasis
Drugs, e.g.: phenytoin
Inflammation and infection
Local infection e.g.: pharyngitis
Bacterial: tuberculosis, syphillis, brucella
Viral: EBV, HIV, HSV, hepatitis
Other: toxoplasmosis
Things to comment on when assessing a lump
3 S’s, 3 T’s, and 3 C’s:
3 S’s: site, size, shape
3 T’s: temperature, tenderness, tethering
3 C’s: colour, contour, consistency
RIsk factors for melanoma
Family Hx (1-2nd degree relative)
Previous melanoma
Nevi (Dysplastic nevus syndrome or increased num benign nevi)
Exposure to sunlight at early age (most important)
Immunosuppressive traits (e.g. renal transplantation)
Pigment trais (blue eyes, fair/red hair, pale complexion)
Types of Melanoma
Superficial spreading (80%) - often from dysplastic nevus. median age 44
Lentigo maligna - common in elderly. least likely to have vertical phase
Nodular - no radial growth. poor prognosis
Acral lentiginous. not related sun exposure, located palm, sole, underneath fingernail. Most often Asians and blacks. Poor prognosis, extremely aggressive
DDx of Tetany
Hypocalcemia
Metabolic alkalosis (with hyperventilation)
Hypokalemia
Hypomagnesemia
Signs of Acute Hypocalcemia
Paresthesia
Chvostek’s sign - percussion of facial nerve
Trousseau’s sign - blood pressure cuff
Causes of a third nerve palsy
diabetes mellitus
vasculitis e.g. temporal arteritis, SLE
false localizing sign* due to uncal herniation through tentorium if raised ICP
posterior communicating artery aneurysm (pupil dilated)
cavernous sinus thrombosis
Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes
other possible causes: amyloid, multiple sclerosis
Treatment for neuropathic pain:
Post-herptic neuralgia
Trigemminal neuralgia
Diabetes
Post herptic - amytryptilline, pregablin
Trigemminal - carbamazepine
DM - duloxetine
Causes of Chorea
** Chorea is caused by damage to the basal ganglia, especially the caudate nucleus.**
Huntington’s disease, Wilson’s disease, ataxic telangiectasia
SLE, anti-phospholipid syndrome
rheumatic fever: Sydenham’s chorea
drugs: oral contraceptive pill, L-dopa, antipsychotics
neuroacanthocytosis
pregnancy: chorea gravidarum
thyrotoxicosis
polycythaemia rubra vera
carbon monoxide poisoning
cerebrovascular disease
DDx of MS
CNS Infection (Lyme disease, HIV, syphillis)
CNS inflmmatory (SLE, sarcoidosis, Sjorgen’s)
CNS microvascular disease (HTN, DM, vasculitis)
Genetic disorder (leukodystrophy, hereditary myleopathy, mitochondrial disease)
Structrual or compressive conditions of the brain and spinal cord (cervical spondylosis, tumor, herniated disc, Chiari’s malformation)
Vitamin B12 deficiency
Differential daignosis of unilateral vs bilateral facial nerve palsy
Unilateral - sarcoidosis, Guillian Barre, polio, Lyme
Bilateral - UMN (Stroke)
LMN (HIV, acoustic neuroma, Bells Palsy, Parotid tumors, MS, DM, Ramsay Hunt)
Side effects of sodium valproate
- gastrointestinal: nausea
- increased appetite and weight gain
- alopecia: regrowth may be curly
- ataxia
- tremor
- hepatitis
- pancreatitis
- thromobcytopaenia
- teratogenic
Side effects of carbidopa
dyskinesia
‘on-off’ effect
postural hypotension
cardiac arrhythmias
nausea & vomiting
psychosis
reddish discolouration of urine upon standing
Treatment of mild/moderate and severe acne rosacea
- mild/moderate: topical metronidazole
- severe/resistant: oral tetracycline
Classify acne
- mild: open and closed comedones with or without sparse inflammatory lesions
- moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
- severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
Define onychomycosis and its causes
fungal infection of the nails. This may be caused by
- dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
- yeasts - such as Candida
- non-dermatophyte moulds
Secondary causes of Raynauds disease
connective tissue disorders: scleroderma (most common), rheumatoid arthritis, SLE
leukaemia
type I cryoglobulinaemia, cold agglutinins
use of vibrating tools
drugs: oral contraceptive pill, ergot
cervical rib
Treatment: Nifedipine
Risk Factors for Pseudogout
hyperparathyroidism
hypothyroidism
haemochromatosis
acromegaly
low magnesium, low phosphate
Wilson’s disease
Painless red eye
Central retinal artery occlusion (VTE)
Central vein occlusion
Vitreous Hemorrhage
Retinal Detachment
Ischemic neuropathy - Amaruosis fugax
Vision manifestation of DM
DM retinopathy
Cataracts
EOM palsy
Ishcemic changes
Causes of A. Fib
Cardiac
Valvular Hrt disease
Sick sinus syndrome
Cardiomyopathy
WPW
HTN
Extracardiac
C2H5OH (holiday heart)
Thryotoxicosis
Pheochromocytoma
Pulmonary (tissue around the pulmonary veins)
Sleep apnea
Obesity
Inflammation (CRP)
Causes of Stevens Johnson Syndrome
idiopathic
bacteria: Mycoplasma, Streptococcus
viruses: herpes simplex virus, Orf
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill
connective tissue disease e.g. SLE
sarcoidosis
malignancy
Side effects of isoretinoin
teratogenicity: females should ideally be using two forms of contraception (e.g. Combined oral contraceptive pill and condoms)
dry skin, eyes and lips: the most common side-effect of isotretinoin
low mood
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
benign intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
